“Scientists create new flu vaccine that works against many different strains of the virus,” The Independent reports.

This headline, and several others like it, is based on early stage research into the development of alternative flu vaccine technologies. While the results of this research are promising, they do not mean that a universal flu jab has been developed.

The study used a new technique where two proteins are bound together to form a nanoparticle. These nanoparticles stimulated an immune response to a greater variety of flu strains than the currently available flu jab.

It is important to stress that this work was carried out in ferrets not humans. Ferrets do have biological similarities to humans, at least in the way they respond to flu and the flu vaccine, so this is a genuinely intriguing development.

But it will take several years of further clinical trials to assess whether this technique can lead to a safe and effective ‘universal flu’ vaccine for humans.

Currently, the best bet is to take measures to protect yourself during peak flu season. This includes regularly washing your hands, staying home from work or school if you have the flu and getting a yearly flu jab if you’re at risk of serious complications.

 

Where did the story come from?

The study was carried out by researchers from the Vaccine Research Center, part of the US National Institutes of Health (NIH) and was supported by the NIH. The lead researcher is now based at Sanofi, a pharmaceutical company that manufactures vaccines.

The study was published in the peer-reviewed journal Nature.

BBC News reports the findings of the study in an appropriate manner. The headline “Universal flu jab 'edges closer'” and the warning that “a vaccine which could defeat all flu was a long way off” properly convey the stage this research is at.

But most other reporting on this study failed to do this. For example, The Independent’s headline “Scientists create new flu vaccine that works against many different strains of the virus” is premature and does not reflect the early stage of technology development that this research is at.

While the work is a step towards a universal vaccine, the technology has not yet been developed and tested to a point at which it could replace the annual flu jab.

 

What kind of research was this?

This was a laboratory and animal study that investigated a new approach to generating flu vaccines.

Current vaccines are designed to protect against three strains of the flu virus that health experts expect to be widely circulating in the population during any given year.

This current approach is limited by the fact that the annual vaccine may not match the most common strains circulating that year. This approach also means seasonal flu vaccinations must be carried out annually to ‘catch-up’ with any changes in flu strains.

The aim of this study was to develop a technique targeting a protein that is common to a wide variety of flu viruses, thus priming the body to mount an immune response to a broader range of flu strains.

This research is at a fairly early stage, but it does suggest that it may be possible to develop a universal flu vaccine. The technology will need to be tested further in animals. It will then need to be proven to be safe and effective for people during clinical trials before a ‘universal jab’ could be made available.

 

What did the research involve?

Researchers fused together two proteins – one, called ferritin, which stores iron and occurs naturally in our blood; the other, called haemagglutinin (HA), which is a viral protein responsible for the initial stages of flu infection. It works by attaching the flu virus to the cell it is going to infect.

Individual ferritin proteins naturally come together and form a smooth hollow ball. Researchers thought that fusing ferritin and haemagglutinin would result in a similar sphere with HA spikes, and that the resulting nanoparticle would be recognised by antibodies.

They further thought that when the spheres were injected into animals they would trigger the body to mount an immune response against a range of flu strains.

To test the ability of this ferritin-haemagglutinin nanoparticle to initiate an immune response, researchers first immunised ferrets with either a traditional flu vaccine or the new complex. They measured the HA titres (titres indicate the number of antibodies the body has produced that recognise the HA spike) three weeks later, and compared the titre levels between the two groups.

Researchers then tested the ability of the ferritin-haemagglutinin complex to protect against a range of flu strains. Three groups of ferrets (one immunised with the new complex, one immunised with a traditional flu vaccine and one non-immunised control group) were exposed to a variety of flu strains. The immune response across the groups was then compared.

 

What were the basic results?

The researchers found that when the ferritin and haemagglutinin proteins were fused together, the proteins self-assembled into a nanoparticle with haemagglutinin spikes sticking out from the core.

When the nanoparticle was exposed to an antibody known to target HA, the researchers found that it bound to the antibody in a similar manner as traditional flu vaccines.

They say this indicates that the newly developed ferritin-haemagglutinin particles resembled the HA spike of the flu virus, which, in theory, could stimulate an immune response against a flu infection.

Three weeks after immunisation, the researchers found that ferrets injected with the ferritin-haemagglutinin nanoparticle had levels of antibodies (antibody titres) that were approximately ten times higher than those seen in the ferrets injected with the traditional flu vaccine.

They also found that a single injection of these nanoparticles produced an immune response similar to two immunisations with a traditional vaccine.

When challenged with different flu strains, the ferritin-haemagglutinin immunised group of ferrets demonstrated an earlier immune response than the control group, and suffered less weight loss than both the traditionally immunised and non-immunised ferrets, which researchers say further demonstrates the protective effect of the new ferritin-haemagglutinin particles.

 

How did the researchers interpret the results?

The researchers conclude that this new HA-nanoparticle technology “represents a foundation for a new generation of influenza vaccines and could be adapted to create vaccines for a wide variety of pathogens”.

 

Conclusion

This is promising research that takes us a step closer to developing a universal flu vaccine. Despite headlines suggesting otherwise, no universal jab has yet been developed.

The researchers say that this new particle is capable of enhancing the body’s immune response compared with the currently used flu vaccine, and that the new complex offers protection against a wider variety of flu strains.

It is important to remember that this research is still in its early stages. This technology development may well lead to the generation of a new type of vaccine. However, significant research is still required to move from the current stage to an available universal flu jab.

Until then, the advice for protecting yourself during flu season remains the same:

• Practise good hygiene – wash your hands regularly, clean commonly used surfaces and use tissues when you cough or sneeze.
• Consider getting an annual flu jab if you are at risk of severe flu complications. Groups at high risk for complications include those over the age of 65, pregnant women and people who have a weak immune system or underlying health condition such as a chronic heart or respiratory disease. 

Read more about preventing the spread of flu.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Universal flu jab 'edges closer'. BBC News, May 23 2013

An end to annual flu injections? Scientists develop new 'universal' jab against all strains of influenza which could last a lifetime. Mail Online, May 23 2013

Scientists create new flu vaccine that works against many different strains of the virus. The Independent, May 22 2013

Concept flu vaccine may be breakthrough. Sky News, May 23 2013

Links To Science

Kanekiyo M, Wei C, Yassine HM, et al. Self-assembling influenza nanoparticle vaccines elicit broadly neutralizing H1N1 antibodies. Nature. Published online May 22 2013

"Terrible night's sleep? Blame your mobile phone" is the advice on the Mail Online website, as "exposure to artificial light 'fools' the brain into staying awake."

This – and similar headlines in the Daily Express, The Guardian and Metro newspapers – is based on a recent opinion piece in the journal Nature, which has published a dedicated supplement on the science of sleep.

The opinion piece suggests that the invention of electric light has altered our sleep patterns over the last century. In particular, the widespread use of LED lights, which we rely on to view smartphones, tablets, televisions and laptops screens, is disrupting our sleep.

This, the author suggests, could have potentially serious health consequences, as poorly controlled insomnia can cause both physical and mental health problems.

As an opinion piece, this should not be taken as evidence that light exposure hampers our ability to sleep. However, it does suggest several ways the two may be linked. The piece offers the theory that one causes the other, but these associations have not been directly tested. But given that the author is a specialist in sleep medicine, his opinion cannot simply be dismissed out of hand.

 

Who wrote the opinion piece?

The editorial was written by Charles Czeisler, a professor of sleep medicine at Harvard Medical School and chief of the division of sleep medicine at Brigham and Women's Hospital in Boston, US.

Over the past 35 years Dr Czeisler has published widely on sleep, the impact of light on sleep, and the effect of restricted sleep on human behaviour and performance.

 

What arguments are made?

Dr Czeisler suggests that since the invention of electric light, there has been a fundamental shift in our sleep patterns. He argues that light has enabled us to evolve into a "24/7 society", and that many of the features of this transformation – early starting times at work and school, long commutes, high doses of caffeine – lead to us getting insufficient amounts of sleep.

Dr Czeisler's arguments for the link between the increasing use of electric light and disrupted sleep have highlighted several issues.

The biological effect of artificial light

Dr Czeisler argues that exposure to artificial light during the evening and at night could block the effects of brain cells that help promote feelings of sleepiness, as well the "sleep hormone" melatonin.

At the same time, artificial light could also stimulate brain cells associated with alertness.

The combination of these effects could result in many of us feeling much less sleepy in the evening than we would normally.

Time-trends in light use, cost and sleep

Dr Czeisler reports that the cost of generating light dropped dramatically over the last 50 years, which was associated with an increase in the use of artificial light.

At the same time that the use of artificial light increased, reported levels of sleep deficiency also went up. A recent study looking at data in England from 1993 to 2007 found a continual increase in people seeking treatment for sleep disorders.

However, it is important to note that, as with any observational time-trend data, this argument only outlines associations between light consumption and sleep deficiency, and should not be interpreted as there being a causal relationship based on this editorial alone.

Increased use of LEDs

Dr Czeisler suggests that the recent move from traditional incandescent light bulbs to more energy efficient solid-state light-emitting diodes (LEDs) could further disrupt our sleep.

LEDs are commonly used in TVs, computer screens and handheld electronic devices such as tablets. These LEDs are typically rich in shortwave length (blue and blue-green) light, which the cells in our retina are more sensitive to.

He offers the theory that time in front of these blue light-rich screens at night will be more disruptive to our sleep than incandescent lighting.

Interestingly, one of the final discussion points in the editorial is about our ability to control the wavelengths emitted by LEDs. Dr Czeisler suggests that any adverse effect of exposure to these lights at night could be mitigated by replacing blue heavy light with red or orange heavy light in the evenings.

This editorial offers interesting discussion points surrounding the relationship between light – especially evening or nighttime exposure to light – and difficulty sleeping.

 

What evidence is cited?

Dr Czeisler's article makes reference to several publications, mainly centred around trends in the average number of hours adults and children sleep each night, and the prevalence of the adverse effects of sleep deprivation. As an opinion piece, the overall discussion points are narrative in nature and are not based on any individual piece of research or evidence.

This specific article on its own cannot provide evidence of a direct link between light exposure and sleep deprivation. However, it is not intended to do so. It offers a broad introduction to a series of articles on the topic, and suggests we consider the ways in which technological changes may impact our ability to get a good night's sleep.

 

Conclusion

It is certainly possible to reduce your exposure to artificial lights. For example, you could dump your smartphone, give away your iPad, banish television from your home, and refuse to work in any job that involves using a computer. But adopting this kind of luddite lifestyle is probably not to most people's tastes.

One proven method of improving your sleep is what is known as "sleep hygiene". This is where you control both physical and environmental factors in order to promote sleep.

Examples of good sleep hygiene include:

• not drinking tea and coffee four hours before bedtime
• avoiding drinking alcohol or smoking before bed
• using thick blinds or curtains, or wearing an eye mask if the early morning sunlight or bright streetlamps affect your sleep
• wearing ear plugs if noise is a problem

Read more advice about sleep hygiene.

If you have persistent insomnia (more than four weeks), contact your GP for advice. You may require more in-depth "sleep training" counselling, often done using cognitive behavioural therapy (CBT) techniques. Alternatively, there may be an underlying condition contributing towards your insomnia.

Read more about the treatment of insomnia.

 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Peering at bright screens after dark could harm health, doctor claims. The Guardian, May 22 2013

Terrible night's sleep? Blame your mobile phone: How exposure to artificial light 'fools' the brain into staying awake. Mail Online, May 22 2013

How your iPad tablet could mess with a good night's sleep. Metro, May 23 2013

Links To Science

Czeisler C. Perspective: Casting light on sleep deficiency. Nature. Published online May 23 2013

'Bad weather could raise your blood pressure and even kill you,' is the unnecessarily alarmist headline in the Daily Mail. It reports on a large, complex study that looked for any association between changes in weather and blood pressure rates.

The research focused on patients at a blood pressure clinic in Glasgow and looked at two consecutive visits the patients made within a 12-month period. The researchers combined these findings with Met Office weather data from the time of these visits to assess whether changes in patients' blood pressure were related to changes in the weather.

They found that decreases in temperature and sunshine, or increases in rainfall and frost, were associated with a slight increase in blood pressure.

In the longer term, individuals whose blood pressure seemed sensitive to decreases in temperature and sunshine had slight increases in blood pressure. They also seemed to have overall shorter survival than people insensitive to weather changes.

We know that our bodies respond to temperature changes, so it is plausible that temperature could influence blood pressure. But factors other than the weather may have had a role to play in the blood pressure results seen.

It is also important to point out that the minor increases in blood pressure detected by the study could in many cases be compensated for by taking more exercise or improving your diet.

 

Where did the story come from?

The study was carried out by researchers from the University of Glasgow. One of the study authors was supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities.

It was published in the peer-reviewed Journal of the American Heart Association.

The quality of the Daily Mail's reporting of this study is mixed. On the negative side, it presents an over-simplistic conclusion that cannot be drawn from the complex analysis used in this study. The claim made in the headline that 'bad weather...can kill you' is needlessly sensationalised.

On the plus side, its story does contain useful advice from a spokesperson from Blood Pressure UK: "Until we can control the weather, we can still rely on more traditional ways of controlling our blood pressure, such as eating more fruit and vegetables, less salt and alcohol, and taking more exercise."

 

What kind of research was this?

The researchers say that there is growing evidence that outdoor temperature has an influence on blood pressure, with blood pressure being higher in winter and lower in summer.

This is believed to be because the constriction of blood vessels at colder temperatures increases blood pressure. However, it is unclear whether the temperature-related response differs among individuals.

The current study aimed to examine people's individual changes in blood pressure in response to a range of weather patterns. The researchers also wanted to see whether this was predictive of longer term blood pressure control and mortality.

 

What did the research involve?

The study included 16,010 people from the Glasgow Blood Pressure Clinic (47% male) who had been referred by their GP in order to control their high blood pressure.

Information on the monthly average weather for the west of Scotland was obtained from the UK Met Office. The Met Office has used a consistent method to analyse climate patterns since 1961, and can provide weather for square kilometre grid points across the UK. Information on four aspects of weather was used in the study:

• air frost
• air temperature
• rainfall
• sunshine

Each visit every person made to the Blood Pressure Clinic was mapped to the mean monthly weather of the west of Scotland. Mean monthly measurements for each of the four aspects of weather were ranked from the lowest to the highest measurement, and then split into four equal groups called quartiles. The lowest quartile (Q1) contained the lowest 25% of measurements and the highest quartile (Q4) contained the highest 25% of measurements.

For each person, the researchers looked at pairs of consecutive clinic visits that were at least one month apart but within the same 12-month period. They were interested in pairs of visits where weather either remained constant (both visits in the same weather quartile) or where weather was very different (one visit in the lowest quartile and one visit in the highest quartile). They categorised the weather for these clinic visits as:

• Q1 to Q4, where weather for the first clinic visit was in the lowest quartile and the subsequent visit was in the highest quartile
• Q4 to Q1, where weather for the first clinic visit was in the highest quartile and the subsequent visit was in the lowest quartile
• Qn to Qn, where both the first and the second clinic visits were in the same weather quartile – there was no change in weather patterns

For each individual, the researchers examined changes in their blood pressure and heart rate between the two visits, and looked at how the size and direction of this change (up or down) related to the change in weather.

The researchers used the General Register Office for Scotland to obtain information on deaths among the participants and causes of death. Mortality information was available up to 2011, allowing up to 35 years of follow-up.

Analyses were adjusted for factors known to influence blood pressure (confounders), including:

• age
• smoking
• alcohol
• high body mass index (BMI)
• kidney disease

 

What were the basic results?

The average age of individuals at their first clinic visit was 51 years, and most were overweight (mean BMI was 28). The average length of follow-up for each person was 6.5 years.

The researchers found that when there was consistent weather between the two clinic visits (Qn to Qn), there was:

• an average 2.1% decrease in systolic blood pressure (the upper figure of a blood pressure measurement) with consistent air frost
• a 2.2% decrease with consistent temperature
• a 1.7% decrease with consistent rainfall
• a 2.2% decrease with consistent sunshine

For change from high to low weather extremes, there was:

• about a 2% increase in systolic blood pressure with a decrease in temperature and sunshine
• no significant change in systolic blood pressure with a decrease in air frost and rainfall

For change from low to high weather extremes, there was:

• a 1.4% increase in systolic blood pressure with an increase in air frost
• a 0.8% increase in blood pressure for an increase in rainfall
• there was no consistent pattern in blood pressure with a change in temperature from low to high 

When the researchers compared the blood pressure changes seen with consistent weather patterns, a change in the weather from the highest to lowest quartile was associated with about a 6% increase in systolic blood pressure when there was a decline in temperature and sunshine, and about a 4% increase in systolic blood pressure when there was a decline in air frost.

Compared with consistent weather, a change from the lowest to highest quartile was associated with 2-6.6% increases in systolic blood pressure for all four weather characteristics assessed.

Looking at longer term changes over five or more years, people whose blood pressure changed when there was a decline in temperature experienced a 2.68mmHg increase in their systolic blood pressure, and a 1.84mmHg increase in their diastolic blood pressure (the lower figure in a blood pressure measurement), compared with people whose blood pressure seemed insensitive to temperature change. 

A similar 1.31mmHg increase in systolic blood pressure and a 1.22mmHg increase in diastolic blood pressure was seen for people who were sensitive to a decline in sunshine.

Looking at survival data, people who were insensitive to temperature or sunlight change seemed to have longer survival than people who were sensitive to a decline in temperature or sunlight.

There were no significant longer term differences in blood pressure or survival between people insensitive to temperature or sunlight change, or in people sensitive to an increase in weather extremes.

 

How did the researchers interpret the results?

The researchers have concluded that for the first time they have demonstrated the extent of alterations in blood pressure between consecutive clinic visits associated with changes in weather in people with high blood pressure.

They have extrapolated that knowing a person's blood pressure response to weather could help prevent doctors making unnecessary changes to blood pressure medication.

 

Conclusion

This study has used a complex method of analysis in order to look at how individuals' blood pressure at consecutive visits within a one-year period varied according to changes in the weather.

The study benefits from its large population sample and long follow-up. The blood pressure measurements taken at this specialist clinic are also likely to be reliable.

Our bodies do respond to changes in temperature and it is biologically plausible that temperature can affect our blood pressure. The researchers have adjusted for many factors known to influence blood pressure, such as age, high BMI and kidney disease.

However, it is still difficult to say with certainty that all blood pressure changes seen in people between clinic visits were solely down to changes in the weather. For example, the researchers did not have complete information about the blood pressure medications being used by the patients, or their levels of physical activity. These factors could also be influencing the findings.

Another limitation is that blood pressure would have been recorded inside the clinics and may not be representative of what blood pressure would have been if it had been taken outside, with full exposure to the weather.

The research was conducted in individuals from the Glasgow area and it is difficult to say whether similar responses would be seen in people in other locations, particularly people living in vastly different climates.

Similarly, the study only looked at people with high blood pressure. It is not clear whether people with normal blood pressure also experience similar changes in their blood pressure in response to weather changes.

The individuals in the study seem to have been variably sensitive to different changes in the weather. It is not yet clear exactly how a person's blood pressure treatment could be individualised according to their sensitivity to weather change, and whether this would successfully reduce blood pressure variability.

One final important point to make is that although we have no control over the weather, we can control a wide range of factors that contribute towards high blood pressure, such as:

• the amount of exercise you take
• diet – if your blood pressure is high, you should cut down on salt, saturated fat and sugar, and eat plenty of fruit and vegetables
• quitting smoking, if you smoke
• the amount of alcohol you drink

Read more about proven lifestyle changes you can make to reduce your blood pressure risk.

 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Bad weather could raise your blood pressure and even kill you. Daily Mail, May 21 2013

Chilly days can kill by raising blood pressure. Daily Express, May 22 2013

Links To Science

Aubinière-Robb L, Jeemon P, Hastie CE, et al. Blood Pressure Response to Patterns of Weather Fluctuations and Effect on Mortality. Hypertension. Published online May 6 2013

“Mothers’ diets may harm IQs of two babies in three,” warns The Independent. The newspaper reports on its front page that iodine deficiency is widespread among pregnant women.

Iodine is recognised to play a role in the healthy development of the baby’s brain and nervous system while in the womb and the World Health Organization recommends that pregnant women eat iodine-rich foods.

Severe lack of iodine is one of the leading causes of brain damage in the developing world. But a new study, reported in most of the media today, suggests that even mild-to-moderate iodine deficiency during pregnancy may be associated with poorer cognitive function in the child.

In this large study, the iodine levels of pregnant women were measured, and their child’s IQ at age eight and reading ability at age nine were tested.

The researchers found that children of women who didn’t get enough iodine were more likely to be in the lowest quartile for verbal IQ, reading accuracy and reading comprehension. However, there was no significant difference in overall IQ.

A study of this kind has limitations, for example the fact that it relies on measurements being taken at a single point in time. Also, although the researchers adjusted for many factors that may have influenced the relationship (for example, parental lifestyle and socioeconomic factors), the study cannot prove a direct cause and effect relationship between a mother’s iodine consumption during pregnancy and her child’s cognitive ability. It is also not clear whether the differences seen in the children’s verbal and reading skills would translate into ‘real-world’ problems for these children.

Nevertheless, the study does highlight the need for pregnant women to get enough iodine during pregnancy.

Where did the story come from?

The study was carried out by researchers from the University of Surrey and the University of Bristol. No specific funding was reported for the current study, but researchers were supported by the Waterloo Foundation, the Commission of the European Communities, the US National Oceanographic and Atmospheric Administration and Wassen International. The latter is a company that makes and sells iodine supplements. However, none of these organisations had any role in how the study was conducted or how the collected data was interpreted.

This study used information taken from a much larger ongoing cohort study known as the Avon Longitudinal Study of Parents and Children (ALSPAC), which is looking at the health outcomes of children born during the 1990s. The ALSPAC study is supported by the Medical Research Council, the Wellcome Trust and the University of Bristol.

The study was published in the peer-reviewed medical journal The Lancet.

The media reporting is generally representative of the study, although the Mail Online headline writers got into a serious muddle. When they first published the story they used the headline “Drinking organic milk in pregnancy is 'vital for the baby's future brain power'". This was then changed later in the day – "Drinking organic milk in pregnancy could be harming baby’s IQ".

Neither claim is supported by this study. The study did not assess women’s dietary iodine intake from different sources. So it is not possible to say how many women drank organic milk and whether those who did were more likely to be in the iodine deficient group.

 

What kind of research was this?

The researchers say that the World Health Organization considers iodine deficiency to be “the single most important preventable cause of brain damage” worldwide. Iodine has a role in regulating the thyroid gland, and thyroid hormones have a role in brain and nervous system development. 

The researchers say that changes to dairy farming after the 1930s increased the amount of iodine in milk in the UK. After this and due to the reduction in cases of goitre associated with thyroid problems in the UK it was considered that iodine intake in the UK was sufficient.

However, some more recent UK studies have suggested that mild iodine deficiency may be quite common among adolescent schoolgirls and pregnant women.

The current study used data collected from participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study to see whether there was an association between pregnancy iodine levels and child cognitive performance. The researchers speculated that women with lower iodine levels during pregnancy would have children with poorer cognitive outcomes.

 

What did the research involve?

The ALSPAC cohort was eligible to all pregnant women in southwest England with a due date between April 1991 and December 1992.

A total of 14,541 pregnant women were enrolled and 13,988 of their children survived for at least 12 months.

The researchers selected 1,040 women for whom they could measure iodine in the first trimester of pregnancy (up to 12 weeks) and their child’s IQ when they were eight years old.

Iodine was measured in a single urine sample. Urinary iodine levels are said to be a good indicator of iodine levels in the body as 90% of ingested iodine is excreted into the urine. However, the results would have been more accurate if the researchers had been able to measure iodine based on 24-hour urine collection.

To try to reduce the impact of this issue, the researchers looked at the iodine-to-creatinine ratio, which is said to be a good way to get a more accurate iodine measurement. The researchers defined adequate iodine as an iodine-creatinine ratio of 150 micrograms or more per litre. Iodine deficiency was sub-categorised as mild-to-moderate (50 to 150) or severe (less than 50).

Child IQ at the age of eight was assessed using a validated scale (the Wechsler Intelligence Scale for Children). At the age of nine psychologists also assessed children’s reading speed, accuracy and comprehension. 

The researchers looked at the association between pregnancy iodine status and IQ at the age of eight and reading at the age of nine. They adjusted analyses for a wide range of confounders including:

• mother’s age
• mother’s ‘parenting score’ (assessed by looking at cognitive stimulation of the baby, parental education and socioeconomic status)
• home environment, including baby’s emotional and cognitive environment
• family adversity
• stressful events during pregnancy
• infant birth weight and prematureness
• breastfeeding history
• maternal smoking and alcohol intake
• other dietary factors during pregnancy, including intakes of omega-3 fatty acids and iron

 

What were the basic results?

The researchers found that, overall, the women in the study had an average (median) urinary iodine concentration of 91 micrograms per litre, and average iodine-to-creatinine ratio of 110 micrograms per litre. About two-thirds of women in the study (67%) were iodine deficient in pregnancy. None of the women was using an iodine supplement.

Compared with mothers with adequate pregnancy iodine, those with iodine deficiency were significantly younger and less educated, but had less exposure to stressful life events in pregnancy.

Compared with children of women with adequate pregnancy iodine levels and after adjustment for confounders, children of women with iodine deficiency were at significantly higher risk of:

• having a verbal IQ score in the lowest quartile (odds ratio 1.58, 95% confidence interval (CI) 1.09 to 2.30)
• having a reading accuracy score in the lowest quartile (odds ratio 1.69, 95% CI 1.15 to 2.49)
• having a reading comprehension in the lowest quartile (odds ratio 1.54, 95% CI 1.06 to 2.23)

However, there was no significant association between pregnancy iodine deficiency and performance IQ or overall IQ score – only verbal IQ. There was also no significant association between iodine deficiency and reading score or number of words read per minute – only reading accuracy and comprehension.

 

How did the researchers interpret the results?

The researchers say that their results demonstrate the importance of having adequate iodine intake during early pregnancy. They say that the results “emphasise the risk that iodine deficiency can pose to the developing infant, even in a country classified as only mildly iodine deficient”. The researchers consider iodine deficiency during pregnancy to be an important public health issue that needs attention.

 

Conclusion

This is a valuable study that demonstrates that in this subsample of a large cohort of pregnant women in the UK, the majority had inadequate iodine levels during pregnancy.

They also found that this deficiency was associated with poorer verbal IQ in their children at the age of eight, and reading accuracy and comprehension at the age of nine.

The study benefits from its relatively large sample size, from the fact that it followed participants up over time and from the fact that it adjusted for extensive confounding factors.

However, there are some limitations to this study:

• As the researchers say, several 24-hour urine collections would have been the ideal way to measure iodine levels, rather than a single measure, but this would be impractical in a large-scale study.
• It would also be useful to continue to reassess the children’s IQ and reading performance at different time points, particularly as the associations were only found for certain measures of IQ and reading ability. Related to this, it is also unclear what impact these differences in verbal IQ and reading accuracy and comprehension would have had on the children’s learning and school performance. Children’s IQs are not thought to be fixed for life but can change over time.
• Studies in other population samples from other countries would be valuable.

The researchers note that a randomised controlled trial assessing the effect of iodine supplementation in pregnant women on child cognitive ability in areas with mild-to-moderate iodine deficiency would be valuable. They say that they hope to run such a trial in the UK, as current evidence from trials in this area is weak. 

Overall, the study highlights the need for pregnant women to obtain sufficient iodine during pregnancy. The World Health Organization recommends that pregnant and breastfeeding women consume 250 micrograms of iodine a day.

Dietary sources of iodine include dairy products and fish. Pregnant or breastfeeding women who are unable or unwilling to eat these types of iodine-rich dietary sources may need supplements.

If you are pregnant or breastfeeding and are concerned about your iodine levels, speak to your GP or midwife before taking supplements. Supplements will not be suitable for every woman.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Mothers' diets may harm IQs in two-thirds of babies. The Independent, May 22 2013

Iodine deficiency 'may lower UK children's IQ'. BBC News, May 22 2013

Women who drink organic milk in pregnancy could be harming their baby's IQ. Mail Online, May 22 2013

Enough iodine vital in pregnancy – study. The Guardian, May 22 2013

Links To Science

Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC) . The Lancet. Published online May 22 2013

'Should you be taking vitamin B to protect against Alzheimer's?,' asks the Daily Mail.

Its question is prompted by new research into whether a daily dose of vitamin B could reduce the loss of brain tissue in people with mild cognitive impairment. Mild cognitive impairment is thought to be a risk factor for developing Alzheimer’s disease.

The researchers were particularly interested in the effects of B vitamins on ‘grey matter’ – brain tissue. Grey matter consists of a complex mixture of nerve cells and is found in regions of the brain associated with higher cognitive functions, such as memory and reasoning. Previous studies have found that in people with Alzheimer’s disease, certain regions of grey matter begin to shrink, and this may contribute towards the symptoms of the disease.

This research clearly shows that grey-matter loss in certain regions of the brain was reduced with B vitamin treatment – and the results were particularly striking in patients with high levels of an amino acid called homocysteine.

However, whether the reduction in grey matter shrinkage caused by the vitamin B treatment reduced the likelihood of participants developing Alzheimer’s disease, is unknown.

Until further trials have confirmed the benefits of B vitamin supplements and found that they outweigh any potential harms, the best way to keep healthy in mind and body is to eat a balanced diet, control your weight and blood pressure, and to take some exercise.

 

Where did the story come from?

The study was carried out by researchers from the University of Oxford, the University of Warwick, and the University of Oslo, Norway. It was funded by a wide range of charitable organisations and research institutes.

The study was published in the peer-reviewed Proceedings of the National Academy of Sciences of the United States of America (PNAS).

The researchers hold patents on the use of B vitamins to treat Alzheimer’s disease or mild cognitive impairment, meaning they could benefit financially if vitamin B treatments were licensed for this use.

This story was widely reported in the media. The Daily Express went with the headline “The daily vitamin B pill that halts the ravages of dementia” and The Daily Telegraph with “Vitamin B could stave off Alzheimer’s”. Unfortunately, these headlines are a little optimistic, as although the study found that vitamin B reduced loss of grey matter in certain parts of the brain, especially in older people with high levels of the amino acid homocysteine, the effects this reduction had on an individual’s risk of developing Alzheimer’s disease were not assessed. 

 

What kind of research was this?

This was a randomised controlled trial that aimed to determine whether B vitamins are effective in preventing the shrinkage of grey matter in areas of the brain known to be vulnerable to Alzheimer’s disease, especially those regions linked to mental processes.

This was a secondary analysis of data collected in a previous study which found that B vitamins reduce whole volume brain shrinkage.

A randomised controlled trial is the best type of study design to address this question.

 

What did the research involve?

The researchers randomised 156 elderly volunteers with memory complaints who fulfilled criteria for mild cognitive impairment to receive B vitamin treatment (folic acid 0.8mg/day, vitamin B12 0.5mg/day, vitamin B6 20mg/day) or placebo for 24 months.

Images of the participants’ brains were taken at the start and end of the study using magnetic resonance imaging (MRI). The researchers compared the images to see whether B vitamins prevented shrinkage of grey matter in areas of the brain affected by the Alzheimer’s disease, especially those regions linked to mental processes.

 

What were the basic results?

Grey matter volumes were similar at the start of the study in both groups. Over the course of the study, areas of grey matter shrunk in both the placebo and B vitamin groups. However, participants who received B vitamins had less shrinkage of certain areas of grey matter than participants who received placebo.

The researchers report that significant reductions in grey matter loss were seen in some of the regions most affected in Alzheimer’s disease.

The researchers drew on the results of previous research, which has found that levels of an amino acid called homocysteine may play a role in cognitive impairment, Alzheimer’s disease and vascular dementia.

They found that participants with higher homocysteine levels had smaller brain volume, and a faster reduction in brain size.

B vitamin treatment had no effect in participants who had homocysteine levels below the median (average), but significantly reduced grey matter loss in participants with homocysteine levels above the median.    

The researchers also monitored changes in participants’ scores on a variety of neuropsychological scales. They found that scores were correlated with grey matter loss in certain regions, some of which shrunk less with vitamin-B treatment than placebo in participants with high homocysteine levels.

Based on these findings, the researchers suggest that changes in vitamin B12 levels that occur with B vitamin treatment leads to a reduction in homocysteine levels. This decreases the rate of grey matter loss. This in turn affects neuropsychological functioning.

 

How did the researchers interpret the results?

The researchers conclude that, “our results show that B-vitamin supplementation can slow the atrophy [shrinkage] of specific brain regions that are a key component of the Alzheimer’s disease process and that are associated with cognitive decline.”

They go on to suggest that “further B vitamin supplementation trials focusing on elderly subjects with high homocysteine levels are warranted to see if progression to dementia can be prevented.”

 

Conclusion

This two-year long randomised controlled trial found that B vitamin treatment significantly reduces loss of grey matter in certain regions of the brain in elderly volunteers with mild cognitive impairment. The researchers report that these regions are specifically vulnerable to Alzheimer’s disease. B vitamin treatment was beneficial for the subgroup of participants who had higher than average levels of an amino acid called homocysteine.

This research clearly shows that grey matter loss in certain regions of the brain was reduced with B vitamin treatment. This follows on from the researchers’ previous findings that B vitamin treatment slows brain shrinkage.

However, it is less clear whether the reduction in grey matter actually had any real health impact on individual people. Although the researchers report that loss of grey matter was linked to declining neuropsychological scores, they do not specifically report that participants who received the B vitamins improved their brain function scores. Whether the B vitamin treatment actually prevented Alzheimer’s disease is also unknown.

B vitamins are a recurring focus of Alzheimer’s disease research, and they have been studied in both the prevention and treatment of the disease. This may partly be because vitamin B deficiency can have an effect on brain function.

For more background information about vitamin B, Alzheimer’s, and how it has been reported in the news, read the Behind the Headlines special report on ‘Alzheimer's in the news’

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Should you be taking vitamin B to protect against Alzheimer's? Daily Mail, May 21 2013

Vitamin B could stave off Alzheimer's. The Daily Telegraph, May 20 2013

The daily vitamin B pill that fights dementia. Daily Express, May 21 2013

Links To Science

Douaud G, Refsum H, de Jager CA, et al. Preventing Alzheimer's disease-related gray matter atrophy by B-vitamin treatment. PNAS. Published online May 20 2013

"Bed-sharing 'raises cot death risk fivefold'," BBC News reports. The news has featured in much of the media, with headlines based on a large analysis of previous studies into the risk of cot death, or sudden infant death syndrome (SIDS), associated with bed-sharing.

Bed-sharing is where babies sleep in the same bed as their parents. It has long been known that bed-sharing with a parent who smokes or has consumed drugs or alcohol increases the risk of SIDS.

This new study aimed to see if bed-sharing still increased the risk of SIDS in the absence of these risk factors.

The researchers found a fivefold increase in the risk of SIDS associated with bed-sharing in breastfed babies who were under three months old, had parents who did not smoke, and when the mother had not had any alcohol or drugs.

The risk of SIDS was even higher when the parents smoked, drank or used drugs.

It is important to note that the researchers did not conclude that babies should not be brought into their parents' bed for comfort and feeding, only that they should not sleep in the same bed as their parents.

It is also important to be aware that the overall risk of SIDS is very small and it is a rare condition. However, there are simple steps parents can take to reduce the risk of SIDS (see box), and it is well worth following this potentially life-saving advice.

  

Where did the story come from?

The study was carried out by an international team of researchers from the London School of Hygiene and Tropical Medicine, the University of Glasgow and the Medical Research Council, UK; the Children's University Hospital, Ireland; the University of Auckland, New Zealand; and the University of Muenster, Germany.

No external sources of funding were reported, although the original research this report is based on was funded by a number of governmental bodies, charities and trusts.

The study was published in the peer-reviewed open access medical journal, BMJ Open.

The story was well reported by the media. 

 

What kind of research was this?

This study combined information from individuals in five large case-control studies. These studies had collected data on babies who died from SIDS (cases) and babies of a similar age who were still alive (controls).

The researchers were interested in bed-sharing specifically. The research aimed to resolve the uncertainty over whether there is a risk of SIDS associated with bed-sharing in breastfed babies where neither parent smoked. 

 

What did the research involve?

The researchers combined individual data from studies in the UK, Europe and Australasia. In total, information was collected for 1,472 babies who died from SIDS and 4,679 control infants, all under one year of age. Control infants were randomly selected normal infants of a similar age, from a similar location and born at a similar time.

The researchers estimated the risk associated with bed-sharing in relation to breastfeeding, smoking, and the mother's recent alcohol consumption or illegal drug use. This was after they had controlled for other important risk predictors, including:

• whether the baby slept in the parents' room or elsewhere
• the position in which the baby was put to sleep
• mother's age
• mother's relationship status
• the number of children the mother had had previously
• the baby's birth weight

 

What were the basic results?

The researchers found that 22.2% of cases and 9.6% of controls reported a history of bed-sharing. Bed-sharing increased the risk of SIDS fivefold (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 2.3 to 11.4) compared with room-sharing (assuming the baby was placed on his or her back in a cot in the parents' room) when:

• neither parent smoked
• the mother did not drink
• the baby was less than three months old
• the baby was breastfed, and
• there were no other risk factors

The researchers estimate that the absolute risk of SIDS for room-sharing infants was 0.00008 (eight per 100,000) when neither parent smoked and the baby was less than three months old, breastfed, and had no other risk factors.

Bed-sharing increased the absolute risk of SIDS by 0.15 per 1,000. This means the absolute risk from bed-sharing was 0.00023 (0.23 per 1,000).

Bed-sharing, smoking and alcohol use all increased the risk of SIDS. However, the risks associated with bed-sharing decreased as the baby got older.

 

How did the researchers interpret the results?

The researchers concluded that, "Bed-sharing for sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. Risks associated with bed-sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed-sharing."

 

Conclusion

This large case-control study combined information from five studies to investigate the risk of sudden infant death syndrome (SIDS) associated with bed-sharing.

It found that bed-sharing is associated with a fivefold increase in the risk of SIDS compared with room-sharing for babies who were less than three months old, breastfed, sharing with non-smoking parents, and the mother had not had alcohol or drugs.

Smoking, alcohol and drug use are already recognised risk factors for SIDS and greatly increase the risk associated with bed-sharing.

The researchers have not concluded that babies should not be brought into the parents' bed for comfort and feeding. Rather, they advise that babies should not sleep in their parents' bed. It is also worth highlighting the very small actual risk of SIDS, both for non-sharing and bed-sharing babies.

Although this study was appropriately designed and controlled for, a number of potential factors that could affect the risk of SIDS and the causes of SIDS are not firmly established. This means that there may be other factors responsible for the observed increase in risk associated with bed-sharing.

To decrease the risk of SIDS, current advice recommends:

• putting your baby to sleep on their back – the safest place for them to sleep is in a cot in a room with you for the first six months
• do not smoke
• do not share a bed with your baby, particularly if you have been drinking or have taken drugs
• never sleep with your baby on a sofa
• do not let your baby get too hot and keep your baby's head uncovered
• if possible, breastfeed your baby

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Bed-sharing 'raises cot death risk fivefold'. BBC News, May 21 2013

Sudden infant death risk 'is five times higher if the baby sleeps in its parents' bed'. Daily Mail, May 20 2013

Sudden infant death risk greater when parents share bed with babies. The Guardian, May 20 2013

Parents warned sharing bed with babies increases risk of cot death. The Independent, May 21 2013

Sharing bed with babies raises cot death risk. The Daily Telegraph, May 20 2013

Cot Death Risks Of Babies Bed Sharing. Sky News, May 21 2013

Links To Science

Carpenter R, McGarvey C, Mitchell EA, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies. BMJ Open. Published online May 20 2013

'A stressful job really can kill you – by raising your cholesterol,' reports the Mail Online website. This headline is based on Spanish research that looked at the relationship between job stress and lipid (fat) levels in the blood of more than 90,000 people.

The research found that people who reported difficulties coping with their job had higher levels of what has been dubbed "bad cholesterol" (LDL cholesterol) and lower levels of "good cholesterol" (HDL cholesterol). High levels of LDL cholesterol can clog up the arteries, increasing an individual's risk of developing cardiovascular diseases such as coronary heart disease.

A significant strength of this study is its size – an impressive 90,000 people participated. But the study did not look at diet, which can also affect cholesterol levels. It could well be the case that people in stressful jobs tend to have unhealthy diets and it is this, rather than stress itself, that is to blame for their higher "bad" cholesterol rates.

While increased LDL levels are a risk factor for cardiovascular diseases, this study did not explore the effect this would have on people's long-term health. The Mail Online's claim that a stressful job will kill you is therefore not supported by this study.

 

Where did the story come from?

The study was carried out by researchers from Ibermutuamur – a mutual insurance company dealing with work-related accidents and occupational illnesses – and two universities in Spain. There were no external sources of funding for the study.

It was published in the peer-reviewed Scandinavian Journal of Public Health.

The Mail Online's headline over-interprets the research, as the study did not assess whether people in stressful jobs were more likely to die. The body of the story was reasonably accurate, but it did not highlight that this type of study cannot prove that one factor is definitely causing another.

 

What kind of research was this?

This was a cross-sectional study that explored whether there is a link between job stress and abnormal levels of fats (lipids) in the blood.

Some studies have found a link between job stress and an increased risk of coronary disease. There are various theories about how this link might come about – for example, by stress increasing the likelihood of unhealthy habits such as smoking.

Some studies have also suggested that stress could directly influence levels of lipids in the blood by possibly adversely affecting the body's metabolism. However, these studies have been small and in selected populations, and have had mixed results.

In the current study, researchers wanted to assess stress and lipid levels in a large representative sample of workers. As this study is cross-sectional, both stress and lipid levels were assessed at the same time. This means the study cannot establish whether participants' lipid levels were directly influenced by their stress levels.

 

What did the research involve?

The study involved workers covered by the Ibermutuamur insurance company who had yearly medical check-ups. More than 430,000 participants were recruited between 2005 and 2007, and a study questionnaire was sent out to more than 100,000 randomly selected individuals. Completed questionnaires were returned by 91,593 of these people.

The questionnaire included the question, "During the last year, have you frequently felt that you cannot cope with your usual job?". Participants who answered "yes" were considered to have job stress.

The questionnaire also included 11 questions relating to anxiety and depression symptoms, such as "Have you felt keyed up, on edge?" and "Have you had difficulty relaxing?".

The researchers took fasting blood samples from participants and measured levels of total cholesterol, HDL cholesterol (so-called "good" cholesterol), and levels of a type of lipid called triglycerides. The levels of so-called "bad" cholesterol were calculated based on these measurements.

Participants were classed as having abnormal lipid levels based on pre-specified levels if they reported taking lipid-lowering medication or had been diagnosed as having abnormal lipid levels.

The researchers then looked at whether abnormal lipid levels are linked to job stress. They took into account the following confounders:

• age
• gender
• smoking
• basic measures of alcohol consumption and physical leisure activity
• obesity 
• type of job ("blue collar" or "white collar")

 

What were the basic results?

Job stress was reported by 8.7% of participants. Participants reporting job stress also had higher levels of anxiety and depression symptoms.

After the researchers took into account factors that could affect the results and adjusted them accordingly, people who reported job stress were found to have 10% higher odds of having abnormal lipid levels (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.04 to 1.17).

They also had increased odds of:

• high levels of "bad" cholesterol (LDL)
• low levels of "good" cholesterol (HDL)
• a high total cholesterol to "good" cholesterol ratio
• a high "bad" cholesterol to "good" cholesterol ratio
   

How did the researchers interpret the results?

The researchers concluded that their results support an association between job stress and abnormal lipid levels in the blood.

 

Conclusion

This study has found an association between job stress and abnormal lipid levels in the blood. Its strengths include the large number of workers assessed (more than 40,000) and the use of the same methods to assess all of the participants.

However, the fact that both job stress and lipid levels were assessed at the same time means it is not possible to say for certain whether job stress might have directly caused changes in blood lipid levels.

There are also other limitations and points to note:

• The study did not assess diet. People with job stress may have less healthy diets, which could account for the differences seen in the blood lipid levels, rather than these differences being a direct impact of job stress.
• Job stress was assessed by a single question, which may not fully capture all aspects of job stress. Also, different people may consider different things stressful, and the question did not disentangle the exact stressful workplace situations and an individual's ability to cope with them.
• Workers who were off sick would not have had the routine medical check-up. This means the sample may have missed some people with more serious health problems with stress.
• The authors acknowledge that the effect of job stress seen is relatively small – a 10% increase in the odds of having abnormal lipid levels.

Overall, it is not clear from this study whether stress is a direct cause of the increased lipid levels seen. Studies looking at whether interventions to reduce work stress can reduce lipid levels in the blood would provide an indication if this is in fact the case.

Despite these limitations, there is a wide range of good quality evidence that workplace stress can have a harmful effect on your physical and mental health.

While some people may thrive on pressure, persistent high levels of stress are likely to be harmful.

Read more about what you can do to reduce your levels of workplace stress.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

A stressful job really CAN kill you - by raising your cholesterol. Mail Online, May 17 2013

Links To Science

Catalina-Romero C, Calvo E, Sánchez-Chaparro MA, et al. The relationship between job stress and dyslipidemia. The Scandinavian Journal of Public Health. Published online January 2 2013 

”Sunshine vitamin 'may treat asthma'”, BBC News informs us, as a new lab-based study suggests vitamin D could help control symptoms of severe asthma.

Asthma is caused by inflammation of the airways, related to malfunctioning of the body’s immune system. In theory, the immune system mistakes harmless substances, such as dust mites, as a threat and triggers inflammation of the lungs and airways (which causes the symptoms of asthma).

The study in question looked at IL-17A, which is one of the molecules thought to be associated with the malfunctioning immune response seen in asthma. Researchers examined whether vitamin D had an effect on the levels of the molecule produced by white blood cells in a laboratory experiment.

Researchers found that vitamin D reduced the levels of IL-17A produced by cells from people with asthma. This included cells from people who had previously failed to respond to the treatment of choice for severe asthma – oral corticosteroids – often referred to as steroids.

While this study suggests that vitamin D can have an effect on IL-17A levels in the laboratory, it is certainly too early to hail vitamin D as a potential “cure” for asthma. A positive effect on cells in the lab does not guarantee vitamin D supplements will improve symptoms for people with asthma. Clinical trials in people with asthma are ongoing to test whether this will be the case.

 

Where did the story come from?

The study was carried out by researchers from King’s College London; Queen Mary, University of London, and the Homerton University NHS Foundation Trust. It was funded by Asthma UK and the National Institute for Health Research, and some researchers received Medical Research Council Funding. The study was published in the peer-reviewed Journal of Allergy and Clinical Immunology.

This study was reported by the BBC, Daily Mail, and the Daily Express. The BBC correctly points out that treating asthma patients with vitamin D “has not yet been tested”. The main text of the Mail’s coverage is generally accurate, although their headline suggests that “Vitamin D ‘helps beat the symptoms of asthma’”, when this was not assessed by the study. The Express’s coverage over-interprets the results by suggesting that “Soaking up sun could be a cure for asthma” or could be “the best way of treating asthma”.

 

What kind of research was this?

This was a laboratory study looking at the effect of vitamin D on one type of white blood cell (T helper cells called TH17 cells) from people with asthma.

One type of T helper cell called TH2 is known to be involved in inflammation of the airways in asthma. However, some evidence suggests that other T cells may also play a role.

TH17 cells are involved in defending the body against bacterial and fungal infections. There is some evidence that these cells may be involved in severe asthma. Also, one of the inflammatory substances produced by these cells, called IL-17A, may exacerbate asthma and reduce patients’ ability to respond to standard treatment for severe asthma – oral corticosteroids (steroids).

Previously, studies had shown that vitamin D could influence the T cells from patients with severe asthma, and also affect TH17 cells. The researchers in the current study wanted to see if vitamin D affected IL-17A production by TH17 cells collected from asthma patients. They also wanted to see whether this effect was different in people who were resistant to steroid treatments.

 

What did the research involve?

The researchers took blood from 10 healthy adults and 28 patients with moderate to severe asthma and extracted white blood cells, including T cells. The patients had to have had diagnosed asthma for at least six months. Of the patients, 18 had asthma that did not respond as well to oral steroid treatment (steroid resistant asthma), and 10 had asthma that responded to steroids.

The researchers grew the white blood cells in the laboratory, either with or without vitamin D and the steroid dexamethasone, and looked at how much IL-17A was being produced. They assessed whether this varied between people with and without asthma, or in people with steroid resistant asthma.

 

What were the basic results?

White blood cells from people with asthma produced higher levels of IL-17A than those from non-asthmatic patients. Furthermore, white blood cells from people with steroid resistant asthma produced the highest levels of IL-17A.

Treating the white blood cells with vitamin D reduced the production of IL-17A. This reduction occurred in cells from people with steroid-resistant asthma and steroid-sensitive asthma, and was not affected by adding the steroid dexamethasone.

 

How did the researchers interpret the results?

The researchers concluded that their results support the hypothesis that vitamin D could improve disease control in people with asthma by reducing IL-17A levels, regardless of whether the person’s asthma is steroid-resistant.

 

Conclusion

The current laboratory study suggests that vitamin D can reduce white blood cell production of an inflammatory molecule implicated in asthma.

These results were obtained from cells in the laboratory, and further research will be needed to determine whether this effect will also be seen if people with asthma are given vitamin D.

While the results perhaps give a reason to investigate vitamin D further, not all treatments showing initially positive results in laboratory studies go on to have a positive effect on real-world clinical outcomes.

The good news is, as the Daily Mail reports, the results of this study are being followed up with a randomised controlled trial in participants with steroid resistant asthma.

Randomised controlled trials are the best way of testing if treatments are effective. This trial, and others, will tell us if vitamin D works as a treatment for asthma and if so, who it might be effective at treating. 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

Sunshine vitamin 'may treat asthma'. BBC News, May 20 2013

Vitamin D 'helps beat symptoms of asthma’. Daily Mail, May 20 2013

Soaking up sun could be a cure for asthma. Daily Express, May 20 2013

Links To Science

Nanzer AM, Chambers ES, Ryanna K, et al. Enhanced production of IL-17A in patients with severe asthma is inhibited by 1α,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion. The Journal of Allergy and Clinical Immunology.

 

 

"Children are picking up the caring roles the state has abandoned," The Guardian says, while The Independent says that 180,000 children work as unpaid carers.

These new figures come from the Office for National Statistics, which has pulled together data on unpaid care in England and Wales from the 2011 census.

The census (which has been carried out every 10 years since the middle of the nineteenth century) reveals an increase in the proportion of the population who are providing unpaid care.

This has risen from 11.5% in 2001 to 11.9% in 2011 in women, and from 8.8% to 9% in men. There tend to be more female carers than male, with the highest burden of care falling on the 50-64 age group for both sexes.

A related report produced by the charity The Children’s Society – based on the same data – has highlighted the issue of children acting as unpaid carers.

The charity's report describes how the census data estimated that there are around 160,000 unpaid young carers in England. It goes on to explain that this is likely to be an underestimate.

 

What does the ONS find about the gender of carers?

Just over half (58%) of the 5.41 million people providing some level of unpaid care in England are female and 42% are male. This higher proportion of female carers is consistent across all regions. Female carers are representative of 11.9% of the total female population of England and Wales, and male carers are representative of 9% of the male population. Ten years ago these figures were 11.5% and 8.8%.

The level of care provided was most often between one and 19 hours a week. However, 2.9% of the female population and 2% of the male population provided 50 or more hours of care a week. In 2011 in England, 9.5% of the male working population and 13.3% of the female working population were also providing some level of unpaid care. In England, 1.2% of the female population and 1% of the male population were in full-time employment at the same time as providing 50 or more hours of unpaid care. If you are a working carer, read the NHS Choices advice on combining caring with working or studying.

Links To The Headlines

180,000 children work as unpaid carers for relatives. The Independent, May 16 2013

Carers putting their own health at risk, census shows. The Daily Telegraph, May 16 2013

Children are picking up the caring roles the state has abandoned. The Guardian, May 16 2013

Young carers: Quarter of a million children provide care for others. BBC News, May 16 2013

“IVF advance triples couples' chances of having a baby”, The Daily Telegraph reports.

The innovation in question is actually based on an old imaging technique called time-lapse photography, where a camera is set to record a series of images at regular intervals. This technology is now available for monitoring the development of IVF embryos before they are transferred into the womb.

The researchers in this study developed a way of using the information collected to identify which embryos had a low or high chance of having an abnormal number of chromosomes (called aneuploidy). Aneuploidy can reduce the chances of embryos successfully implanting and resulting in a healthy live birth.

In this study, the researchers looked back at time-lapse imaging for embryos from 69 couples who had IVF. They wanted to know if their technique correctly identified embryos which were more likely to result in a pregnancy or live birth.

The time-lapse cameras allowed the researchers to potentially ‘screen’ embryos for risk of aneuploidy. From this, they would then be able to choose the low risk embryos for implantation.

The researchers found that 73% of the embryos their assessment would have classed as low risk resulted in a pregnancy at five to six weeks, and 61% resulted in a live birth. These rates were higher compared to the overall rate for all embryos (at any risk level), where the pregnancy rate was 42% and the live birth rate was 39%. However, it is important to restate that the new system was not used to intervene, so the results are based purely on observation.

While the results are promising, the technique is still in its early stages. Further research is needed to more widely test the technique and directly compare its results to standard methods.

 

Where did the story come from?

The study was carried out by researchers from CARE Fertility, an independent provider of fertility treatment and related services in the UK and Ireland. No sources of financial support were reported and the authors reported that they had no financial or commercial conflicts of interest.

The study was published in the peer-reviewed medical journal, Reproductive Biomedicine Online.

The study was well reported in the media, with BBC News coverage including an informative video to explain the technique.

However, potentially confusing figures are reported in other parts of the media.

The Times reported that the new technique “could give a 78% chance of success” while the Daily Mail reports that “Early trials show 78% of women having the test will have a healthy baby”.

The Guardian’s reporting suggests that “Doctors in Nottingham who devised the procedure say it could raise live birthrates at their clinic to 78%...” and this may be where this figure has come from.

However, this 78% figure does not come from the research paper itself, which reports that 61% of the low risk embryos successfully resulted in a live birth – not 78%.

 

What kind of research was this?

This study looked at whether the novel technique based on time-lapse images of IVF embryos might help select the embryos most likely to successfully produce a baby.

Until now, the researchers say that the vital decision about which IVF embryo should be selected and transferred into the mother’s womb is mainly based on between two and six observations of the developing embryo under the microscope.

To observe the embryo’s development, doctors have had to remove the culture dish containing the embryos from the very controlled environment of the incubator and place them under a microscope in the ambient air of the laboratory. This is usually only performed once a day to minimise disturbance to the embryo.

The authors of the study report that a major reason for IVF failure and miscarriage is that the implanted embryo has an abnormal number of chromosomes (aneuploidy). To accurately detect any chromosomal abnormality requires an invasive biopsy of the developing embryo, followed by genetic testing.

Currently it is not possible to reliably identify those embryos with an increased chance of aneuploidy with the normal microscopic observations of the embryo.

The current study tested a way of identifying the embryos at low risk of having abnormal numbers of chromosomal, using time-lapse imaging of the embryo. A relatively new system now allows doctors to obtain a stream of thousands of microscopic images of developing embryos (time-lapse images), without having to remove embryos from the incubator.

Using this system, the researchers previously found that embryos with an abnormal number of chromosomes take a different length of time to reach certain developmental stages than normal embryos. Based on this, they developed a method to identify those embryos at low, medium, and high risk of having an abnormal number of chromosomes.

In their current study, the researchers looked back at the results of IVF procedures where the embryos had been assessed using time-lapse imaging. They wanted to see if their method could identify those embryos which were more likely to go on to successfully implant, develop and be born.

It is important to note that the study did not actually use the method to select embryos for implantation – it only looked at what might have happened if the method had been used.

This is an appropriate first step for this type of research and, if the results are promising, the method would need to go on to be tested “for real” to select embryos, to see if it performed better than standard methods.

 

What did the research involve?

This study looked at the treatment outcomes for 88 embryos from 69 couples who attended the CARE Fertility clinic in Manchester between April 2011 and December 2012, and who had a known outcome from their IVF.

This meant that they knew if transfer of the embryo(s) had resulted in:

• failed implantation – where the woman had a negative pregnancy test
• clinical pregnancy – defined as the presence of a developing embryo with a heart beat at between six and eight weeks of pregnancy
• a live birth – identified through the mother completing a clinic delivery outcome form, which according to regulations is reported to the UK Human Fertilisation and Embryology Authority

The researchers excluded cases where two embryos were implanted but did not both have the same outcome, as they would not be able to tell which embryo had which outcome.

The egg cells collected from the women had been fertilised using intra-cytoplasmic sperm injection (ICSI), where a single sperm is injected directly into the egg. The fertilised eggs were then placed into the time-lapse incubator for culturing and imaging for five to six days.

The inbuilt microscope took images of the fertilised egg cell every 20 minutes. The image-analysis software recorded the precise timing of developmental events as they occurred. The embryos had been selected using standard existing methods before being transferred into the womb (that is, not using the new risk assessment method).

The researchers used this previously collected data model to assess the embryos, and grade whether the embryos were at low, medium or high risk of having an abnormal number of chromosomes. They then looked at what proportion of each of these three groups of embryos had achieved clinical pregnancy and live birth, and if this differed between the groups.

 

What were the basic results?

The researchers found that of the 88 embryos they assessed, 33 were at low risk for having an abnormal number of chromosomes, 51 at medium risk, and four at high risk.

Overall, 42% of the embryos successfully implanted and had a fetal heart beat at five to six weeks.

Among the low risk embryos, almost three-quarters (73%) successfully implanted and had a fetal heart beat at five to six weeks, compared to a quarter (25.5%) of medium risk embryos and no high risk embryos.

This meant that the 73% figure for low risk embryos is a relative increase of 74% compared with the rate for all embryos (42%) – what the media has translated as a ‘74% chance of successful pregnancy’.

The researchers had data on whether or not women had a live birth for 46 of the embryos (18 low risk, 26 medium risk, two high risk). The rest of the pregnancies had not reached term during the study period.

Overall, 39% of the embryo transfers resulted in a live birth. Among the low risk embryos, 61% resulted in a live birth. Among medium risk embryos, 19% resulted in live birth. None of the high risk embryos resulted in a live birth.

Therefore, the 61% figure for low risk embryos is a relative risk increase of 56% compared with the rate for all embryos (39%) – this is where media reports of the ‘increasing live birth rates to above 50%’ come from.

 

How did the researchers interpret the results?

The researchers say that their risk classification model using time-lapse imaging introduces a non-invasive way of selecting the embryos that are at a low risk of having an abnormal number of chromosomes. They say that this can result in higher likelihood of successful pregnancy and live birth.

 

Conclusion

This study reports on a new technique using ‘time-lapse imaging’ to non-invasively identify the IVF embryos least likely to have abnormal numbers of chromosomes.

An embryo having an abnormal number of chromosomes is one of the reasons IVF can be unsuccessful.

By looking back at the results of previous IVF procedures, the study showed that embryos identified as being low risk using the new method were the most likely to result in a live birth.

To date, IVF techniques rely on removing the embryo from the incubator about once daily over the course of five to six days to view its development under the microscope. As such, current methods only allow for a few static images which cannot give a reliable indication of whether an embryo has chromosome abnormalities, and also disturb the developing embryo. To select the best embryo for implantation, biopsies of the embryo have to be taken to examine the genes. The new technique potentially offers a non-invasive way to assess the risk of chromosome abnormality using detailed time-lapse images.

The results of this study are promising, but there are some limitations:

• It only assessed the outcomes for only 69 couples who received care at one fertility service. Larger numbers of embryos would ideally need to be assessed to confirm the results. Ideally, prospective studies comparing this new technique with standard techniques would also be carried out.
• The researchers note that their methods and results may not be directly transferable to other laboratories or other types of patient populations. 

The technique, while potentially promising, is still in an early stage of development. 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links To The Headlines

IVF could be revolutionised by new technique, says clinic. The Guardian, May 17 2013

'Most exciting breakthrough in IVF treatment in 30 years' could triple number of births. The Independent, May 17 2013

IVF advance triples couples' chances of having a baby. The Daily Telegraph, May 17 2013

IVF test that 'trebles the chance of a baby': Photo method helps doctors implant best embryo. Daily Mail, May 17 2013

IVF 'may be boosted by time-lapse embryo imaging'. BBC News, May 17 2013

New IVF Technique Could Triple Number Of Births. Sky News, May 17 2013

IVF time lapse photographing technique breakthrough could help avoid miscarriages and triple number of births. Daily Mirror, May 17 2013

New IVF technique using time-lapse photos to increase number of healthy births. Metro, May 17 2013

Links To Science

Campbell A, Fishel S, Bowman N, et al. Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS. Reproductive BioMedicine Online. Published online May 13 2013