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Home care (domiciliary) health workers are frequently verbally abused by clients and their families, finds research published online in Occupational and Environmental Medicine.

Cramped living conditions, dementia, and unpredictable work schedules are key risk factors for verbal abuse, which is itself strongly linked to the risk of physical abuse, the findings indicate.

Violent behaviour has become an occupational hazard for health and social care workers, but most of the research in this area has focused on physical assault perpetrated against hospital staff or those working in other facilities.

The researchers wanted to find out how often home care (domiciliary) workers--to include nursing, hospice, and personal care aides--have to put up with verbal abuse, which can be harmful to health and lead to job dissatisfaction and burnout, say the researchers.

The domiciliary care sector is rapidly expanding as populations age. In the US alone, there were around 2.9 million home health and personal care workers in 2016, with an additional 1.2 million projected to join the workforce by 2026.

The researchers drew on 954 responses to the US Safe Home Care Survey, which was carried out as part of a larger study (Safe Home Care Project) on home care aides' working conditions. The responses refer to a total of 3189 separate visits.

The survey collected information on home care worker demographics, health issues, and general conditions of employment as well as work practices and living conditions and behaviours for up to five clients in the preceding month.

Verbal abuse was defined as being yelled at or spoken to in an angry or humiliating tone; being made to feel bad about oneself; subjected to racial, ethnic, or religious insults/taunts; being threatened with violence.

Around one in four (206; 22%) domiciliary care workers reported at least one incident of verbal abuse by clients or their relatives during the preceding 12 months. Around half (51%) experienced more than one type of verbal abuse; one in 20 (5%) experienced all four.

Physical abuse was much less common (7.5%), but care workers experiencing verbal abuse were 11 times more likely to be subjected to physical abuse than those who had not been verbally assaulted.

Older workers above the age of 48 were less likely to be verbally abused than younger workers, which may indicate greater experience and therefore better coping and communication skills, suggest the researchers.

But after taking account of age, certain factors were significantly associated with a heightened risk of verbal abuse.

These were cramped client living conditions (52% heightened risk) and having a client with dementia (38% heightened risk) Other factors included a client with limited mobility and an unclear care plan. And domiciliary workers with predictable working hours had a 26% lower risk of being verbally abused.

This is an observational study, and as such, can't establish cause. Reports were also collected at one point in time only, and potential links between incidents of abuse and care workers' health were not studied.

But the researchers nevertheless suggest that their findings may actually underestimate the prevalence of verbal abuse as recall fades over time, and home care workers may make allowances for violence because of their client's age or health condition.

"Home care workers may be especially vulnerable to impacts from verbal abuse, as the isolated nature of their jobs and requirements of client privacy leave them with fewer resources for social support that can help moderate the stress response," they write. "Approaches to reducing it should be a priority for [their] employers," and could also benefit clients, they add.

People living in countries that have experienced armed conflict are five times more likely to develop anxiety or depression, a University of Queensland research collaboration has found.

UQ School of Public Health researcher Dr Fiona J Charlson said the study, conducted with the World Health Organisation (WHO) and University of Washington, highlighted the serious effects of war on mental health.

"The burden of mental disorders is extremely high in conflict-affected populations," Dr Charlson said.

"It is estimated that one in five people in such areas will develop a mental health disorder at any point in time and the rate of anxiety and depression is five times higher than the rest of the world.

"The high prevalence shows the sheer enormity of the problem."

The study also showed that the struggles of everyday life against a backdrop of instability and war have a profound impact on mental health.

"The direct and repeated exposure to trauma and armed conflict takes its toll on the mental health of populations," she said.

"There is also the increased stress involved as people try to go about their normal day, finding food and trying to make an income amongst the conflict.

"Poverty is endemic in wars, and this has strong links to mental illness which we can see reflected in the findings."

The WHO and global community is expected to use the results to make a compelling case for considering mental health during humanitarian crises.

"In these conflict environments, health systems are often destroyed or do not function properly, which means people who may have been previously accessing treatment have been cut off," Dr Charlson said.

"Given the vast numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden."

She said emergencies could be a catalyst for the development of meaningful mental health services due to heightened political interest and increased funding sources.

The research will augment practical guidelines for the management of mental disorders in humanitarian emergencies which already exist.

The WHO Humanitarian Intervention Guide is a guideline of moderate interventions for non-specialist health-care providers where access to specialists and treatment options is limited.

Problem Management Plus focusses on scalable psychosocial support services and the need for interconnectedness between people and communities.

Tuesday, June 11, 2019, Cleveland: In one of the first-of-its-kind studies, Cleveland Clinic researchers found that the use of electronic inhaler monitoring, in combination with a disease management program, is associated with reduced healthcare utilization in patients with chronic obstructive pulmonary disease (COPD).

COPD is a term applied to a family of diseases that includes emphysema, chronic bronchitis, and emphysema due to alpha-1 antitrypsin deficiency.

The paper was published May 16 in the Journal of Telemedicine and Telecare.

Between October 2016 and May 2017, 39 patients who have COPD and had at least one hospitalization or emergency room visit during the year prior to enrollment took part in the study, led by Dr. Khaled Alshabani, Dr. Amy Attaway, Richard Rice RRT and Dr. Umur Hatipoğlu.

Patients were provided with electronic monitoring devices for maintenance and rescue inhalers for one year. The monitoring platform, provided by Propeller Health, connects a small sensor to a patient's existing inhaled COPD medication; the sensor then transmits data to the patient's smartphone, or data hub, delivering alerts and insights on medication adherence and usage trends. Alerts were then emailed to the study team, giving researchers insights on patients' rescue and controller medication use.

The results showed a significant reduction in COPD-related healthcare utilization compared to the year prior to enrollment, from an average of 3.4 trips to the hospital to 2.2. There was also a reduction in all-cause healthcare utilization, but that was not statistically significant.

"We prescribe inhaled medications for patients with COPD all the time. It's really the cornerstone of their therapy, and when they return to the clinic we do ask them whether they're using their medications, but the reality is we never know how adherent patients are objectively," said Dr. Hatipoğlu, a Cleveland Clinic pulmonologist. "Electronic inhaler monitoring allows us to assess inhaler adherence at the point of care."

According the American Lung Association, COPD is the third leading cause of death by disease in the United States. More than 11 million people have been diagnosed with COPD, but millions more may be undiagnosed. There is currently no cure for COPD.

Women get autoimmune diseases, such as multiple sclerosis, lupus and rheumatoid arthritis eight times more than men do. On the other hand, women have a smaller risk of getting non-reproductive cancers such as melanoma, colon, kidney and lung cancer.

And while there are some exciting developments in cancer treatments, such as immunotherapies, research is showing that women are responding more favorably than men to this type of intervention.

So why is there such a big difference between women and men when it comes to human diseases?

An interdisciplinary team of scientists at Arizona State University believes it may have the answer.

In a paper published today in the scientific journal "Trends in Genetics," the team presents a new hypothesis to explain the phenomenon, setting the stage for novel research avenues focused specifically on treating autoimmune diseases and cancer.

"Until now, the differences between women and men in regards to human diseases have not been explained by existing theories," said Melissa Wilson, assistant professor with ASU's School of Life Sciences and senior author of the paper. "We are proposing a new theory called The Pregnancy Compensation Hypothesis.

"Basically, women's immune systems evolved to facilitate their survival during the presence of an immunologically invasive placenta and pregnancy, and compensate so they could also survive the assault of parasites and pathogens. But now, in modern, industrialized societies, women are not pregnant all the time so they don't have a placenta pushing back against the immune system. The changes in their reproductive ecology exacerbate the increased risk of autoimmune disease because immune surveillance is heightened. At the same time, we see a reduction in some diseases, like cancer," Wilson said.

Heini Natri, the lead author of the study and a postdoctoral scholar with the ASU Center for Evolution and Medicine, said because the immune system varies between the sexes, it should be considered when developing immunotherapies and other treatments.

"We think the Pregnancy Compensation Hypothesis can explain why there's a big sex difference in these diseases. Going forward, understanding the evolutionary origin of the sex bias in these diseases can help us better understand the mechanisms and particular pieces of the immune system we can target," said Natri. "Our goal is to actually make treatments better for everyone. We are realizing that cancer is different in men and women. In the study of most cancers and other diseases, and so far in the development of cancer treatments, that has not really been taken into account."

Effects of industrialization

Another factor that may exacerbate this situation is living a modern-day, urban lifestyle.

In industrialized communities, autoimmune diseases appear to occur at a much higher rate than in non-industrialized populations. The researchers believe the human immune system evolved expecting a given load of parasites. In the modern environment, exposure to those parasites has diminished so the immune system has fewer foreign targets. With this reduced load, the immune system attacks 'self.'

"There is a mismatch between the ancestral environment humans were adapted to, and the industrialized environment many people currently live in. In terms of an evolutionary timescale, our environment has changed incredibly fast," said Angela Garcia, also a postdoctoral research fellow with the center.

"We have also shifted from an active lifestyle to a sedentary one. We now have an overabundance of calories available, which potentially allows us to maintain excessive levels of hormones, including the female hormone estradiol. Maintaining such high levels of hormones may increase the chance of triggering autoimmune diseases," she said.

Future treatments

The researchers suggest that by framing future research within the Pregnancy Compensation Hypothesis, scientists could dive deeper into the characterization of genes, environmental context and the longitudinal history of people.

"We think this is more than a hypothesis. By using modern molecular biologic techniques in genetics and genomics, we can look at the differences between male and female immune systems, and between modern immune profiles and those in pre-industrial populations. By doing so, we may find new ways to prevent cancer and autoimmune diseases," Ken Buetow, a professor with the school and co-author of the study.

The researchers also suggest there are places where genes are regulated uniquely in males and females, as well as across environmental contexts.

"Going forward, we need to systematically collect environmental variables like pathogenic exposure, levels of stress and reproductive hormones, and parity. We have to understand these areas better," said Wilson.

PHILADELPHIA (June 11, 2019) - History provides an enhanced understanding of the factors that inform social policy. In the wider arena of public health and its influence on social change, the political and healing import of nursing cannot be ignored.

In an editorial published in The American Journal of Public Health titled "The Great Flu and After: Why the Nurses?" Penn Nursing's Patricia D'Antonio, PhD, RN, FAAN, the Carol E. Ware Professor in Mental Health Nursing; Chair of the Department of Family and Community Health; Director of the Barbara Bates Center for the Study of the History of Nursing; and Senior Fellow at the Leonard Davis Institute of Health Economics provides an historical perspective illustrating how nursing has influenced the cultural and social dimensions of public health policies and practices.

In the editorial, D'Antonio broadens the impact of an article in the same issue about how the role of Black American nurses during the 1918 - 1919 influenza pandemic incrementally advanced civil rights and provided some greater opportunities for Black nurses overall.

D'Antonio suggests that the history of nurses and nursing can move beyond just important events and actors; it can help provide answers to questions about how agendas around change in public health policy and practice might also change attitudes and beliefs; how self-interest or group interest may intersect with broader issues of social justice; and if harm reduction policies are appropriate steps when ultimate goals are for broad-based prevention.

"We can see the illustrative power of how this group of clinicians, and the discipline they represent, allow us to more fully understand the nature of social and political change," said D'Antonio. "Through historical analysis like this, we can see how nurse have used opportunities when there were increased demands for their care to challenge their marginalization or exclusions from larger issues of policy or practice."

LOS ANGELES (EMBARGOED UNTIL JUNE 11, 2019 at 11 A.M. EDT) -- A new analysis conducted by investigators at the Cedars-Sinai Smidt Heart Institute shows for the first time that patients with a common heart defect who undergo catheter-based valve replacement procedures have the same survival and complication rates as patients without the defect who undergo the same procedure.

Published June 11 in JAMA: The Journal of the American Medical Association, the analysis compares outcomes for 2,726 patients born with a bicuspid aortic valve-two leaflets that open and close with every heartbeat-with 79,096 patients born with the normal three leaflets on their aortic valves. Both groups of patients were diagnosed with aortic stenosis, a stiffness of the valve's leaflets that reduces the ability to fully open and close and causes the heart's aortic valve to narrow and the heart muscle to become thicker and sometimes weaker.

Aortic stenosis usually affects people 60 and older, but patients born with bicuspid aortic valve often experience it at a younger age. About 1% of the population is born with bicuspid aortic valve.

TAVR (transcatheter aortic valve replacement) is a minimally invasive, catheter-based procedure during which an interventional cardiologist repairs the valve by placing a new valve into the aorta. For patients with normal aortic valves, the procedure is generally considered less risky and easier to recover from than open-heart surgery. But until now, there was not enough data to prove the TAVR procedure also is safe for patients with bicuspid valves.

"In our analysis, we looked at all the bicuspid anatomy patients and found that death rates were no different than patients who had the normal number of leaflets and TAVR," said Raj Makkar, MD, vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai and the Stephen R. Corday Chair in Interventional Cardiology. "This is important because many of the pivotal studies on TAVR did not include bicuspid patients due to concern that these valves may not expand and work in fish-mouth like narrowing in bicuspid anatomy."

The analysis also showed that bicuspid patients were slightly more likely than tricuspid patients to have a stroke within 30 days of the procedure. Based on these findings, Makkar says "carefully selected patients with bicuspid aortic valve stenosis can be treated with TAVR, sparing them more invasive open-heart surgery and longer recovery times since most patients can be discharged home the day after the procedure."

Makkar's TAVR analysis of patients at 552 U.S. medical centers showed:

2.6% of bicuspid patients died within 30 days of the procedure, compared to 2.5% of tricuspid patients, a difference that is not statistically significant.

10.5% of bicuspid patients died within one year of the procedure, compared to 12% of tricuspid patients, a difference that is not statistically significant.

The 30-day stroke rate was higher for bicuspid patients (2.5%) than for tricuspid patients (1.6%).

The risk of procedural complications requiring open-heart surgery was significantly higher in the bicuspid group (0.9%) than the tricuspid cohort (0.4%).

Both groups experienced the same quality of life as measured by the Kansas City Cardiomyopathy Questionnaire.

"This study highlights a critical evaluation that may help some patients avoid unnecessary surgery and complications," said Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute. "Here at Cedars-Sinai, we put the patient first. Many, but not all, patients with bicuspid aortic valve are candidates for TAVR. The care of each patient is individualized, and those who would benefit more from surgery will be appropriately managed by the appropriate faculty on our team."

Discovery of a new feature of a large class of pathogenic viruses may allow development of new antiviral medications for the common cold, polio, and other illnesses, according to a new study publishing June 11 in the open-access journal PLOS Biology by Rana Abdelnabi and Johan Neyts of the University of Leuven, Belgium, and James Geraets and Sarah Butcher of the University of Helsinki and their colleagues.

Picornaviruses include rhinoviruses and enteroviruses. Rhinoviruses cause millions of cases of upper respiratory infections ("colds") yearly and contribute to asthma, and enteroviruses are responsible for millions of infections including cases such as meningitis, encephalitis and polio. There are currently no antivirals that can be used for the treatment or prevention of any of the rhino- or enteroviruses.

To replicate, viruses must interact with host cells, and in doing so, often need to change shape; stabilizing the virus particle is therefore thought to be a promising strategy for preventing replication. In a search for potential antiviral candidates, the authors found a compound that stabilized a model picornavirus. They performed cryo-electron microscopy (cryo-EM) of the drug-virus complex to determine how the drug exerted its effect. Cryo-EM involves combining thousands of two-dimensional images to develop a highly detailed three-dimensional image of the target.

Although picornaviruses have been studied for decades, the authors discovered a previously unknown pocket, or indentation, on the surface of the virus, in which the compound had lodged, thereby stabilizing it against the kind of shape change that would allow interaction with host cells. The team then used the compound as a starting point to generate multiple variants of the antiviral molecule to maximize the activity against a broad range of picornaviruses.

A major challenge in developing antiviral medications is that viruses mutate quickly, changing in ways that make a once-useful drug ineffective. While it is possible that the newly-discovered pocket may also mutate to make picornaviruses resistant to therapies developed against them, the authors suggest the pocket may be crucial enough for viral replication that viruses containing mutant versions may be less viable, making the drug relatively "resistance-proof."

Further work to develop these compounds into effective drugs is ongoing. "These results open up a new avenue for the design of broad-spectrum antivirals against rhinoviruses and enteroviruses, both of which are major human pathogens," Neyts said.

A new study has found that the sex or pregnancy history of red blood cell donors does not influence the risk of death among patients who receive their blood. The study adds to a growing body of literature examining whether blood donor characteristics such as sex, age, and pregnancy history affect the survival of transfused patients.

The research, which used three large donor-recipient databases for its analyses, was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. The findings appeared online on June 11 in the Journal of the American Medical Association.

Previous studies have suggested that women with a history of pregnancy should be excluded from donating blood products such as plasma, the liquid portion of the blood, because it contains antibodies that pregnant women develop when exposed to fetal blood. The plasma of previously pregnant women has been linked to a potentially lethal complication called transfusion-related acute lung injury (TRALI).

The current study of red blood cell transfusions--not plasma--found no higher risk of death in recipients of red blood cells from once-pregnant women.

"NHLBI is charged with conducting and supporting research that improves the blood supply and outcomes in transfused recipients," said Simone Glynn, M.D., M.P.H., chief of the Blood Epidemiology and Clinical Therapeutics Branch at NHLBI. "The results are reassuring in that the survival of patients who got transfused with red blood cells does not appear to be associated with whether the blood they received was donated by a man, by a woman who had been pregnant--or by one who had not. That's important to know."

Scientists analyzed data from the NHLBI-supported Recipient Epidemiology and Donor Evaluation Study-III (REDS-III), a large, multicenter research program focused on ensuring healthy outcomes in donors and transfusion recipients, as well as the safety and availability of transfused blood products in the United States and abroad. Data from the Kaiser Permanente Northern California (KPNC) health care system and the Scandinavian Donations and Transfusions (SCANDAT) database from Sweden and Denmark were also used for the analyses. Together, the three cohorts made available data on more than 1 million patients who had received red blood cell transfusions from 2003 to 2016.

In the KPNC cohort, 9% of the transfusions were from previously pregnant female donors, 39% from never-pregnant female donors, and 44% from donors of the opposite sex of the recipient. In the REDS-III cohort, 18% of transfusions were from female donors who had delivered babies in the past (parous donors), 43% from never-pregnant female donors, and 49% from donors of the opposite sex. In the SCANDAT cohort, 25% of transfusions were from parous donors; 41% from never-pregnant female donors, and 50% from donors of the opposite sex.

The median age of the recipients was 64 years in the REDS-III cohort, 71 years in the KPNC cohort, and 72 years in the SCANDAT cohort. In the KPNC and SCANDAT cohorts, each patient on average received three transfusions per hospitalization; in the REDS-IIII cohorts, each received two, and the scientists adjusted for those differences in their analyses.

Researchers found no significant associations between patient mortality and red blood cell transfusions from either the parous, previously pregnant, and never-pregnant female donors or the donors of the opposite sex. This finding applied to men and women transfusion recipients, regardless of age. Even in the case of female donors who gave birth for the first time during the study period and continued to donate blood--a group analyzed in detail in the SCANDAT cohort--researchers found no effect on the risk of death among patients transfused with their blood.

"We looked at three donor groups, and after careful adjustment for the number of transfusions, we didn't find any evidence of an association," said Nareg Roubinian, M.D., M.P.H., senior study author and clinical investigator at the Kaiser Permanente Division of Research, Vitalant Research Institute, and the University of California, San Francisco. "Given the different geographic locations and sizes of the cohorts, this finding was very consistent and convincing."

"We proactively address potential risks to the blood supply, and we take this seriously," said Gustaf Edgren, M.D., Ph.D., study author and senior researcher in the Department of Medicine Solna at Karolinska Institute in Stockholm, Sweden. "Transfusions are very common procedures, and our findings ensure that the current practice is safe and doesn't need to be changed."

Worldwide, more than 80 million units of red blood cells are transfused annually. Roubinian said the study adds to our understanding of blood safety in current transfusion practice, in parallel with work studying how donors are selected, how blood is processed, and how those factors may affect patient outcomes.

The researchers' next goal is to investigate whether other blood donor and component factors could pose medical problems in transfused patients, focusing on chronically transfused groups of adults and pediatric patients.

A systematic review and meta-analysis identified significantly increased odds of child obesity when mothers have obesity before conception, according to a study published June 11 in the open-access journal PLOS Medicine by Nicola Heslehurst of Newcastle University in the UK, and colleagues.

Obesity is a leading cause of life-long poor health globally, and is significantly associated with inequalities. Capitalizing on opportunities for early-life prevention of obesity is a priority for public health, global health and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing resources to be channeled into intervention. In the new study, Heslehurst and her colleagues aimed to estimate the extent to which a mother's pre-pregnancy body mass index is associated with the weight status of their children. This systematic review included 79 observational studies that investigated maternal pre-pregnancy body mass index and childhood weight status.

The results revealed significantly increased odds of child obesity with maternal obesity (OR 3.64, 95% CI 2.68-4.95) and maternal overweight (ORs 1.89, 95% CI 1.62-2.19). Significantly increased odds were observed for child overweight/obesity (OR 2.69, 95% CI 2.10-3.46) and for child overweight (OR 1.80, 95% CI 1.25-2.59) with maternal obesity. This study provides substantial evidence for the need to develop interventions that commence prior to conception, to support women of childbearing age with weight management, in order to combat intergenerational obesity. According to the authors, paying more attention to the preconception period in obesity prevention interventions may help to address the complex early-life inequalities associated with obesity development.

Researchers at Helmholtz Zentrum München and the Technical University of Munich, working in collaboration with researchers at the University Medical Center Hamburg-Eppendorf and the University Hospital Heidelberg, have for the first time succeeded in conquering a chronic infection with the hepatitis B virus in a mouse model. The team showed in its publication, that T-cell therapy can provide a permanent cure. Up to now it has not been possible to fully control the virus. Their findings have now been published in the Journal of Clinical Investigation.

Infections with the hepatitis B virus (HBV) are a global health problem. According to the World Health Organisation (WHO), more than 260 million people worldwide are chronically infected with the virus. Vaccination prevents new HBV infections, but for people who are chronic carriers of the virus, a cure has not yet been found. Available drugs only prevent the virus from continuing to replicate in liver cells, but they cannot eliminate it. In the long term, this can lead to complications such as liver cancer or liver cirrhosis, whereby functional liver tissue is replaced by fibrous connective tissue.

"Currently, chronic hepatitis B cannot be cured. We have now been able to show that T-cell therapy exploiting new technologies presents an encouraging solution for the treatment of chronic HBV infection and liver cancer that is triggered by the virus. That is because these 'living drugs' are the most potent therapy we have at our disposal at present," explains Prof. Ulrike Protzer. She is Director of the Institute of Virology at the Helmholtz Zentrum München and at the Technical University of Munich, both members of the German Center for Infection Research (DZIF).

T cells eliminate hepatitis B

According to Dr. Karin Wisskirchen, first author of the study and scientist in the group of Ulrike Protzer, the new T-cell therapy was specifically developed as an approach to fighting HBV infection and HBV-associated liver cancer. It is known that in chronically infected patients, virus-specific T cells either cannot be detected or they demonstrate decreased activity. However, if patients are able to keep the virus under control by themselves, a strong T-cell response becomes detectable. "The obvious answer is therefore to use virus-specific T cells to make up for this deficit," Dr. Wisskirchen says. The genetic information for HBV-specific T-cell receptors was obtained from patients with resolved infection. In the laboratory, it can then be introduced into T cells from the blood of patients with chronic hepatitis B. This leads to the formation of new, active T cells, which fight the virus or virus-induced cancer cells. T cells created in this way were able to completely eliminate HBV-infected cells in the cell culture.

In cooperation with the group led by Prof. Maura Dandri, Hamburg the immune cells were then tested in a humanized mouse model**. A single dose of the receptor-modified T-cells was sufficient to control the virus in the liver. Hereby, the T-cells only attacked infected liver cells and spared healthy tissue. Myrcludex B***, an experimental drug developed by Prof. Stephan Urban, Heidelberg, was then administered to prevent the virus from infecting healthy liver cells again as soon as the T-cells had stopped circulating. As a result, the infection was completely cured.

Preparations for a clinical study

"The promising results of this study will help us to further investigate the potential of T-cell therapy and go ahead with clinical trials along with our partners. We are thus taking a decisive step towards establishing this form of personalized medicine," Prof. Protzer says. Her group will therefore continue to explore ways of applying the therapy to the widest possible group of patients. The Helmholtz Zentrum München has out-licensed parts of its T-cell therapy to SCG Cell therapy Pte. Ltd. "Together with our partner we are planning a clinical trial to study the treatment of patients with HBV-associated hepatocellular carcinoma," Dr. Wisskirchen explains. T-cell therapy is a highly innovative area that has gained momentum thanks to the significant success of clinical trials in the treatment of lymphoma. Prof. Dandri stresses: "Such progress would not be possible without the close cooperation that we have within the German Center for Infection Research."

WASHINGTON, D.C., June 11, 2019 -- Stroke, one of the leading causes of death worldwide, is normally caused by poor blood flow to the brain, or cerebral ischemia. This condition must be diagnosed within the first few hours of the stroke for treatment to be effective, according to the Mayo Clinic.

Researchers from the Army Medical University and China Academy of Engineering Physics have developed a device that uses near-infrared light to monitor blood flow. The hybrid instrument, which relies on the combination of two light measurement techniques, could be used to quickly and noninvasively diagnose cerebral ischemia. The work is described in AIP Advances, from AIP Publishing.

Liguo Zhu, an author on the study, said that the instrument works thanks to near-infrared diffuse optical spectroscopy, which analyzes light scattered from tissues to calculate the amount of oxygen and blood within an area, and diffuse correlation spectroscopy, which analyzes fluctuations in tissue-scattered light to measure the rate of blood flow, or blood flow index.

"We can measure blood volume, blood oxygenation and blood flow using suitable near-infrared techniques," Zhu said, adding that near-infrared light penetrates 1 to 3 centimeters and allows researchers to probe under the skin.

To test their instrument, the authors strapped a device probe to a human subject's forearm, then inflated an arm cuff around the subject's bicep to block off blood circulation. The authors found that the measured light attenuated, or reduced in intensity, as blood flow was cut off and brightened again when the arm cuff was removed -- mirroring the decrease and subsequent increase in oxygen and blood at the probe area. At the same time, the measured autocorrelation, or time lag, function decayed less rapidly when blood flow was cut off, showing that blood was moving more slowly through the area.

The team's device can record a comprehensive profile of a body part's hemodynamics, or blood circulation, said Hua Feng, another author on the study. This capability contrasts those of previous instruments, which could only characterize certain aspects of blood flow. Feng added that devices should measure as many "hemodynamic parameters" as necessary to obtain an accurate diagnosis, as "the hemodynamics of stroke is complex."

The device has another advantage: It is cheap and compact.

"(Both techniques) share the same detectors, which decreases the number of detectors (compared to other instruments)," Zhu said. "The optical switch makes the combination of incoherent and coherent light sources simple, and the custom software makes measurement quick."

Bottom Line: Whether blood donors' sex and pregnancy history were associated with death for red blood cell transfusion recipients was investigated in this study that analyzed data from three study groups totaling more than 1 million transfusion recipients. There were no statistically significant associations between any of the three donor characteristics studied (female donors, previously pregnant donors, and donors and recipients who were of opposite sex) with in-hospital mortality of transfusion recipients in any of the three study groups. Prior research has produced conflicting results about possible associations between red blood cells from female donors and increased risk of death for transfusion recipients. The study has several limitations, including its observational design which can only show associations.

Authors: Gustaf Edgren, M.D., Ph.D., Karolinska Institutet, Stockholm, Sweden, and coauthors

(doi:10.1001/jama.2019.7084)

Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

WASHINGTON -- A combination of elevated symptoms of depression along with modifications in a gene responsible for dopamine activity, important to the brain's pleasure and reward system, appear to influence an addiction to indoor tanning in young, white non-Hispanic women.

That finding comes from a new study, reported by researchers at Georgetown Lombardi Comprehensive Cancer Center and published online June 11 in Annals of Behavioral Medicine.
Excess exposure to ultraviolet radiation can lead to melanoma and non-melanoma skin cancer. Most UV exposure is from the sun, but exposure from indoor tanning is common in certain people and accounts for 10 percent of skin cancer cases in the U.S. There will be an estimated 96,480 new cases of melanoma in the United States and 7,230 deaths from the disease in 2019.

This study compiled survey responses from 292 non-Hispanic white women in the Washington, D.C. area, 18 to 30 years of age, who used indoor tanning beds, sunlamps, or sun booths. The survey asked questions about values and behaviors that might predispose a person to a tanning addiction, as well as a series of questions to determine if they had symptoms of depression.

The researchers also collected saliva samples to obtain DNA to look for 34 single nucleotide polymorphisms (SNPs) in five different genes. SNPs are changes in one of the base molecules on a strand of DNA. The specific SNPs that researchers looked at were in genes known to be related to pathways that reward addictive behavior.

"By demonstrating that genes in behavioral reward pathways are associated with tanning addiction, we are providing stronger evidence that tanning addiction is a cancer risk behavior in need of intervention," says lead author Darren Mays, PhD, MPH, an associate professor of oncology and member of the Cancer Prevention and Control Program at Georgetown Lombardi. "This finding adds to a growing body of evidence from animal studies and neuroimaging studies that have been done in humans."

The researchers adjusted their analyses based on indoor tanning frequency, value of appearance, and depressive symptoms. They found a more than two-fold increased odds of indoor tanning addiction in modifications to the rs4436578 SNP and a slightly less than two-fold increased odds of addiction in modifications to the rs4648318 SNP. When looking at whether the SNPs interacted with depressive symptoms to increase the risk of indoor tanning-addiction, they found a more than 10-fold increase if there were modifications to the rs4436578 SNP and a more than 13-fold increase in the rs4648318 SNP. This knowledge should be helpful if screening for risk of addiction is shown to be beneficial in reducing the chance that people will engage in a cancer-causing activity.

Mays work in tanning addiction continues with a study, just getting underway, that will explore the effectiveness of text messaging as an intervention to help young women quit if they are addicted to indoor tanning. The research is funded by the Prevent Cancer Foundation.

"This grant will enable us to test behavioral interventions in young women who are addicted to indoor tanning," Mays says. "We have used text messaging to intervene in other behaviors and have found that the personalized conversation we can deliver through this medium can help people take steps to quit."

Facial and head injuries from riding electric scooters have tripled over the past decade, according to a Rutgers study.

Electric scooter use has been increasing in popularity as a more environmentally friendly and efficient alternative to gas vehicles. However, state helmet laws vary, and the study found that many people are being injured from not wearing appropriate protective equipment.

The study, published in the American Journal of Otolaryngology, analyzed records in the Consumer Product Safety Commission's National Electronic Injury Surveillance system between 2008 and 2017 to determine the types and frequency of head and facial injuries resulting from motorized scooters. The system collates data from about 100 participating hospitals, which is then extrapolated to provide national estimates on injuries related to consumer products.

The researchers found that over the decade studied, emergency departments recorded 990 head or facial injuries sustained from electric scooter use -- or 32,000 estimated injuries nationwide. The incidences tripled annually from an estimated 2,325 nationwide in 2008 to an estimated 6,947 in 2017.

Most of the people injured were men between 19 and 65; 33 percent were children between 6 and 12. "Children use motorized scooters marketed as toys, but in reality, certain models can reach speeds of almost 30 miles per hour," said co-author Amishav Bresler, a resident at Rutgers New Jersey Medical School.

Closed head injuries, such as concussion and bleeding or bruising of the brain, were most frequent, followed by facial cuts or abrasions. The study showed about 5 percent of the injuries were fractures, most frequently in the skull or nose.

In records where helmet use was recorded, 66 percent of those injured were not wearing helmets. The study also found that helmet use increased with age, from about 19 percent in toddlers to about 67 percent in senior riders.

Bresler noted a significant variation in state laws regarding motorized scooters. For example, the District of Columbia classified motorized scooters as "personal mobility devices" that are not subject to inspection or helmet laws while a new law in New Jersey regulates electric scooters in the same way as a traditional bicycles, requiring helmets in only those under 17.

"The United States should standardize electric scooter laws and license requirements should be considered to decrease the risky behaviors associated with motorized scooter use," said Bresler, who noted the success of such legislation in other countries. "In 2000, Italy implemented a law mandating helmet use for all types of recreational scooter drivers -- legislation that reduced head trauma in scooter riders from about 27 out of 10,000 people before the law passed to about 9 out of 10,000 people afterward."

DALLAS, June 11, 2019 - Patients with left-sided heart failure who get implanted devices to improve the pumping of their hearts may be more likely to develop heart failure on the opposite side of their hearts if they are pre-treated with off-label selective vasodilator drugs, according to new research published in Circulation: Heart Failure, an American Heart Association journal.

Between 10% and 40% of patients who undergo left-ventricular assist device (LVAD) implantation for left-sided heart failure develop right-sided heart failure -- a complication that spells worse outcomes. To head off the complication, physicians sometimes prescribe preemptive treatment with off-label selective vasodilator drugs called phosphodiesterase-5 inhibitors (PDE5i). PDE5i drugs are currently approved for use to avoid right heart failure in patients with pulmonary arterial hypertension due to causes other than heart disease, which is a different patient group from the ones followed in this study.

PDE5i drugs dilate the pulmonary artery -- the large vessel that carries blood away from the heart's right side and into the lungs. A handful of small studies have shown a possible benefit to this off-label approach in some patients but affirmative data from large-scale studies have been lacking and the current study hopes to help close this gap.

An LVAD is a mechanical heart pump. It's placed inside a person's chest, where it helps the heart pump oxygen-rich blood throughout the body. Unlike an artificial heart transplant, LVADs do not replace the heart. LVADs help the heart do its job.

The findings of the new study -- the largest analysis to date to assess the utility of this approach -- call the preemptive treatment with PDE5i drugs into question.

"We found no benefit of this therapy in patients receiving LVAD devices, including patients with pulmonary vascular disease or right ventricular dysfunction -- the very patients who might be expected to benefit most," said study senior investigator Michael Kiernan, M.D., M.S., a cardiologist at Tufts Medical Center and assistant professor of medicine at Tufts University School of Medicine in Boston. "Our findings should give pause to clinicians considering this therapy, and we would caution against routine use of these therapies prior to LVAD surgery."

The results are based on analysis of 11,544 U.S. LVAD recipients who underwent implantation between 2012 and 2017. Of all device recipients, 1,199 (10%) received pre-implantation treatment with PDE5i drugs which target the pulmonary artery to reduce the pressure in the heart's right ventricle. Overall, 24% of all patients who got LVAD implants developed right-sided heart failure, but the group that got pre-implantation drugs did so at higher rates. To minimize the possible effects of other factors that could bias the outcomes, the researchers matched 1,177patients treated with PDE5i drugs to group of 1,177 patients who did not receive such preventive therapy but were otherwise similar to the pre-treated group in terms of disease severity, age and the presence of other diseases that could affect outcome and health status.

Compared with those who did not get drug therapy, the group that received vasodilator drugs before LVAD implantation were 31% more likely to develop right-sided heart failure (29% for those treated, compared with 24% among those who did not receive pre-treatment). Additionally, the relative risk of bleeding within a week of LVAD surgery was 46% higher in patients receiving PDE5i therapy (12% of patients receiving therapy versus 8% of those not receiving this therapy), the analysis showed.