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A New Alternative to Skin Biopsies

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A new ‘virtual histology’ technology being developed by researchers could replace many skin tissue biopsies. The technology is detailed in Light: Science & Applications

Histology is the microscopic study of tissues and organs through sectioning, staining, and examining those sections under a microscope. Often called microscopic anatomy and histochemistry, histology allows for the visualisation of tissue structure and characteristic changes the tissue may have undergone.

“This process bypasses several standard steps typically used for diagnosis – including skin biopsy, tissue fixation, processing, sectioning and histochemical staining. Images appear like biopsied, histochemically stained skin sections imaged on microscope slides,” said the study’s senior author, Aydogan Ozcan, Chancellor’s Professor and Volgenau Chair for Engineering Innovation of the Electrical and Computer Engineering Department at UCLA Samueli.

The technology may enable rapid diagnosis of malignant skin tumours, reducing unnecessary invasive skin biopsies and allowing skin cancer diagnosis at an earlier stage. This technology had only previously been applied to microscopy slides of unstained tissue, acquired through a biopsy. This is the first time virtual histology has been applied to intact, unbiopsied tissue.

“The current standard for diagnosing skin diseases, including skin cancer, relies on invasive biopsy and histopathological evaluation. For patients, this often leads to unnecessary biopsies and scars as well as multiple visits to doctors. It also can be costly for patients and the health care system,” said Dr Philip Scumpia, assistant professor of dermatology and dermatopathology at the David Geffen School of Medicine at UCLA and the West Los Angeles Veterans Affairs Hospital and a member of the UCLA Jonsson Comprehensive Cancer Center. “Our approach potentially offers a biopsy-free solution, providing images of skin structure with cellular-level resolution.”

The research team, led by Ozcan, Scumpia and Dr. Gennady Rubinstein, a dermatologist at the Dermatology & Laser Centre in Los Angeles, created a deep-learning framework to transform images of intact skin acquired by an emerging noninvasive optical technology, reflectance confocal microscopy (RCM), into a format that is user-friendly for dermatologists and pathologists. Analysing RCM images requires special training because they are in black and white, and unlike standard histology, they lack nuclear features of cells.

“I was surprised to see how easy it is for this virtual staining technology to transform the images into ones that I typically see of skin biopsies that are processed using traditional chemical fixation and tissue staining under a microscope,” Dr Scumpia said.

The researchers trained a neural network to rapidly transform RCM images of unstained skin into virtually stained 3D images like the H&E (haematoxylin and eosin) images familiar to dermatologists and dermatopathologists.

“This framework can perform virtual histology on a variety of skin conditions, including basal cell carcinoma. It also provides detailed 3D images of several skin layers,” said Ozcan. “In our studies, the virtually stained images showed similar color contrast and spatial features found in traditionally stained microscopic images of biopsied tissue. This approach may allow diagnosticians to see the overall histological features of intact skin without invasive skin biopsies or the time-consuming work of chemical processing and labeling of tissue.”

“The only tool currently used in clinics to help a dermatologist are dermatoscopes, which magnify skin and polarise light. At best, they can help a dermatologist pick up patterns,” said Rubinstein, who also uses reflectance confocal microscopes in clinic.

The authors said there is a way to go before clinical use, but they aim to introduce the technology at various scales alongside other optical-imaging systems. Once the neural network is “trained,” with many tissue samples and the use of powerful graphics processing units (GPUs), it will be able to run on a computer or network, enabling rapid transformation from a standard image to a virtual histology image.

This technology could usher in a new age of “digital dermatology” and change how dermatology is practised. Additionally, the research team will see if this artificial intelligence platform can work with other AI technologies to look for patterns and further aid in clinical diagnosis.

Source: UCLA

Leafy Vegetable-rich Diet Could Curb Migraine Symptoms

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It may be worth adopting a plant based diet, rich in dark green leafy vegetables, to ease the symptoms of chronic migraine, suggest doctors reporting on a case study.

Writing in BMJ Case Reports, the doctors’ recommendation comes after treating a man who suffered from migraines for 12 years and had tried medication, yoga and avoiding potential ‘trigger foods’ to no avail.

Over 1 billion people worldwide have migraines, characterised as one-sided, pulsating headaches lasting 4–72 hours, and often accompanied by sensitivity to noise and light and sometimes prodromal auras. While the condition may be treated and prevented with drugs, a growing body of evidence suggests that diet can be an effective treatment.

Six months before his clinic referral, the man’s migraines had become chronic, occurring on 18–24 days of every month. The pain was described as starting suddenly and intensely in the forehead and left temple. The pain was throbbing in nature, usually lasting 72 hours. His headaches were accompanied by sensitivity to light and sound, and nausea and vomiting. On a scale of 0–10, he scored the pain severity as 10–12 out of 10.

Blood tests showed little systemic inflammation and a normal level of beta-carotene (53 µg/dL). This is likely due to his daily sweet potato consumption, which, although high in beta-carotene, are relatively low in the nutrients responsible for the anti-inflammatory and antioxidant properties of carotenoids, the authors pointed out. These are instead found in dark green leafy vegetables, such as spinach. Systemic inflammation and oxidative stress are implicated in migraine.

The authors recommended that he follow the Low Inflammatory Foods Everyday (LIFE) diet, which is a nutrient dense, whole food, plant-based diet.

The LIFE diet includes eating at least five ounces (142g) of dark green leafy vegetables every day, drinking one 32-ounce (905g) daily green LIFE smoothie, and cutting back on whole grains, starchy vegetables, oils, and animal protein, particularly dairy and red meat.

After two months on the LIFE diet, the frequency of his migraine attacks had fallen to just 1 day a month; the length and severity of the attacks had also lessened. Blood tests showed a substantial rise in beta-carotene levels, from 53 µg/dL to 92 µg/dL.

He stopped his migraine meds and even when he tried certain ‘challenge’ foods which triggered headaches, they were less intense. At three months his migraines completely stopped, and they haven’t returned in 7.5 years.
The 60-year-old patient, whose identity was not disclosed, said: “Before I changed my diet, I was suffering six to eight debilitating migraines a month, each lasting up to 72 hours. Most days, I was either having a migraine or recovering from one.”

The man was allergic, which studies suggest contributes to migraines, and his allergies had disappeared. He was also HIV positive, also linked to migraine risk, so it is certainly possible that the man’s HIV status and antiretroviral drugs had contributed to his symptoms, the reports acknowledge, which they could not exclude.
Nevertheless they concluded: “This report suggests that a whole food plant-based diet may offer a safe, effective and permanent treatment for reversing chronic migraine.

“While this report describes one very adherent patient who had a remarkable response, the LIFE diet has reduced migraine frequency within three months in several additional patients (personal communication).”

Source: EurekAlert!

An Inspiration Led to Understanding Metformin’s Anti-tumour Effect

Scientists report that metformin, used to treat type 2 diabetes mellitus, induces activation and proliferation of tumor-targeting CD8+ T-lymphocytes (CD8TIL), via mechanisms that involve the generation of reactive oxygen species in mitochondria of CD8TIL and an increase in glycolysis. Credit: Heiichiro Udono from Okayama University

Researchers in Japan have elucidated how the antidiabetic drug metformin exerts an anti-tumour effect as well.

Certain drugs like metformin have recently been found to have anti-cancer properties. Metformin appears to bolster anti-tumour immunity but the underlying immunological mechanisms were a mystery. With all the permutations and combinations of cancer, a blanket, yet targeted therapy would be ideal. 

Japanese scientists led by Professor Heiichiro Udono from Okayama University thus decided to address this oncological research question. In their recent study, they looked at how a specific subset of immune cells, called CD8+ infiltrating T-lymphocytes (CD8TIL), which specifically attack tumor cells, behaved in response to metformin. Their findings have been published as a research article in Journal for ImmunoTherapy of Cancer.

Interestingly, Prof. Udono almost gave up on his anti-cancer pursuits, when he lost his own father to cancer. However, a bolt of inspiration came at a conference: “Nearly 10 years ago, a switch turned on in my head when I attended a Keystone Symposia discussing cancer, and hypoxia, held in Banff, Alberta. I realised that we had missed addressing Warburg effect, an effect which bolsters the growth of cancer, in our previous research. So, reverting Warburg effect to normal metabolic profile in cancers became a topic that got me thinking. Surprisingly, I got a hint from the same conference that metformin may aid cancer immunity. So, we got to work!”

Prof Udono and his team got to work, meticulously conducting a series of experiments on cancer cell lines, and ‘knockout gene’ mice, searching for possible biomolecules that result in metformin-dependent anti-tumour immunity. They probed the intracellular mechanisms in CD8TIL, when exposed to metformin, and assessed different biomarkers for growth. Given that CD8TIL produces proteins called interferons to attack cancer cells, they also assessed corresponding levels.

Accordingly, the scientists found that metformin causes the generation of reactive oxygen species in the mitochondria of CD8TIL (mtROS) and increases glycolysis. They also found that mtROS activated growth pathways in CD8TIL, allowing these cells to proliferate. Notably, this is achieved through a transcription factor involved in anti-oxidative stress response, called Nrf. Though metformin did not directly cause apoptosis, ‘cell suicide’ in tumours, it did cause CD8TIL to secrete interferon-ɣ to alter the tumour microenvironment in favour death of tumour cells.

Summing up the findings, Prof. Udono said: “More than anything else, our study provides the knowledge that we can ourselves protect our body from cancer. We hope that this understanding will result in not only the reduction of cancer incidence and improve treatment, but also will help prolong our life.”

The researchers also added that these findings strongly suggest the possibility of using metformin as a drug to strengthen anti-tumour immunity in patients with cancer. The findings appear in the Journal for ImmunoTherapy of Cancer.

Source: EurekAlert!

Can Prozac be Used to Treat Macular Degeneration?

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The antidepressant fluoxetine, best known as Prozac, could offer the first treatment for the leading cause of blindness among people over 50, new research from the University of Virginia School of Medicine suggests.

Researchers have found early evidence that the drug fluoxetine may be effective against atrophic (or ‘dry’) age-related macular degeneration, a condition that affects nearly 200 million people worldwide. An analysis based on bench research, mouse models and huge insurance databases concluded that patients taking fluoxetine were less likely to develop atrophic macular degeneration (AMD).

On the strength of their findings, which were published in PNAS, the researchers are urging the investigation of fluoxetine to treat AMD, possibly as an oral pill or slow-release implant in the eye.

“These findings are an exciting example of the promise of drug repurposing, using existing medicines in new and unexpected ways,” said Bradley D. Gelfand, PhD, of UVA’s Center for Advanced Vision Science. “Ultimately, the best way to test whether fluoxetine benefits macular degeneration is to run a prospective clinical trial.”

The researchers believe fluoxetine works by binding with an inflammasome, NLRP3-ASC, which triggers the breakdown of the pigmented layer of the eye’s retina.

After conducting extensive bench research, Dr Gelfand and his team tested fluoxetine and eight other depression drugs in lab mice. Fluoxetine slowed the progression of the disease, but the others did not, the scientists found.

Encouraged by their findings, the researchers looked at fluoxetine use among patients aged over 50 in two enormous insurance databases with over 100 million records. They found that people taking the drug had a “significantly” slower rate of developing dry AMD.

Their approach, which combines bench research with big-data analysis, could lead to faster repurposing of existing drugs.

“Traditional approaches to drug development can be expensive and time-consuming: On average, a new FDA-approved drug takes 10–12 years and costs $2.8 billion (present-day dollars) to develop,” the researchers wrote. “Our identification of the unrecognised therapeutic activity of an existing FDA-approved drug using big data mining, coupled with demonstrating its efficacy in a disease-relevant model, could greatly accelerate and reduce the cost of drug development.”

Dr Gelfand was involved earlier this year in using a similar approach to determine that HIV drugs known as nucleoside reverse transcriptase inhibitors, or NRTIs, may be useful against dry macular degeneration as well.

“While we have had a great deal of success with the approach of using real-world patient data, we may have only begun to scratch the surface of finding new uses for old drugs,” said Dr Gelfand, of UVA’s departments of ophthalmology and biomedical engineering. “It is tempting to think about all the untapped therapeutic potential of medicines sitting on pharmacy shelves.”

Source: University of Virginia

Diabetes Drug Could Halve Glaucoma Risk

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GLP-1R agonists, a popular class of diabetes drugs, may also have a protective effect against glaucoma in diabetic patients, according to a new study published in the British Journal of Ophthalmology.

The researchers examined retrospective data of 1961 diabetic patients who were new users of this class of drugs and matched them to 4371 unexposed control subjects. After 150 days on average, 10 patients in the medicated group were newly diagnosed with glaucoma (0.5%) compared to 58 patients (1.3%) in the control group. These results indicate that GLP-1 receptor agonists could halve a diabetic patient’s risk of developing glaucoma.

The findings are supported by a Penn Medicine study from 2020, which found that GLP-1R agonists reduced neuroinflammation and prevented retinal ganglion cell death in mice. This class of drugs has also shown similarly protective effects against Alzheimer’s and Parkinson’s diseases in animal models, and clinical trials are underway to test the medications against neurodegenerative diseases in humans.

Glaucoma is the second leading cause of blindness worldwide, and people with diabetes are twice as likely to develop the condition.

“It was very encouraging to see that a popular diabetes medication could significantly reduce the risk of developing glaucoma, and our study suggests that these medications warrant further study in this patient population,” said Qi N. Cui, MD, PhD, with Brian VanderBeek, MD, MPH, both assistant professors of Ophthalmology at Penn.

Source: EurekAlert!

Nelson Mandela Bay Area Hit by Rabies Outbreak

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An outbreak of rabies has hit the Nelson Mandela Bay metro, with a nine-year-old Gqeberha boy being its first victim so far.

The Nelson Mandela Bay Metropolitan Municipality (NMBMM) issued a warning calling on residents to be vigilant and to take their domestic pets for rabies vaccinations, following the death of a boy last weekend who was bitten by a dog. Health-e News received confirmation from NMBMM that the nine-year-old boy died at the Dora Nginza Hospital on Friday last week.

“We have learnt with sadness of the passing of the boy from Motherwell, who died due to rabies. We have the family in our prayers,” said Acting Mayor Luxolo Namette.

The municipality’s health services directorate deputy director Dr Patrick Nodwele said vaccinating domestic pets can be the most effective way of preventing rabies transmission to humans.

“The boy passed at Dora Nginza Hospital where it was established that he had been bitten by a dog. Our health officials, together with the Department of Agrarian Reform, have been busy these last couple months vaccinating dogs and cats in an effort to curb the virus as we know that rabies is a vaccine-preventable disease and post-bite vaccinations save lives,” Dr Nodwele told Health-e News.

Rabies causes viral encephalitis which kills up to 70 000 people a year around the world. Infected animal saliva transmits viral encephalitis to humans. Rabies is one of the oldest known diseases in history with cases dating back to 4000 years ago. For most of human history, a bite from a rabid animal was uniformly fatal. In the past, people were so scared of rabies that after being bitten by a potentially rabid animal, many would commit suicide. 

Rabies cases rose significantly over August and September, he added, which is why they are calling on residents to take their domestic pets for vaccinations. The outbreak is spread throughout the entire Nelson Mandela metro region and Nodwele said that 61 rabies specimens submitted for testing all came back positive.

So far 5254 dogs and 438 cats have been vaccinated across the metro. The municipality from time to time issues a domestic pets vaccination schedule, and is calling on residents to observe the schedule so that they bring their animals for vaccination. A vaccination and community education programme is also being run.

Dr Nodwele said the incubation period of rabies is two to three months, though with factors such as bite location and viral load, it can also vary from one week to a year.

“Initial symptoms include a fever and pain, and unusual or unexplained tingling, pricking or burning sensations at the wound site. As the virus spreads through the body to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops,” Dr Nodwele explained.

Source: Health-e News

Many Respiratory Diseases Are Borne by Aerosols

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As the COVID pandemic forced a close study of airborne transmission, new evidence has challenged the idea that many respiratory pathogens besides SARS-CoV-2 were only carried in the large respiratory droplets from coughs and sneezes of infected individuals. Rather, they also spread through virus-laden microscopic respiratory aerosols.

In a review published in Science, Chia Wang and colleagues discussed recent research regarding airborne transmission of respiratory viruses and how an improved understanding of aerosol transmission will enable better-informed controls to reduce and mitigate airborne transmission.

Most respiratory pathogens were until recently assumed to spread largely in large droplets expirated from an infectious person or transferred from contaminated surfaces. Public health recommendations in mitigating viral spread has, thus far, been guided by this understanding.

It is also known however, that a number of respiratory pathogens, such as influenza and the common cold, spread through infectious respiratory aerosols, which can remain suspended in the air, travelling further and for much longer, infecting those that inhale them.

According to a growing body of evidence, much of which gained from studying the spread of COVID, airborne transmission may be a more dominant mode of respiratory virus transmission than previously thought. Here, Wang et al. highlight how infectious aerosols are generated, travel throughout an environment and deliver their viral payloads to hosts. Before COVID, the maximum size for droplets to be classified as aerosols was 5 micrometres, but this has now been updated to 100 micrometres, because up to this size, droplets can remain suspended in the air for up to 5 seconds from a height of 1.5m and travel one metre to be inhaled by another.

The deal with this under-appreciated threat, the authors described ways to mitigate aerosol transmission at long and short ranges, including improvements to ventilation and airflows, air filtration, UV disinfection and personal face mask fit and design.

Source: News-Medical.Net

Young COVID Patients Talk About Their Experiences

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To encourage young people to get vaccinated, the UK government has released a video in which young COVID patients tell their stories of battling the virus and suffering long-term debilitating effects.

The video features several patients who experienced serious symptoms of COVID or developed long COVID, as well as the doctors and frontline staff who treated them, to warn of the dangers of the virus for those who are not vaccinated. It is narrated by Dr Emeka Okorocha.

It comes as people aged 16 to 17 in England are offered a COVID vaccine, and all at-risk people aged 12 to 15 in England are also invited for a vaccination. Young people are being encouraged to take up the offer as soon as possible to build vital protection before returning to school in September.

A fifth of COVID hospital admissions in England are aged 18 to 34 – 4 times higher than the peak in the winter of 2020.

The patients who feature in the new short film have issued a rallying call: young people should take up the vaccine to avoid suffering a similar fate.

After putting off the vaccine, Quincy Dwamena, a 31-year-old videographer and support worker spent 2 weeks in hospital with COVID. He said: “I’m a healthy, young guy. I went to the gym often and have no underlying health concerns. I put off getting the vaccine because I thought the way I was living my life would mean there would be little to no chance of me catching the virus, or it would have little effect.

“But I ended up being hospitalised and thought I was going to die. My advice is to get the vaccine: don’t put yourself and others at risk, I wish I’d got mine as soon as it was offered.”

Ella Harwood, a 23-year-old illustrator from London, said:

I’m young and fit but I was bed-bound for 7 months with COVID-19. Before I caught the virus, I was super active and had no health concerns, but I now suffer with asthma which I didn’t have before and a number of allergies.

I fear I’ll never be the same again but I’m making progress and I’m very grateful that I’m still alive. Please get vaccinated if you haven’t already.

People aged 16 and 17 are able to get vaccinated at one of more than 800 GP-led local vaccination sites and NHS England has launched an online walk-in site finder to help this age group locate the nearest available centre. Further sites will come online over the coming days and weeks.

In the UK, 87.5% of people have received their first dose, and 76.3% have received their second. The interviews were filmed in London, where uptake among under 30s is lowest.

According to data from Public Health England, the highest COVID case rates are among 20 to 29-year-olds with a case rate of 670.7 cases per 100 000 people. Additionally, 6.3% of people aged 16 to 29 have had long COVID, higher than the national average. Many of these have said long COVID has had a major impact on their lives, especially the ability to exercise, work, and maintain relationships.

TV doctor and emergency medicine physician, Dr Emeka Okorocha said:

“As an A&E doctor, I’ve seen a lot during the pandemic. But nothing has shaken me like the sight of young, otherwise healthy adults, being rushed into our hospitals with COVID.

“As well as their age, many of them have 1 other thing in common, they are unvaccinated. Vaccines truly are the way out of this pandemic and are the best way to protect everyone from the virus, so please get your vaccine.”

Alongside Dr Emeka and patients, the film features interviews with the frontline workers who have been treating young COVID-19 patients.

Vaccines Minister Nadhim Zahawi said: “There is no doubt the COVID vaccination programme is having a major impact, keeping around 82 100 people out of hospital and saving an estimated 95 200 lives in England.

“But we are seeing more unvaccinated young people in hospital now than ever before. Please don’t delay – get your jabs to avoid a similar fate to these brave people who have shared their stories.”

Source: United Kingdom Government

COVID Eradication is Tough but not Impossible, Study Shows

Image by Ivan Diaz on Unsplash
Image by Ivan Diaz on Unsplash

A new analysis shows that the global eradication of COVID is tough but theoretically more feasible than for polio and less so than it was for smallpox.

The article in BMJ Global Health ranked the feasibility of eradicating the three diseases based on technical, socio-political and economic factors.

Smallpox, which was declared eradicated in 1980, had the highest average score for eradication feasibility. It had an average score of 2.7 on a three-point scale across 17 variables.  COVID had an average score of 1.6 which was close to polio’s average score of 1.5.

Professor Nick Wilson from the University of Otago said that their analysis shows COVID’s eradication is feasible.

Vaccination programmes, public health measures and the global interest in combating the disease together contribute to making eradication possible.

“Elimination of COVID-19 at the country level has been achieved and sustained for long periods in various parts of the Asia Pacific region, which suggests that global eradication is possible.”

Vaccination programmes eradicated smallpox and two of the three serotypes of poliovirus, while other diseases are close to eradication. China recently became the 40th country to be certified malaria-free.

In ranking the feasibility of eradication for the three diseases, the researchers incorporated factors including the availability of safe and effective vaccines, the possibility of lifelong immunity, the impact of public health measures, effective infection control messaging by governments, political and public concern about the infection and public acceptance of infection control measures.

While there has been a focus on the need to reach herd immunity to overcome COVID, population immunity may not be essential to combat the disease, as smallpox was eradicated through ring-vaccination programmes which target the contacts of those infected.

The challenges of eradicating COVID relative to smallpox and polio include poor vaccine acceptance in some countries and the emergence of variants of the pandemic virus that may be more transmissible or able to evade the protection from vaccines.

But Professor Wilson said eventually the virus will be reach the limit of more infectious mutations, and so new vaccines will likely be formulated to deal with evolving strains of the disease.

Other obstacles includedthe cost of global vaccination and upgrading health systems, and achieving international cooperation in the face of aggressive anti-science movements and vaccine nationalism.

Professor Wilson says while the virus may infect animal populations, they will note likely hamper eradication.

“Wild animal infections with SARS-CoV-2 appear to be fairly rare to date and when companion animals become infected, they don’t appear to reinfect humans.”

A co-author of the article, Professor Michael Baker from the University’s Department of Public Health, says global concern about the pandemic could be tapped.

“The massive scale of the health, social and economic impacts of COVID-19 in most of the world has generated unprecedented global interest in disease control and massive investment in vaccination programmes.

“Unlike smallpox and polio, control of COVID-19 also benefits from the added impact of public health measures, such as border controls, social distancing, contact tracing and mask wearing, which can be very effective if well deployed.”

Professor Baker says upgrading health systems to target COVID-19 could also help to control other diseases, and could even aid in eradicating measles.

“When all factors are taken into account, it could be that the benefits of eradicating COVID-19 outweigh the costs, even if eradication takes many years and has a significant risk of failure.”

This work is preliminary, the researchers cautioned.

“The World Health Organization or a coalition of national agencies working collaboratively needs to formally review the feasibility and desirability of attempting COVID-19 eradication on a global basis,” Professor Baker says.

The researchers noted it is important to distinguish between eradication of infection, ie the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; and elimination, ie the reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts.

COVID elimination has been reached and sustained for long periods in a number of jurisdictions in the Asia-Pacific region (notably China, Hong Kong, Taiwan, Australia and New Zealand), demonstrating that global eradication is technically possible.

Source: EurekAlert!

Helping People With Depression Quit Smoking can Save Lives

Source: Sabine R on Unsplash
Source: Sabine R on Unsplash

Giving the means to quit smoking to patients with depression could save as many as 125 000 lives over the next 80 years, researchers estimate. This number could be as high as 203 000 if people with depression who are not yet in mental health care settings are included.

The study, led by the Yale School of Public Health, shows the potential benefits that smoking cessation could have in a population suffering disproportionately from tobacco-related disease and death. Smokers with depression already find it harder to quit, and experience more negative withdrawal symptoms if they do, including increased depression. The study is also the first to estimate the population health effects of integrating smoking cessation treatments with standard mental health care.
Using more than a decade of data from the National Survey on Drug Use and Health, the researchers made a model to project the effectiveness of smoking-cessation treatments into the future. They assessed how the benefits varied based on different rates of treatment adoption over the next 80 years.

Simulating the health benefits reveals that, at least 32 000 deaths could be prevented by 2100 if a significant number of patients with depression adopted any kind of cessation treatment. Assuming 100% mental health service utilisation and pharmacological cessation treatment, the number of potential lives saved could rise to 203 000.

“We’ve known for a long time that people with depression smoke more than the general population, and that mental health care settings often don’t have cessation treatment as part of standard care. Our study asks: what is that missed opportunity? What do we have to gain when mental health care and smoking cessation treatment are fully integrated,” said lead author and assistant professor Jamie Tam, PhD. The findings are published in the American Journal of Preventive Medicine.

Such high benefits would be a best-case scenario, the researchers cautioned. Even so, the model’s results match public health experts’ long-standing predictions of the results of smoking-cessation treatment becoming a routine part of mental health care. The findings show that even less-optimal cessation treatments would greatly impact both quality and length of life for patients living with depression.

“Beyond reducing the risk of early death, smoking cessation improves quality of life and increases productivity,” Tam added. “Decision makers should remove barriers to mental health care and smoking cessation treatments for people with mental health conditions.”

The researchers concluded that while existing treatments, such as nicotine replacement therapy, varenicline, and bupropion, can raise cessation rates by nearly 60%, in the future there would be even larger health gains if there were better cessation treatments.

Source: Yale University