'Fatty apron' fuels ovary cancer

Ovarian cancer

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A "fatty apron" in the abdomen helps fuel the spread of ovarian cancer, research suggests.

In 80% of cases, it has spread to this apron, called the omentum, by the time it is diagnosed.

The Nature Medicine research found once ovarian cancer cells reach the omentum, they take it over.

UK experts said the study was important in aiding understanding of ovarian cancer, the fifth most common cancer in women in the UK.

The omentum lies in the upper abdomen near the stomach. It helps support the organs nearby, but it is not essential.

Often, cancer growth in the omentum exceeds the growth of the original ovarian tumour.

The University of Chicago team injected ovarian cancer cells into the abdomen of healthy mice. They reached the omentum within 20 minutes.

They found that protein signals emitted by the omentum attracted the tumour cells. Disturbing these signals reduced this attraction by at least 50%.

Once ovarian cancer cells reach the omentum, they were found to change so they could feed off the fat cells.

Feeding cancer spread

The researchers suggest that a protein known as fatty acid binding protein (FABP4), a fat carrier, could be key to the process and could be a target for treatment.

Tumour cells next to fat cells in the omentum were found to produce high levels of FABP4, while cancer cells far away from fat cells did not.

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“Start Quote

The cells that make up the omentum contain the biological equivalent of jet fuel. ”

Prof Ernst Lengyel,Lead author

When the action of FABP4 was blocked, the transfer of nutrients from fat cells to cancer cells was drastically reduced. It also reduced tumour growth and the ability of tumours to generate new blood vessels.

Lead author Ernst Lengyel, professor of obstetrics and gynaecology at the University of Chicago, said: "The cells that make up the omentum contain the biological equivalent of jet fuel.

"They feed the cancer cells, enabling them to multiply rapidly. Gaining a better understanding of this process could help us learn how to disrupt it."

The researchers suggest fat metabolism may also contribute to other cancers, such as breast, gastric and colon.

Dr Kat Arney, of Cancer Research UK, said: "These are important results because they suggest that fat cells in the stomach can fuel the spread of ovarian cancer, and point towards potential targets for the development of new treatments for the disease.

"But at the moment these are still early experiments using mice and cells grown in the lab, so there's still a lot of work to be done to turn this knowledge into a treatment that could help women with ovarian cancer."

• Pill 'lowers ovarian cancer risk' 26 OCTOBER 2011, HEALTH
• Early blood clue to ovary cancer 17 AUGUST 2011, HEALTH
• Blow to ovarian screening hopes 05 JUNE 2011, HEALTH

• Nature Medicine
• Cancer Research UK

'Shame on us nurses'

By Prof Ian Peate Consultant editor, British Journal of Nursing

Following the Care Quality Commission's recent report on what it called "alarmingly" poor care for elderly hospital patients, leading nurse Prof Ian Peate says in this week's Scrubbing Up that the profession should look again at how it trains people to look after older people.

Once again we read about the disgraceful care of our elderly and frail population and once again I cringe with embarrassment as I read how we abuse the people who we have the privilege to care for.
Yes I know there are some excellent examples of high quality outstanding care provided to people. But there is something seriously wrong here.
Nursing is well on its way to setting minimum standards for a degree level nursing programme and justifiably so, given the complexities of care and the demands the public rightly make in insisting on high quality, safe and effective care.
The Nursing and Midwifery Council (NMC) regulates nurses and midwives in the UK.
It sets standards for education, attempting to ensure that nurses possess the right skills and qualities when they start work as a qualified nurse.
What the NMC does not do is stipulate any mandatory requirements for elderly care. They leave this up to the individual educational institutions, so each will approach the teaching of elderly care in a variety of ways.
The time has come for the NMC to compel those running courses to stipulate how much time should be dedicated to the care of the elderly, in practice and theory.
There is a need to ensure that students of nursing - our future staff nurses who will be looking after me when I am older - are able to care confidently and competently for older people - geriatrics.
'High touch' - not high-tech
The art and science of gerontology has all but gone and this is a pity.
As a nursing student I was privileged to take a course that instilled in me the skills required to care for geriatrics patients, responding to their unique needs as people who have a number of concurrent illnesses and take a variety of medications.
If nurses get the care of older people right by applying the theory to practice, paying attention to feeding them and providing them with fluids, washing and cleaning them when they are unable to wash themselves, communicating with them and encouraging them through caring, kindness and compassion then caring for other patients will come naturally.

“Start Quote

We need to say sorry to our patients and to tell them what we are going to do to get it right”

End Quote Prof Ian Peate

These are high level skills that require the nurse to apply scientific principles to the art of caring.

As a student I was assessed, on the job - by an experienced nurse - in caring for geriatric patients. But that specific check is no longer required.
We should not be ashamed, embarrassed or made to feel politically incorrect when using the term geriatric.
It is a speciality, with care provided by skilled practitioners, on the geriatric ward as opposed to a busy acute medical ward where high-tech is favoured and preferred over "high-touch".
We have witnessed our medical colleagues embrace so-called "soft skills" (communication skills, a good bedside manner) through their improved undergraduate education.
NMC take heed.
Demand the curriculum you validate has explicit elements of geriatric care in them, in the classroom and on the ward; direct that no student will progress if they do not pass the an elderly care part of their course; continue to reinforce the need for all staff to speak out when they witness substandard or abusive care but also insist that those who speak out are supported.
Shame on us nurses.
We need to say sorry to our patients and to tell them what we are going to do to get it right, and we need to be brought to account each time we fail to provide care that is compassionate, kind and humane.

Cancer cases projected to rise 45% in next two decades

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Big projected rise in new cancer cases

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The number of new cancer cases in the UK could rise by 45% by 2030 to more than 430,000 a year, research suggests.

The rise is explained almost entirely by the expected increase in the number of people living in the UK and the ageing population.

Cancer Research UK, which funded the studypublished in the British Journal of Cancer, says the NHS must act now to avoid being "overwhelmed".

The Department of Health said it was already responding to the challenge.

The research presents projections for 23 different types of cancer. The results are based on taking figures from cancer registries going back to 1975, and then projected forwards to 2030, taking into account expected changes in population.

The study suggests that the number of new cases could rise from about 298,000 in 2007 to 432,000 by 2030 - an increase of 45%. The increase in men is forecast to be 55%, and 35% in women.

Drawing on data from the Office for National Statistics, the authors assume a rise in the population from 61m in 2007 to nearly 71m by 2030.

The proportion of elderly people is projected to grow at a faster rate. The figure for over 65s stood at 16% in 2007. By 2030 it is expected to reach 22%.

Continue reading the main story

“Start Quote

The NHS faces a perfect storm over the next 20 years.”

Harpal KumarCancer Research UK chief executive,

The impact of ageing is starkly reflected in the projected increase in the figures for prostate cancer, which is especially common in older men.

Cases are projected to increase from about 36,000 in 2007 to more than 61,000 by 2030. The authors say even this is probably an under-estimate because in future more men are likely to be tested for the disease.

Although the overall number of cancer cases appears set to rise, the authors conclude that after adjusting for the growing and ageing population, cancer rates are likely to remain "broadly stable". But there are variations within this.

The rate of breast cancer is projected to fall by 7%. The authors attribute this to a recent reduction in the use of hormone replacement therapy, which is a risk factor for the disease.

However the rates of malignant melanoma and kidney cancer are forecast to rise sharply in men and women.

One of the authors, Prof Peter Sasieni acknowledged that the figures should be treated with caution, but said they provided a framework.

"Projections of cancer cases are important for planning health services so we can understand where the future burden is on the NHS and also where health awareness messages need to be raised."

Cancer Research UK chief executive Harpal Kumar added: "At a time when the finances of the health service are being squeezed, it is absolutely crucial that health commissioners plan now for a massive increase in demand for cancer services, to ensure we provide high quality care to all."

The charity's director of health information, Sara Hiom, said: "Smoking and drinking alcohol are two of the biggest things that increase the chance of developing oral, liver and kidney cancer - so by stopping smoking and cutting back on alcohol, we can lower our risk of these cancers as well as other diseases.

"Maintaining a healthy bodyweight is also important in cutting the risk of liver and kidney cancers."

A spokesman for England's Department of Health said the NHS was already responding to the challenge of an ageing population and increases in cancer cases.

"That is why we are investing more than £750m over the next four years to make sure people are diagnosed with cancer earlier and have better access to the latest treatments," he added.

• Four in 10 get cancer - charity 14 JULY 2011, HEALTH
• Cancer survival rates 'doubled' 12 JULY 2010, HEALTH

• British Journal of Cancer
• Cancer Research UK

poachers demand up to $40,000 an animal

Poachers demanding $40,000 (£25,350) for one of the animals were caught by park rangers earlier this month in an undercover sting operation.

It was the fourth such incident since April, making this a record year for the poachers trying to feed a growing black market caught with baby gorillas.

Mountain gorillas are critically endangered, with around 790 remaining in the world - about 480 in the Virunga volcanoes conservation area (shared by DR Congo, Rwanda and Uganda) and just over 300 in the Bwindi Impenetrable Forest in Uganda. Eastern lowland gorillas are more numerous but largely outside protected areas and still in decline.

Emmanuel de Merode, director of Virunga national park, said: "We are very concerned about a growing market for baby gorillas that is feeding a dangerous trafficking activity in rebel controlled areas of eastern DRC.

"We are powerless to control the international trade in baby gorillas, but our rangers are doing everything they can to stamp it out on the ground." Merode added: "Four baby gorillas seized in less than a year is unusually high … [but] it's only the tip of the iceberg, as we only manage to catch a small proportion of the offenders because the wildlife service is under-resourced in Congo."

An infant gorilla was rescued on 6 October when a team of park rangers went undercover posing as potential buyers in the town of Kirumba, near the western border of the park.

Dressed in civilian clothes, they made contact and agreed a price for the one-and-a-half-year-old male eastern lowland gorilla that poachers were hiding in a small backpack. Rangers arrested the three poachers once they had possession of the gorilla.

Christian Shamavu, the leader of the operation, said: "It's very likely that the mother and other gorillas were killed because it's very difficult to take a baby gorilla from its family. The poachers will never admit to this, though."

Baby eastern lowland gorillas were confiscated from poachers in DR Congo in April and June, and Rwandan police recovered a baby mountain gorilla as poachers attempted to smuggle it over the border in August.

The animals suffer physical anguish during the process. Dr Jan Ramer, a vet with Mountain Gorilla Veterinarian Project (MGVP), partners with Virunga national park, said: "Many of these infants are injured from ropes around their hands, feet or waist, and some are quite ill, which is not surprising as they are generally in close contact with their human captors, extremely stressed, and with very poor nutrition."

But the newest orphan gorilla, named Shamavu after the ranger who rescued him, appears to be in good condition, Ramer added. "He appears to be quite healthy other than some parasites and dry skin."

The market price for infant gorillas can reach $40,000, but officials say they lack the resources or jurisdiction to investigate where the gorillas are headed or who is behind the trafficking.

International experts said they believe the route lies east. Ian Redmond, chairman of the conservation group the Ape Alliance, said: "We think the Middle East is a likely source of demand, wealthy animal collectors and a tradition of giving big gifts to curry favour … and maybe wealthy Russians, but there is little hard evidence.

"What we do know is that just the rumour that someone is looking to buy a baby ape can be enough for penniless hunters to think: 'I could get one of those and sell it for $$$$!' And in eastern DRC, once one is captured it is likely to be smuggled eastwards through either Rwanda or Uganda, the traditional trade routes for all goods in that area."

A report on ape trafficking by Karl Ammann, an investigative film maker, claimed that dozens of gorillas and hundreds and chimpanzees have been taken from Cameroon via Nigeria to Egypt.

Emmanuel de Merode added: "Surveillance is the key, at the borders, in the towns, along the roads. The local community are the best surveillance system, if they are on our side.

"A lot more could be done with respect to international trade, especially in the market countries where there is demand for baby gorillas. There, it's a question of enacting legislation and enforcing. As far as I know, very little has been done that's effective with respect to baby gorilla trafficking."

The drought in the Horn of Africa has put nearly 13.3million people in urgent

World Bank Group

Fact Sheet September 10, 2011

Response Plan

Drought in the Horn of Africa

1. The drought in the Horn of Africa has put nearly 13.3million people in urgent need of

humanitarian aid across Somalia, Ethiopia, Kenya, and Djibouti. The crisis has been escalating

dramatically in recent months, especially in Somalia, and as a result more people, crops and livestock

will be affected in the coming months.

2. Somalia remains by far the most affected country, with an estimated 40 percent of its total

population affected, living as internally displaced people or at refugee camps in neighboring countries

(primarily Kenya and Ethiopia). The Dadaab camp in Kenya is now the largest refugee settlement in the

world.

3. The situation is compounded by steep increases in food prices, which further undermine food

security in the region, with particularly adverse effects on poor households. Cereal prices are currently at

record levels in Somalia, Ethiopia and Kenya. The flow of refugees is putting additional pressure on

food markets across the sub-region, including in areas that were not directly impacted by the drought.

4. The World Bank’s International Development Association (IDA), the donor-funded Global

Facility for Disaster Reduction and Recovery (GFDRR), and the State and Peace Building Fund (SPF)

are making available $1.88 billion to respond to the drought crisis in three phases: the Rapid Response

phase covering the first six months, the Economic Recovery phase covering the first two years, and the

Drought Resilience phase focusing on implementation over a longer period of time.

5. The overall thrust of the Bank’s response seeks to link short-term crisis mitigation with longterm

development objectives both at country and regional levels.

Africa Region

World Bank Response – immediate, medium and long term interventions

Six months to

two years

Two to five years

First six months

Rapid

Response

Economic

Recovery

Drought

Resilience

- Increasing safety nets

- Cash transfer & cash for

work programs

- Recovery planning

- Early livelihood recovery

- Jump-starting crop and

livestock production

- Strengthen health facilities

- Resilience & preparedness

- Investments in drought

resilient agriculture, water

- Risk financing, resilience

planning & preparedness

- Investments in social

safety nets

Phases Timing Interventions

-Scaling up operations

through additional financing

- Reallocating operations

- Projects with contingency

and risk financing component

- New emergency projects

- Additional financing

- Emergency Recovery Loans

- Scaling up focus on drought

resilience through regular

investments

Instruments

Increased

livelihood

protection for

vulnerable

groups

Affected

people’s

livelihoods

enhanced

Impact of

drought

mitigated in the

coming years

Outcomes

$288 Million

$384 million

$1.2 billion

World Bank Group

Fact Sheet September 10, 2011

2

6. The first phase has already started and for which $288 million has been allocated for rapid response needs. This phase will continue till early 2012. Activities under this phase will aim at increasing livelihood protection for drought affected by supporting public health response, as well as providing critical safety nets in affected communities. In particular, emphasis is being placed on cash for work programs, cash transfers, health screenings and nutrition schemes targeting vulnerable populations, especially women and children. Resources allocated in this initial phase are also helping with recovery planning.

7. In the economic recovery phase, $384 million have been earmarked as medium-term needs. Activities under this phase will aim on boosting crops and livestock production through improved land management and efficient irrigation techniques. The overall objective will be to strengthen livelihood recovery.

8. The third and final phase, for which $1.2 billion has been allocated, will reinforce and amplify the Bank’s longstanding focus in building drought resilience in the sub-region. In particular, resources will be allocated to investments in drought resilient agriculture, risk financing, resilience planning and strengthening social safety nets.

9. Immediate relief and recovery in the hardest hit areas in Somalia remains an important priority. Political instability impedes access by humanitarian agencies and development partners, but United Nations agencies such as the FAO and the UNHCR have an ongoing presence and a proven ability to deliver in Somalia’s most affected areas. A $9 million project has been mobilized through GFDRR and the SPF for a proposed Drought Management and Livelihood Protection Project in Somalia that will help provide basic supplies to more people. The project will be implemented by FAO.

10. The severity, scale and regional dimension of the drought emergency in the Horn of Africa calls for a coordinated international response where the various partners each maximize their areas of competitiveness. To this end, a $30 million Horn of Africa Emergency Health and Nutrition Project supported by IDA CRW funds has been prepared, which will be implemented through UNHCR. These resources will go toward scaling up health, nutrition, and sanitation services at the two largest refugee settlements (Daabab camp in Kenya and the Dollo Ado in Ethiopia), so as to keep pace with the rapidly growing population and related risks.

Drought

Response

World Bank

UN

(WFP, FAO,

UNICEF,

UNHCR, WHO)

Regional

Organizations

IGAD, EAC,

AU

National

Governments

NGOs

and CSO

Science

FEWSnet,

NASA

Bi-lateral

Donors

IFRC

Red Cross

and Crescent

European

Union

World Bank Group

Fact Sheet September 10, 2011

3

11. The full scale of the economic impact of the drought emergency is not yet appraised, but could be far-reaching. The World Bank experts are contributing to a comprehensive needs assessment that will help inform the scale and form of interventions in the economic recovery and drought resilience phases of the response plan.

12. Following decades of recurring droughts in the Horn of Africa, several World Bank-financed projects have established contingency and risk financing mechanisms that can be used for rapid response to drought crises. In this context, Risk financing mechanism has been triggered under Productive Safety Net Program for Transitory Food Insecurity and $134.7 million has been made available for immediate disbursement. The project will cover 6.5 million beneficiaries and 311,252 transitory food insecure people till November.

13. The World Bank is reviewing a range of projects that can deliver additional financing to prompt economic recovery and drought resilience so recurring droughts do not take such a heavy human toll. Under the Rapid Response Plan, the World Bank has mobilized seven out of ten projects that are proposed to be financed (Additional Finance) from the Crisis Response Window resources. These projects are:

(1) Ethiopia: Productive Safety Net Program; cost $537 million; $70 million under CRW

(2) Kenya: Water and Sanitation Project; Project cost $50 million; $20 million under CRW

(3) Kenya: Health Sector Support Project; Project cost $56.9 million; $56.8 under CRW

(4) Djibouti: Employment &Human Capital Safety Net; cost $8.6 million; $5 under CRW

(5) Djibouti: GFDRR & TFEESD; Project cost $6.2 million; $3.5 required under CRW

(6) Djibouti: Rural Community Dev. & Water Mobilization; cost $7.8; $2 mil. under CRW

(7) Djibouti: Emergency grants for diesel/energy etc.; cost $2.7 million required under CRW

14. Community driven development programs will be supported, including water and sanitation projects, small-scale irrigation for agriculture, or broad support to drought affected farmers and farming activities. Incomes will be recovered through cash grants, public work schemes for temporary income, asset replacement, and micro-insurance schemes. As noted above, some of these interventions are already underway.

Although the region has faced droughts for decades, climate change is making them more intense.

15. In the longer term, it is important that countries in the Horn of Africa prepare for recurring droughts and the World Bank is supporting these efforts.

16. When combined with the region’s population increase, droughts are expected to lead to higher socio-economic impacts in years to come. Climate-smart agriculture is a priority and cross-border strategies for drought risk reduction are needed. The donors and development partners can help by supporting smallholder farmers with seeds, fertilizer, better weather forecasting, and monitoring crop production; creating better ways to get produce to markets; providing food and effective social safety nets for the most vulnerable.

World Bank Group

Fact Sheet September 10, 2011

4

17. The World Bank is boosting agriculture and agriculture-related investment to $6-$8 billion a year from $4.1 billion in 2008.

18. Specifically, the World Bank’s Agriculture Action Plan emphasizes increased support in five areas: raising agricultural productivity; linking farmers to markets; reducing risk and vulnerability; improving nonfarm rural employment; and making agriculture more environmentally sustainable, as well as a source of positive environmental services.

For information on the Global Center for Conflict, Security and Development in Nairobi, visit here.

www.worldbank.org/africa

Facebook: http://www.facebook.com/worldbankafrica

Twitter: http://www.twitter.com/worldbankafrica

YouTube: http://www.youtube.com/worldbank

Somali piracy: Armed guards to protect UK ships

Use of armed guards would be restricted to voyages through particular waters in affected areas

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• UN sanctions anti-piracy guards
• The losing battle against Somali piracy
• 
  

Ships sailing under a British flag will be able to carry armed guards to protect them from pirates, the prime minister has announced.

David Cameron says he wants to combat the risks to shipping off the coast of Somalia, where 49 of the world's 53 hijackings last year took place.

No ship carrying armed security has yet been hijacked, the government claims.

However, allowing ships to carry armed guards may fall foul of laws in other countries, such as South Africa.

Many British-registered ships already illegally carry armed guards because companies feel they have no alternative.

Shoot to kill?

Mr Cameron revealed he wanted to make the practice legal after talks in Australia with Commonwealth leaders from the region over the escalating problem faced in waters off their shores.

Asked if he was comfortable with giving private security operatives the right to "shoot to kill" if necessary, Mr Cameron told BBC1's Andrew Marr Show: "We have to make choices.

"Frankly, the extent of the hijack and ransom of ships round the Horn of Africa is a complete stain on our world.

Continue reading the main story

"The fact that a bunch of pirates in Somalia are managing to hold to ransom the rest of the world and our trading system is a complete insult and the rest of the world needs to come together with much more vigour."

France and Spain provide so-called military vessel protection detachments, while Italy is planning a similar measure.

However, in July, Foreign Office Minister Henry Bellingham said limited resources in the light of current military commitments could not allow Royal Marines to do the same.

Under the plans, the Home Secretary will be given the power to license vessels to carry armed security, including automatic weapons, currently prohibited under firearms laws.

Targeting assets

Officials said up to 200 could take up the offer, which would only apply for voyages through particular waters in the affected region.

Other counter-piracy measures being taken include offering support from Treasury officials to Kenya to help its officials track down pirates' assets.

Mr Cameron also said help could be given to countries such as The Seychelles and Mauritius who were acting to bring pirates to court and imprison them.

• UN sanctions anti-piracy guards 21 MAY 2011, AFRICA
• The losing battle against Somali piracy 10 FEBRUARY 2011, AFRICA
• Q&A: What do you do with a captured pirate? 25 JANUARY 2011, AFRICA

Jo Dent, regional director of CQC for Yorkshire and Humber

York Hospital criticised over patient resuscitation

The hospital's own guidelines say do not attempt resuscitation forms should be updated regularly

York Hospital has been criticised for not asking relatives of some patients if they should be resuscitated.

The Care Quality Commission (CQC) said York Teaching Hospital NHS Trust had failed to meet its own guidelines.

It said Do Not Attempt Resuscitation (DNAR) forms should be updated regularly, with relatives' views taken into account.

The trust said it was "sorry" if any distress had been caused and it would "listen" to the CQC's recommendations.

Inspectors visited the York Hospital, St Helen's Rehabilitation Hospital and White Cross Court Rehabilitation Hospital in July 2011.

'Difficult topic'

They found that DNAR forms at York Hospital and St Helen's were not being completed correctly.

The documents were also not being reviewed as required by the hospital's own guidelines.

This meant that some patients may have had an instruction in place which was out of date, incorrect or no longer in their best interests, inspectors said.

Jo Dent, regional director of CQC for Yorkshire and Humber, said: "We found DNAR forms which had been completed by a doctor but that there was no evidence to say that patients had been involved in the decision, or evidence that relatives, even where they were taking an active role in the patient's progress, had been consulted."

She added: "Doctors we spoke to agreed it was best practice to discuss these decisions with the family or next-of-kin and the patient themselves, where possible.

"But one doctor also told us that it was a difficult topic to raise with relatives and patients and that these decisions were often made when relatives were not around."

'Best interests'

Patrick Crowley, chief executive at York Teaching Hospital NHS Foundation Trust said the trust was "disappointed to be found wanting in any area".

He said everyone within the organisation recognised the "importance and sensitivity" of discussions with patients and their families regarding DNAR decisions.

"We are aware of individual cases where patients and relatives have understandably found this difficult and we are sorry if this has caused any undue distress," he said.

"We want to listen to this feedback to help us develop our processes and ensure we demonstrate that we are acting in patients' best interests."

Mr Crowley added that a new system was introduced not long before the CQC's visit, and that the trust was continuing to roll that out across the organisation.

However, he added that while the CQC found "a small number" of concerns, the reports also highlighted "many examples" of good practice.

CQC has given the trust 28 days to provide a report that says what action they are going to take to address the problem.

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• Care Quality Commission
• York Teaching Hospital NHS Foundation Trust

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It is thought extensive use of sunscreen

The disease, caused by low levels of vitamin D generated in the body from sunshine and certain foods, had died out around 80 years ago but is now coming back.

Cases of rickets in children have occurred in northern England and Scotland where there are fewer months of the year with sufficient sunshine to obtain enough vitamin D but now doctors are seeing it on the South coast as well.

It is thought extensive use of sunscreen, children playing more time on computer games and TV rather than playing outside and a poor diet are to blame.

Professor Nicholas Clarke, consultant orthopaedic surgeon at Southampton General Hospital and professor of paediatric orthopaedic surgery at the University of Southampton, said: "The return of rickets in northern parts of the UK came as a surprise despite the colder climate and lower levels of sunshine in the north, but what has developed in Southampton is quite astonishing."

Children from all backgrounds are being affected now and the disease is not limited to the poor as it was in Victorian times.