#NIHR

[vapolitique]

Femmes enceintes : deux fois plus de réussite pour arrêter de fumer avec la vape par rapport aux patchs

Le tabagisme durant la grossesse est indiscutablement nocif. Non seulement pour la mère, mais aussi pour le fœtus, entrainant des problèmes significativement plus nombreux à l’accouchement et pour le bébé. L’arrêt tabagique est par contre associé à une réduction de ces risques, d’autant plus s’il intervient tôt dans la grossesse. Cependant, les tentatives d’arrêt tabagique chez les femmes…

[artecluster]

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[thenighteternal]

Trhä - ◊an∫aq‡ëactë∫tácactan

[covid-safer-hotties]

Patients With Long-COVID Show Abnormal Lung Perfusion Despite Normal CT Scans - Published Sept 12, 2024

VIENNA — Some patients who had mild COVID-19 infection during the first wave of the pandemic and continued to experience postinfection symptoms for at least 12 months after infection present abnormal perfusion despite showing normal CT scans. Researchers at the European Respiratory Society (ERS) 2024 International Congress called for more research to be done in this space to understand the underlying mechanism of the abnormalities observed and to find possible treatment options for this cohort of patients.

Laura Price, MD, PhD, a consultant respiratory physician at Royal Brompton Hospital and an honorary clinical senior lecturer at Imperial College London, London, told Medscape Medical News that this cohort of patients shows symptoms that seem to correlate with a pulmonary microangiopathy phenotype.

"Our clinics in the UK and around the world are full of people with long-COVID, persisting breathlessness, and fatigue. But it has been hard for people to put the finger on why patients experience these symptoms still," Timothy Hinks, associate professor and Wellcome Trust Career Development fellow at the Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre senior research fellow, and honorary consultant at Oxford Special Airway Service at Oxford University Hospitals, England, who was not involved in the study, told Medscape Medical News.

The Study Researchers at Imperial College London recruited 41 patients who experienced persistent post-COVID-19 infection symptoms, such as breathlessness and fatigue, but normal CT scans after a mild COVID-19 infection that did not require hospitalization. Those with pulmonary emboli or interstitial lung disease were excluded. The cohort was predominantly female (87.8%) and nonsmokers (85%), with a mean age of 44.7 years. They were assessed over 1 year after the initial infection.

Exercise intolerance was the predominant symptom, affecting 95.1% of the group. A significant proportion (46.3%) presented with myopericarditis, while a smaller subset (n = 5) exhibited dysautonomia. Echocardiography did not reveal pulmonary hypertension. Laboratory findings showed elevated angiotensin-converting enzyme and antiphospholipid antibodies. "These patients are young, female, nonsmokers, and previously healthy. This is not what you would expect to see," Price said. Baseline pulmonary function tests showed preserved spirometry with forced expiratory volume in 1 second and forced vital capacity above 100% predicted. However, diffusion capacity was impaired, with a mean diffusing capacity of the lungs for carbon monoxide (DLCO) of 74.7%. The carbon monoxide transfer coefficient (KCO) and alveolar volume were also mildly reduced. Oxygen saturation was within normal limits.

These abnormalities were through advanced imaging techniques like dual-energy CT scans and ventilation-perfusion scans. These tests revealed a non-segmental and "patchy" perfusion abnormality in the upper lungs, suggesting that the problem was vascular, Price explained.

Cardiopulmonary exercise testing revealed further abnormalities in 41% of patients. Peak oxygen uptake was slightly reduced, and a significant proportion of patients showed elevated alveolar-arterial gradient and dead space ventilation during peak exercise, suggesting a ventilation-perfusion mismatch.

Over time, there was a statistically significant improvement in DLCO, from 70.4% to 74.4%, suggesting some degree of recovery in lung function. However, DLCO values did not return to normal. The KCO also improved from 71.9% to 74.4%, though this change did not reach statistical significance. Most patients (n = 26) were treated with apixaban, potentially contributing to the observed improvement in gas transfer parameters, Price said.

The researchers identified a distinct phenotype of patients with persistent post-COVID-19 infection symptoms characterized by abnormal lung perfusion and reduced gas diffusion capacity, even when CT scans appear normal. Price explains that this pulmonary microangiopathy may explain the persistent symptoms. However, questions remain about the underlying mechanisms, potential treatments, and long-term outcomes for this patient population.

Causes and Treatments Remain a Mystery Previous studies have suggested that COVID-19 causes endothelial dysfunction, which could affect the small blood vessels in the lungs. Other viral infections, such as HIV, have also been shown to cause endothelial dysfunction. However, researchers don't fully understand how this process plays out in patients with COVID-19.

"It is possible these patients have had inflammation insults that have damaged the pulmonary vascular endothelium, which predisposes them to either clotting at a microscopic level or ongoing inflammation," said Hinks.

Some patients (10 out of 41) in the cohort studied by the Imperial College London's researchers presented with Raynaud syndrome, which might suggest a physiological link, Hinks explains. "Raynaud's is a condition of vascular control or dysregulation, and potentially, there could be a common factor contributing to both breathlessness and Raynaud's."

He said there is an encouraging signal that these patients improve over time, but their recovery might be more complex and lengthy than for other patients. "This cohort will gradually get better. But it raises questions and gives a point that there is a true physiological deficit in some people with long-COVID."

Price encouraged physicians to look beyond conventional diagnostic tools when visiting a patient whose CT scan looks normal yet experiences fatigue and breathlessness. Not knowing what causes the abnormalities observed in this group of patients makes treatment extremely challenging. "We need more research to understand the treatment implications and long-term impact of these pulmonary vascular abnormalities in patients with long-COVID," Price concluded.

[materialsscienceandengineering]

Hip implants with a delta ceramic or oxidised zirconium head and highly crosslinked polyethylene liner or cup had the lowest risk of revision during the 15 years after surgery, a new study led by the University of Bristol has found. The research could help hospitals, surgeons and patients to choose what hip implant to use for replacement surgery. The aim of the study was to establish hip implant materials at risk of revision to help orthopaedic surgeons, and patients, and to improve shared decision making before surgery by identifying hip implants with the lowest risk of revision. The independently conducted research, published in PLOS Medicine today [7 November], was funded by CeramTec and was supported by the National Institute for Health and Care Research (NIHR) and the NIHR Bristol Biomedical Research Centre (Bristol BRC).

Read more.

[darkmaga-returns]

The timing raises questions about whether the trial and the appearance of the disease are connected, as hundreds of participants received the monkeypox jab.

“The mPower Trial is a clinical trial conducted by Moderna to evaluate the safety of, and immune response to, an investigational vaccine called mRNA-1769, which aims to protect against illness caused by the mpox (previously called monkeypox) virus,” an announcement reads, describing the program that began in March of last year.

“‘Investigational’ means it has not been approved by the MHRA or another health regulatory authority.”

The study was carried out by the National Institute for Health and Care Research’s (NIHR) Clinical Research Network (CRN).

NIHR Director of Strategic Partnerships Dr. Matthew Hallsworth said at the time: “We’re really pleased that Moderna has chosen to run its mpox trial in the UK. This demonstrates our strength in clinical research,” according to an NIHR press release.

Dr. Hallsworth raised the possibility of “future pandemics” striking the U.K.

“Our partnership with Moderna ensures UK research is at the cutting edge of new vaccine technologies with the potential to protect against global health threats such as mpox and future pandemics,” he added.

[disabilityresearch]

‘'Ethno…graphy?!? I can't even say it”: Co-designing training for ethnographic research for people with learning disabilities and carers

This article summarises independent work funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), award 499. The views expressed are those of the authors and not necessarily those of the SPCR, the NIHR or the Department of Health and Social Care

Accessible Summary

We are a team of academic researchers, people with learning disabilities and carers. We worked together to design training materials for people with learning disabilities and carers to work as co-researchers on research projects.

The training was for doing a type of research called ethnography. When you do ethnography, you spend time with people to learn about their lives.

In this article, we describe what we did and what we learnt.

We think more people with learning disabilities and carers should be involved in research but many do not have the confidence to do it. Training can help with that.

We also think that ethnography is a type of research that can be easier to do than other types of research. This is because ethnography uses the skills lots of us already have the following: watching, listening and talking to people.

Background

There is a strong ethical case and an urgent need for more participatory research practices in disability research but a lack of resources to support this. It is important to involve people with learning disabilities and carers at all stages, including when designing training for co-research.

Methods

We co-developed training materials to support people with learning disabilities and carers to work as ethnographic co-researchers and for academic researchers to facilitate co-research. We focused on what people with learning disabilities and carers thought was important to learn.

Findings

Whilst not all types of research methods are easy to democratise, ethnographic observation is a research method that lends itself well to participatory co-research.

Conclusions

For people to be able to meaningfully participate, research processes need to become more accessible and transparent. Training that considers the needs and priorities of people with learning disabilities and carers and addresses the confidence gap is key for meaningful co-research.

[healthpluser]

Treading lightly – reducing the environmental impact of clinical trials - Cancer Research UK Healthpluser

To make trials more environmentally friendly, we first need to understand their carbon footprint and identify the major sources of emissions. With colleagues from the University of Liverpool, we received funding from the National Institute for Health and Care Research (NIHR) to develop a method and guidance for carbon footprinting publicly funded clinical trials. Recently, we also received…

[scientificinquirer-blog]

70% of young people with long Covid recover within two years

Most young people who were confirmed to have long Covid three months after a positive PCR test had recovered within 24 months, finds a new study led by UCL researchers. The Children and young people with Long Covid (CLoCK) study, published in Nature Communications Medicine and funded by the National Institute for Health and Care Research (NIHR), is the world’s largest longitudinal cohort study…

[cad-iksodas-tsenre]

Chemnitz Neueste Nachrichten

Russische Atomraketen um die Rhin-Palast! Dass die BRD-West-Regierung Kniezittern bibbern und Dünnpfiff kriegt. Der gesamte Fahrradbundestag soll sich selber die Knie brechen und die Wirbelsäule versteifen. Der gesamte Autobundestag soll sich selber die Rippen brechen und Schlafapnoe bekommen. -tsenrE

tgeirk-ffifpnnüDK-nu-nrebbiB-nrettizeinK-gnureigeR-drB-tseW eid-saD-tsalap-nihR-eid-mu-netekarmotA-ehcsissuR

i

[systemtek]

Virtual reality and wearable technology pilot to cut drug deaths in the UK

Thousands of lives could be saved through the use of artificial intelligence (AI) and wearable technology designed to reduce drug deaths and improve outcomes. The government has awarded £12 million to projects across the UK that are researching innovative technology to support people with addictions. One of the chosen projects, called PneumoWave ALERT, pairs a chest-worn sensor that monitors breathing to a mobile device that sends out an immediate alert to nearby antidote carriers and emergency services if an overdose is detected, helping people get potentially life-saving treatment as soon as possible. Another study will look at using virtual reality to help people overcome their triggers for cocaine addiction. People will be assessed using watch-like devices to determine which cues in their environment lead to a drug craving, by measuring physical changes to the body. Virtual reality will then be used to create realistic situations to repeatedly expose people to triggers in a safe environment. Previous research shows cue exposure treatment (CET) can significantly reduce the level of craving and relapse among alcoholics, but it has not yet been fully explored for people experiencing a cocaine addiction until now. Minister for Public Health and Prevention, Andrew Gwynne said: Drug addiction devastates lives and rips apart families, and this government is committed to gripping this problem. We’re determined to harness the full potential of cutting-edge technology to save thousands of lives across the country. I want the UK to lead the way in championing innovation to end the harmful effects of addiction. The research is being funded through the Addiction Healthcare Goals programme, which is run by the Office for Life Sciences (OLS). Around £12 million has been awarded to 11 projects across eight organisations in the UK. The projects were selected as part of the Reducing Drug Deaths Challenge and the NIHR i4i Addiction: Innovation for Treatment and Recovery Awards, which are being run in partnership with the Scottish government and National Institute for Health and Care Research (NIHR).   The funding will also support research to improve the accessibility of the life-saving drug naloxone. Naloxone rapidly reverses heroin and opioid overdose but is typically available as an injection or nasal spray which have limitations and cannot always be used in time. Kings College London is looking into naloxone wafers which melt in the mouth and provide rapid access to this emergency medicine and can fit easily in a wallet or purse. Several of the projects are based in Scotland which has the highest rate of drug deaths in Europe. These include a wristband to monitor vital signs such as blood oxygen levels, heart rate and body temperature. If an overdose is suspected, the device, named “Saving Sam”, will send out an alert to a trusted contact. This research is being run by the University of Edinburgh and NHS Fife. The technology being researched could be rolled out to more sites across the UK if successful. The projects support the government’s Health Mission – building an NHS fit for the future – by helping to embed a greater focus on prevention and supporting services. It also helps establish the UK as a global leader for innovative treatments and technologies, supporting the UK’s Growth Mission – for sustained economic growth, good jobs and increased productivity across the country – by inspiring healthcare companies to invest in the UK, while supporting people back into stable work. Science Minister Lord Vallance said: The UK’s life sciences sector plays a critical role in finding new ways to tackle the biggest challenges facing healthcare, including the devastating impact of addiction. The Addiction Healthcare Goals Programme is testament to our commitment to bringing together researchers, clinicians, and innovators to create real change. From wearable technology to AI-powered tools, these innovative projects highlight the power of collaboration in delivering life-saving treatments. By investing in these partnerships, we are tackling addiction head-on and ensuring that cutting-edge science reaches those who need it most, improving public health across the UK. Professor Mike Lewis, NIHR’s Scientific Director for Innovation, said:  Innovation in managing addiction is needed to break the pattern of prison relapse and rebound and the wider impacts of addiction on society. Through the NIHR i4i Addiction: Innovation for Treatment and Recovery Awards, successful projects have been awarded funding to develop approaches to improve treatment and recovery outcomes. Interventions, including AI, that allow management in the community need this research to validate their potential so we can implement them at scale. Professor Dame Anna Dominiczak, Chief Scientific Advisor for Health, Scottish Government, said: Tackling drug-related deaths is a priority for the Scottish Government and NHS Scotland and we are committed to tackling these issues through targeted research, innovation and support. As part of phase two of the Reducing Drug Deaths Innovation Competition, funding has been awarded to develop seven prototypes aimed at reducing drug deaths. These innovative solutions include wearable sensors, digital monitoring and alert applications as well as novel antidote delivery systems. By harnessing the expertise we have in Scotland and across the rest of the UK, we can continue to develop new technologies to drive prevention initiatives. Professor Anne Lingford-Hughes, Chair of the Addiction Healthcare Goals, said:  New approaches to treat drug addiction and reduce drug related deaths, particularly from overdose, are urgently needed. The Addiction Healthcare Goals programme is pleased to fund promising innovations that have brought together partnerships between industry, academia and organisations involved in delivering treatment and care for those experiencing drug addictions. Establishing such collaborations also enhances the UK’s research capacity and ability to deliver novel patient research. This lays firm foundations for the UK to accelerate the development and testing of effective innovations to use in routine care to save lives, reduce harms, and benefit society. Read the full article

[thenighteternal]

Trhä - yuh‡ë

[covid-safer-hotties]

Also preserved in our archive (Thousands of sources and resources with daily updates!)

Study: Children with multiple long-term conditions hospitalized with COVID are almost three times more likely to die - Published Oct 16, 2024

Individuals with multiple long-term conditions are two and a half times more likely to die following COVID-19 infection than others. When children were assessed separately, the risk for mortality among those with multiple long-term conditions increased to almost three times (2.8) the risk of those without. The mortality rates are 22% and 8% respectively.

That is according to an authoritative systematic review and meta-analysis of over four million patients with COVID-19 published 17 October in the Journal of the Royal Society of Medicine. The review is titled "COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people."

The authors are calling for patients with multiple long-term conditions to be prioritized in health care policies.

This systematic review is believed to have considered the largest ever cohort of patients with COVID-19 in a study investigating the impact of multiple long-term conditions. The review synthesized evidence from 111 observational studies of patients with confirmed COVID-19 published between January 2020 and May 2023.

These studies were conducted across 51 countries and most involved high risk or hospitalized patient cohorts with COVID-19, which could account for the high rates of mortality found in the study.

This major study thus provides an updated picture of the impact of COVID-19 for people with multiple long-term conditions.

While previous research has identified risk factors for severe COVID-19 disease—such as older age, male sex, socioeconomic deprivation, being from an ethnic minority background and having a pre-existing condition—there has been limited research into, or reporting of, the outcomes for patients with multiple long-term conditions.

The authors say this should be a matter of growing concern as a third of adults globally—and more than a quarter in England—have two or more long-term health conditions.

This major review found that following COVID-19 infection, and relative to people with a single or no long-term condition, patients with multiple long-term conditions have:

2.4 times higher chance of hospitalization in all ages and specifically 3.5 times higher in children 1.8 times greater chance of needing mechanical ventilation in all ages and 4.3 times higher in children, specifically 1.2 times higher chance of admission to Intensive Care Unit for all ages and 2.9 times greater in children. Dr. Shukrat Salisu-Olatunji, a Ph.D. student at the University of Leiceste was the lead author of the study. She said, "Our systematic review and meta-analysis demonstrated that there is a significantly higher risk of adverse COVID-19 outcomes for people living with multiple long-term conditions, compared with those without.

"Furthermore, relative to those without pre-existing long-term conditions, children and young people with multiple long-term conditions experienced more adverse COVID-19 outcomes. This may suggest that increased vulnerabilities could be associated more with the extremes of age rather than simply older age, as has been previously reported.

"We hope that health policies will prioritize people with multiple long-term conditions, especially in times of public health emergencies such as the COVID-19 pandemic."

Professor Kamlesh Khunti, Director of NIHR ARC East Midlands and a senior author of the paper added, "This study puts into the spotlight the high risk of poorer outcomes for people with multiple long-term conditions. This systematic review is timely as the publication of the recent NHS Darzi Review highlights the biggest challenge facing the nation, as the aging population, who are living longer, often in ill-health with multiple long-term conditions."

More information: COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people, Journal of the Royal Society of Medicine (2024). DOI: 10.1177/01410768241261507

Study link: journals.sagepub.com/doi/10.1177/01410768241261507

[biotech-news-feed]

Almost 50% of adults living with type 1 diabetes experience high levels of diabetes distress #BioTech #science