Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
Mexico's federal health secretary says swine flu cases in January have surpassed the number for all of 2011, a year when the virus barely appeared worldwide.
Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
MEXICO CITY – Mexico's federal health secretary says swine flu cases in January have surpassed the number for all of 2011, a year when the virus barely appeared worldwide.
Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
“Drinking just one glass of milk a day could boost your brain power,” the Daily Mail has reported today. Milk is being hailed as a memory aid, the newspaper says, with a study showing that dairy products could “help stave off mental decline”.
The study on which the story is based found that adults with higher intakes of milk and other dairy products did better in memory and other brain function tests than those who drank little or no milk.
However, the Mail’s excitement is misplaced – the study did not show that milk was responsible for better mental performance. The type of study reported cannot show cause and effect. All it showed was that, at one point in time, people who drank more milk performed better in mental tests than those who drank less. It is possible that many other things influenced people’s performance in mental function tests, including occupation, stress levels, even how well they were feeling at the time they took the tests.
Milk may be good for your bones but so far there is no good evidence that it improves mental performance.
The study was carried out by researchers from the University of Maine in the US and the University of South Australia. It was published in the peer-reviewed International Dairy Journal. It was partly funded by the Maurice de Rohan International Scholarship, the University of South Australia and the National Heart, Lung and Blood Institute, the National Institute on Aging and the National Institutes of Health, all in the US.
The Mail reported the study uncritically. Its suggestion that milk could help stave off mental decline is not supported by this research. It’s worth noting that the study was released to the press by a US PR company on behalf of the National Fluid Milk Processor Promotion Board, which is an industry-funded organisation set up by the US government to promote milk. This may explain how it found its way into the Daily Mail.
This was a cross-sectional analysis of nearly 1,000 participants that aimed to investigate whether dairy food intake was associated with mental functioning. This type of study can provide a “snapshot” of various lifestyle factors and people’s health at one point in time, but it cannot establish cause and effect. A cohort study that recorded people’s dairy consumption over time and then tested their mental function more than once would provide more reliable results although even this type of study cannot establish cause and effect.
The researchers say that as the whole population ages, cognitive decline and dementia place a severe strain on both families and healthcare systems. Change in diet may have a role in preventing cognitive decline, but they say little attention has so far been paid to the relationship between dairy foods and mental performance.
The researchers say there is growing evidence that dairy products may be of benefit to cardiovascular health. Many experts would dispute this. Some dairy foods are high in saturated fat, which is associated with obesity and heart disease. Most dietitians advise a restricted intake of dairy products or consumption of low-fat varieties.
Researchers recruited 1,049 adults of all ages who were taking part in research looking at cardiovascular health and mental functioning. They collected health and lifestyle data from the participants by various methods including self-reports, medical examination, diagnostic interviews, health records and neuropsychological testing.
After excluding those who did not fulfil eligibility criteria (for example, because dietary or cognitive data were missing or because they had suffered a stroke), they were left with 972 participants.
To measure mental functioning of the participants, the researchers used a validated series of tests measuring memory, verbal recall, visual–spatial perception, organisational and verbal skills, and abstract reasoning ability. For dietary intake, they used a recognised questionnaire that included questions about nutrition and lifestyle.
The dietary component of this questionnaire included questions about dairy products. Milk was considered separately from total dairy foods. Total dairy foods were grouped as followed:
Participants were asked how frequently they consumed such foods, with six possible responses:
Participants were also asked which type of milk they consumed – full fat, reduced fat or skimmed.
The researchers used validated statistical methods to analyse the relationship between mental performance scores and dairy intake. They adjusted their results for other factors that might affect the results, including age, education, smoking and alcohol.
The researchers report that participants who consumed dairy products at least once a day had “significantly higher scores on multiple domains of cognitive function” compared with those who never or rarely consumed dairy foods. In addition, those who reported eating dairy foods between two and four times a week performed significantly better on some of the tests than those who ate dairy foods once a week. The association between greater dairy food consumption and mental performance remained significant after adjusting for a number of risk factors. There was no significant association, however, between intake of specific categories of dairy foods (such as milk, cheese or yoghurt) and results of the tests.
The researchers say their results support an association between high dairy food consumption and cognitive function. Although little is known about how dairy foods might influence mental functioning, they say that one possibility is that dairy food consumption may be beneficial for mental functioning through its “favourable effect” on cardiovascular risk factors such as obesity.
Contrary to the headlines, this study does not show that dairy food consumption has benefits for mental functioning. All it can do is provide a “snapshot” of a group of people’s dairy consumption and their mental functioning at one point in time. Some limitations are that:
Dairy products contain many nutrients that are needed for good health, in particular for the development of healthy bones and teeth. However, they are also high in saturated fat, which is associated with heart disease and obesity. At present there is no good evidence that dairy foods are especially beneficial for brain functioning.
Find out how dairy fits into a healthy diet using the Eatwell Plate.
The white stuff: Drinking just one glass of milk a day could boost your brain power. Daily Mail, January 31 2012
Crichton GE, Elias MF, Doreb GA, Robbins MA. Relation between dairy food intake and cognitive function: The Maine-Syracuse Longitudinal Study. International Dairy Journal 2012:22;15-23
Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
“Drinking just one glass of milk a day could boost your brain power,” The Daily Mail has reported today. Milk is being hailed as a memory aid, the newspaper says, with a study showing that dairy products could “help stave off mental decline”.
The study on which the story is based found that adults with higher intakes of milk and other dairy products did better in memory and other brain function tests than those who drank little or no milk.
However, the Mail’s excitement is misplaced – the study did not show that milk was responsible for better mental performance. The type of study reported cannot show cause and effect. All it showed was that, at one point in time, people who drank more milk performed better in mental tests than those who drank less. It is possible that many other things influenced people’s performance in mental function tests, including occupation, stress levels, even how well they were feeling at the time they took the tests.
Milk may be good for your bones but so far there is no good evidence that it improves mental performance.
The study was carried out by researchers from the University of Maine in the US and the University of South Australia. It was published in the peer-reviewed International Dairy Journal. It was partly funded by the Maurice de Rohan International Scholarship, the University of South Australia and the National Heart, Lung and Blood Institute, the National Institute on Aging and the National Institutes of Health, all in the US.
The Mail reported the study uncritically. Its suggestion that milk could help stave off mental decline is not supported by this research. It’s worth noting that the study was released to the press by a US PR company on behalf of the National Fluid Milk Processor Promotion Board, which is an industry-funded organisation set up by the US government to promote milk. This may explain how it found its way into the Daily Mail.
This was a cross-sectional analysis of nearly 1,000 participants that aimed to investigate whether dairy food intake was associated with mental functioning. This type of study can provide a “snapshot” of various lifestyle factors and people’s health at one point in time, but it cannot establish cause and effect. A cohort study that recorded people’s dairy consumption over time and then tested their mental function more than once would provide more reliable results although even this type of study cannot establish cause and effect.
The researchers say that as the whole population ages, cognitive decline and dementia place a severe strain on both families and healthcare systems. Change in diet may have a role in preventing cognitive decline, but they say little attention has so far been paid to the relationship between dairy foods and mental performance.
The researchers say there is growing evidence that dairy products may be of benefit to cardiovascular health. Many experts would dispute this. Some dairy foods are high in saturated fat, which is associated with obesity and heart disease. Most dietitians advise a restricted intake of dairy products or consumption of low-fat varieties.
Researchers recruited 1,049 adults of all ages who were taking part in research looking at cardiovascular health and mental functioning. They collected health and lifestyle data from the participants by various methods including self-reports, medical examination, diagnostic interviews, health records and neuropsychological testing.
After excluding those who did not fulfil eligibility criteria (for example, because dietary or cognitive data were missing or because they had suffered a stroke), they were left with 972 participants.
To measure mental functioning of the participants, the researchers used a validated series of tests measuring memory, verbal recall, visual–spatial perception, organisational and verbal skills, and abstract reasoning ability. For dietary intake, they used a recognised questionnaire that included questions about nutrition and lifestyle.
The dietary component of this questionnaire included questions about dairy products. Milk was considered separately from total dairy foods. Total dairy foods were grouped as followed:
Participants were asked how frequently they consumed such foods, with six possible responses:
Participants were also asked which type of milk they consumed – full fat, reduced fat or skimmed.
They used validated statistical methods to analyse the relationship between mental performance scores and dairy intake. They adjusted their results for other factors that might affect the results, including age, education, smoking and alcohol.
The researchers report that participants who consumed dairy products at least once a day had “significantly higher scores on multiple domains of cognitive function” compared with those who never or rarely consumed dairy foods. In addition, those who reported eating dairy foods between two and four times a week performed significantly better on some of the tests than those who ate dairy foods once a week. The association between greater dairy food consumption and mental performance remained significant after adjusting for a number of risk factors. There was no significant association, however, between intake of specific categories of dairy foods (such as milk, cheese or yoghurt) and results of the tests.
The researchers say their results support an association between high dairy food consumption and cognitive function. Although little is known about how dairy foods might influence mental functioning, they say that one possibility is that dairy food consumption may be beneficial for mental functioning through its “favourable effect” on cardiovascular risk factors such as obesity.
Contrary to the headlines, this study does not show that dairy food consumption has benefits for mental functioning. All it can do is provide a “snapshot” of a group of people’s dairy consumption and their mental functioning at one point in time. Some limitations are that:
Dairy products contain many nutrients that are needed for good health, in particular for the development of healthy bones and teeth. However, they are also high in saturated fat, which is associated with heart disease and obesity. At present there is no good evidence that dairy foods are especially beneficial for brain functioning.
Find out how dairy fits into a healthy diet by checking out the Eatwell Plate.
The white stuff: Drinking just one glass of milk a day could boost your brain power. Daily Mail, January 31 2012
Crichton GE, Elias MF, Doreb GA, Robbins MA. Relation between dairy food intake and cognitive function: The Maine-Syracuse Longitudinal Study. International Dairy Journal 2012:22;15-23
Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
A “sunny break may be alternative to IVF” the Daily Mail has reported. The newspaper said that sunlight can increase levels of vitamin D, which balances sex hormones in women and improves sperm count in men. It added that a study found some couples ‘may be undergoing unnecessary and costly fertility treatment when spending time in the sun could be the answer’.
The news is based on a systematic review of any kind of scientific study that was related to vitamin D and fertility. The review found that there was a lack of human studies, particularly controlled human studies, which had looked at the effect of vitamin D on fertility. This review therefore mostly reviewed animal laboratory and observational studies and it is not clear what the implications of this basic research is for infertile couples without further follow up with human studies. The basic research showed that vitamin D plays a role in biological processes in sperm and ovary cells and may affect levels of sex hormones.
There are many reasons why a couple may be infertile. The cause of a couple’s infertility is usually determined prior to IVF or other fertility treatments. It is not possible to say, as the Daily Mail has suggested, whether some time in the sun would prevent the need for fertility treatments, without assessing the cause.
The study was carried out by researchers from The Medical University of Graz in Austria and was funded by two Austrian governmental agencies and the Styrian Business Promotion Agency
It was published in the peer-reviewed medical journal the European Journal of Endocrinology.
The Daily Mail accurately reported some of the findings of this review but overemphasised the relevance to infertile couples. Without human controlled trials it is not possible to say whether spending time in the sun could reduce the need for fertility treatments, though the advice does present an attractive option.
This was a systematic review that looked at all of the available scientific papers on vitamin D and fertility. Many factors can cause infertility. The researchers said that in approximately 30 to 40% of infertile couples the underlying cause is problems with the men’s sperm. In women, there are various factors that can mean that they don’t release an egg or make it difficult for a fertilised egg to attach to and grow in the uterus. The researchers say that one major cause of female infertility is polycystic ovary syndrome (PCOS), a condition that affects their sex hormones.
This systematic review took a broad sweep approach to look at the evidence for a link between vitamin D and any aspect of fertility. Although systematic reviews are a good way of comprehensively looking at all of the evidence in an area, there can sometimes be limitations to pooling data if the included studies differ in design. In this systematic review, the researchers included both human and animal studies and care has to be taken in reporting which of the included studies have relevance to humans.
The researchers looked in one medical database for English language publications up to October 2011. They searched the terms and phrases: vitamin D, fertility, vitamin D and reproduction, vitamin D and PCOS. They also searched for alternative names for vitamin D and looked at the reference lists from the studies their search had found.
In most systematic reviews, the researchers list their criteria for including or excluding studies. They may, for example. only include some study designs and not others. However, in this review the researchers did not say how they decided to include studies. The researchers said that they did not find many human studies and have included animal and laboratory studies that can give information about the basic biology of vitamin D but don’t tell us whether vitamin D can help infertile couples.
The researchers said that studies have shown that:
The researchers said that evidence based largely on animal work and observation studies rather than controlled trials has suggested that vitamin D deficiency might be important for hormone disturbances including fertility in women as well as men. They say that these findings deserve further investigation.
This systematic review looked for all available studies prior to October 2011 that had looked at fertility and vitamin D. Besides this very broad search, the review included animal, laboratory and observational studies, which means that it’s difficult to draw conclusions on the implications of this data for people. The researchers noted that there was a real lack of human controlled studies. As a result, it is not possible to say that fertility problems in men and women could be helped by vitamin D supplementation, increasing vitamin D through diet or spending time in the sun.
Vitamin D and its human effects is currently a topic of immense interest to the public and to policy makers. This research looks at another angle, that of fertility, and is useful in giving a broad overview of the basic biology of vitamin D and a range of biological processes involved in infertility. It highlights where there has been a lack of studies and where more work could be done. Future assessments into the role of vitamin D in fertility should as a minimum involve controlled human trials.
Sunny break may be alternative to IVF: How the sunshine vitamin can help boost fertility. Daily Mail, January 30 2012
Lerchbaum E, Obermayer-Pietsch BM. Vitamin D and fertility – a systematic review. European Journal of Endocrinology. Puiblished online January 24 2012
Written by admin on Tuesday, January 31st, 2012 in Swine Flu.
THE HUSBAND of a woman with swine flu told Dublin City Coroner’s Court yesterday that he begged paramedics to take her to hospital the night before she died but they refused.
Written by admin on Monday, January 30th, 2012 in Swine Flu.
Today many newspapers and TV stations have reported that medical regulators have launched an investigation into a type of hip replacement called a “metal-on-metal” (MoM) device (DePuy ASR hip replacement implant). The concern is that as the hip replacements wear down, metal particles can be released from the artificial hip, react with the soft tissue (such as muscle and ligaments) surrounding the joint and enter the bloodstream. In 2010, the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a product recall for DePuy ASR, a brand of MoM artificial hip. This meant that surgeons were told not to implant DePuy ASR hip replacements and return any unused implants to the manufacturer.
The MHRA has urged surgeons to tell all patients that had received these DePuy ASR hip replacements about the recall, and to schedule them for annual follow-up visits. If the person who had a DePuy ASR hip replacement implant experiences pain, the surgeons should consider measuring the level of metals in their blood measured and should examine the soft tissue to see if reactions have occurred. If necessary, removal and replacement of the implant should be considered.
The Sunday Telegraph has brought this story to the public attention again because of what it says are subsequent developments. The Telegraph claims that the risk from the devices is greater than previously thought, with greater failure rates. The Telegraph says that the MHRA is drawing up a new alert for anyone with any type of metal-on-metal hip replacement. Channel 4 News reported that around 30,000 people in Britain have received MoM hip replacements, and that the MHRA has said that, on the evidence currently available, “the majority of people with metal on metal hip replacements are at low risk of developing any serious problems”. A spokesman for the MHRA is quoted as saying: “We are continuing to closely monitor all evidence. This needs more analysis before any conclusions can be drawn and further advice given”.
Medical devices, like medicines are regulated but are coming under more scrutiny, from both the regulators and the media following widespread concerns over the emergence of faults with illegally made PIP breast implants. Find out the latest NHS information on PIP breast implants.
In the UK, approximately 70,000 hip replacements are performed each year. In a total hip replacement operation an artificial ball is attached to the top of the leg bone and an artificial socket is attached to the hip bone. The socket can be made out of plastic or ceramic, while the ball is metal. The ball is attached to a shaft, which is placed in the hollow of the leg bone (femur). Some people do not need a total hip replacement, but have a hip resurfacing operation. This has the advantage of removing less of the person’s own bone. The joint surfaces are replaced with metal inserts that cover the surfaces of the hip but do not extend down the inside or hollow of the leg bone. The metal mixtures used in hip replacements contain the metals chromium and cobalt.
When hip resurfacing was initially introduced, metal-on-metal (MoM) replacements were popular, especially with younger, active patients. An article by two orthopaedic surgeons working in Britain and published in the British Medical Journal in 2011 said that they were used in 10% of hip operations between 2006 and 2009, and 50% of all hip replacements in people younger than 50 years. However, problems with the metal resurfacing included raised chromium and cobalt in the blood, loosening of the joint, hip fracture and soft tissue reactions around the hip. It reported that problems with metal on metal hip replacements could include reactions to metal debris and associated pain, swelling, loss of movement and limping.
In March 2011, delegates at the British Hip Society annual conference discussed MoM hip replacements. Units in Belfast, Southampton, Cardiff and Stockton-on-Tees that had researched the outcomes for people who had these devices fitted over the short- to mid-term, said that a high proportion of MoM devices from other manufacturers may also be showing similar results to the withdrawn DePuy device. They found that, overall, the MoM devices showed a higher than anticipated early failure rate (most hip replacements last about 20-30 years). They found that 49% of people who had been fitted with the DePuy device needed it to be replaced by six years and between 12 and 15% who had other metal-on-metal hip replacements needed these to be replaced by five years. They said that the patients whose replacements failed tended to come to the doctors when they experienced pain. X-rays showed some patients had loosening of the joint, and some patients had raised levels of cobalt and chromium in their blood.
The inclusion of the word “poisoned” in some newspapers is likely to be wrong. Metal from the hip replacements can enter the bloodstream, but the levels of cobalt and chromium found give an indication of the wear to the hip replacement. No evidence for damage other than local tissue damage was presented. The MHRA’s advice is to monitor the level of chromium and cobalt to see if a patient requires further follow-up.
The MHRA has not issued new guidance as yet. However, the report from the British Hip Society annual conference says that they believe that the existing advice from the MHRA still applies. This means that people who have been treated with a MoM hip replacement should be followed up regularly for five years and probably for the life of the implant. People with the withdrawn MoM hip replacements who experience pain should have this thoroughly investigated. Following the withdrawal of the DePuy device, and the MHRA guidance, the British Hip Society and the British Orthopaedic Association said:
People who have had a hip replacement, who are concerned, should contact their orthopaedic surgeon or GP. They should be given records of the type of hip replacement they had and receive the follow-up, if any, that is required.
Health warning over hip implants. The Daily Telegraph, January 28 2012
MHRA investigation over ‘toxic’ hip replacements. Channel 4 News, January 29 2012
MHRA launches investigation after hip replacement ‘poisoning’ claims. Metro, January 29 2012
Poison fears sparked over hips. The Sun, January 29 2012
Poison scare for 40,000 from faulty hip implants. Daily Express, January 29 2012
Watchdog starts inquiry into hip replacements. The Guardian, January 29 2012
Fears over hip replacements. Sky News, January 29 2012
Poisonous hip implants ‘putting thousands of British patients at risk’ as medical watchdog launches investigation. Daily Mail, January 30 2012
Written by admin on Monday, January 30th, 2012 in Swine Flu.
“More men [than women] ‘have oral cancer virus”, BBC News has reported, saying that this is “leading to an increased risk for men of head and neck cancers”.
This news story is based on research into the number of people infected with the oral human papillomavirus (HPV) in the United States. HPV is known to cause cervical cancer, and has been the target of recent vaccines in an attempt to decrease the number of new cases of this cancer. Oral infection with the virus can cause a type of mouth cancer. The number of people diagnosed with this oral cancer has been increasing in recent years, and as oral HPV is a known cause, this study aimed to identify how many people in the United States were likely to be infected with oral HPV. The researchers found that approximately 7% of the US population aged 14 to 69 years were infected with this virus, and that men were more likely to be infected than women.
This study shows a marked difference in oral HPV infection between men and women in the United States, but it does not report the number of people infected in the UK. It is important to remember that there are many different types of HPV, and not everyone who is infected will go on to develop cancer.
The study was carried out by researchers from Ohio State University, the US National Cancer Institute and a US company called Information Management Services. The research was funded by Ohio State University, the US National Cancer Institute, John and Nina Cassils and the pharmaceutical company Merck. Merck is the manufacturer of Gardasil, the cervical cancer jab that targets several strains of HPV, including type 16, which is most commonly associated with oral cancer.
The study was published in the peer-reviewed Journal of the American Medical Association.
This research was covered appropriately in the media, with the Daily Mail emphasising that the prevalence estimate was drawn from a US population, and pointing out that not all individuals infected with oral HPV will go on to develop oral cancer. The BBC was careful to point out that it is not known if the existing vaccines against HPV used for preventing cervical cancer are effective against oral HPV infection and that vaccination cannot be recommended for the primary prevention of oropharyngeal cancer.
This was a cross-sectional study that examined the number of people aged 14 to 69 infected with oral HPV in the United States.
Cross-sectional studies are a useful way to generate estimates of the number of cases in a population. However, they only collect information at one point in time, and cannot tell us why things are related, or how things change over time. This study provides a snapshot of the number of infections in one time period (between 2009 and 2010), but it does not attempt to link these numbers to the risk of developing oral cancer.
Background information supplied by the researchers suggests that the number of cases of oral cancer has increased over the past thirty years in several countries, and HPV has been directly implicated as the underlying cause.
Researchers recruited a sample of individuals that was intended to be representative of the US population. They conducted interviews and a physical examination. During the interview, participants provided information about:
During the physical examination samples of cells were taken from the inside of the mouth. These samples were sent to a laboratory where researchers isolated DNA from the cells to determine whether the individual was infected with oral HPV, and if so, to identify the virus type. They tested for 37 HPV types, of which 18 were ‘high-risk’ DNA types.
The researchers then analysed the data, arriving at overall estimates of the number of infections in the US population. They also conducted an analysis that accounted for sociodemographic and behavioural factors.
There were 5,579 participants in the beginning of the study. Of these 5,501 (98.6%) were included in the analysis. The researchers found that overall:
When the researchers accounted for sociodemographic and behavioural factors in their analysis, they found that the following variables were independently associated with oral HPV infection:
Ethnicity, marital status and alcohol and marijuana use were not independently associated with oral HPV infection.
The researchers concluded that approximately 7% of the US population between the ages of 14 and 69 are infected with oral HPV. They say that this is significantly lower than infection with genital HPV.
This was a relatively large cross-sectional study that estimated the number of oral HPV infections in the US among 14 to 69 year olds. These estimates cannot be directly generalised to the UK.
The researchers say that their data provide evidence that oral HPV infection is mainly sexually transmitted. This is because infection was uncommon among participants with no previous sexual partners, but was up to eight times higher among those with previous partners, and increased significantly as the number of partners increased. The researchers do point out, however, that their study did not collect information on possible non-sexual transmission methods.
While policy decisions regarding HPV infection generally focus on genital HPV among females, this research demonstrated that, at least in the US, men are more likely to be infected with oral HPV. As high risk types of oral HPV have been shown to cause mouth cancer, this research may open up discussions on the need to address these risks. Options for reducing the risk of infection include targeting modifiable behaviours, such as smoking and sexual behaviour. Whether current vaccines against HPV can prevent oral cancer is unknown and this research does not provide any evidence as to how effective any vaccine might be.
All in all, this was a well conducted cross-sectional study that estimates the prevalence of oral HPV infections in the United States. However, it does not provide any information on the number of participants who went on to develop oral cancer. It is important to remember that there are many different types of HPV, and not everyone who is infected will go on to develop cancer. This study cannot tell us the rates of oral HPV infection in the United Kingdom, but may provide information on risk factors for infection that apply to populations outside the US.
More men ‘have oral cancer virus’. BBC News, January 27 2012
More than 16 million Americans have oral HPV. Daily Mail, January 26 2012
Gillison ML, Broutian T, Pickard RKL, et al. Prevalence of oral HPV infection in the United States, 2009-2010. Journal of the American Medical Association. Published online January 26 2012
Written by admin on Friday, January 27th, 2012 in Swine Flu.
“Signs of autism can be detected in six-month-old babies by measuring brain activity,” the Daily Mail has reported. While the Mail was correct, the research has not yet proved to be a perfect diagnostic test.
This and other related headlines are based on a study that assessed the brain activity of 104 infants aged 6-10 months as they watched an image of an adult’s face whose eyes moved from looking away from them, to directly at the infant, then away again. Researchers called these eye movements ‘dynamic eye-gaze shifts’. They then assessed whether differences in brain activity in response to the eye-gaze shifts were related to autism developing in the same children at three years.
Children who did not develop autism showed large spikes in brain activity when they saw the ‘gaze shifts’. Much smaller spikes in brain activity were detected in the infants who went on to develop autism, raising the prospect that autism could be identified earlier than is currently clinically possible.
However, this test was not 100% accurate. Some babies showing low brain activity spikes did not go on to develop autism and vice versa. As the groups overlap, there cannot be a simple and useful cut-off value to predict autism.
Developing and refining this type of test into something that can be routinely used to detect autism in infants is likely to take some time and will certainly require more research on larger groups of infants with autism and unselected healthy infants too.
The study was carried out by a collaboration of researchers from English, Canadian and Australian universities and was funded by the UK Medical Research Council. It was published in the peer-reviewed science journal Current Biology.
The media reporting of this story was generally well balanced. Many stories included quotes from the study authors that a definitive test would take time to develop and that the current assessment is not 100% effective.
This study was a prospective longitudinal study investigating whether the brain function of infants aged 6-10 months differed in response to viewing faces that changed the direction of their gaze. The researchers then looked at whether these brain function differences could predict a diagnosis of autism at three years of age.
The authors report that there are currently no reliable methods of predicting autism in infants younger than about two years of age. Current diagnosis relies on the detection of behavioural symptoms of autism that typically develop in a child’s second or third year. Behaviours associated with autism include impairments in social skills and communication, and the presence of rigid, stereotyped and repetitive behaviours.
The authors say previous research shows typical infants’ sensitivity to eye gaze in the first year of life predicts a range of social and communication skills that emerge later. Detecting autism at an early age could potentially lead to ways of better supporting the child during early development, improving their wellbeing and life chances.
The researcher recruited a group of 104 infants – 54 at risk of autism because of a family history of the condition and 50 controls, with no family history of autism. The infants were followed from 6-10 months through to three years of age.
The researchers measured the 6 to 10-month-old infants’ response to changing images of faces. They did this by recording event-related potentials (ERPs), which are a measure of brain electrical activity in response to a thought or perception. In this study, ERPs were used to measure the perception of a face changing between looking directly at the infant and then away from them. The researchers called this ‘dynamic gaze-shift stimuli’.
The researchers also tracked the eyes of the infants to examine the amount of time they spent looking at the eye region of the faces they were shown. This allowed the researchers to assess whether different responses to the eye gaze were due to differences in attention to the eye region or whether brain functions were more important.
The researchers reported that dynamic gaze-shift stimuli are more likely to engage wider social brain mechanisms than static images as they mimic a real social interaction more closely. However, researchers compared their dynamic gaze results with that from ‘static gaze’, (images of a face whose eyes were looking at, or away from, the infant) to see how they compared to each other.
The brain activity levels of infants at risk of autism were contrasted with the controls. The researchers then looked at how the brain function differences at 6-10 months related to a later diagnosis of autism. An independent team assessed whether the infants had autism at two and three years old.
The brain activity of the control group showed large spikes of activity in response to eye gaze changes when the face image held a gaze toward, compared to away from, the infant. The brain activity spikes of infants at risk of autism were significantly smaller in response to the same stimulus.
The differences in brain activity of the control group verse at risk group were not restricted to the dynamic gaze results. Similar results were seen when static images were used.
The researchers found that those who did not go on to develop autism at three years of age showed large spikes in brain activity relating to the changes in eye gaze at 6-10 months. Crucially, those that did develop autism showed significantly smaller spikes in brain activity. The static image test did not predict a later diagnosis of autism.
Eye tracking information was available for 93 of the 104 infants. There was no difference in the time at-risk infants and control infants spent looking at the faces’ eyes relative to other areas of the face.
The authors conclude that ‘brain function measures can successfully differentiate groups of infants at risk [of autism] from low-risk control within the ?rst year of life’. They go on to say that ‘response to dynamic gaze shifts during the first year of life distinguished the group of infants who later develop autism’.
This small study highlights a potential method of identifying children who are likely to develop autism at 6-11 months, much earlier than the current method of diagnosis. The authors suggest this could potentially pave the way for more selective targeting of early intervention efforts and procedures to these children, increasing their life chances.
While this study provides intriguing results it is important to bear in mind some practical limitations. For instance, while the average differences between the brain function of the infants that went on to develop autism compared to those that did not were significantly different, individual values from the two groups did overlap. This means that there is probably no useful clinical cut-off value to predict autism. Similarly, the researchers do not describe how the controls were selected or report how good the test was at diagnosing autism, known as the ‘test sensitivity’. Reporting these key results would have helped us better assess the accuracy and importance of these findings.
Much larger studies would be needed to establish a suitable brain activity level to use to identify as child as ‘likely to develop autism’. These studies could better assess the natural variation in brain activity from a large group of infants. Similarly, it is unlikely a future autism assessment would rely on a single test, such as dynamic eye gaze, but would instead use a combination of tests.
The uncertainty about what cut-off values to use, and the drawbacks of using a single predictive test, makes the development of an early identification test more complex. It may be some time before a predictive test is routinely available to identify infants likely to develop autism earlier than is currently possible.
Autism: Brainwaves ’show risk from age of six months’. BBC News, January 27 2012
Signs of autism ‘can be detected in six-month-old babies’ by measuring brain activity. Daily Mail, January 27 2012
Signs of autism at six months. The Daily Telegraph, January 27 2012
Early test to detect autism. The Independent, January 27 2012
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Written by admin on Friday, January 27th, 2012 in Swine Flu.
‘More than a million cancer carers may be missing out on vital support,’ the Daily Mirror and other newspapers have reported today. The news reports are based on a survey carried out for Macmillan Cancer Support, which identified that among 386 people who provided five or more hours of care a week to someone with cancer, around half had no support of any kind.
There are more than 1 million carers of people with cancer in the UK, and more than 6 million carers of all kinds. The report detailed the impact of the apparent lack of support on carers’ mental health, relationships and finances,finding that just 5% say they have received a local authority carer’s assessment, which enables them to access practical, emotional and financial support.
The ‘More than a Million’ report published by Macmillan is based on the results of a survey carried out by Ipsos MORI. The charity said that around one in seven people had given some unpaid informal support to a person with cancer in the past 12 months and that around one in 50 could currently be described as carers of people with cancer. The survey was carried out between May and August 2011 and it asked questions to identify carers among 18,449 people interviewed face-to-face. They then polled 386 of these people who were identified as carers of people with cancer.
The survey found that like all carers, most carers of people with cancer were women (62%) mostly aged between 45 and 54. The carers most often supported a member of their family such as a parent (23%) or a spouse or partner (17%), but surprisingly 31% said they cared for a friend or neighbour. In this research, being a carer was defined as giving at least five hours of support a week, or giving one to four hours with it affecting their lives in some way. Despite meeting this definition, only 43% of the people surveyed actually considered themselves to be carers (51% said that they would not consider themselves carers). You can find out more who is considered a carer at Carers Direct: what is a carer?
The type of care given is varied, and includes emotional support for someone with cancer and helping with errands such as shopping and collecting prescriptions and helping with transportation. On average, the carers surveyed gave almost 15 hours of support per week and 81% said that being a carer impacted on other aspects of their life. The impacts included effects on emotional wellbeing and mental health, social life, relationships, working life and finances.
Owing to the different ways being a carer can affect outside life, the survey considered many different types of support a carer of someone with cancer may need. The survey found that most of the support that carers receive is informal, coming from their family (44%) or friends (28%). Some carers (20%) received support from their GP or another person working within the NHS. However, half of carers polled said they received no support. The survey revealed that the type of support carers wanted was training on how to give care, and someone to provide emotional support. The carers also wanted more information on the general support available to them.
It is important to note that entitlement to a carer’s assessment is based on them being considered as giving ‘regular and substantial care’ to the person they look after. The report defined carers as those caring for more than five hours a week. While there is no legal definition for what this entails, it could explain why some carers have never had an assessment.
A local authority carer’s assessment allows carers of all types to discuss with social services the help they need to maintain health and a balance between caring and other life commitments. The Macmillan Cancer Support report said that out of the people they surveyed, only 11% said they had received support from social services or local authorities and only five per cent have had a carer’s assessment. If you are looking after someone, social services are obliged to consider the different issues that can affect your caring role to assess your needs.
The Carers Direct helpline (0808 802 0202) is a free and confidential helpline for carers (living in England) needing help or advice on their caring role or on the needs of the person they are caring for. Carers Direct can also be contacted by mail, email and live, online webchat. You can also use Carers Direct to find addresses, phone numbers and websites for carers’ services near you.
Macmillan Cancer Support recognises the needs of people living with cancer and their carers. In the survey, 72% of carers named at least one service or activity that they thought Macmillan offers to carers and over a third said that they had used at least one of these services. These included contact with Macmillan nurses and gaining information and advice through the Macmillan website.
Millions of cancer carers missing out on benefits. The Daily Telegraph, January 27 2012
More than a million cancer carers may be missing out on vital support, charity reveals. Daily Mirror, January 27 2012
Carers ‘missing out on support’, says charity. BBC News, January 27 2012