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Preference: Statistics, epidemiology and research design

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Resistance exercise could be a new ‘prescription’

A new study by Griffith University’s Menzies Health Institute Queensland has linked resistance exercise with boosting you immune system and aiding in injury health.

Until this study was undertaken, little was known about the impact of resistance exercise.

Published in Immunology Letters, the researchers examined 16 previous studies undertaken during1989-2016 that investigated participants undertaking a single session of resistance exercise encompassing various exercises.

“We combined the data from all relevant scientific publications, including two of our own original articles, to conduct a stringent systematic analysis of the resistance exercise research,” said Dr Adam Szlezak from Griffith’s Menzies Health Institute Queensland.

The study found that both high and low dosages of resistance exercise increased the immune system’s surveillance potential in the participants in a similar way to that of aerobic exercise, much like drugs can.

“We found that both high and low dosages of resistance exercise increased the immune system’s surveillance potential in the participants in a similar way to that of aerobic exercise. Even a low dose of thumb resistance exercise increased the number of key white blood cells in the circulation,” Dr Szlezak said.

The research suggested that resistance exercise appears to improve immuno-surveillance similar to that of moderate intensity aerobic exercise, regular moderate intensity 20-45 min work-outs in the gym may provide similar protection against upper respiratory tract infections (URTI).

Now that we know that different resistance exercise doses can result in distinct biological responses, much like drugs can, we now need to see if these responses can be used to reduce risk of URTI, as well as improve recovery from illness and injury, said Dr Szlezak.

The research also suggests that GPs should recommend that their patients abstain from all forms of exercise in the hours prior to blood collection for requesting full blood counts due to its impact on white cell count.

Meredith Horne

UK follows Australia’s lead on plain pack smokes

Britain has introduced plain packaging for tobacco cigarette products sold in that country.

And Oxford’s Cochrane Tobacco Addiction Group says its research involving a review of more than 50 experimental studies, suggests the move will likely have a significant impact on the prevalence of smoking.

Experts from the Cochrane Review say plain packaging appears to diminish the appeal of tobacco and help reduce the practice of smoking.

Some of that evidence comes from observing the Australian experience. In 2012, Australia became the first country in the world to implement standardised packaging of tobacco products, when the then Labor Government successfully enacted plain packaging legislation.

Data collected since then shows the measure has resulted in an extra 0.5 percent a year decline smoking numbers.

“We are not able to say for sure what the impact would be in the UK, but if the same magnitude of decrease was seen as was observed in Australia, this would translate to roughly 300,000 fewer (UK) smokers,” said Jamie Hartmann-Boyce, a Cochrane Review researcher.

British legislation on plain packaging for tobacco came into full effect from May this year.

Cigarette packs must have a uniform colour and font and carry no logos apart from health warnings.

The Cochrane team analysed 51 studies.

“Our evidence suggests standardised packaging can change attitudes and beliefs about smoking,” Mr Hartmann-Boyce said.

“And the evidence we have so far suggests that standardised packaging may reduce smoking prevalence and increase quit attempts.”

Chris Johnson

 

[Series] The evolution of modern respiratory care for preterm infants

Preterm birth rates are rising, and many preterm infants have breathing difficulty after birth. Treatments for infants with prolonged breathing difficulty include oxygen therapy, exogenous surfactant, various modes of respiratory support, and postnatal corticosteroids. In this Series paper, we review the history of neonatal respiratory care and its effect on long-term outcomes, and we outline the future direction of the research field. The delivery and monitoring of oxygen therapy remains controversial, despite being in use for more than 50 years.

[Editorial] Better understanding of youth mental health

Mental health issues are the leading cause of disability in adolescents aged 15–19 years in all the world’s regions, contributing 45% of their overall burden of disease. Early intervention to prevent mental health disorders is crucial to suicide prevention and to improve lifelong wellbeing. On April 18, the charity Mission Australia, in association with the Black Dog Institute, a research institute based in New South Wales, published the 5th Youth Mental Health Report. From a survey of 21 000 Australian adolescents emerges a grim picture of mental health, with 22·8% of young Australians meeting the criteria for probable serious mental illness (PSMI), as assessed by the Kessler 6 measure of non-specific psychological distress.

News briefs

Reprogramming brain cells may help Parkinson’s

Cells similar to dopamine neurons can be induced by treating non-neuronal brain cells with a specific combination of DNA transcription factors, according to a study published in Nature Biotechnology. The new reprogramming method has been demonstrated both in cultured human cells and in a mouse model of Parkinson’s disease. A defining feature of Parkinson’s disease is the progressive death of a specific group of neurons that secrete dopamine. Although several treatments are available to patients, including the chemical precursor of dopamine, none change the course of the disease. A decades-long research effort has sought to develop a disease-modifying therapy in which dopamine neurons or their precursors would be generated in the laboratory and transplanted into the brain. The authors of this study described a different approach to cell replacement that does not require cell transplantation. By testing a number of genes known to be important for dopamine neuron identity, they identified three transcription factors and a microRNA that reprogrammed human brain cells called astrocytes as cells that resemble dopamine neurons. The authors used a toxin to kill dopamine neurons in mice and then delivered the genes for the four factors to the brain using a system designed to express the genes only in astrocytes. Some astrocytes were successfully reprogrammed, acquiring characteristics of dopamine neurons, correcting several behavioral symptoms caused by dopamine neuron loss. Substantial further research would be needed before this approach could be considered for human trials, the authors noted.

http://dx.doi.org/10.1038/nbt.3835

Protein that causes liver disease found

Australian scientists have published research in Nature Genetics which identifies that variations in the interferon lambda 3 (IFNL3) protein are responsible for tissue damage in the liver, paving the way for new treatments to be developed. The international team, led by Professor Jacob George and Dr Mohammed Eslam at the Westmead Institute, had previously identified that the common genetic variations associated with liver fibrosis were located on chromosome 19 between the IFNL3 and IFNL4 genes. The team analysed liver samples from 2000 patients with hepatitis C, using state-of-the art genetic and functional analysis, to determine the specific IFNL protein responsible for liver fibrosis. The team demonstrated that there was increased migration of inflammatory cells from blood to the liver following injury, increasing IFNL3 secretion and liver damage. Notably, this response was determined to a great extent by an individual’s genetic makeup. “We have designed a diagnostic tool based on our discoveries, which is freely available for all doctors to use, to aid in predicting liver fibrosis risk,” Prof Jacob said. “This test will help to determine whether an individual is at high risk of developing liver fibrosis, or whether a patient’s liver disease will progress rapidly or slowly, based on their genetic makeup.” The research team will now extend their work to further understand the fundamental mechanisms of how IFNL3 contributes to liver disease progression and to translate these discoveries into new therapeutic treatments.

http://dx.doi.org/10.1038/ng.3836

[Correspondence] Obesity management in primary care – Authors’ reply

We are grateful to the correspondents for their interest in our research. Asaka Higuchi and Masahiro Kami are surprised that 12% of the support group lost 10% of their baseline bodyweight at 1 year and worry that rapid weight loss will lead to rapid weight regain. However, trial evidence suggests it will not.1 No baseline factors predicted 10% loss, but the use of what we termed effective support was strongly associated with weight loss. Effective support meant, in practice, attending a behavioural weight loss programme similar to those that physicians referred patients to in the support group.

Mapping HIV virus for more effective treatment

Deakin University scientists, with support from CSIRO, have revealed for the first time the individual protein blocks that form the HIV virus.

It is hoped that the research will enable the development of effective and affordable new antivirals to treat millions of people living with HIV.

The exact way the virus formed had eluded scientist for the past 30 years so that current antivirals created only a partial understanding of how the pieces joined together.

“Inadequate supply of anti-HIV drugs in low- and middle-income countries has created an ideal breeding ground for the emergence of drug resistant HIV, which threatens the long-term effectiveness of patient care using existing anti-HIV agents,” said senior researcher Professor Johnson Mak, from Deakin University’s Centre for Molecular and Medical Research.

Professor Mak hoped his team’s work would go on to inform the development of new drugs that work by interfering with the formation of infectious virus particles – essentially blocking HIV from taking a hold on patients.

HIV continues to be a major global public health issue.  UNAIDs estimates in 2015, an estimated 36.7 million people were living with HIV, there were 2.1 million new infections worldwide and in the same year 1.1 million people died of AIDS-related illnesses.

The AMA this year launched its updated position statement on blood borne viruses (BBVs).  The statement expressed the AMA’s support for the availability of new, regularly evaluated treatments for BBVs. 

Further, it acknowledged that prevention, treatment, and management of BBVs is a public health priority that requires a coordinated and strategic policy response, with national leadership driving actions to sustain improvements in their prevention, detection, and treatment. A copy of the statement can be found at: position-statement/blood-borne-viruses-bbvs-2017      

Meredith Horne

Liver research links genetics to treatment

The discovery by scientists at Sydney’s Westmead Institute for Medical Research that the interferon lambda 3 (INLF3) protein causes liver fibrosis, has brought hope for the developments of new liver disease treatments.

The research also revealed a strong link between a patient’s inherited genetic makeup and the amount of liver damage to improve techniques of identifying patients at risk of developing cirrhosis, and the development of new drug targets.

Currently liver transplantation is the only treatment for liver failure. No current treatments are available for a safe pharmacological therapy that prevent the progression of liver disease.

The lead author of the study, Professor Jacob George, says that the research will enable early interventions and lifestyle changes because it helps to predict risk of liver disease to individuals.

The Westmead Institute has developed a diagnostic tool based on their discoveries, which is available for all doctors to use, to aid in predicting liver fibrosis risk.

“This test will help to determine whether an individual is at high risk of developing liver fibrosis, or whether a patient’s liver disease will progress rapidly or slowly, based on their genetic makeup,” Professor George said.

Liver disease is now the fifth most common cause of death in Australia and affects 6 million Australians. Most forms of liver disease significantly increase the risk of liver cancer, which is the most rapidly increasing form of cancer worldwide.

Australia is a world leader for successful transplant outcomes with almost 3,000 Australian adults and children have undergone successful liver transplantation. However there are still many more people requiring transplants than donors.

Meredith Horne

UHT milk used to study age-related diseases

A new study on UHT milk jointly undertaken by ANU, CSIRO, University of Wollongong and international researchers is helping scientists to better understand Alzheimer’s, Parkinson’s and type 2 diabetes – opening the door to improved treatments for these age-related diseases.

The research examined how milk proteins changed structurally when heated briefly to around 140 degrees to produce UHT milk, causing the gelling phenomenon with long-term storage. 

These proteins are the same type of protein clusters found in plaque deposits in cases of Alzheimer’s and Parkinson’s.

Fifty different diseases have been recognised as being associated with protein aggregation.

“Parkinson’s, dementia and type 2 diabetes are big problems for the ageing population in Australia and many other countries around the world,” said Professor John Carver from the ANU Research School of Chemistry.

“Any means we can understand these proteins, their structure and why they form amyloid fibrils has the potential for developing treatments.”

Aging relating diseases affect about 500 million people worldwide and is set to increase over the next 20 to 30 years. 

Population projections by the Australian Treasury forecasts the number of Australians aged 65 is increasing rapidly, from 2.5 million in 2002 to 6.2 million in 2042, or from 13 per cent of the population to 25 per cent.

The collaborative research was published in the published in the journal Small.  The research does not suggest UHT milk can cause these age-related diseases.

Meredith Horne