Body

Everyone knows cigarette smoking causes cancer and as a result, prices and advertising are closely regulated to discourage youth from starting. But another cancer risk, indoor tanning, which has been shown to cause melanoma, lags in regulation. Researchers at the Colorado School of Public Health have found that the tanning industry uses marketing strategies that appeal to adolescents and young adults, including unlimited tanning packages, discounts, and even offering free tanning when paired with other services like an apartment rental or gym membership.

"This study highlights the fact that a lot of businesses out there are providing this service at a low cost which removes a barrier to adolescents and young adults," said Nancy Asdigian, lead author of the study and a Research Associate in the Department of Community and Behavioral Health at the Colorado School of Public Health. "Young people who want to tan do so when they can afford it and don't when they can't. The industry capitalizes on this with the strategies they use to price and promote this risk behavior."

The study was published today in the Journal of Public Health Policy.

According to the Global Burden of Disease Study, about 352,000 people worldwide were diagnosed with potentially deadly melanoma in 2015. That includes 81,000 cases in the U.S.

High profile public health and policy efforts along with state age restrictions have helped decrease the prevalence of indoor tanning among youth, but the study said levels remain 'unacceptably high.'

The researchers posed as customers and contacted tanning facilities in Akron, Ohio, Denver, Colorado, Austin, Texas, Boston, Massachusetts, Portland, Oregon and Pittsburgh, Pennsylvania. These cities were selected because they represent a variety of climate and geography as well as a range of stringency of state indoor tanning laws.

Of the 94 tanning places they contacted, 54 were primary tanning salons, and 40 were 'secondary facilities' that offered indoor tanning secondary to some other service like hair styling or physical fitness.

The study found that indoor tanning was free at 35% of secondary facilities. Nearly all apartments with tanning offered it free compared to 12% of gyms. Free tanning was most common in Austin.

Nearly all primary tanning salons offered time-limited price reductions.

"Many provide promos geared toward young adults. They offer packages that incentivize more frequent tanning. The more you use them the cheaper tanning becomes," Asdigian said. "Everyone wants to get their money's worth. When you buy a ski pass, you want to ski as much as possible." In some cases, an individual tanning session could cost as little as $1 if the customer buys an unlimited monthly plan and uses it frequently.

Some countries, including Brazil and Australia, have banned indoor tanning salons altogether. The U.S. imposed a 10% tax on indoor tanning in 2010 and 19 states and the District of Columbia have enacted complete bans on indoor tanning for those under age 18.

But few of these policies have focused on the advertising, promotions or pricing practices of these facilities.

"A next step is to work with policy makers to restrict the use of discounts and deals to lure customers," said Lori Crane, senior author of the paper. Another strategy would be to eliminate tanning provided in apartment complexes and fitness centers where tanning services are often free and less likely to be licensed and inspected by local regulators.

Another step, Asdigian said, is to understand the connection between pricing and the use of indoor tanning.

"In this study we described the costs and promotions," she said. "An important question to answer is how variability in pricing impacts behavior. Establishing that link is an important step."

New Rochelle, NY, June 14, 2019--A therapeutic gene delivered into the spinal canal of infant rhesus monkeys was still being expressed after nearly 4 years, with no evidence of acute or chronic neuronal toxicity, according to a new study published in Human Gene Therapy, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Human Gene Therapy website through July 14, 2019.

The article entitled "Safe and Sustained Expression of Human Iduronidase After In-trathecal Administration of Adeno-Associated Virus Serotype 9 in Infant Rhesus Mon-keys" was coauthored by James M. Wilson, MD, PhD, University of Pennsylvania, Pe-relman School of Medicine (Philadelphia) and a team of researchers from the Universi-ty of Pennsylvania, University of West Indies (Kingston, Jamaica), and University of California, Davis School of Medicine and California National Primate Research Center.

Dr. Wilson's group used intrathecal injection to deliver adeno-associated virus 9 (AAV9) vectors carrying the gene for the alpha-I-iduronidase (IDUA) enzyme. This en-zyme is deficient in mucopolysaccharidosis type I (MPS I), an inherited lysosomal stor-age disease also known as Hurler disease.

Based on the safety and long-term potency of AAV9-IDUA delivery via the cere-berospinal fluid demonstrated in this study in newborn monkeys, the authors conclude that the clinical development of this method of gene therapy should be pursued for ear-ly-onset severe forms of neuropathic storage diseases such as MPS I.

"The problem of physical delivery of AAV vectors to the appropriate cells remains a significant technical hurdle in gene therapy for disorders affecting the central nervous system," says Editor-in-Chief Terence R. Flotte, MD, Celia and Isaac Haidak Professor of Medical Education and Dean, Provost, and Executive Deputy Chancellor, University of Massachusetts Medical School, Worcester, MA. "Studies like this one provide criti-cal information on the feasibility of delivery approaches that could directly translate to human infants suffering from these fatal diseases."

Research reported in this publication was supported by the National Institutes of Health under Award Numbers HL085794 and OD011107. The content is solely the responsibility of the au-thors and does not necessarily represent the official views of the National Institutes of Health.

Adults with incident coronary heart disease (CHD) are at higher risk for faster cognitive decline in the long-term, according to a study published today in the Journal of the American College of Cardiology.

Coronary heart disease (CHD) is the leading cause of death in men and women. CHD occurs when coronary arteries become damaged due to a build-up of fat and cholesterol and can result in a heart attack or angina when the heart cannot get the blood or oxygen it needs.

The study, one of the largest longitudinal studies investigating the progression of cognitive decline before and after CHD diagnosis, included data from a total of 7,888 stroke-free participants from the English Longitudinal Study of Aging (ELSA), a community-based, biannual, cohort study of adults age 50 and older, from 2002 - 2017. The researchers excluded individuals who had a history of stroke, heart attack and/or angina, had a confirmed diagnosis of dementia and/or Alzheimer's disease, or had an incident of stroke during follow-up.

Three cognitive tests were used to assess participants' cognitive function in eight waves across a 12-year follow-up period. First, verbal memory was assessed by testing immediate and delayed recall of 10 unrelated words. Second, participants were asked to orally name as many different animals as possible in one minute to test semantic fluency. Third, temporal orientation was assessed through four questions regarding the current date (day, month, year and day of the week). Higher scores indicated better cognitive function.

During the study period, 5.6 percent of participants experienced a heart attack or angina. Those with CHD showed faster rates of cognitive decline in all three tests. Patients diagnosed with angina showed a robust decline in temporal orientation, whereas heart attack patients had significant cognitive decline in verbal memory and semantic fluency, and worse overall cognitive decline.

This study found no association between cognitive decline and pre-CHD-diagnosis, nor a short-term cognitive decline after the CHD event occurred.

"Even small differences in cognitive function can result in an increased risk of dementia in the long-term," said Wuxiang Xie, PhD, the study's lead author and a research fellow at the Imperial College School of Public Health in London. "Because there is no current cure for dementia, early detection and intervention are essential to delay the progression to dementia. Heart attack and angina patients need careful monitoring in the years following a diagnosis."

The researchers report that CHD might directly contribute to cognitive decline due to the lack of oxygen to the brain. A previous study determined ischemic heart disease was associated with cerebral microinfarcts, suggesting that CHD may be associated with cerebral small vessel disease - a leading cause dementia in older adults - and therefore contributes to cognitive impairment.

In an accompanying editorial comment, Suvi P. Rovio, PhD, adjunct professor at the University of Turku Research Centre of Applied and Preventive Cardiovascular Medicine in Finland, said the links between cardiovascular and brain health suggest that compromised cardiovascular risk factor levels from early age may damage both vascular and neural tissues of the brain.

"This study provides evidence on the role of incident coronary heart disease as a possible factor bending the course of cognitive decline trajectory in older age," she said. "While primordial and primary prevention would be the most optimal outlooks to postpone clinical cognitive impairment, it is crucial to identify specific at-risk populations for targeted secondary and tertiary prevention."

This study has several limitations, including the use of self-reported doctor-diagnosed incident CHD, as well as a lack of accurate information on the date of CHD diagnosis, symptom severity, acute treatments and medications. Another limitation includes measuring cognitive function using isolated tasks. Further research is warranted to determine the exact link between incident CHD and cognitive decline through elaborate and comprehensive assessment.

(Vienna, June 17, 2019) Poor oral health is associated with a 75% increased risk of hepatocellular carcinoma (HCC), the most common form of liver cancer, new research published in UEG Journal has found1.

The study, by researchers at Queen's University Belfast, analysed a large cohort of over 469,000 people in the UK, investigated the association between oral health conditions and the risk of a number of gastrointestinal cancers, including liver, colon, rectum and pancreatic cancer. Models were applied to estimate the relationship between cancer risk and self-reported oral health conditions, such as painful or bleeding gums, mouth ulcers and loose teeth.

Whilst no significant associations were observed on the risk of the majority gastrointestinal cancers and poor oral health, a substantial link was found for hepatobiliary cancer.

"Poor oral health has been associated with the risk of several chronic diseases, such as heart disease, stroke and diabetes", explained Dr Haydée WT Jordão, from the Centre of Public Health at Queen's University Belfast and lead author of the study. "However, there is inconsistent evidence on the association between poor oral health and specific types of gastrointestinal cancers, which is what our research aimed to examine."

Of the 469,628 participants, 4,069 developed gastrointestinal cancer during the (average) six-year follow up. In 13% of these cases, patients reported poor oral health. Participants with poor oral health were more likely to be younger, female, living in deprived socioeconomic areas and consumed less than two portions of fruit and vegetables per day.

The biological mechanisms by which poor oral health may be more strongly associated with liver cancer, rather than other digestive cancers, is currently uncertain. One explanation is the potential role of the oral and gut microbiome in disease development. "The liver contributes to the elimination of bacteria from the human body", stated Dr Haydée WT Jordão. "When the liver is affected by diseases, such as hepatitis, cirrhosis or cancer, its function will decline and bacteria will survive for longer and therefore have the potential to cause more harm. One bacteria, Fusobacterium nucleatum, originates in the oral cavity but its role in liver cancer is unclear. Further studies investigating the microbiome and liver cancer are therefore warranted."

Another theory in explaining the higher cancer risk due to poor oral health suggests that participants with a high number of missing teeth may alter their diet, consuming softer and potentially less nutritious foods, which in turn influence the risk of liver cancer2.

Liver cancer is the sixth bigger cancer killer in the EU, claiming the lives of almost 60,000 people per year3. The five-year survival rate for the disease across Europe is just 11%4 and approximately 9 in 10 cases are in individuals over the age of 55 ref media pack3. It is believed that up to half of cases of liver cancer are preventable, with risk factors often relating to lifestyle, such as overweight or obesity, smoking and alcohol consumption.

In 2012, Professor Jeroen Raes (VIB-KU Leuven Center for Microbiology) launched the Flemish Gut Flora Project. Sequencing fecal samples of over 3,000 healthy volunteers, Prof. Raes and his team defined the boundaries of a normal, health-associated gut microbiota. Next, the team turned to patient groups to identify microbiome alterations associated with diseases. Recently, they described the so-called B2 enterotype, deficient in some anti-inflammatory bacteria. Today, their results on the high prevalence of this particular enterotype across multiple diagnoses are published in Nature Microbiology.

Comparing microbiomes

Inflammatory bowel disease (IBD) groups several conditions characterized by chronic inflammation of the intestinal tract, including ulcerative colitis and Crohn's disease. Primary sclerosing cholangitis (PSC) is a chronic liver condition involving inflammation and scarring of the bile duct, often concomitant with IBD. In their new study, the VIB-KU Leuven scientists describe microbiome composition in patients suffering from IBD and PSC.

Prof. Jeroen Raes (VIB-KU Leuven): "Over the years, many research groups worldwide have attempted to describe microbiota alterations associated with diseases. Especially IBD is a hot topic in microbiome research. Our study differs from these previous attempts on three fronts. First, we compared the microbiota of patients with profiles from healthy volunteers from our Flemish Gut Flora Project catalog of over 3,000 microbiomes. Second, in our analyses, we did not only look at the percentages of different bacteria present in the stool samples, but also used a new technique to quantify their abundances. Third, we corrected our results for factors such as loose stools, often symptomatic in the diseases studied, but affecting the outcome of microbiome analyses."

A microbial fingerprint of disease

Combining their unique expertise in quantitative microbiome profiling with their knowledge on health-associated microbiota variation, the Leuven scientists identified an altered microbiome configuration - also known as an enterotype - with high prevalence among patient groups. While this enterotype was observed in 13% of healthy volunteers, it could be identified in 38 to 78% of PSC and IBD patients.

Prof. Séverine Vermeire, gastroenterologist at UZ Leuven/KU Leuven, who participated in the research, clarifies: "This aberrant microbiome configuration, which we call the B2 enterotype, is characterized by low bacterial abundances and biodiversity. It is notably deficient in some anti-inflammatory bacteria such as Faecalibacterium. In fact, we detect higher levels of intestinal inflammation in patients with the B2 enterotype. Even among healthy individuals, carriers of this enterotype have slightly higher levels of overall low-grade inflammation."

Gut inflammation, microbes, and depression

Surprisingly, only a few months ago, the lab of Prof. Raes described a similar microbiota alteration to be associated with lower quality of life and even depression.

Prof. Jeroen Raes says: "There appears to be a large overlap in microbiome alterations observed across different patient groups. We detected the B2 enterotype in around 26% of depressed individuals. While the gut microbiota has been shown to play a role in disease development in, for example, ulcerative colitis and Crohn's disease, this is far less clear for depression. However, we will explore the association between the B2 enterotype and depression in more detail in future studies."

While around 13% of healthy individuals can be classified as carriers of the B2 enterotype, the researchers stress that this should not be a reason for concern.

Prof. Jeroen Raes: "At this point, we cannot make any prediction on disease susceptibility or risk based on a person's enterotype. Moreover, enterotypes are not fixed and can be altered by, for example, changing your diet. The observed associations between diseases and microbiota constellations do not imply that the gut bacteria actually cause the disease. Many personal, lifestyle, and environmental factors are linked to a B2 enterotype. However, as also inflammation turns out to be a B2- associated factor in some individuals, we will most certainly be looking further into potential causality."

For health professionals, posting a single negative comment to their Facebook profiles may hinder their credibility with current or potential clients, a new University of Guelph study reveals.

People increasingly use social media to promote themselves or to connect with friends and acquaintances. As the line between personal and professional can easily be confused when professionals use social media to promote themselves, U of G researchers investigated Facebook factors that may affect people's perceptions of professionalism.

They found posting only one subtle comment expressing workplace frustration was enough for people to view you as a less credible health professional.

"This study provides the first evidence of the impact health professionals' personal online disclosures can have on credibility," said psychology professor Serge Desmarais, who conducted the study with U of G Prof. Jason Coe, Department of Population Medicine, and Cynthia Weijs, who conducted the study as part of her dissertation research and is now at University of Calgary. "This finding is significant not only because health professionals use social media in their personal lives, but are also encouraged to use it to promote themselves and engage with the public."

Published recently in the Journal of Medical Internet Research, the study involved more than 350 Canadian participants who viewed a mock Facebook profile and rated the profile owner's credibility and then rated their own willingness to become a client of that profile owner.

The researchers tested factors including the identified gender of the Facebook profile owner, whether they listed their profession as a veterinarian or medical physician and whether their profile included a posting of an ambiguous workday comment or a comment expressing frustration.

The ambiguous comment posted stated: "Started with new electronic patient charts today...interesting experience for sure J."

The workday frustration comment stated: "What is it with some people?? I know I only went through 9 years of university...but really, I know what I'm talking about...yeesh!!"

The only factor that influenced viewers' perception of the profile owner's professionalism was the single workday frustration comment. On a scale from 0 to 100, the profile with the negative workday comment was rated 11 points lower (56.7) than the one with the ambiguous workday comment (67.9).

"That's a meaningful drop," said Desmarais. "This shows that it takes just one simple comment for people to view you as less professional and to decide they don't want to become a client of yours. Depending on who sees your posts, you may really hurt your reputation just by being up late one night, feeling frustrated and posting your thoughts online."

Credibility ratings were determined based on participants' scoring of 16 personality adjectives under the categories of competence, caring and trustworthiness. Profile owners with lower credibility ratings were also deemed by participants as less professional.

Even if a health professional refrains from posting this type of negative comment on their promotional page, potential clients can easily find their personal page online, added Desmarais.

"This blurring between private and public may be particularly problematic for people just entering the health profession field who have essentially grown up posting their lives on social media and haven't yet had the chance to build positive relationships with clients."

While social media can be an effective way to engage with others, as well as promote and brand yourself, it's not the best fit for everyone, he added.

"It makes sense for people whose personalities are a large part of their profession to promote themselves through social media, but it may not make as much sense for health professionals and other professionals whose trust and credibility is a large part of their personal capital."

A sneaky form of antibiotic resistance called "heteroresistance" is more widespread than previously appreciated, scientists at the Emory Antibiotic Resistance Center report.

At the same time, tracking heteroresistance might guide the choice of antibiotic combinations that can defeat bacteria regarded as invincible, the researchers think. Combinations chosen in this way were effective in saving mice from otherwise lethal infections, but their efficacy in hospitalized patients needs to be demonstrated.

The results are scheduled for publication in Nature Microbiology.

Heteroresistance means that standard tests used in hospital labs would not always detect resistance to a given antibiotic, because only a small sub-population of the bacterial cells are resistant to the drug. But that sub-population quickly emerges and thrives, when that particular antibiotic is thrown at the bacterial infection, says David Weiss, PhD, director of the Emory Antibiotic Resistance Center and associate professor of medicine (infectious diseases).

"We can think of heteroresistance as bacteria that are 'half resistant'," Weiss says. "When you take the antibiotic away, the resistant cells go back to being just a small part of the group. That's why they're hard to see in the tests that hospitals usually use."

In clinical labs, heteroresistance will sometimes be incorrectly classified as "susceptible," which could lead to treatment failure. Other times, it will be classified as uniformly resistant.

Weiss and his colleagues examined 104 bacterial isolates from a CDC-supported surveillance program in Georgia (Multi-site Gram-negative Surveillance Initiative), tracking multi-drug resistant "superbugs" (Carbapenem-resistant Enterobacteriaceae or CRE). They found that more than 85 percent were heteroresistant to at least two antibiotics. Viewed in one way, this result is alarming: a lot of those bacteria are resistant to antibiotics in a deceptive way. However, it could actually be an opportunity.

If bacteria were heteroresistant to two antibiotics, Weiss and his team found that combining those two antibiotics was more effective at killing them. That's because the resistant sub-populations were independent and did not rise and fall together. If scientists grew the bacteria in the presence of one antibiotic, or knocked out resistance to that antibiotic genetically, heteroresistance to other antibiotics was not affected.

As pointed examples, the researchers chose two isolates of pan-resistant Klebsiella pneumoniae bacteria, Nevada-2016 and AR0040. The first came from a woman who had died in a Nevada hospital in 2016. This "superbug" stimulated alarm from public health officials, because standard laboratory tests showed it was resistant to 26 different antibiotics, including a last resort drug called colistin.

For two antibiotics, the Nevada bacteria were heteroresistant. Used together, those antibiotics could eradicate the bacteria in culture, the Emory researchers found. A similar approach, but with different antibiotics, prevented mice from succumbing to an otherwise lethal infection with AR0040.

Combinations of antibiotics have been used for a long time but their effectiveness is inconsistent. What's new is the insight into why they work. Microbiologists have thought that some combinations of antibiotics might work together synergistically - one antibiotic working to weaken one part of the bacteria, while the other hits a different spot. But Weiss says that the reasons that combinations work might be explained by multiple heteroresistance.

"Multiple heteroresistance may explain a significant proportion of antibiotic combinations previously identified as synergistic," the authors write.

The current paper covers carbapenem-resistant enterobacteria, which the CDC has designated as a major threat. Heteroresistance has been observed in other types of bacteria as well; more research can document how widespread it is.

Weiss cautions that if heteroresistance to multiple antibiotics ever did become linked in a strain, the combination approach wouldn't work. For now, it could be a way to squeeze more effectiveness out of antibiotics that bacteria have developed resistance to.

"We're saying: don't toss those drugs in the trash, they may still have some utility," Weiss says. "They just have to be used in combination with others to do so."

"Also, we can't tell beforehand what combination will work - there isn't any magic combination," he adds. "You have to test the strain. But that isn't so much different from testing bacterial strains for resistance to individual antibiotics anyway."

PROVIDENCE, R.I. [Brown University] -- Cold weather snaps are followed by a marked increase in fatal opioid overdoses, a new study finds.

A research team led by Brandon Marshall, an associate professor of epidemiology at Brown University's School of Public Health, found a 25 percent increase in fatal opioid overdoses after periods of freezing temperatures compared to days with an average temperature of 52 degrees.

And while the researchers continue to investigate the reasons for this pattern, Marshall suggests some interventions that could reduce overdose risk regardless of the cause. These include cold weather-triggered public health messages that remind people to check on neighbors and loved ones who use opioids, or those that warn individuals who use drugs not to use alone, especially during cold weather.

"It is well known that opioids induce respiratory depression, and that's what causes a fatal overdose," Marshall said. "However, there may be a host of other risk factors that contribute to opioid overdose deaths, which could be avenues for effective interventions. Regardless of what is causing the correlation between cold weather and fatal overdoses, our findings suggest that agencies and organizations should consider scaling up harm-reduction efforts after a period of cold weather."

The findings were published in the journal Epidemiology.

The research involved a partnership between opioid researchers at Brown and the Rhode Island Department of Health (RIDOH), as well as Brown experts who study how the environment impacts human health. Marshall serves also as scientific director for Prevent Overdose R.I., an overdose-surveillance dashboard operated with RIDOH, which provided the data on overdose deaths in Rhode Island.

The research team looked at more than 3,000 opioid-related deaths in Connecticut and Rhode Island from 2014 to 2017. They compared the average temperature on the day of each death -- and up to two weeks before -- to the average temperature of three reference days in the same month. They found that an average temperature of 32 degrees three to seven days prior to day of death was associated with a 25 percent increase in the risk of fatal overdose compared to periods with an average temperature of 52 degrees.

Cold snaps may contribute to increased risk of a fatal opioid overdose in several ways, the study said.

One possibility is that opioid use and exposure to cold weather could combine to create a negative biological effect, said William Goedel, a doctoral student at the School of Public Health, who spearheaded the analysis. Opioids are known to reduce breathing, and even without the effect of drugs, it is already harder to breathe in cold air. Some opioids also reduce the temperature at which the body starts to shiver, which makes it harder to regulate one's body temperature, he added.

Cold weather also changes people's behavior, which could increase the risk of overdose, Marshall said. For example, people may be more likely to use opioids alone when the weather is cold, without someone present who can administer the overdose-reversal drug naloxone. Additionally, cold weather may impact the opioid distribution network. This could potentially increase the risk of using drugs containing illicit fentanyl, or the risk of using drugs more potent than a person is accustomed to, Goedel added.

Despite the increase in overdoses in days following cold snaps, Marshall said the team was surprised to find no direct link between low temperatures on the day of death and the risk of fatal overdose.

"One possibility is that the same-day temperature is based around the recorded day of death, which in some cases is an estimate, especially when a body isn't found for a couple of days," Goedel said. "The lack of a strong correlation with temperature on the day of death could be due to the uncertainty of when people actually died."

The findings might also reflect the cumulative effect of low temperatures on overdose risk, Goedel added.

"Thirty-two degrees on just one day is cold, but to maintain an average of 32 degrees for three or four days means there was a long time where it was quite cold."

Most of the fatal overdoses during the study occurred indoors, Marshall noted. This suggests that providing support for home heating costs or providing warm locations for people to go to during cold spells could also reduce opioid overdoses, he said, although more research is needed.

Marshall would also like to see if the linkage between cold weather and increased risk of overdose deaths is due to major storms or if lower-than-average temperatures alone increase the risk of a fatal overdose.

The researchers also examined above-average temperatures, but did not detect any clear pattern.

Social media use is contributing to poor mental health in Indonesia, research presented in a paper by Sujarwoto Sujarwoto, Gindo Tampubolon and Adi Cilik Pierewan has found.

The paper examines the specific effect of social media on mental health in the developing country.

It found that social media had a detrimental effect on mental health - as has been documented globally. But the authors noted specifics to developing countries such as Indonesia.

Researchers said that the country's high levels of inequality are highlighted on social media leading to envy and resentment at seeing happy, positive social media images of how others live.

Inequality in Indonesia has been rising fast since 2000 and the country has the third-fastest-growing economy among the G20 economies.

It has a rising consumer class which contrasts starkly against those with less education or unable to get employment.

Indonesia's transition to democracy has also played out on social media with negative results.

A cacophony of news about government failures, corruption, crime, conflicts and poverty is amplified on social media on a daily basis - providing little escape for the country's citizens.

The study looked specifically at Facebook, Twitter and chat, and analysed 22,423 individuals across nearly 300 districts of the country.

Social media is incredibly popular in Indonesia; Facebook reported a total of 54 million individual users in Indonesia, making it the fourth largest Facebook-using country in the world, while Twitter reported 22 million Indonesian users, putting the country in fifth place worldwide.

Twitter also reported that Indonesian users publish a total of 385 'Tweets' per second on average.

Meanwhile, mental disorders are becoming a major burden in the country.

Based on the latest Indonesia Basic Health Research survey 2018, the prevalence of individuals with mental disorders in the country is an estimated 11.8 million people.

Global Development Institute researcher Gindo Tampubolon said: "It's a strong reminder that these technologies can have a downside.

"We would like to see public health officials think creatively about how we can encourage citizens to take a break from social media or be aware of the negative consequences it can have on mental health."

The authors call for public health interventions and policies advocating wise use of online social media to prevent increased mental illness driven by excessive social media use in Indonesia.

The study is part of a wider project being conducted at the Department of Optics of the University of Granada, Spain, to investigate various aids marketed as being able to "improve" colour vision among colour-blind people.

In 2018, the researchers demonstrated the ineffectiveness of the Cx-65 glasses produced by another company, EnChroma.

In their new study, they find that the O2Amp 'Oxy-Iso' glasses, marketed by the US company VINO Optics, neither improve the colour vision of people with colour-blindness nor correct their colour-blindness..

In Europe, 8% of the male population and 0.5% of the female population (that is, almost 22 million persons in the EU) present a congenital anomaly in their colour vision, commonly known as colour-blindness. To date, no effective treatment for colour-blindness has been found, although genetic therapies have been successfully tested on mice and primates.

Currently, there are various 'active' and 'passive' aids on the market that claim to improve colour-defective vision among colour-blind people, some of which are of dubious help. So-called 'active' aids modify the colour of images by using image-processing algorithms to increase the contrast between colours that, otherwise, would be indistinguishable for the user. 'Passive' aids are based on colour filters that can even be used as tinted glasses or contact lenses, even with their corresponding optometric compensation. Among the passive aids on the market, the glasses marketed by the US companies EnChroma and VINO are particularly noteworthy for their novelty and media profile.

In 2018, researchers at the University of Granada (UGR) analysed the performance of EnChroma's glasses (model Cx-65), concluding that they do not improve the results of colour-blind participants in a series of diagnostic tests. Nor did they enable the colour-blind participants to enjoy colour vision that resembled that of normal observers. The published conclusions of this research had major social repercussions.

Subsequently, the UGR researchers turned to analysing some of the viral videos made about the O2Amp 'Oxy-Iso' glasses. In these videos, colour-blind users can be seen crying with joy when using the product for the first time. Having studied VINO's advertising claims for such products, the UGR scientists decided to undertake a meticulous study of the effectiveness of these glasses. Their investigative work was driven by a strong conviction that scientists hold a moral contract with society that calls on them to identify and refute--on the basis of rigorous experiments--any erroneous information that companies disseminate. In this case, the information that these companies have targeted at colour-blind people could generate false hopes, such as the suggestion that the product would enable users to see new colours or even to correct their colour-blindness altogether.

Although VINO Optics' O2Amp 'Oxy-Iso' glasses were initially developed for medical professionals to improve the contrast of the veins under the skin, the inventors claim their technology helps colour-blind people with red-green deficiency (known as deutans and protans). On its website, the company currently (June 2019) states: "Our Color Blindness technology corrects red-green color deficiency, based on a scientific understanding of what color vision is for." It also claims their technology "does more than simply allow you to pass the Ishihara test," which is one of the classic, and basic, tests for identifying whether a person is colour-blind.

The researchers followed a dual strategy to assess the efficiency of these glasses. First, they evaluated the vision of 52 colour-blind people, with and without the VINO glasses by means of different tests typically used to assess colour vision: the aforementioned Ishihara colour test (recognition test) and the Farnsworth-Munsell (FM) 100 hue test (arrangement test). They also added a color-naming test based on the X-Rite colour chart. The second strategy was to simulate the effect of the glasses, using the spectral transmittance of the VINO lenses, on observers who presented different degrees of simulated colour-blindness. This enabled the team to assess the changes they produced in the appearance of colours, as perceived by different subjects. The researchers completed their study by comparing the results with those obtained by the EnChroma Cx-65 glasses.

The low-level transmittance of the VINO O2Amp 'Oxy-Iso' glasses in the intermediate region of the spectrum produced a significant change in the appearance of the colour, especially in the chroma attribute. This change allows some colour-blind subjects, particularly deutans, to pass simple recognition tests, such as the Ishihara, but not the more comprehensive arrangement tests, such as the FM100. These results, together with those obtained by means of simulation using a novel "Daltonization" algorithm, showed that these glasses do not improve the colour vision of colour-blind subjects to the extent that they can see colour as people with normal vision. However, they may facilitate some tasks requiring colour discrimination. In fact, these glasses can particularly aid deutans in some tasks, such as helping them to distinguish some colours that can cause confusion (at the risk of confusing others that they previously perceived differently). In addition, the glasses can be useful in some specific applications (such as improving the contrast of veins under the skin), as is the case with other colour filters used in activities such as hunting or shooting, or in low-vision contexts.

In a paper recently published in the journal Optics Express (one of the most widely-respected publications in the optics field, with among the highest impact indices), the UGR researchers conclude: "Our results support the hypothesis that glasses with filters are unable to effectively resolve the problems related to colour vision deficiency."

Despite the efforts of this research team, there remain numerous alternatives on the market that are based on the use of coloured filters. These, too, use similar marketing strategies to promote their products, based on the idea of ??achieving normal colour vision among colour-blind subjects.

Head and neck cancer is an aggressive type of cancer that often grows back, despite patients undergoing harsh treatments. Researchers of the Hubrecht Institute (KNAW) and UMC Utrecht succeeded in growing mini-tumors (or organoids) of head and neck cancers, that can be kept alive in the petri-dish for a long time. Else Driehuis, researcher at the Hubrecht Institute: "These mini-tumors can be used to better understand this complex disease. Moreover, organoids allow us to test both novel and existing therapies in the lab, without burdening the patient."

Head and neck cancer is amongst the ten most prevalent cancers in the world. In the Netherlands, more than 3000 people are diagnosed with this disease every year. Despite heavy treatments that include surgery, radiotherapy and chemotherapy, this aggressive type of cancer grows back within two years in 40 to 60% of the patients. This results in problems with speaking and swallowing and can have large consequences for the physical appearance of the patient. "The treatment of head and neck cancer is harsh", according to medical oncologist Lot Devriese (UMC Utrecht). Often, a combination of therapies is required to treat the disease and this can result in serious side effects. Therefore, there is an urgent need to make treatments more effective and decrease side effects."

Surgery

Researchers working in the group of Hans Clevers (Hubrecht Institute) and doctors and researchers from the UMC Utrecht have now shown that organoids can be grown from so-called head and neck squamous cell carcinomas (HNSCC). These mini-organs are derived from patient-material, for example obtained from the tumor mass removed during surgery. Tumor-organoids of thirty patients diagnosed with head and neck cancer have been kept in culture for over a year. "This is the first time that researchers have been successful in growing organoids derived from head and neck cancer on this scale" says pathologist Stefan Willems (UMC Utrecht). "This technique allows us to multiply the tumor cells of a patient in the lab and will contribute to our understanding of head and neck cancer."

Radiotherapy

After growing the mini-tumors, they were exposed to chemotherapies that are currently given to patients with head and neck cancer. Since radiotherapy is also a common component of the treatment of these patients, the organoids were also exposed to radiotherapy. For seven patients their response to radiotherapy was known. Upon exposure to this therapy, the organoids derived from these patients behaved in the same way as the tumors in these patients did. "We have now started a study in which we will include more patients, to see if organoids can indeed predict the patients response to therapy", says Else Driehuis (Hubrecht Institute)." At the moment, many patients are exposed to harsh chemotherapeutics, whereas some of them in hindsight did not benefit from this therapy. In the lab, we can test many different drugs at the same time to see how the tumor-organoids of the patient respond to them. Potentially, such tests can help us to choose the right therapy for each individual patient."

Predicting patient response

The researchers also exposed the mini-tumors to a range of novel drugs, so-called 'targeted therapies'. As the name implies, these drugs have a very targeted effect and therefore cause less severe side effects than conventional chemotherapies. The downside: they only work for a subset of patients that carry specific alterations in the DNA of their tumor. "For some of these drugs, it has proven difficult to predict which patients will benefit from the treatment. Unfortunately, this has limited the success of these promising therapies so far" says Driehuis. "In our study, we observed that each of the drugs we tested was effective in the organoids of at least one patient. More research will tell us if the tumor-organoids can also predict the patient response for these therapies."

Investigators from Brigham and Women's Hospital are taking advantage of a unique phenomenon of nanoparticles to develop a test for early detection of different types of diseases, including cancer. Through previous investigations, Morteza Mahmoudi, PhD, now a biomedical investigator in the Department of Anesthesiology, Perioperative and Pain Medicine, and colleagues have shown that biomolecules in the blood of healthy individuals and patients form various corona profiles around nanoparticles. Like dipping a donut hole in powdered sugar, nanoparticles collect a unique coating of proteins from the blood. In a new study published in the Royal Society of Chemistry's peer-reviewed journal Nanoscale Horizons, Mahmoudi and the team present evidence that these coronas are personalized and precise, with different compositions or patterns in people with cancers. They have developed a sensor array that has been tested on blood samples, both from people diagnosed with five different types of cancer as well as purportedly healthy people who went on to have a cancer diagnosis several years later. The team's goal is to develop an early detection test that could be used in the clinic to identify those at risk of cancer and other diseases.

"For cancer and many other catastrophic diseases, the earlier you can diagnose, the more likely you can treat and extend survival and attain better quality of life," said Mahmoudi, the paper's corresponding author. Mahmoudi is the former director of the nanobio interactions laboratory at Tehran University of Medical Sciences where he began this work in 2014. "The goal here is to develop a strategy to help people get better information about their health. Today, in the clinic, we have ways to measure lipids and predict risk of cardiovascular disease, but limited ways for cancer. If everything goes well, we hope our work will lead to a screening test for the earliest signs of cancer."

To carry out their investigation, the team combined the concepts of disease-specific protein coronas with sensor array technology. Sensor arrays can identify a wide variety of interacting chemical and biological compounds all at once rather than in isolation. To test blood samples for early patterns of disease, the team developed a sensor array that consisted of three different cross-reactive liposomes -- fatty molecules that caused protein coronas to form around them. The team tested samples from five patients, each with a different form of cancer: lung cancer, glioblastoma, meningioma, myeloma, and pancreatic cancer. The team found that the selected pattern of corona composition, through advanced classification techniques detected by the nanoparticle sensor array, provided a unique "fingerprint" for each type of cancer. The team also tested the tool using blood from 15 people who were subsequently diagnosed with brain, lung, and pancreatic cancer up to eight years later, finding that their approach could identify and discriminate the cancers at the very early stages.

Although promising, as with other diagnostic approaches, the team's preliminary results will need to be validated in a larger number of people to make sure the test not only works but also provides accurate diagnostic information. Mahmoudi and his colleagues are also interested in applying the technology beyond cancer to diagnose other diseases at an early stage.

"The only reason I'm in science is to do something that can help patients," said Mahmoudi. "When I see predictions about cancer, the number of new cases each year and its global burden, it excites me to think that our multidisciplinary expertise in nanobio interfaces, sensor array, and advanced statistics may offer a way to help. There is so much potential here and we are working to tap into it."

In homes across the country, there are dangerous products hidden in plain sight on bathroom counters and bedroom dressers. Personal care products like shampoo, lotion, makeup, nail polish and cologne seem like they should be safe since they are intended for use on our bodies. However, in the hands of young children, these products can quickly lead to trouble. A new study conducted by researchers at the Center for Injury Research and Policy at Nationwide Children's Hospital found that 64,686 children younger than five years of age were treated in U.S. emergency departments for injuries related to personal care products from 2002 through 2016 - that is the equivalent of about one child every two hours.

The study, published today in Clinical Pediatrics, found that most injuries from these products occurred when a child swallowed the product (75.7%) or the product made contact with a child's skin or eyes (19.3%). These ingestions and exposures most often led to poisonings (86.2%) or chemical burns (13.8%).

"When you think about what young children see when they look at these products, you start to understand how these injuries can happen," said Rebecca McAdams, MA, MPH, co-author of this study and senior research associate in the Center for Injury Research and Policy at Nationwide Children's. "Kids this age can't read, so they don't know what they are looking at. They see a bottle with a colorful label that looks or smells like something they are allowed to eat or drink, so they try to open it and take a swallow. When the bottle turns out to be nail polish remover instead of juice, or lotion instead of yogurt, serious injuries can occur."

The top three product categories leading to injuries were nail care products (28.3%) hair care products (27.0%), and skin care products (25.0%), followed by fragrance products (12.7%). Nail polish remover was the individual product that led to the most number of visits to the emergency room (17.3% of all injuries). Of the more serious injuries that required hospitalization, more than half were from hair care products (52.4%) with hair relaxers and permanent solutions leading to more hospitalizations than all other products.

Also of concern, is the ease of access to these products. "Children watch their parents use these items and may try to imitate their behavior. Since these products are often stored in easy-to-reach places and are not typically in child-resistant containers, it is can be easy for kids to get to and open the bottles," said McAdams. "Because these products are currently not required to have child-resistant packaging, it is important for parents to put them away immediately after use and store them safely - up, away, and out of sight - preferably in a cabinet or closet with a lock or a latch. These simple steps can prevent many injuries and trips to the emergency department." Researchers also recommend that pediatricians discuss these safe storage guidelines with caregivers during well-child visits.

Parents and child caregivers can help children stay safer by following these tips:

Up, away and out of sight. Store all personal care products safely: up, away and out of sight - in a cabinet that can be locked or latched is best. Never leave personal care products out unattended and put them away immediately after use.

Store safely now. It is never too soon to start practicing safe storage. Almost 60% of the injuries in this study were to children younger than 2 years of age.

Original containers. Keep all personal care products in their original containers.

Know how to get help. Save the national Poison Help Line (1-800-222-1222) in your cell phone and post it near your home phones.

Decisions to withdraw life support treatments in critically ill patients with severe brain injury are complicated, are based on many factors, and are usually made by critical care physicians and families in the intensive care unit. A study in CMAJ (Canadian Medical Association Journal) provides new understanding on the decision-making processes for this patient population, which accounts for most hospital deaths from trauma.

"Many clinicians struggle to make recommendations to withdraw life-sustaining treatments because decision-making is often complicated by uncertainty from trying to match family or caregiver opinions about what they think the patient would have wanted in terms of quality of life and how well physicians can predict a prognosis," says Dr. Alexis Turgeon, a critical care physician and researcher at CHU de Québec -- Université Laval Research Centre and Canada Research Chair in Critical Care Neurology and Trauma at Université Laval, Québec City, Quebec.

Most deaths in critically ill patients with severe traumatic brain injury occur after a decision to withdraw life-sustaining treatments. This patient population differs from the general intensive care unit (ICU) population as most patients were healthy before admission to the ICU, as compared with older patients who may already have poorer quality of life due to pre-existing illness. Therefore, decisions to withdraw life-sustaining treatments are made differently -- mainly based on long-term prognosis and quality of life.

Researchers performed a descriptive qualitative study of interviews with critical care physicians from across Canada to understand the factors that determine a critical care physician's decision to discuss with families the withdrawal of life-sustaining treatments in patients with severe traumatic brain injury. Results show that several factors are involved, including the patient's pre-expressed wishes and the family's wishes, severity and location of the injury, along with evidence. Past physician experience, legislation, opinions of colleagues and time are additional factors influencing decisions. The incidence of withdrawal of life-sustaining treatments and of death in critically ill patients with traumatic brain injury varies between hospitals.

"A major factor for physicians in decision-making is the influence of the patient circumstances and the family," says Dr. Turgeon. "This is reassuring but challenging when the patient's prognosis is uncertain."

Better evidence, tools to help predict patient outcomes, standardization, better ways to integrate patient values and preferences into decision-making, improved training during critical care fellowships and more time to estimate prognosis are some things that could improve decision-making regarding whether to withdraw life-sustaining treatments.

"Our study has implications for the care of critically ill patients with traumatic brain injury, and we hope it will inform policy to improve how critical care physicians determine prognosis and level of care decisions with families," says Dr. Turgeon.

Hepatitis C virus (HCV) transmission from mothers to babies could largely be prevented if Canada recommended universal screening for HCV in pregnancy, argues a commentary in CMAJ (Canadian Medical Association Journal).

"We encourage all care providers to consider the reproductive implications of HCV, to consider HCV screening in pregnancy and referral for treatment of HCV," write Drs. Chelsea Elwood, Department of Obstetrics and Gynaecology, University of British Columbia, and Laura Sauve, BC Children's Hospital, University of British Columbia, Vancouver, BC. "The time has come to move toward universal HCV screening in women who are pregnant, with initial prenatal investigations that are then repeated based on risk factors in the third trimester."

Almost half of women infected with HCV are unaware of their infection, and current treatment with direct-acting antiviral regimens is quite effective.

"With the care gaps in both maternal screening in pregnancy and postnatal infant screening, Canada likely has a large cohort of infants, children and young adults with progressive liver disease, who could have been cured of the HCV infection if it had been identified early or, quite simply, would not have been infected at all," write the authors.

The elimination of vertical transmission of HCV from mother to child is achievable with collaboration of public health and health care professionals.