RG Kar Case: Junior doctors’ hunger strike enters 10th day, Govt calls for meeting

Kolkata: The hunger strike by junior doctors in West Bengal entered its tenth day on Monday, the strike began in response to the brutal rape and murder of a postgraduate trainee doctor at RG Kar Medical College and Hospital.

A crucial meeting involving various doctors’ associations and the West Bengal government is set for today to seek a resolution. 

According to an IANS report, the number of junior doctors on hunger strike at the dais at Esplanade in central Kolkata has now come down to six as one more striking doctor, Pulastya Acharya, had to be rushed to hospital on Sunday night following a serious deterioration in his medical condition because of continuous fasting.

Acharya had been admitted to NRS Medical College and Hospital, where he is himself attached as a junior doctor, at around 11 p.m. on Sunday, after he complained of severe stomach ache and vomiting tendencies, the two common symptoms of the adverse effects of continuous fasting.  

Also Read:Fast-unto-Death Protest: Junior doctor condition deteriorates, hospitalised

Pulastya is the fourth junior doctor to be hospitalised following a deterioration in medical conditions, with the other three being Aniket Mahato of R.G. Kar, Anustup Mukhopadhyay of Calcutta Medical College & Hospital and Aloke Verma of North Bengal Medical College & Hospital at Siliguri in Darjeeling district.

A crucial meeting between the different doctors’ associations, including the Indian Medical Association (IMA) and the West Bengal Chief Secretary Manoj Pant has been scheduled on Monday at 12.30 pm at Swasthya Bhavan, the state health department headquarters at Salt Lake in the northern outskirts of Kolkata, to find out a solution to the ongoing impasse on this issue, news agency IANS reported.

Meanwhile, the doctors attached to different private hospitals have started partial cease-work at their respective hospitals from 6 a.m. on Monday, which will continue till 6 a.m. on Wednesday. Only the emergency medical services in these private hospitals will be available during this period.

Meanwhile, medical reports of Acharya have suggested that his condition deteriorated on Sunday night because of an imbalance in sodium-potassium level and acid-base, some typical adverse effects of continuous fasting.

He continues to be under saline and the crisis is yet to be over, said a representative of West Bengal Junior Doctors’ Front (WBJDF), the umbrella body of the junior doctors spearheading the movement in the rape and murder case. 

Also Read:West Bengal Junior doctors continue indefinite hunger strike, list 10 demands

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Fact Check: Are 15 almonds equivalent to 1 aspirin for headaches?

An Instagram post claims that 15 almonds are equivalent to 1 aspirin for headaches. This claim is MISLEADING.

Claim

In an Instagram post, it is claimed that 15 almonds are equivalent to 1 aspirin for headaches. The user health.wealth5 says that Studies show eating 15 almonds is equivalent to 1 aspirin for headaches. As per the user, Salicin and magnesium present in almonds are anti-inflammatory and relax blood vessels that take away most minor headaches. The post can be accessed here. 

Fact Check 

The claim made by Instagram user is MISLEADING.

What is a Headache?

Headaches are the most prevalent form of pain and a significant contributor to absences from work or school, as well as frequent medical consultations. When left untreated, headaches can intensify and severely impact daily functioning. The occurrence and severity of headaches can vary greatly. Some individuals may only experience them a few times per year, while others may endure them for over 15 days each month. Certain headaches can persist for weeks or recur frequently, with pain levels ranging from mild irritation to incapacitating. They are often accompanied by symptoms such as nausea, or heightened sensitivity to light and noise.

What are the causes of headache?

The Medical Dialogues Fact Check Team spoke with Dr. Rahul Chawla, MBBS, MD (General Medicine), DM (Neurology), Consultant Neurologist at IBS Hospital, New Delhi and he said, “Headaches can arise from various causes, ranging from lifestyle factors to underlying medical conditions. Common triggers include stress, dehydration, lack of sleep, and prolonged screen time. Factors like poor posture, skipped meals, or exposure to strong odors can also contribute. Medical causes such as sinus infections, high blood pressure, hormonal changes, or migraines are frequent culprits. In rare cases, serious conditions like brain tumors or aneurysms can lead to headaches. Understanding the root cause is essential for proper management, and it’s important to consult a doctor for persistent or severe headaches.”

What are the ways to manage headaches?

Dr. Sohet Gogia, Consultant, Neurosurgery, Neurosciences, Medanta Hospital, Gurugram explained “Managing headaches requires a comprehensive approach depending on the type and cause. Common strategies include using over-the-counter pain relievers, staying hydrated, and resting in a quiet environment. Stress management techniques like yoga or meditation, applying cold or warm compresses, and ensuring proper sleep can also provide relief. It’s important to avoid known dietary triggers and manage caffeine intake appropriately. Regular physical activity may help reduce headache frequency. For persistent or severe headaches, seeking medical advice from doctors is essential to ensure proper diagnosis and treatment options.”

What is Aspirin?

Aspirin is a type of medication that belongs to the group of drugs called NSAIDs (Nonsteroidal Anti-inflammatory Drugs) and non-opioid pain relievers. It works by blocking an enzyme called COX-1 and is commonly used to reduce pain, fever, inflammation, and migraines. It is also taken to lower the risk of serious heart problems like heart attacks and strokes. It is absorbed quickly from the gastrointestinal (GI) tract, though absorption via the rectal route is less consistent. Some absorption occurs through the skin.

Aspirin is available in oral tablets, oral capsules, and rectal suppository forms.

Aspirin is also an antiplatelet medication that helps prevent blood clots in vessels and also acts as an analgesic to relieve pain and inflammation. It may be used in combination with other antiplatelet drugs for enhanced efficacy but is not advised for patients with bleeding disorders.

Nutritional Benefits of almonds

Almonds (Prunus dulcis), part of the Rosaceae family, have long been valued for their rich nutrient content and are increasingly popular as a health food. Research on their composition has revealed a wealth of essential nutrients, including fatty acids, lipids, amino acids, proteins, carbohydrates, vitamins, minerals, and bioactive compounds. However, their nutritional quality is influenced by genetic and environmental factors, prompting further investigation into how these factors affect the nut’s composition. Additionally, recent research highlights their prebiotic properties, further enhancing their role in promoting overall health.

Are 15 almonds equivalent to 1 aspirin for headaches?

Almonds are a rich source of magnesium and contain small amounts of salicin which cannot cure headaches. Traditionally, they have been used in remedies to relieve headaches. However, there is no scientific evidence to support the claim that 15 almonds equivalent to 1 aspirin for headaches.

A study published in Nutrients highlights that almonds are packed with essential nutrients, including vitamin E, protein, mono-unsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), magnesium, potassium, and dietary fiber. Notably, almonds are an excellent source of magnesium, with 100 grams providing 270 mg of this mineral.

In a study published in the International Journal of Chemical and Biochemical Sciences observed that almonds have been traditionally used in remedies to alleviate headaches. They are especially valued for their effectiveness in treating cerebral conditions such as memory loss, headaches, and insomnia.

Another study by Anne R. Swain et. al. highlighted that almonds contain salicin, a compound also found in aspirin. However, the amount of salicin in almonds is relatively low, measuring just 3.0 mg.

Dr. Rahul Chawla responded to the claim and explained, “The idea that eating 15 almonds can match the effect of aspirin for headache relief is inaccurate. Almonds do contain a small amount of salicin, which is similar to aspirin’s active ingredient, but the amount is too minimal to offer any significant pain relief. Aspirin provides much more effective relief due to its higher concentration of the active compound. For effective headache treatment, it is recommended to use approved medications under the advice of a doctor. It is also important to understand the underlying cause of headache and treatment should be provided accordingly.”

Dr. Sohet Gogia further added, “The claim that 15 almonds can provide the same effect as aspirin for headache relief is not supported by scientific evidence. While almonds contain trace amounts of salicin, a compound similar to the active ingredient in aspirin, the quantity found in almonds is far too small to have any significant therapeutic effect. Consuming almonds won’t offer the same pain-relieving or anti-inflammatory benefits that aspirin provides. For effective treatment of headaches, it’s important to rely on proven medications and seek treatment from doctors.”

Medical Dialogues Final Take

Almonds have been traditionally used in remedies for managing headaches and are valued for addressing issues like memory loss and headaches. They are a rich source of magnesium and contain small amounts of salicin. However, there is no scientific evidence or medical consensus to support the claim that 15 almonds are equivalent to 1 aspirin for headaches.

Hence, the claim made by the user is MISLEADING.

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IMI-DIRECT Study Reveals Key Plasma Metabolites Linked to Prediabetes and Type 2 Diabetes Risk

Germany: Recent findings from the IMI-DIRECT study have shed light on the significant role of human plasma metabolites in the progression from prediabetes to type 2 diabetes. 

The research published in Diabetologia has identified not only well-known branched-chain amino acids (BCAAs) and lipids but also novel N-lactoyl-amino acid metabolites that are significantly linked to these conditions. These metabolites mediate the progression of diabetes over time, as observed during follow-ups at 18 and 48 months.

“Causal inference analysis using genetic variants indicates that lipid metabolism and n-3 fatty acids play a causal role in the relationship between metabolites and type 2 diabetes, while the total levels of hexoses contribute causally to the reverse relationship from type 2 diabetes to metabolites,” the researchers wrote. “The identified metabolite markers are valuable for stratifying individuals by their risk of progression and could facilitate targeted interventions.”

Type 2 diabetes is a chronic condition characterized by high blood sugar levels (hyperglycemia). In the study, Sapna Sharma, Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany, and colleagues aimed to analyze the metabolomics to identify their association with the glycemic spectrum and establish a causal relationship between metabolites and type 2 diabetes.

As part of the Innovative Medicines Initiative – Diabetes Research on Patient Stratification (IMI-DIRECT) consortium, the researchers analyzed 3,000 plasma samples using the Biocrates AbsoluteIDQ p150 Kit and Metabolon analytics. A total of 911 metabolites—comprising 132 targeted and 779 untargeted metabolites—passed quality control. They performed multivariable linear and logistic regression analyses, using the concentration or peak areas of each metabolite as explanatory variables and glycemic status as the dependent variable.

The basic model was adjusted for age, sex, BMI, and study center, while the full model additionally accounted for alcohol consumption, smoking, blood pressure, fasting HDL-cholesterol, and fasting triacylglycerol levels. Statistical significance was maintained through Bonferroni correction. Beyond identifying associations, the researchers examined mediation and causal effects, employing causal mediation tests and two-sample Mendelian randomization (2SMR) methods for their analyses.

Based on the study, the researchers revealed the following findings:

  • In the targeted metabolomics, the researchers observed four (15), 34 (99), and 50 (108) metabolites (the number of metabolites observed in untargeted metabolomics appears in parentheses) that were significantly different when comparing normal glucose regulation vs impaired glucose regulation/prediabetes, normal glucose regulation versus type 2 diabetes, and impaired glucose regulation vs type 2 diabetes, respectively.
  • Significant metabolites were mainly branched-chain amino acids, with some derivatized BCAAs, lipids, xenobiotics, and a few unknowns.
  • Metabolites such as lysophosphatidylcholine a C17:0, sum of hexoses, amino acids from BCAA metabolism (including leucine, isoleucine, valine, N-lactoylvaline, N-lactoylleucine and formiminoglutamate) and lactate, as well as an unknown metabolite (X-24295), were associated with HbA1c progression rate and were significant mediators of type 2 diabetes from baseline to 18 and 48 months of follow-up.
  • 2SMR was used to estimate the causal effect of exposure on an outcome using summary statistics from UK Biobank genome-wide association studies.
  • Type 2 diabetes had a causal effect on the levels of three metabolites (hexose, glutamate, and caproate [fatty acid (FA) 6:0]), whereas, lipids such as specific phosphatidylcholines (PCs) (namely PC aa C36:2, PC aa C36:5, PC ae C36:3 and PC ae C34:3), as well as the two n-3 fatty acids stearidonate (18:4n3) and docosapentaenoate (22:5n3), potentially had a causal role in the development of type 2 diabetes.

The findings from the DIRECT study indicate that changes in blood plasma metabolites are linked to glycemic deterioration. The progression from prediabetes to diabetes is influenced by novel metabolites like picolinoylglycine and N-lactoyl-amino acids. Notably, N-lactoyl-amino acids, which are known to be induced by exercise, play a role in suppressing food intake and regulating glucose homeostasis.

According to the authors, further functional research and quantification are essential for enhancing the identification of early metabolic biomarkers, such as N-lactoyl-amino acids, which could help predict the onset of type 2 diabetes. Collectively, these findings emphasize the importance of novel metabolic signatures associated with glycemic decline.

Reference:

Sharma, S., Dong, Q., Haid, M. et al. Role of human plasma metabolites in prediabetes and type 2 diabetes from the IMI-DIRECT study. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06282-6

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Lactic Acid may Help Blood Vessels Relax and Improve Muscle and Heart Health, suggests study

A new study in rats shows that lactate, a substance found in the muscles, initiates a cascade of actions in the muscles that helps blood vessels relax. The surprising results are published ahead of print in the journal Function.

Lactate, also known as lactic acid, is a byproduct that comes from the process of breaking down sugar and other carbohydrates. Lactic acid builds up in the muscles during vigorous exercise.

Researchers sought to understand how skeletal muscle tissue around the blood vessels could influence how the vessels behave. They analyzed RNA, mitochondria and lactate levels from artery and muscle samples from rats to determine the vessels’ vascular tone. The research team found that lactate in the arteries released nitric oxide, a substance that limits contraction of blood vessels.

“Healthy skeletal muscles help keep blood vessels relaxed and regulate blood pressure. When muscles are weakened, this process may not work properly, potentially leading to high blood pressure or premature aging of blood vessels. Understanding this link between muscles and blood vessels could lead to new treatments that benefit both skeletal muscle and heart health,” said Camilla Ferreira Wenceslau, PhD, corresponding author of the study.

Reference:

Milene T Fontes, Tiago J Costa, Ricardo B de Paula, Fênix A Araújo, Paula R Barros, Paul Townsend, Landon Butler, Kandy T Velazquez, Fiona Hollis, Gisele F Bomfim, A Skeletal Muscle-Mediated Anticontractile Response on Vascular Tone: Unraveling the Lactate-AMPK-NOS1 Pathway in Femoral Arteries, Function, https://doi.org/10.1093/function/zqae042.

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Mediterranean Diet Linked to Lower Heart Failure Risk, Especially in Women

Researchers have found a strong association between high adherence to the Mediterranean Diet (Med Diet) and less risk or the likelihood of risk from heart failure (HF), especially among females. HF is one of the most commonly suffered cardiovascular diseases with its incidence being influenced by age, genetics, and lifestyle. A recent study was published in the European Journal of Clinical Nutrition by Veronese and colleagues..

The aim of this study was to carry out a comprehensive review and meta-analysis of observational studies in order to assess whether the Mediterranean Diet affects HF risk, and whether the association could be sex-dependent. Database search till 1 May 2023 on PubMed, Scopus, Web of Science and Cochrane Library was performed. The review was reported in accordance with updated guidance published in 2020 from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses group. Observational prospective studies where the association between adherence to the Med Diet and risk of HF had been previously assessed were included.

• Of the 1,206 studies screened, six observational prospective studies were included in the final analysis, with a total of 216,385 participants.

• A 1-unit increase in the Mediterranean Diet score was associated with a significantly reduced risk of HF over an average follow-up of 11 years (RR = 0.940; 95% CI: 0.912–0.969; p < 0.0001). Heterogeneity between studies seemed moderate (I² = 42.9%).

• Significant associations were found with higher adherence to the Mediterranean diet and the low incidence of HF in women (RR = 0.942; 95% CI: 0.912–0.973; p = 0.001; I² = 41.8%). There was no indication of association among men, and this may reflect a difference in how diet influences the risk of HF by sex.

• The quality of the included studies was rated as good overall, thereby providing general integrity to the findings and supporting the relationship between the Med diet and lower HF risk.

From this systematic review and meta-analysis, higher adherence to the Mediterranean Diet was associated with reduced risk of HF, particularly in females. These results allow for verification of the Mediterranean Diet as an effective preventive strategy against HF, thus further substantiating its position in being a healthy diet pattern for the heart.

Reference:

Veronese, N., Ragusa, F. S., Maggi, S., Witard, O. C., Smith, L., Dominguez, L. J., Barbagallo, M., Isanejad, M., & Prokopidis, K. (2024). Effect of the Mediterranean diet on incidence of heart failure in European countries: a systematic review and meta-analysis of cohort studies. European Journal of Clinical Nutrition, 1–5. https://doi.org/10.1038/s41430-024-01519-4

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Conical Cuffs Show No Advantage Over Cylindrical Cuffs for BP Measurement in Obese Children: Study

Researchers have found that conical cuffs used in BP measurement in obese children and adolescents do not offer any significant advantage over conventional cylindrical cuffs. A recent study of Valencia was published in the journal Blood Pressure by Evripidou and colleagues.

The main purpose was to compare the measurements of blood pressure at the office in obese children and adolescents using conical and cylindrical cuffs, and whether it is more precise with the use of conical cuffs.

This was an observational study that enrolled 37 children and adolescents with obesity from the Obesity and Cardiovascular Risk Unit at the General University Hospital Consortium of Valencia. Arm circumference (AC) of each subject was measured in order to get cuff size appropriate for both types of cuffs, conical and cylindrical, following measurement of blood pressure with both cuff sizes. Comparisons of results obtained from both cuff types were compared. The principal outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), and z-scores.

• Mean age of the subjects was 11.8 ± 2.5 years.

• Mean BMI was 28.8 ± 3.4 kg/m², mean BMI z-score was 2.12 ± 0.32.

• Mean arm circumference was 30.0 ± 3.6 cm.

• Difference between measurement of BP on cylindrical and conical cuffs were not significantly different

• Mean difference for systolic BP between cylindrical and conical cuffs was -0.22 ± 6.55 mmHg.

• For the z-score of SBP, the difference was -0.02 ± 0.81 .

• The difference of DBP was -0.70 ± 4.95 mmHg.

• For the z-score of DBP, the difference was -0.06 ± 0.44.

• Although two cuff types, though showed no statistical differences, were positively related to each other in measurements and the mean and z-score SBP and DBP values were also significantly related to each other (p < 0.001).

• The Bland-Altman analysis confirmed good agreement between the two cuff types, 94.6% of all BP measurements falling within the acceptable limits of agreement.

Conical cuffs failed to offer benefit over cylindrical cuffs in reducing measurement bias in the measurement of blood pressure among the obese pediatric population. Although previous research in adults has indicated that the use of a conical cuff improves the reliability of measurements, there is consensus from studies among pediatric patients that the use of a conical cuff does not have benefits in terms of enhancing reliability of BP measurements. Even though conical cuffs can still be viewed as an alternative for office blood pressure measurement, more such studies involving larger populations and diverse clinical settings are required to ascertain their effectiveness within this group.

Reference:

Evripidou, K., Alvarez-Pitti, J., De Blas-Zapata, A., Chainoglou, A., Goulas, I., Herberigs, K., Hamdani, G., Stabouli, S., & HyperChildNET Working Group 1. (2024). Office BP measurement using conical cuffs in children and adolescents with obesity. Blood Pressure, 33(1). https://doi.org/10.1080/08037051.2024.2411294

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Can Skin Tone Affect Your Meds? Study Sheds Light

Skin pigmentation may act as a “sponge” for some medications, potentially influencing the speed with which active drugs reach their intended targets, a pair of scientists report in a perspective article published in the journal Human Genomics.
The researchers argue that a sizable proportion of drugs and other compounds can bind to melanin pigments in the skin, leading to differences in how bioavailable and efficacious these drugs and other compounds are in people with varying skin tones.
“Our review paper concludes that melanin, the pigment responsible for skin color, shows a surprising affinity for certain drug compounds,” said Simon Groen, an assistant professor of evolutionary systems biology at the Institute of Integrative Genome Biology at the University of California, Riverside, and a co-author on the paper. “Melanin’s implications for drug safety and dosing have been largely overlooked, raising alarming questions about the efficacy of standard dosing since people vary a lot in skin tones.”
According to Groen and coauthor Sophie Zaaijer, a consultant and researcher affiliated with UC Riverside who specializes in diversity, equity, and inclusion (DEI) in preclinical R&D and clinical trials, current FDA guidelines for toxicity testing fail to adequately address the impact of skin pigmentation on drug interactions.
In one example, the researchers found evidence of nicotine affinity for skin pigments, potentially affecting smoking habits across people with a variety of skin tones and raising questions about the efficacy of skin-adhered nicotine patches for smoking cessation.
Groen and Zaaijer propose utilizing a new workflow involving human 3D skin models with varying pigmentation levels that could offer pharmaceutical companies an efficient method to assess drug-binding properties across different skin types.
“It’s a monumental task, requiring clear lines of communication between academics, industry researchers, clinicians, and regulators,” Zaaijer said. “The future of medicine relies on our capacity to connect these currently isolated operational teams.”
They also encourage patients, their advocacy groups, and clinical trial participants to ask questions related to ancestry-specific drug efficacy and safety, such as, “Has this drug been tested to see if it’s safe for people from different ancestral backgrounds, including mine?” Clinicians and pharmaceutical representatives should be able to provide an easy-to-understand document outlining the results of the various tests, the researchers said.
They acknowledge that in the current state of drug development, this will be hard.
“In terms of risk profile testing, drugs are most often tested on one or a few human cell models that mostly come from donors of Northern European descent,” Zaaijer said. “Drugs are then tested in a rodent model. If these tests are successful, drug companies push the drug through to clinical trials. But are drugs ready to be given to a diverse patient group if they haven’t first been tested, for example, on human cell models of different ancestries? Would you bungee jump off a bridge if you knew the ropes had not been tested for your weight category? Unlikely. So why is this currently acceptable with drugs?”
Groen explained that in different ancestral backgrounds, certain genetic variants are more prevalent. Those variants can affect how a drug is metabolized and how it behaves in a body, he said.
Reference: Zaaijer, S., Groen, S.C. Implementing differentially pigmented skin models for predicting drug response variability across human ancestries. Hum Genomics 18, 113 (2024). https://doi.org/10.1186/s40246-024-00677-7

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Ultra Processed and Fried Foods Escalate Diabetes Crisis in India: ICMR-MDRF Clinical Trial

A pioneering clinical trial by the Indian Council of Medical Research (ICMR) has uncovered the significant role of ultra-processed and fried foods, rich in Advanced Glycation End-products (AGEs), in contributing to India’s escalating diabetes crisis. This landmark study, conducted by the Madras Diabetes Research Foundation, an ICMR Centre for Advanced Research in Diabetes, indicates that adopting low- Advanced Glycation End-products diets could be a promising strategy to mitigate diabetes risk.

The research, funded by the Department of Biotechnology and published in the International Journal of Food Sciences and Nutrition, identified high- Advanced Glycation End-products foods including red meat, french fries, bakery products, parathas, samosas, and sugary treats. Advanced Glycation End-products are harmful compounds formed through glycation, where sugars modify proteins or lipids, leading to various health complications like inflammation, oxidative stress, insulin resistance, and cellular damage.
Over 12 weeks, 38 overweight and obese participants (BMI of 23 or higher) followed either a high- Advanced Glycation End-products or low- Advanced Glycation End-products diet. Results showed that those on the low- Advanced Glycation End-products diet experienced improved insulin sensitivity and lower blood sugar levels, while participants on the high- Advanced Glycation End-products diet exhibited increased Advanced Glycation End-products levels and inflammation.
To reduce diabetes risk, researchers advocate for a low- Advanced Glycation End-products diet that includes green leafy vegetables, fruits, fish, boiled foods, and brown rice. The study emphasized that cooking methods such as frying, roasting, and grilling elevate Advanced Glycation End-products levels, whereas boiling helps keep them in check.
Dr. V Mohan, chairman of the Madras Diabetes Research Foundation, noted that obesity, physical inactivity, and consumption of unhealthy diets rich in Advanced Glycation End-products are the primary factors behind India’s diabetes epidemic.

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Can weight-loss surgery help prevent pancreatic cancer in people with obesity?

Obesity and type 2 diabetes are risk factors for various malignancies, including pancreatic cancer, which has a high death rate. A new analysis in Diabetes/Metabolism Research and Reviews suggests that weight-loss surgery-also called metabolic-bariatric surgery-may lower the risk of developing pancreatic cancer in people with obesity, especially in those who also have type 2 diabetes.

In the systematic review and meta-analysis, investigators identified 12 relevant studies that explored the effects of metabolic-bariatric surgery on pancreatic cancer incidence, with a total of 3,711,243 adults with obesity. Surgery was associated with a 44% reduction in pancreatic cancer risk among individuals with obesity but without type 2 diabetes and a 79% risk reduction in those with both obesity and type 2 diabetes.

“Metabolic-bariatric surgery not only has beneficial effects on obesity and type 2 diabetes but also may play a crucial role in reducing the risk of pancreatic cancer in these individuals,” said corresponding author Angeliki M. Angelidi, PhD, of the Broad Institute of MIT and Harvard. “These findings underscore the need for further research to elucidate the underlying mechanisms and understand the full spectrum of health benefits of metabolic-bariatric surgery beyond weight loss.”

Reference:

Metabolic–Bariatric Surgery Reduces Pancreatic Cancer Risk: A Meta-Analysis of Over 3.7 Million Adults, Independent of Type 2 Diabetes Status, Diabetes/Metabolism Research and Reviews (2024). DOI: 10.1002/dmrr.3844. 

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Mental health app may help prevent depression in high risk young people, reveals research

A cognitive behavioural therapy (CBT) app has been found to significantly prevent increases in depression in young people who are at high risk – and could be implemented as a cost effective public mental health measure.

Globally, concern is growing about the high and steadily increasing rates of anxiety and depression in young people. Effective and scalable ways of preventing poor mental health in this group are needed, and digital tools such as mobile apps have been proposed as part of the solution.

Whilst there is emerging evidence for mental health apps being effective in treating anxiety and depression, this project led by the University of Exeter is the first to rigorously test a mental health app on such a large scale across four countries. Two linked papers published in Lancet Digital Health report the results of the ECoWeB-PREVENT and ECoWeB-PROMOTE trials, which ran concurrently in the four-year study funded by Horizon 2020. Critically, these studies found that a CBT self-help app can protect vulnerable young people against depression.

Professor Ed Watkins from the University of Exeter led the project and said: “For young people with elevated risk, our findings suggest the CBT app does have a preventative effect on depression and could have a public health benefit. Participants’ quality-of-life measures were better, and their reported work and social functioning was better.

“However, we also found that it’s hard to make improvements in young people who are basically doing okay. Our findings add to the evidence that prevention for depression works best when we identify and select individuals who are more at risk, rather than take a more universal approach. This identification could be done by an online self-screening process or through professional referral.”

The aim of the £3.3-million project was to test the effects of mobile apps in preventing depression and promoting mental well-being for young people aged 16 to 22. In one of the largest studies of its kind, 3,700 young people took part across the UK, Germany, Belgium, and Spain and were allocated into two trials based on their emotional competence abilities at the start of the study. That resulted in 1,200 young people with reduced emotional competency scores that confer increased risk for depression such as increased worry and overthinking going into one trial focused on prevention, whilst 2,500 without such risk went into the other trial focused on wellbeing promotion.

Those two groups were then randomised in equal numbers to three different apps developed by the study. There was a self-monitoring app where people can report their emotions every day, a self-help app that provided personalised training in emotional competence skills, and a self-help app based on CBT principles. Participants were then followed up at three months and 12 months to see how their wellbeing and depression symptoms changed.

The trials found the CBT app prevented an increase in depression, relative to self-monitoring in the higher risk sample, but that there was no difference between any of the interventions in their effects for the lower risk sample.

Professor Ed Watkins said: “Our results suggest that even when young people used the self-help app just a few times, there was a small but meaningful benefit. Because the app is scalable to large numbers of people in a cost-effective way, these effects have potential value as a public health intervention, within a broader portfolio of digital and in-person services and interventions. Next steps are to identify the active ingredients of the app that were beneficial and to improve engagement and ongoing use of these elements.”

The project involved 13 different partners, including two commercial companies – German voice analysis company audEERING and Danish app creator Monsenso. The University of Exeter (UK), LMU Munich (Germany), Ghent University (Belgium), and Universitat Jaume I (Spain), were the main treatment development and trial sites. Meanwhile, the University of Oxford led on the qualitative analysis.

Reference:

Watkins, Edward R et al., Emotional competenceAJself-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial, The Lancet Digital Health, DOI:10.1016/S2589-7500(24)00148-1.

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