Tiny wearable cameras may improve quality of life in heart failure patients


The ever-present devices that seem to track all our moves can be annoying, intrusive or worse, but for heart failure patients, tiny wearable cameras could prove life-enhancing, according to research presented today at ESC Congress 2019 together with the World Congress of Cardiology.

Minute-by-minute images captured by these little “eyes” provide valuable data on diet, exercise and medication adherence, that can then be used to fine-tune self-management.

“The cameras bring more information to health professionals to really understand the lived experience of heart failure patients and their unique challenges,” stated study first author Susie Cartledge, a registered nurse and dean’s postdoctoral research fellow at Deakin University’s Institute for Physical Activity and Nutrition in Melbourne, Australia. “This is a level of detail and context that will help us tailor their care.”

Something as seemingly trivial as drinking too much fluid—which cameras can “see”—can tax an already burdened heart, leading to a potentially deadly hospital stay.

Heart failure is a chronic condition where the heart isn’t pumping as well as it should be, so the body isn’t getting enough oxygen. There is no cure and limited treatments, meaning that self-care is paramount. Healthcare professionals have traditionally gleaned information on patients’ daily activities from self-reports, which can be unreliable. This “life-logging technique” is still in its infancy, but studies have shown that it gleans useful data.

For this feasibility study, Dr. Cartledge and her colleagues recruited 30 individuals with advanced (NYHA II-III) heart failure from a Melbourne cardiology practice. Participants’ mean age was 73.6, and 60% were male.

Patients attached a wide-angle “narrative clip” to their clothing at about chest height. The cameras, barely two centimetres squared, were worn from morning to night and took still images every 30 seconds.

“You can really just see the context of the patient’s world from chest height,” explained Dr. Cartledge. “We saw their bingo score cards, their families, their friends but we only saw them if they stood in front of a mirror. We felt like we had been with the patient for the day.”

The images revealed no “scandalous” behaviour on the part of the participants, said Dr. Cartledge, but they did highlight areas for improvement. Patients in general needed to increase their exercise and reduce sedentary behaviour that was typically associated with screen time. Participants could also generally improve their diets, for example there was one participant who could cut back on diet sodas, beers at bingo, and cigarettes.

“We can use this information to have a discussion with the patient. Yesterday, one man’s pills sat out on his table for ages before he took them,” continued Dr. Cartledge, who would counsel this patient to take his medication sooner.

Almost all of the participants (93%) said they were happy wearing the camera (the remaining two were neutral). Some went so far as to report that they were reassured “someone was watching over them” or that the cameras spurred them to engage in “good behaviour.” All participants had the option of deleting photos before the research team saw them.

But capturing the images and getting consent from patients was the easy part. By the end of the 30-day study period the authors had a library of more than 600,000 photos which they had to sort through and analyse.

Machine learning techniques grouped the images into four domains: medication management, dietary intake, meal preparation and physical activity. This process had mixed results. It was most successful in identifying diet-related photos (an average of 49% of the time), followed by information on meals (average 40%) and physical activity (average 31%). Drug adherence was the least precise, with an average of only 6%. This may be because prescriptions come in so many different forms—pill strips, bottles, sprays and puffers—making them hard to recognise.

“The sorting is actually extremely difficult,” admitted Dr. Cartledge. She and her colleagues enlisted the help of artificial intelligence experts at Ireland’s Dublin City University to build a more specific platform. Eventually, the team envisions a relatively low-cost venture using a search engine platform and reusable cameras.

The sheer number of images was a limitation, acknowledged the author. And the heart failure findings may not be applicable to other populations, however the study methodology could be implemented for other chronic disease populations. Members of the study group were older, had advanced disease and came from a lower socioeconomic neighbourhood. The author predicted that the system, once refined, will be most helpful for guiding newly diagnosed patients.

“This is the first step,” Dr. Cartledge said. “Patients are happy to wear it. We can see the context of the challenges they face. The next step is to build an artificial intelligence platform to sort the images out in a quick and meaningful way so healthcare practitioners can use it. We’re entering a new frontier.”


Exercise may improve memory in heart failure patients


More information:
The abstract “Seeing is believing: the feasibility and acceptability of using wearable cameras to enhance self-management of heart failure” will be presented during Nursing and Allied Health Professions Investigator Award, Saturday 31 August at 12:40 to 13:40 in Reykjavik-Village 2.

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Australia cancer sufferer first to use new assisted dying law


A 61-year-old cancer patient has become the first person in over two decades to die under controversial assisted dying laws in Australia, a charity said.

Kerry Robertson died in July, three months after the mother-of-two ceased treatment for metastatic breast cancer, the support group Go Gentle Australia said Sunday.

The state of Victoria passed a law in 2017 to legalise the practice, which went into effect this June. Other states are now expected to follow suit.

Robertson, who ended her life in the southeastern town of Bendigo, was diagnosed with breast cancer in 2010—which then spread into her bones, lung, brain, and liver.

She decided to stop receiving treatment in March when the side effects of chemotherapy were no longer manageable and took medication to end her life after a 26-day approval process, the charity said.

“It was quick, she was ready to go. Her body was failing her and she was in incredible pain. She’d been in pain for a long time,” her daughter Jacqui said in a statement.

Euthanasia had previously been legal in Australia’s Northern Territory, but those laws were overturned in a contentious move by the federal government in 1997.


Australian state takes step toward legalizing euthanasia


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Brain changes noted in holocaust survivors and their children

Brain changes noted in holocaust survivors and their children


(HealthDay)—Holocaust survivors may have suffered permanent harmful changes to their brain structure, and the brains of their children and grandchildren may also be affected, a small study reveals.

“After more than 70 years, the impact of surviving the Holocaust on brain function is significant,” said researcher Ivan Rektor, a neurologist from Brno, Czech Republic.

MRI scans of 28 Holocaust survivors showed they had a significantly decreased volume of gray matter in the brain compared to 28 people in the same age group without a personal or family history of the Holocaust. Their average age was about 80.

The affected parts of the brain are responsible for stress response, memory, motivation, emotion, learning and behavior, the study authors said.

Reductions in gray matter were significantly higher among Holocaust survivors who were younger than 12 in 1945, compared to those who were older. This may be because a child’s developing brain is more vulnerable to stress, the researchers suggested.

Gray matter reductions in the Holocaust survivors were found in areas of the brain associated with post-traumatic stress disorder (PTSD) in combat veterans and people who suffered high levels of stress early in life.

But gray matter reductions found elsewhere in the brains of Holocaust survivors were far greater than previously found in people with PTSD, the findings showed.

The study can’t prove that the horrors of the Nazi regime actually caused the changes in brain structure seen among survivors and their descendants.

However, the researchers are now assessing Holocaust survivors’ children and grandchildren. And early findings in the children show reduced connectivity between brain structures involved in processing emotion and memory.

“We revealed substantial differences in the brain structures … between Holocaust survivors and controls. Early results show this is also the case in children of survivors, too,” Rektor said in a European Academy of Neurology news release.

“Our hope is that these findings and our ongoing research will allow us to understand more about the effect of these experiences in order to focus therapy to support survivors’ and their descendants’ resilience and growth,” Rektor said. “We may also reveal strategies that Holocaust survivors used to cope with trauma during their later lives and to pass on their experience to further generations.”

The study results were recently presented at a European Academy of Neurology meeting in Oslo, Norway. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.


New study reveals biological toll on brain function of Holocaust survivors


More information:
The U.S. National Institute of Mental Health has more on stress.

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Study asked people with mental health disorders to recommend changes to international diagnostic guidelines

Study asked people with mental health disorders to recommend changes to international diagnostic guidelines


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A Rutgers University researcher contributed to the first study to seek input from people with common mental health issues on how their disorders are described in diagnostic guidelines.

The study, which was conducted by researchers in the United Kingdom and the United States in collaboration with the World Health Organization Department of Mental Health, appears in The Lancet.

“Including people’s personal experiences with disorders in diagnostic manuals will improve their access to treatment and reduce stigma,” said Margaret Swarbrick, an adjunct associate professor and Director of Practice Innovation and Wellness at Rutgers University Behavioral Health Care, who collaborated with Kathleen M. Pike, executive director and scientific co-director of the Global Mental Health Program on the U.S. portion of the study.

The researchers talked to people with five common disorders—schizophrenia, bipolar disorder type 1, depressive episode, personality disorder and generalized anxiety disorder—about how their conditions should be described in the upcoming 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The ICD is the most widely used classification system for mental disorders. This is the first time people with diagnosed mental health disorders who are not health practitioners have been invited to give input on any published mental health diagnostic guidelines.

The project surveyed 157 people diagnosed with these conditions in the United Kingdom, India and the United States. The participants reviewed an initial draft of the ICD-11 chapter on mental, behavioral and neurodevelopmental disorders and recommended changes to more accurately reflect their experiences and/or remove objectionable language.

Many participants said the draft omitted emotional and psychological experiences they regularly have. People with schizophrenia added references to anger, fear, memory difficulties, isolation and difficulty communicating internal experiences. People with bipolar disorder added anxiety, anger, nausea and increased creativity. People with generalized anxiety disorder added nausea and anger. People with depression added pain and anxiety. People with personality disorder added distress and vulnerability to exploitation.

The participants also suggested removing confusing or stigmatizing terms such as “retardation,” “neuro-vegetative,” “bizarre,” “disorganized” and “maladaptive.”

“We discovered that the current draft reflected an external perspective of these conditions rather than the perspective of the person’s lived experience,” Swarbrick said. “This is a needed perspective for clinicians and researchers. Participants appreciated the non-technical summaries, which suggest that using such common language would go a long way in bridging the communication gap between the people being diagnosed and clinicians.”


WHO mental health guidelines could better capture ‘lived experience’


More information:
Corinna Hackmann et al, Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study, The Lancet Psychiatry (2019). DOI: 10.1016/S2215-0366(19)30093-8

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Do you need a bone density test?

Do you need a bone density test?


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Dear Mayo Clinic: I’ve never had a fracture or bone health issues. Should I still get a bone density test?

A: It depends. A bone density test uses a low dose of X-rays in a quick, noninvasive way to measure the amount of calcium and other minerals in a segment of bone, usually the hips and spine. By identifying decreases in bone mineral density, your health care provider can determine your risk of fractures, and diagnose and monitor osteoporosis progression.

Most young, healthy people do not need a bone density test. But as you age, your risk for osteoporosis increases because bone density tends to decrease as people grow older. That is especially true in women. If you’re a woman 65 or older, a bone density test is recommended. Even if testing reveals your bone health is good, this test can be a baseline measurement for future testing.

For men without fractures, the answer isn’t quite as clear. The U.S. Preventive Services Task Force doesn’t recommend routine bone density testing for men. Because men have a higher bone mass and lose bone more slowly than women, they’re at a lower risk of fracture. There’s also no conclusive evidence that osteoporosis medications can prevent fractures in men. However, up to 1 in 4 men over 50 will break a bone due to osteoporosis. Groups such as the National Osteoporosis Foundation still recommend testing for men 70 and older.

Men 50-69 and women under 65 also may want to have bone density testing if they have risk factors for osteoporosis, including a family history of the disease or a history of fractures. Another risk factor is taking certain kinds of drugs that can interfere with the body’s process of rebuilding bone. Examples of these drugs include steroid medications, such as prednisone, and immunosuppressant medications, such as those taken after an organ transplant or bone marrow transplant.

People over 50 who have broken a bone and people who have lost 1.5 inches of height or more also may need a bone density test to screen for osteoporosis.

Bone density test results are reported in a measurement known as a “T-score.” A T-score of minus 1 or higher is normal. A score of minus 2.5 or lower is osteoporosis. The range between normal and osteoporosis is considered osteopenia, a condition where bone density is below the normal range and puts a person at higher risk for developing osteoporosis. Osteopenia also raises the risk for breaking a bone.

There are things you can do to help keep your bones stay healthy as you get older:

– Exercise is important. Be sure to include a combination of weight-bearing exercises, such as walking, jogging, running or stairclimbing.

– Eat a healthy diet, making sure to get the right amounts of calcium and vitamin D.

– If you smoke, stop. Research suggests that tobacco use contributes to weak bones.

– Limit the amount of alcohol you drink. Regularly having more than two alcoholic drinks a day raises your risk of osteoporosis, possibly because alcohol can interfere with the body’s ability to absorb calcium.

Talk to your health care provider about getting a bone density test, and discuss with him or her any concerns you have about your bone health. Taking steps now can help ensure good bone health in the future.


What’s the right age to test for osteoporosis?


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Does hypertension pose a health risk to older adults who wish to donate a kidney?

Does hypertension pose a health risk to older adults who wish to donate a kidney?


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In an analysis of clinical information on older living kidney donors, hypertension was linked with a higher risk of developing kidney failure. The study, which is published in an upcoming issue of CJASN, provides new information that may help inform discussions with older individuals when they consider donating a kidney.

Receiving a kidney from a living donor is the best treatment for patients with kidney failure, but it is important to ensure that individuals who wish to donate an organ are able to safely do so. Older age is not a barrier for kidney donation; however, for many older individuals hypertension is common. It is unclear whether hypertension elevates the risk of kidney failure or early death among older donors .

To investigate, Fawaz Al Ammary, MD, Ph.D. (Johns Hopkins University School of Medicine) and his colleagues analyzed national registry data on 24,533 older kidney donors from 1999 to 2016, including 2,265 who had hypertension at the time of donation. This information was linked to data from the Centers for Medicare & Medicaid Services and the Social Security Death Master File to determine which donors developed kidney failure or died. The study is the largest to examine what risks older donors with hypertension may face in the long term.

Donors were observed for a median follow-up time of 7.1 years after kidney donation (and up to a maximum of 18 years). During the study period, 24 donors developed kidney failure and 252 died. Hypertension at the time of donation was linked with higher risk of kidney failure, but not mortality. The 15-year risk of kidney failure was 0.8% for older donors with hypertension vs. 0.2% for older donors without hypertension. The risk of kidney failure was 3.1-times higher for donors with hypertension compared with those without hypertension who had otherwise similar clinical characteristics.

When the researchers restricted their analysis to include only donors from the 2004-2016 period (because documentation of antihypertensive therapy was unavailable before this time), they observed a stronger association—a 6.2-fold higher risk for kidney failure among donors with hypertension. There was no significant association between donor hypertension and 15-year mortality.

“Fortunately, the number of kidney failure events in this population is small. Albeit a rather small risk, practice guidelines for live kidney donor evaluation need to be revisited,” said Dr. Al Ammary. “While controlled hypertension in otherwise eligible older individuals may not be viewed as an absolute contraindication for kidney donation, these findings may inform conversations between the provider and the older individuals with hypertension when they consider donating a kidney.”

The investigators plan to conduct additional studies in this area to advance the field of organ transplantation in light of the growing number of older individuals who may offer an important source of organs for living donation.

In an accompanying editorial, Kenneth Newell, MD, Ph.D. (Emory University School of Medicine) and Richard Formica, Jr., MD (Yale University School of Medicine) noted that the findings “should not be used to ‘allow’ or ‘exclude’ individuals from proceeding with living kidney donation but rather should be incorporated into a comprehensive educational program to better inform donors about the long-term consequences of their decision to be a living kidney donor. In addition these findings identify a cohort of medically complex living kidney donors who should be offered the opportunity to enroll in specialized programs to provide lifetime surveillance for and treatment of conditions associated with an increased risk of end stage kidney disease.”


Older kidney donors with hypertension may have good kidney health following donation


More information:
“Risk of End-Stage Kidney Disease in Older Live Kidney Donors with Hypertension,” DOI: 10.2215/CJN.14031118

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Maine legalizes assisted suicide

Maine legalizes assisted suicide


(HealthDay)—Maine has become the eighth state to legalize medically assisted suicide.

“It is my hope that this law, while respecting the right to personal liberty, will be used sparingly,” Gov. Janet Mills, told the Associated Press.

Under the law, doctors can prescribe a lethal dose of a drug to terminally ill patients, and it will not legally be a suicide. The bill had failed to pass in a state referendum and also a number of times in the State Legislature. It finally passed by one vote in the House and a narrow margin in the Senate.

The new law was praised by Staci Fowler, who took on the fight for the law in honor of her friend Rebecca VanWormer, the AP reported. VanWormer died of breast cancer in 2017 and had pressed for such a law for years before her death. “This is what she wanted,” Fowler told the AP. “And now everybody has the option that she didn’t have.”


Vermont becomes third US state to legalize assisted suicide


More information:
AP News Article

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Maine legalizes assisted suicide (2019, June 15)
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Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life

Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life


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A new study shows that type 2 diabetes in midlife is associated with a 30% increased risk of a serious blockage of the brain arteries, often leading to stroke, and a doubling of the risk of narrowing of the brain’s arteries in people over 60 years. The research is based on a cohort of twins in Sweden and published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD).

Cerebrovascular disease (CBD) includes a variety of medical conditions that affect the blood vessels of the brain. It falls into two main classifications: ischaemic, in which the blood flow is restricted; and haemorrhagic, in which bleeding occurs. CBD and type 2 diabetes mellitus (T2DM) are common disorders that the World Health Organization places amongst the top ten causes of death—between them killing approximately eight million people worldwide in 2016.

Both T2DM and CBD are complex genetic and lifestyle-related disorders. Genetic and familial environmental factors (e.g. foetal environment, maternal smoking and childhood socioeconomic status) have been shown to be involved in the development of both conditions. Accumulating evidence from previous studies suggests that T2DM is independently associated with an increased risk of CBD, especially ischaemic CBD.

This study—conducted by Ph.D. candidate Rongrong Yang, Tianjin Medical University, Tianjin, People’s Republic of China, and Dr. Weili Xu, Karolinska Institute, Stockholm, Sweden and Tianjin Medical University together with their colleagues—examined the link between type 2 diabetes in midlife and the risk of the different types of CBD in late life.

Also, by focusing on data from twins, the study aimed to explore whether genetic and familial environmental factors could explain the link between T2DM and CBD. Because twins generally share the same genetic backgrounds as well as the same family life, in the uterus and in childhood and adolescence, comparisons made within pairs of twins provide an ideal opportunity to explore the possible confounding effects of genetics and familial environment on any association between the two conditions.

The study involved twins from the nationwide Swedish Twin Registry (STR), which started in the 1960s. During 1998-2002, all living twins above 40 years of age were invited to participate in the Screening Across the Lifespan Twin study (SALT), a full screening process that gathered data via computer assisted telephone interview. Of the participants in SALT, this study focused on those twins who were still alive on the follow up on 31st December 2014.

Individuals who did not reach the age of 60 years by 31 December 2014, who had type 1 diabetes, had T2DM onset before age 40 years or at or over age 60 years, and/or CBD onset before 60 years old, or had suffered a transient ischaemic attack (mini-stroke), were excluded—leaving 33,086 people remaining for the current analyses. The SALT data included information on demographics (age, gender and educational attainment); lifestyle (smoking, alcohol consumption); anthropometric measures (weight and height, from which BMI was calculated); zygosity (genetic similarity); and medication use.

Both diabetes status and CBD incidence were obtained from Sweden’s comprehensive National Patient Registry. The 33,086 twins included 14,969 men and 18,117 women. Of them, 1248 (3.8%) had T2DM at ages 40 to 59 years and 3121 (9.4%) had CBD at or over 60. The data were adjusted for possible confounders including: age, gender, education, BMI, smoking, alcohol consumption, marital status, hypertension, and heart disease. The co-twin matched analysis considered data from discordant twin pairs i.e. one twin with each condition and the other one without.

The study found that whilst there was no significant association between midlife T2DM and subarachnoid or intracerebral haemorrhage (brain bleed stroke) in late life, individuals who developed T2DM at ages 40 to 59 years had double the risk of cerebral occlusion (artery narrowing) and a 30% higher risk of cerebral infarction (ischaemic stroke). Further analysis of twin-pairs appeared to show that genetic and early-life familial environmental factors do not appear to play a role as confounders in the association between midlife T2DM and ischaemic CBD in late life.

The mechanisms underlying the association of T2DM with cerebral infarction and occlusion of the cerebral arteries are complex, state the authors, and not completely understood. They note that individuals with T2DM develop dyslipidaemia (abnormal amounts of lipids in the blood) and accelerated atherogenesis—the formation of fatty deposits in the arteries. In addition, metabolic disturbances such as insulin resistance, increased insulin production in response to this resistance, inflammation, increased fat deposits and abnormally high blood sugar in T2DM may also contribute to cerebrovascular events.

The authors suggest that increase in the number of the endothelial cells lining the blood vessels, and thickening of the basement membrane, induced by T2DM, lead to an increased risk of blocking of, but not rupture of the vessels—hence a the negative association between the condition and haemorrhagic CBD (rupture of the arteries) and a positive association with ischaemic CBD (blockage of the arteries).

The authors note some limitations to the study. There were only a limited number of discordant twins (one twin with CBD) in the analysis. They also note that both monozygotic twins (sharing 100% genetic material) and dizygotic twins (sharing only 50%) were included in the study—such that the analysis could not completely control for genetic make-up. In addition, the SALT data did not include information on dietary intake and physical activity or allow for these factors to be considered as potential confounders in the association.

The authors conclude: “This large-scale, nationwide, population-based study of Swedish twins provides evidence that midlife T2DM is associated with some types of ischaemic CBD but not haemorrhagic CBD in the over 60s. Our findings highlight the need to control midlife type 2 diabetes to help prevent blockage or narrowing of cerebral arteries in late life and reduce the incidence of stokes caused by such blockages.”


T2DM is risk factor for liver fibrosis progression in NAFLD


More information:
Diabetologia (2019). doi.org/10.1007/s00125-019-4892-3

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Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life (2019, June 5)
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Should measles vaccination be compulsory?

Should measles vaccination be compulsory?


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As measles cases in Europe hit their highest levels this decade, should the UK adopt compulsory vaccination? Experts debate the issue in The BMJ today.

“We need to increase uptake of this vaccine, as we run the risk of measles becoming endemic,” argues Eleanor Draeger, sexual health doctor and medical writer.

Uptake of the measles, mumps, and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but this drops to 87.4% for the second dose, which falls short of the 95% needed to produce herd immunity, she explains.

She points out that mandatory vaccination has increased uptake in other countries, and that in UK society, many things are already legislated to improve individual or public health. “We would argue that the UK now needs to legislate to increase vaccination rates, as current measures aren’t keeping rates high enough to ensure herd immunity.”

Many parents wrongly believe the rhetoric that vaccines are harmful, unnatural, and an infringement of civil liberties, she says.

Ethicists have argued that compulsory vaccination is acceptable because people who don’t vaccinate their children are potentially putting other people’s health at risk, particularly those who can’t be vaccinated and are therefore more vulnerable.

“Passing a law that stops children attending nursery or school unless their vaccinations are up to date or they are medically exempt would allow free choice while protecting vulnerable children,” she concludes.

But Helen Bedford and David Elliman at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital argue that rather than mandatory vaccination, the UK should concentrate on other methods to increase vaccine uptake, such as improving access to services.

For example, ensuring that general practices have an immunisation lead and adequate appointment reminders in place, making immunisation settings child and family friendly, and ensuring staff have adequate time to talk to parents, and have been trained to tackle any issues that arise.

“Only when these components are in place should we consider mandatory vaccination,” they say.

Even then, they warn of potential unintended consequences. For instance, would parents still trust the NHS and healthcare professionals if GP data were used to decide whether a child was admitted to school or whether a family were allowed certain welfare benefits?

If school entry were denied, some parents may resort to home-schooling, and if vaccination were attached to welfare benefits it would be the less well off, but determined, parents who would suffer disproportionately, they add.

They welcome a recent House of Lords debate that favoured improving services rather than compulsion, and say “we believe that the UK should concentrate on improving its infrastructure and not risk alienating parents unnecessarily.”


Should childhood vaccination be mandatory?


More information:
Should measles vaccination be compulsory? BMJ (2019). DOI: 10.1136/bmj.l2359

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Childhood respiratory disorders may be diagnosed with a smartphone

Childhood respiratory disorders may be diagnosed with a smartphone


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Automated cough analysis technology incorporated in a smartphone app could help to diagnose childhood respiratory disorders, according to a study published in the open access journal Respiratory Research.

Researchers at Curtin University and The University of Queensland, Australia, showed that a smartphone app had high accuracy (between 81% and 97%) in diagnosing asthma, croup, pneumonia, lower respiratory tract disease and bronchiolitis.

Dr. Paul Porter, corresponding author of the study, said: “It can be difficult to differentiate between respiratory disorders in children, even for experienced doctors. This study demonstrates how new technology, mathematical concepts, machine learning and clinical medicine can be successfully combined to produce completely new diagnostic tests utilising the expertise of several disciplines.”

To develop the app, the authors used similar technology to that used in speech recognition, which they trained to recognise features of coughs which are characteristic of five different respiratory diseases. The researchers then used the app to categorise the coughs of 585 children between ages 29 days to 12 years who were being cared for at two hospitals in Western Australia. The accuracy of the automated cough analyser was determined by comparing its diagnosis to a diagnosis reached by a panel of paediatricians after they had reviewed results of imaging, laboratory findings, hospital charts and conducted all available clinical investigations.

The authors note that the technology developed for this study is able to provide a diagnosis without the need for clinical examination by a doctor in person, addressing a major limiting feature of existing telehealth consultations, which are used to provide clinical services remotely. Removing the need for a clinical examination may allow targeted treatments to begin sooner.

Dr. Porter said: “As the tool does not rely on clinical investigations, it can be used by health care providers of all levels of training and expertise. However, we would advise that where possible the tool should be used in conjunction with a clinician to maximise the clinical accuracy.”


Cough app targets US success


More information:
A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children, Respiratory Research (2019). DOI: 10.1186/s12931-019-1046-6

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