Monthly Archives: January 2017

Travel and Disease

This blog post is mainly allowing me to put together ideas and research I have found, and to make sure I understand the concepts I will be talking about tomorrow at my schools Biology Discussion Group (BDG) however I thought it was an interesting topic. The biology discussion group from my school meets fortnightly to discuss scientific and ethical topics. In preparation for our session tomorrow, I have been reading up on ‘travel and disease’ which is this weeks topic. I can’t say it’s something I had given much thought to before trying to find some articles to read for this weeks discussion, however, the way epidemics are now predicted is somewhat fascinating.

I always believed that diseases spread from country to country through an infected person jumping on an aeroplane, train or bus to go on holiday. Thus, I thought that if you wanted to predict the spread of a disease, you would look at how many people from one country travelled to another, and how many of those individuals were likely to be infected. Take the Zika Virus, if lots of people were to travel to Rio for the olympics, I would have thought it would spread quickly as each athlete or spectator returned home potentially carrying the disease. I have found however, that it is much more than this.

How quickly a disease can spread depends on two factors – population distribution and human-mobility networks [1]. Thus in a sense, I guess my initial theories were half right. How easy it is for a person to move from place to place is a factor. Consequently, it is not if one person travels from one country to another, but how many people they meet along the way. If an infected person walks into a shop, you then have to consider how busy the shop is likely to be at that time, and how many people the shopkeeper is likely to encounter between the time of infection and the time at which they are potentially unable to work anymore (say at diagnosis). Similarly, if an infected person sneezes on a £10 note and that therefore becomes infected, how many people are likely to encounter that note until it is no longer infectious? The contact goes on and on.

Here are some key points to consider when modelling epidemics:

  • Modern pandemics spread more quickly and less uniformly than those in the past e.g. The Plague. Why? Due to the global air transportation network and and the complex, integrated nature of much of our society.
  • To model the spread of an infectious disease, you must take into account the biological and physical principles alongside social and behavioural factors.

Therefore, what the spread of disease comes down to is actually very minimally air time, but in fact human behaviour. If you know what a population is likely to do, i.e. how many different people may encounter another in a day, the spread of disease is much easier to predict. The more research into human behaviour there is, the more likely it is that we are able to predict the spread of disease accurately [1].

Similarly, a disease is not going to spread across the entire world or even Europe, at the same rate. It may spread between certain cities or countries quickly due to large amounts of human mobility networks and an interactive society. Yet for others, there may be very little contact between two cities and very few people may move from one to the other, meaning that disease would likely spread at a very slow rate.  So, this theory doesn’t work unless we move from analysing small social groups in individual towns or cities, to analysing social aggregate states made up of millions of people [1] – in order to gain a mean activity.

The problems we face with this is that people’s lives are essentially non-conformal. Not everyone does the same thing every day, and each person has their own agenda. As a result of this, standard deviations (the spread of data) are typically extremely large, and there are no typical values for many of the quantities – e.g. the amount of times a person eats out a week.

Consequently, predicting epidemics is no easy feat. There are so many factors to include that it is very rare we will be able to pinpoint the exact spread of a disease. Having said that, techniques allowed scientists to predict the peak in the swine flu pandemic in the USA between late October and November 2009. Whats to learn from this? That the spread of disease is largely due to human behaviour, and that in understanding more of human behaviour we could open many doors to new methods of predicting pandemics and epidemics.

[1] The Flu Fighters – Physics World  – as of February 2010

I will link the podcast to this BDG session here once it has been edited 🙂

http://wgsbdg.podbean.com/e/travel-infectious-disease/ 

Ethics – A man and Australia

On a Tuesday evening, 4-5 aspiring medics from my year meet to discuss medical issues, and what could help us achieve our goal of getting into medical school. Something my mum likes to refer to as ‘Doctor Club’. This week, it was ethics. A series of information on cards was given to us in stages, and we were to decide what action we would take if we were the patients doctor. It went a little like this:

  • The patient was a 65 year old male, who after recent tests you have discovered has cancer. It is untreatable and slow growing. He is also planning and excited about an upcoming trip to Australia.
  • You learn that he recently lost his wife after a long battle with cancer, and has a history of struggling with clinical depression. This is particularly apparent when he hears of serious health issues. He is still very excited about his trip.

We had to make numerous decisions with different amounts of information, and it was based on a real case. Ultimately, the final question was would you tell the patient he had cancer before his trip to Australia, or wait for him to return? What do you think?

For me, this was incredibly difficult but an incredible insight into the factors which doctors need to consider on a day to day basis. It all came down to patient care. Here, the most prominent issue is not the mans cancer, but the probability of a serious bout of depression. I believe that in not telling him before his trip, but similarly not lying to him, you would be providing better patient care than if you were to tell him beforehand. Here in the UK, he has access to support and family members to help him accept his diagnosis, but in Australia there would be very little capacity for this. Also, we were told he would experience no symptoms of his cancer, and it would have no impact on his quality of life.

I found this interesting, as without knowing the man had a history of depression I know my answer would have been completely different – complete honesty. This highlighted for me the importance of medical teams and hospitals working together to produce accurate and up to date patient notes, and collaborations between GP surgeries, hospitals and clinics for example. Interestingly, the answer that the 3 medics who attended on Tuesday came to the conclusion the same as that of the doctor who made the decision themselves. It was only the aspiring vet who thought they would tell the patient before his trip. While the doctor themselves was questioned about their decision, and the case was deemed exceptional, it shows how guidelines have to be interpreted differently for each patient, in order to provide the key patient care. Here, in withholding information for perhaps a couple of weeks longer, the patient was cared for more than if he was told straight away.

Oestrogen and PTSD

The role of oestrogen in the maturation of the female body alongside reproduction and pregnancy is well known. However, oestrogen has the potential for further physiological effects.

Existing research suggests that women are more prone to developing post-traumatic stress disorder (PTSD) than men, despite the fact that women experience fewer traumatic events than males, on average. A new study indicates that oestrogen may place a crucial role in the development of  PTSD. This is a subject I am particularly interested in due to my interest in the military, and a topic I have begun loosely researching for my EPQ.

Different levels of oestrogen have been associated with the brains response to stress, via the hypothalamus, pituitary and adrenal glands. However, a key piece of information from other studies is that women who experience trauma seem to have more trauma related flashback episodes in a particular phase of their menstrual cycle.

PTSDbrain1

 

This phase occurs around a week after ovulation, where the female body produces more progesterone and less oestrogen. Blood samples from 278 females were examined, and they participated in the Grady Trauma Project. [1] This is a large scale study that investigates the role of genetic and environmental factors in the development of PTSD among African-American females. [1]

At childbearing age, women’s levels of oestrogen go up and down depending on where they are in their menstrual cycle, whereas menopausal and postmenopausal women have lower levels of oestrogen. [2] Those involved in the study then assessed DNA methylation of blood, which is an epigenetic mechanism. It modifies the DNA in a way that suggests that some genes are “turned off.” It was found that a form of oestrogen, serum estradiol, is associated with DNA methylation across the genome.

This is potentially a single gene that is associated with the brain’s fear response, found to be affected by oestrogen levels. Researchers also examined brain functionality using brain imaging techniques.

Research has also been performed with experiments in mice to see if their findings would replicate in rodents. The mice experiments suggest that oestrogen can protect against the formation of PTSD. The authors add that in addition to its role in modulating the fear response, previous studies have also suggested that oestrogen alters pain perception. Scientists have also noted that their findings suggest that oestrogen could be used as a preventive treatment for PTSD. [2]

While this hypothesis still has a long way to go in terms of the evidence to provide oestrogen as a treatment for PTSD. I thought it was an interesting set of research. While the sample size was small and those who participated had very little variation, alongside the fact that side affects of the treatment have not been considered, I hope that the evidence for the use of oestrogen in the treatment of PTSD prevails.

Sources:

[1]  http://www.medicalnewstoday.com/articles/315383.php 

[2] https://psychcentral.com/news/2017/01/20/estrogen-levels-influence-susceptibility-to-ptsd/115390.html

Day Centre for Dementia Patients

Since September, I have been volunteering at a day centre for dementia patients on a Friday morning. This is something I really enjoy every week – getting out of school into a new environment, being able to help give the carers a break and of course, being able to communicate with new people. However for me, it is much more than this. It is incredible being able to see how much my presence brightens the patients day, even if by the next week they have forgotten who I am entirely. I have had countless heartwarming conversations with people who love talking about what they can remember; their schools, the war, their jobs, but who also love finding out what it is I’ve been up to and how things have changed since then. Aside from this, being able to prompt their memories in a safe environment is really rewarding, as they have all had incredibly interesting lives, and they smile and laugh as they remember things themselves.

However, this week was a little different and slightly more challenging. While of course, each patient has very individual needs and has differing stages of dementia, up until now they have all been able to talk to me during my time there. Although, a new lady now attends the centre on a Friday, who not only has dementia and is confused about where she is both in time and physically, but no longer has teeth so is very difficult to understand.

At first I’ll admit it was a little daunting, and I felt really empathetic as she was obviously initially very distressed. However, after a couple of games and some encouragement from her friend and member of staff, it was lovely to see her laughing and smiling too. What I learnt specifically from this volunteering session, is that patients do not need words to be able to respond to you, and that actually it really doesn’t matter if they can’t. This lady loved having me talk to and laugh with her, and would light up occasionally on the topic of food! An integral part of care in such an environment is taking the time to get to know each individual, and to be someone who is flexible, adapting to each unusual question or situation which may arise.

It is very easy to forget that elderly dementia patients had lives before their diagnosis, and helping them remember that is a key part of caring for them. We play numerous memory games and quizzes, and while some engage more than others it is lovely to find out more and more about each person who attends the centre. Too much of the time the media is obsessed with the few care homes or centres with corrupt individuals and inadequate care, and until I myself started volunteering I didn’t realise how much of a positive environment these places can be.

I would recommend this form of work experience to everyone, it is something I was never sure I would enjoy but always wanted to try, and is now the only thing which gets me through double maths on a Friday morning! For me, this is not about getting experience in a healthcare environment anymore, it is about being able to make a difference to a persons day, to give the carers who work numerous days at a time a bit of a break and an opportunity to do some paperwork, but mainly to engage with people who rarely meet new people and are always so grateful for my time.

Breast Cancer – Know Your Lemons

what_breast_cancer_looks_like-2Cancer. A word which can ignite fear in anyone. Recently as I’ve been scrolling through my social media I have come across an ingenious image, which presents what the symptoms of breast cancer can look and feel like. Surveys by the charity, ‘Breast Cancer Care’ found that 1/3 women don’t check regularly for signs of breast cancer, and thus he ‘Know Your Lemons’ campaign has enormous potential to save lives. It is an example of how public platforms can be used to raise awareness across the world, a clear and colourful campaign which portrays vital information in very little words.

Breast Cancer currently has a 78% survival rate in the UK with 27% of cases being preventable [1]. This means, that educating people about the signs of cancer can help it be caught early, making a persons life much easier to save. However, it is clear that many people don’t feel comfortable talking about their bodies, even with a doctor which makes this a much harder feat to overcome.

However, the ‘Know Your Lemons’ campaign initiated by Corrine Beaumont, uses lemons as a metaphor for breasts, and draws attention to breast cancer in a memorable way – lemons in an egg carton. I find this an incredible way of increasing people’s cancer of survival, purely through helping the symptoms of the cancer be recognised.

Aside from this, since ‘Know your Lemons’ began in 2003, it has actually helped people gain the confidence and knowledge to see their doctor about breast cancer. For example, Erin Smith Chieze, who was diagnosed with stage 4 breast cancer after recognising and indentation in her breast, following a similar image. She has said that without seeing the picture, she ‘wouldn’t have known what to look for’.

This campaign has opened up the potential of social media and the internet in raising awareness about health issues. While the NHS has an extensive website and there are online GP’s and the likes available, this really stuck with me. Facebook, Twitter and Instagram are all platforms millions of people use every day, and this campaign brings information to people, without them having to look for it. People can become increasingly aware of symptoms without searching for them, and this campaign shows clear advances in how internet is used to educate people about health issues.

 Sources 

[1] http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer

 

Hospital

I sat down last night to watch the new BBC documentary ‘Hospital’ purely because I thought I would find it interesting, and it would give me a small insight into hospital life. However, it did much more than that, it confirmed the research and evidence I had heard in the news, and put into perspective the harsh realities of medicine.

Without going into too much detail, as I will leave a link to the first part of the series below, it is based at the Queen Mary hospital in London – one of the five affiliated to Imperial College London. The hour orientated primarily around two cancer patients who both required operations and a lady who had ruptured her aorta, travelling to the hospital from Norwich. Although, the main focus of the documentary was the chronic bed shortage the hospital was experiencing, a ‘code red’.

It became increasingly apparent to me that the wait to know if either of the cancer operations would be allowed to go ahead, was entirely due to the uncertainty of a bed being available for them to recover in. A seeming waste of anaesthetists, surgeons, nurses and theatres, all unused due to the bed shortage. Many scheduled operations had to be cancelled due to the hospital not knowing how many trauma patients would need ICU beds, as the brutality of the fact that doing the best for the hospital was not the best for every patient was clear. For instance, one of the cancer patients with oesophagus cancer, had already had his operation cancelled previously for the same reason, and it was cancelled again on the Monday of this week, but in doing so a bed was freed for the lady with the ruptured aorta. While luckily the operation was able to take place on the Tuesday, the prospects of having to operate in a specific window after chemotherapy for the best results, and the reoccured cancellation was obviously a serous worry for the patient.

This leads on to not only the medical issues caused by the bed shortage, such as the cancellation of operations, but moral implications. Patients need to retain their dignity in hospitals, and have enough privacy while recovering, but when operating at or over full capacity, this is hardly possible. The hours the surgeons spent presenting their cases for why their patient needed their operation and a bed were endless, while irritating for the surgeons themselves, this clearly showed that their patients were at the forefront of their mind, and they were their priority – restoring my hope and faith in the hospital environment.

So what did I learn from this documentary? What I expected to be some interesting cases and miraculous recoveries turned out to be a stark reminder of the harshness of medicine. It supported what I had previously heard about hospitals being overrun, but also the obvious desire of medical professionals to do what is right by their patients. It showed that tough decisions are having to be made everyday, and none of which are easy when they can influence peoples lives so dramatically.

 

This is the documentary link – http://www.bbc.co.uk/iplayer/episode/b088rp75/hospital-episode-1 it was a really insightful watch and I would definitely recommend it as an eye-opener.

The NHS – Is patient care the priority?

nhs-01-e1401362913281After a week of mock exams, I decided it was time to start thinking about the real world again, and catch up on all the news stories and articles I’ve missed in the past weeks due to my revision. It is undeniable that in the past year the NHS has endured severe turmoil, the good, the bad and the ugly. How can we save a system which does so much good throughout our country? I came across an article in which the Royal College of Nursing has said that ‘conditions in the NHS are the worst they have experienced’. This is incredibly alarming, because it means an incredible system which provides opportunities for people from all walks of life could be in jeopardy.

Additionally to this, leading doctors have warned Theresa May that lives are being put at risk due to pressures on the NHS. It is very easy to get caught up in the news and money surrounding the NHS, but it is incredibly important to remember that they key aim of this institution is to provide healthcare to everyone, and to benefit the lives of people.

Earlier this week, the BBC released shocking record numbers of patients who were facing long waits in A&E. This document showed that this winter has proven to be the most difficult in over 10 years, with almost a 1/4 of patients had had to wait more than 4 hours in A&E just last week. This means that only 75% of patients were seen within the target hours, at no fault to our healthcare professionals, but a system which is not allowing them to flourish.

The main aim of the healthcare professionals in any hospital is to provide the best care possible for their patients. However on the contrary, the Chief Executive at the Royal College of Nursing has said she has heard from frontline nurses saying they were told to discharge their patients before they were fit, just to free up beds. This leads to quality of care concerns for every nurse and healthcare professional, trying to their best to do good in an overrun system. There have also been urgent appeals for investments to help ‘over-full hospitals with too few qualified staff’ by the Royal College of Physicians.

What is truly daunting, as that there are lives at risk. Each patient has a life and hopefully a family to go back to after their hospital treatment, and the prospect of not returning children home to mothers or husbands home to wives when more could have been done is an awful one. Alongside these frank issues within hospitals themselves, there are problems with discharging patients as due to difficulties with placing people in social care.

 What should be done?

It is evident that immediate and long term measures are both needed to address the current and inevitable issues within hospitals and the NHS, and it is a system that needs saving. A crisis in funding has led to inadequate care for some patients, and everyone deserves the best treatment possible – the principles of the NHS is that it is a national health service, open to everyone. When we can not provide the care needed, we are failing as that service.

Having said that, things are looking up. The issues within the NHS are not solely down to funding, there are not enough healthcare professionals themselves to treat the patients. Since last year, 3100 more nurses and 1600 more doctors are working within the NHS, and £10 billion has been pledged to investment in the transformation of NHS services and relieving the press of hospitals.

I think the NHS is an amazing system, providing amazing treatment to everyone throughout our country. Without it, there would be far more deaths per year, and the poorer members of our country would not be able to maintain their health, or get treatment. However, it is evident that it needs reforming, reorganising and needs to remember that the heart of the organisation is the patients themselves. Patient care is the priority of each healthcare professional, doctor, nurse or midwife and it should be the heart of the system they work in. The first part of the change however is accepting it needs to happen, and I am hopeful that the changes in the future will create a much more beneficial and fluent system.

 

Dietary Zinc can help mend our DNA?

Today I came across an article on ‘medical news today’, which talked about the benefits of a modest increase of dietary zinc. I thought I’d share what I’ve learnt with you, as I was surprised to find out how many benefits it could reap.

 What are the benefits of zinc?

Zinc is well known to have a role in aspects of cellular metabolism and division, alongside supporting human development and growth. Limiting inflammation and reducing oxidative stress are also benefits of zinc, with the potential to protect against cardiovascular disease and some cancers. Alongside helping to maintain the health of the human immune system and having a role in DNA and protein synthesis.

It is also known that our DNA deteriorates, although we can regenerate it until late adulthood. What is the role of zinc in this? It aids DNA and protiensyntheis, and thus insufficient zinc compromised the ability of the human body to repair everyday damage to DNA.

 The research 

What is really interesting is that research published in the ‘American Journal of Clinical nutrition’ suggests that a small additional intake (around 4 milligrams) can have a positive impact on the health of cells, and aid the human body to fight infection – certainly a benefit at this time of year!

It was researches from the Benioff Children’s Hospital, Oakland Research Institute who set out to show the benefits of an increase in dietary zinc on metabolic functions, and the effect of the equivalent amount provided by biofortified crops in nutrient-deficient regions was tested. Food fortification slightly increases the zinc content of cereals (e.g. wheat and rice) and some studies have shown a positive effect on the functional indicators of zinc within the human body.

A randomised 6 week controlled study was devised by researchers, and 18 men consumed a low- zinc, rice based diet.The diet consisted of 6 milligrams per day for 2 weeks and continued with 10 milligrams daily for the remaining 4 weeks.Before and after the diet, the researchers measured zinc homeostasis indicators and other metabolic indicators, including oxidative stress, DNA damage and DNA inflammation.

 The results 

It revealed significant changes in the zinc homeostasis indicators, and an increase in the levels of total absorbed zinc, while plasma zinc concentrations remained the same. Something I found both intriguing and promising was that Leukocyte DNA strand breaks were also reduced with increased dietary zinc, which suggests that a modest increase in zinc reduces the everyday “wear and tear” of the DNA.

The potential benefits of an increase in dietary zinc are therefore tremendous, however to what extent is yet to be shown, and more research is underway to investigate if this is a permanent improvement. Zinc rich foods include pumpkin seeds, chickpeas, chicken and cashews – so make sure you’re eating plenty of these, to help your body function and help to mend your DNA!

The article mentioned is linked here http://www.medicalnewstoday.com/articles/315070.php

The Mesentery – The Newly Discovered Organ

Recently, the news has been jam packed with headlines about the ‘mesentery’ – essentially the discovery of a new organ, which was hiding in plain sight. What was previously thought to be a few fragmented structures in the digestive system, has been discovered to be one continuous organ. The double fold of the lining of the abdominal cavity, holding the intestine to the wall of the abdomen. I thought I’d do a bit of research, as what really interested me is what function can the mesentery have? As scientists we have thought we understood the human body, and the roles of each of its organs, however the discovery of a new organ comes with new questions. What does it do? What is its impact on the functions of other organs?

The mesentery has been rigorously investigated by professor J Calvin Coffey since 2012, where electron microscope examinations were used to analyse the structure. This led to the discovery oimage_4479-Mesenteryf one continuous organ, and not just tissue fragments in the digestive system. Understanding the function of this organ is essential in the field of medicine, when the functionis understood, abnormal function can be understood and the differences observed and investigated. Enabling scientists to consequently find the diseases related to that organ, and how to treat them.

The mesentery can be seen as a folded flap around the intestines, from the base of the stomach and pancreas, closing the small intestine and colon, to the rectum. While what appears to be its most obvious purpose is to maintain the positioning of our intestines, there have been suggestions of other roles of the organs. One of which, from J Calvin Coffey and D Peter O’Leary (University of Limerick) is that is may be responsible for the movementof white blood cells around the intestines.

The classification of the mesentery as an organ does not change the structure which has been inside our bodies for millions of years, however it does present a new field of medical science and the possibility of improving health outcomes, such as those for abdominal and digestive diseases. For instance, when the tissue of the mesentery becomes inflamed, it can disturb the intestines, causing stomach pains and discomfort. Why is not yet known, as the function of this new organ is not yet understood. The anatomy and structure of the mesentery has been established and scientists are now working towards establishing the function of mesentery and thus what role in could play in disease, alongside the possibility of new and revolutionary treatments.

This was a discovery I found truly shocking,  as it is one which causes us to question what it is we already know about the human body, and the possibilities of the vast amounts we do not know. However, science is an ever advancing field, and as our investigative techniques improve and advance, I am hopeful that we will continue to discover more about the human body and how it works, enabling us to to improve treatment methods.

sources 

http://www.thelancet.com/pdfs/journals/langas/PIIS2468-1253(16)30026-7.pdf

http://edition.cnn.com/2017/01/04/health/new-organ-mesentery/ 

https://www.kenhub.com/en/library/anatomy/mesentery

http://arstechnica.com/science/2017/01/a-ruffled-intestinal-support-called-the-mesentery-may-be-our-79th-organ/

 

Bad Pharma – Ben Goldacre [1]

I hope everyone had a lovely Christmas and New Year, having found some time to relax. I’m sure, like me, many of you are heading back to school with mock exams looming (best of luck!!). As working for these exams has taken up far too much of my time recently and has been a stressful experience, I decided it was time to sit down with a good book and relax.

I picked up ‘Bad Pharma’ by Ben Goldacre (I will leave a link below), which has been sitting on my shelf since November, but I just didn’t have the time to start. I purchased it after a series of interesting biology discussion group (BDG) sessions, where we touched lightly on the profits pharmaceutical companies make and the incentives of drug companies, whilst discussing genetic modification and cryogenics ( the podcasts of which are also linked below). It is a book based on ‘how medicine is broken, and how we can fix it’ which highlights important flaws in current systems, particularly pharmaceutical companies, and how these can be mended. It is the book which prompted the question, ‘why aren’t all trial results publicly available?’ and a read I would recommend to anyone interested in medicine.

I plan to share my thoughts on what I’ve read, in stages, with you, and what I’ve learnt about the medical and pharmaceutical industries from this book. I feel like it will become something I feel passionately about, as the evidence medicine is based upon, becomes increasingly apparently flawed. The book itself is split into clear sections, with what can be described as ‘case study’ examples integrated along the way. The sections highlight the issues with missing data, where new drugs come from, bad regulators, bad trials, bigger simpler trials and marketing, alongside presenting ideas on how to improve and ‘fix’ these issues – from both the perspective of a patient and a doctor.

While so far I have only read the introduction, I’m really excited to delve further into the issues within modern medicine and our current system. To me, when people’s ill heath has become a business which can provide profit, many people have lost or disregarded the humanity of those patients. I think it is important we all help to find it again.

Bad Pharma – Ben Goldacre – click here

BDG podcasts –  click here