Archive for month: August, 2020

Post-stroke depression is a major issue affecting approximately 33% of stroke survivors. A new study reports that the level to which survivors are uncertain about the outcome of their illness is strongly linked to depression. The relationship is more pronounced for men than for women.
‘Male stroke survivors in the US who subscribe to traditional health-related beliefs may be accustomed to, and value highly, being in control of their health,’ says lead investigator Michael J. McCarthy, PhD, of the University of Cincinnati College of Health Sciences School of Social Work. ‘For these individuals, loss of control due to infirmity caused by stroke could be perceived as a loss of power and prestige. These losses, in turn, may result in more distress and greater depressive syndromes.’
Thirty-six survivors (16 female, 20 male) who had experienced their first stroke within the preceding 36 months participated in the study. Survivors’ depressive symptoms and ability to perform activities of daily living, such as bathing and cutting food with a knife and fork, were measured. The degree to which survivors were experiencing health ambiguity, or uncertainty about the outcomes of their illness, was evaluated by their agreement with statements such as ‘I don’t know what’s wrong with me,’ and ‘I have a lot of questions without answers.’
Investigators found health ambiguity was significantly associated with greater depression for both sexes, and the association was stronger for male survivors than for females. ‘These findings suggest that reducing health ambiguity through proactive communication with patients and family members may be an effective approach for reducing survivor distress and, ultimately, for improving rehabilitation outcomes, Dr. McCarthy says. ‘The also reinforce the importance of rehabilitation professionals acknowledging that health-related beliefs can have a tangible impact on patient outcomes.’
Dr. McCarthy notes that there was a wide variability in time since diagnosis in the study, and patients were likely at different points in recovery with respect to health ambiguity and depressive syndromes. The small sample size and lack of sample diversity may limit the generalisability of the findings to the broader stroke population. ‘Future research, with more socio-economically diverse samples, should examine how gender-based health-related beliefs affect survivor outcomes, and explore the factors that protect female stroke survivors from the harmful effects of health ambiguity,’ he concludes. EurekAlert

By including chemotherapy as a conditioning regimen prior to treatment, researchers have developed a refined gene therapy approach that safely and effectively restores the immune system of children with a form of severe combined immunodeficiency (SCID), according to a study.
SCID is a group of rare and debilitating genetic disorders that affect the normal development of the immune system in newborns. Infants with SCID are prone to serious, life-threatening infections within the first few months of life and require extensive treatment for survival beyond infancy.
Adenosine deaminase (ADA) deficiency, which accounts for approximately 15 percent of all SCID cases, develops when a gene mutation prohibits the production of ADA, an enzyme that breaks down toxic molecules that can accumulate to harmful levels and kill lymphocytes, the specialised white blood cells that help make up the immune system. In its absence, infants with ADA-deficient SCID lack almost all immune defenses and their condition is almost always fatal within two years if left untreated. Standard treatment for ADA-deficient SCID is a haematopoietic stem cell transplant (HSCT) from a sibling or related donor; however, finding a matched donor can be difficult and transplants can carry significant risks. An alternate treatment method, enzyme replacement therapy (ERT), involves regular injections of the ADA enzyme to maintain the immune system and can help restore immune function; however, the treatments are extremely expensive and painful for the young patients and the effects are often only temporary.
Given the limitations of HSCT and ERT, in the 1990s researchers began investigating the efficacy of gene therapy for ADA-deficient SCID. They discovered that they could ‘correct’ the function of a mutated gene by adding a healthy copy into the cells of the body that help fight infectious diseases. Since then, there have been significant advances in gene therapy for SCID, yet successful gene therapy in patients with ADA-deficient SCID has been seen in only a small series of children due to the difficulty of introducing a healthy ADA gene into bone marrow stem cells and to engraft these cells back into the patients.
‘Although the basic steps of gene therapy for patients with SCID have been known for a while, technical and clinical challenges still exist and we wanted to find an optimized gene therapy protocol to restore immunity for young children with ADA-deficient SCID,’ said Fabio Candotti, MD, one of the study

In research funded by the Medical Research Council and leading UK research charity, Action on Hearing Loss, experts from the University

A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
‘If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system,’ Ole Olsen says and adds, ‘In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world.’
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer caesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
‘Patience is important if women want to avoid interference and give birth spontaneously,’ says Jette Aaroe Clausen. ‘At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.’
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgement stating that ‘the right to respect for private life includes the right to choose the circumstances of birth’. This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies. University of Copenhagen