Wednesday, 26 February 2014

Flooded Homes Health Suffers Long After the Water Subsides

For many of us the current flooding disaster will slip from our attention a few weeks after the terrible pictures stop being broadcast on our TV's and printed in our newspapers. Sadly for those affected directly who have last many possessions and have had their homes rendered unavailable for months the difficulties don't stop when the water eventually disappears.

This report in the journal New Scientist emphasis's that the costs in terms of the consequences for the health of people living in a flooded area extend to months or possible years after the water has gone. In the past statistics for hospital admissions were not recorded (i.e. noted as being due to flooding) once the flooding is gone, but once we start to look at figures for the period after the flood we can see a significant rise in admissions (admissions double) over the next year, whereas those in nearby none flooded areas saw no rise. Deaths apparently rise 50% in flooded areas after the waters subside.

A review by the World Health Organisation (WHO) reports similar findings in other parts of the world eg in China and in homes following Hurricane Katrina, but other similar, more recent studies fail to confirm this finding.

Quoting from the article
However, Bettina Menne, co-editor of the WHO review, says people affected by flooding often subsequently move house, possibly to a different, less flood-prone postcode. If more of them later died than would have normally, this would muddy the data, by cutting the apparent death-rate among the flooded and boosting it among the non-flooded. There's also the fact that people's health overall will have improved since 1968. The problem, Menne says, is that "a study like the one in Bristol, directly comparing people we know were flooded with people who weren't, has never been done again, anywhere". 
One way of finding out for sure would be to set up a health registry of people flooded this time, so the health of those affected can be compared with those who weren't. Virginia Murray of Public Health England called for such a registry in January, and said a protocol for setting one up was nearly ready. But no decision to fund one has yet been taken, she says.
Still, the standard medical surveillance of people whose homes have been flooded is reassuring. "Nothing worrying is happening," says Murray. But what happens in six months to people fleeing floodwaters these past weeks, we may never know.

Monday, 24 February 2014

Itraconazole - anticancer drug?

Itraconazole is well known as an antifungal drug that is effective and has been in use for decades against various fungal infections including aspergillosis in its many forms.

It has been known for some time (since 2007) that itraconazole has anti-angiogenic properties which means that it can restrict new blood vessel formation - blood vessels that may help the infection grow and can cause excessive bleeding.
This is useful to doctors treating deep seated fungal infections , and may even partly explain why it is a useful antifungal as new blood vessels are formed around infections in the lung.  Other medical fields are now interested in using a drug that is already established (consequently has little or no development costs) and about which there is a lot known (e.g. safe usage).

Some cancer tumours are also supported by a network of new blood vessel formation - if the blood supply is insufficient to support the growth of a tumour it can grow no more! Treatment that helps block the growth of new blood vessels would consequently be valuable weapons with which to help prevent tumour growth.

This new study looks at how effective itraconazole is at reducing tumour size after one month of treatment. The results are encouraging with a 45% reduction in cell proliferation and 26 This was a small study with only 19 patients treated with itraconazole, but it should now trigger a new trial taking place over a longer time in order to establish longer term efficacy using a larger number of patients in order to get stronger evidence to support the use of itraconazole to treat some cancers (e.g. basal cell carcinoma and those tumours that are known to growth by causing active angiogenesis).

Thursday, 20 February 2014

Elegant Towers of Fungi

We have seen furniture made using fungi that illustrates the strength and utility of fungal mycelia once dried and baked (and varnished the seal in any allergic material), but now another artist/architect David Benjamin has designed a far more ambitious project.

David plans an outdoor structure in New York that will be dozens of feet high and will be big enough to walk through and provide shade for participants of events at the Museum of Modern Art.

The structures will be entirely built of bricks that are made of fungi and corn husk. Details of which fungi will be used is not yet forthcoming and of course we can only hope that careful consideration is given to using a species that is not pathogenic or allergenic! A major feature of this project is that nearly all of the materials used will eventually be composted and have very little impact on the environment.

Slightly concerning is the claim by the publicity that the fungus will be encouraged to continue to grow, further strengthening the tower. Depending on the type of fungus used this has potential to impact on health as many people are allergic to moulds. The furniture we mentioned earlier was varnished to reduce this risk and of course the bricks were baked to kill the fungus.

It is also worth commenting that the publicity specifically states that they will encourage light to enter the tower so as to encourage fungal growth. Most students of mycology will tell you that unlike plants, fungi do not use light for growth and many stop growing in light so this may be an error of the publicist, or more concerning perhaps an error in the perception of the original designer. What light can do is encourage the production of spores and that would be a worry for public health - allergy and the vulnerability of some people to infection are important considerations.

Friday, 14 February 2014

Horizon 2020: UK launch for EU's £67bn research budget

The European research budget for the next seven years has been announced as £67 billion (an increase of 30%) , of which the UK is forecast to get £1 billion per year which is roughly 10% of the whole allocation (28 countries can apply) and equates to 20% of the total research budget for the UK. This funding is thus very important for UK research and all scientists are being encouraged to apply for this funding, which is allocated on a competitive basis.

"My challenge to the UK's researchers, universities, small and medium-sized enterprises, and large companies is to apply in huge numbers to participate in the programme," said EU Research Commissioner Maire Geoghegan-Quinn.
"The competition will be fierce but I also believe that the excellence of the projects and the proposals coming from the UK means it will do very well out of Horizon 2020."
In addition the highly selective European Research Council (ERC) has had its funding increased by 60% to £10.9 billion and the UK is a major beneficiary, taking 20% of these funds up until now.

Sir Paul Nurse is president of the UK's Royal Society, which hosted Friday's launch event.
He told BBC News: "European money is really important and it's very good that it is going up by 30%. I think also driving collaboration across Europe is really good because we get access to 350 million people - it's one of the reasons [science] works so well in the United States.
"But particularly, at least from my perspective at the discovery research end, the ERC has made a very real difference. The European Commission is very proud of it and rightly so."
To put this in context by comparing it with the budget for the National Institute of Health (NIH) in the US - the organisation that funds most of the federal funded medical research - NIH alone gets £20 billion per year.

This is a big step forward for EU scientific funding but there is some way to go to match our competitors in the US, Japan and the up and coming countries like China.

Original story on the BBC website

Tuesday, 11 February 2014

A new online programme to help patients become their own ambassadors

There is a lot of political impetus building throughout the European Union to involve the patient and carer more in decisions that effect their healthcare.

Lancelot Spratt from the 1950's films based
on the books by Richard Gordon
This is a big change from the way we received healthcare in the UK in the past. Patients were told what was going to happen to them, what was wrong with them and how they must behave whilst under the supervision of medical staff. The possibility of questioning a doctors decision or course of treatment was remote! The doctor knew best.

Limitations of that approach have been acknowledged more recently, not the least being the anxiety caused to a patient by the lack of information being given to them, and the fear of telling a doctor that they had not been fully understood led to shortcomings in treatment and a reduction in quality of care. A more relaxed and effective 2-way exchange is now preferred and is indeed required by the National Institute for Healthcare and Excellence (NICE) in its Patients and Public Involvement Policy (1999) - NICE is the body responsible for several aspects of patient care in the NHS.

This is a big change for patients. Once little was asked of a patient other than to cooperate with the medical staff, but now they are asked to discuss and approve their care. Few are able to do that as effectively as they could as there is little experience and not a little anxiety about disagreeing with a highly qualified medical professional. There have been programs to try to improve this such as the 'Expert Patient Programme (EPP)' - contrary to what it sounds like this is a course on how to get more out of your healthcare rather than a course on how to become an expert on your particular illness! These courses are offered free of charge in some areas of the UK (to those with chronic conditions) and are highly effective ways for some to become a 'better patient'. Takeup is often mixed - many are still more comfortable (and happy) with accepting what the doctor says.

Doctors are also compelled to encourage the patient (and carer) to discuss their condition more - this is a 2 way process!

The European Lung Foundation (ELF) and National Institute for Health Research (NIHR) have now devised an easy to access online course that bears some similarity with EPP but is more explicitly about people understanding their illness, understanding how and why decisions are made about their treatment, helping in government policies for their future care, helping with research (NICE also requires a patient input into research applications) and helping with raising awareness and support for people with the same illness. This last part is particularly important for rare illnesses such as aspergillosis.

Called European Patients Ambassadors these individuals are given the techniques to stand up for themselves and encourage fellow patients to do the same. They can be the 'go to' people for members of the medical profession and researchers. This course os for patients and carers.

So - if you feel well enough and motivated enough this course could change your life and could have a big impact into awareness of your illness and all its difficulties amongst governments throughout the EU, large funding organisations, health services, help charities with awareness, help fellow patients, carers and their doctors, nurses and those who are working to find a better way to treat your illness. You can try the course in complete privacy in your own home and drop it if it isn't for you. You can take the course and never do anything more than use it to help yourself manage your own illness (most people will probably do just that) - it is up to you but it is worth having a look at it.

The National Aspergillosis Centre and Fungal Infection Trust would be more than happy to have as many ambassadors as we can get!

Who is the programme aimed at?

The programme is aimed at:
  • People with experience of a condition as a patient or carer
  • People who are interested in how their condition is treated or managed
  • People interested in new research into their condition
  • People who want to influence policy around their condition at local, national or European level
  • People interested in working with the media or using social media to raise awareness of their condition
You may wish to get involved in representation because you are passionate about raising awareness of your condition; or perhaps you had a poor or good experience and want to help change the way a condition is managed.
The programme is currently in English but can be used by people across Europe with any condition to influence healthcare from local to European levels.

Monday, 3 February 2014

Regrowing Damaged Organs Takes a Step Closer.

We have commented several times in this blog on the potential uses for stem cells, ranging from repair of damaged tissue to the growth of entire organs that may one day be used for transplant.

Stem cells are able to growth and form all of the different tissues that make up a body. Some can only form  a single type of tissue while other, rarer stem cells can form any tissue. Recent research has enabled us to isolate many of the stem cells that can grow to form lungs or kidneys for example (also spine, liver and heart) and they are grown and used to treat some forms of cancer via bone marrow transplants.

Much work has been carried out on adult stem cells as they have a few advantages over embryonic stem cells i.e.

  • they are less controversial with no destruction of embryo's 
  • if it becomes possible to generate viable organs that can be transplanted into a patient then they will cause far fewer problems of tissue rejection if the stems cells used came from the patient.
However adult stem cells are difficult to find. Isolation of them is laborious and slow and in a few cases there are risks to the patient. What is needed is a simple, quick, cheap method to produce adult stems cells that would enable far more labs to carry our more research and thus lead more rapidly to successful treatments.

Dr Obokata

It seems that this has been achieved after a major breakthrough in Japan by Dr Haruko Obokata who discovered that all we need to do to transform ordinary cells from an adult into stems is incubate ordinary cells in slightly acidic growth medium for 30 mins! This discovery is remarkable and a reminder that sometimes the simplest solutions may well be the best.

Dr Obokata describes her discovery in this article on the BBC website, and her american co-authors (Charles Vacanti) also discuss the implications of this work in the video below:

Further work is needed to work out how to control the growth of stem cells such that full size organs can be grown or to allow stem cells to be injected into a human patient so as to promote regrowth of a damaged organ, but one great barrier may well have been removed thanks to this work.

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