BBC News

BBC News


Using 'fat' may encourage people to take more personal responsibility, says Anne Milton GPs and other health professionals should tell people they are fat rather than obese, England's public health minister says.

Anne Milton told the BBC the term fat was more likely to motivate them into losing weight.

She said it was important people should take "personal responsibility" for their lifestyles.

But health experts said the word could stigmatise those who are overweight.

Ms Milton, who stressed she was speaking in a personal capacity, said: "If I look in the mirror and think I am obese I think I am less worried [than] if I think I am fat."

She said too many staff working in the NHS were worried about using the term, but suggested it could help encourage "personal responsibility".

Continue reading the main story
“
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People don't want to be offensive. There is a lot of stigma to being a fat person”
End Quote
Professor Lindsey Davies

UK Faculty of Public Health
"At the end of the day, you cannot do it for them. People have to have the information," she added.

The minister spoke to the BBC after setting out the coalition government's vision for public health.

A white paper is expected to be published in the autumn, which she said would stress the combined role of the individual, state, business and society.

The comments come after Health Secretary Andrew Lansley last month attacked the "lecturing" of recent public health campaigns, such as the drive on school meals that followed Jamie Oliver's TV shows.

'More brutal'

Professor Steve Field, of the Royal College of GPs, said he agreed with Ms Milton and already tried to use the term fat as much as he could.

"I think the term obese medicalises the state. It makes it a third person issue. I think we need to sometimes be more brutal and honest.

"You can be popular by saying the things people want to hear and in the NHS we too often do that when we should be spelling things out clearly."

The history of the term obesity
Continue reading the main story The term obesity comes from the Latin word obesus, which roughly translated means intensive eating
Societies have long been worried about problems of excess weight with Greek philosopher Hippocrates even writing about the dangers
But it was not until the mid 1600s that obesity started being used as a medical term and then in time directly linked to other diseases
Between 1830 and 1850 a Belgian scientist invented the BMI index to measure obesity by dividing weight by height
The Journal of Chronic Diseases reported in 1972 that BMI was the best way of measuring excess fat
Over the last three decades the terms BMI and obesity have been getting more and more popular with health professionals as a result
But Professor Lindsey Davies, president of the UK Faculty of Public Health, which represents public health professionals, warned against using 'fat' when dealing with patients.

"People don't want to be offensive. There is a lot of stigma to being a fat person."

She said health professionals started using the term obesity to encourage patients to think about the condition in a different way.

"Obesity is something that happens to people rather than something they are. The language you use all depends on the relationship you have with a patient.

"I would probably be more likely to say something like 'can we talk about your weight' rather than obesity, but that is a judgement you make on a patient-by-patient basis."

Diabetes costs 'out of control

26 July 2010 Last updated at 03:06 Share this pageFacebookTwitter ShareEmail Print Diabetes costs 'out of control'By


Insulin is just one of many drugs available for diabetes control The NHS is spending too much on diabetes drugs say researchers, who found the medicines account for 7% of the UK prescribing budget.

A big rise in the number of people with type 2 diabetes in recent years does not fully explain the spiralling costs, say Cardiff University researchers.

With rates of the condition expected to rise further, the NHS needs to get the budget under control, they conclude.

But GPs said they had to look out for the best interests of their patients.

In 2008 the NHS spent £700m on drugs to control blood sugar, figures show.

Continue reading the main story
“
Start Quote
We need to do whatever it takes to get blood sugar down and some of the cheaper drugs don't do the job”
End Quote
Dr Niti Pall

GP, Diabetes UK
The researchers calculated that between 2000 and 2008 the number of prescriptions for glucose-lowering drugs had risen by 50%.

But costs, even taking into account the price of inflation, rose by 104%, they said.

Writing in the journal Diabetic Medicine, they said figures for England specifically show an increase from £290m to £591m over the study period.

Researchers pointed to marked increases in use of the most expensive therapies.

Newer drugs, like rosiglitazone, as well as increasing use of insulin - the hormone that controls blood sugar levels in the body - have contributed to the increased costs, they said.

Lifestyle

Dr Chris Currie said the findings suggested that national guidelines are not being followed.

The National Institute for Health and Clinical Excellence recommends lifestyle changes as a first-step in controlling type 2 diabetes, before drug treatment is started.

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GPs should then start people on the basic treatments before looking at other options if they do not work.

The researchers said in recent years the new expensive treatments had been aggressively marketed by drugs companies.

However, the figures also showed a dramatic rise in use of metformin - a cheap generic drug recommended as first line treatment - which the researchers said was reassuring.

It is thought that 2.6m people in the UK have diabetes - 90% of those type 2 diabetes - and a further one million have the condition but have not yet been diagnosed.

"The drugs bill is extremely high," said Dr Currie.

"Somebody has got to take a lead in managing the way we treat people with diabetes and making sure doctors adhere to the recommendations.

"This is going to continue to rise and part of the issue is people don't realise how big the problem is."

But Dr Niti Pall, a GP in Birmingham and spokesperson for Diabetes UK said she did not agree with the authors' conclusions.

She said the job of GPs was to get blood sugar levels as low as possible by whatever means possible to prevent complications in their patients.

"They have not looked at the health economics, we are saving the NHS money in the long run.

"We need to do whatever it takes to get blood sugar down and some of the cheaper drugs don't do the job."

'Toxic trio' triggers gut disease

'Toxic trio' triggers gut disease




Foods like cake are off-limit to coeliacs The precise cause of the immune reaction that leads to coeliac disease has been discovered.

Three key substances in the gluten found in wheat, rye and barley trigger the digestive condition, UK and Australian researchers say.

This gives a potential new target for developing treatments and even a vaccine, they believe.

Coeliac disease is caused by an intolerance to gluten found in foods like bread, pasta and biscuits.

It is thought to affect around 1 in every 100 people in the UK, particularly women.

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The link between gluten and coeliac disease was first established 60 years ago but scientists have struggled to pinpoint the precise component in gluten that triggers it.

The research, published in the journal, Science Translational Medicine, studied 200 patients with coeliac disease attending clinics in Oxford and Melbourne.

The volunteers were asked to eat bread, rye muffins or boiled barley. Six days later they had blood samples taken to measure their immune response to thousands of different gluten fragments, or peptides.

Continue reading the main story
“
Start Quote
It's an important piece of the jigsaw but a lot of further work remains so nobody should be expecting a practical solution in their surgery within the next 10 years."”
End Quote
Sarah Sleet

Coeliac UK
The tests identified 90 peptides that caused some level of immune reaction, but three were found to be particularly toxic.

Professor Bob Anderson, head of the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, said: "These three components account for the majority of the immune response to gluten that is observed in people with coeliac disease."

Coeliac disease can be managed with a gluten-free diet but this is often a challenge for patients. Nearly half still have damage to their intestines five years after starting a gluten-free diet.

Professor Anderson said one potential new therapy is already being developed, using immunotherapy to expose people with coeliac disease to tiny amounts of the three toxic peptides.

Early results of the trial are expected in the next few months.

COELIAC DISEASE
Continue reading the main story Coeliac disease is an autoimmune disease
Gluten found in wheat, barley and rye triggers an immune reaction in people with coeliac disease
This damages the lining of the small intestine
Other parts of the body may be affected
Source: Coeliac UK
Sarah Sleet, Chief Executive of the charity Coeliac UK, said the new finding could potentially help lead to a vaccine against coeliac disease but far more research was needed.

She said: "It's an important piece of the jigsaw but a lot of further work remains so nobody should be expecting a practical solution in their surgery within the next 10 years."

The symptoms of coeliac disease vary from person to person and can range from very mild to severe.

Possible symptoms include diarrhoea, nausea and vomiting, recurrent stomach pain, tiredness, headaches, weight loss and mouth ulcers.

Some symptoms may be mistaken as irritable bowel syndrome or wheat intolerance.

'Cut down on meat to lose weight'

People in Denmark, Germany, Spain, Sweden and the Netherlands ate the most meat Eating less meat may be the key to keeping a healthy weight, say researchers.
A European study of almost 400,000 adults found that eating meat was linked with weight gain, even in people taking in the same number of calories.

The strongest association was found with processed meat, such as sausages and ham, the Imperial College London team reported.


It suggests that high-protein diets may not help slimmers in the long run.


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Death link to too much red meat
The findings, published in the American Journal of Clinical Nutrition, also support public health messages advocating cutting down on the amount of meat we eat, the researchers said.
The study looked at data from adults taking part in a large project looking at the link between diet and cancer.
Participants from 10 European countries, including the UK, were weighed and measured at the start and then asked to report their weight five years later.
They also filled in a detailed food questionnaire.
Weight gain
Overall, the researchers found that meat consumption was associated with weight gain in both men and women.
More detailed analyses showed that the link was still significant after taking into account overall calorie intake, physical activity and other factors which may have skewed the results.
The team calculated that in people who ate the same number of calories, an extra 250g of meat a day - equal to a small steak - led to an additional weight gain of 2kg (5lbs) over five years.


Although it is not clear why meat would lead to weight gain in people eating the same number of calories, one theory is that energy-dense foods like meat alter how the body regulates appetite control.
But there could also be another lifestyle or dietary explanation for the link that was not accounted for by the study.
Study leader Dr Anne-Claire Vergnaud said: "I would recommend to people to control their consumption of meat to maintain a healthy weight and good health in general during life."
But she added: "Decreasing the amount of meat alone would not be an adequate weight loss strategy."
Sian Porter, a dietician and spokeswoman for the British Dietetic Association, said there were caveats in the study, including the fact that at the end-weight was self-reported.


But she said it was an interesting finding.
"We eat more meat than we need.
"What I say to my patients is to think about variety - so have an egg for breakfast instead of bacon, cheese for lunch instead of ham and fish for the evening meal.
She advised people to eat lots of lentils and pulse, wholegrains, fruit and veg and oily fish as well as meat.
"Portion size is the other thing - a portion of meat should be about the size of a deck of cards."

Archaeologists have discovered a second henge

The new "henge" is about 900m (2,950ft) from the giant stones
Archaeologists have discovered a second henge at Stonehenge, described as the most exciting find there in 50 years.

The circular ditch surrounding a smaller circle of deep pits about a metre (3ft) wide has been unearthed at the world-famous site in Wiltshire.

Archaeologists conducting a multi-million pound study believe timber posts were in the pits.

Project leader Professor Vince Gaffney, from the University of Birmingham, said the discovery was "exceptional".

The new "henge" - which means a circular monument dating to Neolithic and Bronze Ages - is situated about 900m (2,950ft) from the giant stones on Salisbury Plain.

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“
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It's a timber equivalent to Stonehenge”
End Quote
Professor Vince Gaffney

University of Birmingham
Images show it has two entrances on the north-east and south-west sides and inside the circle is a burial mound on top which appeared much later, Professor Gaffney said.

"You seem to have a large-ditched feature, but it seems to be made of individual scoops rather than just a straight trench," he said.

"When we looked a bit more closely, we then realised there was a ring of pits about a metre wide going all the way around the edge.

"When you see that as an archaeologist, you just looked at it and thought, 'that's a henge monument' - it's a timber equivalent to Stonehenge.

"From the general shape, we would guess it dates backs to about the time when Stonehenge was emerging at its most complex.

"This is probably the first major ceremonial monument that has been found in the past 50 years or so.

Continue reading the main story
Archaeologists say the find is "exceptional"

Discovering the henge
"This is really quite interesting and exceptional, it starts to give us a different perspective of the landscape."

Other wooden structures have been found in the area, one of these being Durrington Walls about 3km (1.86m) to the north east of the stones.

Data from the site is being collected as part of a virtual excavation to see what the area looked like when Stonehenge was built.

Speculation as to why the 4,500-year-old landmark was built will continue for years to come, but various experts believe it was a cemetery for 500 years, from the point of its inception.

In 2008, the first excavation in nearly half a century was carried out at the iconic site on Salisbury Plain.

This latest project is being funded by the Ludwig Boltzmann Institute for Archaeological Prospection and Virtual Archaeology, in Vienna, and the University of Birmingham, and is assisted by the National Trust and English Heritage.

Professor Gaffney said he was "certain" they would make further discoveries as 90% of the landscape around the giant stones was "terra incognita" - an unexplored region.

"The presumption was this was just an empty field - now you've got a major ceremonial monument looking at Stonehenge," he said.

standards in the NHS

The new framework will eventually cover most NHS work A consultation has begun on how standards in the NHS in England should be measured.

The government says it wants to move from national targets to a "set of national outcome goals".

So far it has taken a cautious response to dismantling the targets put in place by Labour.

Experts say gains made in cutting waiting times should not be lost in any changes.

In future, it has proposed the health service should be judged by measures which include how well it prevents people dying prematurely, how they recover and patients' experience of care.

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The first set of new standards is to be developed by April 2011. Under the planned shake up of the health service the new NHS commissioning board would use them to hold GP groups to account. Family doctors are due to take over NHS budgets for their local community by 2013.

The Health Secretary Andrew Lansley said: "I want to free doctors and nurses to focus on what really matters - better results for their patients - instead of them being stifled by top down targets."

So far the only target introduced by Labour to be removed outright is the obligation for GPs to offer an appointment within 48 hours to all patients.

Continue reading the main story
“
Start Quote
Much of what is proposed is already part of the performance management system for the NHS ”
End Quote
Kings Fund

Catherine Foot
Accident and Emergency departments have had the target to see patients within four hours relaxed slightly, but not removed. The promise of hospital treatment within 18 weeks of referral from a family doctor is no longer being monitored nationally but the health service has been told that long waits are not acceptable.

After angry exchanges in the Commons last week the government confirmed it would also be keeping the maximum two week wait for an appointment with a cancer specialist for urgent suspected cases.

The new outcome measures will include, wherever possible, information that can be compared internationally with standards in other major economies. This may help more accurate comparisons to be made. Andrew Lansley has said he wants to close the gap in cancer survival between the UK and other European countries.

Death rates from diseases which are treatable are one way of giving a rough idea of how well health systems are looking after their patients. Survival rates might also be important, as they take account of the number of patients suffering from any particular condition.

Performance management

The clinical watchdog for England, the National Institute for Health and Clinical Excellence (NICE), is being asked to develop 150 new outline standards for different areas of healthcare to support the new framework.

They are expected to be similar to the work it has already done in setting out what constitutes best care for groups of patients such as those suffering strokes, or dementia.

One common criticism of the targets developed by Labour was that they often had unintended consequences. Managers would focus all their efforts on improving areas where there were targets, sometimes at the cost of paying less attention to types of care which had few or no targets.

The Department of Health says the new outcomes framework should eventually cover most of the work of the health service.

Catherine Foot, senior policy fellow at the Kings Fund, said the ambition to develop such a comprehensive set of standards was welcome. But she added

"Much of what is proposed is already part of the performance management system for the NHS and it is positive to see this document building on what has been established before rather than reinventing things."

The independent health think tank says in order for the new outcomes to make a difference the NHS at a local level will probably still need to measure staffing levels and waiting times.

The beautifully-preserved remains

Cave yields marsupial fossil haul
Nimbadon may have travelled in herds, say the scientists
Fossil hunters in Australia have discovered a cave filled with the 15-million-year-old remains of prehistoric marsupials.

The rare haul of fossils includes 26 skulls from an extinct, sheep-sized marsupial with giant claws.

The finds come from the Riversleigh World Heritage fossil field in north-west Queensland.

Continue reading the main story
“
Start Quote
To find a complete specimen like that and so many from an age range is quite unique”
End Quote
Liz Reed

Flinders University
The beautifully-preserved remains have been described in the Journal of Vertebrate Paleontology.

"It's extraordinarily exciting for us," said University of New South Wales palaeontologist Mike Archer, co-author of the research.

"It's given us a window into the past of Australia that we simply didn't even have a pigeonhole into before.

"It's an extra insight into some of the strangest animals you could possibly imagine."

The giant-clawed, wombat-sized marsupial is named Nimbadon lavarackorum; researchers discovered the first of the Nimbadon skulls in 1993.

The palaeontologists have been stunned at how well preserved the fossils were - and by how many were found.

Discovering such a large assemblage suggests the animals may have travelled in herds - like modern-day kangaroos, said palaeontologist Karen Black, who led the research team.


The specimens offer an extra insight into the life of an extinct creature But how the animals all ended up in the cave remains a mystery. One theory is that they accidentally plunged into it through an opening obscured by vegetation and either died from the fall, or became trapped and later perished.

The Nimbadon skulls include those of babies still in their mothers' pouches, allowing the researchers to study how the animals developed.

The skulls reveal that bones at the front of the face developed quite quickly, which would have allowed the baby to suckle from its mother at an extremely young age.

Those findings suggest that Nimbadon newborns developed very similarly to modern kangaroos - likely being born after a month's gestation and crawling into their mother's pouch for the rest of their development, Black said.

Nimbadon also may have something in common with another marsupial. The fossils revealed the creatures had large claws, which may have been used to climb trees - as koalas do, Dr Black explained.

"To find a complete specimen like that and so many from an age range is quite unique," said Dr Liz Reed of Flinders University in South Australia, who was not affiliated with the study.

"It allows us to say something about behaviour and growth and a whole bunch of things that we wouldn't normally be able to do."

diagnosis of autism is based on a range of behavioural features, not just language development.

mengele-westof
Voice technology 'could help detect autism'

Children with autism have a very different vocal development pattern Young children with autism can be identified by listening to the noises they make, say US scientists.


Research suggests the babbling of infants with autism differs from that of children without it. The differences were spotted with 86% accuracy using automated vocal analysis technology.


Vocal characteristics are not currently used for diagnosing autism, even though the link has been suggested before.


The study is in the journal Proceedings of the National Academy of Sciences.


Autism is the name given to a group, or "spectrum", of lifelong developmental conditions characterised by an inability to communicate with or relate to others, a lack of social skills, obsessional traits, and repetitive behaviour.


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An estimated 500,000 people in the UK are believed to be affected by autism.


'Child utterances'


The US scientists analysed nearly 1,500 day-long vocal soundtracks from battery-powered recorders attached to the clothing of 232 children aged between 10 months and 4 years.


In total more than three million individual child utterances were used in the research, the study notes.


The study focused on 12 specific sound parameters associated with vocal development.


Continue reading the main story
“
Start Quote
The diagnosis of autism is based on a range of behavioural features, not just language development. The social aspects of communication must also be considered”
End Quote
Dr Gina Gomez de la Cuesta


The National Autistic Society
The most important were those involving "syllabification" - the ability of children to produce well-formed syllables with rapid movements of the jaw and tongue.


Experts believe these sounds form the foundation of words.


In autistic children up to four years old, there was a mismatch between the expected parameter values and age.


Professor Steven Warren, an expert in autism spectrum disorders at the University of Kansas, US, who took part in the study, said: "This technology could help paediatricians screen children for ASD (autism spectrum disorder) to determine if a referral to a specialist for a full diagnosis is required and get those children into earlier and more effective treatments."


The new system, called Lena (Language Environment Analysis) could make a big difference to the screening, assessment and treatment of autism, say researchers.


Speech patterns


They point out that since the analysis is based on sound patterns rather than words, it could be used to screen speakers of any language for signs of autism.


"The physics of human speech are the same in all people as far as we know," said Prof Warren.


Dr Gina Gomez de la Cuesta, action research leader at The National Autistic Society, said: "Any tools which could help to identify speech and language difficulties at a younger age have the potential to help families, when used with professional guidance.


"However, they are no substitute for proper assessment by experienced and well-trained professionals."


Dr de la Cuesta added: "The diagnosis of autism is based on a range of behavioural features, not just language development.


"The social aspects of communication must also be considered, and it should be remembered that every child is different and develops at their own pace."

malicious GP risk

Shipman's Hyde colleague warns of malicious GP risk
By Peter Marshall



Shipman killed at least 215 patients, an inquiry found A doctor who worked alongside serial killer Harold Shipman has told the BBC there is still scope for wrongdoing within the medical profession.

Dr Raj Patel, who still works in Hyde, believes that a malicious doctor could still exploit weaknesses in GP systems - 10 years after Shipman was jailed.

Dame Janet Smith, who chaired the Shipman inquiry, also said more still needed to be done to protect patients.

Shipman was jailed in January 2000 for murdering 15 of his patients.

A subsequent inquiry decided he had killed at least 215 people over a period of more than 20 years, making him the UK's most prolific serial killer.

Shipman exploited weaknesses in death certification and other systems used by GPs to avoid detection.

Ten years on from his imprisonment, Shipman's Market Street surgery in the Greater Manchester town is now a thriving business. Dr Patel works over the road in the Brooke Surgery.

Continue reading the main story
“
Start Quote
I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer”
End Quote
Dr Raj Patel

Hyde GP

Shipman 'thought he was a god'
Are patients safer after Shipman?
Shipman response 'lacks progress'
As a young GP he occasionally stood in for Shipman as a locum and counter-signed many of his cremation forms - Shipman lied on those forms to avoid alerting the authorities to his crimes.

When the Shipman Inquiry highlighted weaknesses in that system, doctors at the Brooke Surgery say they tightened procedures almost overnight.

Anyone counter-signing a form would always speak to a relative or carer of the deceased and always examine medical records.

"We decided that we did not have to wait for the authorities to write legislation," said Dr Patel.

"We determined, as a group of doctors, if we decided we would behave differently around particularly cremation then we could effect that change very quickly."

But it was not until January 2009 that the government introduced a more stringent cremation form nationally. But new tighter checks before a body is cremated do not apply to burials.


Dr Raj Patel said his colleagues did not wait for legislation changes "The fact that the body is retrievable is an important factor for the process for burial to be more simple," Dr Patel added.

"However, I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer."

It is a fear echoed by Dame Janet Smith, the senior judge who chaired the Shipman Inquiry.

In an exclusive BBC interview, she said the inquiry, which concluded its reports in 2005, had still not achieved as much as she had hoped.

"We haven't moved at all on basic death certification. It's exactly the same. There hasn't been any further work done since I moved off it in 2003," said Dame Janet.

Wholesale reform

For more than 20 years, Shipman used the drug diamorphine to kill patients both in their homes and at his surgery. He was jailed for life in January 2000 and committed suicide in prison in 2004.

In 2003, her inquiry recommended wholesale reform of death certification to make it less dependent on the honesty of a single doctor.

A single system covering burials and cremations, recommended by the inquiry, is yet to be implemented, although cremation forms have been made more stringent.

The government has said its new Coroners' and Justice Act, which includes plans for medical examiners to scrutinise death certificates, will help prevent a repeat of Shipman's killings.


Dame Janet Smith said Shipman's weapon was his syringe
"The act cannot function until secondary legislation in the form of rules have been prepared and brought into force," said Dame Janet.

"And that hasn't happened yet. That will take another year or two at least."

The Department of Health has insisted that the majority of recommendations from the Shipman Inquiry have been implemented with the aim of improving the quality and safety of patient care.

"Reforming the process of death certification requires changes to primary and secondary legislation - this takes time." said a spokesman.

"We've already made changes to primary legislation and decisions on priorities for this area will be made in the coming weeks."

Revalidation of doctors

The Shipman Inquiry was also highly critical of the General Medical Council's (GMC) approach to managing dangerous and incompetent doctors.

Dame Janet said the GMC's initial plans for revalidation - a process of assessing and re-licensing doctors - amounted to a "rubber stamp".

However, despite her recommendation for a robust evaluation of a doctor's fitness to practice, this has still not happened.

GMC chief executive Niall Dickson admitted that convincing the profession had been a slow process.

"I certainly think some older doctors found it a threatening process," he said.

"I know there will inevitably be frustration with how slowly the system moves and I can understand that. I think people who've seen system failure leading to the loss of a relative have genuine anger at how slowly things operate.

"The only assurance I can give sitting where I am now is that our commitment to drive through a regular checking system for doctors is absolute and I will do everything I can both to see the system launched and delivered."

out-of-hours care

15 July 2010

Dr Stuart Gray, son of David: 'Not confident mistake won't happen again'
A company providing out-of-hours care in an area where a pensioner died after a painkiller overdose had "systematic" failings, the NHS regulator says.

David Gray, 70, from Manea, Cambridgeshire, was killed by Dr Daniel Ubani, a German medic working his first NHS shift for Take Care Now.

The now-defunct firm was criticised for failing to act on previous cases and warnings on standards.

The Care Quality Commission said the whole NHS should learn lessons too.

The death of Mr Gray in February 2008 after he was given 10 times the normal dose of diamorphine has focused national attention on weekend and night GP cover, which in many cases is provided by private firms.

Continue reading the main story
“
Start Quote
Take Care Now failed on many fronts. The lessons of its failure must resonate across the health service”
End Quote
Dame Jo Williams

CQC chairman
The CQC criticised Take Care Now (TCN) for failing to investigate and learn from two previous cases of diamorphine overdoses prior to Mr Gray's death.

Both were given by doctors from Germany, where the drug is not routinely used.

The firm was also warned prior to the case by one of its own doctors that it was "only a matter of time before a patient is killed".

But it did not take sufficient action, the Care Quality Commission (CQC) said.

Staffing levels were also said to be potentially unsafe.

'Stinging reminder'

The report also criticised the NHS trusts which used the firm, which is no longer in existence. As well as Cambridge, TCN had contracts in place with NHS Great Yarmouth and Waveney, NHS South West Essex, NHS Suffolk and NHS Worcestershire.

None of the trusts had robust arrangements to share information and out-of-hours care was judged to be a low priority - reflecting the national position.

Who Were Take Care Now?
Continue reading the main story The firm originated form Suffolk Doctors on Call (SDOC), a not-for-profit co-operative of GPs established in 1994
TCN was formed as the commercial wing of SDOC in 2005, following changes to out-of-hours care
The firm won contracts with five NHS trusts to provide weekend and night cover for GPs
Following the death of Mr Gray, the firm had its contract with the local NHS terminated
Its services were taken over by a larger company called Harmoni
The lack of attention from regional health authorities was also highlighted.

CQC chairman Dame Jo Williams said: "Take Care Now failed on many fronts. The lessons of its failure must resonate across the health service."

A spokeswoman for the Patients Association said the findings were a "stinging reminder".

Since the case, standards have been tightened. Guidance has been issued to local health managers stressing the importance of good monitoring and information sharing, while firms providing out-of-hours care must be registered with the CQC from 2012.

But Health Secretary Andrew Lansley said more action was needed.

He said the steps outlined in a White Paper on Monday to give GPs more responsibility for running services would lead to improvements.

"Out of hours care needs urgent reform," he said.

Meanwhile, German medical authorities have signalled an intention to bring Dr Ubani before disciplinary hearings.

He has been struck off the medical register in the UK, but is still free to work in Germany.

An inquest in February ruled Mr Gray had been unlawfully killed.
More on This Story
Related storiesVetting urged for foreign medics 28 JUNE 2010, HEALTH
GP struck off for fatal overdose 18 JUNE 2010, ENGLAND
German GP death family given £40K 24 MAY 2010, ENGLAND
Patient 'killed unlawfully' by GP 04 FEBRUARY 2010, HEALTH
GP out-of-hours variation fears 02 FEBRUARY 2010, HEALTH
Inquest hears of fatal injection 14 JANUARY 2010, HEALTH
Related Internet linksBritish Medical Association Department of Health Care Quality Commission Share this page

Exclusive I must lose my 38KKK boobs ...or I will die

By RHODRI PHILLIPS and CAROLINE GRANT

Published: 17 Jul 2010
Add a comment (50)
A MODEL with the world's biggest breasts last night told how she must have them removed - or die.
Sheyla Hershey was struck down by a potentially fatal infection during an op on her 38KKK implants.

The Brazilian beauty, 30, said: "Surgeons say there's an 80 per cent chance I can keep one, but if I lose one I don't want to keep the other.

"The chance of being able to keep both is 10 or 20 per cent."



Filmed ... Sheyla in a clinic last year
Splash
On Thursday we reported how Sheyla was undergoing corrective surgery in the US after her boobs became infected following an op in Brazil last month.




The model travelled there to have her breasts restored - her tenth op - after giving birth last year.

US doctors refused to boost the size of her breasts - as it is illegal there to place more than a GALLON of silicone in implants.


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Yesterday Sheyla was due to meet docs again to see if there was any hope of saving them.

The bug has entered her bloodstream, leaving her struggling to breathe. She added: "I am in a lot of pain which I am trying to control with medication. The infection is like a cancer.

"The only way to get rid of it is to cut away breast tissue."

Sheyla is obsessed with plastic surgery and also had liposuction and a nose job. Her boobs were hailed as the world's largest by a Brazilian book of records.



Read more: http://www.thesun.co.uk/sol/homepage/news/3058163/I-must-lose-my-38KKK-record-boobs-or-die.html#ixzz0u0vTZ3pX

Low vitamin D levels 'linked to Parkinson's disease'

Low vitamin D levels 'linked to Parkinson's disease'
Sunlight on the skin helps generate vitamin D Having low vitamin D levels may increase a person's risk of developing Parkinson's disease later in life, say Finnish researchers.

Their study of 3,000 people, published in Archives of Neurology, found people with the lowest levels of the sunshine vitamin had a three-fold higher risk.

Vitamin D could be helping to protect the nerve cells gradually lost by people with the disease, experts say.

The charity Parkinson's UK said further research was required.

Parkinson's disease affects several parts of the brain, leading to symptoms like tremor and slow movements.

30-year study

The researchers from Finland's National Institute for Health and Welfare measured vitamin D levels from the study group between 1978 and 1980, using blood samples.

They then followed these people over 30 years to see whether they developed Parkinson's disease.

They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson's, compared with the group with the highest levels of vitamin D.

Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from foods like oily fish, milk or cereals.

As people age, however, their skin becomes less able to produce vitamin D.

Doctors have known for many years that vitamin D helps calcium uptake and bone formation.

But research is now showing that it also plays a role in regulating the immune system, as well as in the development of the nervous system.

Vitamin target

Writing in an editorial in the US journal Archives of Neurology, Marian Evatt, assistant professor of neurology at Emory University School of Medicine, says that health authorities should consider raising the target vitamin D level.

"At this point, 30 nanograms per millilitre of blood or more appears optimal for bone health in humans.

"However, researchers don't yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination."

Dr Kieran Breen, director of research at Parkinson's UK, said: "The study provides further clues about the potential environmental factors that may influence or protect against the progression of Parkinson's.

"A balanced healthy diet should provide the recommended levels of vitamin D.

"Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson's, and at what stage these would be most beneficial."Vitamin D
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other uses, see Vitamin D (disambiguation).

Cholecalciferol (D3)
Calcium regulation in the human body.[1] The role of vitamin D is shown in orange.Vitamin D is a group of fat-soluble secosteroids, the two major physiologically relevant forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D without a subscript refers to either D2 or D3 or both. Vitamin D3 is produced in the skin of vertebrates after exposure to ultraviolet B light from the sun or artificial sources, and occurs naturally in a small range of foods. In some countries staples such as milk, flour and margarine are artificially fortified with vitamin D, and it is also available as a supplement in pill form.[2]

Vitamin D is carried in the bloodstream to the liver, where it is converted into the prohormone calcidiol. Circulating calcidiol may then be converted into calcitriol, the biologically active form of vitamin D, either in the kidneys or by monocyte-macrophages in the immune system. When synthesized by monocyte-macrophages, calcitriol acts locally as a cytokine, defending the body against microbial invaders.[3]

When synthesized in the kidneys, calcitriol circulates as a hormone, regulating, among other things, the concentration of calcium and phosphate in the bloodstream, promoting the healthy mineralization, growth and remodeling of bone, and the prevention of hypocalcemic tetany. Vitamin D insufficiency can result in thin, brittle, or misshapen bones, while sufficiency prevents rickets in children and osteomalacia in adults, and, together with calcium, helps to protect older adults from osteoporosis. Vitamin D also modulates neuromuscular function, reduces inflammation, and influences the action of many genes that regulate the proliferation, differentiation and apoptosis of cells.[4]

Link between inactivity and obesity queried

Link between inactivity and obesity queried

Child obesity levels have been rising for decades Researchers have challenged the assumption that a lack of exercise causes children to put on weight.

An 11-year study of more than 200 children in Plymouth suggests the effect is the other way around - that getting fatter makes them inactive.

The paper, published in the Archives of Disease in Childhood, concludes that programmes to tackle obesity may need to focus more on food than exercise.

However, some other experts have questioned the findings.

The paper says there is no disputing the association between physical activity and body fat. And there is no suggestion that exercise is not good for children. But it does question its value as a way of tackling obesity.

Continue reading the main story What we shouldn't do is take the paper at face value and allow lean children to be as lazy as they please
Dr David Haslam
National Obesity Forum
The researchers at the EarlyBird Diabetes Study, based at the Peninsula Medical School in Plymouth, has been following a group of more than 200 city school children for the past 11 years.

As part of the long-term study, they monitored body fat and exercise at regular intervals over three years.

They found no indication that doing more physical activity had any effect on weight, but they did find that children who put on weight did relatively less exercise.

The findings indicate that 10% more body fat in a seven-year-old leads to four minutes less moderate or vigorous exercise each day. The lead author, Professor Terry Wilkin, says this may not sound a lot, but it adds up over time.

"Moderate and physical activity only occupies in boys a little less than an hour a day and in girls about 45 minutes.

"So it's a not insubstantial amount of activity that is gained by having the lower body mass.

"And that of course is energy expenditure day in day out, week in week out, month in month out so the balance is changed substantially."

The paper suggests that overweight children may perceive their body image negatively, and as a result choose not to join in sports and exercise. It also argues that children who put on too much weight may suffer discomfort and pain during exercise more quickly.

Professor Wilkin says the policy implications are far-reaching, indicating that nutrition, rather than ever-increasing doses of physical activity, is the key to tackling childhood obesity.

However many experts believe that exercise does have a role to play in helping children to lose weight. Professor Andy Ness from Bristol University, who has also examined activity and obesity in children, says the EarlyBird findings are "partly right".

Academic debate

"In our study we can see evidence that physical activity is predictive of a change in fatness," he said. "But that doesn't mean there's not something going on the other way. We think it's a combination."

Dr David Haslam from the National Obesity Forum says the wider health benefits of exercise for children must not be overlooked.

"The EarlyBird team really force us to question our comfortable assumptions regarding childhood obesity.

"What we, as clinicians must do, is nod reverently at their work, learn lessons from it, and re-appraise our own practices accordingly.

"What we shouldn't do is take the paper at face value and allow lean children to be as lazy as they please, as that would be a catastrophic mistake!"

In a statement the Department of Health in England said the EarlyBird study provided some "useful messages".

A spokesperson said: "We will consider this evidence alongside other research which has different findings on the link between physical activity and weight when we are developing our policy to produce better public health outcomes."

westof: Brain clue may explain autism 'hug avoidance'

westof: Brain clue may explain autism 'hug avoidance'

'Cookie-shaped' fossils point to multicellular life Page last updated at 10:07 GMT, Thursday, 1 July 2010 11:07 UK E-mail this to a friend Printable v

'Cookie-shaped' fossils point to multicellular life
Page last updated at 10:07 GMT, Thursday, 1 July 2010 11:07 UK
E-mail this to a friend Printable version A virtual reconstruction of the inner and outer form of one of the fossils Relics of some of the first stirrings of modern life may have been uncovered.

Scientists report in the journal Nature the discovery of centimetre-sized fossils they suggest are the earliest known examples of multicellular life.

The specimens, from Gabon, are 2.1 billion years old - 200 million years older than for any previous claim.

Abderrazak El Albani and colleagues describe the fossils' distinctive appearance as resembling irregularly shaped "wrinkly cookies".

The step from single-celled to multicellular organisation was a key step in the evolution of life on Earth and set the scene for the eventual emergence of all complex organisms, including animals and plants.

The big question is whether the new West African specimens truly represent large organisms growing in a co-ordinated manner, or are merely a record of the remains of aggregations of unicellular bacteria.

The team tells Nature that its analysis of the fossils' three-dimensional structure using X-ray microtomography leans it towards the former explanation.

The fossils would have existed during a period in Earth history that came shortly after the so-called Great Oxidation Event, when free oxygen concentrations in the atmosphere rose rapidly.

Another oxygen surge that occurred about half a billion years ago co-incided with the Cambrian Explosion - the huge spurt in evolution that established all the major animal groupings.

"The evolution of the Gabon macrofossils, representing an early step toward large-sized multicellularity, may have become possible by the first boost in oxygen," Dr El Albani and colleagues said in a statement, "whereas the Cambrian Explosion could have been fuelled by the second.

"Why it took 1.5 billion years for the multicellular organisms to take over is currently one of the great unsolved mysteries in the history of the biosphere."

The Gabonese fossils were laid down in shales

Hay fever season is well under way

Why do adults suddenly develop hay fever?



WHO, WHAT, WHY?
The Magazine answers...


Hay fever season is well under way, meaning misery for millions of people across Britain. But why are some people suddenly struck by the condition after years of experiencing no symptoms?

With pollen counts soaring, hay fever sufferers are in the midst of their annual bout of summer misery.

But although the condition is generally assumed to begin in childhood, some adults will be getting a nasty shock as they experience unpleasant symptoms such as sneezing and itching for the first time.

THE ANSWER
Despite plenty of research, no-one really knows
It could be that something in the environment of those with a genetic predisposition to allergies that sets it off
Alternatively, sufferers possibly experience very mild symptoms that they do not notice as children


Can you make your garden hay fever-proof?
Unfortunately, there is no way to predict when people who are atopic - that is, genetically predisposed towards allergies - begin to show signs that they are sufferers, says Beverly Adams Groom, chief palynologist at the National Pollen and Aerobiology Unit at the University of Worcester.

But broader theories about whether pollution or, conversely, a more sanitised environment could be causing a rise in hay fever symptoms could offer a clue.

"Lots of people assume that everyone with hay fever develops it in childhood, but we've had people coming to us in their 70s who've just been diagnosed," says Ms Adams Groom.

"People who have a genetic disposition are going to develop it, but as to what triggers it we don't know."


The bee may love pollen... but hay fever sufferers certainly don't
Hay fever is an allergy to pollens - the male reproductive parts of plants - from grasses and trees.

When these come into contact with the tissue inside the nose, they trigger an immune reaction that can cause congestion, sneezing, itching, and a runny nose.

Between 15 and 20% of people in the UK are thought to be affected, with the numbers being even higher among teenagers and symptoms typically peaking in people's 20s.

However, not all follow this pattern, and Ms Adams Groom suggests this could be linked with whatever is driving the general rise in hay fever cases.

Allergy specialist Prof Stephen Durham has calculated that the number of sufferers has doubled over a 20-year period.

"There's some evidence that pollution exacerbates it," he says. "And you've also got the hygiene hypothesis - that our bodies aren't as strong because we aren't exposed to infections when we are small children that our systems rebel against."

Oddly, researchers in Austria have also found that young children in regular contact with farm animals are less likely to develop allergies later in life.

WHO, WHAT, WHY?

A regular part of the BBC News Magazine, Who, What, Why? aims to answer some of the questions behind the headlines
Children living on farms were found to be three times less sensitive to hay fever and nearly four times less likely to suffer from asthma than those living in a non-rural environment.

This all may suggest that something about modern lifestyles may be responsible.

But, as Brian Lipworth, professor of allergy and respiratory medicine at the University of Dundee says, not enough work has been done to be sure either way.

However, he suggests that it could just be that many supposed adult-onset cases were in fact sufferers all along - just that their symptoms started off as too minor to notice.

"The data sets just aren't there to establish anything," he says.

"I'm suspecting that teenagers may not report symptoms because they are so mild, and it's not until they get to a certain level that they are any the wiser - but we just don't know."

It will, of course, be of little comfort to those currently plagued by itchy eyeballs and streaming noses. But the subject is surely a doctoral thesis waiting to happen

Swine flu vaccine

Swine flu vaccine contracts "lacked get out clauses"
Page last updated at 10:26 GMT, Thursday, 1 July 2010 11:26 UK

The government sent leaflets about swine flu to every UK household The contracts negotiated by the UK government for a swine flu vaccine should have had get-out clauses to protect taxpayers' money, experts say.

An independent review, led by Dame Deirdre Hine, a former chief medical officer for Wales, said that was just one of the lessons that should be learned.

Some of the communications about the pandemic were confusing, it added.

But the review praised the overall approach taken.

The review said the four devolved administrations worked well together.

And it said the spending - more than £1.2 billion in total on preparing and responding - was justified.

The review said without such a thorough approach the consequences could have been disastrous if the pandemic had proven to be more severe.

But the review team acknowledged the UK government should have cut a deal over vaccines.

'Threat remains'

More than 30m doses are thought to be left over after one of the manufacturers, GlaxoSmithKline (GSK) refused requests for the contract to be torn up.

Dame Hine: 'the only predicable thing is its unpredictability.'
The other manufacturer, Baxter, agreed to a "break clause" allowing the government to cancel its order.

The review makes 28 recommendations aimed at ensuring a better response to any future pandemic.

Dame Deirdre said: "It is important that the experience of 2009 does not lead to complacency.

"The threat of a flu pandemic remains and the next one could be very serious."

Hundreds of thousands of people were infected with the virus, although most only had relatively mild symptoms.

However, more than 400 people still died in the UK.

Pregnant women and young children tended to be the worst affected.

The UK had been planning for a pandemic for years.

Originally it was thought it would be caused by bird flu, which would probably have meant a much more severe pandemic.

Containment

When swine flu emerged in April last year the government already had stockpiles of anti-flu drugs to lessen the symptoms and pre-contract agreements in place for vaccines.

This level of planning was praised by the review.

When infections started occurring in the UK, the authorities initiated a containment approach. This involved giving anti-flu drugs to anyone who had come into contact with an infected person.

The review said there was no definitive proof this had worked in slowing the spread.

The use of the phrase containment was also criticised along with others for confusing the public. It said there was a perception the approach was designed to stop the pandemic spreading completely instead of just disrupting it.

There was also criticism of the projections given for deaths.

In England, officials released the worst-case scenario figures which at one point were saying there could be more than 60,000 deaths.

This caused confusion, the report says, as some interpreted it as a straight prediction.