cunfuion over sunlight

Concerns over vitamin D deficiency -

 A quarter of toddlers affectedThe chief medical officer for England, Dame Sally Davies, is to contact medical staff about concerns young children and some adults are not getting enough vitamin D.

Government guidelines recommend some groups, including the under-fives, should take a daily supplement.

However, recent research found that many parents and health professionals were unaware of the advice.

There has been an increase in childhood rickets over the past 15 years.

According to Dr Benjamin Jacobs, from the Royal National Orthopaedic Hospital, links to heart disease and some cancers are also being investigated.

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The consultant paediatrician told BBC Breakfast that the hospital saw about one severe case a month of rickets - softening of bones through lack of vitamin D in childhood.

He said: "There are many other children who have less severe problems - muscle weakness, delay in walking, bone pains - and research indicates that in many parts of the country the majority of children have a low level of vitamin D."

The Feeding for Life Foundation report, published in October last year, suggested one in four toddlers in the UK is vitamin D deficient.

However, this may be an underestimate as only vitamin D from food was included, and not any vitamin D obtained through sun exposure.

Vitamin D supplements are recommended for all people at risk of a deficiency, including all pregnant and breastfeeding women, children under five years old, people aged over 65, and people at risk of not getting enough exposure to sunlight.

Vitamin D is mainly obtained from sunlight. However, too much sun exposure increases the risk of skin cancer.

According to one recent study, nearly three-quarters of parents and more than half of health professionals are unaware of the recommendations.

The Department of Health has asked the Scientific Advisory Committee on Nutrition to review the issue of current dietary recommendations on vitamin D.

Dame Sally Davies: "We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood. People at risk of vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements.

Free supplements

"Our experts are clear - low levels of vitamin D can increase the risk of poor bone health, including rickets in young children.

"Many health professionals such as midwives, GPs and nurses give advice on supplements, and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free vitamin supplements through our Healthy Start scheme.

"It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at-risk groups."

It has long been known that vitamin D prevents rickets and children were once given food supplements like cod liver oil.

However, this practice was stopped in the 1950s because it was thought unnecessary.

In the last 10 years, doctors have been seeing more cases of vitamin D deficiency, leading to a debate over the use of food supplements and concern that many medical staff are unaware of the problem.

mengele: Good communication reduces reliance on drugs

mengele: Good communication reduces reliance on drugs

Thorkil Sonne an extraordinary memory and a remarkable eye for detail.

Four years ago Thorkil Sonne realized that his young autistic son

 possessed an extraordinary memory and a remarkable eye for detail. Those traits are prevalent among people with autism, and Sonne saw an opportunity to help individuals with the disorder find productive employment. As the technical director of a Danish software venture, he knew those qualities were critical in software testers. So he went out on his own and launched Specialisterne, a Copenhagen-based software-testing firm that now has 51 employees, including 37 with autism, and revenues of $2 million.

You started your company to improve the lives of people with autism. Why not just create a nonprofit focused on research or job training?

I wanted to do more than just provide a sheltered workplace for people with a disability. My goal is to create opportunities for people with autism on an international scale. You might find money to support sheltered working environments in Scandinavia but not in Poland or Spain or Brazil. To extend its reach, our organization needs the kind of funding that only a profit-making venture can generate. It must succeed on market terms.

Is it hard to reconcile two missions—serving customers and aiding people with a disability?

We’re constantly asked whether we support customers or a cause. We want to do both, of course, but we’re always fighting against the suspicion that we’re just a charity. Our corporate social responsibility profile might open doors with CEOs, but executives in charge of software testing aren’t evaluated on CSR, only on getting the most for the company’s money. To wipe away their suspicions, we must exceed performance expectations every time.

All our business comes from the private sector. Because Denmark has no tradition of social enterprises, the government doesn’t earmark contracts for companies like ours or give them tax breaks. We have to compete head on.

How does managing autistic workers differ from managing other people?

Most of our consultants with autism have a mild form called Asperger’s and are high functioning. Still, because they’re often hypersensitive to noise, they can be uncomfortable in open-concept office spaces without doors or walls. They also have trouble working in teams and understanding social cues, such as gestures, facial expressions, and tone of voice. You have to be precise and direct with them, be very specific about your expectations, and avoid sarcasm and nonverbal communication. Though we expect employees to do their jobs well, we don’t ask them to excel socially or to interact all the time with others. We just find them the right role. That takes tremendous stress off them. I think normality is whatever the majority decides it will be, and in our company people with autism are the norm.

What about the relationships between customers and your autistic consultants?

About 70% of our work is done at customer sites. The customer appoints a contact—someone who’s good with special people, who will select the right tasks and a comfortable place for them. We also give our clients a short introduction to autism and to our firm’s unique culture. After working with our consultants, the customers start being more direct with their own colleagues and stating their expectations more clearly. That’s helped them improve in an area that many companies struggle with.

In what other ways might firms benefit by adopting your techniques for managing autistic employees?

Companies sometimes unknowingly employ autistic people because the condition often goes undiagnosed. But people with autism aren’t the only employees who don’t thrive in open offices or in the traditional management system, with its emphasis on teamwork and unclear instructions like “Figure out on your own how to deal with this.”

You have to get the most from employees, especially when labor is scarce. Our sector is crying out for manpower, but Specialisterne has many job seekers knocking on the door. The key is to find situations that fit employees’ personalities and ambitions, not force everybody into one mold. That just causes stress, and workplaces already produce too much of that.

NHS plans: Unions move to 'outright opposition

The unions representing nurses and midwives have joined others in stating their "outright opposition" to the government's NHS plans in England.

The Royal College of Nursing and the Royal College of Midwives had expressed concerns in the past, but said they were willing to work with ministers.

However, now they want the entire bill covering the changes to be dropped.

Health Secretary Andrew Lansley said the unions wanted to "have a go" at government about "pay and pensions".

The colleges' stance comes after a similar move by the British Medical Association last year.

It also mirrors the stance adopted by Unison, which represents a host of administration and support staff, such as porters.

But what impact this intervention has remains to be seen.

The Health and Social Care Bill is still working its way through Parliament, and the bill is in the Lords at the moment.

In many ways it is over the worst political hurdles and it seems the only way it could be stopped would be if the Lib Dems blocked it when it returns to the Commons - but that is considered unlikely.

On the ground, changes are already being made to pave the way for the new system to kick in, in 2013.

For example, while the doctors union is against it there has still been enough GPs coming forward to pilot the new plans in 97% of the country.

Anger

Under the plans, GPs are being put in charge of much of the NHS budget, while the health service is being opened up to greater competition from the private and voluntary sector.

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In June the government announced a series of changes to the original proposals in the face of mounting opposition.

These included giving health professionals other than GPs more power over how NHS funds were spent, as well as watering down the role of competition.

The health unions initially gave the changes a cautious welcome, but they have been left disappointed by the finer details that have emerged during the parliamentary process.

One of the key developments was the news, which emerged just after Christmas, that NHS hospitals would be allowed to do 49% of their work in the private sector.

Peter Carter, general secretary of the RCN, which represents 410,000 nurses, midwives, support workers and students, said: "The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil, however, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them.

"The sheer scale of member concerns, which have been building over recent weeks, has led us to conclude that the consequences of the bill may be entirely different from the principles which were originally set out."

Cathy Warwick, of the RCM, said: "The government has failed to present sufficient evidence that its proposals are necessary. They have failed to present evidence that the upheaval will result in an improvement in services to the people of England.

"And they have failed to answer the concerns of the people who fear for the future of the NHS under these plans."

Savings plans

Both unions also expressed concerns that the changes were compromising the ability of the NHS to make the £20bn of savings it has been asked to make by 2015.

Mr Lansley said that nurses had previously been "right at the heart" of the process of planning reforms to the NHS to deliver better care for patients.

"The only thing that has happened in the last few weeks that has led to this situation with the Royal College of Nursing, is that the two sides of the Royal College of Nursing have shifted," he told BBC Breakfast.

"They used to be a professional association that was working with us on professional issues, and will carry on doing that, but now the trade union aspect of the Royal College of Nursing has come to the fore.

"They want to have a go at the government - and I completely understand it - they want to have a go about things like pay and pensions."

A Department of Health spokesman said: "The bill is needed to empower doctors, nurses, and other front-line healthcare workers across the NHS to take charge of improving care.

"We will continue to work with nurses and all other health professionals to ensure that the NHS delivers the best possible care for patients."

Shadow health secretary Andy Burnham said it was time to scrap the bill.

"A reorganisation on this scale needs a professional consensus for it to succeed. A year since the bill was introduced, it is abundantly clear that the government's plans do have failed to build that."

Analysis

The move by the two unions is unlikely to see the bill stopped in its tracks.

But it is clear the government's relationship with NHS staff is fracturing, possibly beyond repair.

Some inside government were saying the move by the royal colleges was being driven by their dissatisfaction over pensions.

That has undoubtedly played a role. So too has the drive to make £20bn of savings by 2015 - the equivalent of 4% of the budget a year.

This is putting more and more pressure on hospitals and waiting times in particular.

It means there is a toxic cocktail brewing inside the health service - and this spells trouble for the government.

It came to power saying - in private at least - that the NHS was its good news story, but all too often it is finding the headlines are negative.

Indian TB

Indian TB cases 'can't be cured'

Some strains are becoming resistant to antibiotics

Continue reading the main story

Related Stories

• Plan to tackle drug-resistant TB
• TB vaccine provides 'double hit'
• 'First ever' fall in global TB

Tuberculosis which appears to be totally resistant to antibiotic treatment has been reported for the first time by Indian doctors.

Concern over drug-resistant strains of TB is growing, with similar 'incurable' TB emerging in Italy and Iran.

Doctors in Mumbai said 12 patients had a "totally drug resistant" form of the infection, and three have died.

The Indian Health Ministry is investigating the cases and has sent a team of doctors to Mumbai.

TB is one of the world's biggest killers, second only to HIV among infectious diseases.

Normally a patient with TB is given a six to nine month course of antibiotics to eradicate it.

However, new strains of the bacterium have developed which are increasingly resistant to the antibiotics most commonly used to treat it.

Partially drug-resistant TB can now found in countries across the world, and "multi-drug resistant" strains affect countries such as Russia and China.

'Serious threat'

The Indian reports will fuel concerns over the ability of doctors to contain the disease in years to come.

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“Start Quote

Anytime we see something like this, we better get on top of it before it becomes a more widespread problem”

Dr Kenneth CastroCenters for Disease Control

The doctors at the Hinduja National Hospital in Mumbai who discovered it said they had treated patients for up to two years with a battery of drugs, to no avail.

The patients came from slum areas of the city, they said, where close contact between people meant further spread was likely.

The American Centers for Disease Control (CDC) confirmed that the Indian strain did appear to be completely resistant.

Dr Kenneth Castro, director of its Division of Tuberculosis Elimination, said: "Anytime we see something like this, we better get on top of it before it becomes a more widespread problem."

Patients who do not finish their lengthy course of treatment also present the bacterium with the perfect environment for developing further resistance.

However, there have been repeated calls for the pharmaceutical industry to make more efforts to develop fresh antibiotics.

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TB

• Tuberculosis is an infectious disease that usually affects the lungs
• It is transmitted via droplets from the lungs of people with the active form of the disease
• Symptoms of TB include coughing, chest pains, weakness, weight loss, fever and night sweats
• Tuberculosis is usually treatable with a course of antibiotics

Dr Ruth Mcnerney, a senior lecturer at the London School of Hygiene and Tropical Medicine and a trustee of charity TB Alert, said the new cases represented a "serious threat" to global efforts to control TB.

"What we're seeing is probably just the tip of the iceberg. We don't know how widespread this is because so few people are tested for drug resistance."

She said the high prevalence of TB in India, coupled with high population density within its cities, meant that the new type of TB could be a bigger problem than previous "totally resistant" strains.

"It's going to take a massive effort and change in political will to get to grips with this - not just from the Indian government but from everyone else. This is a global problem, not just an Indian one."

More on This Story

Related Stories

• Plan to tackle drug-resistant TB 14 SEPTEMBER 2011, HEALTH
• TB vaccine provides 'double hit' 23 JANUARY 2011, HEALTH
• 'First ever' fall in global TB 11 OCTOBER 2011, HEALTH

Depression drugs ‘causing falls’

Falls are the leading cause of accidental death in the over-65s

Continue reading the main story

Related Stories

• 'Poor' NHS care for elderly falls
• 'My mother's care was appalling'
• Elderly broken hip care concerns

Elderly people with dementia are more likely to suffer falls if they are given anti-depressants by care home staff, a study claims.

Many dementia patients also suffer from depression and drugs known as selective serotonin uptake inhibitors (SSRIs) are frequently prescribed.

But the British Journal of Clinical Pharmacology reports that the risk of injuries from falls was tripled.

The Alzheimer's Society called for more research into alternative treatments.

The risk of falls following treatment with older anti-depressants is well established, as the medication can cause side effects such as dizziness and unsteadiness.

It had been hoped that a move to newer SSRI-type drugs would reduce this problems, but the latest research, from the Erasmus University Medical Center in Rotterdam, appears to show the reverse.

'Worrying'

Dr Carolyn Sterke recorded the daily drug use and records of falls in 248 nursing home residents over a two-year period.

The average age of the residents was 82, and the records suggested that 152 of them had suffered a total of 683 falls.

The consequences of falls were relatively high, with 220 resulting in injuries including hip fractures and other broken bones - and one resident died following a fall.

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“Start Quote

More research is now needed to understand why this anti-depressant is having this effect on people with dementia and if there is an alternative treatment for depression that they could be prescribed”

Professor Clive BallardAlzheimer's Society

The risk of having an injury-causing fall was three times higher in residents taking SSRIs compared with those not taking the drug, and this risk rose further if the patient was being given sedative drugs as well.

Dr Sterke said that these risks needed to be taken into account when assessing whether anti-depressants were required.

She said: "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses."

Professor Clive Ballard, from the Alzheimer's Society, said it was "worrying" that such a commonly prescribed anti-depressant was causing increased risk.

He said: "It is important to highlight any aspect of care that might be causing risk to a person with dementia. We want to ensure that people with the condition are always receiving the best care possible.

"More research is now needed to understand why this anti-depressant is having this effect on people with dementia and if there is an alternative treatment for depression that they could be prescribed.

"One in three people over 65 will die with dementia yet research into the condition continues to be drastically underfunded. We must invest now.'

More on This Story

Related Stories

• 'Poor' NHS care for elderly falls 18 MAY 2011, HEALTH
• 'My mother's care was appalling' 11 NOVEMBER 2010, HEALTH
• Elderly broken hip care concerns 02 SEPTEMBER 2010, HEALTH
• Falls cost NHS millions each day 21 JUNE 2010, HEALTH

meat 'linked to pancreatic cancer

Processed meat 'linked to pancreatic cancer'A link between eating processed meat, such as bacon or sausages, and pancreatic cancer has been suggested by researchers in Sweden.

They said eating an extra 50g of processed meat, approximately one sausage, every day would increase a person's risk by 19%.

But the chance of developing the rare cancer remains low.

The World Cancer Research Fund suggested the link may be down to obesity.

Eating red and processed meat has already been linked to bowel cancer. As a result the UK government recommended in 2011 that people eat no more than 70g a day.

Prof Susanna Larsson, who conducted the study at the Karolinska Institute, told the BBC that links to other cancers were "quite controversial".

She added: "It is known that eating meat increases the risk of colorectal cancer, it's not so much known about other cancers."

The study, published in the British Journal of Cancer, analysed data from 11 trials and 6,643 patients with pancreatic cancer.Increased risk

It found that eating processed meat increased the risk of pancreatic cancer. The risk increased by 19% for every 50g someone added to their daily diet. Having an extra 100g would increase the risk by 38%.Prof Larsson said: "Pancreatic cancer has poor survival rates. So as well as diagnosing it early, it's important to understand what can increase the risk of this disease."

She recommended that people eat less red meat.

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Cancer Research UK said the risk of developing pancreatic cancer in a lifetime was "comparatively small" - one in 77 for men and one in 79 for women.

Sara Hiom, the charity's information director, said: "The jury is still out as to whether meat is a definite risk factor for pancreatic cancer and more large studies are needed to confirm this, but this new analysis suggests processed meat may be playing a role."

However, she pointed out that smoking was a much greater risk factor.

The World Cancer Research Fund has advised people to completely avoid processed meat.

Dr Rachel Thompson, the fund's deputy head of science, said: "We will be re-examining the factors behind pancreatic cancer later this year as part of our Continuous Update Project, which should tell us more about the relationship between cancer of the pancreas and processed meat.

"There is strong evidence that being overweight or obese increases the risk of pancreatic cancer and this study may be an early indication of another factor behind the disease.eating red and processed meat and your chances of developing bowel cancer, which is why WCRF recommends limiting intake of red meat to 500g cooked weight a week and avoid processed meat altogether."

Routine aspirin 'may cause harm'

Healthy people who take aspirin to prevent a heart attack or stroke could be doing more harm than good, warn researchers.

An analysis of more than 100,000 patients, published in Archives of Internal Medicine, concluded the risk of internal bleeding was too high.

The UK-led study said only people with a history of heart problems or stroke should take the tablets.

Experts said any decision should be made with a doctor.

Aspirin helps people who have had a heart attack or stroke. It prevents blood clots from forming by preventing cells, known as platelets, from sticking together. By reducing the number of clots formed, the tablets reduce the risk of another heart attack or stroke.

There have also been suggestions that the drug can prevent some cancers, however, the drug is known to increase the chance of internal bleeding, including bleeds on the brain.

The discussion has been whether at-risk or even healthy people should also take aspirin.

Official guidelines were issued in 2005 by the Joint British Societies, which includes the British Cardiac Society, British Hypertension Society and The Stroke Association. It recommended 75 mg of aspirin a day for high risk patients over the age of 50. The Drugs and Therapeutics Bulletin said in 2008 that preventative aspirin should be abandoned unless there was already evidence of cardiovascular disease.

Good or bad?

Researchers analysed data from nine trials, from a total of 102,621 patients.

They said that while there was a 20% reduction in non-fatal heart attacks in people taking aspirin, there was no reduction in deaths from heart attack, stroke or cancer.

Meanwhile the risk of potentially life threatening internal bleeding increased by 30%.Prof Kausik Ray, from St George's, University of London, told the BBC: "If you treat 73 people for about six years you will get one of these non-trivial bleeds.

"If you treat about 160 people for the same period of time, you're preventing one heart attack that probably wouldn't have been fatal anyway.

"It suggests that the net benefit for aspirin is not there, it certainly doesn't prolong life. If you think about it the net benefit, actually there is net harm.

The study followed patients for an average of six years. An analysis led by Prof Peter Rothwell, from Oxford University, suggested that regularly taking aspirin reduced the risk of a series of cancers, when patients were followed for much longer.

Prof Rothwell said the new study was "very nicely done, but I don't think it develops [the argument] much further".

He added: "It really just emphasises the need for a more detailed analysis of how risks change over time."

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: "Aspirin can help reduce the risk of heart attack or stroke among those with known heart disease, and this group of people should continue to take aspirin as prescribed by their doctor.

"Our advice is that people who don't have symptomatic or diagnosed heart disease shouldn't take aspirin because the risk of internal bleeding may outweigh the benefits.

"If you're taking prescribed aspirin and have any concerns, don't simply stop taking it. Always talk to your doctor first."

Sotiris Antoniou, from the Royal Pharmaceutical Society, said: "People who buy aspirin should consult with their pharmacist to make sure that it is appropriate for them based on their individual likelihood of having a heart attack or stroke and their likelihood of experiencing a side effect such as stomach ulceration.

"If you are already taking aspirin, don't simply stop taking it, speak to the pharmacist about your individual circumstances."