Heavy drinkers should get early screening for liver disease, says Nice

Heavy drinkers should be screened for early signs of liver disease, health officials have said.

Harmful drinkers – women who drink more than 35 units a week and men who drink more than 50 – should also be sent for scans to detect liver scarring, the National Institute for Health and Care Excellence (Nice) said.

A bottle of wine is estimated to contain 10 units of alcohol and a pint of beer is estimated to contain 2.3 units. Across England there are estimated to be 1.9 million “harmful drinkers”.

In a bid to identify early liver problems among these people, Nice said GPs should refer them for scans to detect liver cirrhosis, or scarring.

In its new draft quality standard, the health regulator said diagnosing cirrhosis would ensure patients received the treatment and support needed to manage their condition.

The document, which is out for consultation until February, also says people with cirrhosis should be sent for ultrasounds twice a year to check for liver cancer.

Dr Andrew Fowell, consultant hepatologist at Portsmouth hospitals NHS trust who helped draft the document, said: “Identifying people who are at risk of liver disease and offering them non-invasive testing to diagnose cirrhosis is key to ensuring they are given the treatment and support they need early enough to prevent serious complications.

“Ten years ago diagnosis of cirrhosis would often require a liver biopsy, but now with advances in non-invasive testing, it is much easier for patients and health professionals to make a diagnosis.”

Prof Gillian Leng, deputy chief executive of Nice, said: “Many people with liver disease do not show symptoms until it is too late. If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover.

“Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do.”

Liver disease is the fifth largest cause of death in England and Wales.

Heavy drinkers should get early screening for liver disease, says Nice

Nice proposes "smooth driving" measures to cut air pollution

Speed bumps should be removed, speed limits made variable on England’s motorways, sometimes dropping as low as 50mph, and a congestion charge considered in more cities to cut air pollution and save lives, health experts have said.

The National Institute for Health and Care Excellence (Nice) released a series of recommendations on Thursday which it said would “promote a smoother driving style” and help keep emissions down.

Health officials said vehicles created more emissions when they were speeding up and slowing down, as on congested motorways. To keep a more consistent speed, they said, the limit could be temporarily lowered to 50 or 60 mph when traffic is stop-start. That represented a “more sensible” approach than having lower fixed limits, Nice’s Prof Mark Baker said.

The officials added that some speed bumps encouraged people to speed up, then slow down. They urged planners to consider using average speed technology on the roads to promote smoother driving. Figures released earlier this year by the RAC Foundation showed that cameras measuring average speeds were now monitoring drivers on more than 250 miles of Britain’s roads. Sections covered range in length from a quarter of a mile on London’s Tower Bridge to 99 miles on the A9 between Dunblane and Inverness in Scotland.

On top of that, they want towns and cities with pollution problems to consider implementing clean air zones and look into the possibility of introducing congestion charging zones.

The draft guidance for England also contains proposals for “no-idling” zones around schools to prevent parents leaving their cars running during school drop-offs. Air pollution is a contributory factor to about 25,000 deaths a year in England, almost 5% of all deaths, Nice said, and road traffic is estimated to contribute to about a third of air pollution in urban sites.

Provisional figures show that road usage is at record levels, with an estimated 320bn vehicle miles travelled on Britain’s roads in the year ending September 2016.

Health campaigners welcomed the draft proposals, which were devised for local authority staff and are out for consultation, but environmental groups called for more stringent measures.

The British Lung Foundation said it backed the plans because “air pollution contributes to tens of thousands of early deaths every year” and the British Heart Foundation called them a “step in the right direction”.

Jenny Bates, a Friends of the Earth air pollution campaigner, said the proposals were to be welcomed but that “we must deal with the real crux of the issue and reduce air pollution levels”.

She said: “Action is needed both to ensure vehicles on the road are clean and that there are fewer of them. Diesel vehicles, which are the most polluting, must be phased out and our transport and planning policy needs a radical overhaul.”

Nice officials called for a review of trees lining streets in urban areas. “In some cases, they restrict street ventilation, causing poorer air quality. In others they improve it”. It also warns that solid barriers placed next to roads to mitigate noise can actually lead to a wider dispersal of pollution.

Other suggestions by Nice included:

• Town planners should avoid putting cycle routes on heavily polluted roads but, where this was unavoidable, they should consider using foliage to screen cyclists from vehicles. .

• Local authorities may want to look into setting a standard for the types of cars used for taxis.

• Some areas should consider public awareness initiatives such as “car-free days”. Those could be similar to measures sometimes used in Paris, which only allows drivers with a number plate ending in an odd or even number into the city on given days when pollution reaches high levels.

• House builders should place living rooms at the back of houses away from roads and hedgerows should be grown to protect cyclists using cycle paths.

Nice proposes "smooth driving" measures to cut air pollution

The psychology behind a nice cup of tea | Daniel Glaser

As the temperature drops, you might find yourself reaching for a hot cup of coffee or tea, or warm mulled wine or cider more often than usual. But this may not just be because of the obvious benefits of warming your hands around the cup and banishing the cold from your belly.

In fact, studies have shown there’s a psychological element to choosing hot drinks – they can actually make us feel cosier and friendlier. In an experiment, people were asked to rate strangers on how welcoming and trustworthy they thought they were. Holding a warm cup of coffee made them rate the strangers higher on these attributes, while holding a cold drink had the opposite effect.

Those holding hot drinks were also more likely to be generous, and less likely to display behaviour thought of as selfish. This is due to the strong linguistic and metaphorical links created in the brain by repeatedly using the words ‘warm’ or ‘cold’ to describe personalities.

The same applies with sweetness. People who have eaten something sugary are more likely to describe a person positively – as ‘sweet’. Time to put the kettle on, perhaps.

Dr Daniel Glaser is director of Science Gallery at King’s College London

The psychology behind a nice cup of tea | Daniel Glaser

So you"ve beaten breast cancer. Some congratulations might be nice | Fay Schopen

‘Exercise is excellent for you, cancer or no cancer. The tips really don’t seem notably arduous – just above twenty minutes a day of moderate ­exercise, like strolling.’ Photograph: Justin Kase zninez/Alamy

Cancer, that invasive and insidious ailment, is by no means far from the information, and breast cancer, the pinkest and fluffiest of all the cancers, especially so. We’re horribly used to the issues-that-lead to-cancer story – final week, for example, we realized that eating red meat in early life may possibly result in breast cancer, except it most likely doesn’t. And for great measure, two studies recommended that there may possibly be a genetic or hormonal website link between possessing a whole lot of moles and developing the disease. So now you can lie awake at evening in terror, examining each inch of your entire body, although digesting your dinner of lentils and tofu. So far, so acquainted.

But when you’re a single of the virtually 50,000 females in Britain diagnosed with breast cancer each and every 12 months, things are distinct, correct? You are slashed, you are burned, poison is pumped into your veins. You say goodbye to 1 breast, potentially two, or just component of one if you are fortunate. Hopefully you recover. No more worrying about cancer, since you’ve already had it. Have a burger, why will not you?

But perhaps not. There was yet yet another piece of analysis on breast cancer last week, a research telling us, in the words of 1 headline author, that “breast cancer survivors ‘do not exercising enough’”. Exercising has been proven to help recovery, but a US examine identified that only 35% of women who had had the illness met the weekly guidelines for physical exercise – 150 minutes at reasonable intensity, or 75 at vigorous intensity.

As a person who has had breast cancer – and who hates the word “survivor” by the way – I understand, I actually do. Exercising is very good for you, cancer or no cancer. And the suggestions don’t appear particularly arduous – just in excess of twenty minutes a day of moderate physical exercise, like strolling.

But whilst I am familiar with pre-cancer scaremongering, the publish-cancer model is new. Lifestyle following cancer is difficult enough. Having the condition is the straightforward bit. That is in which you have a single goal: not to die of cancer. So you subject by yourself to the surgeries, the chemotherapy and the radiation, and right after it is all more than – and you are not dead, hopefully – it truly is time to move on and overlook it ever happened.

Except there is a unwanted fat opportunity of performing that. You get undressed and observe you are missing some or all of your breasts. An individual you haven’t observed for a while greets you with a amazed cry of “You look properly!”. A properly-meaning buddy emails you a link to an post about this kind of-and-this kind of creating cancer. And you go through stories telling you that you are not undertaking it proper.

I don’t need to be told I will not consider adequate exercising. I worry about that as it is. I fret that I’m not taking the drug my oncologist insists I ought to consider for five many years, simply because the horrible side-effects stop me. I worry I drink also considerably alcohol, and never consume sufficient greens. And with every single ache and soreness, each cough and cold – my stupid brain can not assist pondering that it might be the cancer returning.

I do not mean to propose that I am a crazed hypochondriac who spends every waking minute residing in fear of cancer. I have rebuilt my daily life, thank you very significantly, and any person who meets me nowadays would not have a clue I’d been ill. But these ideas rumble in the background, a quietly ominous soundtrack to this new phase of my life.

Cancer casts a lengthy shadow. And even though some folks want to run away from the shadow towards the light as speedily as achievable, other individuals really feel defeated by the darkness and sit down in the shade, not sure of what to do subsequent.

And you know what would aid with that? Opening the newspaper and reading through a headline, for as soon as, that says: “Well done for being alive. Why do not you go and have a beautiful glass of wine, and perhaps a pizza also?”

Twitter: @fayschopen

So you"ve beaten breast cancer. Some congratulations might be nice | Fay Schopen

Nice calls for national database for weight-loss programmes

Lifestyle weight management programmes focus on reducing calories consumed and increasing physical activity. Photograph: Dominic Lipinski/PA

A national database for lifestyle weight management programmes that have achieved positive long-term results should be set up to help combat the obesity epidemic, government advisers have said.

The National Institute for Health and Clinical Excellence (Nice) said participants in such programmes – which focus on reducing calories consumed and increasing physical activity – lose 3% of their body weight on average, which if sustained would be enough to lower the risk of type 2 diabetes and high blood pressure.

Carol Weir, guidance developer for Nice and head of service for nutrition and dietetics at Leeds Community Healthcare NHS Trust, said: “Obviously, if you need to lose weight, the more weight you lose the better, and the health benefits derive from that, but even a 3% loss, kept up long-term, is beneficial and that is why we are recommending sensible changes that can be sustained lifelong.”

The NHS recommends that obese people should aim to lose between 5% and 10% of their weight, and Nice emphasised that it was not replacing that guidance. But it said people needed encouragement and achievable goals.

It found that Rosemary Conley, Slimming World and Weight Watchers had been shown to be effective at 12 to 18 months, and said lifestyle weight management programmes were “one part of the solution”, but robust data was not available for many of them.

Gill Fine, chair of the Nice guidance group, said: “The issue is the variation in the types of programme available, and this is a real challenge for local authorities who have limited resources available when commissioning programmes. If there was a central resource that local providers could go in and see those programmes which are effective, it would help them to commission.”

The group has also published guidelines on best practice for programmes, including ensuring the tone and content of all communications.

Dr Alison Tedstone, chief nutritionist at Public Health England, said: “Elements of PHE’s work to support effective commissioning are already contributing to delivering some of the recommendations that Nice has developed. PHE is currently developing its future obesity work plan, which includes supporting local public health teams to deliver lifestyle and weight management services that meet local needs.”

Richard Welbourn, president of the British Obesity and Metabolic Surgery Society, welcomed the Nice guidance but stressed the benefits of surgical interventions. “The fact remains that significant weight loss is hard to achieve and even harder to sustain, even with the help of health professionals,” he said. “We promote the safe and effective use of surgical strategies as part of a coordinated pathway of care for people who are obese. There is compelling evidence that weight-loss surgery is clinically effective, safe and cost-effective.”

Nice is reviewing its guidance on bariatric surgery, which it currently recommends for adults with a body mass index of more than 40 who have tried but failed to lose weight using non-surgical techniques. The revised guidance is due to be published in November.

Nice calls for national database for weight-loss programmes