Almost untreatable superbug CPE poses serious threat to patients, doctors warn

Doctors are warning that the rise of an almost untreatable superbug, immune to some of the last-line antibiotics available to hospitals, poses a serious threat to patients.

The number of lab-confirmed cases of the bug, called carbapenemase-producing Enterobacteriaceae (CPE), rose from three to nearly 2,000 in the 12 years to 2015, according to Public Health England (PHE). But that may be far short of the real number because hospitals are not compelled to report suspected cases. PHE admits it does not know where the infections are coming from or how many people are dying.

Freedom of information requests made by the Bureau of Investigative Journalism reveal that at least 81 people infected with CPE have died since 2009 at 66 NHS trusts in England – although the bug may have been a complicating factor rather than the main cause of death in some cases.

But the real figure is almost certain to be much higher. Many trusts did not respond to the requests or were unable to supply complete data. Out of 136 NHS hospital trusts that were asked for the numbers of infections and deaths between 2009 and 2016, 97 responded but nearly half did not have data on CPE or could not extract the details.

In Manchester and London, dealing with CPE has cost NHS trusts almost £10m. There have also been confirmed outbreaks in Liverpool, Leeds, Sheffield, Birmingham, Nottingham, Colchester, Edinburgh, Belfast, Dublin and Limerick, among others.

Elsewhere, Italy had only sporadic cases of CPE in 2009 but by 2014, the bugs were rife across the country. “If you look at Italy they’ve suspended bone marrow transplant programmes,” said Dr Matthew Laundy, consultant medical microbiologist at St George’s University Hospitals NHS Foundation Trust. “If you’ve got no antibiotics to treat CPEs you’re stuck.”

Experts are calling for reports of suspected CPE infections to be made mandatory. The numbers revealed by the Bureau are “shocking,” said Val Edwards-Jones, emeritus professor of microbiology at Manchester Metropolitan University.

“It should absolutely be mandatory for trusts to report this,” she said. “If you go back to the 1990s MRSA [reporting] wasn’t mandatory. It was only when hospitals did proper surveillance and began looking at the bugs in the blood that we knew the scale of the problem. Then it was found that there were certain things that weren’t being done correctly.”

Dr Michael Cooper, a consultant microbiologist and director of infection control at the Royal Wolverhampton NHS Trust, said: “If something’s not mandatory, it’s the places doing well that take care to report. You don’t get figures from the trusts with their head in the sand, the poor performers.

“Public Health England have no idea how many people are dying, they’ve no outcome data. This is a serious mistake.”

CPE is carried harmlessly in the gut, but may kill if it enters the bloodstream through a wound of a patient who is already sick or frail, which makes it a real danger in hospitals. About 40-50% of patients with a CPE bloodstream infection die. CPE is not untreatable, but it is difficult as antibiotic combinations or older, more toxic drugs have to be used.

CPE, dubbed the “nightmare bacteria” by Tom Frieden, former head of the Centers for Disease Control and Prevention in the USA, has developed resistance to the carbapenems, a group of “last resort” antibiotics that are used in serious infections when other drugs will not work. They include KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase).

Experts have warned that antibiotic resistance is a major threat to the world and could turn the clock back on medical advances by making some surgery, such as heart transplants, impossible.

There are high levels of CPE in India, Bangladesh, Pakistan, the Middle East, south and Central America, China, southeast Asia, Taiwan, Japan, some countries in southern Europe and the USA. In February the World Health Organisation named carbapenem resistant bugs a “critical priority” for which new antibiotics are urgently needed.

In 2014, the medical directors of both Public Health England and NHS England took what they called “the unusual step” of writing to all NHS Trust chief executives, urging them to take action to prevent the spread of CPE.

“CPE represents one of the most serious emerging infectious disease threats that we currently face, and the failure to control their spread now, while we still have the opportunity, could have substantial human health and financial consequences,” wrote Dr Paul Cosford and Sir Bruce Keogh.

However, Professor Alan Johnson, head of the department of healthcare-associated infection and antibiotic resistance at PHE, said patients should be reassured that infections caused by CPE can usually be treated with other antibiotics. Fewer than 2% of E coli or Klebsiella bloodstream infections are resistant to carbapenems, he said.

“We carry out enhanced surveillance on carbapenem-resistant bacteria to determine the numbers and different types of CPE. Although reports of CPE have increased recently, part of this may reflect increased laboratory testing of many sample types other than blood stream infections, as awareness of CPE has grown,” he said.

Manchester

New figures show that four times as many people have died as had previously been reported in an outbreak in Manchester.

In 2009, the first cases of a type of CPE called Klebsiella pneumoniae carbapenemase were detected. In 2014, the hospital trust confirmed that 14 people had died from this infection, contracted within the hospital, in the previous four years.

But the Bureau’s research shows that there have been 61 deaths in the last seven years, including a six-year-old boy with leukaemia who caught the infection while undergoing a bone marrow transplant.

Many of those affected were very ill and had underlying medical problems and so it is not known whether the infection directly caused their death. Some may have died with a CPE infection rather than from it.

An investigation into the outbreak found in 2015 that CPE bacteria were living in the hospital kitchen sinks and handwash basins, which had drains that allowed splashback. Hugh Pennington, a leading microbiologist who chaired official inquiries into E coli outbreaks in 1996 and 2005, said such basins elsewhere in the NHS should be replaced. “It’s all about sound plumbing. It’s not rocket science. If your sink is going to spread the bug, get rid of it.”

Almost untreatable superbug CPE poses serious threat to patients, doctors warn

First US sugar tax sees soft drink sales fall by almost 10%, study shows

The first sugar tax to be introduced on soft drinks in the United States to fight obesity has cut sales by nearly 10% and apparently increased the numbers of people buying water instead, a study has shown.

Berkeley, California, introduced a substantial tax on sugar-sweetened beverages on 1 March 2015. At the rate of 10% – or one penny per fluid ounce – it adds 12 cents to a 12 ounce can of soda priced at $ 1, or 68 cents to a two litre bottle costing just over $ 2 before the tax.

Experts hope that sugar taxes will hike the prices of unhealthy drinks and reduce the number of people who consume large quantities of them. Sugar-sweetened drinks are known to be a significant contributor to obesity, particularly in children and young people.

But taxes have only been introduced after battles with the industry. The latest tax to be introduced – in Philadelphia, in January, where unlike Berkeley incomes are low and obesity rates high – is still being challenged in the courts.

Berkeley is unlike most cities in America, with far higher levels of wealth and education and low consumption of colas and other sugary drinks. Yet Barry Popkin of the Carolina Population Center at the University of North Carolina at Chapel Hill, USA and Lynn Silver from the Public Health Institute found that, even there, the tax had changed people’s behaviour.

“This surprised me,” Popkin told the Guardian. “I didn’t think we’d get much effect at all.” The debate around obesity and the sugar tax had already brought consumption down in Berkeley – and yet the introduction of the tax appears to have brought it down further.

One year after the introduction of the tax, their paper in the journal Plos Medicine shows that sales of sugary drinks in Berkeley fell by 9.6%, while sales in surrounding areas with no tax rose by 6.9%.

While the academics cannot prove that consumers bought water instead, bottled water sales in Berkeley increased by 15.6% after the introduction of the tax. Sales of other non-taxed drinks such as unsweetened teas, milk and fruit juices also rose. But diet drinks and energy drinks appeared not to be so popular – those declined by 9.2%.

Shopkeepers did not lose out because the average grocery bill remained the same. The authors of the study suggest it is possible that consumers are shifting away from sugary drinks to healthier ones – and without causing undue economic hardship because spending did not drop.

In the first year, the tax was levied only in the chain supermarkets and chain petrol stations, so there is still scope for a bigger effect when independent and small shops also bring it in. The money raised is going to child health programmes.

Popkin expects the impact of the tax to be far greater in Philadelphia, where it has been set higher, at 15%, and where incomes are some of the lowest in the USA and consumption of sugary drinks and obesity are high. Proceeds from the tax are going to pay for much needed daycare centres for children. “That was how they sold it,” said Popkin. “The revenue has been double what they expected. Daycare centres have doubled and tripled in size.”

The battle for sugar taxes has not yet been won in the USA, he said. “The industry is still fighting tooth and nail. We have reached a turning point, but the industry is still fighting. They are fighting desperately in Philadelphia because it is a low-income and very high-purchasing city. The implications are quite profound.”

The American Heart Association praised study and the sugar tax.

Its CEO, Nancy Brown said: “This study adds to the compelling evidence that simply cannot be ignored. The residents of Berkeley, who voted for a sugary drink tax in their community, are now seeing the benefits of significantly reduced consumption of sugary drinks, significantly increased consumption of water and consumers are switching to healthier drinks.

“Additionally, Berkeley small businesses have not seen a drop in overall sales. This positive impact is magnified by the fact that the revenue from the tax is being invested in health and wellness across the city.”

But the American Beverage Association said: “This study acknowledges that taxes do not demonstrate a meaningful reduction in obesity rates. A beverage tax that increases the price on certain beverages by more than 50 percent only yields a reduction of 6.4 calories per day.

“America’s beverage companies know we must play a role in improving public health, which is why we are taking aggressive actions to help people reduce the sugar and calories they get from beverages.”

First US sugar tax sees soft drink sales fall by almost 10%, study shows

"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

The Guardian has discovered that dozens of hospitals are struggling to recruit doctors to fill gaps in their rota. They are sending out urgent emails and text messages, often hours before a shift needs covering, asking for medics to come in. They are also offering increased hourly rates – of up to £95 an hour – in an attempt to encourage staff to cover.

But, despite this, doctors say many shifts are going unfilled, putting patient safety at risk. Doctors are being spread too thinly, they say, often having to leave other departments to offer help where its needed. They are also missing out on training due to staff shortages and being asked to work long hours back to back as a result.

We heard from dozens of NHS doctors about this. Here are a selection of responses.

Michael, a trainee surgeon: ‘We often have to cancel our emergency clinic because of a lack of staff’

We’ve had a rota gap for well over half a year now in my department. It has a knock-on effect. First, it means that my colleagues and I are constantly asked to cover extra 12-hour on-call shifts, despite already working long hours. Second, it affects services. We often have to cancel our emergency clinic because of lack of staff. But most importantly as a trainee surgeon in the past, I have not been able to attend theatre sessions to get training. This is worrying because when I am asked to perform certain life-saving procedure I may not be confident doing them on my own.

All junior doctors needs training to progress. When there are long-term rota gaps, this falls by the wayside and covering the services become the priority. Without adequate training, the service we provide will inevitably get worse as years go on.

It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people

Brian

Jack, A&E locum: ‘One hospital had just two doctors for their A&E department – they called an emergency meeting’

I am working as a junior doctor in A&E. Since the tax rule changes (known as IR35) the gaps in A&E rotas in hospitals in the Midlands have got bigger. They were present before but not as visible.

One hospital I was in had only two doctors for a large A&E department overnight. They had to call emergency meetings and take doctors from other areas of the hospital. It meant patients needing treatment had to wait longer. Doctors stayed on for hours to try to bridge the gap. I stayed for as long as I could but in the end I was so tired I wasn’t safe. On the drive home I rolled the windows down and played music loudly just to try and stay on the road.

I work in three hospitals across the Midlands and the majority of the time there is not a full rota of doctors. When I arrive in the morning for handover, I have been told someone needs to go home and come back for the night shift as there isn’t enough cover. One consultant who was on call for 72 hours was in the hospital for the majority of that time trying to see patients and find more staff. A&E is the worst hit. This is because it has the lowest percentage of filled posts in training schemes and is most heavily reliant on locums. Its training schemes are underfilled because it has difficult hours, difficult time pressures, and it is one of only two ways into the NHS system. The GPs close, but the emergency department never closes so it’s always on the frontline.

Brian, a foundation doctor: ‘It’s terrifying when staffing gaps leave you responsible for loads of people’

Night cover is almost permanently short-staffed. It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people. I am also seeing the effects on the more senior members of the team. They are sometimes expected to be in two or three places at once (somehow simultaneously covering the ward and clinic). I don’t understand how the problem seems to be taken so lightly. It’s a threat to patient safety.

Tensions run high as ridiculous last-minute rota changes result in people getting angry that a staff member they were planning on using has now been seconded elsewhere. The government capped rates for locums, the doctors who cover when staff members are ill or on holiday. Given that we sometimes already do 70-hour weeks (yes, that’s legal too somehow) our free time is very precious. The extra work is heavy enough as it’s short staffed, so the pain and risk just isn’t worth what we’re being offered.

Mandy, middle grade doctor: ‘Remaining staff take up the slack – teaching falls away and morale drops as a result’

Every rota has rota gaps. Obstetrics and gynaecology requires seven registrars; we have 1.8 doctors at our hospital. In intensive care, they are at least six registrars short. Every day we receive messages requesting staff to work extra shifts. Today working on renal the issue wasn’t a rota gap with doctors but with nurses: patients who needed dialysis couldn’t receive it due to not enough nurses to care for them on it.

The issue is the remaining staff take up the slack and go above and beyond every day to ensure patients remain safe. This makes our lives fairly miserable: teaching falls away, morale drops and tensions rise.

‘Rota gaps are ubiquitous, a daily occurrence. As a junior doctor you become desensitised to them.’ Photograph: Peter Byrne/PA

Al, a core medical trainee: ‘Not a day goes by where we don’t get emailed about a need for cover’

Rota gaps are ubiquitous, a daily occurrence. As a junior doctor, you become desensitised to them, which is a scary thing to say. Not a day goes by where we don’t get emailed about a need for cover. Sometimes phone calls are made to all the employed staff asking of they can work an evening shift or a weekend shift.

You become desensitised to gaps in the rota, which is a scary thing to say

Al

If this fails, then the vacancy is put out to the preferred locum agency dealing with the hospital who then have thousands of doctors at hand. Often these medics have not worked at the hospital before and although they agree to step in, they are nowhere near as efficient or diligent as the staff doctors.

My trust are also employing long-term locums to fill these gaps in the rota. This a positive step as these doctors become well acquainted with the hospital policies and procedures

Iman, consultant physician: ‘Highly-skilled surgeons are sometimes pulled out of theatre’

I have been given the thankless task of coordinating the junior doctor rota, a role which no one wants, but is almost forced on you. The reason people are reluctant to take it on is the almost daily severe shortage of staff which means that you are firefighting all the time.

I have rota gaps more often than not. The number of junior doctors allocated to the hospital by deanery is less than what we are supposed to have. We try to cover the rest by recruiting locums, which is often unsuccessful partly due to locum pay caps.

The remaining juniors are often under a lot of stress due to manpower shortages and consequently the sickness rates are high. On several occasions some of the wards have no juniors at all, which then requires senior staff to act down. This is a waste of resources as it means a highly-skilled surgeons or physicians are pulled out of the operating theatre or clinic to do these jobs.

On several occasions some of the wards have no juniors at all, which then requires senior staff to act down.

Iman

It’s hugely concerning. I have raised these repeatedly with the trust board, but they are powerless to do anything. We do not have enough junior doctors full stop. Deanery cannot recruit enough in specialities such as medicine and A&E due to onerous on-calls. The 1% pay caps have eroded pay and the imposition of contract has resulted in many juniors leaving the country, depleting the pool further.

Tom, general surgery registrar: ‘Increasing rota gaps is one of the factors driving doctors out of the profession’

Most hospital doctors are extremely worried about the impact of rota gaps on patient care. Clearly, having doctors who have stayed on for up to an additional 12 hours beyond a normal 12-hour shift means they are far too tired to make reliable clinical decisions, especially for the sickest emergency patients. Beyond fatigue, the routine reassignment of doctors from their ward duties to the emergency department leaves vast numbers of patients with too few doctors to look after them. It is often the most junior doctors who are left caring for large numbers of vulnerable post-operative and/or elderly patients without quick recourse to or support from more experienced colleagues.

In the 10 years since I qualified, I have seen nothing but a relentless increase in the demands put upon hospital staff. Increasing rota gaps have compounded the pressure on staff and is one of the factors driving doctors out of the profession and into mental health problems.

• All names have been changed.

"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

UK eats almost four times more packaged food than fresh

The UK eats almost four times as much packaged food as it does fresh produce, according to new data, with most of western Europe and north America following a similar pattern.

The packaged food revolution – which includes ready meals and calorific cakes and biscuits – is held at least partly to blame for the rise in obesity in the US and Europe. Fresh food has played a smaller and smaller part in some families’ lives as the pace of life has speeded up over recent decades, working hours have increased and more women have entered the workplace. Set against this is the rise of ever more tasty instant meals.

Euromonitor has analysed data from 54 countries and shown that the balance has shifted from fresh to packaged food in the most developed. In some of the other populous but less developed nations – China, India and Vietnam – the nutrition transition, as obesity experts term it, has not yet reached tipping point and they are still getting most of their calories from fresh food.

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In 2015, the data shows, 85% of the countries Euromonitor looked at consume more calories from packaged food than from fresh. The data relates to sales, but there is an assumption that most food that is bought is also eaten.

Brazil’s population consumed the highest number of calories per person per day as fresh food, out of the nine major countries in the survey, at 1,065 calories. The UK was second to bottom, at 405, above Japan which consumed just 247 calories from fresh food.

The UK bought the second highest calorific load of packaged food – 1,547 per person per day in 2015. Belgium was top, on 1,670 calories. China, Vietnam and India bought the least, with India buying just 164 calories in the form of packaged food.

Taking packaged and fresh food together, Belgium’s population buys the most calories per head, at nearly 2,600. India buys the least, at just over 760 calories per head in 2015.

Sara Petersson, nutrition analyst at Euromonitor International, said that the rise of packaged food was not necessarily all bad. “It is kind of the way we are today. The food we eat today is convenient. It is fast to consume and we don’t have to prepare it. Much of it is high in salt, sugar and fat but there are so many healthier packaged foods coming out all the time,” she said.

Food companies are now looking at reformulating food, to reduce the salt, sugar and fat content, reducing the pack size – which in the case of confectionery will probably result in smaller chocolate bars – and they can direct their customers to healthier lines, such as reduced sugar soft drinks.

But the rise of packaged food is cause for concern among obesity experts.

“Sadly, processed, packaged foods tend to be less healthy,” said Dr Tim Lobstein, director of policy at the World Obesity Federation.

“Better profits can be made from products with a long shelf-life and that can be formulated and branded as a commercial commodity. Fresh and perishable foods have a tough time competing with processed, additive-laden, brightly-packaged products. The logic of mass production means that the least healthy foods will often be the cheapest, and will be widely promoted in lower-income urban areas.”

Last month a professor of neuroscience who won an award for his work on the brain’s reward system advocated that high calorie food should be sold in plain packaging to be less attractive to shoppers.

“Colourful wrapping of high energy foods of course makes you buy more of that stuff and once you have it in your fridge, it’s in front of you every time you open the fridge and ultimately you’re going to eat it and eat too much,” said Wolfram Schultz, of the University of Cambridge.

Euromonitor also reveals that in many countries – 28 of the 54 its analysts examined, including the UK – more calories are bought in the form of alcohol than soft drinks.

“With the current obesity crisis, a lot of bad press has surrounded soft drinks, especially sugar-sweetened beverages,” said Petersson. The government’s proposed sugary drinks tax is aimed at reducing child obesity. However, she said, the data on alcoholic drinks suggests that sugar-sweetened drinks are not the only problem when it comes to adults.

“Of course, the relationship between sugar consumption and obesity/diseases is still crucial,” she said. “However, given the even stronger evidence for the relationship between alcohol consumption and morbidity, this data cannot be disregarded. Instead, this data could be used by soft drinks companies to argue against statements such as ‘soft drinks are primarily to blame for the obesity crisis’ or by policy makers/public health organisations to strengthen incentives against alcohol consumption.”

UK eats almost four times more packaged food than fresh

Why a Woman With a Latex Allergy Almost Died at an Adele Concert

The dozens of balloons that fell on the crowd at Adele’s concert earlier this month in Adelaide, Australia, was probably a fun surprise for most attendees. But for Pooja Newman, a mother of three with a severe latex allergy, the trick nearly killed her.

The balloons were coated in latex powder, Newman, 38, told a local news station, and caused her to have a dangerous reaction. “I felt my lips swelling and couldn’t breathe,” she told 7 News. “I knew I was in trouble.”

Newman’s sister called an ambulance after three EpiPens were not enough to stop her swelling. She was transported to a local hospital, where she was still recovering in the intensive care unit a few days later.

Latex is a natural rubber that’s found in thousands of products, from condoms to children’s toys. About 1% to 5% of the general population is allergic to latex, but the number is higher—about 10% to 17%—among health-care workers. (Doctors and nurses who wear gloves or handle equipment made with latex are more likely to develop an allergy, because the risk increases with repeated exposure.)

Newman is, in fact, a doctor, and is president of the advocacy group Anaphylaxis Australia. After her close call, she is urging event organizers to rethink using props that could expose large crowds of people to the material.

A latex allergy can appear at any time in childhood or adulthood, says Purvi Parikh, MD, an allergist with the non-profit Allergy & Asthma Network. (As a result of the concert incident, the Allergy & Asthma Network partnered with Avella Specialty Pharmacy to release a new paper on the risks associated with latex allergies.) Latex reactions can also vary a great deal, she says, from mild to deadly.

Some people may only develop a rash or itching, while others can go into anaphylactic shock. “If you have anything more than a rash, even if it is sneezing, coughing, wheezing these are all signs you are at risk for a severe reaction,” Dr. Parikh says.

It’s also important to know that latex allergies aren’t just triggered by touch, she says. Some people are so sensitive that inhalation of latex particles—like the fine powder that can coat gloves or balloons—can also set off a reaction.

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Once someone is diagnosed, Dr. Parikh says, it’s important for them to avoid latex in any form. As the public becomes better educated about latex allergies, its use has declined—but, as Newman’s experience shows, it’s still out there. Just a few places latex can still be found are in condoms, adhesives, bandages, rubber bands, toys, sports equipment (like tennis and basketballs), compression stockings, medical masks, catheters, stethoscopes, and—yup—balloons.

“The main thing we can learn from the concert in Australia is that it is very important to have your emergency medication and use it immediately when you start experiencing distress,” says Dr. Parikh, “but also to not hesitate to call 911, as the medication may not be enough to stop the reaction.”

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She also recommends carrying at least two epinephrine auto injectors, as often one is not enough during severe reactions. “Timing is everything, even with an ambulance on the way,” she says.

It’s also a good idea for people with latex allergies to carry an antihistamine like Benadryl (although this won’t help during a severe reaction), and to wear a medical alert bracelet so medical providers will be aware of their allergy if they’re unconscious or unable to speak. “A lot of medical devices or facilities may contain latex, so it is important to let all health care facilities know,” she says.

Why a Woman With a Latex Allergy Almost Died at an Adele Concert

Rotavirus vaccine could save lives of almost 500,000 children a year

A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year.

Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.

According to results published in the New England Journal of Medicine, the vaccine has proven as effective as those currently used to treat severe gastroenteritis. Trials in Niger’s Maradi region successfully treated 4,000 children under the age of two.

Unlike existing vaccines, the BRV-PV vaccine does not require refrigeration and can remain stable for up to one year at 37C or six months at 40C. It is particularly effective against the strains of rotavirus found in sub-Saharan Africa, as well as affordable: at only $ 2.50 (£2), the vaccine could potentially be rolled out quickly in routine immunisation programmes.

“This is a game-changer,” said Dr Micaela Serafini, MSF’s medical director. “We believe that the new vaccine can bring protection against rotavirus to the children who need it most.”

Diarrhoea is the second largest cause of death in infants and children worldwide, primarily in low-income countries where access to clean water and sanitation is limited. Rotavirus is highly contagious, particularly among babies and young children, and can be spread by contaminated hands, objects such as toys and surfaces, and water and food.

Children in the world’s poorest countries account for 82% of rotavirus deaths, but vaccines make a significant difference. In Mexico, diarrhoeal deaths among children under five declined by as much as 50% after rotavirus vaccines were introduced.

The trials in Niger – the first of their kind to be approved in an African country – were conducted by MSF’s research and epidemiology branch Epicentre, in collaboration with Niger’s ministry of health, the Cincinnati children’s hospital and the makers of the vaccine, the Serum Institute of India. According to MSF, the results demonstrated no safety concerns and as a result the vaccine is hoped to fill the current supply gaps of the existing rotavirus vaccines, RotaTeq and Rotarix, both of which require refrigeration.

The World Health Organization recommends that rotavirus vaccines should be included in all national immunisation programmes, and considered a priority in south and south-east Asia and sub-Saharan Africa. The BRV-PV vaccine is awaiting pre-qualification from the WHO before it can be rolled out.

Licensing the product could take up to 18 months, said Anna-Lea Kahn, a WHO technical officer looking at innovations for facilitating vaccine supply and delivery. During that period, WHO scientists evaluate data supporting the vaccine’s quality and safety, drawing on independent specialist help when needed.

Most difficulties with vaccine delivery tend to arise during the “last mile” of the vaccine supply chain, said Kahn. “That’s where it goes wrong the most: where being able to maintain the cold chain is hardest; where constraints are most pronounced, be it due to lack of electricity or lack of resources, or inability to maintain a cold fridge. There may be geographical barriers, too, presenting a logistical challenge.

“In these scenarios, not having to depend on the cold chain … can make a valuable difference in getting vaccines to those who otherwise might not receive it.”

Serafini said: “The success of this trial shows that research and development into vaccines that are specifically adapted for use in low-income countries yields results.”

A spokesperson for Gavi, the international vaccine alliance, said BRV-PV’s results were encouraging.

“Adding more flexibility to the cold chain could allow more vaccines to reach the hardest-to-reach locations, boosting coverage and giving many more children access to lifesaving vaccines,” the spokesperson said. “However, it is anticipated that an important consideration for the countries will be the final recommendations on temperature control conditions of the vaccine, which could be different than the conditions used during the clinical trial.”

Rotavirus vaccine could save lives of almost 500,000 children a year

Male contraceptive jab almost as effective as female pill, trial shows

A male contraceptive jab has been shown to be almost as effective as the female pill in a trial that could pave the way for men and women being able to share equal responsibility for birth control.

In the study, 350 men were given injections of hormones that were shown to dramatically lower their sperm count by “switching off” the male reproductive system. The drugs caused some unpleasant side-effects, however, meaning that the trial had to be halted early.

The men, who were all in long-term relationships, relied on the drugs to prevent unplanned pregnancies – and the combination of hormones was found to be nearly 96% effective.

Richard Anderson, a professor of clinical reproductive science and author of the study, said: “If you’re comparing it to other reversible male methods, it’s far better than the condom and it puts it in the same ballpark as the pill.”

However, the treatment was judged to have unacceptable side-effects, including depression, acne and increased libido, which caused 20 men to drop out of the study and ultimately led to the trial be stopped earlier than planned.

The trial involved injections of two hormones. A long-acting form of progestogen was designed to act on the pituitary gland to switch off sperm production. Testosterone was added to offset a drop in the male hormone triggered by the progestogen. “You need the testosterone to feel OK,” said Anderson.

After an initial period, when couples used both the injections and other birth control methods, the men entered the study’s “efficacy phase”. This lasted up to a year and the men relied on the jabs alone, which they received every two months.

Only four pregnancies occurred among partners of the 274 men, indicating a similar level of efficacy to the female combined pill and significantly better protection than condoms, which in real-life conditions are about 82% effective.

However, scientists stopped enrolling new participants into the study in 2011 due to the rate of reported side-effects.

Of the 1,491 incidents, 39% were found to be unrelated to the treatment. This included one suicide. One man experienced an abnormally fast and irregular heartbeat when he stopped receiving the injections.

Despite the side effects, at the end of the trial, three-quarters of the men said they would be willing to continue using the contraceptive jab. The scientists said it might be possible to reduce the side-effects by changing the dose of hormones or the way they are delivered.

“The results provide us with confidence that this can be done,” said Anderson.

He added that it would be difficult to convert the treatment to a pill form because the hormones are quickly metabolised by the liver, but the scientists are planning a new trial in which the combination is delivered through a gel that the men could rub on their chest each morning.

Other scientists were less convinced that the side-effects of could be overcome, however. Sarah Jones, a reader in pharmacology at the University of Wolverhampton, said: “Most previous attempts at male contraception that have involved hormonal targets have led to severe side-effects or have been irreversible. This study does seem better than previous ones, but it still doesn’t seem very good to me.”

Jones recently published research demonstrating that certain compounds could be used to impede sperm’s ability to swim, which she argues offers a more realistic route to reversible male contraceptives in the future.

Allan Pacey, professor of andrology at the University of Sheffield, agreed that the side-effects found in the study were a “major concern”. However, he said the efficacy was impressive. “Using long-acting injectable forms of [progestogen and testosterone] the authors were able to suppress the production of sperm to a remarkable degree,” he said. “As such, this contraceptive was extremely effective and therefore certainly has promise.”

The findings are reported in the Journal of Clinical Endocrinology & Metabolism.

Chris Barratt, professor of reproductive medicine at the University of Dundee, said: “This is high quality research from a very experienced group of investigators, and as there has been no progress in male contraceptives for 40 plus years this is a very significant and welcome development. Additionally, the fact that the study reports relatively low side-effects and good ease of use are real-world developments. The study involved a reasonable number of patients so the results are likely to be robust.”

Male contraceptive jab almost as effective as female pill, trial shows

Almost 75% of NHS maternity facilities "need improvement"

Maternity care at almost three-quarters of local NHS groups needs to improve, data suggests.

In total, 209 clinical commissioning groups (CCGs) were rated, of which 144 needed improvement, with 11 registering the greatest need for improvement, according to NHS England. Just one group, West Kent, was ranked as top performing, while a further 53 were classed as performing well.

The figures, released on Thursday, have been hailed as a positive step for transparency by the midwives’ trade union. Maternity was assessed in four areas to give a “broad representation” of care: stillbirth and neonatal mortality rates, maternal smoking rate at delivery, and experience and choice.

Cathy Warwick, chief executive of the Royal College of Midwives, said she welcomed the “openness and transparency in publishing these ratings”, but was “concerned about the number of services requiring improvement … This is a positive step, and one that could help women to be informed about the quality of services where they live and empower them to make more informed decisions about their care. Hopefully, these ratings will be used to help CCGs learn from the best and to improve quality where that is shown to be needed.”

Dr Matthew Jolly, of NHS England, said: “It has never been safer to give birth in this country, and the vast majority of women report a good experience, but there is more that we can do. The ratings published today will help local areas identify where they are doing well and importantly where improvements can be made – helping to ensure women and their families have a good experience wherever they live.”

NHS England said that it would offer a “comprehensive support package” to help CCGs in need of improvement.

The stillbirth and neonatal mortality figures came from 2014 ONS data, while the maternal smoking indicator used NHS Digital data. The experience and choice indicators were based on answers to the 2015 Care Quality Commission national maternity services survey.

Elizabeth Duff, of the National Childbirth Trust (NCT), said: “We’re pleased to see NHS England is delivering on its commitment to be more transparent about CCGs’ performances, and this is a positive step forward. These figures starkly highlight areas where improvement is needed. Parents shouldn’t use these figures alone to decide where to have a baby. They are baseline ratings which don’t take into account every aspect of care.”

Almost 75% of NHS maternity facilities "need improvement"

Almost half of young Australian adults binge-drink every month, report says

Almost half of young Australian adults engage in binge-drinking on at least a monthly basis, a new report shows – but across the board rates of alcohol consumption are falling.

Findings from the Australian Institute of Health and Welfare on trends in alcohol availability, use and treatment show that 18- to 24-year-olds are most likely to report risky drinking behaviour.

The report says 47% reported drinking more than four standard drinks on a single occasion on at least a monthly basis, 33% consumed 11 or more standard drinks on a single occasion at least yearly, and 18% at least monthly.

But older Australians were more likely to have more than an average of two standard drinks a day, with 23% of respondents aged from 40 to 49 reporting what was defined as a “lifetime” risk.

Similarly, nearly half (49%) of respondents receiving treatment were aged in their forties. Overall, treatment for alcohol had increased by 20% from a decade ago, with patients in 2014-15 most likely to be males aged over 40 and living in major cities.

Researchers said it was possible that problems related to drinking did not develop until later in life or that people simply did not seek treatment for them until then.

The report, released on Friday, assessed trends in alcohol availability, use and treatment.

Volume of alcohol consumed per capita

Tim Beard, a spokesman for the AIHW, said binge-drinking – particularly among younger Australians and those living in rural or very remote areas – was at odds with the downward trend of consumption rates overall.

“That contrast really jumped out at us.”

He said drinking alcohol in significant quantities became less socially acceptable as people aged, and those who reported receiving treatment was “an ageing cohort”, seeking help for “habits they formed sometimes 20, 30 years ago”.

“They might have been receiving treatment for years.”

In 2013, just over 15 million Australians, about 78% of the population, had consumed alcohol in the past year – but the apparent consumption of alcohol as determined through sales and taxation data has decreased nationally from 2003-04 to 2013-14.

The proportion of people abstaining – who had never consumed a full serving of alcohol – had risen from 17% in 2004 to 22% in 2013; the rate of ex-drinkers had also increased.

Alcohol consumption per person had also fallen to 9.7 litres in 2013-14 from 10.8l in 2008-9.

The increasing price of alcohol, restrictions on trading hours, and fewer outlets were understood to be effective in reducing harms.

“I think there’s a lot more public awareness of the impact of all sorts of behaviours on health,” said Beard, noting the National Drug Strategy aimed to reduce rates of smoking, drinking and drug abuse across the board through prevention.

“It’s not just younger people who aren’t taking it up – it’s a lot of people who are giving it up.”

But despite some emerging positive patterns, risky drinking and alcohol dependence continued to be significant issues in Australia, particularly among some groups.

Remote and very remote areas were more likely to engage in risky drinking than people living in major cities, said Beard.

Interactive

“They’re sort of bucking the trend, unfortunately, when you look at them as a group. It’s a small pocket but a notable one.”

The report found 15% of people who identified as lesbian, gay or bisexual reported drinking at very high levels each month, compared to 7% of people who identified as heterosexual.

Indigenous Australians were more likely than non-Indigenous Australians to report risky drinking on single occasions, and more than three times as likely to drink at very high levels every week – though the gap was decreasing over time.

Alcohol was the leading cause of burden of disease for Australians under the age of 45 in 2011; alcohol-use disorders were responsible for 1.5% of the total burden of disease.

Research published by the University of Adelaide last week highlighted the difficulties experienced by Australians to cut back on their alcohol intake or quit altogether.

Ashlea Bartram, a PhD researcher at the university’s School of Public Health, found that people routinely made excuses to remove themselves from situations where others were drinking, or provided accepted excuses for abstaining such as being unwell or needing to drive.

She said it was “quite clear there is a stigma attached” to people attempting to change their drinking habits. “It’s as though some kind of social code has been violated.”

People tended to make excuses not to attend social gatherings, and instead found “new ways to spend time with their peers that weren’t focused on alcohol,” Bartram said.

Almost half of young Australian adults binge-drink every month, report says

Female Viagra? Almost everything You Wanted to Know About Sex Drug Flibanserin But Have been Afraid To Request

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Female Viagra? Every thing You Wanted to Know About Flibanserin But Had been Afraid To Inquire I&rsquom a 37-yr-old married female with two small young children, a total-time work, and not enough hours in the day. Putting my occupation as a journalist aside, you&rsquore darn straight I have a lot of queries about the [...]

Female Viagra? Almost everything You Wanted to Know About Sex Drug Flibanserin But Have been Afraid To Request

The FDA Is Generally Approving Almost everything. Here is The Information To Prove It

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Bear in mind when the FDA rejected medicines? We just received taken care of to a entire great deal of drama this week as to no matter whether Addyi, a drug to increase ladies&rsquos libidos, would be approved. But primarily based on the data, that approval was possibly a foregone conclusion. As recently as 2008, businesses filing applications to promote [...]

The FDA Is Generally Approving Almost everything. Here is The Information To Prove It

US female genital mutilation petition collects almost 37,000 signatures

A petition to get the Obama administration to commission a report that would update statistics on the prevalence of women subjected to demale genital mutilation (FGM) in the US had collected more than 36,600 signatures as of Thursday afternoon.

Jaha Dukureh, a 24-year-old survivor of FGM, created the petition as a first step in getting the United States to create a comprehensive plan to end FGM and provide services to people who have already been subjected to the practice.

People in every US state have signed the petition, with the most signatures coming from California and New York, said Change.org communications manager Shareeza Bhola.

“It is one of the top 10 fastest growing petitions on the site in the US,” Bhola said, adding that it is also one of the fastest growing women’s issue-related campaigns on the site this week. The Change.org petition has also collected at least one signature from 116 different countries.

The US government outlawed FGM in 1996, but at least 228,000 women in the US are thought to be affected, according to research from Brigham and Women’s hospital in Boston.

The United Nations secretary general, Ban Ki-moon, has issued his support for the campaign. Nafissatou Diop, of the UN’s United National Population (UNFPA) and Unicef joint program on FGM, spoke on behalf of Ban on its Monday US launch.

“This is a serious health and human rights issue,” said Diop. “The effects include depression, insecurity, pain, infections, incontinence and deadly complication in pregnancy and childbirth. While some may say FGM is a tradition, it constitutes a human rights violation that must cease.”

Campaigners are also working to collect more signatures on a letter written to the US Department of Health and Human Services by Joe Crowley, the Democratic congressman for New York’s 14th district.

“It’s fantastic that the Guardian has helped amplify the voices of brave American FGM survivors such as Jaha and joined the existing US movement towards ending FGM,” said Shelby Quast, a Senior Policy Advisor at international human rights advocacy group Equality Now. “We urge all members of the House of Representatives to sign and endorse Congressman Crowley and Congresswoman Jackson Lee’s letter calling for a strategic national action plan to end FGM, which would include an updated prevalence study, full implementation of the law, education and child protection measures in particular.”

US female genital mutilation petition collects almost 37,000 signatures

"Almost everything Is Great" And "Sterile Productivity": Two Frequent Sources Of Organizational Dysfunction -- And Hope -- In Biopharma

Two of the most typical causes of organizational dysfunction may possibly also be powerful forces for great – if only we can identify and control them appropriately.

“Everything Is Awesome”

We’ve all been there, struggling to keep our jaws from dropping as we observe a polished colleague make clear to senior management how a particular venture is moving much quicker, far better, or cheaper than the information as we know them may propose.    The opportunity – better than anticipated!  The difficulties – manageable, and largely solved!  The staff – collaborative and impassioned!  Everything – wonderful!

It tends to make sense.  Everyone prefers hearing very good news to bad news, and everyone likes the notion of problems eliminated from their plate rather than added.   You will nearly definitely go further, faster if you constantly supply very good information and remedies rather than bad news and much more troubles.

The real kicker right here is attribution bias.  We inevitably attribute good results or failure to leaders rather than circumstances.  A coach that can make a statistically foolish decision that takes place to lead to victory will be lionized, even though a wise coach who occurs to get rid of the huge game might be fired.  (See Michael Mauboussin’s fantastic Achievement Equation for a a lot more total, extremely engaging discussion of these troubles.)

The collective consequence of these influences are properly-known: troubles are minimized or kicked down the road – arguably an even much more frequent technique in today’s IBGYBG world of intense employee mobility, but also a distinct issue in industries like pharma characterized by unusually long timelines.  It is undoubtedly tempting to imagine this bias assists clarify the remarkably high failure price of phase 3 research – earlier phase trials may possibly not have been designed with adequate stringently, nor evaluated with appropriate rigor.

At the same time – though perhaps much less obviously – we should also identify how important, vital, and needed (at least to a level) a deep sense of optimism is to organization success, especially in industries requiring substantial innovation, and exactly where important new products emerge from higher threat, higher reward projects, an setting exactly where most factors will not function, and the ingoing probability of achievement is inherently really minimal.

Most essential progressive tasks wouldn’t get really far without having  irrationally positive leadership, an advocate with the potential to see a ray of hope by means of a sea of gloom, and the audacity to continue where a lot more affordable folks might quit.  Data also suggest confidence (even, and possibly specifically excessive confidence) can enhance overall performance in some situations.

Taken to an excessive, nevertheless, and you have (in accordance to a priceless Valleywag post by Sam Biddle), today’s Silicon Valley, which “demands uniform positivity, towards all evidence for positivity, and punishes cynicism or mere criticism as witchcraft.”

At least in drug advancement, traders usually identify the optimism that’s baked in, and (outdoors of ultrasexy areas like immuno-oncology) tend to be really cautious about early outcomes.  The challenging challenge for biopharma executives is cultivating optimism — so that teams sally forth into brutal battles against outrageous odds — even though preserving a sense of pragmatism, so that excessive very good income does not go into bad, doomed tasks.

In addition, given the inevitable incentives for participants to game the method, and the asymmetric details among participants and everybody else, the perfect remedy would look to involve, inevitably, making sure participants have real skin in the game, and a stake in the ultimate final result – i.e. have more to drop by kicking the can down the street then by calling it quits and shifting consideration to a a lot more promising undertaking .  Notably, this is specifically the kind of strategy David Grainger of Index Ventures has repeatedly advocated.

“Sterile Productivity”

It is difficult to think of a trait that better defines the productive middle manager – specifically in huge and mid-sized pharma – than the capacity to search occupied, with tons of deliverables, lots of reviews, tons of exercise, and all of it documented – or at least documentable.   It’s sterile productivity.

My sense is this reflects a mixture of personality and function, but the result is that most organizations harbor a huge number of pretty influential managers who produce little light but a ton of heat, the result of futile cycles that churn by way of resources and leave employees dispirited.

As soon as once again, I suspect that a key component of the issue, at least in biopharma, stems from the length of growth cycles, which are so long that it can be tough to effectively assess overall performance based mostly on the high quality of selections, and rather, there is a powerful tendency to revert to proximal, method metrics that are effortlessly measured.  The outcome: you get what you incent, and the consequences can be a rather cynical, procedure-oriented culture that values exercise over all else, and exactly where creativity can struggle for expression.

But, just before we indulge ourselves in this generalization, we would do effectively to keep in thoughts the suggestions of IDEO’s Kelley brothers, creativity experts who remind us of the significance of doing versus simply considering.  The most successful creatives in organizations seem to be to be the ones biased in the direction of action, who are ready to get something accomplished, and then iterate, versus abstractly and incessantly questioning which strategy may be best.

"Almost everything Is Great" And "Sterile Productivity": Two Frequent Sources Of Organizational Dysfunction -- And Hope -- In Biopharma

People who dwell or perform near takeaways "are almost twice as very likely to be obese"

Those who dwell or function close to takeaways eat an extra 40g of high-calorie meals a week on average. Photograph: Alamy

Individuals who reside or work close to takeaways consume far more junk meals and are practically twice as likely to be obese as people who have none on their doorstep, a examine has found.

Shoppers who are the most tempted by takeaways and quick foods eat an additional 40g of large-calorie foods – the identical as half a little serving of McDonald’s fries – each and every week in contrast with people who remain away.

Operating close to a rapidly meals spot or takeaway triggered the largest problems, closely followed by having them close to residence.

The investigation, published on the internet in the British Health-related Journal (BMJ), is the very first United kingdom examine to combine information from property, perform and commuting and concerned 5,442 grownups from Cambridgeshire aged 29 to 62.

On typical, folks had been exposed to 32 takeaway retailers – nine each and every in their nearby neighbourhood and on their commute, and 14 within a mile of perform. There had been about 48% much more takeaway shops and fast foods joints near perform in contrast with residence, the review identified.

Researchers examined how a lot takeaway foods men and women ate making use of questionnaires for meals such as pizza, burgers, fried food (this kind of as fried chicken) and chips. They also measured people’s entire body mass index (BMI) as a measure of their fat.

The final results showed that men and women exposed to the highest variety of takeaways have been 80% far more likely to be obese and 20% much more probably to have a greater BMI than those with the lowest number of encounters. They also ate more of these sorts of foods.

The researchers stated: “Compared with folks least exposed to takeaway meals outlets, we estimate these most exposed consumed an additional five.7g per day of takeaway food, which would constitute a 15% larger consumption than those least exposed.

“In a week, this translates into an additional 39.9g of takeaway foods. This weekly sum constitutes more than half a small serving of McDonald’s french fries (usually 71g per serving).”

Dr Thomas Burgoine, lead writer of the examine from the UK’s centre for diet program and exercise study, based mostly in the Healthcare Study Council’s epidemiology unit at the University of Cambridge, explained: “The foods we eat away from residence tend to be much less healthful than the meals we put together ourselves, so it is critical to consider how publicity to meals retailers selling these high-calorie meals in our day-to-day environments may well be influencing consumption.

“Our examine supplies new proof that there is some type of relationship between the amount of takeaway food shops we encounter, our consumption of these foods, and how considerably we weigh.

“Of course, this is most likely to be just a single of a number of elements that contribute to a person’s danger of establishing weight problems. Nevertheless, our findings do recommend that taking actions to restrict takeaway outlets in our towns and cities, specifically close to workplaces, could be one way of positively influencing our diet program and wellness.”

Prof Jill Pell, chairwoman of the Health-related Research Council’s population health sciences group, stated: “To date, research examining the link between the neighbourhood foods setting and diet program and physique fat have provided mixed outcomes, which is why it is crucial that we continue to research these relationships.

“In potential this sort of investigation will provide the robust proof required to create effective approaches to tackle obesity and encourage a healthier life style.”

More than the past decade, consumption of foods outdoors the residence has improved by 29%, although at the exact same time, the variety of takeaway food shops has improved dramatically, the researchers explained. This, they argued, could be contributing to increasing levels of obese and obesity.

People who dwell or perform near takeaways "are almost twice as very likely to be obese"

Statins have almost no side-effects, study finds

But investigation published on Thursday in the European Journal of Preventive Cardiology suggests that only a little minority of reported signs are attributable to the medication.

“Almost all would take place just as regularly on placebo,” stated Dr Judith Finegold from the Nationwide Heart and Lung Institute in London at Imperial School.

“Most folks in the basic population will not really feel perfectly nicely in each and every way on every day. Why need to they all of a sudden really feel nicely when taking a tablet after becoming warned of achievable adverse effects?

“We feel that patients need to be empowered to make their very own choices, but we need to 1st make confident they have prime quality unbiased details. This is why we phone on drug regulators to highlight in the extended lists of side results individuals number of whose charge is incrementally better than that experienced with a dummy tablet.”

Statins have for years been linked to a lengthy record of side effects like nausea, renal disorder, muscle troubles and aches, insomnia, fatigue, erectile dysfunction and gastrointestinal disturbance. But of all the signs and symptoms, only the risk of diabetes was identified to be slightly raised by the drugs.

Even so Dr Aseem Malhotra, a cardiology expert registrar at Croydon University Hospital, explained numerous folks underneath-report side effects in clinical trials and claims it would be incorrect to dismiss their symptoms.

“To suggest that these symptoms are imagined is an insult to individuals who have suffered, many for months, from side results that are real and increasingly appreciated by front-line medical doctors,” he explained.

Last week a survey by Pulse magazine uncovered that the bulk of GPs would not consider statins themselves underneath the new draft guidance or advocate them to a relative.

Dr Kailash Chand, deputy chairman of the British Healthcare Association, has suffered debilitating muscle pains while taking statins.

Speaking as a GP he explained: “I feel a lot of of the benefits of statins have been hyped up and the side results ignored.”

In draft guidelines launched in February, the National Institute for Overall health and Care Excellence recommended that the “risk threshold” for statins be cut in half – so that anybody with a 10 per cent chance of developing cardiovascular disease would now be prescribed medicines.

Nonetheless statins are already the most commonly prescribed medication in Britain, presently costing the NHS £450 million a 12 months. And surveys have proven that up to half of individuals voluntarily end taking the medication right after a year, numerous reporting side results.

Nevertheless it is estimated that statins conserve 7,000 lives in the Uk each and every 12 months and charities welcomed the findings, claiming they must reassure people. Doireann Maddock, senior cardiac nurse at the British Heart Basis, stated: “Previous investigation has demonstrated the security and effectiveness of statins. Whilst all drugs have the possible for side results this study could offer even more reassurance to the many men and women in the United kingdom who are prescribed statins.

“Side results this kind of as muscle ache, which is frequently linked with statins, can also be connected to a lot of other items. If you consider you are encountering side results it’s crucial to talk about it with your doctor so that they can discover what may well be triggering them.”

Dr Shamim Quadir, investigation communications manager at the Stroke Association, additional: “This investigation might assist to avert stroke individuals from coming off statins unnecessarily.”

Statins have almost no side-effects, study finds

Ladies are almost 42 per cent a lot more most likely to consider sick days than guys

She said: “Presenteeism is considerably greater in men than girls. They are a lot much more very likely to go into perform while they are ill, which can have lengthy phrase consequences – conditions can go undiagnosed, they not going to get early treatment method.

“Women have far more contact with the well being method, so they are a lot more aware of the significance of these items and attuned to the value of health.

“Females are far more frequently going to be the principal carer regardless of whether for a kid or an elderly relative. A lot of workplaces are quite inflexible about emergency depart, so the only way to get that time off is sick depart.”

The new figures also reveal that people operating in the public sector are 24 per cent more probably be sick, although the gap has shrunk given that 1993.

The worst sick prices have been in the health service, in which 3.4 per cent of operating hrs were lost every single yr to sickness. In central government the figure was 3 per cent, although in neighborhood government it was two.seven per cent. In the private sector, by contrast, 1.8 per cent of working hrs have been lost to sickness.

Jamie Jenkins, a labour market place analyst at the Office for Nationwide Statistics, said that folks doing work in the personal sector are a lot more most likely to make up hours lost to sickness.

He explained: “Individuals in the personal sector are significantly less very likely to have a payment for getting off sick than they are in the public sector.

“A great deal of the smaller workforces for people with significantly less than 25 personnel have reduce levels of sickness. Individuals in smaller sized workforces have a tendency go into function when they are sick simply because they don’t want to let their colleagues down.”

The all round amount of days lost to sickness has fallen from 178million twenty years ago to 131 million last 12 months, equivalent to 4 days per worker.

Staff in London had the lowest percentage of hours misplaced to sickness, at 1.five per cent, whilst the highest had been in the East Midlands, Wales and the North East at 2.4 per cent.

The principal lead to for doing work days lost final 12 months was musculoskeletal situations such as back and neck pain, leading to 31 million days misplaced, followed by small illnesses this kind of as coughs and colds. Around 15 million days were lost since of pressure, nervousness or depression, up from 11.eight million in 2010.

Ladies are almost 42 per cent a lot more most likely to consider sick days than guys

Where Recollections Go: Why Dementia Alterations Almost everything by Sally Magnusson – assessment

Alan Bennett launched himself to me at a get together. “I read your book about your mam,” he explained. “She went mad far more interestingly than my mam.” In the madness of dementia, people can seem beatific, getting to be quieter and quieter, lowered to a faint smile. They can sit slackly, eyes unfocused in the direction of the green blur of the nursing home garden, or they can rave and be unreasonable. Dementia can be a disease of cruelty, insults, bodily violence – the patient attacking the carer. My mom had vascular dementia, and invested the last four many years in a residence in which she was described as the most challenging situation they had ever had.

Sally Magnusson, broadcaster daughter of Magnus, who presented Mastermind, had a mom she adored, Mamie Baird Magnusson, a newspaper journalist. When dementia took hold, it started with sweetness, humour and an component of insight. Her loved ones had been adamant that they would care for her at house, setting up complex rotas by Dropbox folder. By the finish, Mamie was aggressive and alienated from her personal twin sister. “I am aghast at how swiftly my temper frays when practically nothing I say or do seems to aid,” Sally writes.

Mamie was previously exhibiting the signs of Alzheimer’s illness when her husband died of cancer. It was not protected for her to administer his medication. A working-class woman who entered journalism in the 1940s, in her heyday she had been a pioneer who became the star author of the Scottish Day-to-day Express. The photographs in In which Memories Go demonstrate that all through her existence she possessed elegance, vivacity and a smile that could eclipse lighthouses. She was a woman who loved language, and the 1st realisation that one thing was incorrect comes when she reads an tackle at a friend’s funeral, then starts once more on the first page and has to be led away.

A trip on a paving stone and a proposed hip operation turns into a hospital remain of unmitigated horror: delirium in the evening, cancelled operations and subhuman nursing leaving her terrified and alone, with out foods or drink. The household decides that she will by no means yet again face institutional care. By now, Mamie’s memory is becoming bulldozed. Sally’s brother, her parents’ 1st-born, died aged 11, run more than by a lorry. Mamie would sit howling on the bedroom floor with 1 leg flung against the door in situation a youngster need to see her. In her dementia come phrases that Sally hears “with a thud of horror”. After a long browsing look, Mamie asks: “Now remind me. Who is Siggy?”

And on and on the condition relentlessly runs with the sickening bumps of new revelations of its advance and the occasional surprises of comedy: the calm declaration that Mamie and Magnus had found America, a last holiday to a Spanish city that she likens to Aberdeen and the gnomic observation that the then president of the Czech Republic, Václav Klaus, was the person who forced Sally’s inlaws to depart their property and come to Scotland (a feasible confusion with Hitler). But Magnusson understands that these startling inventions are a “straining to get element in a conversation by appropriating whatever has presented itself” to her mother’s imagination “by way of a story after heard or a snippet of info absorbed”.

Dementia is a ailment that proceeds in minor spirals – there are a handful of mirages of a return to cogency – but, as opposed to psychological illness, it is, at present, incurable. It ends only in death. The narrative construction of The place Memories Go alternates amongst the story of Mamie’s advancing sickness and Sally’s very own journalistic excursions – like other carers just before her, Magnusson trudges round from skilled to professional making an attempt to understand. I did considerably the same myself a decade earlier. The professionals throw some light on the nature of Alzheimer’s condition, but it is challenging to see how any of it helps, and these are the least interesting chapters.

She has selected, unusually, to publish the guide in the second person singular, and is speaking to her mother (“you”) during. This effect is rather suffocating: it the two excludes the reader from the dialogue and raises the query of how a lot is not getting mentioned. Is Magnusson saying what she would have liked to have told her mother if she could have understood her, or what she would never ever have dared to have communicated? How trustworthy are really like letters, specially people written as a posthumous eulogy?

We hear minor about Magnusson’s romantic relationship with her mother ahead of she was sick, apart from a lengthy letter Mamie wrote to her a couple of weeks before her wedding in 1984. It displays what a lively and thoughtful author she was. The breakdown, the eclipse of these skills, should have been heartbreaking to watch, but we get little sense of who Mamie genuinely was prior to the condition. Admiration smooths out comprehending.

The ultimate pages detailing the final couple of weeks of Mamie’s existence had been agonizing for me to read through. Mamie’s death and my personal mother’s death had been of a piece: the breakdown of language into fragments of syllables, the hands clutching the air, the hallucinations, the skeletal figure in the bed. This isn’t the first guide-length account of dementia, nor will it be the final. But as dementia goes on repeating itself, the story bears repeating, in excess of and over once more since the loss of memory is a single of the biggest mysteries of our age. Without memory we are practically nothing and no one.

• Remind Me Who I Am, Yet again by Linda Grant is published by Granta.

Where Recollections Go: Why Dementia Alterations Almost everything by Sally Magnusson – assessment

Almost a tenth of babies and toddlers in England and Wales are Muslim, census figures display

The figures display there had been 3.five million kids aged -four of whom 320,000 had been Muslim. That proportion is a lot more than 9 per cent and compares with a total Muslim population amid all age groups of much less than five per cent.

“It surely is a startling figure,” stated Professor David Coleman, Professor of Demography at the University of Oxford. “We have had substantial immigration of Muslims for a extended time. Continuing immigration from Pakistan, Bangladesh and India has been extra to by new immigration from African nations and from the Middle East.

“Birth prices of Muslims of Pakistani and Bangladeshi origin remain fairly substantial, even though falling. There look to be very lower amounts of falling away from religion among Muslims.”

Christians stay the biggest religious group between individuals aged -four, at one.5 million, 43 per cent.

Dale Barton, priest in charge at St Clement’s, a Church of England parish in Bradford, mentioned: “This was a white doing work-class British region 50 many years ago. They have all gone. There are two pubs hanging on by their fingertips. There’s a Labour club. 1 club has just gone. Outlets are now Muslim-owned. I’m not decrying that. A considerable quantity open on Christmas Day.”

Ibrahim Mogra, assistant secretary-standard of the Muslim Council of Britain said that the big quantity of younger Muslim children was a vote of self-assurance in the country by Muslims. “I just wouldn’t want our fellow citizens to be alarmed by an boost in quantity,” he stated. “This generation is really significantly British. They truly feel quite significantly this is their residence. It’s not about Britain turning into a Muslim nation but about Britain enabling the practice of Islam, which provides self-assurance to the vast vast majority of Muslims. It’s a fantastic country to regard as our house.”

Philip Lewis, a scholar of Islam and writer of Youthful, British and Muslim, warned that the one-in-ten birth rate statistic could “generate alarmism”.

He emphasised the selection of the Muslim population across the country, which in London incorporated an affluent Arab elite and Europeanised Turkish Cypriots. In components of the urban north, even though, there was a “bicultural reality” of indigenous and Kashmiri operating classes. “We don’t have real diversity in a lot of of these northern mill towns or excellent swathes of Bradford,” he stated.

Almost a tenth of babies and toddlers in England and Wales are Muslim, census figures display