Author Archives: markdowe1

Britain, Health, Medical, Research, Science

A breakthrough test to tell if you really need antibiotics…

CRP TEST

A simple three-minute blood test could tell doctor’s whether a patient needs antibiotics.

Not only could this help patients avoid suffering nasty side-effects from taking unnecessary drugs, but it could also tackle one of the greatest threats to modern health – antibiotic resistance. The test tells a doctor whether the patient is suffering from a viral or bacterial infection – that way, they will know whether or not to prescribe antibiotic medication.

Antibiotics are only effective against bacteria – they do not kill viruses. Currently, the type of infection can only be confirmed with a blood test which must be analysed in a laboratory, a process that can take two to three days.

GPs say they often give antibiotics as a full-safe measure, and that patients pressure them for the pills. According to Public Health England (formerly the Health Protection Agency), if patients ask their doctor for an antibiotic, the vast majority will get one.

Over-prescribing of antibiotics has consequences both for the patient and the population. As well as causing side-effects, over-use can lead to bacteria becoming resistant, making antibiotics less effective at fighting infections. The Government’s chief medical officer has described this as ‘one of the greatest threats to modern health.’

Over the past five years alone, the number of antibiotic prescriptions has risen by 10 per cent to 41 million prescriptions at a cost of £170 million to the NHS. A third of all Britons have taken them in the past 12-months.

A simple finger-stick test could solve this ‘catastrophic threat’. The test – which involves taking a drop of blood from the finger – can tell doctors within three minutes whether an illness is caused by a bacterial infection which requires antibiotics, or a virus, which does not.

It measures a substance called C-Reactive Protein (CRP) in the blood. The amount of this protein increases when the body is fighting a bacterial infection, but not when it is fighting a virus, which triggers a different immune response.

So a doctor would know that if the CRP level was shown to be low, antibiotics would not be required.

Studies show that providing ‘proof’ that they are unnecessary to patients who demand antibiotics can significantly reduce the number of prescriptions.

One EU-funded study, presented at the World Association of Family Doctors conference in 2010, looked at how respiratory infections which are generally caused by viruses were treated by 600 GPs in six different countries. It found that antibiotic prescriptions fell by 25 per cent when doctors used the CRP test.

British scientists say the test could be a useful tool for significantly reducing antibiotic prescriptions.

A senior clinical research fellow at Cardiff University who specialises in antibiotic resistance in primary care, said:

… Unfortunately, it is very difficult to accurately determine whether an infection is viral or bacterial.

… Markers such as CRP have evolved to help where there is lingering uncertainty after a clinical assessment or where the patient has strong beliefs that antibiotics are needed.

… (However, not everyone needs the test) … Patients who appear very unwell should be treated with antibiotics or admitted to hospital without the test because they could develop complications.

… But for those patients where there is doubt, or where the GP feels antibiotics are not needed but the patient is putting pressure on to prescribe them, the test can be helpful.

The test is currently only available in laboratories in the UK (it can be carried out privately for around £50) because the NHS does not yet fund it in GP practices. The machine to analyse the test would initially cost £1,000 and then £3 per test.

A spokesman for the Royal Pharmaceutical Society says it is likely to be some time before the test is routinely available on the NHS.

… CRP testing would be a natural extension to the clinical services we offer but it will be two or three years before there is enough evidence for it to be made widely available.

Other concerns about the test are that the results are not always clear – levels of CRP also increase as a result of inflammation caused by other conditions such as rheumatoid arthritis as well as infections.

The test is deemed to be a guide and does not categorically imply that a patient has a bacterial infection if the results are synonymous with having an infection. It gives the doctor a number that has to be interpreted in light of the other symptoms and the patient’s overall risk profile.

For example, a doctor is more likely to treat an elderly person with diabetes with antibiotics than a young healthy person, as the elderly person is more likely to develop complications.

Clinical experts say the best way to reduce antibiotic prescriptions is to educate doctors and patients about common complaints and when antibiotics are necessary.

The Royal Pharmaceutical Society warns that to see this test as the panacea would be an extremely dangerous idea. The Society says it needs to work hard to educate patients about when it is appropriate to take antibiotics and by making sure they take them correctly as prescribed by finishing the course.

Public Health England adds:

… CRP may be useful in a small range of infections provided the test is robustly quality controlled.

… But nothing can replace taking a detailed patient history and thorough examination.

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Medical, Psychology, Research, Science, United States

Different types of happiness and the effects on our genes…

GENE-EXPRESSION PROFILES

Research has found that people who derive their happiness from helping others have strong antibody genes, while people who get their kicks from self-gratification can suffer from low antiviral and antibody expression. The study by UCLA, a public research University in Los Angeles, California, is the first of its kind to examine how positive psychology impacts human gene expression.

People deemed ‘do-gooders’ have high levels of ‘eudaimonic’ well-being. Researchers say they derive their happiness from a deep sense of purpose and meaning in life and found favourable gene patterns and expression profiles in their immune cells. Those studied from this happiness group had low levels of inflammatory gene expression and strong antibody and antiviral genes.

The findings by UCLA, first published in the journal Proceedings of the National Academy of Sciences, also conclude that individuals who have high levels of ‘hedonic well-being’, i.e. the type of happiness that comes from consuming goods and self-gratification, showed the opposite. This group of people showed a high propensity towards inflammation and weak antibody and antiviral genes.

The research, led by Steven Cole, a UCLA professor of medicine and Barbara Fredrickson of the University of North Carolina, has taken more than a decade to complete.

The scientists have examined how the human genome responds to fear, stress, misery and other negative mental states. Their focus was on how human genes might respond to aspects of positive psychology in this study. They studied the biological implications of hedonic and eudaimonic well-being through some 21,000 genes.

Previous research found immune cells shifting in baseline gene expression during times of stress, fear and uncertainty. The shift is generally characterised by an increased expression of genes involved in inflammation and much less so of those involved in antiviral and antibody functions.

Professor Cole believes the response probably evolved to help human immune systems cope with the changing nature of microbial threats associated with changing social and environmental conditions at the time. Those threats include bacterial infection from wounds produced by fighting and the increased risk of viral infections as people lived closer together and became more sociable.

Professor Cole said:

… In contemporary society and our very different environment, chronic activation by social or symbolic threats can promote inflammation and cause cardiovascular, neurodegenerative and other diseases and can impair resistance to viral infections.

Researches from the present study drew blood samples from 80 healthy adults who were assessed for hedonic and eudaimonic well-being, as well as negative psychological traits and behavioural factors.

Professor Cole’s team used the gene-expression profile to map the potentially distinct biological effects of hedonic and eudaimonic well-being.

The study found people with eudaimonic well-being showed favourable gene-expression profiles in their immune cells and those with hedonic well-being showed an adverse gene-expression profile.

Interestingly, though, Professor Cole also said:

… People with high levels of hedonic well-being didn’t feel any worse than those with high levels of eudaimonic well-being.

… Both seemed to have the same high levels of positive emotion. However, their genomes were responding very differently even though their emotional states were similarly positive.

… What this study tells us is that doing good and feeling good have very different effects on the human genome, even though they generate similar levels of positive emotion.

… Apparently, the human genome is much more sensitive to different ways of achieving happiness than are conscious minds.

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Britain, Business, Economic, Government, Society

Zero-hours employment contracts should be reformed, not outlawed…

ZERO HOURS CONTRACTS

In 2008 there were around 100,000 people employed on ‘zero-hours’ contracts offering them no guarantee of day-to-day work. That number has steadily risen since. In the last few days the Office for National Statistics upped its previous estimate by a quarter to 250,000. Other sources have quoted the figure nearer to one million, which equates to more than 3 per cent of the labour market.  Such employer tactics are not just restricted to sectors with sharply fluctuating demand such hospitality; the NHS, Amazon and large retail outlets such as sportsdirect.com also use them.

Employers benefit from arrangements under which they have a contingent workforce on call but must pay only when it is active. Some employees will appreciate the flexibility too, earning at times sums of money that may help them in their work-life balance, particularly as zero-hour contracts fluctuate with the seasons. More importantly still, in times of economic and financial uncertainty, when companies might otherwise not be hiring, it is better to have unpredictable and unsociable hours than no job at all. For small firms, in particular, such adaptability by having a flexible workforce will be a crucial factor for survival.

The problem, though, is that too often zero-hours contracts are a licence for employer exploitation. Commonly registered complaints include employees being required to be permanently available, despite there being no certainty of work. Many staff are also displeased with no entitlement to standard benefits such as maternity pay, sick pay or pension contributions. Holiday pay is another contentious area, although some firms offer discretionary holiday payments for some staff employed on zero-hours.

There is also an unhealthy concentration of power in the hands of individual departmental managers, who may allocate hours or withdraw them according to personal preference. In theory, at least, workers may turn down work, but most assume – probably rightly – that such a refusal would mean no further offers, with little or no hope of redress.

As estimates of the working-based concept inexorably rise, there have been calls for zero-hours contracts to be banned. The Business Secretary, Vince Cable MP – who is reviewing the situation – is resisting such moves. He is right to do so. The issue is not so much the contracts themselves, but more as to how and why they are used.

Consider a case in point: social care. Social care has long been disproportionately reliant on zero-hours contract arrangements because government funding is way too low to pay anything but meagre wages. As the population ages, and more people are expected to live longer into retirement, the situation will only worsen. By banning them, is to allow the specifics of one, very particular sector to skew a policy affecting all.

There are things, however, that should be done. The first priority for the Business Secretary will be to establish the true scale of the issue, and there is a strong case for reform. For instance, staff required to be always ‘on call’ should be compensated given the inconvenience involved. Basic employee rights should also be enforced. It might also be argued that businesses above a certain size, such as 50 employees, should be required by law to provide a minimum number of hours. For larger companies, what excuse do they have for passing on risks they can well afford?

It should come as no surprise that the number of zero-hours contracts has risen significantly since the recession of 2008. Economic stagnation has forced many firms to cut their workforces, but have required a degree of flexibility in the knowledge that expansion and growth would return. But as the outlook improves, it is essential that staff are given more typical terms. If the current spike in zero hours terms is no cyclical occurrence but, instead, is an emergence of a new and insecure, low-paid workforce, then the price of flexibility being asked of people will be too high.

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