doctors arrogant as well

Doctors 'must root out bad care'

Doctors should speak out more, the head of the new health regulator says

NHS staff - and in particular doctors - must do more to tackle bad care, the head of the new health regulator says.

Care Quality Commission chairman Barbara Young said there was a culture of silence among health staff, as shown by the Stafford Hospital scandal.

The hospital was criticised in an official report last month for its appalling standards of care.

But doctors' leaders warned medics were often bullied and harassed into accepting the status quo.

Ms Young said that, as head of the super regulator which was set up at the beginning of April to cover both health and social care, she was determined to make quality "the priority".

I think we should be less tolerant of mediocrity and failure Mark Britnell, of the Department of Health

But she added: "The regulator cannot do it alone.

"We need to create a culture where doctors are obliged to challenge each other. It is not happening everywhere at the moment. There is a silence among professionals."

She said nurses could also play an essential role.

"They are the glue in the system that. They are there 24/7."

Ms Young, who was speaking at a conference hosted by the King's Fund health think tank, also said other front-line staff such as social workers could have an impact, but stressed doctors and senior nurses were probably in the strongest position because of the clout they had.

Failure

Mark Britnell, who as the NHS director of commissioning is one of the most senior officials in the Department of Health, said: "Quality is the be-all and end-all, but sometimes we do let the professionals off by blaming the organisation.

"I think we should be less tolerant of mediocrity and failure. We should expect more from our professionals who are well paid and well educated."

Dr Hamish Meldrum, chairman of the British Medical Association, said he agreed professionals had a "vital role" to play.

"I, like others, am still asking about what happened in Mid Staffordshire."

But he added staff could be "beaten down by the system".

"There can sometimes be a culture of threats and bullying that stops whistle-blowing".

Joyce Robins, of Patient Concern, said: "If we had a few more whistle-blowers in the NHS we might avoid scandals like that at Mid-Staffordshire hospital where staff kept quiet as the body count rose."

astma diet

Med diet 'cuts baby asthma risk'

The Mediterranean diet is rich in fruit and vegetables

Pregnant women who eat a Mediterranean diet may help protect their children from asthma and other allergies, researchers say.

The Crete team studied 468 mothers and their children from pregnancy to six and a half years after the birth.

They found asthma and allergies were significantly less common in children whose mothers ate lots of vegetables, fruit, nuts and fish during pregnancy.

The Thorax study also found eating high levels of red meat increased the risk.

It made that conclusion in cases where red meat was being eaten more than three to four times a week.

This is of particular significance to mothers in the UK as we have one of the highest rates of childhood asthma worldwide Leanne Male Asthma UK

More than five million people in the UK have asthma, and one in 10 children is affected.

Previous work by the same team, from the University of Crete, found that children who ate a Mediterranean diet appeared to be protected from asthma and allergies.

The latest study suggests that the protective effect of the diet may kick in an even earlier stage.

The researchers found that by the time the children were six-and-a-half years old their diet appeared to have little impact on their risk of asthma and allergy.

However, their mother's diet during pregnancy appeared to be much more important.

Beneficial nutrients

Consumption of vegetables more than eight times a week, of fish more than three times a week, and of legumes more than once a week, seemed to be particularly protective.

The researchers said the Mediterranean diet tended to be well balanced and full of foods which contained beneficial vitamins and minerals.

In particular, the diet was high in antioxidants, which help to keep tissues - including those in the lungs - healthy.

Fatty acids from fish were known to help cut potentially damaging inflammation.

The Thorax study continues: "Further studies are needed to better understand the mechanisms of this protective effect and the most relevant window of exposure."

Leanne Male, assistant director of Research at the charity Asthma UK, said: "This supports our advice to pregnant mothers to eat a healthy, balanced diet.

"It is of particular significance to mothers in the UK as we have one of the highest rates of childhood asthma worldwide, with one in 10 children suffering from the condition."

asthma

Vitamin deficiency asthma 'link'

Asthma affects 5m people in the UK

A low intake of vitamins A and C could raise the risk of asthma, a team which reviewed 40 studies carried out over the past 30 years has said.

A Nottingham University-led team found people with a low intake of vitamin C had a 12% increased risk of asthma, the Thorax journal reported.

For vitamin A the raised risk was less clear cut, the team said, but there was still a significant association.

Asthma UK and the Medical Research Council said more research was needed.

There has been a lot of confusion over the link between vitamins and the condition, which affects five million people in the UK.

The jury is still out as to how exactly vitamin intake and asthma are related Leanne Male Asthma UK

Previous studies have come up with a variety of conclusions.

In this study, the researchers analysed the relevant reports on both children and adults published since 1980.

They found no link for vitamin E, but said the associations for A and C were significant.

They concluded low levels of vitamin C - found in fruit and vegetables - increased the risk of asthma by 12%.

They were unable to put an exact figure on vitamin A - found in cheese, eggs and oily fish - but noted that those with severe asthma consumed on average half of the recommended intake of the vitamin.

Lead researcher Dr Jo Leonardi-Bee said: "Our findings indicate that low levels of vitamin C intake and to a lesser extent vitamin A are consistently associated with asthma risk to a degree that, if causal, would be sufficient to be clinically relevant."

He said it was now important to carry out larger-scale studies to clarify the link and to see if there was a direct cause between vitamin intake and asthma.

Other factors

Experts agreed more research was needed, but warned other factors would also play a significant role.

Glenys Jones, a nutritionist with the Medical Research Council, said: "The data provided is interesting, but inconclusive.

"There are many factors such as smoking, physical activity and socio-economic status that have not been taken into account.

"Therefore more research is required to investigate a causal relationship."

Leanne Male, assistant director of research at Asthma UK, added: "The jury is still out as to how exactly vitamin intake and asthma are related."

hysterical , neurotic ,female ,university nonsense

Fruit and veg allergies soaring

By Sue Emmett BBC News

"It's difficult when I see people eating things I would like to try - but I know that I can't". Alexander Lambert, 15, is allergic to some fruit

Cases of oral allergies to fruit and vegetables are rapidly increasing, according to a British specialist.

Dr Pamela Ewan, an allergy consultant at Addenbrooke's Hospital in Cambridge, said the rise in cases appears to be outstripping even peanut allergies.

Dr Ewan, who sees more than 8,000 people with allergies a year, said most patients with reactions to fruit and vegetables were youngsters.

Symptoms include swelling in the mouth and throat, and breathing difficulties.

ALLERGY OR INTOLERANCE? An allergy is when the immune system reacts to a harmless substance such as a food or pollen, as if it isn't safe A severe allergy can cause a potentially life threatening shock known as anaphylaxis An intolerance does not affect the immune system An intolerance is generally not life threatening and the symptoms less severe An intolerance is being unable to digest certain foods such as lactose in milk What causes allergies?

She said: "We have seen a big rise in the number of cases in the past four to five years.

"It is a bit like the peanut allergy was the epidemic of the 1990s. I think fruit and vegetables are becoming the epidemic now.

"In term of numbers, fruit and vegetables are the new form of peanut allergy."

Dr Ewan urges parents to take the problem seriously.

"We think fruit and vegetables are healthy, which they mostly are, but you can be allergic to them."

"Early on when we first picked it up, it was passed off as not being serious. It began with fairly mild itching in the mouth.

"But now we are seeing people who are getting really severe throat closure, a significant swelling at the back of the throat which can impede breathing."

Reaction to bananas

One of her patients is Alexander Lambert, a 15-year-old schoolboy from Essex. He first discovered he had a reaction to bananas when he was 11.

Tests have since proved positive to other fruits. Alexander said that now he even has to be careful about what fruits other people can eat around him for fear of triggering a reaction.

Allergy specialist Dr Pam Ewan: "Peanut allergy was the epidemic of the 1990s - fruit and vegetables are the epidemic now"

Other specialist centres in the UK have confirmed to the BBC that allergies to fruit and vegetables is a growing problem.

Dr Adam Fox, a consultant paediatric allergist at Guy's and St Thomas' Hospital in London, said: "We are certainly seeing lots of oral allergy syndrome.

"This affects people who are actually allergic to pollen - such as birch pollen.

"There is a cross-reactivity between the protein in that pollen with those in fruit and vegetables, so people start getting a reaction to fruits such as apples and pears.

Now we are seeing people who are getting really severe throat closure, a significant swelling at the back of the throat which can impede breathing Dr Pamela Ewan, allergies expert

"Normally we would see this among young adults as they start to develop hay fever but we are starting to see more of it among young children.

"As there is more allergy, the severity seems to be increasing and the patterns are changing."

Pollution a factor

Whilst allergy to hay fever is seasonal, allergy to fruit and vegetables can continue all the year round.

Dr Jonathan North, from Birmingham, agrees with Dr Fox. He believes that particles from diesel exhaust may be making the situation worse as these make pollen more allergenic.

He said: "Fruits are a particular new problem, possibly due to similarities between the proteins in some tree pollens, birch especially.

ALLERGY HOUSE Where are the allergens in your house?

"The chance of cross-reactions with fruits increases with the larger number of types of fruit to which we are exposed."

Dr Paul Williams, a clinical immunologist at the University Hospital of Wales, has also seen a rise.

"There is a real increase in the number of patients seen with Oral Allergy Syndrome in the specialised allergy service we run.

The records indicate a five-fold increase in the rate of oral allergy syndrome in the same six year period, albeit from a low base.

The rate of final clinically diagnosed cases rose from about one for every 100,000 of the population in the Cardiff and South Wales area, to five in the year 2007/8.

Resources issue

However, the centre emphasises that it does not yet know why this is.

It could, for example, be due to improved diagnostic procedures.

Many of the consultants contacted by the BBC have raised concerns that the UK has inadequate resources to cope with the growing demands being placed on allergy services.

They say there are too few specialist centres and specialists.

Dr Ewan estimates that, with the current facilities, it would take 50 years to see all the people estimated to be currently suffering from severe or complicated allergies.

But the Department of Health says it is responding to rising demand with an increase in staffing. It is also planning a pilot allergy centre as a potential model for the future.

On the BBC News website tomorrow: How much is the modern, Westernised lifestyle to blame for the allergy epidemic

Alcohol flush 'shows cancer risk'

A flush could be a warning sign

People who get a flushed face when they drink alcohol should be particularly wary of gullet cancer, experts warn.

About 8% of the population - mostly people of East Asian descent - have an enzyme deficiency that causes their skin to redden when they drink alcohol.

National Institute on Alcohol Abuse and Alcoholism research found even moderate drinkers with this deficiency were more at risk of oesophageal cancer.

The report authors told PLoS Medicine such people may benefit from screening.

We estimate that at least 540 million people have this alcohol-related increased risk for oesophageal cancer Lead researcher Dr Philip Brooks

Alcohol-induced flush is predominantly down to an inherited deficiency in an enzyme called aldehyde dehydrogenase 2 (ALDH2).

Although this is widely known, few are aware of the accumulating evidence that ALDH2-deficient individuals are at much higher risk of oesophageal cancer from alcohol consumption, say the researchers.

Dr Philip Brooks and his team from the National Institute on Alcohol Abuse and Alcoholism, working with Japanese colleagues, assessed how big the extra risk is.

They found individuals with one copy of the inactive gene causing ALDH2-deficiency were 6-10 times more likely to develop oesophageal cancer than individuals with the fully active ALDH2 enzyme who drank comparable amounts of alcohol.

They said if moderate or heavy drinking people with this deficiency were to become light drinkers instead, 53% of oesophageal cancers might be prevented among Japanese men.

They based their calculations on light consumption being fewer than 25 UK units of alcohol per week, moderate being fewer than 50 UK units and heavy being more than 50 UK units per week.

Raising awareness

In the UK, a unit of alcohol is 8g and the Department of Health recommends men should not drink more than three to four units of alcohol a day, and women should drink no more than two to three.

Dr Brooks said: "Cancer of the oesophagus is particularly deadly, with five-year survival rates ranging from 12% to 31% throughout the world.

"And we estimate that at least 540 million people have this alcohol-related increased risk for oesophageal cancer.

"We hope that, by raising awareness of this important public health problem, affected individuals who drink will reduce their cancer risk by limiting their alcohol consumption."

He said doctors could determine ALDH2 deficiency simply by asking about previous episodes of flushing.

Then people could be counselled to reduce alcohol consumption, and those high-risk patients could be assessed for endoscopic cancer screening.

Oliver Childs, of the charity Cancer Research UK, said: "We know that drinking alcohol increases the risk of several different cancers, and that the more you cut down on your drinking, the more you reduce your cancer risk.

"This research helps us better understand how our environment and genes work in tandem to influence our risk of cancer."

Dairy Products and Health

Heart Disease - a challenge to the dairy industry

It is widely accepted that saturated fats raise cholesterol and increase risk of heart disease. Official dietary guidelines across the world recommend that no more than 10% of calories should come from saturated fats. In the UK, dairy foods contribute about 20% of total fat intake and over a third of saturated fat; in the USA, dairy foods contribute about 15% of total fat and 30% of saturated fat. Saturated fat from dairy foods alone amounts to 5% of total calories - about half the recommended maximum intake.

The message to cut dairy fat to promote good health is clear, but rather than accepting and working with that recommendation the dairy industry has chosen to put profit above health and keep on pushing dairy fat into the food supply. When consumers voted with their wallets against milk fat by switching to lower-fat milks, the dairy industry responded by recycling the fat back into them by other routes (cheese, cream, ice-cream and convenience foods) and charging them twice for the privilege. The success of the dairy industry in recycling its unwanted fat is shown by fact that the amount of fat and protein supplied by dairy products other than butter has remained remarkably constant in both the UK and USA for the last four decades despite whole milk sales plummeting.

Based on a study of 80,000 women over a period of 14 years, Professor Walter Willett observes that "replacing 5% of calories from saturated fat with unsaturated fats would reduce the risk of heart attack or death from heart disease by 40%." In other words, if the 5% of total calories currently coming from dairy products as saturated fat were replaced by largely unsaturated fats such as olive oil and nuts and seeds, a very substantial decrease in heart disease would be expected.

The UK Dairy Council, however, makes a concerted attempt to undermine this health message with claims such as:

"There is a growing body of evidence ... that milk itself does not raise blood cholesterol."

"Compelling new research has confirmed that regular milk drinkers do not increase their risk of heart disease."

These claims are echoed by the US National Dairy Council Handbook of Dairy Foods and Nutrition (2000) which goes so far as to claim:

"Findings to date do not support blanket recommendations to preferentially decrease intake of animal fats such as milk fat to reduce the risk of heart disease or other major chronic diseases. Rather moderation in total fat intake, from both animal and vegetable sources, is recommended."

It is tempting to dismiss the dairy industry claims as mere wishful thinking, but in the interests of clarity as to the health implications of a dairy-free diet we have chosen to challenge these claims head-on. The Vegan Society, of course, would like to see the dairy industry disappear for animal welfare and environmental reasons as well as for health reasons, so in that sense we are not unbiased either. However, in the interests of exposing the truth about dairy foods and health we are offering the UK Dairy Council, and indeed its US counterpart, a right of reply on our website and in a future issue of our magazine. We will give them every opportunity to engage in an open debate - if they dare.

Claim No. 1: Dairy products are necessary to provide enough calcium to prevent osteoporosis, regardless of adverse effects.

Calcium is a very good thing, but increasing calcium intake from 500 mg per day to 1500 mg per day will add less than 90 mg per day to the calcium retained by most adults, and less than 50 mg per day for the 10% of adults with the lowest calcium absorption, who are at particular risk of osteoporosis.

Other aspects of diet are equally significant. 10 g of salt per day will subtract about 70 mg per day from retained calcium by increasing calcium losses in urine whereas 4000 mg of extra potassium from a diet rich in vegetables, fruits and other unrefined plant foods will add 60 mg per day to retained calcium by reducing calcium losses.

Vitamin K is especially important in promoting healthy bones and reducing calcium losses, particularly in postmenopausal women.

In other words, relying on calcium alone to prevent osteoporosis is like fielding a football team with only strikers and no defenders.

Dairy products are not the best source of calcium as they cause calcium losses at the same time as providing calcium. A third of the calcium absorbed from milk and more than two thirds of the calcium absorbed from cheese is wasted in this way. In contrast, green leafy vegetables such as kale and spring greens provide plenty of well absorbed calcium while at the same time reducing calcium losses.

Our prehistoric ancestors obtained abundant calcium from plant foods while dairy products are a recent and unnecessary innovation. A diet based on Vegan Society recommendations will have abundant amounts of calcium and potassium along with plenty of vitamin K - a key nutrient for bone health which is notably missing from milk but plentiful in green leafy vegetables.

A comprehensive review of relevant research can be found at www.vegansociety.com/briefings/dietandbone/dietandbone.doc

Dairy products are an exceptional source of calcium, but relative to recommended intakes they are an equally exceptional source of saturated fat. The recommended maximum daily saturated fat consumption on a 2000 kcal diet (typical for many women) is 22g. 1000 mg of calcium from dairy products comes with 17g of saturated fat somewhere in the food supply while a 1000 mg of calcium from cheddar cheese comes with a stunning 30 g of saturated fat. The dairy industry charges as much for reduced-fat milk as for any other milk creating a cheap source of unwanted and unhealthy fat which is pumped back into the food supply, thus negating any benefit to the population as a whole.

Claim No. 2: Dairy products are beneficial for heart health despite raising cholesterol.

The "compelling new research" indicating that "regular milk drinkers do not increase their risk of heart disease" refers to the study by Andy Ness and others published last year entitled "Milk, coronary heart disease and mortality." Like the study by Willett cited earlier, this study measured some aspects of diet and lifestyle and observed subsequent mortality but it involved less than a tenth of the number of people in Willett's study.

The authors observed a statistically significant reduction in deaths from heart disease with increased consumption of milk as a drink (11% for the medium milk group and 32% for the high milk group) before adjustment for risk factors, other than age. This relationship remained largely unchanged after adjustment for other risk factors, but was found to have a 1 in 10 chance of being a random observation - in other words it ceased to be statistically significant.

On the other hand, in Hu and Willett's study of US nurses, the fully adjusted risk of heart disease in those consuming two glasses of whole milk per day was 67% higher than for those consuming no whole milk, with less than a 1 in 10,000 chance that the increased risk was a random observation. This study observed no significant effect from skimmed milk.

Both studies are subject to the criticism that it is difficult to adjust for all related characteristics of individuals freely choosing their own diet and lifestyle. It is even more difficult to persuade people to make long-term changes to their diet according to specific instructions, so observational studies such as those cited are often the best evidence available. However, this is not the case for milk and heart disease.

There was a common but misguided belief in the 1950s that high dairy ("Sippy") diets were good for ulcers. Some doctors assigned most of their ulcer patients to high dairy diets while others made little use of such diets. Thus a unique experiment on the effect of assigning individuals to high dairy consumption was created.

A 1960 study on the Sippy diet compared mortality in ulcer patients in the UK and USA depending on whether they had been assigned to the "Sippy" diet or not. Ulcer patients on the Sippy diet were compared both with ulcer patients on other diets and with other patients in terms of the percentage showing heart attacks (myocardial infarction) on autopsy. The results were striking:

	Ulcer patients on Sippy diet	Ulcer patients on other diets	Patients without ulcers
UK	18%	3%	8%
USA	36%	15%	15%

In the UK the chance of the differences between the Sippy groups and each of the other groups being a random finding was less than 1 in 20 and in the USA it was less than 1 in 100. The study thus provides uniquely strong evidence that high dairy intake substantially increases risk of dying from a heart attack.

The dairy industry also advances two indirect arguments for milk being protective due to non-fat components, namely calcium and B12.

There is good evidence that increases in calcium intake work with increases in potassium and decreases in sodium to reduce blood pressure and reduce risk of stroke and heart disease. As noted above, a healthy vegan diet provides ample calcium without the dangerous saturated fat that goes with it in dairy products.

Milk is also a source of B12 and adequate B12 is essential to avoid elevated levels of homocysteine - a major risk factor for heart disease and overall mortality. Most nonhuman primates get enough B12 from plant foods contaminated with soil and insects. Modern vegans spare the insects and avoid the potential ill effects of contaminated soil and are therefore advised to get at least three micrograms of B12 from fortified foods or supplements daily. This, along with plentiful folate and B6 from green leafy vegetables and other plant foods, is sufficient to minimise homocysteine levels.

Once again, a diet following Vegan Society guidelines provides everything humans need for health. Adding dairy products with their accompanying saturated fat offers only disadvantages in terms of health.

Claim No. 3: Dairy products don't actually raise cholesterol anyway.

The first two claims were flimsy and unsubstantiated but this claim moves even further into the realms of fantasy. The US Dairy Council Handbook provides 178 references in the chapter on "Dairy Foods and Cardiovascular Health" and highlights a 1977 study by Howard and Marks suggesting that milk consumption causes a significant drop in cholesterol. It also includes several other studies carried out around that time. Unsurprisingly, it completely ignores a later paper by Howard and Marks which states:

"Roberts et al. report that they can find no evidence that milk contains a cholesterol-lowering factor as previously proposed by us. After reviewing their evidence, our other published work, and more recent unpublished results, we agree that such is indeed the case."

The handbook also fails to mention the paper by Roberts et al. which shows a 9% increase in cholesterol with one litre of whole milk per day: to lose one key reference could be considered an accident, to lose two is (at best) carelessness.

Conclusion

The addition of dairy products to a diet based on Vegan Society recommendations will significantly undermine health. The dairy industry is indulging in wishful thinking and selective citation and should either

• stop recycling fat from low fat dairy products back into the food supply, or
• stop promoting dairy foods as healthy, or
• show that we have got it completely wrong.

We welcome a debate to make the truth evident to all.

veg again

Harvesting seaweed must be handled carefully and transported with environmentally friendly non-motorized fishing boats.

The terms "seaweeds" and "sea vegetables" are used interchangeably herein and refer to the large, visible macroalgae growing attached to each other, rocks, and the seafloor in the intertidal zone and shallow seawater. Microalgae, phytoplankton, cyanobacteria (blue-green algae) and eel grasses are not included. The term "sea herbs" is not used and not recommended since it compromises the true cryptogamic identity and phylogenetic classification of the macroalgae, even though it is used affectionately by herbalists. The term "seaweed" is a bit misleading: with a few notable exceptions, seaweeds are actually saltwater-tolerant, land-dependent plants growing almost exclusively at the narrow interface where land and sea meet. Most must be firmly attached to something to stay in the "photic zone", where they can receive sufficient sunlight.

All seaweeds are photosynthetic. The best-known truly "pelagic" seaweed (pelagic means living and growing at sea, independent of land) is Sargasso weed, a prolific brown seaweed of the genus Sargassum. This lush plant covers an area of 7000 square miles near the Bermuda Triangle, with a floating layer 1-2 feet thick; modest wave action sorts it out into long even rows that resemble a carefully-planted field on land. After several days of slowly chugging through the Sargasso Sea while taking transatlantic transect vertical plankton tows, I experienced a common visual hallucination and urge to jump off the boat and walk around on the Sargasso weed as had many mariners before me. The urge was compelling. I nearly had to be restrained.

Sea vegetables have been consumed regularly by all coastal peoples since the first days.

Seaweeds are best used as regular components of a wise diet. Sea vegetables have been consumed regularly by all coastal peoples since the first days. Special harvesting, processing, storage, and eating rituals evolved to meet local needs. The ease of drying sea vegetables in full sunlight, and, their innate long-term stability when kept completely dry permits safe long-term storage and facilitates both personal and commercial transport, And, an almost indefinite shelf-life when stored completely dry and away from light.

Worldwide post-industrial healthy living consciousness has in the most recent score of years initiated a very deliberate increase in overt human dietary seaweed consumption, especially in the more-developed postindustrial nations where voluntary vegetarian and macrobiotic diets are increasingly popular. Most east Asian populations (Japan, Korea, china) continue to eat large amounts of seaweed per capita. Japan has the highest per capita dietary

Japan has the highest per capita dietary sea vegetable consumption (and, correspondingly, the highest per capita dietary iodine consumption, and, an extremely low incidence of breast cancer).

sea vegetable consumption (and, correspondingly, the highest per capita dietary iodine consumption, and, an extremely low incidence of breast cancer). In the most developed countries, covert sea vegetable product consumption by the average person probably far exceeds overt consumption. This results from the widespread use of several phycocolloids as food additives for both bulking foods with cheap water (carageenan from the red algae Chondrus crispus, Irish moss, and Gigartina spp., grapestone) where the clathritic capacity of the phycocolloid to control large amounts of water in a semisolid gel makes for an even texture and distribution of favor and clobbering, as in cheap frozen semi-dairy confections; and, for stabilizing semisolid structure, as in ice cream, where about one pound of the brown seaweed extract algin is used to stabilize a ton of ice cream.

nhs again

Malnutrition affecting '3m in UK'

Malnourishment costs £13bn a year in health costs
People suffering from malnutrition - or at risk of it - in the UK stands at three million, experts believe.
It is the clearest idea yet of the scale of the problem after those in the community as well as hospitals and care homes were included in the count.
The British Association for Parenteral and Enteral Nutrition said the problem was costing £13bn a year to treat and urged GPs to do more.
But GPs said that it was already being taken seriously.
BAPEN's report looked at previous research on the extent of malnutrition in a range of settings from hospitals and mental health units to sheltered housing and care homes.
Researchers estimated that of the three million either malnourished or at risk of malnutrition, 93% were living at home or in sheltered accommodation, 5% were in care homes and 3% in hospitals and other NHS settings.
The emphasis must now be on prevention and that means spotting it in the community
Professor Marinos Elia, report author
Viewpoint: Malnutrition matters
They said elderly people, particularly those with long-term conditions, were most at risk, although isolation and poverty also played key roles.
The association, together with a range of charities, have been campaigning about nutrition for years.
The pressure has resulted in a number of improvements, including more screening and better food in hospitals and care homes.
But BAPEN said it was now time for GPs to do more.
Under guidelines, they are meant to use the official malnutrition screening checklist, which measures weight, height and any recent weight loss to give a malnutrition risk score, when they believe someone might be at risk.
But the association said this was still not being done routinely and urged ministers to include more incentives in the GP contract.
Cost
The report said the health cost of the problem was also likely to be in the region of £13bn - twice as high as some previous estimates.
Malnourished people stay in hospital longer, succumb to infection more often and visit their GP more frequently.
Professor Marinos Elia, one of the lead authors of the report and a former chair of BAPEN, said: "The evidence is clear and the time is right.
"The emphasis must now be on prevention and that means spotting it in the community."
As well as GPs, he said pharmacists could get involved in community screening, while transport planners could do more to ensure people had good links to supermarkets.
Pamela Holmes, of Help the Aged, said: "Malnutrition in the community is drastically overlooked.
"Social workers, community nurses, GPs and other health professionals need to be educated and trained to spot and treat the signs of malnutrition."
Professor Steve Field, of the Royal College of GPs, said: "It is a very important issue, but I think it is something GPs are already taking seriously.
"We routinely weigh and measure patients so I don't think it is necessary to change the GP contract."
Government response
But the Department of Health in England said despite the problems being reported overall people were getting healthier.
A spokeswoman said: "The Department recognises that good diet and nutrition are important for everyone.
"Sustained investment in tackling health inequalities has paid off. Life expectancy in England is the highest it has ever been, including in disadvantaged areas.
"We are committed to reducing health inequalities further, and have put in place the most comprehensive programme ever in this country to address them."
She also pointed out the Nutrition Action Plan published in Autumn 2007 specifically aimed to address the issue of malnutrition in care homes and hospitals by encouraging screening and staff training as well as issuing guidance.

asthma

Pregnant women who suffer from stress are more likely to have a child with asthma, according to research from Children of the 90s study.
Researchers working with about 6,000 families in Bristol found anxious mums-to-be were 60% more likely to have a baby who would develop the illness.
The findings show 16% of asthmatic children had mothers who reported high anxiety while pregnant.
Mothers-to-be who were less stressed had a lower incidence rate.
Key findings
Professor John Henderson, from the Children of the 90s team, said: "Perhaps the natural response to stress which produces a variety of hormones in the body may have an influence on the developing infant and their developing immune system that manifests itself later on."
The Children of the 90s study - carried out by the University of Bristol - has been following 14,000 children.
They are regularly tested and monitored to see how different lifestyles affect growth, intelligence and health.
The aim is to identify ways to optimise the health and development of children.
Key findings to come out of the project include left-handed children do less well in tests than their right-handed peers and women who eat oily fish while pregnant have children with better visual development.

cancer support bristol

Support groups

A cancer diagnosis means a lot of changes in your life. This group offers support and a safe place for you
to talk about your experience.

It is a confidential and supportive group where you can voice your hopes, fears and frustrations; share ideas and experiences with others, and learn ways to manage the emotional strain of living with cancer.

We offer you a free introductory appointment with the group facilitator. This gives you an opportunity to visit and find out more about the support group and how you could benefit. In addition we can tell you about other services on offer.

Our Support Groups are:-

• professionally led by a member of our
• psychotherapy Team
• limited to a maximum of nine participants
• running during Spring and Autumn every year
• weekly on a Thursday 2-3.30pm for 15 weeks

The next groups starts 19 March 2009 and will run until 15th July 2009. The group costs £5 per session (donation rate is available).

The support group takes place at Penny Brohn Cancer Care, Chapel Pill Lane, Pill, Bristol BS20 0HH.

Click here for directions

To find out more

If you are interested in finding out more, please contact Bookings on 01275 370 111 or email bookings@pennybrohn.org to book a FREE introductory appointment with a group facilitator.

biofuel debate favourite arguments of climate-change deniers.

Natural mechanism for medieval warming discovered

Europe basked in unusually warm weather in medieval times, but why has been open to debate. Now the natural climate mechanism that caused the mild spell seems to have been pinpointed.
The finding is significant today because, according to Valerie Trouet at the Swiss Federal Institute for Forest, Snow, and Landscape Research in Birmensdorf, the mechanism that caused the warm spell in Europe – and meant wine could be produced in England as it is now – cannot explain current warming. It means the medieval warm period was mainly a regional phenomenon caused by altered heat distribution rather than a global phenomenon.
The finding scuppers one of the favourite arguments of climate-change deniers. If Europe had temperature increases before we started emitting large amounts of greenhouse gases, their argument goes, then maybe the current global warming isn't caused by humans, either.
To work out what the global climate was doing 1000 years ago during the so-called "Medieval Warm Period", Trouet and colleagues started by looking at the annual growth rings of Moroccan Atlas cedar trees and of a stalagmite that grew in a Scottish cave beneath a peat bog. This revealed how dry or wet it has been in those regions over the last 1000 years.
The weather in Scotland is highly influenced by a semi-permanent pressure system called the Icelandic Low, and that in Morocco by another called the Azores High. "So by combining our data, which showed a very wet medieval Scotland and very dry Morocco, we could work out how big the pressure difference between those areas was during that time," says Trouet.

Warm blast

This pressure difference in turn revealed that the medieval period must have experienced a strongly positive North Atlantic Oscillation (NAO) – the ocean current that drives winds from the Atlantic over Europe. The more positive the NAO is, the more warm air is blown towards the continent.
The idea to use growth rings to work out past climate change is not new, but Trouet's team is the first to look back beyond 1400 in the European record. They found that the strongly positive NAO lasted for about 350 years from 1050 to 1400.
By combining their data with information from other regions of the world during medieval times and plugging it into different models, the researchers have also come up with a hypothesis of what made the warm winds so persistent.
"It turns out that in the tropical Pacific, the El Niño system was in a negative La Niña mode, meaning it was colder than normal," says Trouet.

Climate loop

El Niño and the NAO are connected by a process called thermohaline circulation, which drives the "ocean conveyor belt" that shuttles sea water of different density around the world's oceans.
According to Trouet, a Pacific La Niña mode and a positive NAO mode could have reinforced each other in a positive feedback loop – and this could explain the stability of the medieval climate anomaly.
Trouet thinks external forces like abrupt changes in solar output or volcanism must have started and stopped the cycle, and hopes to pinpoint the most likely candidates in a workshop with other climatologists in May.

'Profound implications'

Michael Mann at Pennsylvania State University says that based on the analyses and modelling that he has done, increased solar output and a reduction in volcanoes spouting cooling ash into the atmosphere could have not only kicked off the medieval warming, but might also have maintained it directly.
Mann is also concerned that the dominance of medieval La Niña conditions now indicated by Trouet's work might make it more likely that the current man-made warming could also put the El Niño system back into a La Niña mode, although most climate models so far had predicted the opposite.
"If this happens, then the implications are profound, because regions that are already suffering from increased droughts as a result of climate warming, like western North America, will become even drier if La Niña prevails in the future", he says.
Journal Reference: Science (DOI: 10.1126/science.1166349)

Oh! really what a surprise, surprise

Homeless need mental health help

The number of homeless is expected to rise this year

Homeless people need more help to deal with mental health problems, leading charities are warning.

Experts have already predicted that the recession could lead to a rise in homeless people.

And now Crisis and St Mungo's have called for improved access to specialist services because of the high rates of problems being reported.

Research shows that a third of people in hostels have severe mental health problems such as personality disorders.

Once other conditions, including depression and anxiety, are taken into account as many as eight in 10 are affected.

The link between homelessness and mental health problems is well known Leslie Morphy, of Crisis

But the charities, which run homelessness services including hostels, said most are given no help.

One of the key reasons why homeless people struggle to access services when they want to is that they are often not registered with a local GP.

The campaigners called for mental health specialists to run outreach clinics in hostels as well as greater access to drop-in centres.

They are now planning to hold discussions over the next 10 weeks with other homeless services, NHS experts and social services to see what can be achieved, before publishing a full report in the summer.

While the number of rough sleepers has been falling in recent years, there are still estimated to be about 800 people on the streets of the UK at any one time.

On top of that there are more than 40,000 people living temporarily in shelters and hostels.

Rise

And many believe these figures will rise in the coming months as people struggle to cope in the current financial climate.

St Mungo's chief executive Charles Fraser said: "These are often the individuals with the most intractable problems, who need the most determined help and it is reprehensible they are not getting it."

And Leslie Morphy, the head of Crisis, added: "The link between homelessness and mental health problems is well known.

"Yet, despite all the evidence, we still do not have the right services and support in place to address what is both such a common cause and consequence of homelessness."

But the Department of Health said funding for mental health services had been increasing and local health bosses were investing some of this into care for homeless people.

"Many trusts now have successful community outreach teams that work with hard to reach people such as the homeless."

middle class BBC know nothing

Warning of food price hike crisis

The price of pork sausages has gone up 51% in the past year

A crisis is unfolding in the UK as people in poverty struggle with rising food prices and the recession, the Save the Children charity has warned.

It comes as new figures from The Grocer magazine show food prices rose by more than 18% over the last year.

On Monday, the charity will launch a crisis grant scheme to help families.

The government says it believes food prices have peaked and it is tackling child poverty through increased child benefits and child tax credits.

'More unequal'

Colette Marshall, of Save the Children, said: "We are facing a crisis. Benefits simply haven't been enough and with rising food costs it means that families cannot afford to give children proper decent food.

"We think we are heading towards malnutrition here in the UK."

Pensioner on her struggle with food costs

She is calling on the government to meet its target of halving child poverty by 2010 by putting £3bn in the Budget.

Penny Greenhough, a single mother of two young children, said the family was struggling on a food budget of £3 per head per day.

"I am having to compromise on a daily basis on quality and quantity. I used to manage, but it's getting harder and harder," she told BBC News.

"Once you get into the supermarket then you have got to start looking for the cheapest of everything, every type of commodity you want, whether it is soap powder, some meat or bread or anything else, it's always the cheapest variety," said pensioner Rita Young.

"We have to go for the cheapest of everything and it's just not doing us any good. Too much salt, too much fat, too much sugar - cheap, cheap, cheap, just isn't good enough."

ANNUAL FOOD PRICE RISES Rice - up 81% Pork sausages - up 51% Mince - up 22% Milk - up 14% Source: The Grocer

Kate Green, of the Child Poverty Action Group, said that many families were buying less fresh fruit, vegetables, meat and fish, and consuming more affordable tinned and packet food that was often higher in sugar, salt and fat.

Government efforts had lifted 600,000 children out of poverty in the last 10 years, but one in three still lived below the poverty line, she said.

"Part of the problem is... many people have seen their prosperity improve over the last 10 years, so we have become a much more unequal country," she said.

"That is very damaging for the people who just haven't kept up, and it really is quite wrong morally, and it's economically very stupid actually, not to make sure that we share the resources more equally and protect those who have least."

According to The Grocer, a typical basket of 33 items of food cost £48 a year ago. That has now risen to £57.50.

Seasonal produce has caused a small drop in monthly figures, but the cost of basic essentials remains high.

Extra benefits

James Ball, from the magazine, told the BBC: "It is the staples that have really gone up and that's tough for people who buy the cheapest food.

"Rice costs double what it did last year, baked beans are up more than a third. Lots of everyday items cost a lot more than they used to."

As the UK imports about 40% of its food, the weak pound has driven up prices. Unpredictable world harvests and a spike in oil prices last year have also played a part.

However, as British produce comes into season, prices are expected to drop.

Treasury minister Stephen Timms said a raft of benefits due to come in on Monday would help struggling families.

"Extra help on child benefit, child tax credit, the state pension, and pension credits is going to assist children, families and older people who are feeling the pinch at the moment.

"Of course we always look at the time of the budget to see if there is more that can be done but I think people will appreciate the help that is being provided."

big sister

Polypill 'could become a reality'

The polypill has been hailed as the magic bullet to heart problems

A cheap five-in-one pill can guard against heart attacks and stroke, research suggests.

The concept of a polypill for everyone over 55 to cut heart disease by up to 80% was mooted over five years ago, but slow progress has been made since.

Now a trial in India shows such a pill has the desired effects and is safe and well-tolerated by those who take it.

Although The Lancet study is proof of concept, experts still question the ethics of a pill for lifestyle issues.

There is a danger that lifestyle factors could be overlooked in favour of 'popping a pill' Mike Rich of UK charity the Blood Pressure Association Q&A: The Polypill

Critics say the problems of high blood pressure and cholesterol should be tackled with diet and exercise rather than by popping a pill.

The polypill used in the latest study combines five active pharmacological ingredients widely available separately - aspirin, a statin to lower cholesterol and three blood pressure-lowering drugs - as well as folic acid.

Does what it says on the tin

Trials on 2,053 healthy individuals free of cardiovascular disease, but with a risk factor such as high blood pressure or a long-term smoker, showed combining the drugs into one tablet delivered a similar effect to each drug separately.

Reductions were seen in both blood pressure and cholesterol without any major side effects.

WHAT'S IN IT? Aspirin to thin the blood A statin drug to lower cholesterol Three blood pressure-lowering drugs: ACE inhibitor Diuretic Beta-blocker Folic acid to reduce the level of homocysteine in the blood which is another risk factor for heart disease

The researchers believe that the combined action of all the components in their "Polycap" capsule made by Cadila Pharmaceuticals, could potentially halve strokes and heart attacks in average, middle-aged people.

On a global scale, this would save tens of millions of lives.

The study, led by Dr Salim Yusuf, from McMaster University in Ontario, Canada, took in people at 50 centres across India.

A spokeswoman for the British Heart Foundation said: "The results suggest that the polypill has the potential to reduce the incidence of cardiovascular disease.

The polypill does exactly what it should, but no more UK researcher Professor Simon Thom

"We now need further research to examine whether the polypill actually reduces mortality."

A UK team led by Professor Simon Thom of Imperial College London is hoping to do just this.

They have been testing a four-in-one polypill called the Red Heart Pill, with the backing of the Wellcome Trust and the British Heart Foundation, which could cost as little as 15 euros per person per year.

Professor Thom said it would be at least five years before there was enough data to convince drug regulators to approve a polypill.

"Mounting evidence shows the polypill does exactly what it should, but no more, whereas exercise has wide reaching effects on health and wellbeing. So a polypill is an addition rather than a replacement for lifestyle interventions."

FROM THE TODAY PROGRAMME More from Today programme

Mike Rich of UK charity the Blood Pressure Association said: "This study further stimulates the debate over whether a 'magic bullet' is the answer to the prevention of heart disease and strokes.

"Eating healthily and taking regular exercise are proven ways to lower high blood pressure - and have many other health benefits too - and there is a danger that these lifestyle factors could be overlooked in favour of 'popping a pill'."

Joanne Murphy of The Stroke Association said: "By combining these medications in one pill, it will make it easier for people to take their medication. However, it is important that more research and investigation is done into this pill to ensure its safety."

One GP, Dr Sarah Jarvis, said the pill should not be viewed as an alternative to improving lifestyles through diet and exercise.

"What we need to bear in mind is that this may well cut the likelihood of dying of heart disease dramatically. Fantastic. But it's not going to stop you getting arthritis, it's not going to stop you get lung disease," she said

common infections

How infection may spark leukaemia

Common infections may trigger cancer cell growth

Scientists have shown how common infections might trigger childhood leukaemia.

They have identified a molecule, TGF, produced by the body in response to infection that stimulates development of the disease.

It triggers multiplication of pre-cancerous stem cells at the expense of healthy counterparts.

The Institute of Cancer Research study appears in the Journal of Clinical Investigation.

While infection is clearly only one factor in triggering progression, this study greatly increases the strength of evidence for its role in the commonest form of childhood leukaemia Dr Shabih Syed Leukaemia Research

Leukaemia occurs when large numbers of white blood cells take over the bone marrow, leaving the body unable to produce enough normal blood cells.

The researchers had already identified a genetic mutation - a fusion of two genes - occurring in the womb that creates pre-leukaemic cells.

These cells then grow in the bone marrow, effectively acting as a silent time bomb that can stay in the body for up to 15 years.

Evidence suggests the mutation may be present in as many as one in 100 newborn babies, but only about one in 100 of these children then go on to develop leukaemia.

This suggests that the cells will only complete the transformation to fully-fledged cancer cells if they exposed to an independent trigger.

The latest study suggests production of TGF in response to an infection could be that trigger.

Because the molecule hugely increases the rate at which the pre-leukaemic cells multiply, this significantly raises the the chance that some will become even further damaged in a way that results in the child developing leukaemia.

Preventative measures

Researcher Professor Mel Greaves said: "Identifying this step means we can determine how an unusual immune response to infection may trigger the development of the full leukaemia and eventually perhaps develop preventative measures such as a vaccine."

Dr Shabih Syed, scientific director at the charity Leukaemia Research, said: "Before this study, there had been only circumstantial evidence to implicate infections in the progression from a child carrying pre-leukaemic cells to actually having leukaemia.

"There was no evidence of the mechanism by which this might happen.

"While infection is clearly only one factor in triggering progression, this study greatly increases the strength of evidence for its role in the commonest form of childhood leukaemia."