Goth teens 'at increased risk of depression and self-harm'

Friday August 28 2015

Goths favour black clothes and stark make-up

"Goths are three times more likely to be depressed than other teenagers, with 37% admitting to self-harming," the Daily Mail reports. 

A new study looked at mental health outcomes in young people who said they identified with the goth sub-culture. Goths favour black clothes, stark make-up, gloomy music and an interest in the darker side of life.

The study involved 2,000 teens and looked at whether self-identification as a goth at age 15 is linked to depression and self-harm at 18. 

After full adjustment for prior mental health and behavioural problems in the child, the study found goths were around a quarter more likely to have depression by 18 and a third more likely to report self-harming.

The obvious question is, does being a goth make you prone to depression, or are people already prone to depression more likely to identify with goth culture?

It's likely the relationship between mental health and self-identity is a complex one that cannot be boiled down to a simple "X leads to Y" statement.

And it could even be the case that for some teens who would otherwise have remained socially isolated, adopting the goth sub-culture brings a sense of peer solidarity.

Nevertheless, the study still indicates that those who identify with goth culture may be a group with an increased risk of mental health problems. Providing support to these young people could be beneficial.  

Where did the story come from?

The study was carried out by researchers from the University of Oxford and other academic institutions in the UK. 

It was funded by the Wellcome Trust and the Medical Research Council Programme, and was published in the peer-reviewed Lancet Psychiatry on an open access basis, so it can be read for free online.

The UK media's reporting of this well-conducted research is generally accurate. But an exception to this is The Daily Telegraph, which carried the headline: "Chavs are less depressed than goths, Oxford University finds". This is unsupported by the evidence provided by the study. Rates of depression and self-harm in this group are not given in the paper. 

What kind of research was this?

This cohort study aimed to look at the association between teen self-identification as a goth and depression and self-harm.

Previous research observed that deliberate self-harm is associated with goth culture in young people. However, it is unclear whether this is a direct causative association or whether this link is being influenced by other factors – for example, family, peer or life circumstances.

The researchers aimed to try to look at the direction of effect by assessing self-identity at 15 years and then look for the emergence of new mental health problems at 18 years. 

What did the research involve?

This study involved children enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC). This is an ongoing study that recruited pregnant women in Avon due to have a baby between April 1991 and December 1992. All children in this study have been invited to attend follow-up assessments every year since the age of seven.

This study included those who took a computer-based survey at the assessment at the age of 15, which asked them to self-identify as one of eight different social groups: sporty, populars, skaters, chavs, loners, keeners, bimbos, and goths.

They were asked further questions about how much they identified with these categories. For example, "Is there a group of teens in your school or neighbourhood with the reputation of rebelling against the norm (in clothing or ideas, for example), or in attempting not to conform to social ideals (e.g. goths)?" and "How much do you identify with the goths?" – to which they answered "not at all", "not very much", "somewhat", "more than somewhat", or "very much".

At the same time they also completed the Development and Wellbeing Assessment, which includes questions about symptoms of depression and self-harm.

Then, at the age of 18, depression was assessed using the Clinical Interview Schedule-Revised (CIS-R), where diagnoses are made according to standard diagnostic criteria from the International Classification of Diseases (ICD). 

This scale also assessed self-harm with questions such as, "Have you ever hurt yourself on purpose in any way (e.g. by taking an overdose of pills or by cutting yourself)?". The researchers didn't make a distinction between whether or not self-harm was associated with suicidal intent.

The researchers looked at the association between goth identification and depression or self-harm at 18 years, adjusting for these factors at 15 years to try to better determine a causative direction of effect. 

They further adjusted their analyses for various individual, family and social characteristics, making use of earlier ALSPAC assessments. This included the mother's history of depression, temperament and educational attainment, as well as the child's earlier history of depression, emotional or behavioural problems, or bullying. 

What were the basic results?

Overall, full data on self-identification and mental health at 15 and 18 years was available for 2,351 teens, who formed the sample for this analysis. This represented just under half of the potential ALSPAC cohort who were still participating in the assessments at 15 years.

Those identifying as goths were more likely to be girls, to have mothers with a history of depression, to have reported being bullied as a child, and to have a history of depression or emotional or behavioural problems themselves.

Depression at 18 years was associated with the extent they identified with goth culture. For example, the depression rate among those who did not identify at all was 6%, compared with 9% of those who identified "somewhat" and 18% of those who identified "very much". After adjustment for confounders, people who identified as a goth were 27% more likely to have depression at 18 years (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11 to 1.47). The confounder having the greatest influence was previous depression in the teen/child themselves.

There was also a similar link between goth identification and self-harm, with the greater the extent of identification being associated with the highest risk. 

After adjustment for confounders, goths were a third more likely to report self-harm at 18 years (OR 1.33, 95% CI 1.19 to 1.48). A total of 37% of those who "very much" identified as a goth had self-harmed by 18.

As a comparison, for those who identified "very much" with other groups:

• skaters – 11% with depression and 25% had self-harmed by 18
• loners – 9% with depression and 26% had self-harmed by 18
• sporty – 4% with depression and 6% had self-harmed by 18  

How did the researchers interpret the results?

The researchers concluded that, "Our findings suggest that young people identifying with goth sub-culture might be at an increased risk for depression and self-harm."

They go on to say that, "Working with young people in the goth community to identify those at increased risk of depression and self-harm and provide support might be effective." 

Conclusion

This cohort study has found positive links between self-identification as a goth at 15 years, and subsequent depression and self-harm at 18 years.

The study has many strengths, including the use of a large ongoing cohort study, which has carried out regular annual assessments of the mother and child. This has allowed the researchers to adjust their analyses for prior history of mother and child mental health and behavioural problems.

The study also used recognised assessment scales throughout, which has allowed the researchers to make valid clinical diagnoses of mental health problems.

However, the main point is as the researchers rightly say: "Our observational findings cannot be used to claim that becoming a goth increases risk of self-harm or depression". 

The study has made a valid attempt to explore the possible direction of effect by seeing whether identifying as a goth at 15 precedes depression and self-harm at 18 years.

But this still can't prove cause and effect. You can't say, for example, that if this individual hadn't become immersed in goth culture, they would never have developed depression or self-harm behaviours by 18 years.

It could still be the case that personality characteristics, family or peer relationships, or life circumstances may make the teen more likely to be drawn to the goth culture, but may also separately make them more predisposed to depression or other mental health problems.

The self-identification categories on the survey are also quite vague. Even though the researchers made clear attempts to explore the extent the individual identifies with a particular category, each category is still likely to have captured a wide range of personality characteristics and behaviours.

Self-identification is highly subjective, and two people who identify themselves as a goth "very much" may be quite different. It is possible that teens may not have identified particularly with any of these categories and were just having to opt for the one that seemed to be the best fit.

It is also not known how sincerely teens may have responded – for example, people may have called themselves a "chav" or a "bimbo" only lightheartedly.

And although the research and media attention has focused on goths, the findings suggest other groups, such as "skaters" and "loners", may also be vulnerable young people.

Overall, this research cannot prove direct causation, but it still indicates that those identifying with the goth culture may be a group with an increased risk of mental health problems. As the researchers suggest, providing support to these young people could be beneficial. 

Those who may be well placed to recognise young people who may be having emotional or behavioural difficulties – goths or otherwise – include family members and other peers, schools, and youth groups. 

Depression can potentially affect all teens, whether they are goths, Directioners (especially since the One Direction break-up), chavs or sporties. Read more about the possible signs of depression in young people.

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Low vitamin D levels linked to increased multiple sclerosis risk

Thursday August 27 2015

The body gets vitamin D from sunlight and our diet

"Lack of vitamin D may cause multiple sclerosis, study finds," reports the Guardian. A large study found people genetically programmed to have lower vitamin D levels are at an increased risk of multiple sclerosis (MS).

MS is a condition where the immune system attacks the coating of nerves in the brain and spinal cord, leading to symptoms such as vision loss, fatigue, and difficulties with balance and co-ordination.

Our body makes vitamin D under the skin in reaction to sunlight. We also get small amounts of the vitamin from our diet in foods such as eggs and oily fish.

A link between vitamin D deficiency and an increased risk of MS has long been suspected, as the condition is more common in areas of the world with less sunlight, such as northern Scotland. But it has been difficult to prove cause and effect because other factors may be involved.

This study used a genetic approach believed to be less susceptible to the problem of confounding – where other factors influence the results.

The researchers learned four genetic variants influence vitamin D levels found in the blood. People can have different combinations of these genetic variations. They found people with a combination of the genetic variations giving them lower levels of vitamin D had double the risk of MS.

But what the study does not tell us is whether MS could be prevented in those at higher risk by increasing their vitamin D levels through taking supplements or other methods.

Find out more about the "sunshine vitamin" in our special report on the health claims made about vitamin D.

Where did the story come from?

The study was carried out by researchers from McGill University and the Jewish General Hospital in Canada; the University of Bristol and King's College London in the UK; and Massachusetts General Hospital and Harvard Medical School in the US.

It was funded by the Canadian Institute of Health Research, The Fonds de la Recherche en Santé Québec, the Lady Davis Institute, the Jewish General Hospital, and the Canadian Diabetes Association.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it is free to read online.

The UK media reported the story accurately, and many reports included reactions to the research findings from experts such as Professor Danny Altmann, an immunologist at Imperial College London. 

Professor Altmann said: "While it may be too much to expect therapeutic vitamin D to treat or reverse ongoing MS, this paper will add to the weight of argument for routine vitamin D supplementation of foodstuffs as a broad preventative public health measure." 

What kind of research was this?

This genetic study looked at whether there is an association between genetically influenced levels of vitamin D and the risk of MS.

Previous observational studies found an association between lower levels of vitamin D and MS risk. In particular, MS is more common in people living in geographical areas with reduced sunlight – vitamin D levels are increased by exposing the skin to the sun.

But these studies were unable to prove cause and effect. Questions remain, such as whether the low vitamin D caused MS, or whether vitamin D levels go down in people with MS because they have less exposure to the sun as a result of their condition.

Exposure to sunlight is just one way to increase our vitamin D levels. There is also a genetic component that will have a lifetime influence. This study specifically looked for genetic variations linked to vitamin D levels and whether these genetic variations were also associated with MS risk.

This type of study is called a Mendelian randomisation study because these genetic variations are inherited randomly (each parent will have two copies of each, which one we inherit is random). The term is named after Gregor Mendel, a pioneering 19th century scientist, widely regarded as the father of modern genetics.

The study design means confounding by other factors is not a problem.The researchers in the study took additional steps to be sure this was the case. 

What did the research involve?

The researchers identified genetic variations associated with vitamin D levels using data from the SUNLIGHT study. The Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits included blood samples from 33,996 people.

They identified four genetic variations associated with lower vitamin D levels. These were close to four genes that create products that have an effect on the level of vitamin D:

• a protein that binds to vitamin D and carries it in the blood to target organs
• an enzyme involved in making vitamin D in the body in response to sunlight
• an enzyme that activates production of vitamin D
• an enzyme that inactivates vitamin D

They then used data from the Canadian Multicentre Osteoporosis study (CaMos) of 2,347 people to confirm the effect of these four genetic variants on vitamin D levels.

The researchers used the results to investigate the risk of MS depending on the genetic variations a person carried and their genetically determined lifetime level of vitamin D using data from two studies:

• the International Multiple Sclerosis Genetics Consortium (IMSGC), which has data from 14,498 people with MS and 24,091 healthy controls, all of European descent
• the IMSGC/Wellcome Trust Case Control Consortium 2 (IMSGC/WTCCC2) study, which has data from 9,772 people with MS and 6,332 controls

The researchers took the following factors into account when analysing the results:

• age
• sex
• body mass index (BMI)
• time of year the blood sample was taken
• ethnicity  

What were the basic results?

The four genetic variants associated with reduced vitamin D levels were also associated with an increased risk of MS, with three showing stronger links than the fourth. Each variant was only associated with a relatively small increase in the odds of MS (odds ratio [OR] of 1.04 to 1.11).

Each genetically determined standard deviation decrease in vitamin D levels doubled the risk of MS (OR 2.0, 95% confidence interval [CI] 1.7 to 2.5).

How did the researchers interpret the results?

The researchers concluded: "Genetically lowered 25OHD [a form of vitamin D in the blood] level is associated with an increase in the risk of MS in people of European descent."

They said that: "These findings provide rationale for further investigating the potential therapeutic benefits of vitamin D supplementation in preventing the onset and progression of MS." 

Conclusion

This study found people with a genetic susceptibility to having lower levels of vitamin D have an increased risk of developing MS.

What the study does not tell us is whether MS could be prevented in those at higher risk by taking steps to increase their vitamin D levels. The results also may not apply to people who are not of European descent.

Studies in healthy children and adults are now underway to explore this area. This study does not show what effect taking supplementary vitamin D would have in people who already have MS.

Previous research into vitamin D being used as a treatment for MS and to prevent relapse has been inconclusive because of small study sizes and poor methodology, so large randomised controlled trials are required.

Nevertheless, this piece of research adds to the growing picture that low levels of vitamin D appear to play some part in the development of MS.

You can usually get enough vitamin D through modest exposure of the skin to sunlight (no suntanning required) and a healthy diet that includes oily fish, eggs and foods fortified with vitamin D.

Some people may require vitamin D supplements, such as people aged 65 and over or those not exposed to much sunlight. The NHS suggests that if you take vitamin D supplements, you should not take more than 25 micrograms (0.025mg) a day as it could be harmful.

Find out more about vitamin D.

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Many white English and Irish pensioners 'drinking to excess'

Monday August 24 2015

Just a few drinks every day can soon add up to a harmful level

"One in five people over 65 who drink is consuming an "unsafe" level of alcohol, say researchers," BBC News reports. Their research also found that "unsafe drinking was far more common among the white British and Irish population".

The study involved nearly 28,000 older adults (aged 65 and over) living in the Lambeth area of London. It found that people were more likely to drink alcohol above safe limits if they were male, aged closer to 65, of Irish ethnicity and higher socioeconomic status.

The researchers used anonymised data from almost all GP practices in this inner-city area. They found that a third of older adults drink alcohol and that 7% drink above safe limits. The research was reliant on GP records, so may in fact be an underestimate, as people are often reluctant to disclose the actual amount of alcohol they consume, due to concerns about stigma. The figures may not be representative of what would be found in other parts of the UK.

The recommended safe limits of alcohol consumption for men are up to 21 units per week, and for women it’s 14 units per week. "Social drinking" can often sneak up on you and lead to conditions such as alcoholic liver disease, obesity and depression.

If you are concerned about your alcohol consumption, read more practical advice on how to cut down.

Where did the story come from?

The study was carried out by researchers from the Institute of Psychiatry and King’s College London. No external funding was reported.

The study was published in the peer-reviewed medical journal BMJ Open and the study is free to access online.

In general, the media reported the story accurately, though headlines such as, "one-fifth of over-65s drinking at unsafe levels" from The Guardian are misleading. The study found that one-fifth (about 20%) of over-65s who drank any alcohol at all were drinking at unsafe levels. As only a third of over 65-year-olds drank alcohol in this study, this equates to a lower figure of 7%, which is around 1 in 14.

What kind of research was this?

This was a cross-sectional study looking at the level of alcohol consumption in older adults according to age, sex, ethnicity, health and socioeconomic deprivation.

It aimed to see which factors are most associated with high alcohol intake in this population, to inform which groups of people to target with intervention programmes. There has previously been little research of this type in this age group.

As this was a cross-sectional study, it can only look at information from one time point, so it cannot show that the increased alcohol intake caused any of the health problems listed. However, it can show that people drinking alcohol excessively are more likely to experience these conditions.

What did the research involve?

The researchers looked at anonymised data from all adults aged 65 and over from 49 of 50 GPs in the Lambeth inner-city area of London participating in the Lambeth DataNet project – an ongoing project that makes use of anonymised GP data to track and study health trends. 

This current study consisted of 27,991 people in 2013, the study looked at data on their:

• age
• gender
• ethnicity
• socioeconomic deprivation
• long-term medical conditions
• alcohol consumption

Socioeconomic deprivation in the area where each person lived was measured using the Index of Multiple Deprivation 2010 – a government-funded project that measures levels of deprivation and the consequences. For a given area, this looks at:

• income deprivation
• employment deprivation
• health deprivation and disability
• education skills and training deprivation
• barriers to housing and services
• living environment deprivation
• crime

The data was then analysed to look for associations between these factors and people drinking over the safe limits (21 units a week for men and 14 units a week for women).

What were the basic results?

A third of older adults drank alcohol, (9,248 people) and 7% drank above safe limits, (1,980 people). The factors most likely to predict drinking alcohol and drinking above safe limits were:

• younger age
• male gender
• Irish ethnicity

People were less likely to drink alcohol if they were of Asian, black Caribbean or black African ethnicity.

Socioeconomic deprivation and medical conditions such as high blood pressure did not significantly predict whether someone was drinking above safe limits. However, for those who were drinking above safe limits, less socioeconomic deprivation predicted higher levels of alcohol consumption.

How did the researchers interpret the results?

The researchers concluded that there were "higher levels of alcohol misuse in the 'baby boomer' cohort than in younger age groups". They say that their findings "suggest that close attention needs to be paid to identifying alcohol misuse in 'young older' men, paying close attention to the needs of those born outside the UK and those living in areas of lower deprivation".

Conclusion

This cross-sectional study found that in the over-65s in an inner city area in London (Lambeth), people were more likely to drink alcohol if they are male, in the younger age bracket and of Irish ethnicity. These factors and less socioeconomic deprivation were also predictors of unsafe drinking levels in those who drank.

The findings of this study are important, as they could help to identify people at risk of alcohol-related conditions and provide them with support to reduce their consumption.

However, the study has some limitations. These include a reliance on data recorded by GP services – in particular, self-reporting of alcohol intake, which could be subject to inaccurate recall or reluctance to give true estimates due to stigma. The true figures of alcohol consumption are likely to be higher.

This study was conducted on an inner-city area in London, so results may differ for people living in other geographical areas. For example, there was a higher percentage of people with Irish ethnicity in this area – 5% compared to 1.7% of the general UK population.

If you are drinking above the safe levels recommended for men and women, you can find advice on how to cut down.

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Working long hours 'increases stroke risk'

Friday August 21 2015

Long hours can impact both mental and physical health

"People working long hours are more likely to have a stroke, according to analysis of more than half a million people," BBC News reports.

Researchers pooled the data from 25 previous studies that included more than 600,000 individuals who were free from heart disease or other types of cardiovascular disease at enrolment. 

They found the risk of developing stroke increased by a third in individuals who worked long hours (above 55 hours a week) compared with individuals with traditional 9-5 working hours. The association of long working hours with heart disease was less – only a 13% increase.

This study has several strengths, including its large size and the inclusion of published and unpublished studies, which removes the risk of publication bias. But the study does have limitations.

The idea that overwork can lead to serious illness and even death is not a new one. The Japanese even have a word for it – "Karōshi". But it is very difficult to prove direct cause and effect. 

Although the researchers tried to account for some health and lifestyle factors that may influence risk, it is problematic to pin down working hours as the single direct cause of a health outcome.

Overall, the results of these studies show an association between long working hours and the risk of developing heart disease and stroke.  

Where did the story come from?

The study was carried out by researchers from various academic institutions in the UK, Finland, France, Sweden, Denmark, Belgium, Germany and Netherlands.

It was funded by multiple organisations, including the Medical Research Council, the Economic and Social Research Council, and the European Union New and Emerging Risks in Occupational Safety and Health research programme.

The study was published in the peer-reviewed medical journal, The Lancet.

The study has been widely reported in the UK media. Overall, the results are accurately reported, but some of the strengths and limitations have not been fully explained. 

The BBC quoted one of the researchers, Dr Mika Kivimaki, of University College London, who said: "People need to be extra careful that they still maintain a healthy lifestyle and ensure their blood pressure does not increase."

While Dr Shamim Quadir of The Stroke Association is quoted as saying: "Working long hours can involve sitting for long periods of time, experiencing stress, and leads to less time available to look after yourself."

He added: "We advise that you have regular blood pressure checks. If you're at all concerned about your stroke risk, you should make an appointment with your GP or health professional." 

What kind of research was this?

This was a systematic review combined with a meta-analysis that assessed the impacts of long working hours on coronary heart diseases and stroke.

The researchers say previous reviews have shown an association between long working hours and cardiovascular disease. However, these studies have several limitations, including few available studies, lack of adjustment for potential confounding factors, and difficulty in proving the direction of effect (that long working hours have preceded the health outcome).

In this review the researchers aimed to include both published and unpublished studies to avoid any publication bias. They also aimed to only include studies where people were free from disease at the start of the study, exclude disease events that took place in the first year of follow-up to make sure of the direction of effect, take confounding factors into account, and look at the influence of socioeconomic class.

Overall, systematic reviews are the best way to gather all evidence on a particular topic, and meta-analysis pools the data from many studies to give an overall indication of the effect. However, the reliability of the findings is only as good as the quality of the studies included.  

What did the research involve?

Researchers identified 25 eligible published and unpublished studies assessing the association between cardiovascular disease and long working hours. Out of the 25 studies, the researchers judged 17 of them to be of a high quality.

The studies were from the US, Australia, Finland, Denmark, Sweden, the Netherlands, Belgium, Germany, the UK, Northern Ireland, and Israel.

The definition of long working hours was mostly 55 hours or more, though some studies used 45 hours or more. The average follow-up period for heart disease was 8.5 years and 7.2 years for stroke. For heart disease outcomes, the results of all 25 studies were pooled, including 603,838 men and women who were free from heart disease at study start. The analysis for stroke included 528,908 men and women from 17 studies who had not had stroke at enrolment.  

What were the basic results?

The review found an association between long working hours and the risk of developing heart disease or stroke.

When adjusted for age, sex and socioeconomic status, long working hours of above 55 hours a week were associated with a modest 13% increase in risk of heart disease (relative risk [RR] 1.13, 95% confidence interval [CI] 1.02 to 1.26) compared with standard working hours (35-40 hours a week).

An analysis restricted to high-quality studies showed the increased risk of heart disease associated with long working hours was higher among those of low socioeconomic groups (RR 2.18, 95% CI 1.25 to 3.81) than in the intermediate group (RR 1.22, 95% CI 0.77 to 1.95) or the high socioeconomic group, where in fact there was no significant link (RR 0.87, 95% CI 0.55 to 1.38).

For stroke, long working hours were associated with a third increased risk of developing stroke (RR 1.33, 95% CI 1.11 to 1.61). Overall, for stroke there was evidence of an increase in risk as the number of additional hours worked increased.

People working for 49-54 hours also had increased risk (RR 1.27, 95% CI 1.03 to 1.56) compared with people working standard hours. For those working 41-48 hours there was a suggestion of increased risk, but the link was non-significant (RR 1.10, 95% CI 0.94 to 1.28).

The associations were not reported to be influenced by gender or geographical area. 

How did the researchers interpret the results?

The researchers concluded by saying: "Our meta-analysis shows that employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker."

They added: "Our findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours." 

Conclusion

This systematic review with meta-analysis aimed to assess the association between long working hours and the risk of developing heart disease and stroke. 

Overall, the study found longer working hours above 55 hours a week was linked to a third increased risk of stroke. The link with heart disease was weaker. 

It also found the influence of long hours on heart disease risk was higher for those of lower socioeconomic groups than it was for those of intermediate or high socioeconomic groups.

This study has several strengths. This includes the large overall sample size and the inclusion of both published and unpublished studies, which should reduce the risk of publication bias. The researchers also excluded disease events that took place in the first year of the follow-up period to better assess the direction of effect. They have also taken into account various confounding factors.

However, this study still cannot prove cause and effect. Though the researchers adjusted for some common confounding factors, various hereditary, health and lifestyle factors may influence the risk of heart disease and stroke. It is not possible to single out working hours as the direct cause of these events.

The studies included may also vary in the working populations covered, definitions of working hours, and assessment of outcomes (such as medical records or self-reports). The studies also came from high-income countries. This makes it hard to generalise the findings to all people.

It is sage advice that we should aim to maintain a healthy lifestyle through a balanced diet and regular exercise habits. Free time to relax away from work is essential to wellbeing, so it is quite plausible that work stress through long working hours may have detrimental health effects.

If you're concerned your working hours are taking a toll on your health, discuss your concerns with your manager or human resources representative. For most professions, employment law states you shouldn't be made to work more than 48 hours a week unless you choose to do so.

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E-cigarettes '95% less harmful than smoking' says report

Wednesday August 19 2015

Vaping is a lot safer than smoking

"E-cigarettes are 95% less harmful than tobacco and could be prescribed on the NHS in future to help smokers quit," BBC News reports. 

This is the main finding of an evidence review (PDF, 485kb) carried out by Public Health England, a government agency that aims to protect and improve the nation's health and wellbeing, and reduce health inequalities.

What are e-cigarettes?

Most e-cigarettes contain a battery, an atomiser and a replaceable cartridge. The cartridge contains nicotine in a solution of either propylene glycol or glycerine and water, and sometimes flavourings.

When you suck on the device, a sensor detects the air flow and starts a process to heat the liquid inside the cartridge, so it evaporates to form water vapour. Inhaling this vapour delivers a hit of nicotine straight to your lungs.

Unlike "traditional" cigarettes, they do not contain the many dangerous chemicals that can increase the risk of lung cancer, heart disease and stroke.

What are the main findings of the review?

• There has been a rise in e-cigarette use that has been matched by a corresponding decrease in smoking.
• E-cigarettes are now the most popular quitting aid in England.
• There is good-quality evidence that e-cigarettes can be effective in helping people quit smoking.
• While data on their long-term safety is unavailable, expert opinion is that e-cigarettes are around 95% safer than smoking.
• When used as intended, e-cigarettes pose no risk of nicotine poisoning.
• E-cigarettes release negligible amounts of nicotine into the environment, and no health risks to bystanders (e.g. passive smoking) have been identified.

What suggestions does the review make?

• E-cigarettes should not be treated in the same way as normal cigarettes and their use should not be banned in prisons and hospital trusts.
• E-cigarettes offer the potential of providing a low-cost, effective intervention that could help England’s 8 million smokers to quit the habit for good.
• Stop smoking services should actively engage with smokers who want to use e-cigarettes to quit.
• Once e-cigarettes are regulated as medical products – which is expected in 2016 – e-cigarettes could be made available by the NHS on prescription.  

Links to the headlines

E-cigarettes could be prescribed by the NHS to help smokers quit, report says. BBC News, August 19 2015

Vaping: e-cigarettes safer than smoking, says Public Health England. The Guardian, August 19 2015

Make e-cigarettes available on NHS, say Government health officials. The Independent, August 19 2015

Health chiefs call for free e-cigarettes on the NHS: Review says 76,000 lives could be saved every year if people switched as it is 95% safer than smoking tobacco. Daily Mail, August 19 2015

Call For E-Cigarettes To Be Prescribed On NHS. Sky News, August 19 2015

E-cigarettes on the NHS: A game-changer that could save countless lives. Daily Mirror, August 19 2015

E-cigarettes 'should be prescribed on the NHS' to prevent smoking deaths. ITV News, August 19 2015

Smokers 'to get free e-cigarettes on the NHS' to help them kick the habit. Daily Express, August 19 2015

Further reading

Public Health England. E-cigarettes: a new foundation for evidence-based policy and practice (PDF, 485kb). Summary. August 2015

Public Health England. E-cigarettes: an evidence update (PDF, 2.07Mb). Full Report. August 2015

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Is your purse a hotbed of bacterial infection?

Monday August 17 2015

95% of the purses studied had bacterial consumption

"More than 90 per cent of purses have bacteria on them, and women are the worst offenders," the Mail Online reports. A study found purses could be a reservoir for bacteria, especially those made out of synthetic materials.

This study took swabs from the purses of 145 men and women from Mauritius, and tested them for bacteria in the laboratory. It found that bacteria could be grown from almost all purses (95%). The most common types of bacteria identified were Micrococcus and Staphylococcus, followed by Bacillus.

Importantly, these are usually carried harmlessly on the skin of most people. It is only in specific circumstances – for example, if the person has a weak immune system or if the skin is wounded, allowing the bacteria to enter the body – that infection may take place. 

This study has many limitations. One is that it’s a small sample of purses taken from a tropical environment, and the findings may not be representative of the wider population or those from other countries.

We don’t live in a completely sterile environment and ditching the purse or excessively washing it won’t make our environment – or us – bacteria-free. This study should not be a cause for concern for people who own a purse. Remembering to regularly wash your hands, particularly before eating or handling food, is likely to be a better way to reduce our chances of germs spreading that could lead to infection.

Where did the story come from?

The study was carried out by researchers from the University of Mauritius and was published in the peer-reviewed scientific journal Advanced Biomedical Research. No sources of financial support are reported.

The Mail Online’s reporting that purses could be making us sick does not give very reliable coverage of this study or cover the important limitations. A key limitation is that the bacteria grown are naturally found on skin and in the environment, and normally pose no risk to healthy people.

The study did not examine if the bacterial contamination of an individual purse went on to have an effect on a person’s health.

They are also incorrect in saying that "women are the worst offenders" and that "bacteria growth was higher on the purses of women than on those of men". While the researchers do report that bacterial growth was higher on women’s purses, it also reports that the average number of bacterial colonies grown from men’s wallets was higher – so results do not appear to be clear-cut.

What kind of research was this?

This was a laboratory study that swabbed the purses and wallets from a sample of men and women to see what bacteria grew from them under culture (culture, in this context, means creating an environment ideal for the growth of bacteria).

The researchers say that purses are hardly ever washed and are often only thrown out when they become worn out and unusable. What is often not considered is that they could be a breeding ground for bacteria. In fact, all of the things we use in the environment around us, like mobile phones, computers, keyboards and other equipment are all likely to carry some bacteria.

What did the research involve?

The study recruited 145 adults (80 women and 65 men) from the general population in Mauritius. They answered questions on their daily life and work, materials of their purse and frequency of washing their purses. 

They then had swabs taken from the outer surfaces of their purses. These were then swiped across the surface of a gel "plate" in the laboratory, to encourage any bacteria on the swabs to grow. Bacterial growth was assessed after 24 hours, by counting the number of "colonies" – small clumps of bacteria – growing on each plate. 

Fewer than 20 colonies was defined as scanty growth, 20 to 50 colonies as moderate growth, and more than 50 colonies as heavy growth. 

What were the basic results?

Most of the purses sampled (43%) were made of leather; the remainder were synthetic (39%) and cloth (18%). Synthetic purses were more often used by women than men. Only 2% of women (three women) reported washing their purses once a month.

Other purse habits among women were:

• 11% often placed them on kitchen tables
• 18% placed them on dining tables
• 18% allowed their children to handle them
• 82% never emptied them
• Most women kept purses in handbags, most men in trouser pockets

The majority of purses sampled (95%) showed bacterial contamination. In about three-quarters (73%) this was scanty growth; 13% showed moderate growth and 14% showed heavy growth. The average number of bacterial colonies grown from each purse was significantly higher for men’s (25 colonies) than women’s purses (19 colonies). However, bacterial growth was said to be higher on women’s than men’s purses. These results appear to conflict with each other, and it was unclear why.

In roughly half of purses, there was only a single type of bacterial growth; in the other half, there was mixed growth. The most common bacteria grown were types of Micrococcus and Staphylococcus, each accounting for around two-thirds, followed by Bacillus (14%). Micrococcus was more common on the men’s purses, while Bacillus was found only on women’s purses.

Synthetic purses showed a higher number of colonies than on leather or material purses. There were no other differences in bacterial growth by age of the purse or occupation of the person. 

How did the researchers interpret the results?

The researchers say that theirs "is the first study to demonstrate that the purses of both women and men from the community could be contaminated with micro-organisms". They also say that these are "potential vectors for transmission of diseases" and that the use of synthetic purses in particular should be discouraged.

Conclusion

This laboratory study looked at the bacteria surrounding us in our environment, this time focusing on sampling carried out on men’s and women’s purses or wallets.

However, before jumping to the conclusion that we need to be either excessively washing our purses, or ditching them altogether and carrying money in our pockets, there are various important points to bear in mind:

• Considering that the vast majority of adults will own some form of purse or wallet, this was a very small sample of purses being tested. The characteristics found in this sample – such as bacterial levels, or purse use and washing habits – may not apply to the general population.
• This was also a specific sample of people from Mauritius. The warm, humid, tropical environment may be a different breeding ground for bacteria, compared with colder climates such as the UK.
• The study only swabbed the outside of the purse. When thinking of the possible bacterial carriage of a purse or wallet, people may think that this could come from the "unclean" coins and notes that have transferred through many hands. However, the study did not swabbed the inside of the purse, which could have given different results.
• Related to this, it is possible that the researchers could have swabbed almost any surface in the environment and found similar bacterial growth. They chose the outside of the purse. They could have swabbed handbags, keys, money, mobiles, computers, door handles – the list goes on. We don’t live in a completely sterile, bacteria-free environment and we are always surrounded by potential sources of infection. From this study, the purse shouldn’t be singled out as the thing we need to ditch to be completely safe from any bacteria.
• The researchers have called purses "potential vectors for transmission of diseases". The study does not show that purses directly have or could cause infection. One of the most common types of bacteria grown was Staphylococcus. This is normally carried harmlessly on the skin of most people. It is only in certain circumstances that it causes infection – for example, if the person has a weak immune system through other disease or illness, or if the skin is wounded, allowing the bacteria to enter the body. Similarly, the other two bacteria grown – Micrococcus and Bacillus – are both found in the natural environment and usually carry no risk to humans. As the researchers rightly say, these bacteria have been called "opportunistic" organisms, rarely causing infection in healthy people.

Being, reportedly, the first study to swab and culture bacteria from purses, this research may be of interest, but it should not be a cause for concern for people who own a purse.

Not regularly washing your hands before preparing food or after going to the toilet is probably a bigger threat to your health than having a messy purse.  

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Checking emails out of work 'can reduce wellbeing'

Wednesday August 12 2015

Is your work following you home?

"Checking your emails outside of work really IS bad for your health," the Mail Online reports. A German study recruited a sample of 132 workers and aimed to look at how extended working outside normal hours influenced people's mood the next day.

It found working outside normal working hours limits the sense of detachment from work, and these factors are linked to feeling more tired and less relaxed and content the next day. It was also linked to higher morning levels of the stress hormone cortisol.

This issue is very relevant to today's working culture, where remote working and smartphones allow many of us to be continually engaged with work outside normal working hours.

However, the study gives limited representation of UK workers in general. It assessed the effect of formal "on-call" duties, compared with days when people didn't have these duties. This means it isn't as relevant as it first appears to be for the many UK workers who don't have formal arrangements like this, but who do respond to emails and calls at home outside normal working hours.

If you are not contractually obliged to respond to emails or phone calls outside your normal working hours, we recommend you don't. Creating a clear split between your working life and home life could make you less stressed and, ultimately, improve your performance at work.  

Where did the story come from?

The study was carried out by researchers from the University of Hamburg and supported by the German Federal Ministry of Education and Research.

It was published in the peer-reviewed Journal of Occupational Health Psychology.

The Mail's coverage implies the findings apply to all workers, when in fact the study was focused on formal on-call arrangements. The effects of being officially on-call may be different from more informal out-of-hours work, such as checking emails on your smartphone in the evening.   

What kind of research was this?

This was an experimental study exploring the relationship between the extended availability of employees outside work hours and the physical and psychological effect this can have on the body by looking at mood and stress hormones.

The researchers discuss today's mobile technology environment of smartphones and easy access to the internet, and remote communication with co-workers and customers at any time and place.

Previous studies observed how this technical opportunity to continue working outside normal hours and beyond the normal workplace has led to larger workloads and greater employer expectations. It also intrudes on home and family life, crossing the "work-family border".

The researchers define extended work availability as "a condition in which employees formally have off-job time, but are flexibly accessible to supervisors, co-workers or customers, and are explicitly or implicitly required to respond to work requests". The expectation is that recovery from work is limited under such conditions and this may impair wellbeing.

Three main hypotheses were investigated by this study:

• extended work availability the previous day has negative effects on mood at the start of the following day, and is associated with higher levels of the stress hormone cortisol when waking up
• extended work availability has negative effects on psychological detachment on the same day and limits control over out-of-work activities
• the effect extended work availability has on mood at the start of the next day is influenced by the amount of psychological detachment the previous evening and how much control the person felt they had over out-of-work activities

What did the researchers do?

The study recruited 132 participants from 13 organisations. Participants were 91% male with an average age of 42 years, and the majority had worked at the same organisation for more than five years. The organisations were involved in transport and logistics, water supply, IT and technical services, trade, nurseries and hospitals.

The participants completed daily surveys during four days when they were on on-call duty (defined as being expected to be available during non-working hours) and four days when they were not on call. These were both composed of two weekday and two weekend days.

Participants completed the surveys using handheld computers that had an alarm to prompt them to complete them at set times of the day – for example, the start of the day and the afternoon.

The surveys contained questions on work and covered components from different psychological assessment scales. For example, to assess extended availability they would be asked, "How many calls from work did you receive in the last 24 hours?".

Recovery would be assessed using a scale where participants had to assess how much they agreed with statements such as, "This evening, I didn't think about work at all".

Mood at the start of the day was assessed by choosing from options such as, "At this moment, I feel discontent/content and unwell/well (valence), tired/awake and without energy/full of energy (energetic arousal), agitated/calm and tense/relaxed (calmness)."

A sub-sample of 51 participants gave consent to provide saliva samples so cortisol levels could be measured. Cortisol is a hormone the body releases in response to stress.

The researchers were mainly examining the effects of on-call duties for individuals, rather than between individuals. Potential confounding factors adjusted for in the analyses were age, gender, normal working hours, and the day of the week of the assessment. Cortisol measures were also adjusted for individual factors such as body mass index (BMI), smoking status, and subjective physical and mental health. 

What were the basic results?

In support of the researchers' first hypothesis, the results suggested extended work availability had negative effects on the three core mood components the following morning: energetic arousal, calmness and valence. It also increased cortisol levels the next morning.

In support of the second hypothesis, there was also a negative effect of extended work availability on recovery from work – that is, feeling detached from work and having a sense of control over one's out-of-work activities.

Lastly, they found the amount of recovery a person felt mediated the effect extended working hours had on their mood the next day. However, recovery experiences of control and detachment did not mitigate the effect extended working hours had on cortisol levels.  

How did the researchers interpret the results?

The researchers concluded that their study "provides evidence that extended work availability during non-work hours negatively affects employee wellbeing and recovery".

By this, they mean being expected to respond to work issues outside work restricts employees' crucial leisure time, which allows them to recover from work.  

Conclusion

This study explored the effects of extended working hours on an individual's mood and cortisol levels the next day. Perhaps unsurprisingly, it found working outside normal working hours limits a person's sense of detachment from work, and these factors are linked to feeling more tired and less relaxed and content the next day. The study will be of interest to sociologists, psychologists and the general public – being very relevant to today's 24/7 working culture.

However, a key limitation of this study is whether its findings apply to workers in the UK in general. The study involved a fairly small sample of predominantly male middle-aged workers, who will not be representative of the general UK population.

They had all responded to an advertisement saying this was a study aiming to optimise on-call work. It is possible the people who are most impacted by extended working hours may not respond to such an advertisement, as they may have thought they were too busy or had no time to take part in a study on top of all their other commitments.

This study looked at the impact of formal on-call days, when people were expected to be available during non-working hours, compared with days without this requirement. The formal on-call duty may be applicable in some professions – hospital workers, for example – but is this really representative of the general work culture the study aimed to assess? 

We live in an environment centred in mobile technology, where people have continued access to colleagues, clients and work projects. Many professionals won't have formal "on-call" days, but they may be in an environment where every working day has the potential to encroach on what should be their out-of-work recovery time. This environment of non-formal extended working hours – through emails, calls, at-home working, etc – may have an even greater effect on general health and wellbeing.

Even for this specific sample, the study's results may not be concrete. The study used surveys making use of valid psychological assessment scales, but these may not be able to capture all of the person's thoughts and feelings and other factors that may be involved beyond just the influence of working hours.

Also, the researchers only assessed this on a sample of days within a two-week period, which may not necessarily be representative of long-term working patterns.

What's more, this study was conducted in Germany, which may have a different work culture and environment from other countries.

Overall, the study is undoubtedly of topical interest, but because of the limitations of its small sample size, it can't provide definitive answers.

Most occupational psychologists would agree with the principle that you need to create a clear divide between your work life and your home and family life. If you are not on call, try to resist the temptation to check your work emails in the evening, or even worse, on holiday.

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A 15 minute daily walk 'will help you live longer' says study

Tuesday August 4 2015

Small amounts of exercise can lower the risk of heart conditions and strokes

Going for a 15-minute walk every day will ‘make you live longer’ reports the Mail Online. It is one of several news outlets to report that small amounts of daily exercise may be enough to increase your chances of living longer.

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