10 Şubat 2017 Cuma
29 Ocak 2017 Pazar
Study dispels myth of links between poverty and weight
Call it the “Benefits Street effect” – the popularity of widely held preconceptions about unemployed people. And one of the most prevalent is that jobless people are more likely to be overweight than those in work.
While television documentaries and newspapers can help perpetuate this belief, academic studies also reinforce it. A series of studies have suggested that employers are biased against larger candidates when hiring staff. As a result, slimmer people tend to be employed first, leaving the overweight in the pool of the unemployed for longer.
But a study in the journal Preventive Medicine produces evidence that unemployed people are far more likely to be significantly underweight than the average person. The study’s authors, Dr Amanda Hughes and Professor Meena Kumari from the Institute for Social and Economic Research at the University of Essex, believe their findings provide a corrective to popular misconceptions about unemployed people and should alert health professionals to the heightened mortality risks that come from being underweight.
Hughes explained that she first became suspicious of a link between weight and unemployment when volunteering at a food bank. She observed that there were more people coming in who were painfully thin than were clearly overweight.
“There were people who had not eaten that day or the day before, or who had walked for two hours to get there, because paying for a return bus journey was out of the question,” she said. This set her thinking: had researchers become so concerned with obesity that they were ignoring the big picture?
“In public health there’s a really quite consistent and replicated finding that obesity is more common among more disadvantaged groups,” Hughes said. “It’s such a well replicated finding that, even in public health, there has always been this assumption that if unemployment affects body weight it will be in the direction of increasing it.”
We now have quantitative evidence that many unemployed people are not eating enough in simple caloric terms
But Hughes’s work suggests the picture is far more complex: that there is a “U-shaped” association between unemployment and body weight, with jobseekers tending to be more susceptible to being obese or underweight than those in work.
Using the Understanding Society database, a nationally representative survey of more than 40,000 UK households, Hughes looked at the BMI (body mass index) of 10,737 working-age adults between 2010 and 2012, a time when the effects of the recession were being keenly felt and substantial changes were being made to the benefits system.
Of those who were in employment, were full-time parents or in full-time education, 0.7% had a BMI below 18.5 and were therefore classed as underweight. But for those who were unemployed, the proportion shot up to almost 4%.
When factors such as education, gender and smoking were taken into account, it was revealed that the unemployed were still four times more likely to be classed as underweight than those who were not classed as unemployed.
Furthermore, just under 29% of those unemployed were classed as overweight compared with almost 40% of those in work or full-time education.
The study found that unemployed people were more likely to be obese, but only if they were non-smokers. Hughes suggested that this might be because some people on severely restricted budgets chose to prioritise their spending on tobacco rather than food.
“Together, these results point to a complex picture in which jobseekers, depending on the complexities of individual lives, are at increased risk of being either underweight or obese, each with their own associated health risks,” Hughes said.
“We now have quantitative evidence that many unemployed people are not eating enough in simple caloric terms. These results make an important contribution to research trying to explain the increased risk of chronic illness and mortality for unemployed people. They suggest that, at least in contemporary Britain, being underweight may contribute to this much more than previously realised.”
Study dispels myth of links between poverty and weight
24 Ocak 2017 Salı
What links the NHS and US healthcare? Political choices | Mary O’Hara
When the lifelong Republican Jeff Jeans recently questioned the House of Representatives Republican speaker, Paul Ryan, about the party’s healthcare proposals, Ryan probably expected him to oppose Obamacare.
However, Jeans, who was diagnosed with a treatable form of cancer aged 49, now relies on the insurance put in place after the 2010 introduction of Obamacare – formally known as the Affordable Care Act (ACA). So to Ryan’s surprise, he said: “I want to thank President Obama from the bottom of my heart because I would be dead if it weren’t for him.”
His story is far from isolated but following the spectacle of Donald Trump signing an executive order within hours of entering the Oval Office on Friday that directed government agencies to unravel the act, it is all the more poignant. Thanks to Obamacare 20 million more people had insurance in 2016 than in 2010 – many of them poor or on low incomes, but also people who couldn’t previously afford cover due to pre-existing medical conditions that made insurance policies prohibitively expensive. For many, Obamacare was the first time they had ever had health cover. For some it was also the difference between a health condition being treated or not, or bankrupting a family.
In Britain, reports of families being left destitute in the US because they couldn’t afford private health insurance have been rightly judged as scandalous and prompted many people to fear any hint of NHS privatisation. While the NHS is currently under enormous pressure (courtesy of the austerity-obsessed Tories), including bed shortages, the crisis in A&E and cancelled operations, to say nothing of social care cuts making a bad situation worse, access to healthcare is still seen as a fundamental right for all.
In the US, where access to even basic healthcare has historically been seen as a luxury not a right, it’s easy to understand why so many embraced Obamacare. It was hardly a flaw-free initiative, but it was a start.
Even though Trump has repeatedly dismissed the ACA as a disaster and Republicans have ratcheted up efforts to dismantle the programme (they’ve been trying since its inception, saying it’s “big government” gone mad), the latest surveys show Obamacare is growing in popularity. Half of Americans polled by NBC and the Wall Street Journal this month said the law was working well, while the same proportion had little or no confidence in Republican proposals to change it. To a degree this reflects how politically split the country is, but as NBC News pointed out, 45% of people said they thought the law was a good idea – more than at any time since the question was first asked in 2009. Judy Solomon, the vice-president of health policy at the Center on Budget and Policy Priorities, says this may be down to more people having first-hand experience of the ACA. “I think people are really beginning to understand what this thing is and what it does and they don’t want to lose it.”
The Republicans say they would repeal key provisions while keeping others and then replace it later with something better. However, this month the non-partisan Congressional Budget Office (CBO) released an analysis of the party’s proposals from 2015 (the Restoring Americans’ Healthcare Freedom Reconciliation Act, which Obama vetoed) that painted a damning picture should this strategy be followed. Within a year of repeal 18 million people would lose their insurance, it found. The CBO also estimated that insurance premiums would soar by 20%-25% in the year following a dismantling of the law.
If the worst happens it’s hard to contemplate what people like Jeans will do. Rebecca Vallas, a director at the Center for American Progress, in a reference to Trump’s inaugural speech, concludes that its eradication would be “the real American carnage”. Josh Hoxie, a director at the Institute for Policy Studies thinktank, says the impact on lower-income people, and on inequality more broadly, would be dramatic, and not just in terms of access to healthcare. He points to research showing that dismantling the ACA would result in 7 million low-income people becoming instantly poorer because they stand to lose premium tax credits included in the ACA. Meanwhile – and perhaps illuminating why Republicans may be so keen to overthrow Obamacare – the same research found that the 400 richest Americans would get a combined tax cut of $ 2.8bn (£2.3bn) as a result of repeal.
Whether it’s austerity in the UK or lining the pockets of the rich in the US, healthcare is about political choices. The wrong choices can be devastating, which is why they should be fought at every opportunity.
Mary O’Hara writes on social affairs and is the author of Austerity Bites
What links the NHS and US healthcare? Political choices | Mary O’Hara
15 Aralık 2016 Perşembe
12 Aralık 2016 Pazartesi
UK university launches inquiry into links to work of controversial surgeon
It was the case of the superstar surgeon, the prestigious Swedish institute and the ill-fated windpipe transplants that escalated into allegations of misconduct, dismissal and a criminal investigation.
Now, a leading British university has launched an inquiry into its own links with the endeavours of Paolo Macchiarini, the surgeon at the centre of the trachea operations following which six patients died.
The surgery, pioneered five years ago with the world’s first synthetic windpipe transplant at Stockholm’s prestigious Karolinska Institute, appeared to mark the beginning of an era in which artificial organs could be created from scratch by scientists and seamlessly integrated into the human body.
However, the remarkable success story began to unravel. In March, the Italian surgeon was dismissed from the Karolinska Institute amid an unfolding medical scandal and Swedish prosecutors are conducting a criminal investigation.
Now, in a case that has sent ripples across the scientific world, University College London has launched an inquiry into links with the controversial surgeon.
The latest investigation will probe its relationship with regenerative medicine research that may have taken place at Karolinska. Several of its senior scientists contributed to the procedures pioneered by Macchiarini, in which donor or synthetic tracheas were seeded with the patient’s own stem cells with the aim of creating new, functioning organs.
There is no suggestion that the UCL academics are implicated in any misconduct.
The regenerative surgery initially appeared to have gone well, and was described as successful in high profile journal articles, but it later emerged that six of the eight patients to receive synthetic tracheas had died, while another remains in intensive care. Karolinska’s vice chancellor resigned and its entire board were sacked earlier this year after they continued to back the Italian surgeon despite warnings of clinical and scientific misconduct.
Karl-Henrik Grinnemo, a surgeon who worked alongside Macchiarini at Karolinska, said of his former colleague that there was always a sense of emergency that led to him bypassing standard ethical safeguards in international collaborations.
“It was ‘They’re severely ill and they will die very soon and … we can’t wait to get the permissions from the regulators’,” he said. “Everything was always in a hurry when it came to Paolo Macchiarini.”
Alexander Seifalian, a former UCL professor of biomaterials, created the first synthetic trachea to be transplanted into a patient. The 36-year old Eritrean man, Andemariam Beyene, had been suffering from advanced tracheal cancer and died two-and-a-half years after the transplant. Seifalian was dismissed from UCL in July, after a tribunal in an unrelated case found that he had dishonestly obtained £24,000 from an overseas student.
Seifalian, who had developed a polymer material to make artificial ears and noses, said he agreed to produce a synthetic trachea in just 10 days after being approached by Macchiarini, who told him his patient had only two weeks to live. In a 2013 TED talk, Seifalian recalled asking his PhD student to obtain sheep and pig tracheas from the butchers, because they did not know what the organ looked like.
“I said ‘Go on Google and type in trachea’,” he recalled in the talk.
According to Grinnemo, who assisted in the operation, “none of the [Stockholm] patients needed an operation that urgently. They would have survived even years. You could have waited for the regulators to look at the material and the cells.”
Grinnemo later concluded that the entire synthetic trachea concept was doomed to fail because the plastic would inevitably become infected as it was exposed to bacteria and viruses with each breath, adding that he now views the synthetic transplant as a “death tube”.
While the material was approved as safe for clinical use, the actual trachea was never formally assessed as a new medical device, meaning this risk was not fully considered.
Seifalian told the Guardian: “At the time he came to our laboratory and he said this is the only chance of survival for this patient … Yes if we had a longer time, we would have made a better scaffold. Everything was in a rush.”
Seifalian later made a synthetic trachea for a 20-year-old British woman, Keziah Shorten, who was treated at University College Hospital London in 2011.
Martin Birchall, a UCL professor of laryngology who coordinated the surgery, said that on the back of positive reports from Karolinska, the team were given approval to perform a synthetic trachea transplant under compassionate use rules. The surgery allowed Shorten, who had been in a critical condition in intensive care following cancer treatment, to return home for a brief period, but she died three months later.
“At the time it was the rational thing to do,” said Birchall. “We wouldn’t do it again now.”
Birchall had collaborated with Macchiarini on a transplant carried out in a Spanish clinic in 2008.
He too recalls a sense of urgency when helping to prepare the donor trachea that had been stripped of its cells and re-populated with stem cells taken from the bone marrow of the 30-year-old patient, Claudia Castillo.
Birchall, then at Bristol University, was given permission by the Human Tissue Authority to prepare the cells in a veterinary laboratory, that was not licensed for clinical applications. In a 2008 letter the HTA said it would not stand in the way of what “could in this particular case be life-saving therapy” for a “carcinoma patient”.
The surgery was required because one branch of Castillo’s windpipe (the bronchus) had been damaged by a TB infection. Her left lung was at risk of being surgically removed, but she was not at immediate risk of dying, according to the Barcelona clinic where she was treated.
Birchall told the Guardian that he believed the additional risk this carried was justified because “my firm belief was her life was in danger and we needed to move quickly”, adding that even so he would not have carried out the work without HTA approval.
There is no suggestion that the cells caused any health problems, but Castillo suffered extensive complications and ultimately had her lung removed earlier this year, raising questions about whether the risk was warranted.
In a statement, UCL said: “Following recent events at the Karolinska Institute in Sweden relating to some aspects of regenerative medicine research, UCL’s Vice Provost (Research) has instigated a special inquiry in order to establish the nature and scope of regenerative medicine research at UCL and to establish the nature of UCL’s relationship with regenerative medicine research that may have taken place at the Karolinska Institute.”
Macchiarini rejected claims that he misrepresented the clinical condition of patients to collaborators. Of the first synthetic transplant, he said: “All of us involved in Andemariam Beyene’s care wanted to give him the very best chance possible, and he and his family expressed their gratitude for the extra years we gave him.”
UK university launches inquiry into links to work of controversial surgeon
25 Ekim 2016 Salı
Study links blood pressure risk to road noise
People living near noisy roads could have a bigger risk of high blood pressure, a new study suggests.
Meanwhile, long-term exposure to air pollution can also increase a person’s risk, experts found.
The new study tracked 41,000 people in five different countries for up to nine years.
An extra adult per every 100 living in the most polluted areas will develop high blood pressure compared with those living in the less polluted areas, the research suggests.
The study, published in the European Heart Journal, also found that traffic noise is associated with an increase in cases of hypertension.
Researchers gathered information on 41,000 people from Norway, Sweden, Denmark, Germany and Spain at the start of the study and again during a follow-up examination between five and nine years later.
None suffered high blood pressure when they joined the study, but during the follow-up period 15% had developed hypertension or started to take blood pressure-lowering medications.
The researchers also measured air pollution during three separate two-week periods.
And they assessed traffic density outside the homes of participants.
They found that people living in noisy streets, where there were average night-time noise levels of 50 decibels, had a 6% increased risk of developing hypertension compared to those living on quieter streets.
And those living in areas with higher concentrations of polluting particles were significantly more likely to have self-reported high blood pressure.
Lead author Barbara Hoffmann, professor of environmental epidemiology at at Heinrich-Heine-University of Dusseldorf, Germany, said: “Our findings show that long-term exposure to particulate air pollution is associated with a higher incidence of self-reported hypertension and with intake of anti-hypertensive medication.
“As virtually everybody is exposed to air pollution for all of their lives, this leads to a high number of hypertension cases, posing a great burden on the individual and on society.
“Exposure to traffic noise shares many of the same sources with air pollution and so has the potential to confound the estimates of the adverse effects of pollution on human health. However, this study controlled for traffic noise exposure and found that the associations of air pollution with hypertension did not vanish. This is important because preventive measures for air pollution and noise differ.”
But Prof Francesco Cappuccio of the University of Warwick, said: “The present aggregate analysis suggests that whilst measures of air pollution across different European countries are associated with a greater risk of ‘self-reported’ hypertension, there is no evidence of such an association with the incidence of ‘measured’ hypertension.
“This finding, understated in both the study’s conclusion and in the press release, introduces a big note of caution. It is well recognised that the awareness of hypertension in the general population is weakly correlated with its presence when measured, and the lack of symptoms or signs often associated with it makes self-reported estimates unreliable, often biasing population hypertension estimates.”
Study links blood pressure risk to road noise