Researchers conducting long-term follow ups of adults given knee X-rays found that a decrease in body mass index (BMI) was associated with both a lower incidence of the structural defects of knee osteoarthritis. Published in Arthritis & Rheumatology, also found reduced odds of these defects progressing.
In the study radiographic analyses were conducted of adults’ knees with and without the structural defects of knee osteoarthritis at baseline and at 4 to 5 years’ follow up from adults. A total of 9683 knees (from 5774 individuals) were assessed in an ‘incidence cohort’ along with 6075 knees (from 3988 individuals) in a ‘progression cohort.’
The researchers observed that a 1-unit drop in BMI was linked to a 4.76% reduction in odds of the incidence and progression of knee osteoarthritis. A 5-unit BMI drop, which can downgrade a BMI category (eg, from overweight to normal), reduced the odds of incidence and progression by 21.65%.
“These findings could be empowering for people with or at risk of knee osteoarthritis,” said lead author Zubeyir Salis, BEng, and a PhD student for Public Health at the University of New South Wales in Australia. “The current prevailing view is that knee osteoarthritis is part of ageing and that we have no control over it. However, my analyses suggest that some people could potentially prevent, slow or delay knee osteoarthritis by losing weight.”
With heatwaves becoming increasingly common around the world, researchers examined how outdoor nighttime temperature changes affect body temperature and sleep quality. Their literature review published in the Journal of Sleep Research, the researchers suggest that high, uncomfortable temperatures can disrupt sleep by interfering with the body’s normal thermoregulation ability.
A recent study found that on average in Europe, the number of days with extreme heat (ie >99% percenticle) has tripled since 1950. Even temperatures on extremely hot days have increased by 2.3 °C throughout the same period. In the future, these heatwaves will be more frequent and of longer duration. Of particular concern is that nighttime temperatures will increase more than daytime ones – and high nighttime temperatures are associated with increased mortality risk.
The authors, from the European Insomnia Network, note that there are certain groups such as older adults, children, pregnant women, and individuals with psychiatric conditions, who may be especially vulnerable to the sleep disruptive effects of heatwaves. They also offer several coping methods adapted from elements of cognitive behavioural therapy for insomnia.
“This paper is considered to be important and timely to disseminate expert recommendations to the research and clinical community as well as to the general population,” the authors wrote. “Nevertheless, it points out several areas of research which are still lacking, especially for specific populations. Even more important, literature evidence is still scarce.”
In addition to the skin-related impacts of climate change, the field of dermatology also has to address its own contribution to global warming. A commentary in the International Journal of Dermatology stresses the need for dermatologists to engage more meaningfully on key climate issues and to move beyond discussions of the skin-related impacts of climate change.
The article follows a 2021 editorial published en masse by 233 international medical journals that called for emergency action to limit global warming and adverse health effects related to climate change.
The authors of this new commentary note that they and other dermatologists are professionally charged with diagnosing, treating, researching, and mitigating the health harms from climate change but also must consider that healthcare is among the most carbon-intensive service sectors worldwide.
They point out that significant reductions in carbon emissions are readily achieved in dermatology by increased use of telehealth services and virtual medical meetings and residency interviews. Also, dermatologists should prioritise funding for climate-health research to improve healthcare sustainability and decarbonise the profession.
“Our research, advocacy, and policies must be ambitious in scope, reaching beyond cutaneous disease to integrate the impact of climate change on social determinants of health and support resiliency and social justice invulnerable populations,” the authors wrote. “We have an ethical imperative to act. The time is now for dermatologists and our medical societies to collectively rise to meet this crisis.”
A major analysis of all relevant published studies indicates that poor periodontal health and tooth loss may increase the risk of both cognitive decline and dementia. The finding, published in the Journal of the American Geriatrics Society, affirms a long-suspected connection between dental and cognitive health.
The analysis included 47 studies. Poor periodontal health, reflected by having periodontitis, tooth loss, deep periodontal pockets, or alveolar bone loss, was linked to a 23% increase in risk for cognitive decline and a 21% higher risk of dementia. Tooth loss on its own was associated with a 23% higher odds of cognitive decline and a 13% higher risk of dementia. The overall quality of evidence was low, however.
“From a clinical perspective, our findings emphasise the importance of monitoring and management of periodontal health in the context of dementia prevention, although available evidence is not yet sufficient to point out clear ways for early identification of at-risk individuals, and the most efficient measures to prevent cognitive deterioration,” the authors wrote.
New research published in the Journal of Bone and Mineral Research identified a number of risk factors for cardiovascular disease in adults with compromised bone health, such as osteoporosis or a fragility fracture. Male sex was associated with a 61% increase in cardiovascular risk in the case of osteoporosis.
The prospective cohort study used data from a UK primary care database. Major adverse cardiovascular events (MACE, a composite outcome for the occurrence of either myocardial infarction [MI], stroke, or CVD death) were identified in patients aged 50 years or older at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n = 65 295), incident fragility fracture (IFX, n = 67 065), and starting oral bisphosphonates (OBP, n = 145 959). About 1.90%, 4.39%, and 2.38% of the participants in OST, IFX, and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54–20.73) in OST, 52.64 (50.7–54.5) in IFX, and 26.26 (25.41–27.12) in OBP cohorts.
The researchers found that risk factors for MACE in the three cohorts included male sex, older age, smoking, alcohol consumption, atrial fibrillation, use of anti-hypertensive medications, history of heart attack or stroke, established cardiovascular disease, low kidney function, high systolic blood pressure, elevated cholesterol level, and use of multiple concomitant medicines.
“Although there are some calculators to produce risk estimates of cardiovascular disease, these are not targeted at those at high risk of fracture,” said corresponding author Daniel Prieto-Alhambra, MD, PhD, of the University of Oxford. “To our knowledge, this is the first study to identify cardiovascular disease risk factors for osteoporotic individuals using data that is routinely collected and readily available.”
A new publication in Nature Communications explains how T cell protection against tuberculosis is controlled by their oxygen responses.
In 2021, 10 million people fell ill and 1.5 million died of Tuberculosis (TB), caused by infection with the intracellular Mycobacterium tuberculosis bacteria. Proper CD4 T cell responses are critical for the control of M. tuberculosis infection by activating intracellular bacterial killing.
Professor Martin Rottenberg and PhD student Ruining Liu at the Karolinska Institutet, explained how they discovered that hypoxia-inducible factors (HIF-1 and HIF-2) control T cell metabolism as well as activation and differentiation in response to hypoxia or during inflammation.
“We showed that genetically modified mice, in which HIF-1 expression T cells was stabilised by genetic manipulation, were highly susceptible to the infection with M. tuberculosis and did not respond to vaccination. CD4 T cells from these mice were profoundly weakened in their early responses to mycobacteria-specific antigens, said Prof Rottenberg. “By impairing and or controlling HIF-1 stabilisation in T cells, responses to vaccines and protection against infections might be improved”.
The studies were carried out on mouse models of M. tuberculosis infection. The mice used were genetically modified to either lack or overexpress HIF-1 in T cells.
“The infection with M. tuberculosis, and the immune responses it generates in man, is fairly mimicked in the mouse infection. Our next step is to identify the molecular targets HIF-1 in T cells that account for their impaired activation, which could be targeted for improving T cell responses,” Prof Rottenberg concluded.
Women and men share most of the same risk factors for cardiovascular disease (CVD), according to a study published in The Lancet. This is the first such study to include people not only from high income countries, but also from low- and middle-income countries – which have the highest burden of CVD. One of the differences observed was a greater sensitivity to diet in women than in men.
The global study assessed risk factors, including metabolic (eg hypertension, obesity and diabetes), behavioural (smoking and diet), and psychosocial (economic status and depression) in about 156 000 people without a history of CVD between the ages of 35 and 70. Living in 21 low, middle and high-income countries on five continents, they were followed for an average of 10 years.
“Women and men have similar CVD risk factors, which emphasises the importance of a similar strategy for the prevention of CVD in men and women,” said first author Marjan Walli-Attaei, a research fellow at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS).
Overall, women had a lower risk of developing CVD than men, especially at younger ages.
However, diet was more strongly associated with CVD risk in women than men – “something that’s not been previous described, and which requires independent confirmation,” said Salim Yusuf, lead investigator of the study, senior author, executive director of PHRI, professor of medicine at McMaster University, and cardiologist at HHS.
High levels of bad (LDL) cholesterol and symptoms of depression were more strongly associated with CVD risk in men than in women. The patterns of these findings were generally similar in high-income countries and upper-middle-income countries, and in low-income and lower-middle-income countries.
A new international study revealed that eight in 10 Europeans believe tans are attractive with almost as many (73%) saying tans are healthy, according to a new study presented at the 31st European Academy of Dermatology and Venereology (EADV) Congress.
This is despite decades of awareness campaigns linking too much sun exposure to skin cancer and ageing in many countries. Latest estimates also presented at EADV 2022 found that about 1.7% of adults in Europe have skin cancer (around 7.3 million people).
Results from a survey, conducted by La Roche-Posay Laboratoires and IPSOS, of 17 000 people from 17 countries, including 6 000 people from the UK, Germany, France, Spain, Italy, and Russia, found the ‘healthy tan’ and other myths about sun safety are still very much alive in Europe and other countries.
Other myths included believing sun protection was not needed in cloudy weather and that you did not need sunscreen if you already had a tan.
People surveyed from non-European countries, including North and South America, Africa, Oceania, and Asia, were slightly less enthusiastic about suntans than Europeans, with 67% saying a tan was attractive and 59% believing a tan was healthy.
Although 92% of Europeans were aware of the skin ageing risks posed by the sun (86% outside of Europe), 84% of them admitted they did not protect themselves all year round (79% outside of Europe).
Lead researcher Prof Thierry Passeron commented on the findings: “This research shows just how entrenched the ‘healthy’ suntan myth is – even in those who have already suffered sun damage or developed skin cancer.”
“We must drive awareness of the damage to skin cells caused by exposure to the sun, which can lead to photoaging and skin cancer. This is particularly important in Europe where sun protection appears most inadequate compared to other countries” added Prof Passeron.
The survey also revealed that only 56% of Europeans know sun protection is useful when the weather is overcast (vs 64% outside of Europe), and 24% thought it was safe to go outside without sun protection when they were already tanned (vs 21% outside of Europe).
Only in 10% of Europeans said they routinely or often used all forms of sun protection, such as applying sunscreen, staying in the shade, wearing a hat and protective clothing all year round, compared to 14% amongst those outside of Europe.
“The public must also understand that they need to protect their skin all year round, even during overcast weather conditions. Once sunscreen has been applied, it must be reapplied every two hours to ensure sufficient protection. Other measures such as wearing sunglasses, a hat, and protective clothing, and seeking shade when it is possible, are also key photoprotection habits”, commented Prof Passeron.
Other study findings include:
Just over half of Europeans (51%) said they were likely to wear a hat routinely or often, compared to 57% outside Europe.
When it comes to staying in the shade (73%) of Europeans said they did so routinely or often, compared to 80% of those outside Europe.
A second analysis by the team found awareness of the dangers of the sun were higher in at-risk* groups of people. But 59% of this group said they could not imagine coming back from a holiday without a tan, compared to 48% of those without a medical history.
62% of Europeans and 52% of non-Europeans applied sunscreen routinely or often, especially on their arms, legs, and chest. But 10% of Europeans said they never used suncream at all, compared to 16% outside Europe. Of those who applied sunscreen in the sun – 34% applied it only once a day, compared to 49% outside Europe.
90% of those in at-risk groups said they were aware of the risks the sun posed to their skin, yet 72% still regarded a tan as healthy, which is higher than those who had no history of skin cancer or other sun-exposure related skin conditions (62%). Additionally, of those who said they applied sunscreen in at-risk groups, only 1 in 4 (26%) applied it every 2 hours or more often than is recommended.
Opioid use is a significant cause of premature death, caused by supressing respiratory activity. New research, published in The Journal of Physiology, points to a novel treatment for respiratory depression associated with opioid use that administers electrical pulses to the back of the neck, helping patients regain respiratory control following high dosage opioid use.
Breathing problems can occur after opioid use or post-operative complications from anaesthesia because opioids desensitise the brain stem to rises in carbon dioxide. This can cause respiratory failure, which can be fatal. Current treatments, such as manual lung inflation and medication, can work in the short term to combat breathing problems following opioid use, but getting patients to breathe independently remains a challenge. Therefore, this new research, which administers epidural electrical stimulation (EES) offers an alternative, non-pharmacological treatment.
EES administered at the cervical spinal cord, which is located at the back of the neck, activates a network of neurons in the brainstem that stimulates and coordinates respiratory muscles and improves the rate and depth of breathing.
Researchers from the University of California, Los Angeles (UCLA), targeted sensory-motor circuits in the cervical spinal cord of 18 patients with degenerative spine diseases who were anaesthetised for surgical treatment. They delivered 30 Hertz of EES to the cervical spinal cord continuously for no longer than 90 seconds.
They found that short periods of continuous low-intensity EES not only increased the volume of breath but also actively controlled the frequency and rhythm during opioid-induced breathing problems. The rhythmic breathing pattern was sustained briefly after the EES stopped in the presence of high-dose opioids.
Senior author Dr Daniel Lu, UCLA professor and vice chair of neurosurgery, said: “Our results provide proof of principle that cervical EES could improve respiration following opioid use. We can compare the human body to a car, our goal is to jump start the body so it can run by itself without periodic pushes. We hope to use EES to provide novel approaches to restore breathing for healthcare providers as we are now using defibrillation devices for restoring cardiac activities.”
Future human trials with larger cohorts will be conducted to further assess the practical application and impact of EES to determine whether EES can alleviate or reduce the need for ventilator support in acute pathological conditions such as OIRD, stroke, and traumatic brain, brain stem or spinal cord injury. Experimental studies in mice will be carried out to further investigate the role specific neurons play in response to EES.
A malaria vaccine developed by Oxford University has been described as “world changing” following its successful trial in children in Burkina Faso. Their results of their double-blind randomised controlled trial were published yesterday in The Lancet Infectious Diseases.
The researchers had previously reported that in children, the R21/Matrix-M malaria vaccine reached the WHO-specified goal of 75% or greater efficacy over 12 months.
To test the immunogenicity, and efficacy results at 12 months after administration of a booster vaccination, the researchers conducted a trial was done in children aged 5–17 months in Burkina Faso, who had written informed consent provided by their caregivers. Eligible children were randomised to receive three vaccinations of either 5 μg R21/25 μg Matrix-M, 5 μg R21/50 μg Matrix-M, or a control vaccine (the Rabivax-S rabies vaccine) before the malaria season, with a booster dose 12 months later. Exclusion criteria included any existing clinically significant comorbidity or receipt of other investigational products.
Vaccine safety, efficacy, and a potential correlate of efficacy with immunogenicity, measured as anti-NANP antibody titres, were evaluated over one year following the first booster vaccination. Efficacy analyses were performed for all participants who received the primary series of vaccinations and a booster vaccination.
Between June 2, and July 2, 2020, 409 children returned to receive a booster vaccine, which was the same received in the primary series of vaccinations. R21/Matrix-M had a favourable safety profile and was well tolerated. Vaccine efficacy remained high in the high adjuvant dose (50 μg) group, similar to previous findings at one year after the primary series of vaccinations. Following the booster vaccination, 51% of children receiving R21/Matrix-M with low-dose adjuvant, 39% of children receiving the same but with high-dose adjuvant, and 86% of 140 children who received the rabies vaccine developed clinical malaria by 12 months.
Vaccine efficacy was 71% in the low-dose adjuvant group and 80% in the high-dose adjuvant group. In the high-dose adjuvant group, vaccine efficacy against multiple episodes of malaria was 78%, and 2285 cases of malaria were averted per 1000 child-years at risk among vaccinated children in the second year of follow-up. Among these participants, at 28 days following their last R21/Matrix-M vaccination, titres of malaria-specific anti-NANP antibodies correlated positively with protection against malaria in both the first year of follow-up (Spearman’s ρ –0·32 [95% CI –0·45 to –0·19]; p = 0·0001) and second year of follow-up (–0·20 [–0·34 to –0·06]; p = 0·02).
A booster dose of R21/Matrix-M at 1 year following the primary three-dose regimen maintained high efficacy against first and multiple episodes of clinical malaria. Furthermore, the booster vaccine induced antibody concentrations that correlated with vaccine efficacy. The trial is ongoing to assess long-term follow-up of these participants and the value of further booster vaccinations.
Speaking to BBC News, Prof Katie Ewer said that “this is not like COVID where we have seven vaccines straight away that will work… it’s much, much harder”. This malaria vaccine is the 14th that she has worked on, and it was “incredibly gratifying” to get this far and “the potential achievement that this vaccine could have if it’s rolled out could be really world-changing”.
The Oxford-developed vaccine shares similarities with the current, approved malaria vaccine from GSK: both target the first stage of the parasite’s lifecycle by intercepting it before it can establish itself in the liver.
The vaccines use a combination of proteins from the malaria parasite and the hepatitis B virus, but the Oxford vaccines has a more malaria proteins, which may help the immune system to focus on malaria rather than the hepatitis.
The trial is continuing for a further 2 years to assess both the potential value of additional booster vaccine doses and longer-term safety.
