Wednesday 26 December 2012


Norovirus: The winter vomiting bug that is hard to conquer

Norovirus is the Ferrari of the virus world," says Professor Ian Goodfellow, a Wellcome Trust fellow


Vomiting bug still affects wards

'Vomiting Larry' is busy being sick over and over again in an experiment to test just how far the winter vomiting bug can travel when it makes you ill.
Lucky for Larry, he is not a constantly retching human - but a simulated vomiting system that shows the virus can travel an impressive 3m (9.8ft) in a projectile episode, according to his creators at the Health and Safety Laboratory.
The winter vomiting bug (norovirus) has been responsible for an estimated 880,000 cases of vomiting and diarrhoea in the UK since the summer.
It is a hardy virus that clearly spreads with ease - one of the few infections you really can catch from a toilet seat, or even from the air in the bathroom if an infected person has recently pulled the flush.
Luckily most people make a full recovery in a few days, but for anyone who is already vulnerable - people who are already unwell or in their later years for example - it can pose a serious threat.
It was first noticed when 150 children at the Norwalk-Bronson Elementary School in Ohio were all struck down with the bug in 1968.
This 40-year-old incident is now eternalised in medical history, making up the first part of the virus's name.
And unsuspecting groups of students continue to be knocked down by its tenacious grip on the small intestine.
A girls' football team from Canada was taken ill after a team-mate developed the illness - but she had had no contact with them.
The culprit was a grocery bag in the corner of the bathroom she had used.
Computer model of the virusOne in 20 people in the UK suffer from norovirus each year
Aerosolised particles of the virus landed on the grocery bag, and spread to members of the team who touched the bag or ate the packaged crisps and cookies inside it, according to research published in the Journal of Infectious Diseases.
And it can stick around for a long time.
It is widely accepted that it can last for two weeks on hard surfaces, says Professor Ian Goodfellow of the University of Cambridge.
It is not only its ability to travel so far or survive on everyday surfaces that makes it, in viral terms, "the ideal infectious agent", says Dr Aron Hall, from the Centers for Disease Control and Prevention in the US.
'Rapid reproduction'
As few as 18 viral particles can infect a new person, but there are often thousands of particles present in each drop of vomit.
And it is able to reproduce at a rapid speed - thousands of times more quickly than humans.
The fact it makes most of us only mildly or moderately ill is all part of its high-achieving strategy.
If it made people more seriously ill, or even killed them, it would not be able to spread so well.
"From an evolutionary stand point if you kill your host you are not going to have anywhere to live, so keeping your host alive has its advantages," says Dr Hall.
All these factors make it very difficult to stop in its tracks.
That is, apart from the good old fashioned method of washing your hands with soap and water.

NOROVIRUS

  • Symptoms include vomiting and/or diarrhoea
  • You may also have a fever, headache and stomach cramps
  • Over-the-counter medicines can be useful in treating headaches and other aches and pains
  • Do not visit your GP surgery or A&E unit if you have it
  • If symptoms persist for more than three or four days, or if you have a serious illness, seek medical attention through contact with your GP
  • Wash hands thoroughly, particularly after using the toilet and before eating
  • Clean hard surfaces with detergent followed by disinfection with a bleach solution, paying particular attention to the toilet and surrounding area
According to a study of seven outbreaks at an international scout jamboree, each boy scout who had the infection passed it on to 14 others until enhanced hygiene measures were imposed.
This included separate bathrooms for infected people and strict hand-washing regimes.
The number of infections passed on per person then went down to two - but still not enough to stop it from spreading completely.
The virus also manages to evade many commonly used alcohol gels and some domestic cleaning products.
You are safe with thoroughly cooked food, but it can escape freezing and mild heating.
Scientists have spent many years trying to find a way to stop it from closing hospital wards, leaving offices short-staffed in winter months and causing chaos on cruise ships.
Legend has it that the first of the now many attempts to study the virus involved volunteers who drank the filtered diarrhoea of people who had the infection.
Study designs may have moved on a lot since then, but we are still far from finding a cure.
One of the reasons is that no one has been able to persuade the virus to grow in a lab, says Prof Ian Goodfellow:
"In my lab we are trying to understand how these viruses work, with the overall aim of trying to identify a drug that will prevent infection and control outbreaks when they do occur," he says.
But no one has yet pinned down why it is so elusive. And until a vaccine or cure is found it is likely to continue to put some people off their turkey this Christmas.

Tuesday 25 December 2012

patient neglect


Alexandra Hospital neglect: Jeremy Hunt 'disgusted'

Alexandra Hospital, RedditchVulnerable patients were left starving and thirsty, a solicitor for the families said in a statement

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Health Secretary Jeremy Hunt has said he is "disgusted and appalled" at accounts of patient neglect at a hospital in Worcestershire.
It was claimed in one case an 84-year-old man starved to death at Redditch's Alexandra Hospital in 2009.
Worcestershire Acute NHS Hospital Trust will apologise to the families of 38 people and many will receive a payment of, on average, about £10,000.
In a statement, the trust issued an apology over its "shortcomings".
'Appalling failings'
The incidents happened between 2002 and 2011, with 35 cases brought against the Alexandra Hospital and three against the Worcestershire Royal Hospital, Worcester.
Lawyers for the families started a class action against the trust 15 months ago, after failings in basic day-to-day care were highlighted in a report by health watchdog the Care and Quality Commission (CQC).
Inspectors concluded the trust was breaking the law in failing to meet "essential standards".
Health bosses at the trust agreed in November to write to each of the families apologising for lapses in care, but have not admitted legal liability.
The financial payments will total £410,000.

Start Quote

The most shocking thing about these cases is the fact that they went on over so many years”
Solicitor Emma Jones
Lawyer Emma Jones, who brought the legal action, said the failings uncovered were "appalling".
Some patients treated by the trust were left thirsty with drinks left out of reach, while others were left to sit in their own excrement, she said.
A man was unable to feed himself and nurses would simply take his uneaten food away, according to his daughter.
There were further claims from the families of a man whose ribs were broken while hospital staff tried to lift him and a great-grandmother whose hip fracture went undetected by doctors.
Former nurse Patricia Brindle, 86, was left unwashed for 11 weeks despite her son Peter begging nurses for her to be bathed, he said.
Mrs Brindle, from Redditch, was admitted to the Alexandra Hospital in 2008 after a suspected mild stroke. She was transferred to another hospital but died a few days later.
Mr Hunt said: "I am disgusted and appalled to read these accounts of what patients and their relatives went through.
"These are examples of the sort of 'care' that should simply not happen in the NHS and there is no excuse for them.
"We will be keeping a careful eye on this situation, and will take further action if necessary."
'Significant changes'
Ms Jones said: "The most shocking thing about these cases is the fact that they went on over so many years, despite repeated assurances given from the management of the hospital.
"Families who complained were told that changes would be made so others would not have to endure these kinds of failings but, in fact, the problems were not tackled.
"Although the issues went on for almost a decade, we are pleased that the current management seems to be taking the matter seriously and making changes, and righting wrongs."
In March 2011, CQC inspectors arrived unannounced at the Alexandra Hospital and concluded the trust needed to improve care.
The trust said in a statement: "Whilst the trust has accepted that certain aspects of the care afforded to some patients fell below the standard that they were entitled to expect, all of the cases cited are several years old, in many incidences, more than a decade old.
"A number of very serious allegations made by the families of deceased patients are not borne out by the medical records.
"Nevertheless, the trust accepts that the care afforded to some patients some years ago - between 2002 and 2009 - fell below the requisite standard and has apologised for the shortcomings."
It said that following an inspection by the CQC in early 2011, "significant changes have been made to ensure patient care is excellent".

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Multiple sclerosis: World's highest rate in Orkney Islands

Brain scan of MS patientMS disrupts messages from the brain to the rest of the body

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Scotland's Orkney Islands have the highest rate of multiple sclerosis (MS) in the world, according to a major new study.
Researchers said that the rate for probable or definite MS was now 402 per 100,000 people, up from a previous 309 per 100,000 which was recorded in 1974.
Teams at the universities of Edinburgh and Aberdeen carried out the study.
They are now trying to work out why the figure in Orkney is so high, but believe genes could play a key role.
With MS, the protective layer around nerves, known as the myelin sheath, becomes damaged.
Messages from the brain to the rest of the body are disrupted, resulting in difficulty moving, muscle weakness and blurred vision.
There are many suspected risk factors, and the disease is known to be more common away from the equator.
MS affects about 100,000 people in the UK.
The new study found that one in 170 Orcadian women suffer from the condition.
The current figure for Orkney compares to 295 per 100,000 in Shetland and 229 per 100,000 in Aberdeen.
'So high'
Dr Jim Wilson, of the University of Edinburgh's Centre for Population Health Sciences, said: "Our study shows that Orkney has the highest prevalence rate of MS recorded worldwide.
"These findings may reflect improved diagnostic methods, improved survival or rising incidence.
"We are trying to work out why it is so high, but it is at least partly to do with genes."
It has previously been noted that areas of high MS prevalence around the world have been settled in by Scottish immigrants.
'Interesting study'
Previous studies have shown high rates of MS in Canada and Scandinavia.
The new study is published in the Journal of Neurology, Neurosurgery and Psychiatry.
An MS Society spokesperson said: "This in an interesting study which highlights the high prevalence of MS in Orkney, but it's still not clear why this might be the case.
"Further research is essential to build on our knowledge of the underlying causes of MS so that potential treatment and preventative strategies can be developed."

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Simple eye scan can reveal extent of Multiple Sclerosis



Simple eye scan can reveal extent of Multiple Sclerosis

EyeThe retina sits at the back of the eye and houses the cells that provide us with vision

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A simple eye test may offer a fast and easy way to monitor patients with multiple sclerosis (MS), medical experts say in the journal Neurology.
Optical Coherence Tomography (OCT) is a scan that measures the thickness of the lining at the back of the eye - the retina.
It takes a few minutes per eye and can be performed in a doctor's surgery.
In a trial involving 164 people with MS, those with thinning of their retina had earlier and more active MS.
The team of researchers from the Johns Hopkins University School of Medicine say larger trials with a long follow up are needed to judge how useful the test might be in everyday practice.
The latest study tracked the patients' disease progression over a two-year period.
Unpredictable disease
Multiple sclerosis is an illness that affects the nerves in the brain and spinal cord causing problems with muscle movement, balance and vision. In MS, the protective sheath or layer around nerves, called myelin, comes under attack which, in turn, leaves the nerves open to damaged.
There are different types of MS - most people with the condition have the relapsing remitting type where the symptoms come and go over days, weeks or months.
Usually after a decade or so, half of patients with this type of MS will develop secondary progressive disease where the symptoms get gradually worse and there are no or very few periods of remission.
Another type of MS is primary progressive disease where symptoms get worse from the outset.
There is no cure but treatments can help slow disease progression.
It can be difficult for doctors to monitor MS because it has a varied course and can be unpredictable.
Brain scans can reveal inflammation and scarring, but it is not clear how early these changes might occur in the disease and whether they accurately reflect ongoing damage.
Scientists have been looking for additional ways to track MS, and believe OCT may be a contender.
OCT measures the thickness of nerve fibres housed in the retina at the back of the eye.
Unlike nerve cells in the rest of the brain which are covered with protective myelin, the nerve cells in the retina are bare with no myelin coat.
Experts suspect that this means the nerves here will show the earliest signs of MS damage.
The study at Johns Hopkins found that people with MS relapses had much faster thinning of their retina than people with MS who had no relapses. So too did those whose level of disability worsened.
Similarly, people with MS who had inflammatory lesions that were visible on brain scans also had faster retinal thinning than those without visible brain lesions.
Study author Dr Peter Calabresi said OCT may show how fast MS is progressing.
"As more therapies are developed to slow the progression of MS, testing retinal thinning in the eyes may be helpful in evaluating how effective those therapies are," he added.
In an accompanying editorial in the same medical journal that the research is published in, MS experts Drs Robert Bermel and Matilde Inglese say OCT "holds promise" as an MS test.

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Sunday 23 December 2012

'I have plenty of people to do things with, I just have no one to do nothing with


Lonely Britain

When Esther Rantzen wrote in the Mail about her aching loneliness, she broke a great social taboo. The huge and heartfelt response she received paints a devastating portrait

By Esther Rantzen

  • A few weeks ago, I wrote (with some trepidation, I must confess) about the aching loneliness that sometimes overwhelms me. How I often wake at midnight still lying on the sofa, the TV blaring and lights blazing, and have to force myself to my empty bed.
I admitted that now I have been a widow for ten years, with grown-up children who have busy lives of their own, I dreaded the empty weekends and didn’t go on holiday this year because it seemed pointless to go somewhere gorgeous without anyone to share it with.
Worst of all, I confessed I had started pressurising my daughter to give up her independence and move in with me. I didn’t expect much sympathy.
All by myself: But Esther discovered she isn't alone in feeling lonely
All by myself: But Esther discovered she isn't alone in feeling lonely
After all, as a famous novelist once declared: ‘Forget sex or politics or religion: loneliness is the subject that clears out a room.’
But then a strange thing happened. Of all the articles and books I have written, the subject provoked by far the greatest response. I was inundated with letters and emails — some expressing sympathy, others advice, but most sharing their own tales of aching isolation.
It was only as I read them that the scale of this epidemic of loneliness in Britain started to become clear to me.
Their stories chimed with a shocking report earlier this month from a group called the Campaign To End Loneliness, focusing, in particular, on the ‘pernicious impact’ of isolation on older people.


It included the startling fact that, according to the World Health Organisation, loneliness poses a huge health risk — even more, they say, than smoking. The report estimates that loneliness ‘blights the lives of about one in ten older people’.
So what lessons can be learned from the many, often moving, responses I received?
The first is that loneliness is a subject we need to talk about, because unless we do, we can never solve it. And solve it we must. Because what was most clear from your letters is that loneliness is all around us, yet too often it remains invisible.


'Loneliness has a shaming quality born out of the perception of social failure. It is an ache that dares not speak its name'
Loneliness does not respect gender or age. And money in the bank is certainly no defence against it. Young and old have written to me, divorcees and disabled people, widowers and many, many widows, because, alas, we women tend to outlive the men we love.
But we don’t talk about it because loneliness bears its own stigma. Many correspondents wrote about the ‘shame’ they felt, and how ‘brave’ and ‘honest’ I had been, and in their letters they revealed just how much of a taboo there is in admitting that you feel lonely.
In fact, one friend was angry with me for writing about my predicament. ‘How could you, Esther? Don’t you have pride?’ he said.
Another friend neatly summed up why people don’t admit to loneliness.
He told me: ‘Loneliness has a shaming quality born out of the perception of social failure. It is an ache that dares not speak its name for fear that people will think us needy, and so will shun us like an empty restaurant.’
As a result, it seems there are many people who prefer to disguise their loneliness and put on a brave face to the wider world and even to their families.
‘J’ from Surrey wrote to me: ‘When I was first widowed, I told my family I was “fine” so they were able to go back, as they should, to their busy lives. By trying not to make a fuss, though, we may have shot our ourselves in the foot!’
But sharing our feelings, and knowing you are not the only one to experience this, is a source of comfort.
Esther Rantzen
Esther didn't like to talk about loneliness because it bears its own stigma
I searched among your letters for the cure for loneliness. But for many, there is no complete cure. No one can bring back the love they have lost, or fill the empty rooms.
Instead, I found many suggestions about ways to alleviate the symptoms; something as simple as keeping the radio on, or buying a puppy, or learning new skills. Many who wrote had forced themselves to be proactive and were now reaping the benefits.
Pat Woods, aged 68, from Lincoln, said that after she lost her husband Alan, she knew no one would walk up her garden path and take her under his wing — ‘so I decided I had better try to do something myself.
‘I had a cheese-and-wine evening, and invited ten widows. Like you, I thought weekends were dreadful, and so I suggested that on the first Sunday of the month we should take it in turns to meet at each other’s homes.

'I have plenty of people to do things with, I just have no one to do nothing with'
‘That was five years ago, and we are now 22-strong. We have visited Crete, Krakow and Berlin, and London for the theatre.
‘We have enormous fun, much laughter, and when you are feeling low, there is always someone there who understands.’
Margaret Bell, from Tonbridge, had a similar inspiration. Four years ago, she and two friends started up CAMEO (Come And Meet Each Other) — and they do, 40 men and women. Most of them are bereaved, but not all.
‘We manage to find at least 12 things a month to do: Sunday lunches, films, shows, walks, minibus outings, plays, concerts,’ she told me.
‘Last year, 11 of us went on our first CAMEO holiday to Scotland, which was such a success that this year, 15 of us went to the Isle of Wight.’

Of course, there are existing organisations that can fill the gap for some people. The Church is widely praised, as are the Women’s Institute and the Townswomen’s Guild. Institutions like these are ones we should treasure.
But, for others, activities are not enough to ease the sense of isolation. And it’s especially so for those, like me, who lose a soulmate.
My husband Desmond Wilcox died in 2000 after 23 years of marriage. I have plenty of work to distract me, but my home is dark and empty when I return at night.
As the legendary journalist Felicity Green once said: ‘I have plenty of people to do things with, I just have no one to do nothing with.’
Empty home: Being without husband Desmond Wilcox is the worst part of Esther's loneliness
Empty home: Being without husband Desmond Wilcox is the worst part of Esther's loneliness
Mary Simpson emailed me to say that for her, loneliness is like being trapped in ‘quicksand’. Advice on pulling herself together is useless , she said, because as she struggles, she just feels she falls deeper into it.
I know only too well that for some of us the loss of that life partner — the warmth, the laughter, the sharing — is the sharp edge that draws blood. Having experienced that closeness, you miss it desperately.
While some are lucky to meet new partners, many don’t. And I don’t think there’s any easy solution, except perhaps to learn to count your blessings.
As I read the kind, brave letters I received, I felt as if I’d suddenly found a new community of friends.
But some, of course, have taken me to task. They rebuke me for not appreciating how lucky I am to have my health and my family.
I do know that. And I am hugely fortunate to own a cottage in the country, with a lovely garden that Desmond created with me.
Jacqueline Norris from Farnborough points out that I’m daft just to sit at home fixing myself the single person’s constant meal of cheese and biscuits.
‘You say you have a country cottage — so use it!’ she reprimands. ‘Marvel at nature. And do cook for yourself – just something simple. You will enjoy the preparation — and the satisfaction of being able to tell the family what you’ve enjoyed.’

‘My greatest fear is being regarded as a burden on anyone’
You inspired me, Jacqueline, to make an enormous beef casserole. The blessed thing lasted a week, but I did find myself enjoying it until the third day. Next time, having learned from that experience, I may halve the quantities.
Eighty-three-year-old Pat, an ex-nurse, told me kindly but briskly: ‘Esther, count your blessings and go and volunteer. Go to bed tired and feed yourself properly.’
Olive, from Romsey, was tougher. She says she was ‘incensed’ by my attitude. She roundly declared: ‘I am now 87 and am aware every day of my good fortune. At Esther’s age, I holidayed alone, walked and enjoyed my garden. Grow up, Esther.’
Responses like these stiffened my spine; these women are so uncomplaining and courageous. Then a lady from Pembrokeshire stirred my conscience when she told me I didn’t ‘know the first thing about loneliness’.
She asked me not to print her name — because ‘it makes me ashamed to admit these things’ — so I will call her Sheila.
‘Your whinge about loneliness made me angry,’ Sheila, 77, wrote. ‘I have been alone in a cottage in this tiny village since my beloved husband died eight years ago.
‘Unlike you, I have no children, no siblings, no parents or relatives at all, and my friends are either dead or far-flung.
‘The village is full of families who are entirely insular, which is understandable; but there have been times when I have not spoken to anyone for weeks, especially as I am often ill. I have survived cancer and a broken hip.
‘Another difference: you have money in the bank. You could cruise every month, and as you can talk for England, I doubt you’d remain lonely for long.’
Sheila belongs to the growing numbers of older people who are imprisoned in disability and poverty, and it is their plight that inspired the Campaign to End Loneliness, which was launched earlier this year, backed by four national charities.
The report accompanying the campaign stressed that loneliness is more than just socially embarrassing. It’s the ‘hidden killer’ of the elderly, because those who suffer ‘intense’ loneliness are at increased risk of depression, bad eating habits and poor physical health from lack of exercise.
And they predict it will only become more acute in the future as people live longer and families become more disparate and dispersed.
According to Dr Ishani Kar-Purkayastha, writing in the Lancet, there are already too many ‘men and women who are not yet done with being ferocious and bright, but for whom time now stands empty as they wait in homes full of silence; their only mistake to have lived to an age when they are no longer coveted by a society addicted to youth’.
But as the campaign highlights, loneliness can be conquered if there is the will to recognise it, if we battle against the stigma and work to overcome it.
While the internet and the telephone may be useful tools for communicating, we need to treasure the opportunities we get for ‘a chat and a cuppa’.

WHO KNEW?
A survey found 60 per cent of those aged 18 to 34 spoke of feeling lonely often or sometimes, compared with 35 per cent of those aged over 55
It costs so little, yet achieves so much. As the campaign says: ‘Wherever they arise, we should be protecting and extending these routine and inexpensive ways of keeping people connected.’
And best of all, as one interviewee told the charity Age UK: ‘You don’t need a Criminal Records Bureau check to be a good neighbour.’
So I will treasure the huge bundle of letters I have received from people who have so much vitality and vision. And they have prompted me to make some new resolutions myself.
I will attend the campaign’s forthcoming conference on tackling loneliness, which they are organising in a month’s time, to hear of other groundbreaking projects around the country designed to bring people together.
I will also explore ways of using television to tackle this issue, because it is crucial to our physical and our emotional health.
And I will consider an idea put to me by Ada, an old friend who is now in her 80s and has been on her own for 31 years since her husband died.
‘Esther,’ she said, ‘you need a companion, and you need more exercise. The answer’s simple. Buy yourself a rescue dog.’
Good idea, Ada. The dog and I may, after all, be rescuing each other.

I may seem to have it all - but I yearn for human contact

Sarah Bolitho lives in Cardiff and helps the disabled and the elderly to keep fit.
‘On the surface, I have everything,’ says 53-year-old Sarah. ‘A successful career, a beautiful flat, good looks for my age and self-confidence. But underneath, I am extremely lonely.
‘I have been married and divorced twice, and I live far from my family. My daughter and granddaughter live in Durham, and my sons live in London.
Sarah Bolitho has been divorced twice and lives far from her family
Sarah Bolitho has been divorced twice and lives far from her family
‘And although professionally I’m very confident, personally I’m painfully shy. I think I rushed into both of my marriages. The first lasted 13 years and the second six years. Now I’m scared to start another relationship.
‘I don’t see much of my sister, as she is very busy with her own life.
‘Similarly, my friends have families of their own — and I’m reluctant to intrude.
‘I’d love to have someone to go to films or the theatre with, but I’m too shy to pick up the phone.
‘Recently I bought two tickets for the theatre, but I couldn’t find anyone to come with me, so I ended up going on my own.
‘My greatest fear is being regarded as a burden on anyone.


Read more: http://www.dailymail.co.uk/femail/article-2048488/Lonely-Britain-When-Esther-Rantzen-wrote-Mail-aching-loneliness-received-overwhelming-response-heartfelt-understanding.html#ixzz2FsCEbDTO
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