Wednesday, 7 April 2010

a study into the link between diet and disease has found.

Five-a-day has little impact on cancer, study finds

By Clare Murphy
Health reporter, BBC News

tomatoes
Researchers are trying to harness key chemicals like lycopene in tomatoes

Eating more fruit and vegetables has only a modest effect on protecting against cancer, a study into the link between diet and disease has found.

The study of 500,000 Europeans joins a growing body of evidence undermining the high hopes that pushing "five-a-day" might slash Western cancer rates.

The international team of researchers estimates only around 2.5% of cancers could be averted by increasing intake.

But experts stress eating fruit and vegetables is still key to good health.

In 1990, the World Health Organization recommended that everyone consume at least five portions of fruit and vegetables a day to prevent cancer and other chronic diseases.

The advice has formed a central plank of public health campaigns in many developed countries. It has been promoted in the UK since 2003 and in the US for nearly two decades.

But research has failed to substantiate the suggestion that as many as 50% of cancers could be prevented by boosting the public's consumption of fruit and vegetables.

It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw
Yinka Ebo
Cancer Research UK

This latest study, which analysed recruits from 10 countries to the highly-regarded European Prospective Investigation into Cancer and Nutrition, confirms that the association between fruit and vegetable intake and reduced cancer risk is indeed weak.

The team, led by researchers from the Mount Sinai School of Medicine, in New York, took into account lifestyle factors such as smoking and exercise when drawing their conclusions.

But writing in the Journal of the National Cancer Institute, they said they could not rule out that even the small reduction in cancer risk seen was down to the fact that the kind of people who ate more fruit and vegetables lived healthier lives in many other respects too.

Broccoli not biscuits

In the best case scenario, an extra two portions of fruit and vegetables each day could prevent 2.6% of cancers in men and 2.3% of cases in women, the study concluded.

Research should focus more sharply on specific fruits and vegetables and their constitutents
Walter Willett
Harvard School of Public Health

Vegetables, which tend to be richer in nutrients, appeared to be more beneficial than fruits, while heavy drinkers seemed to gain the most from a higher intake of both when it came to protection from cancers caused by alcohol and smoking.

In an accompanying editorial, Professor Walter Willet of Harvard University said the research strongly confirmed the findings of other studies, showing "that any association of intake and fruits and vegetables with risk of cancer is weak at best".

But he stressed specific substances contained in certain fruit and vegetables, if harnessed, could still have an important, protective effect.

Substantial evidence suggests lycopene from tomatoes, for instance, may reduce the risk of prostate cancer, while chemicals in broccoli are thought to stimulate a gene which protects against bowel cancer.

And data still suggests fruit and vegetables may provide protection against cardiovascular disease, one of the major killers in the developed world - although this too has yet to be proven categorically.


Prof Sikora: 'Eating five-a-day still has health benefits'

Keeping lean

But while the links between diet and cancer remain unclear, obesity is now seen as an established risk factor.

Fruit and vegetables could therefore be beneficial just by virtue of taking the place of more calorific fare, health experts say.

In any event, a reduced risk of 2.5% should not be dismissed out of hand, the World Cancer Research Fund argues.

"For the UK, this works out as about 7,000 cases a year, which is a significant number," says Dr Rachel Thompson from the charity, which in a major 1997 report said there was "convincing evidence" of the protective effect of fruit and vegetables.

Yinka Ebo of Cancer Research UK said: "It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw.

"There are many things we can do to lower our chances of developing cancer such as not smoking, keeping a healthy weight, cutting down on alcohol, eating a healthy balanced diet, being physically active and staying safe in the sun."

Friday, 2 April 2010

Staffordshire hospital battles resistant superbug

Staffordshire hospital battles resistant superbug

By Michele Paduano
BBC West Midlands health correspondent

University Hospital of North Staffordshire
The infections were almost all on a kidney ward at the hospital

A strain of superbug unique to Staffordshire has killed a kidney patient and infected at least seven others, the BBC has learned.

Klebsiella pneumoniae affected 13 patients on Ward 29 at University Hospital of North Staffordshire.

The dead patient and seven others, developed a resistant strain of the disease.

A hospital spokesman said: "Eight [patients] have a new strain that has not been seen elsewhere."

It is understood the infection was contained by late February with 13 cases still being treated.

'Highly contagious'

Hospital microbiologist George Orendi said was surprised by the contagious nature of Klebsiella.

He said: "What makes it of concern is the number of patients that we have found with the resistant strain.

"It is transmitted between patients. This particular type has not been seen elsewhere."

The hospital has cleaned ward 29 to intensive care standards and all patients on the ward, which is used for kidney patients, are now being screened weekly for Klebsiella.

Health professionals say the strain of superbug to which Klebsiella belongs is capable of adapting far more quickly than MRSA.

A University Hospital of North Staffordshire spokesperson said: "Various different strains have been identified in the 13 cases currently at University Hospital.

"Eight have a new strain that has not been seen elsewhere.

"One of the patients who developed the infection had a number of other serious conditions and has subsequently died."

Tuesday, 30 March 2010

hunting for body parts and tissues to satisfy demand for amulets

Folk medicine poses global threat to primate species

Traditional folk medicine poses a significant and ongoing threat to the future of primates around the world.
According to a major scientific survey at least 101 primate species are still used in traditional folk practices and in magic or religious rituals.
For example, spider monkeys are eaten to treat rheumatism, while gorilla parts are given to pregnant women.
Such practises are accelerating the declines of many already vulnerable species, say the survey's authors.
Details of the survey are published in Mammal Review, the journal of the UK Mammal Society.
Of 390 species studied, 101, or more than a quarter, are regularly killed for their body parts, with 47 species being used for their supposed medicinal properties, 34 for use in magical or religious practices, and 20 for both purposes.
MONKEY MEDICINE
Around the world, the number of primate species used in traditional medicine varies:
Neotropics: 19 of 139 species
Africa: 25 of 79 species
Madagascar: 10 of 93 species
Asia: 47 of 79 species
These primates belong to 38 genera and 10 different families, ranging from monkeys such as langurs and macaques to apes such as gorillas, and smaller primates such as lorises.
"Despite laws, use and trade of the species for medicinal purposes persists," says Professor Romulo Alves of the State University of Paraiba in Brazil, who conducted the survey with colleagues.
The trade in all primate species is tightly regulated by CITES legislation.
Yet despite this, their body parts are being put to a range of uses.
Curing ailments
At least 30% of the primates used are administered to treat one than one ailment.
Black-faced spider monkeys (Ateles chamek) and brown or tufted capuchins (Cebus apella) are each used to treat more than six ailments, for example, with spider monkey body parts used in Bolivia to cure snake bites, spider bites, fever, coughs, colds, shoulder pain, sleeping problems and leishmaniasis.
Assamese macaque (copyright Manoj Shah)
Assamese macaques are eaten to treat rheumatism
In India, say the survey's authors, many people believe that eating the blood of macaques (Macaca assamensis and M. mulatta) treats asthma.
Other monkeys or lorises have their bones or skulls ground up into powder administered with tea, or have their gall bladders ingested or blood or fat used as ointments.
Matter of faith
Primates are also commonly associated with myths within the faiths of different countries, say the survey's authors.
For example, in Sierra Leone, a small piece of chimpanzee bone is sometimes tied around the waists or wrists of children in the belief that it makes them stronger as they grow into adulthood.
ON THE BRINK
Gorillas might be extinct within 20 years, conservationists warn
Two of the world's rarest primates are to be helped by the creation of new nature reserves in south-east Asia
Watch some of the BBC's best films of wild primates
In India, the eye of the Hanuman langur (Semnopithecus entellus) is sometimes worn in an amulet to increase courage.
Although many primates are killed for magical or religious purposes, the authors point out that folk beliefs can in some cases help conserve species.
In parts of Asia, Hindu beliefs help protect species such as long-tailed macaques (Macaca fascicularis) in Bali or grey langurs (Semnopithecus spp) in India.
While in the village of Bossou in the Republic of Guinea, the Manon people consider chimpanzees sacred.
The researchers who conducted the survey also emphasise that many pressures, such as habitat loss, subsistence hunting and the trade in bushmeat, are decreasing primate numbers.
Chimpanzees
Chimp parts are thought make infants stronger
But the trade in primate body parts is often overlooked, yet could help drive many species toward extinction.
Of the 101 primates recorded by the survey, 12 are classified by the International Union for the Conservation of Nature as being critically endangered, 23 as endangered and 22 as vulnerable.
For example, in Vietnam, pygmy lorises are severely threatened, but the biggest hazard to them is now the high prices people will pay to smuggle the animals into China to be used in medicines.
Many langur species are similarly threatened, not just from subsistence hunting and habitat loss but by hunting for body parts and tissues to satisfy demand for amulets, remedies and aphrodisiacs

Monday, 29 March 2010

Gulf Stream 'is not slowing down'

Gulf Stream 'is not slowing down'

By Richard Black
Environment correspondent, BBC News

Argo float being deployed
Data came from the global network of Argo floats in the oceans

The Gulf Stream does not appear to be slowing down, say US scientists who have used satellites to monitor tell-tale changes in the height of the sea.

Confirming work by other scientists using different methodologies, they found dramatic short-term variability but no longer-term trend.

A slow-down - dramatised in the movie The Day After Tomorrow - is projected by some models of climate change.

The research is published in the journal Geophysical Research Letters.

The stream is a key process in the climate of western Europe, bringing heat northwards from the tropics and keeping countries such as the UK 4-6C warmer than they would otherwise be.

It forms part of a larger movement of water, the Atlantic Meridional Overturning Circulation, which is itself one component of the global thermohaline system of currents.

Between 2002 and 2009, the team says, there was no trend discernible - just a lot of variability on short timescales.

The Atlantic overturning circulation is still an important player in today's climate
Josh Willis, Nasa

The satellite record going back to 1993 did suggest a small increase in flow, although the researchers cannot be sure it is significant.

"The changes we're seeing in overturning strength are probably part of a natural cycle," said Josh Willis from Nasa's Jet Propulsion Laboratory (JPL) in California.

"The slight increase in overturning since 1993 coincides with a decades-long natural pattern of Atlantic heating and cooling."

Short measures

The first observations suggesting the circulation was slowing down emerged in 2005, in research from the UK's National Oceanography Centre (NOC).

Using an array of detectors across the Atlantic and comparing its readings against historical records, scientists suggested the volume of cold water returning southwards could have fallen by as much as 30% in half a century - a significant decline.

The warm surface water sinks in the Arctic and flows back southwards at the bottom of the ocean, driving the circulation.

However, later observations by the same team showed that the strength of the flow varied hugely on short timescales - from one season to the next, or even shorter.

But they have not found any clear trend since 2004.

Global thermohaline circulation
The global thermohaline circulation takes warm and cold water across the oceans

Rapid relief

The NOC team now has a chain of instruments in place across the Atlantic, making measurements continuously.

"In four-and-a-half years of measurement, we have found there is a lot of variability, and we're working to explain it," said NOC's Harry Bryden.

The quantities of water involved are huge, varying between four million and 35 million tonnes of water per second.

The array is part of the UK-funded Rapid project, which aims to refine understanding of potentially large climate change impacts that could happen in short periods.

Professor Bryden's team calculates that their system is good enough to detect a long-term change in flow of about 20% - but it has not happened yet.

He believes the JPL approach - using satellite altimeters, instruments that can measure sea height precisely, and the Argo array of autonomous floating probes - could potentially add useful data to that coming from long-term on-site monitoring arrays.

But, he points out: "The method concentrates only on the upper [northward] flow - it doesn't give you much information on the returning flow southward."

Fantasy and reality

Driven by Hollywood, a popular image of a Gulf Stream slowdown shows a sudden catastrophic event driving snowstorms across the temperate lands of western Europe and eastern North America.

That has always been fantasy - as, said Josh Willis, is the idea that a slow-down would trigger another ice age.

"But the Atlantic overturning circulation is still an important player in today's climate," he added.

"Some have suggested cyclic changes in the overturning may be warming and cooling the whole North Atlantic over the course of several decades and affecting rainfall patterns across the US and Africa, and even the number of hurricanes in the Atlantic."

Thursday, 25 March 2010

'X-woman'

DNA identifies new ancient human dubbed 'X-woman'

By Paul Rincon
Science reporter, BBC News

Denisova Cave (J. Krause)
The finger bone was unearthed in 2008 at Denisova Cave

Scientists have identified a previously unknown type of ancient human through analysis of DNA from a finger bone unearthed in a Siberian cave.

The extinct "hominin" (human-like creature) lived in Central Asia between 48,000 and 30,000 years ago.

An international team has sequenced genetic material from the fossil showing that it is distinct from that of Neanderthals and modern humans.

Details of the find, dubbed "X-woman", have been published in Nature journal.

Ornaments were found in the same ground layer as the finger bone, including a bracelet.

Professor Chris Stringer, human origins researcher at London's Natural History Museum, called the discovery "a very exciting development".

Whoever carried this mitochondrial genome out of Africa about a million years ago is some new creature that has not been on our radar screens so far
Svante Paabo
Max Planck Institute for Evolutionary Anthropology

"This new DNA work provides an entirely new way of looking at the still poorly-understood evolution of humans in central and eastern Asia."

The discovery raises the intriguing possibility that three forms of human - Homo sapiens, Neanderthals and the species represented by X-woman - could have met each other and interacted in southern Siberia.

The tiny fragment of bone from a fifth finger was uncovered by archaeologists working at Denisova Cave in Siberia's Altai Mountains in 2008.

An international team of researchers extracted mitochondrial DNA from the bone and compared the genetic code with those from modern humans and Neanderthals.

Origin unknown

Mitochondrial DNA comes from the cell's powerhouses and is passed down the maternal line only.

The analysis carried out by Johannes Krause from the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, and colleagues revealed the human from Denisova last shared a common ancestor with modern humans and Neanderthals about one million years ago.

This is known as the divergence date; essentially, when this human's ancestors split away from the line that eventually led to Neanderthals and ourselves.

The Neanderthal and modern human evolutionary lines diverged much later, around 500,000 years ago. This shows that the individual from Denisova is the representative of a previously unknown human lineage that derives from a hitherto unrecognised migration out of Africa.

Infographic (BBC)

"Whoever carried this mitochondrial genome out of Africa about a million years ago is some new creature that has not been on our radar screens so far," said co-author Professor Svante Paabo, also from the Max Planck Institute for Evolutionary Anthropology.

The divergence date of one million years is too young for the Denisova hominin to have been a descendent of Homo erectus, which moved out of Africa into Asia some two million years ago.

And it is too old to be a descendent of Homo heidelbergensis, another ancient human thought to have originated around 650,000 years ago. However, for now, the researchers have steered away from describing the specimen as a new species.

Dr Krause said the ground layer in which the Denisova hominin fragment was found contain tools which are similar to those made by modern humans in Europe.

Slice of time

"We have ornaments, there is a bracelet, so there are several elements in the layers that are usually associated with modern human archaeology," he told BBC News.

"That's quite interesting, but of course, it is hard to prove that the bone is strongly associated to this archaeology, because it is possible that bones could have moved within the site.

"We are also not sure how exactly the excavation was done. It could have come from a deeper layer, so that's hard to say."

Hobbit and modern human (Peter Brown)
The "Hobbit" persisted until 12,000 years ago on Flores

Professor Clive Finlayson, director of the Gibraltar Museum, said the find presented a number of questions, such as to what extent culture could continue to be used as a proxy for different prehistoric human groups.

Referring to his research on Neanderthals and modern humans in southern Iberia, he told BBC News: "The assumption is that when one group - the moderns - arrives the other group disappears. Here you have a very clear example of co-existence for long periods.

"Where is the rule that says you can have only one species in an area? Especially if they're at low density... the implications are big."

The research contributes to a more complex picture that has been emerging of humankind during the Late Pleistocene, the period when modern humans left Africa and started to colonise the rest of the world.

Professor Finlayson has previously argued: "A time slice at a point in the late Pleistocene would reveal a range of human populations spread across parts of Africa, Eurasia and Oceania.

"Some would have been genetically linked to each other, behaving as sub-species, while the more extreme populations may well have behaved as good species with minimal or no interbreeding."

It was long known that modern humans overlapped with Neanderthals in Europe, apparently for more than 10,000 years.

But in 2004, researchers discovered that a dwarf species of human, dubbed "The Hobbit", was living on the Indonesian island of Flores until 12,000 years ago - long after modern humans had colonised the region.

Difficult classification

Neanderthals appear to have been living at Okladnikov Cave in the Altai Mountains some 40,000 years ago. And a team led by Professor Anatoli Derevianko, from the Russian Academy of Sciences, has also found evidence of a modern human presence in the region at around the same time.

Professor Stringer commented: "Another intriguing question is whether there might have been overlap and interaction between not only Neanderthals and early moderns in Asia, but also, now, between either of those lineages and this newly-recognised one.

"The distinctiveness of the mitochondrial DNA patterns so far suggests that there was little or no interbreeding, but more extensive data will be needed from other parts of the genome, or from the fossils, for definitive conclusions to be reached."

Denisova Cave (J. Krause)
The archaeology of Denisova presents a puzzle of sorts

Experts have been wondering whether X-woman might have links with known fossil humans from Asia, which have controversial classifications.

"Certain enigmatic Asian fossils dated between 250,000-650,000 years ago such as Narmada (in India), and Yunxian, Dali and Jinniushan (in China) have been considered as possible Asian derivatives of Homo heidelbergensis, so they are also potential candidates for this mystery non-erectus lineage," said Prof Stringer.

"However, there are other and younger fragmentary fossils such as the Denisova ones themselves, and partial skulls from Salkhit in Mongolia and Maba in China, which have been difficult to classify, and perhaps they do signal a greater complexity than we have appreciated up to now."

Other experts agreed that while the Siberian specimen may be a new species, this has yet to be shown.

"We really don't know," Ian Tattersall of the American Museum of Natural History in New York, told the Associated Press news agency.

Dr Tattersall, who wasn't involved in the new research, added: "The human family tree has got a lot of branchings. It's entirely plausible there are a lot of branches out there we don't know about."

Distinguishing ancient DNA from modern has been difficult until now

DNA analysed from early European

By Paul Rincon
Science reporter, BBC News

Kostenki 14 (Vladimir Gorodnianskiy)
The DNA comes from the skeleton of a male in his twenties

Scientists have analysed DNA extracted from the remains of a 30,000-year-old European hunter-gatherer.

Studying the DNA of long-dead humans can open up a window into the evolution of our species (Homo sapiens).

But previous studies of this kind have been hampered by scientists' inability to distinguish between the ancient human DNA and modern contamination.

In Current Biology journal, a German-Russian team details how it was possible to overcome this hurdle.

Svante Paabo, from the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, and colleagues used the latest DNA sequencing techniques to study genetic information from human remains unearthed in 1954 at Kostenki, Russia.

Excavations at Kostenki, on the banks of the river Don in southern Russia, have yielded large concentrations of archaeological finds from the Palaeolithic (roughly 40,000 years ago to 10,000 years ago). Some of the finds date back as far as 45,000 years.

The ironic thing is that our group has been one of those that raised this issue
Professor Svante Paabo, Max Planck Institue

The DNA analysed in this study comes from a male aged 20-25 who was deliberately buried in an oval pit some 30,000 years ago.

Known as the Markina Gora skeleton, it was found lying in a crouched position with fists reaching upwards and a face orientated down towards the dirt. The bones were covered in a pigment called red ochre, thought to have been used in prehistoric funeral rites.

The type of DNA extracted and analysed is that stored in mitochondria - the "powerhouses" of cells. This mitochondrial DNA (mtDNA) is passed down from a mother to her offspring, providing a unique record of maternal inheritance.

Using technology pioneered in the study of DNA from Neanderthal bones, they were able to distinguish between ancient genetic material from the Kostenki male and contamination from modern people who handled the bones, or whose DNA reached the remains by some other means.

Markina Gora/Kostenki 14 (Soviet picture)
The ancient skeleton was unearthed in 1954 at Kostenki in Russia (Courtesy of Vladimir Gorodnyanskiy)

The new approach, developed by Professor Paabo and his colleagues, exploits three features which tend to distinguish ancient DNA from modern contamination. One of these is size; fragments of ancient DNA are often shorter than those from modern sources.

Previous ancient DNA studies used the widespread polymerase chain reaction (PCR) technology. PCR amplifies a few pieces of genetic material, generating thousands to millions of copies of a sequence. But the researchers found many fragments of ancient DNA were too small to be amplified by PCR.

A second characteristic of ancient DNA was its tendency to show particular changes, or mutations, in the genetic sequence at the ends of DNA molecules.

A third feature was a characteristic breakage of molecules at particular positions in the DNA strand.

Trust issues

The apparent ease with which modern DNA can infiltrate ancient remains has led many researchers to doubt even those studies employing the most rigorous methods to weed out contamination by modern genetic material.

"The ironic thing is that our group has been one of those that raised this issue," Professor Paabo told BBC News.

"To take animal studies on cave bears, for example, if we use PCR primers specific for human DNA on cave bear bones, we can retrieve modern human DNA on almost every one. That has made me think: 'how can I trust anything on this'."

Kostenki 14 site (Science)
Large concentrations of Palaeolithic finds have come from Kostenki

Using the new techniques, the researchers were able to sequence the entire mitochondrial genome of the Markina Gora individual.

Future studies like the one in Current Biology could help shed light on whether the humans living in Europe 30,000 years ago are the direct ancestors of modern populations or whether they were replaced by immigrants who introduced farming to the continent several thousand years ago.

The modern gene pool contains a wide variety of mtDNA lineages. Studying these maternal lineages provides scientists with clues to the origins and histories of human populations.

Scientists look for known genetic signatures in order to classify an individual's mtDNA into different types, or "haplogroups". These haplogroups represent major branches on the family tree of Homo sapiens.

Early arrival

The researchers were able to assign the Kostenki individual to haplogroup "U2", which is relatively uncommon among modern populations.

U2 appears to be scattered at low frequencies in populations from South and Western Asia, Europe and North Africa.

Despite its rarity, the very presence of this haplogroup in today's Europeans suggests some continuity between Palaeolithic hunters and the continent's present-day inhabitants, argue the authors of the latest study.

DNA molecular structure (SPL)
Distinguishing ancient DNA from modern has been difficult until now

U2, along with closely related haplogroups such as U5, are among those which could plausibly have arrived in Europe during the Palaeolithic.

Geneticists use well-established techniques to "date" particular genetic events, such as when a haplogroup first diversified. The "U" branch (comprising haplogroups U1, U2, U3 and so on) appears to be more ancient than many other genetic lineages found in Europe.

A recent study found a very high percentage of U types in the skeletal remains of ancient hunter-gatherers from Central Europe compared with later farming immigrants and modern people from the region.

Meanwhile, an analysis last year of mtDNA from 28,000-year-old remains unearthed at Paglicci Cave in Italy showed this individual belonged to haplogroup "H" - the most common type found in modern Europeans.

Sunday, 21 March 2010

Nutrition training for doctors 'must be improved'

Nutrition training for doctors 'must be improved'

Person eating
Previous research shows doctors often miss signs of malnutrition

Nutrition needs to be made a more important part of the doctor training system, a leading expert has said.

Gastroenterologist Dr Penny Neild, who works at London's St George's Hospital, said training on how to spot and tackle malnutrition was "patchy".

She said medical schools and junior doctor programmes were focusing too much on the science of being a doctor rather than basic care.

But regulators said courses should give medics a "good understanding".

The issue of malnutrition has been a long-running concern in the NHS.

The problem is that doctors do not recognise it and if it is not picked up the patients cannot be passed on to dieticians to address the problem
Dr Penny Neild, gastroenterologist

Up to one in four patients may be at risk, research shows.

But the British Association for Parenteral and Enteral Nutrition (Bapen) campaign group has warned that doctors working both in hospitals and as GPs often miss the signs.

To address the issue, the government published a Nutrition Action Plan in 2007 encouraging better screening and staff training.

But Dr Neild, who is an adviser to Bapen, said it was now time to improve doctor training, in an article for the newly-formed Frontline Gastroenterology journal.

Nutrition is a core element in the first year of a junior doctor course, but it is not a mandatory part of medical school curriculums or many specialist training courses in the latter part of the junior doctor training programme.

Dr Neild said as a gastroenterologist she had to deal with the consequences of severe malnutrition which requires tube-feeding to be introduced.

"The problem is that doctors do not recognise it and if it is not picked up the patients cannot be passed on to dieticians to address the problem.

"Doctors are taught a lot about medical interventions, but not how to assess and manage poor nutrition."

'Good understanding'

However, she accepted progress was being made.

The introduction of nutrition in the first year of junior doctor training has only been rolled out in recent years, while the royal colleges are looking at devising a standardised curriculum for medical schools which may well have more emphasis on nutrition.

But Dr Neild said it was important to build on this. In particular, she wanted to see specialist training - the part of the junior doctor course which enables medics to become a particular type of doctor such as GP or surgeon - incorporate tailored courses on nutrition.

The General Medical Council, which from April will take responsibility for all stages of doctors' education and training, said that by the time medical students graduate they should already have a "good understanding" of nutrition.

"The GMC outlines the knowledge, skills and behaviours that UK medical students should learn in its guidance, Tomorrow's Doctors.

"It specifies that newly qualified doctors must be able to make an assessment of a patient's state of nutrition; discuss the role of nutrition in health; and be able to apply to practice the scientific principles on nutrition."

Thursday, 18 March 2010

What Shall We Do With the Drunken Sailor?


Drunken sailors left out of rhyme


Beer barrel
The pirates are being tickled, rather than sobering up in the brig

"Drunken sailors" have been removed from the lyrics of a nursery rhyme in a government-funded books project.
But the Bookstart charity says the re-writing of What Shall We Do With the Drunken Sailor? has "absolutely nothing to do with political correctness".
The charity says that the shift from drunken sailor to "grumpy pirate" was to make the rhyme fit a pirate theme, rather than censorship.
"Put him in the brig until he's sober," has also been lost in the new version.
This latest ideological spat over nursery rhymes was sparked by the re-writing of What Shall We Do With the Drunken Sailor.
'Rusty razor'
Bookstart, a project that encourages parents to read with their young children, has produced a different version - with no references to alcohol-swigging sailors.
PIRATES AHOY!
What shall we do with the grumpy pirate?
What shall we do with the grumpy pirate?
What shall we do with the grumpy pirate?
Early in the morning
Hooray and up she rises
Hooray and up she rises
Hooray and up she rises
Early in the morning
Do a little jig and make him smile
Do a little jig and make him smile
Do a little jig and make him smile
Early in the morning

Instead the hard-drinking sea shanty has been turned into something gentler, with lyrics such as "Tickle him till he starts to giggle, Early in the morning."
The charity has dismissed accusations that this is a politically-correct attempt to avoid the alcohol references, saying that it was a case of re-cycling a familiar tune for reading events that were based on a pirate theme.
"We wanted to find a rhyme which would fit in with this subject and this one has a tune which is instantly recognisable by all," said a statement from Bookstart.
"The inclusion of action lyrics like 'wiggle' and 'tickle' offer parents and small children an opportunity to interact, have fun and enjoy acting out the rhyme together."
Although the Drunken Sailor version familiar to children already leaves out some of the saltier verses.
The original includes such suggestions as: "Shave his belly with a rusty razor", "Stick him in a bag and beat him senseless" and "Put him in the hold with the captain's daughter."
The captain's daughter was a euphemism for a lashing from a cat o' nine tails.
Baa-baa
This is the latest in a series of disputes over nursery rhymes.
There were complaints in 2006 about pre-school children attending two nurseries in Oxfordshire being taught "Baa Baa Rainbow Sheep".
Last year, a story based on the Three Little Pigs fairy tale was turned down by a government agency's awards panel as the subject matter could offend Muslims.
A digital book, re-telling the classic story, was rejected by judges who warned that "the use of pigs raises cultural issues".
However, a study in 2004 showed that nursery rhymes exposed children to far more violent incidents than an average evening watching television - including Humpty Dumpty's serious head injury.

Sunday, 14 March 2010

Social care under-funded and rationed, say MPs

Social care under-funded and rationed, say MPs

By Nick Triggle
Health reporter, BBC News

Elderly man
Care funding is currently means-tested

Adult social care in England is "chronically under-funded" and "severely rationed", MPs say.

The Health Committee warned urgent action was needed and told the political parties to stop their point-scoring and seek solutions instead.

The cross-party group said if politicians failed they would "betray current and future generations".

Ministers are expected to set out their plans for reform of the £16bn system in the coming weeks.

ANALYSIS
The challenge facing social care is the perennial problem of supply and demand. While the NHS budget doubled in real terms over the last decade, social care funding rose by little more than 50%.

It has created a situation where councils have responded to more and more requests for help by restricting access to services, leaving vulnerable people to decide between struggling along on their own or selling their homes to pay for residential care.

In truth, the social care system was only ever created as a safety net. The expectation was that a large proportion of caring would be done by relatives and friends, but with community and family life now very different from the 1940s that has become less likely.

Politicians have responded by calling for a "partnership" between the state and individuals. That, of course, requires people to dip into their own pockets, creating an explosive issue in the run up to the election.

Social care, which includes support provided by councils to people in their own homes for things such as washing, eating and dressing as well as residential home placements, is now at the top of the political agenda.

Last summer the government put forward three options for change - one of which involved charging people a compulsory levy of up to £20,000, which has been dubbed a death tax by the Tories.

In recent weeks, the row has escalated with the parties launching attacks on each others' policies.

Two summits have been held in the last month alone, but still no consensus has been reached.

But the committee said it was essential agreement was brokered early in the next parliament so as not to "betray current and future generations".

The report said reform was long-overdue, pointing out it is 13 years since Tony Blair announced changes would be made.

In that time, councils have been placing more and more restrictions on who can get access to care.

Three quarters of the 152 local authorities with responsibility for care now only provide services to those with the highest needs.

Costs

What is more, the means-tested threshold, which stipulates that anyone with assets of more than £23,000 has to pay for their care, was unrealistic, the MPs suggested.

They point out that the actual cost of care on average, certainly of care homes, was much higher.

And without reform, the situation is only going to get worse because of the ageing population, the MPs said.

WHERE THE PARTIES STAND
Labour - Put forward three proposals - all of which involve the state providing a basic level of care which would be topped up by either personal contributions, a voluntary insurance scheme or compulsory levy. The third option - dubbed a death tax - is said to be favoured by ministers
Tories - Proposed an £8,000 voluntary insurance model to cover residential care costs. Now drawing up plans for a voluntary scheme to cover domestic care, such as help washing, eating and dressing in the home
Lib Dems - Initially supportive of free personal care - like Scotland has introduced - but now want a "partnership" whereby state pays some and individual tops this up. Open to compulsory levy

Q&A: Social care

However, they pointed out that the baby-boomer generation will not hit their mid 80s until the early 2030s, creating what they claimed was a "window of opportunity" to improve the system.

Committee chairman Kevin Barron added: "We don't want this issue to be turned into an election football for it to be kicked back into the long grass again in a few weeks."

And as an interim measure, while the system is being reformed, he said the £23,000 threshold should be raised so that more people could get access to care.

Mr Barron also said general taxation should not be ruled out as a way of funding social care - all the options being considered at the moment involve some state funding, coupled with individual contributions.

Stephen Burke, of Counsel and Care, a charity for older people, said: "This sets out in clear terms why we need reform. The three parties now need to meet the challenge."

Care services minister Phil Hope said a white paper setting out how the system should be changed and funded in the future would be published soon.

He added: "Fixing our system of care for people who are older and disabled is our very highest public service priority."

Thursday, 11 March 2010

Its chief, Rajendra Pachauri, was talking about the need for an internal review before the UN announced this external one

Venice_in_snowThere's little doubt, I think, that the forthcoming review of the Intergovernmental Panel on Climate Change (IPCC) can make quite a lot of difference to the organisation itself.

(This is the review that was demanded last month by ministers, and whose terms of reference and operating agency the UN has just announced, entrusting the running of it to the Inter-Academy Council, an umbrella body for science academies independent of the UN.)

Many scientists who have served in the IPCC believe its 22-year-old shape is no longer fit for purpose, and have said so publically.

Its chief, Rajendra Pachauri, was talking about the need for an internal review before the UN announced this external one; and it is surely impossible that there is nothing that can be improved in the working practices of an organisation that was conceived before instantaneous electronic distribution of information became the norm and before climate science became the political battleground it is now.

A bigger question is whether the review can have much impact outside the organisation. Will governments be any keener to act on the recommendations of a reformed IPCC? Will the public find its currently rather impenetrable phraseology easier to decipher? Will it be more widely trusted?

It's possible to divide published opinions on the issue into three broad categories: those who are only concerned with getting the message across that man-made climate change is an over-riding threat requiring urgent action, those who are concerned about the issue but are more concerned by what they see as lack of rigour and transparency within the IPCC, and those who are convinced that global warming is a fraud anyway and the IPCC one of the lead swindlers.

Ban_Ki-moonThose in the first group are unlikely to be influenced by the review, even if it eventually contains damning passages.

Those in the third group are unlikely to be swayed by anything praiseworthy; in fact I have e-mails coming in right now that are already assuring me that the review will be a whitewash, which is I suppose a logical conclusion if your frame of reference is that everything about climate change is just a conspiracy.

It's the second group that intrigues me, including as it does some pretty smart and independent-minded people.

Most are yet to comment. One who has, Roger Pielke Jr, describes what we know about the review so far as a "good start", but has some words of caution as well. I'll be watching the blogosphere and the op-ed-o-sphere with interest over the next couple of days to see what other thoughts come up.

One issue that was raised at the UN news conference - who raised it I cannot tell, as I listened to the conference remotely in London - was how independent the scientists on the Inter-Academy Council's review panel will be from the scientists who contributed work to the IPCC in the first place.

It's a natural question to ask. There's clearly a chance that the first people you would think of to take part in such a panel would be the most eminent climate scientists of the day, and they're wholly likely to have been intimately involved with the IPCC at some juncture.

There's also the wider point that some of the institutions involved with the Inter-Academy Council, such as the UK's Royal Society, have taken a very public stance on climate change.

But to assume this will automatically cause problems for the review is, I think, to misunderstand its nature and purpose.

It is not a review of climate science - some would say it ought to be, but it isn't, it's a review of IPCC practice - and it will surely draw more interesting and meaningful conclusions through involving scientists working in completely different fields, with experiences of completely different collating organisations.

They do exist; medicine alone has many. One that provides an interesting comparison is the Cochrane Review process, which aims to provide something analogous to IPCC reports - regular assessments of the evidence base on its chosen subject - but works very differently.

Will the Inter-Academy Council choose to make use of expertise from fields apparently unrelated to climate science? We shall see - and that, perhaps, will be one of the factors that determines how meaningful and visionary the review turns out to be, and how it is eventually perceived.

Featured post

More patients in Scotland given antidepressants

More patients in Scotland given antidepressants 13 October 2015   From the section Scotland Image copyright Thinkstock Image ca...