Healthcare professionals are failing smell loss patients

smell

People who have lost their sense of smell are being failed by healthcare professionals, new research has revealed.

A study by Newcastle University, University of East Anglia and charity Fifth Sense, shows poor levels of understanding and care from GPs and specialists about smell and taste loss in patients.

This is an issue that has particularly come to the forefront during the COVID-19 pandemic as many people who have contracted the virus report a loss of taste and smell as their main symptoms.

Around one in 10 people who experience smell loss as a result of COVID-19 report that their sense of smell has not returned to normal four weeks after falling ill.

The study, published in the journal Clinical Otolaryngology, highlights the difficulties that people with smell and taste disorders experience in accessing treatment.

The research team say that identifying these barriers is vital to help people have better access to healthcare.

More resources needed

Dr. Stephen Ball, from Newcastle University’s Faculty of Medical Sciences, who led the study, said: “This research highlights that a greater focus needs to be dedicated to patients with smell or taste loss.

“When you contrast the healthcare services funded and available for people with loss of other senses—such as vision or hearing the differences are vast. Our results show this exists for patients through both primary and secondary care.”

“More attention and resources need to be provided for this group of patients that has increased significantly following the COVID-19 pandemic.”

More than 600 smell loss patients took part in a survey which captured their poor experiences of accessing healthcare.

The survey highlights poor levels of understanding from many GPs and consultants (both in Neurology and Ear, Nose and Throat departments) about the impact of smell and taste disorders on patients.

Over 60 percent of patients reported suffering from anxiety or depression since their smell loss. And almost all of the patients—98 percent—said their quality of life has been affected.

Only around 20 percent of patients reported that that they had experienced an improvement in their symptoms following treatment.

Professor Carl Philpott, from the University of East Anglia’s Norwich Medical School, said: “Before the pandemic, smell disorders affected around five percent of the population. But the huge rise in smell loss caused by COVID-19 has created an unprecedented worldwide demand for treatment.

“Smell disorders cause people to lose their sense of smell or change the way they perceive odors. Some people perceive smells that aren’t there at all.”

“There are many causes for smell loss—from infections and injury to neurological diseases such as Alzheimer’s and as a side-effect of some medications.”

“Our research shows that there is an unmet need for smell loss patients in accessing healthcare and a clear need to improve training within healthcare to remove the barriers faced.”

Quality of life impacted

This research was conducted before the COVID-19 pandemic, but it identifies many areas that were consistent across multiple experiences.

Further issues reported included repeated ineffective treatments, difficulties getting referrals for further care, and an average personal cost of £421 seeking advice and treatment.

Duncan Boak, Founder and Chair of Fifth Sense, a charity for people affected by smell and taste disorders, said that “smell disorders can have a huge impact on people’s quality of life in many ways.”

“An important part of Fifth Sense’s work is giving our beneficiaries a voice and the opportunity to change the way society understands smell and taste disorders, whether through volunteering or participating in research studies like this one.”

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Inflammation could be a core feature of depression

inflammation

People with depression have higher levels of inflammation in their bodies than those without depression, regardless of socioeconomic background, ill health or unhealthy behaviors, a study by King’s College London finds.

C-reactive protein (CRP), a marker for inflammation in the body, was found in higher levels in depressed people compared to non-depressed people in the largest ever study into the genetic, environmental, lifestyle, medical pathways leading to inflammation in major depressive disorder (MDD).

The effect was reduced but remained significant when factors known to be related to increased inflammation such as smoking, body mass index (BMI) and trauma were taken into account, adding to the body of evidence that there may be a direct biological link between inflammation and depressive disorders. The study was conducted by researchers funded by the NIHR Maudsley Biomedical Research Center and NARSAD (National Alliance for Research on Schizophrenia & Depression) and it was published in the American Journal of Psychiatry.

Largest study of its kind

In any given week in England 3 in 100 people will have depression. The economic costs of mental illness in England have been estimated at £105.2 billion each year by the government which includes direct costs of services, lost productivity at work and reduced quality of life.

This study used the largest ever community-based sample with information on mental health, inflammation, genome-wide association study (GWAS) data linking genes to certain diseases, environment, lifestyle and physical health with approximately 86 thousand participants.

Researchers analyzed blood samples, genetic data and physical and mental health questionnaires collected by UK Biobank, the large-scale biomedical database and research resource with over half a million UK participants who were recruited between in 2006-2010. Of the 86,000 participants included in the study just under a third (31%) were classified as having major depressive disorder. This percentage is similar to estimates found by other studies on the global prevalence of depression occurring during a person’s lifetime.

The study showed that depressed participants had raised C-reactive protein (CRP) levels in their blood compared to non-depressed participants, and were more likely to have low-grade inflammation, defined as CRP levels in the blood of over 3 mg per liter. Inflammation is a biological response which is predominantly directed to fight infection but also has an important role in regulating behavior. CRP is one marker for inflammation.

Further analysis showed that this increased inflammation in depression is only partially explained by clinical and sociodemographic factors including age, sex, body mass index (BMI) smoking, alcohol consumption, exposure to early life trauma, socio-economic status and self-reported health status.

Genetics x environment

The study found that the greater the genetic risk for depression, the greater the level of inflammation.

The polygenic risk score gives an estimate of how likely an individual is to have a given trait based only on genetics. The researchers calculated polygenic risk score in participants for major depression was strongly associated with levels of CRP. However, this association was no longer present when BMI and smoking were taken into account. In contrast, polygenic risk scores for three immune disorders—biliary cirrhosis, Crohn’s disease and rheumatoid arthritis- are all positively associated with CRP levels even after controlling for BMI and smoking.

First author Maria Pitharouli, Research Associate at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London said: “Our study provides the most conclusive evidence to date that people with depression have proteins in their blood indicating activation of the inflammatory system. Furthermore, through in-depth analysis of data from over 86,000 people we have discovered more about the mechanisms that may be behind the relationship between inflammation and depression.”

Joint senior author, Professor Cathryn Lewis who leads the Social, Genetic and Developmental Psychiatry Center at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London said: “Our study highlights how genetics can be used as a tool for dissecting mental health disorders. Here we’ve shown that the genetic contribution to inflammation in depression comes mostly from eating and smoking habits. That finding is important to help us understand depression better—and one further piece in the jigsaw puzzle towards improving care for people with depression.”

Joint senior author, Professor Carmine Pariante from the National Institute for Health Research Maudsley Biomedical Research Center says: “Our large-scale analysis of data removed socioeconomic background, ill health, unhealthy habits as well as genetic predisposition to immune dysfunction as the only explanations for the relationship between depression and inflammation. By this process of elimination, we show that there may be a core biological process that is behind the association between depression and increased inflammation. If we can identify this process and uncover more detail about its role in the development of depression, we can pave the way for trialing new treatments for this widespread mental health disorder.”

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Planned cesarean births safe for low-risk pregnancies

pregnancy

New research shows that planned cesarean deliveries on maternal request are safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes than planned vaginal deliveries. The study is published in CMAJ (Canadian Medical Association Journal).

The study used province-wide data from the Better Outcomes Registry & Network (BORN), Ontario’s provincial birth registry. The authors analyzed data on 422,210 low-risk pregnancies over 6 years (2012 to 2018). There were 46,533 cesarean deliveries, of which 1827 (3.9%) were planned at the request of the mother; this proportion was unchanged during the years of study. Mothers who requested cesarean delivery were more likely to be White, to be aged 35 years or older, to have conceived by in vitro fertilization, to be delivering their first baby, and to live in a higher-income neighbourhood, among other characteristics.

“Our finding that CDMR [cesarean delivery on maternal request] rates have remained stable in Ontario provides reassurance to those concerned about the potential contribution of CDMR to rising cesarean delivery rates,” writes Dr. Darine El-Chaâr, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, with coauthors.

Importantly, the findings also showed that cesarean deliveries that were performed following maternal request and vaginal deliveries were both safe delivery options for mother and baby, with planned cesarean deliveries on maternal request being associated with a lower risk of adverse delivery outcomes for both the mother and the baby than planned vaginal births.

The authors caution that research is needed to understand potential longer-term effects of planned cesarean deliveries.

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