Employee wellbeing in healthcare is reflected in patient satisfaction, and a new study found that a heavy workload, even positive challenges such as learning new things are experienced as increased stress.
Researchers from the Department of Psychology at the University of Jyväskylä in Finland explored how the staff of a healthcare district experienced increasing job demands, and how wellbeing at work was linked to these demands. The study also clarified whether the demands on employees were reflected in patient satisfaction.
More than a thousand employees took part in the study and evaluated their experiences in a survey measuring intensified job demands, work exhaustion, and work engagement. Additionally, nearly a thousand patients of the healthcare district evaluated their treatment by the healthcare staff.
In line with expectations, healthcare staff’s experiences of greater time pressure and workload were associated with greater exhaustion. An especially high risk of exhaustion was seen in those working in emergency care and nurses.
Additionally, experience of increased job planning demands shared by the working community was associated with greater exhaustion and lower customer satisfaction. This was particularly evident in the staff of leadership services.
“A surprising observation was that none of the intensification demands was positively connected with work engagement,” said Senior Lecturer Mari Huhtala. “In the light of previous studies, employees may find some demands such as learning new things positive challenges, especially when the demands are reasonable. However, this was not the case with the studied healthcare employees. It is possible the general workload in healthcare has led to these positive challenges being experienced as additional stress as well.”
Research data for the study were collected using an electronic survey in the third quarter of 2019. The study will continue in the third quarter of 2021 with the collection of follow-up data.
Journal information: Huhtala, M., et al. (2021) Intensified job demands in healthcare and their consequences for employee well‐being and patient satisfaction: A multilevel approach. Journal of Advanced Nursing. doi.org/10.1111/jan.14861.
A new study has discovered that people who live to be 100 or older have a unique microbiome that may protect against certain bacterial infections including those caused by multidrug-resistant bacteria. The findings, published in Nature, could point to new ways to treat chronic inflammation and bacterial disease.
A team of researchers studied microbes from faecal samples of 160 Japanese centenarians who had an average age of 107. They found that centenarians, compared to people aged 85 to 89 and those between 21 and 55, had higher levels of several bacterial species that produce molecules called secondary bile acids. Secondary bile acids are generated by microbes in the colon and are thought to help protect the intestines from pathogens and regulate the body’s immune responses.
Next, the researchers treated common infection-causing bacteria in the lab with the secondary bile acids that were elevated in the centenarians. One molecule, called isoalloLCA, was found to strongly inhibit the growth of the antibiotic-resistant bacterium Clostridioides difficile. Feeding mice infected with C. difficile diets supplemented with isoalloLCA similarly suppressed levels of the bacteria. The team also found that isoalloLCA potently inhibited or killed many other gram positive pathogens, suggesting that isoalloLCA may play a role in keeping the delicate equilibrium of microbial communities in a healthy gut.
“The ecological interaction between the host and different processes in bacteria really suggests the potential of these gut bugs for health maintenance,” said Plichta, a computational scientist at the Broad.
Additional studies from different regions around the world with more participants and longer duration could help find a causal link between longevity and bile acids. The bacteria identified in this study could help researchers in the meantime discover how to treat infections caused by antibiotic-resistant bacteria by manipulating bile acid.
“A unique cohort, international collaboration, computational analysis, and experimental microbiology all enabled this discovery that the gut microbiome holds the keys to healthy aging,” said co-first author Xavier, core institute member at the Broad. “Our collaborative work shows that future studies focusing on microbial enzymes and metabolites can potentially help us identify starting points for therapeutics.”
Journal information: Sato Y, Atarashi K, et al. Unique bile acid-metabolizing bacteria in centenarians’ microbiome. Nature. Online July 29, 2021. DOI:10.1038/s41586-021-03832-5
Clinical trial data helps in deciding prescriptions and is good for science, but a new study revealed that not many pharmaceutical companies are completely transparent with the development data for their products. The study also found that large companies are much more transparent than smaller ones.
The study, co-authored by Yale researchers and published in The BMJ Open, assessed the data-sharing practices of 42 pharmaceutical companies for clinical trials of 40 novel drugs and 22 biologics which received US Food and Drug Administration approval in 2016 and 2017. They were evaluated with the Good Pharma Scorecard, which consists of transparency measures and a ranking system.
The researchers found that only seven of the 42 companies (17%) entirely met the tool’s standards for transparency and sharing data, with smaller companies being particularly opaque.
“The non-large pharmaceutical companies are dragging down the sector, often failing to meet federal reporting requirements, much less voluntary standards,” said study co-author Jennifer Miller, assistant professor at Yale School of Medicine, founder of Bioethics International.
“The lack of transparency is a problem because access to robust clinical-trial data supports patient care and good science,” she added. “Full transparency allows scientists to learn from previous work and prevents people from being exposed to unnecessary experiments.”
From the late 1990s, requirements for pharmaceutical companies to register and report results from clinical trials have been increasing. However, not all companies fully comply with the rules and industry guidelines vary. In a smaller 2019 study using the transparency scorecard, 25% of companies fully met the standards, which include registering clinical trials, sharing data and study protocol publicly, and annually reporting requests for data. When given a 30-day window to improve, 33% met the standard.
For the latest study, the researchers also included biologics and smaller companies. While 17% of companies had perfect scores, 58% of the companies assessed had publicly available results for all patient trials, 42% complied with federal reporting laws, and 26% met the scorecard’s data-sharing measure.
Non-large companies were less responsive than large companies when offered the 30-day window to fix errors and improve data-sharing practices. Four companies used the window to improve data-sharing procedures
“It’s not surprising that non-large companies lag behind large as they may have fewer resources and smaller staffs with less compliance experience,” Miller said. “Our findings suggest that large companies may benefit from reviewing the transparency procedures of smaller companies before partnerships, mergers, and acquisitions so they don’t inherit any deficiencies.”
The researchers did notice improvements among large companies between the 2019 study and the latest one. For example, the median data-sharing score for large companies increased from 80% for drugs approved in 2015 to 100% for products approved in 2017.
Journal information: Clinical trial transparency and data sharing among biopharmaceutical companies and the role of company size, location and product type: a cross-sectional descriptive analysis, BMJ Open (2021). DOI: 10.5061/dryad.r2280gbdb
Three-quarters of COVID cases were among the vaccinated in an outbreak during large public gatherings at Cape Cod island in Massachusetts, USA, with the Delta variant predominating, researchers found. This helped reverse the official US recommendations on mask-wearing when fully vaccinated.
Of 469 cases linked to numerous summer events and large summer gatherings in a small town, 346 (74%) happened in fully vaccinated people, and almost 80% of those cases were symptomatic, reported Catherine Brown, DVM, of the Massachusetts Department of Public Health, and colleagues.
There were five hospitalisations, four among fully vaccinated people, and no deaths. Of 133 cases with sequence information available, 89% were from the Delta variant, the authors wrote in the Morbidity and Mortality Weekly Report.
Moreover, vaccination coverage in Massachusetts was reported to be 69% as of July 3, they noted.
The data on this outbreak, along with the Delta variant, reportedly motivated the Centers for Disease Contol’s change in indoor masking guidance earlier last week.
CDC Director Rochelle Walensky, MD, noted that “rapid receipt and review of unpublished data” contributed to the guideline change.
The authors found that RT-PCR cycle threshold (Ct) values in vaccinated and unvaccinated people were comparable. Pointing to these high viral loads among the vaccinated in this case, Dr Walensky said it suggested that vaccinated individuals infected with Delta could still transmit the virus.
“This finding is concerning and was a pivotal discovery leading to CDC’s updated mask recommendation,” she said, saying it was “updated to ensure the vaccinated public would not unknowingly transmit virus to others, including their unvaccinated or immunocompromised loved ones.”
The authors detailed increased reports of COVID cases in Barnstable County, beginning on July 10, including those who were fully vaccinated. Many COVID patients reported attending large indoor and outdoor gatherings.
They identified a cluster of cases, 346 of them fully vaccinated, in Massachusetts residents, who tested COVID positive 14 days or sooner after travel to or staying in Barnstable County.
Cases were also reported from residents of other states who traveled to this town during the period, and reports of secondary transmission.
The authors urged stricter prevention measures at such events, given, “the potential risk of infection during attendance at large public gatherings that include travelers from many areas with differing levels of transmission.”
Journal information: Brown CM, et al “Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings – Barnstable County, Massachusetts, July 2021” MMWR 2021; Published July 30, 2021.
Mutations in DNA that lead to melanoma result from a sunlight-fuelled chemical conversion in DNA, not just a DNA copying error as previously believed, according to a new study.
The findings of the study, led by the Van Andel Institute scientists and published in Science Advances, upend long-held beliefs about the mechanisms underlying the disease, reinforce the importance of prevention efforts and offer a path forward for investigating the origins of other cancer types.
“Cancers result from DNA mutations that allow defective cells to survive and invade other tissues,” said corresponding author Gerd Pfeifer, PhD, a VAI professor. “However, in most cases, the source of these mutations is not clear, which complicates development of therapies and prevention methods. In melanoma, we’ve now shown that damage from sunlight primes the DNA by creating ‘premutations’ that then give way to full mutations during DNA replication.”
Melanoma begins in pigment-producing skin cells. Although less common than other types of skin cancer, melanoma is more likely to metastasise, significantly reducing patient survival. Previous studies have shown that melanoma has the most DNA mutations of any cancer. Like other skin cancers, melanoma is linked to sun exposure, specifically UVB radiation which damages cells and DNA.
Most cancers are to arise when damaged DNA causes a mutation that is propagated through subsequent cellular generations. In the case of melanoma, however, Pfeifer and his team found a different mechanism that produces disease-causing mutations – the introduction of a chemical base not normally found in DNA that makes it prone to mutation.
In melanoma, the problem occurs when UVB radiation from the sun hits certain sequences of bases: CC, TT, TC and CT, causing them to chemically link together and become unstable. This resulting instability induces a chemical change to cytosine that transforms it into uracil, a chemical base found in the messenger molecule RNA but not in DNA. This change, called a “premutation,” primes the DNA for mutation during normal cell replication and eventually melanoma.
These mutations may lay dormant for years, not causing disease. More mutations can build up throughout a person’s lifetime exposure to sunlight, resulting in a stubborn cancer that evades many therapeutic options.
“Safe sun practices are very important. In our study, 10–15 minutes of exposure to UVB light was equivalent to what a person would experience at high noon, and was sufficient to cause premutations,” Prof Pfeifer said. “While our cells have built-in safeguards to repair DNA damage, this process occasionally lets something slip by. Protecting the skin is generally the best bet when it comes to melanoma prevention.”
The study used a method developed by Prof Pfeifer’s lab called Circle Damage Sequencing, enabling scientists to ‘break’ DNA at each point where damage occurs. DNA is coaxed into circles and replicated with PCR. With enough DNA, next-generation sequencing then identifies which DNA bases are present at the breaks. Pfeifer and colleagues plan to use this technique going forward to examine other types of DNA damage in different kinds of cancer.
Journal reference: Jin, S-G., et al. (2021) The major mechanism of melanoma mutations is based on deamination of cytosine in pyrimidine dimers as determined by circle damage sequencing. Science Advances. doi.org/10.1126/sciadv.abi6508.
While radon is commonly known as a radioactive gas that sometimes builds up in basements, people in pain travel to Montana in the US to be surrounded by it. The visitors view the radon exposure as low-dose radiation therapy for a long list of health issues.
But the Environmental Protection Agency and the World Health Organization, among others, list the gas as the second-leading cause of lung cancer. Though radiation is used to kill cancer cells, in the US, using low doses for other ailments is disputed – one such debated use is treating respiratory conditions. Clinical trials are testing whether low doses of radiation can help treat COVID patients.
But radon gas is not the same as the targeted radiation in radiotherapy. It can be inhaled, making it particularly dangerous. Sitting in a radon-filled room and radiotherapy are as different as “chalk and cheese,” said Brian Marples, a professor of radiation oncology at the University of Rochester.
“In clinical therapy, we know exactly what the dose is, we know exactly where it’s going,” he said.
Prof Marples said much of the argument for radon’s therapeutic use stems from historical reports, unlike evidence-based research on clinical radiation. However, there is debate as to what level of radon gas exposure is harmful. Another concern is that the radon treatment in the mines is largely unregulated, and bodies like the EPA don’t have the power to mandate limits on radon.
Nonetheless, each year travelers head to western Montana, where four inactive mines with high levels of radon are within 18 kilometres of one another. Radon gas forms from the radioactive decay of naturally occurring uranium in the bedrock and has a short half-life. In the Merry Widow Health Mine, visitors can bathe in radon-contaminated water or simply sit and work on a puzzle.
For owner Chang Kim, 69, his business helps treat chronic medical conditions such as arthritis or diabetes. Adherents claim radon in low doses creates stress on the body, triggering the immune system to readapt and reduce inflammation.
“The people coming to the mines, they’re not stupid,” Mr Kim said. “People’s lives are made better by them.”
He learned about the mines 14 years ago when his wife, Veronica Kim had developed a connective tissue disease which crumpled her hands and feet. Traditional medicine wasn’t working for her. After takim=ng two sessions a year in the mines ever since, Veronica smiles when she shows her hands.
“They’re not deformed anymore,” she said, adding she’s been able to reduce her use of meloxicam for pain and swelling.
Radon users point to European countries such as Germany, where the controversial radon therapy can still be prescribed for various conditions.
In the US, the EPA maintains that no level of radon exposure is risk-free, noting it is responsible for about 21 000 lung cancer deaths every year. The agency recommends that homes with radon levels of 150 Becquerels (radioactive decays per second) per cubic metre or more should have a radon-reduction system. The EPA derived this valuefrom lower values being subject to false negatives, and it being an achievable level with radon-reduction systems. By contrast, the owners of Montana’s oldest radon therapy mine, Free Enterprise Radon Health Mine, said their mine has an average of about 64 000.
The federal guidelines are “a bunch of baloney” according to Monique Mandali, who lives in Helena, about 40 minutes from the mines, and tries to fit in three sessions at Free Enterprise a year – 25 hours of exposure spread out over 10 days for arthritis in her back.
“People say, ‘Well, you know, but you could get lung cancer.’ And I respond, ‘I’m 74. Who cares at this point?'” she said. “I’d rather take my chances with radon in terms of living with arthritis than with other Western medication.”
Antone Brooks, formerly a scientist at the US Department of Energy and who studied low-dose radiation, is one of those who believes the low dose threshold is excessive.
“If you want to go into a radon mine twice a year, I’d say, OK, that’s not too much,” he said. “If you want to live down there, I’d say that’s too much.”
In the early 1900s, before antibiotics were popularised, small doses of radiation were used to treat pneumonia with reports it relieved respiratory symptoms. Since then, fear has largely kept the therapeutic potential of low-dose radiation untapped, said Dr Mohammad Khan, an associate professor with the Winship Cancer Institute at Emory University. But amid the pandemic, health care providers struggling to find treatments as hospital patients lie dying have been giving clinical radiation another look.
Patients who received low doses of radiation to their lungs were weaned off of oxygen and were discharged from hospital sooner than those without the treatment. Dr Khan said more research is necessary, but it could eventually expand clinical radiation’s role for other illnesses.
“Some people think all radiation is the same thing, that all radiation is like the Hiroshima, Nagasaki bombs, but that’s clearly not the case,” Dr Khan explained. “If you put radiation in the hands of the experts and the right people – we use it wisely, we use it carefully – that balances risk and benefits.”
