Category: MIL-OSI

Source: The Conversation – UK – By Samina Akhtar, PhD candidate in Population and Public Health and a Fogarty Fellow, Aga Khan University

For decades, one of the most prominent public health messages has been that smoking kills. But another everyday habit, far less dramatic and far more socially acceptable, may also be damaging our health: prolonged sitting.

Many people now spend up to ten hours a day seated at desks, in meetings or in front of screens. It may feel harmless, even unavoidable, but growing evidence suggests that too much sitting is linked to serious health risks, including cardiovascular disease, type 2 diabetes and early death.

People are often told to protect their health by exercising more and eating better. That advice matters, but it misses something important. Even those who meet recommended exercise targets may still face increased health risks if they spend most of the day sitting down.

This is because sedentary behaviour and physical inactivity are not the same thing. Physical inactivity means not doing enough moderate or vigorous exercise. Public health guidelines recommend at least 150 minutes of moderate activity a week, such as brisk walking or cycling, or 75 minutes of vigorous activity, such as running. Sedentary behaviour, by contrast, refers to long periods of sitting or reclining with very low energy expenditure, whether at a desk, in front of the television or during a long commute.

A person can therefore be physically active and still highly sedentary. Someone might go for a run before work, then remain seated for most of the next eight hours. The exercise helps, but it does not erase the effects of prolonged sitting on the body.

When the body stays still for long periods, a series of changes begins to take place. Skeletal muscle activity drops, making it harder for the body to absorb glucose from the blood. Over time, this contributes to insulin resistance, a major pathway to type 2 diabetes. Fat metabolism also slows down.

Blood flow becomes less efficient, reducing the delivery of oxygen and nutrients to tissues. This can impair vascular function and, over time, contribute to raised blood pressure.

Together, these metabolic and circulatory changes increase the risk of cardiometabolic problems, including high blood sugar, unhealthy cholesterol levels and the accumulation of abdominal fat.

Prolonged sitting also affects the musculoskeletal system. Poor posture and limited movement place strain on the neck, shoulders and lower back, helping to explain the aches and pains so common among office workers.

The effects are not only physical. Long periods of inactivity can reduce alertness, concentration and energy levels. Employees who sit for extended periods often report feeling more sluggish and less productive.

Globally, physical inactivity is estimated to contribute to around four to five million deaths each year. Much of the public health response has focused on encouraging people to exercise more, but reducing sedentary time is increasingly recognised as an important goal in its own right.

Since most adults spend a large share of their waking hours at work, the workplace is one of the most important settings for tackling the problem. Offices, universities and hospitals are not just places of productivity. They are also environments in which daily habits are shaped and reinforced.

Reducing sitting time does not require a gym membership or a dramatic office overhaul. Small, regular interruptions to sitting can make a meaningful difference.

Research suggests that standing up or moving for just two to five minutes every 30 to 60 minutes can improve glucose metabolism and reduce cardiometabolic risk.

Some organisations are already trying to build this into the working day. Walking meetings, prompts to stand or stretch and short movement breaks between tasks can all help people spend less time sitting.

Workplace design matters too. Height-adjustable desks allow employees to alternate between sitting and standing, while accessible staircases and walking routes can encourage more movement throughout the day.

A study of offices in the UK found that these kinds of measures can reduce daily sitting time by around one to one and a half hours. Employees also reported improvements in energy, focus and musculoskeletal comfort.

The message is straightforward: regular exercise is essential, but it does not fully offset the risks of sitting for too long. If smoking forced us to rethink the environments in which we worked and socialised, prolonged sitting should force us to rethink the structure of the working day itself. A short walk at lunch, standing during a phone call or simply getting up between meetings may sound like trivial adjustments. They are not. For modern workers, protecting health is not only about moving more before or after work. It is also about sitting less while work is happening.

Samina Akhtar has received funding from the Health Research Institute, National Institutes of Health, Islamabad, Pakistan. She is also a sub-recipient of a grant from the Fogarty International Center of the National Institutes of Health (USA) supporting her PhD research.

– ref. What sitting all day does to the body – https://theconversation.com/what-sitting-all-day-does-to-the-body-277444

Source: The Conversation – UK – By Ed Hutchinson, Professor, MRC-University of Glasgow Centre for Virus Research, University of Glasgow

The world is full of animal viruses, and we’re pretty sure that one of them will cause the next pandemic. To prevent pandemics, we need to predict which of the vast number of animal viruses are most likely to infect humans. A new study, published in Nature, sets out an elegant and powerful way for scientists to sift through the enormous diversity of animal viruses without risking being infected by them in the process.

In this study, a team of researchers in the UK used cutting-edge lab techniques to track down a previously obscure virus infecting bats in Kenya. Here’s what they did, and how they may have helped us to get ahead of the next pandemic.

Fortunately, most animal viruses will never cause pandemics because when they try to infect human cells, they fail at the first step.

To infect a cell, the first thing a virus has to do is to bind to an “entry receptor”. This is a specific molecule on the cell’s surface that the virus attaches to so it can enter the cell.

When a virus infects a new host species, it has a problem. The cells will be coated with different molecules from the ones the virus is used to, and often the virus has nothing to grab hold of. Viruses are adept at all the stages of cellular breaking and entering, but none of them matters if they can’t even get hold of the door handle.

If we could predict which viruses could use the entry receptors found on human cells, we would know which viruses we needed to take special care around to reduce the risk of pandemics. However, for most viruses, we don’t know what their entry receptors are, let alone if human cells carry them.

Finding the door handle

In this new study, the researchers set out on a hunt for viruses that could bind to human entry receptors. They chose the alphacoronavirus family. This group of viruses includes two common cold viruses, so clearly some of them can infect humans. They also include many viruses that infect other animals, particularly bats.

Alphacoronaviruses are distant cousins of the betacoronaviruses and hence of SARS-CoV-2, which famously jumped from bats to humans to cause the COVID pandemic. Could an alphacoronavirus do something similar?

The entry receptors of almost all alphacoronaviruses, like those of the vast majority of viruses, are not known. What we do have is the virus’s genome sequences. From these, the team identified the genes of the spike proteins. If you picture a virus, such as SARS-CoV-2, the spike proteins are the bits that stick out from the surface of the virus. Their job is to bind to entry receptors.

Not unreasonably, the scientists wanted to study viral receptor binding without spending any time in the presence of potentially dangerous pathogens. They did this by creating particles called “pseudotyped viruses”: dummy virus particles that carry the spike proteins of a real virus on their surface.

Pseudotyped viruses can bind to cells but cannot replicate. As a result, they are entirely safe to work with.

As expected, pseudotypes of the two common cold viruses grabbed firmly on to human cells. Comfortingly, most of the other alphacoronaviruses could not. But there was one exception. The coronavirus KY43, a rather obscure virus previously identified in heart-nosed bats in Kenya, bound very well to a protein found on human cells.

How worried should we be about KY43? Related viruses are found in bats around the world, but, fortunately, most of them are not very good at binding to the human version of their entry receptor. The ones that can bind to human proteins are found in a relatively small region of east Africa, and people living in the part of Kenya where the virus was first identified don’t seem to show any evidence of infection.

This is reassuring, though not surprising. There are multiple steps needed for a virus to break into a human cell, after all, and binding was just the first of them. But this work marks KY43 as a virus to keep an eye on.

More generally, this paper is a powerful proof of concept for how we could carry out pre-pandemic risk assessment. Screens like this can be safely applied to any virus that we have a genome sequence for. More broadly, it should be possible to design similar screens for many of the other things a virus needs to do in order to pose a threat to humans.

The world is overflowing with animal viruses, most of which will never hurt us. But some of them could. Work like this will help us spot the ones we need to take more care of.

Ed Hutchinson receives funding from the UK Medical Research Council and the Wellcome Trust. He is a board member of the European Scientific Working group on Influenza and chairs the virus division of the Microbiology Society.

– ref. Scientists have found a safer way to hunt for the next pandemic virus – https://theconversation.com/scientists-have-found-a-safer-way-to-hunt-for-the-next-pandemic-virus-281287

Source: The Conversation – UK – By Adam Brentnall, Reader in Biostatistics, Queen Mary University of London

Over the past decade, millions of men without symptoms of prostate cancer have voluntarily undergone a prostate-specific antigen (PSA) test in the UK to find out if they might have prostate cancer.

While research has shown that PSA screening in men aged 50-69 years can reduce cancer deaths, many countries hesitate to recommend or implement formal prostate cancer screening programmes that would offer PSA testing systematically and fairly to all men. The hesitation stems from concern about overdiagnosis and overtreatment.

But our latest research shows that prostate cancer overdiagnosis from PSA screening is mainly a risk for men over the age of 70.

Prostate cancer overdiagnosis occurs when a person is diagnosed with prostate cancer through PSA testing – even though that cancer would not otherwise have been diagnosed within the patient’s lifetime. So had the person not been tested, they might never have known they had prostate cancer.

Overdiagnosis from PSA testing occurs for two main reasons.

The first reason is because PSA tests might identify a cancer that is so slow growing it would never cause problems – even if the man lives to be 100 years old.

The second reason is because a PSA test is able to find prostate cancer a decade or more before it would cause symptoms. Some patients may die from other causes in that time. Had they not been screened, they might have died without ever knowing they had prostate cancer.

Prostate cancer overdiagnosis is a concern because of what follows diagnosis. Subsequent treatment, such as surgery, may lead to harm – including loss of ability to maintain an erection and urinary incontinence.

Had the cancer not been found through screening, the man would not have been treated and would have avoided the side-effects of treatment. Overdiagnosis affects quality of life – and results in costs both to patients and to the healthcare system.

To help men make an informed choice, our research looked at how risk of overdiagnosis changes with age at screening. We found that the risk of prostate cancer overdiagnosis from a PSA test is low in otherwise healthy men in their 50s and early 60s. But this risk sharply increases in men screened from age 70 onward.

First, we looked at long-term data from a large UK trial of more than 400,000 men to examine, over a 15-year period, what proportion of men developed prostate cancer – and whether that proportion differed between those who were screened and those who weren’t.

We found that, on average across all age groups, 12% of prostate cancers were so slow-growing that they would not have caused symptoms or been picked up by a doctor within 15 years of a PSA test. We also found that 88% of prostate cancers detected by PSA tests would, if not treated earlier, cause symptoms and be diagnosed within 15 years – provided the patient lived long enough and did not die of other causes.

We then used national data on men’s deaths in England to understand how many men die from causes other than prostate cancer after a PSA test. Risk of death from other causes within 15 years of a PSA test increases from 10% aged 50, to 49% aged 70 and 89% if aged 80. This steep rise in risk of death drives increased overdiagnosis with old age, because, naturally, the older you are the more likely you are to die from other causes.

Taking these findings together, we projected that there was a 16% chance that the average English man diagnosed with prostate cancer at age 50 from a PSA test would not otherwise have been clinically diagnosed within 15 years. This doubled to 32% for men diagnosed aged 70, and jumped to 58% for men diagnosed at age 80 years.

Essentially, as men age, they are more likely to die from other natural causes before prostate cancer would be detected. For men older than 70 years at screening, screening offers very little, if any, benefit, but carries a high risk of unnecessary harm from overdiagnosis.

It’s also worth noting that health is more than a number based on age. Overdiagnosis risk will be lower for men who are in generally in good health and follow a healthy lifestyle.

It’s important to point out as well that healthcare is evolving. Our findings are based on data from prostate cancer screening done in the UK between 2001 and 2007. Today, doctors use magnetic resonance imaging (MRI) for targeted prostate cancer biopsy in those with an elevated PSA test. This is expected to lower overdiagnosis compared with our estimates by filtering out slower-growing cancers. More significantly, the use of MRI substantially reduces the risk of overtreatment, so the harms of overdiagnosis are smaller than they were 15 years ago.

Two new trials are also evaluating whether such innovations can improve the benefits of screening without increasing the harms.

In the meantime, men without symptoms of prostate cancer who are concerned about their risk have to decide for themselves whether to request a PSA test. For now, our recommendation, as statisticians, is to consider your age before making a decision. But if you do have symptoms, regardless of your age, you should definitely see your GP.

Adam Brentnall receives funding outside this work from Prostate Cancer UK, NIHR, Breast Cancer Research Foundation, MRC, Cancer Research UK. He is a co-applicant on the TRANSFORM trial, and member of the UK National Screening Committee Research and Methodology Group, but this work is independent and not supported by or associated with either role.

Peter Sasieni is a lead investigator on the IMProVE trial, which is investigating whether prostate cancer screening can be improved by combining PSA testing with MRI scanning.

Rhian Gabe receives funding outside this work from Prostate Cancer UK, NIHR, Cancer Research UK and Yorkshire Cancer Research. She is a co-lead on the TRANSFORM trial but this work is independent and not supported by this role.

– ref. Prostate cancer overdiagnosis risk sharply rises after age 70 – new research – https://theconversation.com/prostate-cancer-overdiagnosis-risk-sharply-rises-after-age-70-new-research-281166

Source: The Conversation – UK – By Simon Kolstoe, Associate Professor of Bioethics, University of Portsmouth

The chief executive of the UK Biobank, one of the world’s largest biomedical databases, recently wrote to over 500,000 participants telling them that some of their data had been made available for sale online through a Chinese website. This wasn’t a data breach or hack, but rather researchers who had legitimately accessed the data trying to sell it.

Although it was stated that participants could not be identified, and there was no sign that the data had actually been bought by anyone, the fact that someone could even try to sell parts of the dataset is extremely concerning. Unfortunately, the failure was unlikely to be in the protection set up by the biobank itself, but rather in the honesty of the researchers accessing the data.

This raises the wider question of whether data – any data – can ever really be protected. Many databases, including the UK Biobank, operate secure research environments where restrictions are put on those accessing the information. This can be through secure computer portals or platforms (as used by the UK Biobank), or limiting researchers to only downloading the results of their analyses rather than the raw data itself.

But the problem is that once data exists, there is always a chance that it can be leaked through either accident or dishonesty. Legal restrictions, such as data protection laws, can give power to police or governments to try to stop this happening, or to subsequently prosecute. But in a world of international computer networks, and very different national views on privacy, even laws can only do so much. For instance, it has been claimed that data has been exposed accidentally from the UK Biobank 198 times before.

If this isn’t bad enough, the increasing availability of sophisticated AI tools means that even anonymised data can be de-anonymised. This is because AI tools are able to find complex patterns or links in data that no human would ever be able to discover.

So what is the answer? Do we revert to using pen, paper and filing cabinets, or do we need to keep evolving the way we think about our data and its security?

Harms v benefits

Possibly the main fear that people have with their data being made widely available is becoming the victim of fraud, bribery or perhaps a commercial organisation using it to make large profits or using it in other ways that we would not approve of. But the possibility of this depends on the type of data.

For instance, there are very clear reasons to keep data on personal finances, telephone records, or many other details about our personal lives confidential. However, when considering health data, including the types held in biobanks, does the potential for significant societal benefits change the way we think about risks and harms?

Medical confidentiality is considered a human right, certainly in Europe and the UK. This is because of the possibility of coercing or manipulating people if you have inside knowledge about their health. Doing this for nefarious gain is clearly wrong and must remain illegal.

Giving health data access to insurers or employers is less clear cut. While we all accept that their business practices mean that they do need to know a certain amount of information about us, many people feel uncomfortable with the idea of giving companies all of our healthcare information. This is where data protection laws come in that limit what and how commercial organisations use our data, albeit such laws require ongoing scrutiny as they are not always as effective as we may like.

However, looking beyond the individual, the real value of health data is at a group level. Humans are complex both biologically and psychologically, meaning that researchers need to look across a lot of people before patterns start to emerge. So how can this be balanced with personal privacy?

Veil of ignorance

The philosopher John Rawls proposed a thought experiment for considering issues of justice and society. His idea was to suggest people adopt a “veil of ignorance” by trying to forget their own personal position – including, race, gender, class, intelligence and health – when thinking about what might be best for society. So what would adopting a veil of ignorance mean when considering health data?

Aggregating health data is certainly not a new idea, and is the reason why organisations like UK Biobank exist, which to date has resulted in more than 18,000 research publications. So from the position of a veil of ignorance, the more data from the more individuals the better, as it does seem to lead to more research possibilities.

Second, research is very complex and now involves a wide range of disciplines, individuals and skills. Data from the UK Biobank has been used by 22,000 researchers in more than 60 countries. Again, from the veil of ignorance position, making data freely available to the widest range of researchers seems to be a good thing as the more people looking at it, in different ways, the higher the likelihood of discovering something useful.

Of course, safeguards do need to be in place to stop information being shared too widely, but these safeguards are becoming harder to implement as data processing software and AI is making it increasingly easy to identify individuals from otherwise “anonymous” data. Perhaps the issue is therefore focusing efforts less on controlling the availability of data, and instead increasing our focus on controlling how it is subsequently used.

This latest incident, alongside the wider context of daily cyber-attacks and leaks from other databases, seems to show that sooner or later most attempts at protecting data will fail. As a consequence, rather than trying to protect data, maybe we should start to accept that this type of data could now be considered a type of public good.

As with other public goods, the ethical obligation is to ensure how they are used. Yes, this may mean that commercial organisations, or even foreign governments, could use our data in ways we may not individually approve of, but disapproval of the actions of companies or other countries is hardly a new thing.

Political and international agreements regulate how all sorts of resources are used, and health data should now be included. Similarly, laws already exist to dictate what businesses can and can’t do with data.

It could be argued that if the potential benefits of fully open data sharing are truly enormous, and this incident among many others has shown we cannot protect such datasets, maybe we need to stop focusing on the futile task of trying to protect the data, and instead focus on working out how to ensure it is used in the right way.

Simon Kolstoe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. UK Biobank records listed for sale in China: why open data might be the answer – https://theconversation.com/uk-biobank-records-listed-for-sale-in-china-why-open-data-might-be-the-answer-281388