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Diabetes’ effect on mental health explored

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NEW research from Diabetes UK has found that seven out of ten people feel overwhelmed by the demands of living with diabetes, significantly affecting their mental and physical health.

The survey of more than 2,000 adults with Type 1, Type 2 and other types of diabetes from across the UK shows that the majority (three quarters) of those who feel overwhelmed say that this affects how well they can manage the condition.

In order to explore the links between mental health and diabetes, the charity collected extensive insights from people affected by the condition and healthcare professionals from across the UK.

The findings, published in the report “Too often missing: Making emotional and psychological support routine in diabetes care”, show that diabetes is much more than a physical condition.

Management of physical symptoms 24/7 – for example checking blood glucose levels, or managing diet – alongside the continual need to make decisions and take actions in order to reduce the likelihood of short and long-term complications, can affect every aspect of day-to-day life.

The research revealed that the relentless nature of diabetes can impact people’s emotional, mental and psychological wellbeing and health, from day-to-day frustration and low mood, to specific psychological and mental health difficulties such as clinical depression and anxiety.

Three-quarters of those needing specialist mental health support to help manage the condition, such as from a counsellor or psychologist, could not access it. Seven out of ten people with diabetes also reported that they are not helped to talk about their emotional wellbeing by their diabetes teams.

Healthcare professionals surveyed also revealed that there was more to be done in this area. Specifically, 40 per cent of GPs say they are not likely to ask about emotional wellbeing and mental health in routine diabetes appointments, while only 30 per cent feel there is enough emotional and psychological support for people living with diabetes when needed.

The report marks the launch of a Diabetes UK campaign to make the emotional and psychological demands of living with diabetes recognised and provide the right support to everyone who needs it.

Diabetes UK Cymru is marking the launch with an event on Wednesday 22 May at the Norwegian Church in Cardiff Bay from 12 pm to 2 pm.

The charity is urgently calling on each of the four nations’ health services to create national standards for diabetes emotional and mental healthservices. These should ensure that everyone is asked how they are feeling as part of every diabetes appointment and that a mental healthprofessional with knowledge of diabetes is part of every diabetes care team.

Dai Williams, National Director, Diabetes UK Cymru, said: “The day-to-day demands of managing diabetes can be a constant struggle, affecting people’s emotional wellbeing and mental health. In turn, people tell us that struggling emotionally can make it even more difficult to keep on top of self-management. And when diabetes cannot be well managed, the risk of dangerous complications, such as amputations, kidney failure and stroke increases.

“Diabetes services that include emotional and psychological support can help people improve both their physical and mental health, reduce pressure on services, and save money.

“Mental health and physical health go hand in hand, but services for people with diabetes don’t always reflect this. We need to bridge the divide between physical and mental health services to ensure those with emotional and psychological difficulties related to their condition do not have their needs overlooked. It is critical that all diabetes care sees and supports the whole person, and explores what matters most to them.”

Diabetes UK is launching a petition to call for national standards for diabetes mental health support and services.

To find out more about the campaign and sign the petition go to www.diabetes.org.uk/missing

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The challenge of loneliness

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Living with loneliness: An issue for public health and society

INTERNATIONAL experts, including researchers from Swansea University, have published a letter in The Lancet medical journal calling for a unified approach to addressing the global challenge of loneliness.
In response to the growing concerns about the rates and consequences of loneliness, international experts based in universities, research and public health organisations have been working together to help address this issue.
The signatories include experts from the Institute of Public Health in Ireland; Columbia University; George Mason University; University of Auckland; Swansea University; Ulster University; St James’s Hospital; University of Chicago; Trinity College Dublin; Boston College; University of California; Vrije Universiteit Amsterdam; and Brunel University London.
The letter is based on discussions of international researchers at a meeting hosted in Belfast by the Institute of Public Health in Ireland. This has led to the establishment of an International Loneliness and Social Isolation Research Network.
While demographic shifts suggest that the number of people experiencing loneliness will increase, experts say that it is important to recognise that most older adults are not chronically lonely and that young adults are also affected.
Experts say that loneliness can be defined as a “subjective negative experience that results from inadequate meaningful connections”, and have called for a standardised approach to defining and measuring loneliness to help inform those developing policy and services in this area.
The expert group added that charities, community sectors, and governments, who are delivering programmes often have inadequate evidence to plan from and need a more coherent message from research, and a stronger evidence base.
And while more research is needed to find out the full consequences of loneliness, the evidence shows association with poor health and wellbeing, non-communicable diseases, and depression.
Professor Vanessa Burholt from the Centre for Innovative Ageing, in the College of Human and Health Sciences at Swansea University, said that in a time when as a society we have never had more opportunities to connect with people, there is a growing focus on loneliness and its association with poor health outcomes.
She said: “Our understanding of loneliness is still limited and is often stereotypical. While it is often confused with a lack of social engagement, the reality is that some people with lots of friends can still feel lonely and those who live alone may not.
Although loneliness is a very personal experience, addressing loneliness is not simply a matter for individuals but is also an issue for public health and society as a whole. By building evidence and pooling expertise, we can support governments and policymakers to make better-informed decisions to address this challenge.”

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Protect your children from flu

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Protect your children from flu

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CAT1i-17.jpg – Flu vaccination: ‘Really important’ protection for children

Story:
PARENTS in Pembrokeshire are being urged to protect their children against flu
Flu is circulating and parents of 2 and 3-year-olds in Pembrokeshire are being asked to ensure their children receive the nasal spray flu vaccine as soon as possible.
Flu can be serious for children and every year children in Wales need treatment in Intensive Care Units because of flu. If you are in a risk group and think you have flu, it is important to speak to your GP surgery or community pharmacy as soon as possible.
Ros Jervis, Director of Public Health at Hywel Dda UHB, said: “We are starting to see more cases of flu so it is really important that as many of our youngest population are protected by the nasal spray vaccine.
“Having a flu vaccine will help protect your child from flu and protection starts around two weeks after having the vaccine.
“It also helps reduce the chance of children spreading flu to others who are at high risk from flu, such as young babies, grandparents, and those with long-term health conditions.”
If your child was aged 2 or 3 years old on 31 August 2019 contact your GP as soon as possible to book an appointment.
If you think you may have flu you can check your symptoms using the NHS Direct Wales symptom checker.

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Research breakthrough in schizophrenia

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WHAT comes to mind when you hear ‘schizophrenia’? Hallucinations and delusions? Cognitive impairment? Feeling withdrawn from everyone around you? Apathy? With all the above being symptoms of this mental disorder, and with 1 in every 100 people affected, each individual’s life becomes a relentless battle, struggling with habitual activities, social interaction, and general wellbeing and self-care.
Current treatments help to reduce the severity of symptoms and allow patients to maintain a more functional daily life. However, antipsychotic medications, which are typically required lifelong, are not guaranteed to work for all schizophrenia patients, with only about 4 in 5 people benefitting usually.
Advances in scanning have allowed researchers for the first time to show lower levels of a protein found in the connections between neurons in the living brains of people with schizophrenia.
The researchers, who conducted the scans at the psychiatric imaging facility at the MRC London Institute of Medical Sciences, say these changes could underlie the cognitive difficulties seen in schizophrenia and provide targets for research into new treatments.
Synapses are the junctions between neurons. Neurons communicate across the synapse via neurotransmitters; chemicals that transmit the nerve signal.
Researchers investigated the relationship between synaptic density and schizophrenia, questioning whether a reduction in these brain connections is present in schizophrenia and whether they result from treatment with antipsychotic drugs.
The study was inspired by findings from previous post-mortem studies that demonstrated synaptic reductions in the brains of schizophrenia patients compared to healthy controls.
Measuring synaptic protein levels in living patients was not possible before the development of a new PET (Positron Emission Tomography) radioactive tracer that binds to a specific protein associated with synapses. Being “one of the first centres in the world” to have access to this, Professor Oliver Howes, Head of the Psychiatric Imaging Group at the MRC LMS, and his team grasped this opportunity to investigate synaptic loss in schizophrenic brains through the synaptic marker protein SV2A, which is found on the nerve terminal preceding the synapse and is involved in regulating neurotransmitter release.
The team found lower levels of SV2A in the brains of schizophrenia patients, indicating a reduction of synapses. Certain areas exhibited significantly lower levels, such as the frontal cortex which coordinates use, recall and processing of memory, planning complex cognitive behaviour and personality expression. These findings were supported by the understanding that these areas are associated with some of the major cognitive impairments seen in schizophrenia, thus providing a potential clue that synaptic loss may underlie these problems.
But to test whether the loss was a result of the illness or in fact due to treatment, a preclinical study was conducted in rat models investigating the effect of antipsychotic drugs on the levels of SV2A. They found that the antipsychotics did not contribute to the synaptic loss seen in schizophrenic patients, thereby reinforcing their overall findings.
So, what does this mean for the development of schizophrenia treatment?
If the synaptic loss is an underlying key contributor in the disease, further research into the mechanisms could lead to exploring ways to prevent this loss. Moreover, since microglia, known as the immune cells of the brain, play a role in mediating synaptic pruning, there is also potential to target microglia and see if it could introduce a way of preventing excess synaptic loss; an investigation that the team have already begun.
“The human brain, with its approximately 100 trillion synapses, is an extraordinarily complex organ,” says Dr Ellis Chika Onwordi of the Psychiatric Imaging Group and first author of this study. “Having the means to characterise the distribution of these synapses in the living brain, and to find differences in synaptic distribution between patients with schizophrenia and healthy controls, represents a significant advance in our ability to study the neurobiology of schizophrenia.”
Professor Oliver Howes, who led the study, said: “Our current treatments for schizophrenia only target one aspect of the disease – the psychotic symptoms – but the debilitating cognitive symptoms, such as loss of abilities to plan and remember, often cause much more long-term disability and there’s no treatment for them at the moment. Synaptic loss is thought to underlie these symptoms.
“Our lab at the MRC London Institute of Medical Sciences is one of the few places in the world with this new tracer, which means we’ve been able for the first time to show there are lower levels of a synaptic protein in people with schizophrenia. This suggests that loss of synapses could underlie the development of schizophrenia.
“We need to develop new treatments for schizophrenia. This protein SV2A could be a target for new treatments to restore synaptic function.”
The people with schizophrenia who were scanned had all received antipsychotic medication, so the researchers wanted to exclude this as a factor in the synaptic dysfunction. They gave antipsychotic drugs, haloperidol and olanzapine, to rats for 28 days and found it did not affect the levels of the protein SV2A.
Professor Howes said: “This is reassuring as it’s suggesting that our antipsychotic treatments aren’t leading to loss of brain connections.
“Next we hope to scan younger people in the very early stages to see how synaptic levels change during the development of the illness and whether these changes are established early on or develop over time.”

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