Lancet study: 'Mindfulness option for depression'

A mindfulness-based therapy could offer a "new choice for millions of people" with recurrent depression, a Lancet report suggests. 

Scientists tested it against anti-depressant pills for people at risk of relapse and found it worked just as well.  The therapy trains people to focus their minds and understand that negative thoughts may come and go.

In England and Wales doctors are already encouraged to offer it.

Patients who have had recurrent clinical depression are often prescribed long-term anti-depressant drugs to help prevent further episodes.

In this study, UK scientists enrolled 212 people who were at risk of further depression on a course of mindfulness-based cognitive therapy (MBCT) while carefully reducing their medication.

Patients took part in group sessions where they learned guided meditation and mindfulness skills.

The therapy aimed to help people focus on the present, recognise any early warning signs of depression and respond to them in ways that did not trigger further reoccurrences.

Researchers compared these results to 212 people who continued to take a full course of medication over two years.

By the end of the study, a similar proportion of people had relapsed in both groups. And many in the MBCT group had been tapered off their medication.

Scientists say these findings suggest MBCT could provide a much-needed alternative for people who cannot or do not wish to take long-term drugs.

Providing an independent comment on the study, Dr Gwen Adshead, of the Royal College of Psychiatrists, said: "These findings are important from the point of view of people living with depression who are trying to engage in their own recovery."

"And it provides evidence that MBCT is an intervention that primary care physicians should take seriously as an option."

But he cautioned the research does not suggest MBCT is useful for all types of depression; nor that it should replace anti-depressant treatment for people with severe disorders who have needed hospital treatment or are suicidal.

And experts caution patients should only reduce their anti-depressant medication under medical supervision.

Researchers say their next step is to tease out what the active ingredient in mindfulness therapy might be, and to check it compares favourably to other group-based approaches.

View article in Lancet: 

View more on The Guardian here

Water and Birth Study

It's beyond water: Stories of women's experience of using water for labour and birth The Lancet

This Lancet study aimed to give ‘voice’ to women's experiences of using water for labour and birth.

Purpose:
This study aimed to give ‘voice’ to women's experiences of using water for labour and birth.

Participants:
Five women from a large urban region in New Zealand, who used water for labour and birth, at home and in hospital.

Methods:
The study employed an interpretive design using audio-taped conversations as the method of data collection and a thematic analysis of the women's stories.

Findings:
Data analysis produced two core categories; ‘Getting to the water’ which revealed the impact of preparing for and anticipating the water; and ‘Getting into the water’ which provided a sanctuary and a release from pain.

Conclusion:
The all-encompassing warmth associated with being enveloped in warm water cradled, supported, relaxed, comforted, soothed, sheltered and protected the women; it created a barrier and offered a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opened possibilities for these women. The women used water to reduce their fear of pain and of childbirth itself; to cope with pain, not necessarily to remove or diminish pain; and to maintain control over the process of birth. The women indicated that it was not necessary to actually give birth in the water to achieve these benefits. Listening to the stories of women provides us with insights into what is important to them. Women's knowledge contributes an important part of the evidence on which we base our practice.

EU states 'can do more' to battle Ebola virus

Former Irish European commissioner David Byrne has called on Ireland and other EU states to do more to fight the outbreak of the deadly Ebola virus in west Africa.

Mr Byrne, who held the health portfolio in the European Commission from 1999 to 2004, is one of 44 prominent public health experts who signed a letter in The Lancet medical journal that urged Western governments to “mobilise all possible resources” to assist west Africa in controlling the epidemic. On Friday, the death toll from the disease passed the 3,000 mark, six months after the outbreak began.

The Irish Government could help by facilitating medical staff to take career breaks so they can volunteer to work fighting the disease, and by providing medical supplies to control the spread of infection, Mr Byrne told The Irish Times yesterday.

The EU Commission has donated more than €180 million to help fight the epidemic, he said. “It’s for the governments of the member states now to up their game. The EU doesn’t have the ability to send health personnel into west Africa in the numbers needed, but the health communities in each country can.”

Ireland is a long-standing supporter of the WHO and enjoys a good reputation internationally for its aid work, he pointed out. It is also a signatory of an international agreement that requires countries to be supportive when the WHO declares an outbreak a “public health emergency of international concern,” as it has done in the case of the current Ebola outbreak.“We’re now dealing with an outbreak of a serious disease in developing countries that don’t have the resources to fight it. Meanwhile, the developed world hasn’t given enough attention to the problem, probably because it doesn’t think the disease will spread further,” said Byrne.

Irish Aid has made donations totalling about €460,000 in response to the Ebola outbreak.

The Lancet letter said the Ebola epidemic has “spiralled completely out of control” after months of “inaction and neglect” from the international community.

“Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world.

“The Ebola epidemic represents a public health imperative; unchecked, it might very well become a geopolitical one.”
View article in Irish Times here

Global increase in obesity and overweight

The latest analysis from the Global Burden of Disease Study 2013 shows there has been a startling increase in rates of obesity and overweight worldwide—in both adults (28% increase) and children (up by 47%) in the past 33 years. The number of overweight and obese people has increased from 857 million in 1980 to 2·1 billion in 2013. In a Comment, Klim McPherson calls for a political solution stating that policy needs to solve the problem of rising obesity.

According to the comprehensive global study of the problem, Ireland's population has overweight and obesity levels in excess of the European average, .

The research, details of which are published in the journal The Lancet today, shows 26.5% of Irish girls and 16% of Irish boys under the age of 20 are classed as overweight or obese.

These figures compare to a western European average of 24.2%. 

View more information on RTE/Health here

Doctors announce treatment for peanut allergy

Doctors have said they could treat peanut allergy by feeding children the very thing their bodies reject, so building tolerance that could save a life in case of accidental ingestion.

Small doses of peanut powder taken over several months seemed to induce tolerance in children with the potentially deadly allergy, a research team wrote yesterday in The Lancet medical journal.

After six months of treatment, dubbed oral immunotherapy or OIT, 84-91% of the children in a trial could safely tolerate daily doses of 800mg (0.03 ounces) of peanut powder - the equivalent of about five peanuts.

This was 25 times the amount they could tolerate before the therapy, and much larger than any accidental dose is likely to ever be.

"The treatment allowed children with all severities of peanut allergy to eat large quantities of peanuts, well above the levels found in contaminated snacks and meals, freeing them and their parents from the fear of a potentially life threatening allergic reaction," said study leader Andrew Clark from Cambridge University Hospitals.

"The families involved in this study say that it has changed their lives dramatically."

The trial involved 99 allergic children aged seven to 16.

One in five of the kids receiving OIT reported "adverse events" - mostly mild itching of the mouth, the authors said.

They stressed that people should not try the treatment at home as more research was needed.

Peanut allergy affects about one in 50 children and is the most common cause of fatal food allergy reactions, said a press statement. About 10 million people around the world are allergic to peanuts.

Symptoms vary from mild to severe, from swollen lips or shortness of breath to anaphylactic shock, which can be fatal.

While "exceptionally promising", the method remains experimental, Matthew Greenhawt from the University of Michigan Food Allergy Center wrote in a comment also carried by The Lancet.

"It is unknown if OIT can produce lasting tolerance," he wrote.

View Study here in The Lancet : Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial

How should medical science change?

Comment published in The Lancet, 18 January 2014

"In December, 2013, Randy Schekman received a Nobel Prize in Physiology or Medicine for his codiscovery (with James Rothman and Thomas Südhof) of the cellular machinery regulating vesicle traffic. He used the occasion to launch a ferocious attack against what he called “luxury journals”—Nature, Science, and Cell. (See link below). Although he didn't mention The Lancet, JAMA, or The New England Journal of Medicine, it probably isn't unreasonable to think he would include us in his definition of “luxury journal”. 

This is what he wrote in The Guardian: “These luxury journals are supposed to be the epitome of quality, publishing only the best research. Because funding and appointment panels often use place of publication as a proxy for quality of science, appearing in these titles often leads to grants and professorships. But the big journals' reputations are only partly warranted. While they publish many outstanding papers, they do not publish only outstanding papers. Neither are they the only publishers of outstanding research”
Schekman and his lab are now boycotting those luxury journals and he is encouraging other scientists to do the same.

There is clearly a strong feeling among many scientists, and not only Nobel Prize winners, that something has gone wrong with our system for assessing the quality of scientific research. Does the fault lie with myopic university administrations led astray by perverse incentives or with journals that put profit and publicity above quality? The likely answer is that it is a mix of both. But perhaps the discussion provoked by the latest Nobel awards needs to be widened still further. Perhaps all of us engaged in the enterprise we call “science” need to pause and reflect on the present state of what we do." - view rest of article in The Lancet here

Randy Schekman writing in The Guardian 9 December 2013

The end of the beginning for tissue engineering

For three decades we have heard about the hope of tissue engineering. Hyperbole has become routine, but amidst unreasonable expectations are serious scientists, like Paulo Macchiarini, who believe that by combining cells and degradable materials ex vivo they can develop organs to replace or repair diseased tissues. After many years of trying to build engineered tissues on a backbone of synthetic degradable polymers, a growing body of evidence suggests that decellularised whole organs and tissues are clinically effective degradable scaffolds.

View full article in the Lancet here

Comparison of cancer survival rates

Adults in the UK and Ireland continue to have shorter survival than the European average for many common cancers, particularly colon, (52 per cent vs 57 per cent) ovary (31 per cent vs 38 per cent) and kidney, (48 per cent vs 61 per cent) but have about average survival rates for rectum, breast, prostate, melanoma of the skin, and lymphomas.

This is the conclusion of the latest EUROCARE-5 reports for 1999-2007, covering more than 50 per cent of the adult and 77 per cent of the childhood population of Europe.  It says cancer survival still varies widely between European countries, despite major improvements in cancer diagnosis and treatment during the first decade of the 21st Century.

The findings, published in The Lancet Oncology,(click to view article) analysed data from cancer registries covering all or part of 29 countries to compare five-year survival from diagnosis for more than nine million adults diagnosed between 2000 and 2007.  The 29 countries were grouped into five regions, with England, Ireland, Northern Ireland, Scotland and Wales forming one region, titled ‘the UK and Ireland’.

View article in Irish Medical Times

Research: increasing value, reducing waste

Increasing value and reducing waste in biomedical research regulation and management
The Lancet, Volume 383, Issue 9912, Pages 166 - 175, 11 January 2014

Summary:
Correctable weaknesses in the design, conduct, and analysis of biomedical and public health research studies can produce misleading results and waste valuable resources. Small effects can be difficult to distinguish from bias introduced by study design and analyses. An absence of detailed written protocols and poor documentation of research is common. Information obtained might not be useful or important, and statistical precision or power is often too low or used in a misleading way. Insufficient consideration might be given to both previous and continuing studies. Arbitrary choice of analyses and an overemphasis on random extremes might affect the reported findings. 

Several problems relate to the research workforce, including failure to involve experienced statisticians and methodologists, failure to train clinical researchers and laboratory scientists in research methods and design, and the involvement of stakeholders with conflicts of interest. Inadequate emphasis is placed on recording of research decisions and on reproducibility of research. Finally, reward systems incentivise quantity more than quality, and novelty more than reliability. We propose potential solutions for these problems, including improvements in protocols and documentation, consideration of evidence from studies in progress, standardisation of research efforts, optimisation and training of an experienced and non-conflicted scientific workforce, and reconsideration of scientific reward systems.

See full article in The Lancet here

Breast cancer: Drug 'halves' risk of tumours

A "landmark study" shows a drug can more than halve the development of breast cancer in high-risk women.

A trial on 4,000 women, published in the Lancet, showed anastrozole was more effective, cheaper and had fewer side effects than current medications.

It stops the production of the hormone oestrogen, which fuels the growth of the majority of breast cancers.

Doctors and campaigners are asking health services to consider offering the drug to healthy women.

The study at Queen Mary University of London has followed women with a high risk of breast cancer, based on their family history, for an average of five years.

It showed that out of 2,000 high-risk women given no treatment there were 85 cases of breast cancer in the study.

But in the same number of women given anastrozole there were 40 cases, with virtually no side-effects.

Click here to view full article on BBC News Health

Concussion in sport - European conference

First Brain Injury and Sport - European Conference:                 
Tackling the concussion crisis Acquired Brain Injury Ireland, in association with EBIS (European Brain Injury Society) will host a ‘Brain Injury and Sport’ conference at the Aviva Stadium, Lansdowne Road, Dublin on Friday 13th December 2013. Educating players, coaches and clinicians about concussion management and return to play guidelines; ABI Ireland and EBIS are bringing together a panel of expert speakers to discuss the growing concern surrounding the head injury. For more information see www.braininjuryandsport.ie

Concussion in Sport - view editorial in The Lancet here

 Sports-related concussions in youth: improving the science, changing the culture released on Oct 30 by the US Institute of Medicine and National Research Council—focuses on concussions in young people between 5 and 21 years of age. Incidence data are far from definitive, but the report cites estimates of between 1·6 million and 3·8 million traumatic brain injuries related to sports and leisure in the USA per year, and National Collegiate Athletic Association data suggest that sports-related concussions have increased in recent decades. Information on the long-term health sequelae of concussions in young people is also patchy.

However, the report authors highlight that the ongoing development of the brain might affect susceptibility to, and recovery from, concussion. Concussion can result in physical, cognitive, emotional, and sleep problems: typically recovery takes 2 weeks, although persistence of symptoms for periods of up to years has been reported. Worryingly, previous concussions are associated with an increased risk of further concussions, and there is evidence that repeated concussions increase the number and severity of symptoms.