US researchers have used mathematical models to show how worries over vaccine risks affect vaccine uptake within the community. The study shows how to predict ways in which population vaccinating behaviour might unfold during a vaccine scare, testing the model against real data from two infamous vaccine scares in England and Wales: the 1970s pertussis outbreak and the measles-mumps-rubella vaccine scare in the 1990s. 

Feel free to use these quotes in your stories.  If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Julie Leask is a senior research fellow and manager of social research at the National Centre for Immunisation Research & Surveillance at the Children’s Hospital Westmead. She is also a senior lecturer at the Sydney Medical School at the University of Sydney

“The study confirms that parents’ immunisation decisions are influenced by what is going on around them. The authors point out a well described evolution in vaccination programs – where good disease control lessens the visibility of diseases motivating people to be vaccinated. When they are scared off that vaccine, as with the MMR-autism controversy, large groups may start to stop or delay vaccination. However, as the study shows, it took some years for immunisation rates to bottom out after the scares. Also, there have been vaccine scares that did not result in lowered vaccination coverage. What this says to me is that it is actually quite hard to put people off vaccination. Why? It’s still valued, we still have some exposure to the effects of the diseases (eg, whooping cough), and vaccination is strongly reinforced within our healthcare system.

The MMR and pertussis vaccine scares in the UK were the result of charismatic doctors laying their theories Galileo like at the door of the scientific church, positioning themselves as brave whistle-blowers willing to break ranks. That’s a very appealing approach. The great tragedy with the MMR controversy is that the science was saying all along that the vaccine is safe and worthwhile but it was often dismissed or ignored in place of heart-wrenching stories from parents whose lives were overturned by autism. Once the measles epidemics returned, people regained an appreciation of vaccination because we then had stories of the impact of measles to counterbalance things. It’s unfortunate that it took epidemics for the scares to go away. Generally, I think we need to have constant reminders of why we vaccinate. If that’s not possible because the diseases are not around as much, then we need to have grandparents, doctors and nurses telling us their stories – of their impact. The research is showing us increasingly that the cold hard facts about the success of immunisation needs to be augmented with stories about the impacts of the diseases.”

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*Bauch CT, Bhattacharyya S (2012) Evolutionary Game Theory and Social Learning Can Determine How Vaccine Scares Unfold. PLoS Comput Biol 8(4): e1002452. doi:10.1371/journal.pcbi.1002452. PLEASE ADD THIS LINK TO THE FREELY AVAILABLE ARTICLE IN ONLINE VERSIONS OF YOUR REPORT (the link will go live when the embargo ends): http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1002452

U.S. scientists have been investigating whether prenatal exposure to mobile phone radiation has any impact on mice, though the authors caution that their findings may be difficult to translate to human risks.

Female mice were exposed to an active mobile phone call throughout their pregnancy. The authors found that fetal exposure to mobile phone radiation may affect neurological development and function of adult mice, reporting that the exposed mice tended to be more hyperactive and had decreased anxiety and reduced memory capacity.

Feel free to use these quotes in your stories. If you would like a copy of the research or to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Prof Rodney Croft is Professor of Health Psychology, School of Psychology, University of Wollongong and former Executive Director of the Australian Centre for Radio Frequency Bioeffects Research

“There are two major limitations with the paper that preclude any comment about the effects of mobile phone emissions on ADHD. The first is that the measurement of absorbed doses (dosimetry) was not adequate as we don’t even know if one group of mice was exposed more than the other. The second is that we can’t extrapolate from the mouse results to ADHD in humans (indeed the changes observed in the mice were not even consistent with ADHD).

None-the-less, should associations be found between mobile phone emissions and behaviour in mice, this would be very important scientifically, particularly as none have been identified to date. It will thus be important to replicate the study with improved methodology to determine whether mobile phone emissions can affect long-term memory, hyperactivity or anxiety; a pattern that although not relating to ADHD, would be important for human wellbeing more generally.”

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UK expert comments – collected by our friends at the UK Science Media Centre:

Dr Mischa de Rover, Cognitive Psychologist, Leiden University, The Netherlands, said:

“I performed scientific studies in mice, rats and humans and I found extrapolation of animal data to humans the most difficult part in that area of science. Good animal data is of crucial importance as a starting point for human studies but should never be used as a basis for risk assessment in humans.”

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Eric Taylor, Emeritus Professor of Child & Adolescent Psychiatry, Institute of Psychiatry, King’s College London, said:

“This paper does not show any link between radiofrequency exposure and ADHD.  The rate of ADHD problems has been steady for more than 20 years (any increase is due to greater recognition), so mobile phones are an unlikely cause.

“Taking animal studies and extrapolating directly to humans requires much more care.  The exposure of the animals was very great, and the researchers’ tests of animal memory should not be directly equated to human attention; different species can react differently.”

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Professor Malcolm Sperrin, Director of Medical Physics and Clinical Engineering, Royal Berkshire Hospital, said:

“This paper presents work from a highly respected organisation and does bring additional insight into how electromagnetic radiation may affect tissue and its development during gestation.  The study is designed appropriately and the conclusions are reasonable.  However, the authors repeatedly state that any correlation between the effects on mice during the study and predicted effects on humans are too tenuous to be reasonably claimed.

“This study does not suggest that mobile phones could be the cause of ADHD in humans for several reasons: Firstly, the developmental model for mice bears no practical resemblance to humans (19 days gestation versus nine months). Secondly, the mice experienced long periods of exposure – in some cases continuously. Thirdly, the distance between the source of radiation and the target tissue is not representative of human usage (a few cm as opposed to a metre or so). And finally, Power density and exposure conditions will be different between the mice and humans.

“It is reasonable to conclude that this study is a worthy step aimed at understanding non-ionising radiation effects, but great caution must be given not to stretch the data too far until more work is done to move toward human equivalent studies.

“It should also be recognised that ADHD is a syndrome which is still being researched and the increase in incidence may arise because of a greater understanding and willingness to describe the occurrence of ADHD.  The paper does recognise this and the presence of other contributory factors as possible confounding influences.

“It would be very interesting to identify control groups including those where mobile phone exposure is very limited and to correlate against ADHD in such communities.”

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Katya Rubia, Professor of Cognitive Neuroscience, Institute of Psychiatry, King’s College London, said:

“The extrapolation of the behavioural and brain effects of prenatal mobile phone exposure in mice to human ADHD and its increase in our society is alarmist and unjustified. Some enhancement in motor activity in mice is not translatable to the complex human ADHD behaviour characterised by impulsiveness, inattention and motor activity. ADHD is not associated with memory problems, or with decreased anxiety, and the key brain deficits are in the basal ganglia rather than the frontal lobe. While research in humans is warranted there is no convincing evidence in the data to back up such extrapolations to human ADHD.”

“This research does not show that mobile phone radiation exposure in utero is linked to ADHD in humans because:

• The study is in mice and radiation levels are far higher for a mouse foetus than a human foetus.

• The behavioural outcome features are not comparable to those measured in humans. For example, the mice showed higher motor activity levels and not “hyperactivity”, and the enhanced motoricity does not translate into human ADHD, which is defined as a complex behaviour including hyperactivity, impulsiveness and inattention.

• Long-term memory that is tested in this study is not associated with ADHD, working memory is but this was not tested in the mice. The introduction mentions working memory impairment in ADHD but then the study measures long-term memory which has nothing to do with working memory. These are two separate functions with dissociated neurobiological substrates. Long-term memory is mediated by the hippocampus and not the frontal lobes, which mediate working memory.

• Anxiety was reduced in exposed mice, but this is typically higher in ADHD and a key comorbidity.

• The frontal lobe glutamate system is associated with most psychiatric disorders and there is therefore no specific association between frontal lobe impairment and ADHD. In fact the basal ganglia are the most consistently associated brain areas with ADHD and not the frontal lobes.

“Overall the association between the behavioural and brain complications in rodents due to prenatal mobile phone exposure and human ADHD is clearly over-egged and not justified by the data.”

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Jim Stevenson, Emeritus Professor of Developmental Psychopathology, University of Southampton, said:

“The study by Aldad et al. concerns the effects on behaviour in mice of exposure to cellular telephone radiation in utero.  In introducing their research and in the discussion of their findings the authors propose that the study contributes to our understanding of the origins of hyperactivity and attention-deficit hyperactivity disorder.  The paper itself presents no findings on behaviour in children.  The authors imply that since a previous study found an association then their work can be seen as suggesting a possible mechanism for the association.

“The paper makes just one reference to a study on humans linking prenatal exposure to cellular radiation to children’s behaviour. The authors of the study referred to conclude:   “These associations may be noncausal and may be due to unmeasured confounding.” (Divan et al., 2008).

“In a subsequent paper from this same research group it was concluded that there was “No evidence of an association between prenatal cell phone use and motor or cognitive/language developmental delays among infants at 6 and 18 months of age was observed. Even when considering dose response associations for cell phone use, associations were null.” (Divan et al, 2011).

“The only other study I have been able to locate on this topic in children concluded: “This study gives little evidence for an adverse effect of maternal cell phone use during pregnancy on the early neurodevelopment of offspring.” (Vrijheid et al., 2010).

“So, rather than established link in humans between prenatal exposure and neurodevelopmental disabilities there is to date only little evidence of an association.  This makes it irresponsible for the Aldad et al. to speculate about the adverse risks of prenatal exposure from their evidence based on mice.  It is known that elevated levels of hyperactivity can arise from genetic and a wide range of environmental factors (for example diet, institutional care and premature birth).  It may be that prenatal exposure to cellular phone radiation is another noxious experience contributing to hyperactivity (we just do not know but at present the evidence suggest it is not) but this conjecture cannot be supported by the evidence from mice reported in this paper.”

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Philip Asherson, Professor of Molecular Psychiatry and Honorary Consultant Psychiatrist, Institute of Psychiatry, King’s College London, said:

“There are many causes of hyperactivity in mice and most have nothing to do with ADHD. In the paper the mice are more active and less anxious, potentially meaning that they are less anxious (because anxious mice are less active than non-anxious mice).  I think it is sufficient to say that the intervention may cause changes in some aspects of behaviour and cognition – and could therefore potentially be linked to development of mental health or cognitive problems later in development. There is nothing here to make any specific link to ADHD or what (in the past) some people referred to as childhood hyperactivity.”

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* ‘Fetal Radiofrequency Radiation Exposure From 800-1900 Mhz-Rated Cellular Telephones Affects Neurodevelopment and Behavior in Mice‘ by Aldad, T. et al. published in Scientific Reports, Friday 16th March.

[*Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial, Nijhof et al, The Lancet, Published online March 1, 2012]
Feel free to use these quotes in your stories.   If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Dr Rosanne Coutts is an Accredited Exercise Physiologist and  Lecturer in Sport and Exercise Psychology at Southern Cross University

“These results are very encouraging and again demonstrate the importance of the psychological aspects within treatment processes. By using the internet, which adolescents are very familiar with, they have met them ‘where they live’. The patients also seemed fairly involved in what they did, it was quite self-driven, putting patients back in charge of their own recovery. Further detail about the actual physical activity conducted in both groups would be of interest and would assist with understanding any physiological changes that had also occurred. The study also relied on, self-report, however even with consideration for some self-reporting bias the school attendance is a clear indicator of levels of recovery.  Previous studies report a good prognosis for adolescents and this study again supports this.”

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Research published in the BMJ suggests that women who do not go to sleep on their left side on their last night of pregnancy have an increased risk of late stillbirth compared with women who do sleep on their left side. The New Zealand research also suggests that women who get up to go to the toilet once or less on the last night, and those who regularly sleep during the day in the last month of pregnancy, are more likely to have a stillborn baby. Experts independent of the study say the suggestions need further research.

* Association between maternal sleep practices and risk of late stillbirth: a case-control study, Stacey et al., BMJ, 342:d3403, 2011. doi: 10.1136/bmj.d3403

Please let us know if you would like a copy of the paper, press release and accompanying editorial piece from BMJ.

Feel free to use these quotes in your stories.  Any further comments will be posted here. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 7120 8666 or by email.

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Associate Professor Vicki Flenady is from the Australian and New Zealand Stillbirth Alliance. She comments on behalf of ANZSA, which has experts available for interviews

“Prevention strategies to reduce the risk of stillbirth in late pregnancy remain limited.  Many of these deaths are unexplained, despite a thorough examination, leaving parents and care providers struggling with the reasons why. The static stillbirth rate for over 20 years, when all other mortality statistics have shown an improvement, suggests we need new leads.

This interesting study by Stacey et al shows the requirement for large studies to identify new potential factors. This study is important because it generates new ideas for closer investigation in future studies. These future studies need to carefully take into account confounding factors which are linked to maternal sleep position, but where sleep position may not be the true reason for the death. Studies need to also address whether there is a biologically plausible mechanism that will allow us to understand how sleep position could result in stillbirth.

The authors of the paper and the editorialist all agree that this is a preliminary result that needs to be confirmed. Based on the information that is available, expectant mothers should not change their behaviour. This is part of the continuing research effort to reduce the risk of stillbirth. Often research goes down blind alleys. We won’t know if this is a blind alley until further work is done.

There are a number of known important risk factors for stillbirth for which we must offer advice and support including obesity, smoking and maternal age over 35 which contributes to around one-third of stillbirths. Smoking cessation programs in pregnancy are effective, however, many women are not provided with the support they need to stop smoking – this must be addressed as a priority. While we work to create awareness of these known risk factors, it is hoped that the planned study by ANZSA will help to resolve some of the unanswered questions on maternal sleep position and stillbirth.”

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The following comments were compiled by our colleagues at the UK Science Media Centre in London:

Science Media Centre Round-up

Expert reaction to BMJ paper on stillbirth risk and sleeping position*

Jim Neilson, Professor of Obstetrics & Gynaecology, University of Liverpool and Liverpool Women’s Hospital said:

“The risk of having a stillborn baby in this study is broadly similar to the risk in the UK, as the New Zealand researchers did not include stillborn babies before 28 weeks, stillborn twins, or babies with malformations.

“There are important public health messages here – that women who are overweight or who smoke are more likely to have a stillborn baby.

“The link with sleeping patterns by the mother is much less clear. More research is needed. Until then, women need not change the position for sleeping in which they feel most comfortable.”

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Ms Daghni Rajasingam, spokesperson for the Royal College of Obstetricians and Gynaecologists, said:

“There are many factors which are linked to stillbirth including obesity, increasing maternal age, ethnicity, congenital anomalies and placental conditions.  A significant number are unexplained.

“This small scale study looks at another possible factor, however, more research is needed into sleep patterns before any firm conclusions over sleeping positions can be made.  In the meantime, women should speak to their midwives if they are concerned.

“All new research into the causes of stillbirth is encouraging and is a step forward in understanding why they happen and improving stillbirth rates in the future.”

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Dr Alexander Heazell, Walport Clinical Lecturer at the University of Manchester School of Medicine, said:

“Stillbirth affects in 1 in 200 births in the UK: over 4,000 per year. This study suggests that mothers sleeping on their left are less likely to have a stillbirth than those sleeping on their backs or on their right-hand side. However, even the risk of stillbirth reported in the study for mothers sleeping on their back or right-hand side (3.93 in 1,000) is lower than the current UK rate. It is too early to say whether we should encourage mothers to sleep on their left and more in depth studies are needed to confirm this study’s findings and to understand why sleeping on the left might reduce stillbirths.

“There are several weaknesses in the study, including the fact that mothers were asked to recall their sleeping position 25 days after experiencing a stillbirth. I agree with Professor Smith and Dr Chappell’s editorial, which describes these results as an interesting hypothesis that needs validation.”

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*’Association between maternal sleep practices and risk of late stillbirth: a case-control study’, by Tomasina Stacey et al. will be published in the BMJ at 11.30pm on Tuesday 14^th June 2011, which is also when the embargo will lift.

Each year there are an estimated 3.2 million stillbirths across the world and they are still a daily occurrence even in countries such as Australia and New Zealand, where many cases are still unexplained. Even though infant mortality rates have been dropping, there has been no reduction in the rate of stillbirths. The Lancet journal has been working with the International Stillbirth Alliance to pull together the latest research and show new data in a special series on stillbirths which is being launched simultaneously in Australia (at the Perinatal Society of Australia and New Zealand annual congress in Hobart), London and the US. The series includes six papers, eight commentaries and two supplemental research papers involving 69 authors across 18 countries. (Please let us know if you would like to see the embargoed papers.)

At the online press briefing in Hobart we will have four expert panellists who are part of the Australian and New Zealand Stillbirth Alliance, an alliance of organisations and individuals who collaborate to enhance the conduct of high quality research, promote evidence based maternity care.

Listen in to the briefing to hear about the new findings and ask questions such as:

• What are the main causes of stillbirths and what does this latest research tell us?
• Why is the rate of stillbirths not dropping despite reductions in infant mortality?
• Can anything be done to stop a stillbirth from happening and can we ever expect to stop all stillbirths completely?
• How do Australia and New Zealand compare to the rest of the world?

Watch the full presentation here (Webex) – note: the last 10 minutes of audio is missing from this playback

SPEAKERS:

Speaker bio notes here (pdf)

• A/Prof Vicki Flenady, Perinatal Researcher at the Mater Medical Research Institute, South Brisbane, Queensland and Chair of the International Stillbirth Alliance | Listen (mp3)
• Prof David Ellwood, Professor of Obstetrics and Gynaecology at Canberra Hospital and Deputy Dean of Australian National University Medical School and International Stillbirth Alliance Board Member | Listen (mp3)
• Philippa Middleton, Research leader at the Australian Research Centre for the Health of Women and Babies (ARCH), Adelaide | Listen (mp3)
• Ros Richardson, Health Promotion Manager for SIDS and Kids NSW and Parent Advisory Committee Member for the International Stillbirth Alliance | Listen (mp3)
• Listen to the Q and A session here (mp3)

BRIEFING DETAILS:

DATE: Today, Wednesday 13 April 2011

START TIME: 10.30am AEST

DURATION: Approx 60 min

VENUE: Online