Culture

Food insecurity, meaning inadequate or insecure access to food because of a lack of money, has worsened in Nunavut communities since the introduction of the federal government's Nutrition North Canada program in 2011, found research published in CMAJ (Canadian Medical Association Journal).

Even before the introduction of Nutrition North Canada, food insecurity was a widespread problem in Nunavut communities, with some of the highest rates of food insecurity in Canada.

"Our study raises serious concerns about the federal government's continued focus on food subsidy initiatives to improve food access in the North," says lead author Andrée-Anne Fafard St-Germain, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario.

Nutrition North Canada is a retail subsidy focused mainly on nutritious, perishable foods such as fruit and vegetables, milk and other food items. It is provided to food suppliers in southern Canada and retailers in the North, who are expected to pass on lower costs to shoppers.

"Food insecurity is an experience of material deprivation strongly influenced by household income, but high food prices are also considered an important contributor in Canada's North," says Fafard St-Germain, a doctoral candidate who works with Valerie Tarasuk, a University of Toronto professor and senior author on the paper.

The researchers used an 18-item Household Food Security Survey that asks about whether households worry about running out of food, eat less or have gone an entire day without eating because of a lack of money. In 2010, just before the program was launched, food insecurity in Nunavut communities affected 33% of households, and by 2014, when the program was fully implemented, food insecurity had increased to 46%. Even after accounting for changes in several household characteristics over time, the researchers found that food insecurity worsened.

"Food insecurity is an important determinant of health, and effective policy actions are urgently needed to address the high rates of food insecurity in Canada's North," says Fafard St-Germain.

Other factors, such as a reduction in traditional food harvesting, a population increase and harvest restrictions for wildlife species, may have contributed to the increase in food insecurity, suggest authors in a related commentary.

"Despite our more cautious interpretation of the result of the linked research, we share [the authors'] concerns over the effectiveness of Nutrition North Canada in improving food access in Nunavut," writes Dr. James Ford, Priestley International Centre for Climate, University of Leeds, Leeds, Yorkshire, United Kingdom, with coauthors. "The absence of price caps, program accountability and transparency, and limited responsiveness to community needs, have been noted to undermine the ability of the program to meet its goals, along with a neglect of traditional foods and their cultural significance in Nutrition North Canada's support mechanisms."

Your smile, and associated oral health, may be a factor for successfully passing through the revolving doors of life. It is your first impression to a stranger, the closing argument to land a job and a major factor to achieving a good quality of life. For those who struggle with substance use disorder, oral health often falls off the precipice of self-care thereby seriously damaging interpersonal skills, while causing poor nutrition, increased oral and general infections and debilitating oral pain.

A team of researchers at the University of Utah School of Dentistry explored the effect of comprehensive oral care for a more holistic approach to substance use disorder treatment. Their work shows for the first time that participants who had their major oral health problems addressed by a dental professional stayed in treatment approximately two times longer and had a more than 80 percent increase in completing their substance abuse treatment program. The results of the study are available online May 20 in the Journal of the American Dental Association.

"There is a powerful synergism between oral health care and substance use disorder," said Glen Hanson, D.D.S., Ph.D., professor of Pharmacology and Toxicology and School of Dentistry at U of U Health and first author on the paper. "Those who received comprehensive dental care had a better quality of life as measured by substantial improvements in employment and drug abstinence as well as a dramatic decrease in homelessness."

While the study did not examine specific reasons for the different positive responses observed for the FLOSS participants compared to the controls, a statistical analysis supports the idea that the improvements in substance abuse treatment outcomes were associated with the comprehensive dental care and not to other variables such as gender, type of drug abused, treatment facility, or age.

Hanson and his team joined collaborators at two Salt Lake City substance use clinics, Odyssey House and First Step House, to develop the FLOSS (Facilitating a Lifetime of Oral Health Sustainability for Substance Use Disorder Patients and Families) program. While the project was designed to provide the next generation of dentists with the skill set to care for underserved populations, Hanson discovered the participants got much more than just an improved smile from the experience.

Between 2015 and 2017, the substance use treatment centers recruited patients for the study. First Step House allowed patients to self-select for dental care (158 males in dental and 862 males in control), while Odyssey House identified participants with major oral health problems and then randomly assigned those to treatment or control (70 males and 58 females in dental and 97 males and 45 females in control). Patients in the FLOSS program received care at the U of U Health School of Dentistry for treatments ranging from extractions to root canals, to restorations to dentures.

Hanson and his team conducted a retrospective study of the data to explore the role of FLOSS in helping patients completing their substance use programs.

After comprehensive dental care, the FLOSS participants, either self-selected or randomly selected, were more likely to continue and complete their substance use treatment program. Hanson and his colleagues believe that providing complete oral care as part of treating the whole patient, is critical to resurrecting self-esteem and restoring important body functions as an essential first step on the long path to recovery from drug abuse.

"The experience is life changing not only for the patients but also dental providers such as dental students who now know how their work can dramatically alter their patients' lives," Hanson said. "I think if we do the same thing for patients experiencing other chronic health problems, like diabetes, we could see similar positive results for treatment outcomes."

A team of economists has concluded that soda taxes serve as a "net good," an assessment based on an analysis of health benefits and consumer behavior. The work, which sees advantages similar to those of long-standing cigarette taxes, also offers policy parameters that it views as more effective than many existing soda taxes.

The analysis, by researchers at New York University, the Wharton School at the University of Pennsylvania, and the University of California, Berkeley, was released today as a National Bureau of Economic Research (NBER) working paper.

"The research is clear that sugary drinks are bad for our health," observe NYU's Hunt Allcott, Wharton's Benjamin Lockwood, and UC Berkeley's Dmitry Taubinsky, the papers' authors. "Our study takes a next step to evaluate the overall economic rationale as to whether we should impose a tax. Using an economic framework, we show that taxing soda generates net benefits to society--taking into account the health effects, the enjoyment that people get from drinking the drinks they enjoy, the value of the tax revenues, and other factors."

The research estimates that a nationwide soda tax would yield $7 billion in net benefits to society each year.

The research also considers concerns about regressivity.

"We estimate that soda taxes benefit both low- and high-income people," the researchers say. "While low-income people drink more sugary drinks and thus pay more in soda taxes, their health also benefits more from drinking less."

The researchers also find that state-level taxes would be even more effective than city-level taxes, such as those implemented in San Francisco, Philadelphia, and other U.S. cities.

"Soda taxes would yield more benefit at the state level than they would at the city level, both because they cover more people and because buying tax-free soda just outside the city, which some people do, dilutes the benefits of a tax," the authors observe.

Arizona, California, Michigan, and Washington have passed legislation or referenda banning their cities from adopting new soda taxes. The papers' findings suggest that these bans are not economically justified.

Their conclusions on the societal benefits of soda taxes are based on the following:

Much like the cars emitting pollution that harms others, sugary drinks are linked to diabetes, obesity, and heart disease, resulting in medical bills ultimately paid by taxpayers through Medicare and Medicaid, or by private insurers. The researchers estimate that, on average, drinking a 12-ounce can of Coke will impose about 10 cents of health care costs on others.

Fifty-three percent of Americans who consume sugary drinks say they do so "more often than I should," according to a previous survey, which suggests that soda taxes help people reduce consumption toward the level they want for themselves. In addition, people with high nutrition knowledge drink many fewer sugary drinks, indicating that soda taxes help people reduce consumption toward the level they would choose for themselves if they were fully informed about the health impacts.

Previous studies have shown that low-income people bear the brunt of diabetes, obesity, and heart disease--afflictions linked to consumption of sugary drinks--so they would likely benefit the most from drinking fewer of these beverages. Furthermore, low-income people have lower nutrition knowledge and are more likely to report drinking soda "more often than I should."

The work also offers guidelines for making existing soda taxes more effective while acknowledging finding an optimal tax level requires additional study:

Noting that it's the sugar, not the water, that is unhealthy, the researchers say that taxes should scale with the amount of sugar in a drink, not the volume of liquid. They calculate that the net benefits would be much larger at a tax rate of 0.5 cents per gram of sugar than at the standard 1 cent per ounce of liquid.

Implementing taxes at the state or national level, instead of the current smattering of city-level taxes, would be more beneficial as it would diminish "cross-border shopping."

The existing tax in Philadelphia includes diet drinks, even though the health harms from diet drinks are not clearly established, posing a financial burden while not offering a robust health benefit. "Soda taxes should be limited to sugary drinks, where the health evidence is more clear," the economists argue.

The analysis shows that the standard 1-cent-per-ounce tax rate might be too low for a state-level tax to yield health and economic benefits and might be too high for a city-level tax in places with substantial cross-border shopping. "Because these estimates involve a number of assumptions, we need more research on this issue," the researchers write.

Results from a study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, point to the need for improved access to medical care for sexual minority cancer survivors, in particular female survivors. In female cancer survivors, poor access to care is more strongly related to poor quality of life among sexual minorities compared with heterosexuals.

Access to quality medical care is critical to the long-term health and well-being of cancer survivors. Evidence from non-cancer-related studies indicates that sexual minorities--including lesbian, gay, bisexual, or other non-heterosexual identified individuals--have worse access to care, but previous studies have not examined the issue among cancer survivors.

To assess sexual minority cancer survivors' access to care and their quality of life, Boston University School of Public Health's Ulrike Boehmer, PhD, and Jessica Gereige, MD, along with their colleagues, examined four years of Behavioral Risk Factor Surveillance Survey data on U.S. men and women who reported a history of cancer. Among the 70,524 cancer survivors, 1,931 identified themselves as sexual minorities.

"While we have extensive cancer surveillance in the U.S., sexual minority cancer survivors are excluded from surveillance, which means we have very limited information about this group. This study therefore provides much needed information about sexual minority cancer survivors," said Dr. Gereige.

Compared with heterosexual women, sexual minority women were more likely to report having no health insurance, being without a personal physician, avoiding medical care due to costs, and being without an annual medical visit. Among men, sexual minority men were more likely to avoid medical care due to costs, but men of all sexual orientations had similar access to care with respect to insurance status, having a personal physician, and annual visits.

Sexual minority women's access to care had a stronger association with three quality of life measures compared with heterosexual women. Specifically, deficits in access to care were linked with a greater likelihood of poor physical quality of life, poor mental quality of life, and difficulty concentrating among sexual minority women compared with heterosexual women. In men, deficits in access to care were linked with a higher likelihood of difficulty concentrating among sexual minorities than heterosexuals. Also, sexual minority status increased the likelihood of poor mental quality of life in men.

"Our study shows that sexual minority women suffer from poor access to care and that this is linked to worse quality of life. Since poor quality of life is linked to worse cancer survival rates, this calls for policy changes to improve access to care for sexual minority cancer survivors," said Dr. Boehmer. "The study's findings also point to an opportunity for clinicians to address difficulties in access to care with patients during treatment discussions, or at the completion of cancer therapy and during follow up visits. Clinicians who are aware of these disparities and address them during clinic visits may have an impact on sexual minority women's survival rates, which are lower than their heterosexual counterparts' rates."

A study of nearly 300 patients with mild persistent asthma found that inhaled steroids--long considered the gold standard for asthma treatment--were no more effective than placebo in nearly three-fourths of the study patients, all over age 12. Inhaled steroids were better than placebo for a subset of the patients who had high levels of a particular type of inflammatory cells, called eosinophils, in their sputum, but they represented about a fourth of patients enrolled in the trial.

The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, and appeared online on May 19 in the New England Journal of Medicine (NEJM). The publication coincides with the study's presentation at the international conference of the American Thoracic Society, which takes place in Dallas.

The research highlights the need for developing more effective treatments for asthma and suggests that it may be possible to target particular therapies to subsets of patients, such as those with high or low eosinophils. New approaches to treating the "low eosinophil" group could be especially helpful for improving the overall effectiveness of treatments for mild asthma, the most common type of this respiratory condition.

"We're intrigued by the results of this study and believe it raises questions about the way doctors manage mild persistent asthma," said Stephen Lazarus, M.D., lead study author and a professor of medicine at the University of California, San Francisco. "We're not saying that steroids are unimportant for mild asthma, but our study does suggest that treatment guidelines should be re-evaluated for patients with mild persistent asthma who have low sputum eosinophils."

James Kiley, Ph.D., director of the Division of Lung Diseases at NHLBI, said the research underscored the value of customizing treatments to help people with asthma. "This study adds to a growing body of evidence that different patients with mild asthma should be treated differently, perhaps using biomarkers like sputum eosinophils to select which drugs should be used--a precision medicine approach," he said.

Asthma affects nearly 25 million Americans, according to the Centers for Disease Control and Prevention. Despite significant research strides, increasing numbers of people continue to have poorly controlled asthma. Mild persistent asthma is characterized by symptoms such as coughing, wheezing, and chest tightness, symptoms that occur less frequently than in people with severe asthma and are generally easier to control with steroids. However, daily steroid use can have adverse side effects over time, including weight gain and diabetes, and, at $200 to $400 per inhaler, can be expensive. A growing number of studies suggest that it may be possible to manage mild persistent asthma safely without daily steroid use.

In the quest to improve treatments for this type of asthma, researchers in the current study focused on sputum eosinophils, white blood cells found in the lung that can serve as biomarkers of airway inflammation. Biomarkers are generally used to guide treatment only in the most severe forms of asthma. Past studies have estimated that about half of the population with mild persistent asthma have less than 2% sputum eosinophils and that most people with low eosinophils do not respond well to steroid treatment. But laboratory tests to measure sputum eosinophils are relatively complex and not routinely used in most clinics.

The multicenter study included 295 people over the age of 12 with mild persistent asthma. The researchers further divided the group based on low or high sputum eosinophil levels (low = less than 2%; high = greater than or equal to 2%). The researchers assigned the participants in random sequence to three treatment groups for 12-week periods: inhaled steroids; long-acting muscarinic antagonists (LAMA), a nonsteroidal treatment for uncontrolled asthma; or placebo. By the end of the study, every participant had received each treatment. The inhaled steroid used in this study was mometasone and the LAMA drug was tiotropium. The researchers were surprised to find that nearly 73% of the participants, or 221 people, were classified as having low sputum eosinophils, a much higher frequency than expected. Among those participants who were classified as "Eos-low," the number who responded better to active treatment with steroids was no different than the number who responded better to placebo. By contrast, those who were classified as "Eos-high" were nearly three times as likely to respond to inhaled steroids than placebo.

Among those who were 'Eos-low' and had a better response to one of the treatments, 60% had superior results on LAMA, versus 40% who had better symptom control on placebo. While Lazarus cautioned that this difference is not large enough to conclude that patients are more likely to do better on LAMA drugs, he said it does highlight the need to study alternatives to inhaled steroids in mild asthma. The researchers emphasized that for now people with asthma should continue to follow their doctor's recommendations regarding their treatments.

A new laboratory-based method of estimating outcomes for patients with a severe pulmonary disorder that has no cure can help physicians better provide proper care, referrals, and services for patients at the end of life, according to a new study of more than 17,000 patients from Intermountain Healthcare.

The Laboratory-based Intermountain Validated Exacerbation (LIVE) score is a prediction model that predicts all-cause mortality, morbidity, and hospitalization rates for patients with chronic obstructive pulmonary disease (COPD), a chronic, progressive lung disease that gradually makes it hard to breathe. COPD affects roughly 16 million Americans, or just under five percent of the U.S. population. It's estimated that millions more have the disease, but are undiagnosed.

The LIVE score combines a patient's simple laboratory values (levels of hemoglobin, albumin, creatinine, chloride, and potassium) to identify patients who are at high risk of death or further disease advancement, and who may most need referrals to palliative care and advanced care planning resources.

In the study, Intermountain Healthcare researchers calculated the LIVE scores of 17,124 patients with COPD from the Kaiser Health System Northwest Region. They found that patients with high-risk LIVE scores had the highest one-year mortality rates (39.4%) and the highest rate of palliative care referrals (41.7%). In comparison, patients with the lowest risk LIVE scores had 0.7% all cause one-year mortality and 0.7% palliative care referral rate.

"We found the LIVE score helps personalize therapy to patients beyond the COPD diagnosis alone and provides additional risk information to both patients and their doctors. From a population health perspective, the LIVE score allows for designing pathways of care that identify and treat patients based on individual risk beyond a single diagnosis label alone," said Denitza Blagev, MD, the study's lead author, and a pulmonary and critical care physician at Intermountain Medical Center, who serves as medical director for Quality, Specialty Based Care at Intermountain Healthcare in Salt Lake City.

Results from the study will be presented at the annual international conference of the American Thoracic Society, in Dallas on May 19.

Unlike other COPD risk scores, the LIVE score is entirely based on blood tests and assesses rates of other diseases in COPD patients rather than lung function specifically. While diseases such as heart disease and kidney disease contribute to the risk of death, hospitalization, and symptoms in patients with COPD, there has been no systematic way of incorporating these diseases in determining overall risk for patients with COPD, until now.

Researchers say the findings can help physicians determine which of their COPD patients are at highest risk, and who may benefit from palliative care and appropriate end-of-life services. Palliative care focuses on relief from the symptoms of a serious disease, rather than on a cure, and is often provided in the final stages of a patient's life.

While patients with COPD in general are considered high risk, there is a lot of variability in the risk of death for a particular patient with a COPD diagnosis. By using the LIVE score clinicians can design health system interventions that assess high-risk patients for palliative care evaluation.

"By exploring the association of palliative care referrals and LIVE score risk, this study is a step forward in understanding how the LIVE score may be used to target appropriate patient care," said Dr. Blagev.

"Our findings lend more insight into how we can use these laboratory-based scores at the bedside to ensure that patients are receiving the most appropriate care," she said. "This doesn't mean everyone with high risk needs to be referred to palliative care, but it shows potential opportunities to improve care for patients in that highest risk group," said Dr. Blagev.

For example, for a COPD patient with a low-risk LIVE score, interventions aimed at optimizing COPD management may be most effective, as the risk of other diseases and death is relatively low. In contrast, a patient with a high-risk LIVE score may see benefit from COPD-directed therapy, but may find even more improvement with management of their other diseases, which contribute to the risk of death.

Researchers note that the LIVE score model has already been validated in more than 100,000 COPD patients at several diverse health systems, so these new study findings further demonstrate the effectiveness of using the model to enhance care and planning for patients.

After 20 years of rapid increases in life expectancy at birth, the rate of growth in Australia is now falling behind most other high-income nations, meaning better control of health risk factors such as obesity will be needed if further life expectancy increases are to be achieved, research shows.

Published today by the Medical Journal of Australia, researchers from the University of Melbourne School of Population and Global Health have analysed data for Australia and 26 other high-income countries from 1980-2016.

Researchers found from 1981 to 2003, life expectancy at birth increased rapidly in Australia, both in absolute terms, and in comparison, with other high-income countries.

For males, the difference in life expectancy between Australia and the other 26 countries increased from +0.7 years to +2.3 years over this period. For females, the difference in life expectancy increased from +0.9 years to +1.3 years.

University of Melbourne Rowden-White Chair of Global Health and Burden of Disease Measurement Alan Lopez said the main contributor to greater increases in life expectancy for males in Australia than in western Europe was lower mortality from ischaemic heart disease.

"Compared with the United States, mortality from ischaemic heart disease, cerebrovascular disease, and transport-related injuries was lower," Laureate Professor Lopez said.

Since 2003, researchers found life expectancy has increased more slowly for both sexes than in most other high-income countries, mainly because declines in mortality from cardiovascular disease and cancer have slowed. For males, it was +2.3 years in 2015, and females, +1.1 years.

"Together with the high prevalence of obesity, this suggests that future life expectancy increases will be smaller than in other high-income countries," Professor Lopez said.

University of Melbourne researcher and co-author Tim Adair said this slowing should concern public health policy makers.

"Life expectancy in Australia is among the highest in the world, a testament to boldly progressive public health interventions over several decades," Dr Adair said.

"However, there are several major barriers to marked increases, including the notably higher mortality of more recent birth cohorts and the comparative failure of efforts to reduce levels of overweight and obesity.

"Other high-income countries have greater scope for reducing the prevalence of smoking. As a result, our high global ranking with regard to life expectancy at birth is unlikely to be maintained unless new strategies for reducing mortality associated with specific behaviours are developed and deployed effectively."

PITTSBURGH, May 19, 2019 - Reversibly paralyzing and heavily sedating hospitalized patients with severe breathing problems do not improve outcomes in most cases, according to a National Institutes of Health-sponsored clinical trial conducted at dozens of North American hospitals and led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine.

The trial--which was stopped early due to futility--settles a long-standing debate in the critical care medicine community about whether it is better to paralyze and sedate patients in acute respiratory distress to aid mechanical ventilation or avoid heavy sedation to improve recovery. The results, presented today at the American Thoracic Society's Annual Meeting, will be published in the Thursday issue of the New England Journal of Medicine.

"It's been a conundrum--on the one hand, really well-done studies have shown that temporarily paralyzing the patient to improve mechanical breathing saves lives. But you can't paralyze without heavy sedation, and studies also show heavy sedation results in worse recovery. You can't have both--so what's a clinician to do?" said senior author Derek Angus, M.D., M.P.H., who holds the Mitchell P. Fink Endowed Chair of the Pitt School of Medicine's Department of Critical Care Medicine. "Our trial finally settles it--light sedation with intermittent, short-term paralysis if necessary is as good as deep sedation with continuous paralysis."

The Re-evaluation Of Systemic Early neuromuscular blockade (ROSE) trial is the first of the new National Heart, Lung, and Blood Institute's (NHLBI) Prevention & Early Treatment of Acute Lung Injury (PETAL) Network. PETAL develops and conducts randomized controlled clinical trials to prevent or treat patients who have, or who are at risk for, acute lung injury or acute respiratory distress syndrome. The trial network places particular emphasis on early detection by requiring every network member institute include both critical care and emergency medicine, acute care or trauma principal investigators to ensure that critical health issues are recognized and triaged as fast as possible to improve patients' odds of recovery before they are even transferred to the intensive care unit.

From January 2016 through April 2018, 1,006 patients at 48 U.S. and Canadian hospitals were enrolled in ROSE within hours after onset of moderate-to-severe acute respiratory distress syndrome. Half were given a 48-hour continuous neuromuscular blockade--a medication that paralyzes them--along with heavy sedation because it is traumatizing to be paralyzed while conscious. The other half were given light sedation, and the clinician had the option of giving a small dose of neuromuscular blockade that would wear off in under an hour to ease respiratory intubation.

"This is the kind of important question that the PETAL network was designed to answer efficiently," said James Kiley, Ph.D., director of the Division of Lung Diseases at the NHLBI. "These results will help practicing clinicians make decisions early on in the care of their patients with acute respiratory distress syndrome."

The trial was needed because a French trial found in 2010 that neuromuscular blockade reduced mortality. However, in that trial all participants were heavily sedated, regardless of whether they received the neuromuscular blockade or not. In recent years, particularly in North America, clinicians have trended away from heavy sedation, which is associated with cardiovascular complications, delirium and increased difficulty weaning patients from mechanical ventilation.

In the ROSE trial, the patients who received the neuromuscular blockade and sedation developed more cardiovascular issues while in the hospital, but there were no significant differences in mortality between the two groups three, six or 12 months later, said David Huang, M.D., M.P.H., who oversaw clinical implementation of the trial and is an associate professor of critical care and emergency medicine at Pitt's School of Medicine.

"Due to the exceptional work of our research coordinators, the study completed enrollment ahead of schedule, a rarity in multicenter clinical trials," said lead author Marc Moss, M.D., The Roger S. Mitchell Professor of Medicine and head of the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado's Department of Medicine. "Therefore, these important findings are available to health care providers sooner and should result in more rapid implementation of enhanced care for our patients."

Angus, who also directs Pitt's Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, said the trial results make him confident when he says that avoiding paralysis and deep sedation is the best practice for most patients hospitalized with breathing problems. However, he notes that future trials will be needed to tease out whether there is a subpopulation of patients with acute respiratory distress syndrome who still benefit from neuromuscular blockade.

ATS 2019, Dallas, TX -- In addition to suppressing tumors, the protein tuberous sclerosis complex 2 (TSC2) may play a role in preventing or treating pulmonary arterial hypertension (PAH), according to research presented at ATS 2019. Researchers found that a deficiency of this protein produced dysfunctional molecules unable to support cell structure and function, resulted in thickening of pulmonary blood vessels and led to PAH.

San Diego, CA (May 18, 2019) -- Damage to the lining of the stomach can occur quickly when children swallow button batteries; therefore, clinicians should consider prompt endoscopic removal, even when the child is symptom free and the battery has passed safely through the narrow esophagus, according to research presented at Digestive Disease Week® (DDW) 2019. The recommendations represent a change from current practice of watching and waiting.

"We know there can be injury even when there are no symptoms," said Racha Khalaf, MD, lead researcher and pediatric gastroenterology, hepatology and nutrition fellow at the Digestive Health Institute at Children's Hospital Colorado, Aurora. "Batteries in the stomach cause damage, including perforation of the gastric wall, so physicians should consider removing the batteries as soon as possible and not let them pass through the digestive tract."

Researchers from pediatric hospitals in Colorado, Florida, Texas and Ohio collected data regarding 68 button battery ingestions from January 2014 to May 2018. Previous research has been conducted on button batteries lodged in the esophagus, but little is known about the effect in the stomach.

"We have been seeing more injuries from button batteries," Dr. Khalaf said. "The batteries come in toys, remote controls, key fobs, singing greeting cards and watches. They are everywhere."

Erosive injuries to the mucous lining of the stomach were found in 60 percent of cases reviewed, with no apparent relationship between damage and symptoms, or with the amount of time passed since ingestion. This suggests that clinicians and parents should not wait for symptoms or passage of time to act, Dr. Khalaf said, adding that removing the battery earlier avoids repeated trips to the emergency room or pediatrician's office and reduces repetitive x-rays or other imaging.

The authors' recommendations are more aggressive than those of two national organizations that have issued recommendations about button battery ingestion. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends observation when it's been less than two hours since ingestion, the battery is 20 mm or smaller, and the child is at least 5 years old. The National Capital Poison Center, which runs the National Battery Ingestion Hotline, currently recommends observation alone for asymptomatic gastric button batteries to allow them to pass through the digestive system.

Many men continue to abuse steroids despite knowing that they have serious, life-limiting and potentially lethal side effects, according to findings to be presented in Lyon, at the European Society of Endocrinology annual meeting, ECE 2019. The study findings indicate that men using anabolic steroids to improve strength and physical performance are often aware of the side effects but choose to continue taking them. This raises serious concerns not only for their own health but that of future generations, since side effects are known to damage sperm as well as increase the risk of sexual dysfunction, heart disease and liver damage.

Anabolic steroids such as testosterone are performance-enhancing hormones that increase muscle mass and boost athletic ability, which has led to their misuse and abuse by some, and men in particular. However, the use of steroids has some life-limiting and serious side effects including reduced sperm count, erectile dysfunction, baldness, breast development and an increased risk of heart disease, stroke and liver or kidney failure. Despite this steroid misuse persists, a 2014 study estimated that worldwide 3.3% of the population or 6.4% of the male population are abusing steroids. Recent evidence has suggested that not only do steroids pose serious health risks to the individual but that they also cause damage to sperm, so could be harmful to their future children. To adequately tackle this health issue, it is necessary to establish whether men abusing steroids are fully aware of all the risks or if they are choosing to ignore them.

In this study, Dr Mykola Lykhonosov and colleagues from Pavlov First Saint Petersburg State Medical University in Russia, conducted an anonymous survey of men, who regularly attend the gym, to assess their knowledge of, use of and attitude towards the health risks of anabolic steroids. Of 550 respondents 30.4% said they used steroids, 74.3% of users were aged 22-35 years old and 70.2% of users said they were aware of the side effects. In addition, 54.8% of all respondents indicated that they would like to receive more expert information on steroids and their side effects.

Dr Lykhonosov says, "These findings were surprising, not only was the prevalence of steroid abuse high, knowledge of the damaging side effects was also high, yet this does not stop them taking them."

Dr Lykhonosov's now plans to investigate how to treat hormonal imbalances and disorders caused by steroid abuse. He also thinks that greater public awareness of steroid abuse and its health risks may help discourage users.

Dr Lykhonosov comments, "We need to tackle this growing public health problem, increasing awareness through the promotion of stories from former users, on how steroid abuse has negatively impacted on their health and lives, could be a good strong message to discourage abuse."

Gastric cancer, Q fever, Legionnaires' disease, whooping cough--though the infectious bacteria that cause these dangerous diseases are each different, they all utilize the same molecular machinery to infect human cells. Bacteria use this machinery, called a Type IV secretion system (T4SS), to inject toxic molecules into cells and also to spread genes for antibiotic resistance to fellow bacteria. Now, researchers at Caltech have revealed the 3D molecular architecture of the T4SS from the human pathogen Legionella pneumophila with unprecedented details. This could in the future enable the development of precisely targeted antibiotics for the aforementioned diseases.

The work was done in the laboratory of Grant Jensen, professor of biophysics and biology and Howard Hughes Medical Institute investigator, in collaboration with the laboratory of Joseph Vogel at the Washington University School of Medicine in St. Louis (WUSTL). A paper describing the research appeared online on April 22 in the journal Nature Microbiology.

There are nine different types of bacterial secretion systems, Type IV being the most elaborate and versatile. A T4SS can ferry a wide variety of toxic molecules--up to 300 at once--from a bacterium into its cellular victim, hijacking cellular functions and overwhelming the cell's defenses.

In 2017, Caltech postdoctoral scholar Debnath Ghosal and his collaborators used a technique called electron cryotomography to reveal, for the first time, the overall low-resolution architecture of the T4SS in Legionella, the bacteria that causes Legionnaires' disease, a severe and often lethal form of pneumonia.

Ghosal, along with Kwangcheol Jeong of WUSTL and their colleagues, have now made a detailed structural model of this dynamic multi-component machine. The team also made precise perturbations to the bacterium's genes to study mutant versions of the T4SS, revealing how this complex machine organizes and assembles.

The model revealed that the secretion system is composed of a distinct chamber and a long channel, like the chamber and barrel of a gun. Characterizing these and other components of the T4SS could enable the development of precisely targeted antibiotics.

Current antibiotics act broadly and wipe out bacteria throughout the body, including the beneficial microorganisms that live in our gut. In the future, antibiotics could be designed to block only the toxin delivery systems (such as the T4SS) of harmful pathogens, rendering the bacteria inert and harmless without perturbing the body's so-called "good bacteria."

UPTON, NY--From the ancient pyramids to modern buildings, various three-dimensional (3-D) structures have been formed by packing shaped objects together. At the macroscale, the shape of objects is fixed and thus dictates how they can be arranged. For example, bricks attached by mortar retain their elongated rectangular shape. But at the nanoscale, the shape of objects can be modified to some extent when they are coated with organic molecules, such as polymers, surfactants (surface-active agents), and DNA. These molecules essentially create a "soft" shell around otherwise "hard," or rigid, nano-objects. When the nano-objects pack together, their original shape may not be entirely preserved because the shell is flexible--a kind of nanoscale sculpturing.

Now, a team of scientists from the U.S. Department of Energy's (DOE) Brookhaven National Laboratory and Columbia Engineering has shown that cube-shaped nanoparticles, or nanocubes, coated with single-stranded DNA chains assemble into an unusual "zigzag" arrangement that has never been observed before at the nanoscale or macroscale. Their discovery is reported in the May 17 online issue of Sciences Advances.

"Nanoscale objects almost always have some kind of shell because we intentionally attach polymers to them during synthesis to prevent aggregation," explained co-author Oleg Gang, leader of the Soft and Bio Nanomaterials Group at the Center for Functional Nanomaterials (CFN)--a DOE Office of Science User Facility at Brookhaven Lab--and professor of chemical engineering and applied physics and materials science at Columbia University. "In this study, we explored how changing the softness and thickness of DNA shells (i.e., the length of the DNA chains) affects the packing of gold nanocubes."

Gang and the other team members--Fang Lu and Kevin Yager of CFN; Yugang Zhang of the National Synchrotron Light Source II (NSLS-II), another DOE Office of Science User Facility at Brookhaven; and Sanat Kumar, Thi Vo, and Alex Frenkel of Columbia's Department of Chemical Engineering--discovered that nanocubes surrounded by thin DNA shells pack in a similar way to that expected on the macroscale, with the cubes arranged in neat layers oriented directly above one another. But this simple cubic arrangement gives way to a very unusual type of packing when the thickness of the shells is increased (i.e., when the shell becomes "softer").

"Each nanocube has six faces where it can connect to other cubes," explained Gang. "Cubes that have complementary DNA are attracted to one another, but cubes that have the same DNA repel each another. When the DNA shell becomes sufficiently soft (thick), the cubes arrange into what looks like a zigzag pattern, which maximizes attraction and minimizes repulsion while remaining packed as tightly as possible.

"This kind of packing has never been seen before, and it breaks the orientational symmetry of cubes relative to the vectors (directions of the x, y, and z axes in the crystal) of the unit cell," said first author Fang Lu, a scientist in Gang's group. "Unlike all previously observed packings of cubes, the angle between cubes and these three axes is not the same: two angles are different from the other one."

A unit cell is the smallest repeating part of a crystal lattice, which is an array of points in 3-D space where the nanoparticles are positioned. Shaped nanoparticles can be oriented differently relative to each other within the unit cell, such as the by their faces, edges, or corners. The zigzag packing that the scientists observed in this study is a kind of nanoscale compromise in which neither relative orientation "wins." Instead, the cubes find the best arrangement to co-exist in an ordered lattice based on whether they have the same or complementary DNA (i.e., repelling or attracting each other accordingly).

In this case, two different lattice types can occur: body-centered cubic (BCC) and body-centered tetragonal (BCT). Both BCC and BCT have similar placements of particles in the center and corners of the cubes, but BCC has unit cell sides of equal length while BCT does not.

To visualize the shape of the cubes and their packing behavior, the scientists used a combination of electron microscopy at the CFN and small-angle x-ray scattering (SAXS) at the former X9 beamline of NSLS and the Complex Materials Scattering beamline of NSLS-II. The electron microscopy studies require that the materials are taken out of solution, but SAXS can be conducted in situ to provide more detailed and precise structural information. In this study, the scattering data were helpful in revealing the symmetries, distances between particles, and orientations of particles in the 3-D nanocube structures. Theoretical calculations performed by the Kumar Group at Columbia confirmed that the zigzag arrangement is possible and rationalized why this kind of packing was happening based on the properties of the DNA shells.

The team is now eager to determine whether soft-shelled nano-objects that are not cubes or have more than one shape also pack together in unexpected ways.

"An understanding of the interplay between shaped nano-objects and soft shells will enable us to direct the organization of objects into particular structures with desired optical, mechanical, and other properties," said Kumar.

May 13, New Delhi: Children born to teenage mothers are more likely to be undernourished than children of adult mothers. A new study, the first to comprehensively examine links between teenage pregnancy and child undernutrition in India, by researchers at the International Food Policy Research Institute (IFPRI) helps to understand how this happens.

India is home to the more stunted children than any other country and is one of the ten countries with the largest burden of teenage pregnancy. Although marriage before the age of 18 years is illegal in India, the 2016 National Family and Health Survey (NFHS)-4 revealed that 27 percent of girls are married before their 18th birthday and further, 31 percent of married Indian women gave birth by the age of 18 years.

"Reducing adolescent pregnancy in India can hasten our progress towards achieving the United Nations' Sustainable Development Goals, particularly those related to poverty, health, nutrition, general wellbeing, equity, and education," says IFPRI Research Fellow and study co-author, Phuong Hong Nguyen.

The study, "Social, biological and programmatic factors link adolescent pregnancy to early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey", co-authored by IFPRI's Phuong Hong Nguyen, Samuel Scott, Sumanta Neupane, and Purnima Menon; and FHI360's Lan Mai Tran, was published in The Lancet Child and Adolescent Health. The authors analysed data from 60,097 mother-child pairs and examined the extent to which teenage pregnancy is associated with child undernutrition. Further, they explored potential social, biological, and programmatic factors linking early pregnancy to child undernutrition.

The study found that stunting and underweight prevalence were 10 percentage points higher in children born to adolescent mothers than in children born to adult mothers. "Our study sheds empirical light on pathways between teenage pregnancies and chid undernutrition. People have talked about these pathways before, but this data allowed us to put some numbers to those pathways," explains study co-author Samuel Scott.

Compared to adult mothers, teenage mothers were shorter, more likely to be underweight and anaemic, less likely to access health services and had poorer complementary feeding practices. They also had lower education, less bargaining power and lived in poorer households with poorer sanitation. "The strongest links between adolescent pregnancy and child stunting were through the mother's education, her socio-economic status, and her weight," said Scott.

The good news is that there is a very clear single, but admittedly not simple, policy target to address the problem: ending early marriage.

Policies and programs to delay marriage can potentially help break the intergenerational cycle of undernutrition through many routes. "Unfortunately, in India, early marriage and subsequent pregnancy is often not a deliberate choice, but rather the result of an absence of choices, and of circumstances beyond a girl's control," says IFPRI Senior Research Fellow and study co-author, Purnima Menon. Indeed, the Teenage Girls Survey 2018 (TAG Survey) by Naandi Foundation, a direct conversation with girls across India, shows that 73.3 percent of teenage girls want to marry only after the age of 21, which is a heartening news, but also highlights the mismatch between their aspirations and the reality of early marriage. "Continuing schooling, exploring employment opportunities, and delaying marriage and pregnancy are challenges for India's girls that are reinforced through patriarchy and social norms."

"We are very encouraged by the decline in the prevalence of early marriage over the last decade but also puzzled by why it is high in states like Andhra Pradesh and Telangana", Menon added. "Further investments in appropriate interventions targeting young people, both men and women, can contribute to further declines in early marriage and early childbearing in India".

Several strategies exist to reduce early marriage. A review of interventions to prevent child marriage in low and middle-income countries shows that interventions including unconditional cash transfers, cash transfers conditional on school enrolment or attendance, school vouchers, life-skills curriculum and livelihood training had a positive impact on increasing age at marriage.

The Government of India has legal instruments in place to prevent early marriage. Central and state governments have also piloted different cash transfers conditional on education, with complementary programming meant to encourage investment in girls' human capital. In addition, there are several ongoing adolescent health programs under different ministries in India. At the same time, the problem of early marriage in India isn't geographically uniform. High variability between states and districts suggests that subnational policies and programs that address local reasons for early marriage and early childbearing are still needed. These actions should account for differences in cultural practices and other context-specific conditions affecting early marriage and early childbearing.

The rate of bowel cancer--otherwise known as colorectal cancer or CRC--is rising among adults aged 20-49 in Europe, suggests research published online in the journal Gut today.

Rates rose most steeply among the youngest age group (20-29 years), and the authors warn that if the trend continues, screening guidelines may need to be reconsidered.

Rates tend to be lower among people over 50, but the opposite is true among younger adults in North America, Australia and China, say the researchers.

And in the US, the increase in new cases among people aged 20-40 has prompted The American Cancer Society to recommend lowering the age at which to start screening to 45.

Over the past decade, the number of new cases of bowel cancer has risen in most European countries, but the situation on rates among younger adults is unclear.

So to shed some light on European trends, a team of researchers analysed data from national and regional cancer registries on the number of new cases and deaths related to bowel cancer between 1990 and 2016.

They used data from 143.7 million people aged 20-49 years from 20 countries, including Germany, Sweden, the UK and the Netherlands.

Between 1990 and 2016, a total of 187,918 people were diagnosed with bowel cancer and there was a steeper rise in the number of new cases in more recent years.

Among 20-29 year olds, bowel cancer incidence rose from 0.8 to 2.3 cases per 100,000 people between 1990 and 2016, and the sharpest rise was between 2004 and 2016 at 7.9% per year.

For the 30-39 year olds group, the incidence increased less steeply than the younger age group, at an average of 4.9% per year from 2005 to 2016.

Finally, among the 40-49 years age group, the bowel cancer rates fell by 0.8% between 1990-2004, but then increased slightly by 1.6% per year from 2004 to 2016.

New cases of bowel cancer rose significantly among people aged 20-39 in 12 countries, namely, Belgium, Germany, the Netherlands, the UK, Norway, Sweden, Finland, Ireland, France, Denmark, Czech Republic and Poland. But Italy showed a decrease in the number of cases.

In eight countries--the UK, Greenland, Sweden, Slovenia, Germany, Finland, Denmark and the Netherlands--the number of cases rose significantly among 40-49 year olds, but rates fell significantly in the Czech Republic in more recent years (1997-2015).

The number of deaths from bowel cancer did not significantly change among the youngest adults (20-29 years), but fell by 1.1% per year between 1990 and 2016 in the 30-39 age group and by 2.4% per year between 1990 and 2009 among those aged 40-49 years.

This is an observational study, and as such, cannot establish cause. Moreover, the authors highlight some limitations, including the fact that the quality of data varied between countries and in some cases was only available for a limited number of regions.

Several factors may be behind these trends, including the rise in obesity, and lifestyle factors such as lack of physical activity, alcohol intake and smoking, they write.

Bowel cancer in young adults is "in part due to hereditary cancer syndromes, but most cases are sporadic," they add.

They say that it is too early to use their findings to support lowering the screening age to 45 in Europe, but if the trend continues, screening guidelines may need to be reconsidered.

They conclude: "Until the underlying cause of this trend is identified, it would be [a good idea] to raise clinicians' awareness and identify factors possibly associated with this trend."