Latest / Morning Medical with Dr. Chow / Peanut Allergy Treatment Advances, Dementia Prevention Strategies, and Post-Pandemic Healthcare Trust

Transcript

Peanut Allergy Treatment Advances, Dementia Prevention Strategies, and Post-Pandemic Healthcare Trust · Morning Medical with Dr. Chow

• 0:00
  Good morning and welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow.
• 0:05
  I am Dr.
• 0:06
  Chi-Ming Chow, your host, and today we have some groundbreaking news in the field of
• 0:10
  allergy treatment.
• 0:13
  Australia has launched a pioneering peanut allergy immunotherapy program for babies,
• 0:18
  making it the first country in the world to introduce such a program into mainstream care.
• 0:24
  This initiative is a collaboration between Australia’s National Allergy Centre of
• 0:28
  Excellence and the Murdoch Children’s Research Institute.
• 0:35
  The program, known as the ADAPT Oral Immunotherapy Program, is designed for infants
• 0:41
  under 12 months who have been diagnosed with a peanut allergy.
• 0:46
  These infants must be under the care of an allergy specialist at one of the ten pediatric
• 0:51
  hospitals across five states that are participating in this initiative.
• 0:56
  This treatment is provided at no cost to those who qualify, making it accessible to many
• 1:03
  families in need.
• 1:05
  The treatment involves a carefully planned daily dosing schedule of peanut powder, which
• 1:09
  the infants will take at home over a period of two years.
• 1:13
  The ultimate goal is to shift the approach to peanut allergies from strict avoidance to
• 1:18
  building up a tolerance, and hopefully achieving remission.
• 1:22
  Professor Kirsten Perrett, director of the National Allergy Centre of Excellence and
• 1:26
  population allergy lead at the Murdoch Children’s Research Institute, emphasized the
• 1:32
  potential impact of this program.
• 1:34
  She stated, 'Ultimately, we want to change the trajectory of allergic disease in Australia so
• 1:40
  that more children can go to school without the risk of a life-threatening peanut reaction.'
• 1:46
  Australia is known as the allergy capital of the world, with approximately 5 million people
• 1:52
  suffering from allergic diseases.
• 1:55
  Peanut allergy affects around 3 percent of 12-month-old children in Australia.
• 2:01
  Given these statistics, it is expected that hundreds of babies will benefit from this
• 2:07
  program in its initial years.
• 2:11
  The program is funded by Australia’s federal government, and its results will be evaluated
• 2:16
  by the National Allergy Centre of Excellence with the hope of expanding it to more hospitals
• 2:21
  and clinics if successful.
• 2:24
  The focus for now is on babies because their immune systems are more malleable at an early
• 2:29
  age, making them more responsive to oral immunotherapy.
• 2:34
  Professor Perrett explained that younger children tend to have better effectiveness and
• 2:39
  a reduced risk of reactions when undergoing this treatment.
• 2:45
  The family of Hunter Chatwin, a baby who had an allergic reaction to peanut butter at six
• 2:50
  months old, is hopeful that the program will help him.
• 2:54
  Hunter has already been referred to the ADAPT Oral Immunotherapy Program at The Royal
• 2:59
  Children’s Hospital in Melbourne.
• 3:02
  His mother, Kirsten, shared her optimism, saying, 'We are taking part in the program to
• 3:08
  try and improve his chance of being able to safely eat peanut in the future.'
• 3:13
  The program has garnered international attention and praise.
• 3:18
  Adam Fox, a London-based professor of pediatric allergy and chair of the National Allergy
• 3:23
  Strategy Group in the United Kingdom, described it as a 'really exciting initiative' and noted
• 3:29
  that the global allergy community will be closely monitoring its outcomes.
• 3:35
  He added, 'By taking a large-scale, public health approach to the problem with early
• 3:40
  aggressive intervention, there is a real chance of reversing Australia’s unwelcome record of
• 3:46
  the world’s highest rates of peanut allergy.'
• 3:50
  Food allergies are also a significant public health concern in the United States, where
• 3:55
  peanut allergy affects about 2 percent of children, or nearly 1.5 million people under
• 4:01
  the age of 18.
• 4:03
  Peanuts are among the foods that can cause the most severe allergic reactions, including
• 4:08
  anaphylaxis, a life-threatening condition.
• 4:11
  Recent studies have shown that early introduction of peanuts can help reduce the
• 4:16
  risk of developing a peanut allergy.
• 4:19
  Research published in the journal NEJM Evidence in May revealed that feeding children smooth
• 4:25
  peanut butter during infancy and early childhood can reduce their risk of developing a
• 4:29
  peanut allergy by 71 percent compared to avoiding peanuts.
• 4:34
  This new program in Australia is a game-changer for many families who have been desperate for a
• 4:40
  solution.
• 4:41
  Some have even traveled interstate or overseas to seek oral immunotherapy treatment at private
• 4:47
  clinics.
• 4:48
  Having this treatment available and free at public hospitals is a significant step forward.
• 4:56
  As we continue to monitor the progress of this program, we hope it will pave the way for
• 5:00
  similar initiatives globally, providing relief to countless families dealing with peanut
• 5:06
  allergies.
• 5:08
  More than 55 million people worldwide have dementia, a number that is expected to nearly
• 5:14
  triple by 2050.
• 5:16
  However, addressing 14 risk factors over the course of one’s life, starting in childhood,
• 5:22
  could prevent or delay nearly half of cases, according to a large report by 27 dementia
• 5:29
  experts.
• 5:31
  Based on reviews of the latest evidence, the Wednesday report by The Lancet Commission on
• 5:35
  dementia prevention, intervention, and care adds two risk factors—high cholesterol and
• 5:42
  vision loss—to 12 others previously identified in its 2020 report.
• 5:47
  Those existing risk factors are less education, head injury, physical inactivity, smoking,
• 5:54
  excessive alcohol consumption, hypertension, obesity, diabetes, hearing loss, depression,
• 6:01
  air pollution, and infrequent social contact.
• 6:05
  The research team wanted to compile and add to the evidence to give individuals and government
• 6:10
  accessible, reliable information and to help set a research agenda by highlighting what we
• 6:15
  do not know, said the report’s lead author Dr.
• 6:19
  Gill Livingston via email.
• 6:21
  'The progress in preventing and treating dementia is accelerating,' Livingston added.
• 6:26
  The initial 12 risk factors were linked with 40 percent of cases, but the new report suggests
• 6:32
  addressing the 14 risk factors could help eliminate or delay 45 percent of dementia
• 6:37
  cases, said Livingston, a professor of psychiatry of older people at University
• 6:43
  College London.
• 6:44
  High cholesterol in midlife, from around age 40, was linked with 7 percent of dementia
• 6:50
  cases, and untreated vision loss in late life was associated with 2 percent of cases.
• 6:58
  The risk factors associated with the greatest proportion of people developing dementia
• 7:02
  worldwide were high cholesterol, hearing impairment, less education in early life, and
• 7:08
  social isolation in later life, the authors found.
• 7:12
  This 'critical' update calls attention to two risk factors that preventive neurologist Dr.
• 7:18
  Richard Issacson says his clinical practice has been evaluating for over a decade.
• 7:24
  'Now the evidence has caught up to what we recommend to patients,' said Issacson, director
• 7:28
  of research at the Institute for Neurodegenerative Diseases in Florida, who was
• 7:33
  not involved in the new study.
• 7:35
  The report does not establish with certainty that these risk factors directly cause
• 7:40
  dementia, experts said.
• 7:42
  It is also possible that some risk factors may be early signs of a dementia diagnosis yet to
• 7:47
  come, meaning eliminating those factors may not always reduce the risk of developing the
• 7:53
  disease, said Dr.
• 7:55
  Klaus Ebmeier, Foundation Chair of Old Age Psychiatry at the University of Oxford, in a
• 8:00
  news release.
• 8:02
  Ebmeier was not involved in the study.
• 8:05
  But other research has provided theories on the link between these vulnerabilities and dementia
• 8:11
  risk.
• 8:12
  The link between excess body fat and dementia, for one, may be due to the involvement of body
• 8:18
  fat in metabolic and vascular processes associated with the buildup of beta-amyloid
• 8:24
  protein, a hallmark sign of Alzheimer’s disease.
• 8:28
  Exercise may help keep dementia at bay by increasing levels of a protein known to
• 8:33
  strengthen communication between brain cells, according to a January 2022 study.
• 8:39
  Exercise can also reduce inflammation, which kills nerve cells.
• 8:44
  And being socially engaged can help someone reduce stress and better access health care.
• 8:50
  Education is also vital for several reasons.
• 8:53
  'Most importantly, it makes the brain more resilient to damage, so people can have changes
• 8:58
  but still function well,' Livingston said.
• 9:01
  'It also helps people make good choices by enabling them to think about evidence in a more
• 9:06
  educated way, and it is related to getting better jobs, and money gives more choices, for
• 9:11
  example, in health care and where to live.'
• 9:15
  The full mechanisms of these risk factors need to be further investigated, said American
• 9:19
  Academy of Neurology fellow Dr.
• 9:21
  Glen R.
• 9:22
  Finney, who was not involved in the study.
• 9:24
  Explanations for the findings could boil down to a 'combination of promoting the physical
• 9:28
  development and health of the brain, preventing damage to the brain, and enhancing and
• 9:34
  maintaining stimulation of the brain, which in and of itself aids brain health and function,'
• 9:40
  added Finney, director of the Geisinger Memory and Cognition Program in Wilkes Barre,
• 9:45
  Pennsylvania.
• 9:47
  That may explain the increased risk potentially imparted by vision or hearing loss and air
• 9:53
  pollution.
• 9:55
  How well a person can hear or see influences their ability to engage with their
• 9:59
  surroundings, have meaningful interactions with other people, and be physically active, all of
• 10:05
  which are sensory inputs that stimulate the brain and build up its cognitive reserve,
• 10:10
  Isaacson said.
• 10:12
  'If you do not use it, you lose it,' he said, adding that giving patients hearing aids or
• 10:19
  glasses often provides them with a new lease on life.
• 10:23
  Researchers are still trying to understand what components of air pollution may be responsible
• 10:28
  for the connection to dementia risk, but particles have been found in the buildup of
• 10:33
  amyloid plaques in the brains of people with Alzheimer’s, Isaacson said.
• 10:38
  Living near a highway has also been associated with a higher risk of dementia.
• 10:44
  Many of these risk factors can be addressed by individuals on their own, said Dr.
• 10:49
  Susan Kohlhaas, executive director of research at Alzheimer’s Research United Kingdom, in a
• 10:54
  news release.
• 10:55
  'But others, like air pollution and early childhood education, are bigger than
• 11:00
  individuals and communities,' said Kohlhaas, who was not involved in the study.
• 11:04
  'Tackling them will need structural changes to society to give everyone the best chance of a
• 11:10
  healthy life, free from the impact of dementia.
• 11:13
  Public health leaders must not ignore this message.'
• 11:17
  Based on the risk factors, the authors also recommended 13 policy and lifestyle changes to
• 11:22
  help prevent or better manage dementia.
• 11:25
  Policy guidance for government agencies includes ensuring quality education is
• 11:29
  available to all and providing information about the risks of cigarette smoking and
• 11:34
  excessive alcohol consumption and how to stop, as well as controlling prices and preventing
• 11:39
  smoking in public places.
• 11:41
  Individuals should engage in cognitively stimulating activities, use head protection in
• 11:46
  contact sports or while riding bikes, and exercise regularly.
• 11:51
  Maintaining a healthy weight and treating obesity as early as possible also helps prevent
• 11:56
  diabetes risk.
• 11:57
  The authors also recommended people maintain a systolic blood pressure of 130 millimeters of
• 12:03
  mercury or less beginning at age 40.
• 12:07
  Treatment for depression, hearing loss, vision loss, and high cholesterol is also important.
• 12:13
  If you cannot move to an area with less air pollution, what you can do is use HEPA filters
• 12:18
  in your house and avoid using wood- or coal-burning ovens or heating, experts said.
• 12:24
  The health and social impact of dementia worldwide has been estimated to cost over $1
• 12:29
  trillion per year.
• 12:30
  But implementing some of these guidelines could save England, for example, around 4.2 billion
• 12:35
  Euros, according to a modeling study published alongside the report.
• 12:40
  'Even in the cases of dementia these steps do not prevent, quality of life is better for
• 12:45
  people who have had these risks addressed,' Finney said via email.
• 12:49
  'And the dementia-specific medications like the acetylcholinesterase inhibitors and memantine
• 12:55
  can help and should be used.
• 12:57
  We have to fight neurologic nihilism—we can protect and help the brain and should!'
• 13:03
  Our final story today focuses on a critical issue that has emerged from the COVID-19
• 13:08
  pandemic: trust in doctors and hospitals.
• 13:12
  According to a survey study of United States adults, trust in physicians and healthcare
• 13:17
  institutions decreased sharply during the pandemic and remains low.
• 13:21
  The study, published in JAMA Network Open, analyzed responses from over 400,000 unique
• 13:27
  participants and found that the proportion of adults who had 'a lot of trust' in physicians
• 13:32
  and hospitals plummeted from 71.5 percent in April 2020 to just 40.1 percent in January
• 13:38
  2024.
• 13:40
  Dr.
• 13:41
  Roy Perlis from Massachusetts General Hospital, the lead author of the study, noted that this
• 13:46
  decline in trust was surprising in its magnitude.
• 13:50
  He suggested that while trust might have initially increased at the onset of the
• 13:55
  pandemic, it significantly dropped as the pandemic progressed.
• 14:00
  High levels of trust were closely linked with higher vaccination rates for both COVID-19 and
• 14:06
  influenza, as well as with receiving COVID-19 booster shots.
• 14:11
  This correlation emphasizes the broader public health implications of declining trust in
• 14:16
  medical professionals.
• 14:18
  The study identified several demographic factors associated with lower levels of trust.
• 14:24
  These included being between the ages of 25 to 64, female, having lower educational levels,
• 14:30
  lower income, being Black, and living in rural areas.
• 14:35
  These associations held even when controlling for political partisanship, indicating that the
• 14:40
  decline in trust is multifaceted and not solely driven by political beliefs.
• 14:45
  One of the key insights from the study was understanding why respondents had low levels of
• 14:50
  trust.
• 14:51
  Among those with the lowest levels of trust, 35 percent cited financial motives over patient
• 14:56
  care, 27.5 percent pointed to poor quality of care and negligence, 13.5 percent mentioned the
• 15:03
  influence of external entities and agendas, and 4.5 percent cited discrimination and bias.
• 15:10
  Dr.
• 15:11
  Perlis emphasized the importance of understanding these varied reasons for mistrust
• 15:17
  to effectively address them.
• 15:19
  Interestingly, the study found that the decline in trust was not entirely due to a general
• 15:26
  distrust in science.
• 15:28
  There seemed to be a specific mistrust in medicine, which poses unique challenges for
• 15:33
  healthcare providers.
• 15:34
  Despite the decline, the study also highlighted that a significant portion of respondents still
• 15:40
  had 'some' or 'a lot' of trust in physicians and hospitals during the spring and summer of
• 15:46
  2023.
• 15:48
  In response to this crisis of trust, initiatives like 'Building Trust' by the
• 15:53
  American Board of Internal Medicine have emerged.
• 15:56
  Launched in 2021, this initiative encourages clinicians to focus on the five
• 16:02
  C's—communication, caring, competency, comfort, and cost—in their interactions with patients
• 16:08
  and stakeholders to rebuild and reinforce trust.
• 16:13
  While there are no quick fixes, such efforts are steps in the right direction.
• 16:19
  The study analyzed responses from over 582,000 surveys conducted from April 2020 through
• 16:25
  January 2024.
• 16:28
  Participants were asked how much they trusted healthcare providers and institutions to do
• 16:32
  what is right, with options ranging from 'a lot' to 'not at all.' They were also asked
• 16:38
  about their trust in scientists and researchers and their vaccination status.
• 16:42
  The survey had its limitations, including reliance on nonprobability sampling methods and
• 16:48
  the use of a single question to assess trust levels.
• 16:52
  Despite these limitations, the findings offer valuable insights into the state of public
• 16:57
  trust in healthcare.
• 16:59
  The decline in trust has significant implications for public health, especially in
• 17:04
  areas like vaccination uptake.
• 17:07
  Understanding and addressing the reasons behind this mistrust are crucial steps for healthcare
• 17:12
  providers and policymakers.
• 17:15
  That wraps up today's episode of Morning Medical with Dr.
• 17:18
  Chow.
• 17:19
  Thank you for joining us as we explored these important topics in healthcare.
• 17:23
  Stay tuned for more updates and insights in our next episode.
• 17:27
  Have a great day, and stay healthy!