more_vertWe gather in the atrium of the Royal Swedish Academy of Sciences, founded in 1739, surrounded by statues of Carl Linnaeus and portraits of the great (male) heroes of science (Newton, Galileo, Brahe). Reflecting on the pride and responsibility that Swedish scientists feel for their stewardship of the Nobels, some recalled with fond nostalgia the great lost years of Swedish influence in global health. The amplification of Sweden’s presence in health stemmed from the nation’s distinctive values, innovative research, policy translation, and strong activism.
Preference: Statistics, epidemiology and research design
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[Comment] New pathways of treatment for psoriatic arthritis
Psoriatic arthritis occurs in up to 30% of patients with psoriasis.1 The prevalence of psoriasis varies geographically, ranging between 1% and 3% of the population, depending on genetic variation.2 Since the discovery of the cytokine interleukin 17A in 1993, and the subsequent discovery of one of the key cells that produce interleukin 17A and related cytokines, the T-helper-17 cell, in 2005,3 this pathway has been a focus of research in the pathogenesis of psoriasis and closely related conditions, psoriatic arthritis and spondyloarthritis.
[Editorial] A platinum age for rheumatology
On June 14–17, over 14 000 rheumatologists, health-care professionals, and patients will gather in Madrid, Spain, for the European League Against Rheumatism (EULAR) Annual Congress. 2017 is a particularly special year for the organisation as EULAR celebrates its 70th anniversary. Since our inception, The Lancet has been pleased to have shared in the rich history of rheumatology research, including The “Rheumatic Disease”, coauthored by the founding President of EULAR, Mathius Pierre Weil, in 1928 and today’s issue, which highlights recent and innovative developments in therapeutics and management strategies for rheumatic diseases.
[Obituary] Mark Arnold Wainberg
HIV researcher and activist. He was born in Montreal, QC, Canada, on April 21, 1945, and drowned while on vacation in Bal Harbour, FL, USA, on April 11, 2017, aged 71 years.
[Perspectives] Elizabeth Mayer-Davis: leader in adolescent diabetes
“Doing a lot of seemingly different things that are actually connected”, is the way that Elizabeth Mayer-Davis describes working life as Chair of Nutrition at the University of North Carolina at Chapel Hill, NC, USA. She is currently prioritising research into glycaemic control and weight management in type 1 diabetes; and soon hopes to be working on a trial to investigate how an automated insulin delivery system (the so-called bionic pancreas) will impact on diet and bodyweight. “When it comes to research, I try and see where the gaps in research lie, and work out where I can make a difference”, she says.
[World Report] Medical research in the UK party manifestos
On June 8, the UK will elect the next head of government. Ahead of the election, what are the leading parties promising for medical research? Talha Khan Burki reports.
News briefs
Antiretroviral therapy gives patients with HIV infection 10 more years
Life expectancy of 20-year-old patients starting treatment for HIV has increased by about a decade in the European Union and North America since the introduction of antiretroviral therapy in the mid-1990s, according to research published in The Lancet HIV. The authors, from the University of Bristol, proposed that their findings could reduce stigmatisation and help people with HIV infection gain employment and obtain medical insurance, as well as encouraging diagnosed patients to start treatment as soon as possible. Their projections indicate that the life expectancy of a typical 20-year-old patient who began treatment since 2008 and had a low viral load after a year of treatment may approach that of the general population (about 78 years). The study analysed data from 18 EU and North American studies for 88 504 people with HIV infection who started antiretroviral treatment between 1996 and 2010. It tracked how many people died during the first 3 years of their treatment, their cause of death, HIV viral load, immune cell (CD4) count and whether they were infected through injecting drugs. Fewer people who started treatment between 2008 and 2010 died during the first 3 years of treatment than those who started treatment between 1996 and 2007. The number of deaths during treatment directly attributable to AIDS declined between 1996 and 2010, probably the result of newer drugs being more effective in restoring immune function. Measures of HIV also improved, with the average CD4 cell count after a year of treatment increasing from 370 cells per microlitre of blood in 1996–1999 to 430 cells per microlitre in 2008–2010, while the proportion of people with a low HIV viral load increased from 71% to 93%. Between 1996 and 2013, the life expectancy of 20-year-old patients treated for HIV infection increased by 9 years for women and 10 years for men in the EU and North America. Projections based on death rates in the second and third year of treatment for Europeans and North Americans estimated that 20-year-old men and women starting therapy between 2008 and 2010 who survived the first year of treatment would live to 73 and 76 years respectively.
http://dx.doi.org/10.1016/S2352-3018(17)30086-3
Untethered proteins found in MKD
Researchers from the Garvan Institute of Medical Research in Sydney have shown that a family of untethered proteins builds up in the cells of children with a rare genetic condition, mevalonate kinase deficiency (MKD). Individuals with MKD experience repeated and frequent inflammatory febrile episodes that last for days and are accompanied by hepatosplenomegaly, lymphadenopathy, arthralgia, and skin rash. These febrile crises are similar to those associated with hyperimmunoglobulinemia D and periodic fever syndrome. The attacks usually begin in infancy and continue throughout life, although they are most frequent in children. In blood cells from people with MKD, the investigators found that several intracellular proteins from the same family (Rab proteins) had no isoprenoid tail. Much like a child holding the string of a balloon, an isoprenoid tail is thought to act as a molecular tether for the protein to which it is attached. The isoprenoid tails on Rab proteins keep them close to the cell membrane; without their tethers, the Rab proteins, and other related proteins, are free to move into other parts of the cell. It is thought that this could initiate the disease process in MKD, triggering inflammation. The researchers found that untethered Rab proteins are found only in people in MKD, and not other rare diseases that have similar clinical symptoms (the periodic fever syndromes) or in the parents of children with MKD. These findings, published in the Journal of Allergy and Clinical Immunology, pinpoint a key feature of MKD that could be used to fast-track diagnosis of the disease, a process that is often difficult and protracted.
AMA nomination sought for NHMRC committee
Expressions of interest are being sought for an AMA nomination for consideration as a member of the National Health and Medical Research Council’s working committee reviewing its ethical guidelines on organ and tissue donation and transplantation.
The NHMRC has asked the AMA to nominate a member for the committee as it plans to start a review of the following ethical guidelines:
- Organ and tissue donation after death, for transplantation – Guidelines for ethical practice for health professionals, 2007;
- Making a decision about organ and tissue donation after death, 2007;
- Organ and tissue donation by living donors – Guidelines for ethical practice for health professionals, 2007;
- Making a decision about living organ and tissue donation, 2007; and
- Ethical guidelines for organ transplantation from deceased donors, 2016.
An integral part of this process will be the establishment of the Organ and Tissue Working Committee (OTWC) comprised of members who have experience or expertise in one or more of the following:
- Health ethics;
- Religion;
- The donation and transplantation of organs and tissues from living donors;
- The donation and transplantation of organs and tissues from deceased donors;
- The coordination of organ and tissue donation and transplantation;
- Community and consumer issues related to transplantation, donation and/or health ethics;
- Government policy regarding donation and transplantation of organs and tissues from living and deceased donors; and
- Aboriginal and Torres Strait Islander health issues.
The NHMRC is currently seeking nominations of persons for appointment to the OTWC for the period to 30 December 2019. The AMA has been asked to provide a nominee with experience or expertise in ‘the donation and transplantation of organs and tissues from living and deceased donors’.
The NHMRC will consider nominations from a number of organisations and there is no guarantee the AMA’s nominee will be appointed.
The NHMRC will seek formal declarations of interest, following initial consideration of all nominations. The NHMRC’s Policy on the Disclosure of Interests Requirements for Prospective and Appointed NHMRC Committee members. This policy can be found on their website at: https://www.nhmrc.gov.au/_files_nhmrc/file/about/committees/nhmrc_policy_disclosure_of_interests_committee_members_150513.pdf
The OTWC will be effective for the period 1 July 2017 to 30 December 2019.
Deadline for consideration as AMA nomination
AMA members should send their nomination, along with their Curriculum Vitae, to the Federal AMA Secretariat at ethics@ama.com.au by COB Monday, 12 June. Your personal information will be protected in accordance with the AMA’s privacy policy which can be found on the AMA’s website at privacy-policy.
Australian women’s health needs awareness
A recent study published in PLOS ONE revealed the long-term health picture of Australian women to be deeply concerning.
About 80 per cent of women are not eating enough fruit and vegetables, 70 per cent are not getting enough weekly physical activity and more than half are overweight.
The ongoing Women’s Healthy Ageing Project, undertaken at the University of Melbourne, obtained data on more than 20,000 women aged between 18 and 98 from around Australia for the published study.
Professor Cassandra Szoeke, the Director of the Women’s Healthy Ageing Project, said there was a lack of awareness about women’s health, even among women themselves.
“The recent Alzheimer’s Association report showed that of all cases of dementia, two thirds are women,” Prof Szoeke said.
“And last year the Hidden Hearts report showed heart disease was more common in women than men. Yet when asked, women most feared getting breast cancer despite the fact they had twice the lifetime chance of getting dementia – a terminal disease.”
The top leading cause of death in women is heart disease, followed by dementia. According to the Australian Heart Foundation, heart disease claims 24 female lives every day, more than three times as many women as breast cancer. Fifty Australian women have a heart attack each day.
The Heart Foundation believes that awareness is central to address the heart disease in Australian women. This can start with GPs.
They found in their own research that only 27 per cent of women have spoken to a GP about heart disease and are considerably less likely than men to have a heart attack check.
Other recent research also highlights the importance of raising awareness to women’s long term health.
University of Queensland’s research published in the journal of Paediatric and Perinatal Epidemiology, showed that years of gradual weight gain more than doubles the risk of blood pressure disorders in pregnancy.
The research suggests a gradual weight gain during a woman’s reproductive years can more than double her risk of hypertensive disorders during pregnancy.
UQ Researcher Akilew Adane said this builds on earlier evidence that parents and clinicians should think of pre-pregnancy health across the entire reproductive stage of women’s lives – “not just the year before starting a family”.
“High blood pressure in pregnancy can progress to pre-eclampsia, a potentially fatal complication and one of the leading causes of pre-term birth and low birth weight due to intra-uterine growth restriction,” Mr Adane said.
The research also showed that gradual weight change does have long-term consequences. Previously little was known about the relationship between hypertensive disorders and weight changes in the years leading up to pregnancy.
“We found that women who were obese just prior to pregnancy tripled their risk of developing hypertensive disorders (HDP) compared to women in the healthy BMI category,” Mr Adane said.
“In the years leading up to pregnancy, women with moderate to high annual weight gains of more than 2.5 per cent of their body weight had a 2.3 times greater risk of developing HDP than those whose weight remained stable.
The good news is that women who lost more than 1.5 per cent of body weight between the ages of 20 to 24 years were 46 per cent less likely to develop hypertensive disorders.
Meredith Horne
Handgrip exercise can help with blood pressure
New research from the University of New England suggests a simple handgrip exercise might be a safe way to help people at risk of cardiovascular disease to manage blood pressure.
Those who can’t perform the recommended levels of aerobic exercise could use an isometric handgrip (IHG) as an effective alternative method for lowering blood pressure.
Debra Carlson from the university’s School of Science and Technology said the research found that simple exercises with isometric handgrip dynamometers were enough to lower blood pressure.
Reductions in systolic blood pressure after eight weeks were comparable to those seen in aerobic exercise studies.
Ms Carlson’s team conducted a randomised trial involving 40 participants training at two different intensities of isometric handgrip exercise.
Participants attended three times a week for eight weeks to determine the effect on blood pressure during IHG, and after eight weeks of training.
Researchers took continual blood pressure measurements prior to participants starting the study, during IHG exercise, and again at the end to see the effect of the exercise on their blood pressure.
The study demonstrated that eight weeks of IHG exercise lowers blood pressure, with minimal effect on Rate Pressure Product in pre-mild hypertensive participants during the handgrip exercise.
“The participants sat in a chair and squeezed a hand dynamometer for two minutes and then would rest for three minutes, then squeeze again, until they had completed four isometric handgrip repetitions,” Ms Carlson said.
“Rate pressure product during IHG wasn’t as substantial as those seen during moderate and vigorous aerobic exercise in previous studies. The data does show that there is a positive relationship between blood pressure and intensity of isometric handgrip exercise.
“We would recommend for future research would be to conduct Isometric Resistance Training and aerobic exercise with participants to get a direct comparison in the two exercise modalities within the same cohort.”
Cardiovascular disease remains the leading cause of death, representing about 31 per cent of global mortality. High blood pressure is the biggest risk factor, with almost 34 per cent of Australian adults having hypertension or taking anti-hypertensive medications.
Chris Johnson