Millions of UK asthma sufferers "not receiving basic levels of care"

Millions of asthma patients are not receiving basic levels of care to keep their condition in check, a charity has warned.

Two-thirds of sufferers are not being given fundamental care to manage their condition, Asthma UK said. This is about 3.6 million people across the UK.

Full provision of this basic care would “reduce the impact of asthma, reduce hospital admissions and improve the lives of hundreds of thousands of people”, according to a new report by the charity.

Basic care includes having an appropriate asthma review at least once a year – or more often for severe cases and children – being on the right medication and knowing how to use it, and having a written asthma action plan.

The annual asthma survey, based on responses from 4,650 patients from around the UK, found a variation in the proportion of people receiving basic care across the country, with some areas “lagging behind others”.

Patients in Northern Ireland appeared to get the best basic care, with 47.6% receiving all elements of recommended care.

The lowest proportion was in London, where just 27.5% of patients received this level of care.

The report’s authors said it was not just this basic care that was “failing people with asthma”. The report stated that seven out of 10 patients who required hospital care or out-of-hours treatment did not have a follow-up appointment.

The authors said: “Correct discharge arrangements after a hospital stay for asthma saves lives, and this is a particularly worrying finding.”

There are about 5.4 million people with asthma in the UK. In 2015, 1,468 people died from the condition – the highest number for more than a decade. The charity said two-thirds of asthma deaths were preventable with the right basic care.

“It is worrying that basic care is not being delivered on a consistent basis because every person with asthma should be receiving this care,” said the charity’s clinical lead, Dr Andy Whittamore.

Kay Boycott, chief executive of Asthma UK, said: “With the 2014 national review of asthma deaths reporting two out of three asthma deaths are preventable with good basic care, it is hugely disappointing that the latest Asthma UK care survey shows little has changed since that damning report.

“It is clear that expecting old ways to tackle long-standing problems won’t work. We must take a bold new approach and take advantage of new asthma digital health solutions to transform the way asthma care is delivered and support self-management.

“Digital asthma action plans, smart inhalers and automated GP alerts are just some of the ways asthma care could be brought up to date and help reduce the risk of potentially fatal asthma attacks.”

The proportion of patients in each region who received all elements of basic asthma care, according to Asthma UK

East Midlands: 33.5%

East of England: 30.4%

London: 27.5%

North-east: 38.5%

North-west: 34.5%

Northern Ireland: 47.6%

Scotland: 41.1%

South-east: 33.2%

South-west: 34.2%

Wales: 32.2%

West Midlands: 32.2%

Yorkshire and the Humber: 28.1%

Millions of UK asthma sufferers "not receiving basic levels of care"

Over 130,000 patients a year are not receiving vital NHS cancer care on time

More than 130,000 patients a year are not receiving vital NHS cancer care on time because hospitals are struggling to look after the growing number of people suspected of having the disease.

Doctors are warning that a widespread and growing failure to meet waiting time targets was causing huge anxiety for patients affected and may even harm their chances of survival.

A total of 132,138 patients in England last year did not see a cancer specialist within the required 14 days or start treatment such as surgery or radiotherapy within the supposed maximum 31 after diagnosis, or 62 days after initial consultation and tests, according to an analysis of NHS-wide performance data conducted by Cancer Research UK.

Delays in some hospitals were so severe that more than 6,000 patients who should have had their first treatment within 62 days of being urgently referred by their GP last year were forced to wait for 104 days or more, the figures collected by hospitals show.

101,140 patients with suspected cancer were not seen by a specialist within 14 days last year

“These figures are alarming. The number of people for whom these targets are being missed is a real source of concern,” said Prof Peter Johnson, Cancer Research UK’s chief clinician. “Delay creates additional anxiety for people. That matters for individual patients affected in a precise way because they have a prolonged period of uncertainty. Do I have cancer or do I not? And if I do have cancer, will it be curable?

“In some cases delays may even mean the chance to give curative treatment may be lost. Delays mean that there will be some people whose cancer gets worse while they wait for the result [of a test]. I’m pretty angry about that. This all reflects a system that’s failing to meet the needs of people with cancer or suspected cancer,” added Johnson, who is a leading NHS cancer specialist in Southampton and professor of medical oncology at Southampton University.

The figures show that 101,140 people with suspected cancer did not get to see a specialist within 14 days of being referred as urgent cases by their GP during 2015-16. Another 6,713 patients found to have the disease did not receive their first treatment within 31 days. And a further 24,285 were not treated within 62 days, despite being referred urgently by their family doctor.

Leading cancer doctors claim that a failure to invest in NHS diagnostic and treatment services in recent years has left hospitals struggling to cope with the 1.5 million people a year whom GPs now refer for tests because they suspect they may have the disease. They pinpointed a lack of scanners and key personnel such as radiologists and endoscopists to meet demand as key problems.

6,713 patients did not receive their first definitive treatment within 31 days of a cancer diagnosis last year

And they warned that the NHS is increasingly ill-equipped to give timely care to the even greater number of people who will be diagnosed with cancer over coming years as a result of the ageing population and impact of lifestyle factors such as obesity, smoking and drinking.

The NHS is testing, diagnosing and treating record numbers of people with cancer. But the number of patients not cared for within 14, 31 or 62 days is rising relentlessly. Last year’s total of 132,138 people affected was more than double the 63,701 such cases in 2011-12.

Doctors say that cancer waiting time standards, originally introduced by then prime minister Gordon Brown in January 2009, are vital to ensure early diagnosis of cancer and central to the NHS’s determined efforts to help tackle Britain’s poor record of late diagnosis of the disease.

The targets specify that hospitals in England should ensure that 93% of those referred by a GP should see a specialist within two weeks, that 96% of patients diagnosed with cancer should receive their first treatment within 31 days and that 85% should start urgent treatment within 62 days of GP referral.

24,285 people diagnosed with cancer were not treated within 62 days after being referred by their GP last year

The NHS as a whole has breached the 62-day target in every quarter for the last two and a half years. In that time, 57,112 people have had to wait longer than that for supposedly urgent care, NHS England’s figures show. “We now have a situation where most hospitals don’t meet their targets to start treating people within 62 days of referral with radiotherapy, chemotherapy or surgery. That’s regrettable for patients because for an affected patient any extension of those 62 days is both psychologically challenging and damaging both for them and their loved ones,” said Dr Richard Roope, the Royal College of GPs’ spokesman on cancer.

“There’s always the worry that that delay might affect your outcome and that delay is well-placed because in some cases it will mean that the cancer is more advanced at the time of treatment, which will then be detrimental to the outcome – it could reduce their chances of survival,” Roope added.

Although hospitals overall have hit the 14-day and 31-day targets, performance has been slipping. More hospitals have been missing one or both targets since early 2014. The number of patients who have not seen a specialist within two weeks has shot up from 45,414 in 2011-12 to 101,140 last year, while the number denied treatment within 31 days rose from 4,132 to 6,713 during that period.

“If you look after people with cancer it’s a desperate situation to be asking them to wait for their tests and to be planning to see them after a month because they won’t have their results until then, and we know that’s going to be a month of terrible worry for them,” said Johnson.

Dr Giles Maskell, until recently president of the Royal College of Radiologists, said: “There are gaps right across the NHS cancer workforce, including oncologists, therapists, nutritionists, nurse specialists and other groups. The shortage of radiologists – who interpret x-rays and scans – is so serious that one university hospital in the south-east recently had 11 of its 33 consultant radiologist posts unfilled because there were too few applicants, while another teaching hospital in the north-west has eight of its 36 posts unfilled, and seven have been vacant for over a year.”

The Department of Health declined to comment directly on the large numbers of patients not getting timely care. Instead, a spokesman said in a statement that: “Cancer survival rates have never been higher and just this week the NHS announced a new £130m investment to kickstart the upgrade of radiotherapy equipment and transform cancer treatment across England.

“The reality is the NHS is seeing over 90% more patients with suspected cancer within two weeks – that’s over 800,000 more people – and treating nearly 50,000 more patients following a GP referral compared to 2010.”

Over 130,000 patients a year are not receiving vital NHS cancer care on time

Quarter of a million children receiving mental health care in England

Almost a quarter of a million children and young people are receiving help from NHS mental health services for problems such as anxiety, depression and eating disorders, figures show.

The scale of the growing crisis in young people’s mental wellbeing is laid bare with the disclosure that 235,189 people aged 18 and under get specialist care, according to data covering 60% of mental health trusts in England.

Sarah Brennan, the chief executive of the mental health charity Young Minds, said: “It’s staggering that so many children and young people are in need of specialist mental health care. These figures should act as a wake-up call.”

The Guardian reveals the figures for the first time at the start of a two-day series prompted by rapidly accumulating evidence that growing numbers of children, teenagers and young adults are being afflicted by debilitating psychological and psychiatric ailments.

Among the 235,189 young people who were in contact with mental health services in June were 11,849 boys and girls aged five and under, and 53,659 aged between six and 10. Just over 100,000 patients were 11 to 15, and 69,505 were 16 to 18.

Contrary to some experts’ expectations, the total comprised more boys (130,395) than girls (104,522).

NHS Digital, the health service’s statistical arm, began collating the figures in January. The numbers for the whole of England would be higher as 40% of mental health trusts did not provide data.

Experts blame growing pressures on the young, including the need to excel academically, look good and be popular, as well as poverty and family breakdown for the growing burden of mental illness in school-age children and young adults. An NHS inquiry found last week that self-harm and post-traumatic stress disorder had risen sharply in young women aged 16 to 24 in recent years.

Azia, 17, from West Yorkshire, went to her GP in 2014 for help with problems including anxiety and depression. “I had been feeling hopeless and helpless, tearful, with no motivation or interest in doing anything,” she said. “I was not getting any enjoyment out of life and had suicidal thoughts. From around the age of 13, I also experienced anxiety. The physical symptoms were headaches, soreness in my limbs, bloatedness, sweats and shivers, loss of libido and increased sleeping.”

Azia, who has received cognitive behavioural therapy from NHS children and adolescent mental health services, said she was doing much better but still needed help. Her anxiety meant her family could not do things like go on holiday, she said.

“There’s a lot more pressure now on young kids to get excellent grades and go to university. It can make these feelings worse. Also, sometimes it feels like adults think that when you’re young you can’t have anything really serious going on. It makes it harder to speak to people about it.”

The figures have sparked calls for ministers, schools and the NHS to do much more to prevent, identify and treat mental disorders in young people.

Jeremy Hunt, the health secretary, said the extra £1.4bn that the government had pledged to improve support for troubled children during this parliament was funding an expansion of services so that the increasing numbers seeking help could get access.

“Tackling the problems of mental ill health in children and young people is a priority for this government and I welcome the Guardian’s focus on this important area,” he said. New waiting time standards for treatment for eating disorders and early intervention in episodes of psychosis would help ensure that the £1.4bn got to the areas of greatest need, Hunt added.

Childline said it saw a significant rise in calls about young people’s mental health in 2015-16 and conducted 92,891 counselling sessions – by telephone, email and social media – as a result. Of those, 19,481 contacts were about young people who were thinking about ending their own lives – double the numbers received five years ago. It conducts an average of 53 suicide counselling sessions a day – more than one every 30 minutes.

Luciana Berger, a former shadow cabinet minister for mental health and now president of the Labour campaign for mental health, said: “These new figures shine a spotlight on the extent of the demand for mental health treatment, particularly when we know there are thousands of children who are being turned away because thresholds to access services are out of reach for too many.”

NHS England said: “We know that increasing numbers of children and young people are accessing mental health services across the country. It’s an absolute priority for us that these vulnerable children and young people are provided with the best services possible and the additional £1.25bn, which started to go into the NHS in 2015, is helping us to kickstart this upgrade in care.”

• In the UK, Childline can be contacted on 0800 1111 and the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Quarter of a million children receiving mental health care in England

Proportion of under-twos receiving first MMR jab falls again

The proportion of children given the measles, mumps and rubella (MMR) jab by their second birthday has fallen for the third consecutive year, figures show.

Last year 91.9% of children received their first dose of the vaccine by age two, down on the 92.3% in 2014-15 and 92.7% the year before.

However, by the age of five, 94.8% of children had had their first dose – a record high. GPs invite children for the first dose of the jab when they are 12-13 months.

The data, from NHS Digital, also shows that 93.6% of children reaching their first birthday had their first dose of the combined jab that protects against diphtheria, tetanus and polio (DTaP/IPV/Hib). This is down slightly on the 94.2% in 2014-15 and 94.3% in 2013/14.

Overall, coverage for most routine childhood vaccinations at one and two years of age fell in 2015-16 for the third consecutive year. Only about one in three children aged two to four were also vaccinated against seasonal flu, despite a huge push for them to receive the immunisation.

Just 30% of four-year-olds were vaccinated in 2015-16, while the proportion was 35.4% for two-year-olds and 37.7% for three-year-olds.

Measles is a highly infectious viral illness. Anyone can contract the disease if they have not been vaccinated or had it before, although it is most common in children between one and four. Initial symptoms include fever, red eyes and sensitivity to light, greyish white spots in the mouth and throat and cold-like symptoms. The measles rash typically appears after two to four days.

Vaccination levels for measles need to be at about 95% to achieve “herd immunity” to prevent outbreaks of the disease. Wherever vaccination rates are lower an outbreak is possible.

After doubts over the safety of the MMR vaccine in a now-discredited scientific paper in 1998, vaccination rates fell as some parents lost confidence in the vaccine.

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “While routine childhood vaccination coverage at one and two years remains high, it is a concern that the rate has fallen slightly for a third consecutive year.

“These figures are a reminder of how important it is for parents to ensure their child is up to date with their vaccinations, including the MMR vaccine, which has also seen a drop in uptake.

“Measles may not be hitting the headlines every day, but councils, which have responsibility for public health, would encourage people to contact their GP to check their family’s medical records and make sure they and their loved ones are protected. It is important they don’t miss out.”

Proportion of under-twos receiving first MMR jab falls again

Summertime loving may not be recipe for receiving pregnant, review finds

Lead author Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, explained: “The most clear explanation is that it is to do with increased temperatures but they we looked at the effect of tight underwear, which also triggers a rise in temperature, and that had no influence on sperm shape.

“If a guy ejaculates in August his sperm is created 3 months ahead of.

“We could speculate that it could be issues like daylight or a lack of vitamin D but we do not know.

“But people shouldn’t end trying in the course of the summertime months since the most important factor for men and women trying to conceive is getting a lot of sex.”

The form of the sperm is critical for conception as sperm with misshapen heads struggle to get by means of the cervix.

Studies in the laboratory also suggest that sperm with poor shape also swim much less well because their abnormal shape tends to make them much less efficient.

However the review also discovered that unhealthy lifestyles such as smoking and drinking were unlikely to have any impact on sperm wellness.

But the academics discovered that smoking cannabis doubled the opportunity of sperm becoming misshapen and swimming much more gradually.

“Our understanding of aspects that influence sperm dimension and form is very restricted, but faced with a diagnosis of bad sperm morphology, numerous guys are concerned to attempt and determine any elements in their way of life that could be causing this,” extra Dr Pacey.

“It is for that reason reassuring to uncover that there are very number of identifiable dangers, although our data suggests that cannabis consumers may possibly be suggested to cease making use of the drug if they are preparing to try out and begin a household.”

The research, published in the medical journal Human Reproduction, recruited two,249 men from 14 fertility clinics about the Uk and asked them to fill out comprehensive questionnaires about their health care history and their lifestyle.

They found that men who had fewer than four per cent normal sperm have been twice as very likely to have created a sample in the summertime months.

Dr Andrew Povey, from the University of Manchester’s Institute of Population Overall health, explained: “This research builds on our study of two many years ago which looked at the danger aspects connected with the amount of swimming sperm in men’s ejaculates.

“This prior examine also located that there have been fairly couple of chance variables that men could modify in order to improve their fertility.

“We consequently have to conclude once again that there is small evidence that delaying fertility treatment method to make adjustments to a man’s lifestyle will improve their odds of a conception.”

A previous examine by the same teams discovered that tight underwear lowered the amount of sperm made, but the new study found it did not effect on the form of the heads of movement.

Summertime loving may not be recipe for receiving pregnant, review finds

Are you receiving enough rest?

But the two are trumped by Harriet Green, who this week won the Veuve Clicquot Businesswoman of the Yr award. She has explained: “I don’t rest significantly, I never have. It is above-rated.” She claims to get up at three.30am to solution all her emails, right after no much more than “three to four” hrs asleep.

Dr Simon Archer, an additional contributor to the report, says these non-sleepers ought to not turn into part models: “I do agree that there has been this prevailing ‘you snooze, you lose’ mindset, but some quick sleepers such as Thatcher may possibly be better capable to cope better on much less rest.”

Other rest specialists are sceptical of these boasts. Jim Horne, Professor of Psychophysiology at Loughborough University, says: “I am sorry, I just don’t believe anybody can get by on three to 4-hour sleeps with out any daytime naps.”

^{Prime 10 Large ACHIEVERS WHO Claim THEY GET BY ON Extremely Little Sleep}

There has been a very definite elongating of the day in most places of British lifestyle, not just in the organization planet. In the Eighties, pubs threw you out at 11pm and stores only had 1 late-night opening, and that meant 9pm. Until finally Very first Direct came along in 1989 and launched the 1st “24-hour bank”, it was unheard of to phone any services soon after 5pm. As just lately as 1962 there had been villages in Devon that did not have electricity – studying in the evening was carried out by gaslight or candles.

Prof Foster estimates that we are sleeping about one particular and a half hours much less a evening than we did 60 many years ago, and only reaching about eight hrs. This is based mostly on American information from the University of Chicago, to which Prof Horne says: “There is no proof at all, I’m sorry, that we are obtaining any much less rest in Britain than we had been about 50 years in the past. We’ve usually had about seven hours.”

Nonetheless, he does agree – along with most experts – that the top quality of our sleep has declined. “The total ‘you need eight hours each and every night’ tends to make as much sense as saying everybody need to wear dimension eight sneakers. It is the good quality of rest that matters. 6 hours undisturbed is possibly far better than ten hours of interrupted sleep.”

A single of the main brings about of disturbed sleep is the growing sum of light we are exposed to late at evening – both via the electrical light bulb or, possibly far more damagingly, by way of phones, TVs or laptop screens. Research has demonstrated that evening-time light exposure – not least by means of brief-wave or “blue” light emitted by screens – suppresses the manufacturing of melatonin, the key hormone secreted by the pineal gland that controls sleep and wake cycles.

Melatonin suppression has far worse consequences than a bad night’s sleep: it has also been shown to boost the chance of cancer, impair immune method perform, and possibly lead to variety two diabetes, weight problems and heart disease.

As Prof Horne factors out, it is not just the physiological facet of the light from the display. “Sitting up waiting to see if a person solutions your text, or retweets you until the modest hours, can wind you up. It is so critical to wind down from the active day – switch off the Television. Bear in mind the very good outdated days of a mug of Horlicks?” he says.

Certainly, lack of sleep – in certain since of disrupted sleep or night-doing work – is now related with a hospital-worth of poor well being. If you have 5 hours’ rest or less a evening, you have a 50 per cent probability of currently being obese, because fewer than about 6 hours’ rest increases the manufacturing of ghrelin, the so-named hunger hormone. The British Health-related Journal calculated that shift function was linked to a 23 per cent elevated chance of heart attack, 24 per cent improved danger of coronary event and 5 per cent elevated chance of stroke.

Tiredness is often ignored as a significant problem. But in the United States it was located that 31 per cent of drivers had fallen asleep at the wheel at some stage and that a hundred,000 street accidents a yr had been linked to rest deprivation. Both the Chernobyl and the Challenger Space Shuttle disasters have been discovered to be partially brought on by poor judgment brought on by lack of sleep.

One particular of the main functions of sleep is to enable our brains to method data we have learnt during the day. “After attempting to find out a job,” explains Prof Foster, “it is smashed in rest-deprived people.”

Several individuals are exacerbating the dilemma, not just via their inability to switch off at evening but by turning to in excess of-the-counter medication to remain awake. The Tab newspaper in Cambridge, which surveyed college students across 42 universities, located that one particular in 5 had taken modafinil, a drug that is employed to avert sleepiness and enhance concentration, in order to assist them with their academic work.

Lack of rest is a serious public well being crisis, in accordance to Prof Foster and several other individuals, and 1 that is leading to mental health issues for numerous folks. Bipolar disorder, for instance, is now confirmed to be preceded by rest disruption.

Some are much less convinced and recommend that anxiousness about lack of sleep is just as serious an issue. Prof Horne says: “The acid check is: if you are sleepy throughout the day – apart from a dip in the afternoon, which is standard – then you are sleep-deprived. If you are alert and awake, then you really don’t need to have to be concerned about it.”

And, he adds, there is a remedy to rest deprivation: an previous-fashioned afternoon nap. He says that we need to see this not as an indulgent siesta but as a high-attaining “power nap”.

“The physique clock is designed to have two sleeps a day. A lengthy one at evening and a shorter one in the afternoon,” he says, pointing out that we have evolved from an equatorial climate, in which predators slow down in the afternoon. “The restorative power of a twenty-minute nap in the afternoon is wonderful, it can fix considerably of the harm caused by lack of rest.”

There is a precedent in Britain. In the medieval era, the upper courses in distinct had what was referred to as a “fyrste sleep” at about 6pm, for about an hour, so they’d really feel refreshed for the evening.

We may possibly have turn out to be an arrogant species, but perhaps we must put our self-regard to very good use and insist to our sleep-deprived bosses that we all need a lie-down soon after lunch. As Prof Foster says: “Sleep is not an indulgence.”

Are you receiving enough rest?

Why receiving up out of a chair can reveal how extended you have left to dwell

In accordance to their reckoning, a 53-12 months-outdated guy who can hold the flamingo pose with his eyes closed for 10 seconds has a greater life expectancy than the guy who topples in excess of. Based on research that started out in 1946, the faller-over is 12 times much more probably to die in the subsequent 13 years than the chap who stays upright past the 10-2nd mark. Which elevates this physical exercise from a gentle gymnasium work out into the equivalent of obtaining a gipsy fortune-teller get a single look at your palm and supply you your cash back.

So what do my wobbles indicate? Far more to the point, if I’m going to end up in the swingbin of historical past by the time I’m 66, am I wasting my time paying money into my pension each month? And please could I have an additional go at the test, this time with my eyes open? “The whole level of having your eyes closed is that you cannot depend on visual cues,” says Dr Cooper. “You are dependent on your muscle groups and your organic power.”

Once again, for that reason, I repeat the question: what’s wrong with me? “It does not automatically mean there is anything wrong with you,” she replies. “On the other hand, it suggests that even just before symptoms grow to be obvious, failure to compete the test effectively could be a marker of undetected illness or long term disability.”

I want I hadn’t asked. Probably I’ll do much better on the subsequent check. This includes sitting in a chair, and then seeing how many occasions you can stand up and sit down once again in the room of a minute. Men with the lowest threat of early death carried out much more than 39 of the movements in the time offered, while the worst managed 22.

Although heeding Dr Cooper’s no-warm-up principles, I request if, instead of searching at my watch, I can programme the kitchen microwave to run for a minute. Its supportive, whirring noise will spur me on to higher athleticism.

And I am proud, dear reader, to report that in much less time than it requires to heat a ramekin of baked beans, I control to full no fewer than 48 stand-ups and sit-downs. It leaves me breathless, but not so unable to talk that I can not utter a croak of triumph when it turns out that I’m ahead of the Grim Reaper.

All the exact same, even though, I’m nevertheless worried by my wobbling. “The function we have completed does demonstrate how, if taken in mid-existence [she’s currently being type here, I’m 58], these measurements are relevant to eventual mortality,” says Dr Cooper.

So what’s the stage of this early-warning technique if all it does is tell you how small time you’ve got left?

“The level,” says Dr Cooper, “is that you shouldn’t wait until finally you expertise a deterioration in your physical capabilities in buy to do some thing about it. These tests enable you to see how you examine with other individuals the identical age as you.”

So does that suggest people with the lowest scores ought to make a point of rushing round to their GP, demanding head-to-toe examinations and organ-scanning? “That’s not what we are advocating, no,” she replies. (GP receptionists of the Uk, breathe a sigh of relief). “What does seem clear, even though, is that increasing exercise just a tiny when you’re younger could spend dividends when you are older.”

I’ll get my hat off to that tips. At least 50 times.

Why receiving up out of a chair can reveal how extended you have left to dwell

Sorry, Prince William, you know you are receiving old when...

_{Prince William in 2014 (Getty Images)}

Now that he has turn into a father, Prince William’s hair has commenced to recede quicker than a Eurozone economic climate. Sorry, Your Royal Highness, it seems that you’re obtaining previous.

Right here, then, are some much more telltale indicators that time is taking its toll on us men…

1. Going to bed early is not a punishment, but a blessed relief.

2. You are, quite sometimes, far more interested by infants than babes.

3. Someone famous dies and your immediate reaction is to subtract your age from theirs and realise, with a start off, that the difference is terrifyingly small. Or, even worse, that you are older.

4. You uncover that there is an inverse partnership among the quantity of hair on your head and the quantity of shampoos, conditioners, grooming gels, creams, bottles of Just For Males, restorative foams and anti-baldness tablets you possess. Soon, you will have a bathroom cabinet that puts Boots to shame and a scalp like Kojak’s even balder brother.

5. You get the reference to Kojak.

^{Kojak: “who loves ya, child?” (ALAMY)}

6. All people furious female Television presenters who are often protesting that they’re also old to get good jobs any a lot more, well, they don’t seem to be that old to you.

7. You are clearing out the garage – due to the fact that is the kind of thing you do these days – and you uncover a pile of old vinyl LPs. You haven’t played any of them in 20 many years, perhaps a lot more, but each and every sleeve brings back a memory.

_{Vinyl LP covers: a reminder of happier occasions (ALAMY)}

eight. You see a quite young issue swishing down the street on a sunny day and your heart still lights up as it always did. But the blood does not pound as challenging as a youthful man’s does. And then you realise that you are probably older than the fairly young thing’s father. Or, in some elements of the nation, her grandad.

9. It is not just that you’re older – much, much older… – than the footballers on Match of the Day. It’s that the managers have started out to seem to be youthful, as do the pundits and certainly the referees. Not that you see several of them, due to the fact you’ve dropped off less than halfway by way of the programme. Speaking of which …

10. Afternoon nap – the two best words in the lexicon.

11. You start off to consider a perverse pride in wearing previous garments. They are agreeably acquainted, and the tattier they get, the more cozy they grow to be. It is a incredible relief to give up buying practically totally. You start contemplating they’ll most likely see you out if you look after them very carefully. And what could offer a lot more satisfaction than being able to get into the jeans you bought when you were 35?

12. Squat on your haunches. Now stand. Just a number of twinges, are not there? Kneel down for far more than 30 seconds. Try out to get up. See what I suggest?

13. Although viewing Steve Coogan and Rob Bryden in The Trip to Italy, you hoot with laughter at Coogan’s spot-on impersonation of Neil Kinnock while your unsmiling teenage son asks: “Who’s Neil Kinnock?”

14. Pensions cease to be a topic of no curiosity whatever and become an overriding obsession. See also the iniquities of annuity costs, the rapacity of fund managers, the dubious potential of monetary advisers. And as for George Osborne’s pension reforms in the Spending budget, oh, be still my beating heart: what excitement!

15. Gardening – there is yet another issue that never ever used to be of any interest no matter what. But all of a sudden you uncover by yourself brooding in excess of slug repellents, leafing via seed, bulb and David Austin rose catalogues and, yes, becoming genuinely grateful for a actually great pair of gardening gloves at Christmas.

16. It is not that you invest Saturday evenings in, viewing all these Euro-cop demonstrates on BBC Four, laying off the Scandinavian murder mysteries and Belgian conspiracy thrillers just long enough to relish the intrigues of Danish coalition politics it is that you really believe you are rather fashionable as you’re doing it.

17. You employed to be reasonably hip, but now you have virtually no concept at all what the number one single could probably be. If you occur to hear it, your 1st reaction is to spot all the songs and artists you don’t forget from the old days from which it (like practically all contemporary hits) has been ripped off.

18. How can one be each shortsighted and longsighted at the exact same time? Reach middle-age, that is how. Out of the blue Tv dinners turn out to be a nightmare as you find out that you can both see the telly, or the foods on your plate. But not both, and suddenly…

19. You can hold your own in a discussion about varifocals. “Oh, do they function for you? Actually? I couldn’t get the hang of them at all, myself. They just created me come to feel woozy and strolling downstairs was a nightmare of vertigo. What? You have various prescription lenses in either eye? Remarkable, etc…”

^{One particular Path (I feel…) (GETTY Photographs)}

20. The baby that you as soon as held so nervously in your arms goes to school, and you include ‘nativity plays’ to the listing of sudden pleasures. Then you go to cello recitals and cheer at football games and battle to get your young children into the school you wished and you suffer through GCSEs and A-Levels, by way of fights with friends and first romances, by means of furious rows and slamming doors, through endless evenings spent ferrying them to events and back. Then suddenly they’re halfway round the globe, backpacking anyplace from Bolivia to Bangkok. And they are graduating, receiving jobs and by some means costing even much more than they ever did before. And you just cannot picture how the time could have gone by so rapidly.

Oh, and a single ultimate thing…

21. You know you left an additional sign of receiving previous somewhere safe, just in situation you needed it, but you just can not bear in mind in which…

Sorry, Prince William, you know you are receiving old when...

Sorry, Prince William, you know you"re receiving outdated when...

_{Prince William in 2014 (Getty Images)}

Now that he has become a father, Prince William’s hair has started to recede faster than a Eurozone economy. Sorry, Your Royal Highness, it seems that you’re getting old.

Here, then, are some more telltale signs that time is taking its toll on us men…

1. Going to bed early is not a punishment, but a blessed relief.

2. You are, very occasionally, more interested by babies than babes.

3. Someone famous dies and your immediate reaction is to subtract your age from theirs and realise, with a start, that the difference is terrifyingly small. Or, even worse, that you’re older.

4. You discover that there is an inverse relationship between the amount of hair on your head and the number of shampoos, conditioners, grooming gels, creams, bottles of Just For Men, restorative foams and anti-baldness pills you possess. Soon, you will have a bathroom cabinet that puts Boots to shame and a scalp like Kojak’s even balder brother.

5. You get the reference to Kojak.

^{Kojak: “who loves ya, baby?” (ALAMY)}

6. All those furious female TV presenters who are always protesting that they’re too old to get decent jobs any more, well, they don’t seem that old to you.

7. You’re clearing out the garage – because that’s the kind of thing you do these days – and you find a pile of old vinyl LPs. You haven’t played any of them in 20 years, maybe more, but every sleeve brings back a memory.

_{Vinyl LP covers: a reminder of happier times (ALAMY)}

8. You see a pretty young thing swishing down the street on a sunny day and your heart still lights up as it always did. But the blood doesn’t pound as hard as a young man’s does. And then you realise that you’re probably older than the pretty young thing’s father. Or, in some parts of the country, her grandad.

9. It’s not just that you’re older – much, much older… – than the footballers on Match of the Day. It’s that the managers have started to seem young, as do the pundits and certainly the referees. Not that you see many of them, because you’ve dropped off less than halfway through the programme. Speaking of which …

10. Afternoon nap – the two finest words in the lexicon.

11. You start to take a perverse pride in wearing old clothes. They’re agreeably familiar, and the tattier they get, the more comfortable they become. It’s a tremendous relief to give up shopping almost entirely. You start thinking they’ll probably see you out if you look after them carefully. And what could provide more satisfaction than being able to get into the jeans you bought when you were 35?

12. Squat on your haunches. Now stand. Just a few twinges, aren’t there? Kneel down for more than 30 seconds. Try to get up. See what I mean?

13. While watching Steve Coogan and Rob Bryden in The Trip to Italy, you hoot with laughter at Coogan’s spot-on impersonation of Neil Kinnock while your unsmiling teenage son asks: “Who’s Neil Kinnock?”

14. Pensions cease to be a subject of no interest whatever and become an overriding obsession. See also the iniquities of annuity rates, the rapacity of fund managers, the dubious ability of financial advisers. And as for George Osborne’s pension reforms in the Budget, oh, be still my beating heart: what excitement!

15. Gardening – there’s another thing that never used to be of any interest whatever. But suddenly you find yourself brooding over slug repellents, leafing through seed, bulb and David Austin rose catalogues and, yes, being genuinely grateful for a really good pair of gardening gloves at Christmas.

16. It’s not that you spend Saturday evenings in, watching all those Euro-cop shows on BBC Four, laying off the Scandinavian murder mysteries and Belgian conspiracy thrillers just long enough to relish the intrigues of Danish coalition politics; it’s that you actually think you’re rather trendy as you’re doing it.

17. You used to be reasonably hip, but now you have literally no idea at all what the number one single could possibly be. If you happen to hear it, your first reaction is to spot all the songs and artists you remember from the old days from which it (like virtually all contemporary hits) has been ripped off.

18. How can one be both shortsighted and longsighted at the same time? Reach middle-age, that’s how. Suddenly TV dinners become a nightmare as you discover that you can either see the telly, or the food on your plate. But not both, and suddenly…

19. You can hold your own in a discussion about varifocals. “Oh, do they work for you? Really? I couldn’t the hang of them at all, myself. They just made me feel woozy and walking downstairs was a nightmare of vertigo. What? You have different prescription lenses in either eye? Amazing, etc…”

^{One Direction (I think…) (GETTY IMAGES)}

20. The baby that you once held so nervously in your arms goes to school, and you add ‘nativity plays’ to the list of unexpected pleasures. Then you go to cello recitals and cheer at football games; and fight to get your children into the school you wanted; and you suffer through GCSEs and A-Levels, through fights with friends and first romances, through furious rows and slamming doors, through endless evenings spent ferrying them to parties and back. Then suddenly they’re halfway round the world, backpacking anywhere from Bolivia to Bangkok. And they’re graduating, getting jobs and somehow costing even more than they ever did before. And you simply can’t imagine how the time could have gone by so fast.

Oh, and one final thing…

21. You know you left another sign of getting old somewhere safe, just in case you needed it, but you simply can’t remember where…

Sorry, Prince William, you know you"re receiving outdated when...

Sorry, Prince William, you know you happen to be receiving outdated when...

_{Prince William in 2014 (Getty Images)}

Now that he has become a father, Prince William’s hair has started to recede faster than a Eurozone economy. Sorry, Your Royal Highness, it seems that you’re getting old.

Here, then, are some more telltale signs that time is taking its toll on us men…

1. Going to bed early is not a punishment, but a blessed relief.

2. You are, very occasionally, more interested by babies than babes.

3. Someone famous dies and your immediate reaction is to subtract your age from theirs and realise, with a start, that the difference is terrifyingly small. Or, even worse, that you’re older.

4. You discover that there is an inverse relationship between the amount of hair on your head and the number of shampoos, conditioners, grooming gels, creams, bottles of Just For Men, restorative foams and anti-baldness pills you possess. Soon, you will have a bathroom cabinet that puts Boots to shame and a scalp like Kojak’s even balder brother.

5. You get the reference to Kojak.

^{Kojak: “who loves ya, baby?” (ALAMY)}

6. All those furious female TV presenters who are always protesting that they’re too old to get decent jobs any more, well, they don’t seem that old to you.

7. You’re clearing out the garage – because that’s the kind of thing you do these days – and you find a pile of old vinyl LPs. You haven’t played any of them in 20 years, maybe more, but every sleeve brings back a memory.

_{Vinyl LP covers: a reminder of happier times (ALAMY)}

8. You see a pretty young thing swishing down the street on a sunny day and your heart still lights up as it always did. But the blood doesn’t pound as hard as a young man’s does. And then you realise that you’re probably older than the pretty young thing’s father. Or, in some parts of the country, her grandad.

9. It’s not just that you’re older – much, much older… – than the footballers on Match of the Day. It’s that the managers have started to seem young, as do the pundits and certainly the referees. Not that you see many of them, because you’ve dropped off less than halfway through the programme. Speaking of which …

10. Afternoon nap – the two finest words in the lexicon.

11. You start to take a perverse pride in wearing old clothes. They’re agreeably familiar, and the tattier they get, the more comfortable they become. It’s a tremendous relief to give up shopping almost entirely. You start thinking they’ll probably see you out if you look after them carefully. And what could provide more satisfaction than being able to get into the jeans you bought when you were 35?

12. Squat on your haunches. Now stand. Just a few twinges, aren’t there? Kneel down for more than 30 seconds. Try to get up. See what I mean?

13. While watching Steve Coogan and Rob Bryden in The Trip to Italy, you hoot with laughter at Coogan’s spot-on impersonation of Neil Kinnock while your unsmiling teenage son asks: “Who’s Neil Kinnock?”

14. Pensions cease to be a subject of no interest whatever and become an overriding obsession. See also the iniquities of annuity rates, the rapacity of fund managers, the dubious ability of financial advisers. And as for George Osborne’s pension reforms in the Budget, oh, be still my beating heart: what excitement!

15. Gardening – there’s another thing that never used to be of any interest whatever. But suddenly you find yourself brooding over slug repellents, leafing through seed, bulb and David Austin rose catalogues and, yes, being genuinely grateful for a really good pair of gardening gloves at Christmas.

16. It’s not that you spend Saturday evenings in, watching all those Euro-cop shows on BBC Four, laying off the Scandinavian murder mysteries and Belgian conspiracy thrillers just long enough to relish the intrigues of Danish coalition politics; it’s that you actually think you’re rather trendy as you’re doing it.

17. You used to be reasonably hip, but now you have literally no idea at all what the number one single could possibly be. If you happen to hear it, your first reaction is to spot all the songs and artists you remember from the old days from which it (like virtually all contemporary hits) has been ripped off.

18. How can one be both shortsighted and longsighted at the same time? Reach middle-age, that’s how. Suddenly TV dinners become a nightmare as you discover that you can either see the telly, or the food on your plate. But not both, and suddenly…

19. You can hold your own in a discussion about varifocals. “Oh, do they work for you? Really? I couldn’t the hang of them at all, myself. They just made me feel woozy and walking downstairs was a nightmare of vertigo. What? You have different prescription lenses in either eye? Amazing, etc…”

^{One Direction (I think…) (GETTY IMAGES)}

20. The baby that you once held so nervously in your arms goes to school, and you add ‘nativity plays’ to the list of unexpected pleasures. Then you go to cello recitals and cheer at football games; and fight to get your children into the school you wanted; and you suffer through GCSEs and A-Levels, through fights with friends and first romances, through furious rows and slamming doors, through endless evenings spent ferrying them to parties and back. Then suddenly they’re halfway round the world, backpacking anywhere from Bolivia to Bangkok. And they’re graduating, getting jobs and somehow costing even more than they ever did before. And you simply can’t imagine how the time could have gone by so fast.

Oh, and one final thing…

21. You know you left another sign of getting old somewhere safe, just in case you needed it, but you simply can’t remember where…

Sorry, Prince William, you know you happen to be receiving outdated when...

Herbalife Convertibles: The Hedgers Are Receiving Nervous

Effectively, it might be taking place with Herbalife. Or at least, it may possibly be starting up.  The organization is being investigated by the Federal Trade Commission, and even though it is placing on a brave encounter publicly, management are not able to be satisfied with these most recent developments.  As I compose this the stock is down about 8% on the day. Bill Ackman, who has claimed the organization is an illegal pyramid scheme that will sooner or later be shut down, has to like what he is seeing.

Final month, when Herbalife Herbalife announced its new convertible bond, I discussed some of the implications of the deal.  In some respects the bond appeared designed to squeeze brief-sellers by producing a new group of traders probably willing to pay out to borrow the stock.  But given that Herbalife created arrangements, basically, to lend phantom stock to hedge funds, the deal did not (at least at first) develop any kind of squeeze.

I did note, however, that one particular of the central tenets of convertible investing—that a bond holds its worth reasonably well even when the underlying stock will get beaten up—might not apply to Herbalife.  Portion of the issue, as one of the smartest convertible guys I know explained, is that Herbalife’s volatility may well be “existential”—in other phrases, there is concern that the problem major to the stock’s sharp decline could conceivably destroy the business.  This is what we contact “bad volatility.”  Very good volatility applies solely to a stock’s valuation, but not to its legitimacy as a going concern.

Other problems with Herbalife are the company’s debt load, which whilst seemingly manageable now could grow to be highly problematic with a key stock decline, and some of the likely complications with borrowing the stock for hedgers. If short-sellers pile on a falling Herbalife stock—something they have been acknowledged to do—convertible hedgers will become increasingly dependent on the phantom stock, or borrow facility, arranged by the firm. Individuals hedgers unwilling to consider this danger are likely to consider their lumps and sell the bonds, accepting a specified reasonable loss alternatively of exposing themselves to a possibly much bigger one particular if the borrow facility ought to come unglued.

Early indications show that the convertible marketplace is without a doubt worried about how this may perform out. Herbalife’s convertibles are looking for their new degree with the stock hovering around 60 (about an 8% decline on the day).  The bonds have been quoted in the mid-80’s when the stock was down close to $ 57, though it subsequently bounced back to close to $ 60 and lifted the bond quote a couple of points.  As I compose this the stock is somewhat over 60 and the bonds would possibly be quoted, for an educated guess, close to the 87-88 degree.

This isn’t good. The bonds had been originally priced at one hundred with the stock at 69.02.  So the stock is down about 13% and—guess what—so, it seems, are the bonds. Convertibles are supposed to do a whole lot better than this, although, in fairness, you can’t completely indict a bond off brief-phrase functionality. Still, an investor would typically hope that a convertible in this scenario would only fall by about half the percentage of the stock, which would have had the bonds around 93-94 rather of 87-88.

One particular see is that most of the bonds had been initially offered to hedge funds, which were enticed to buy each by the borrow facility and by a belief that the $ 1 billion deal would turn into a convertible index benchmark issue. If the bond had been to be incorporated in the major convertible indices, outright (unhedged) customers whose functionality is measured versus those indices would essentially be forced to buy, in spite of their discomfort with the credit score.  But apparently the index inclusion has not taken place, and nervous hedge funds are now scrambling to get out.

For institutional traders who think in the Herbalife story (one more issue with the bond is that, like a lot of newly issued convertibles, it is a private placement that will not become offered to most personal traders for a year or so, unless they personal the bond by means of a mutual fund), the convertible promote-off may be an chance to perform the identify on a lot more appealing terms.  But for now handful of investors seem interested. To be continued.

Herbalife Convertibles: The Hedgers Are Receiving Nervous

Abnormal cervix cells linked to threat of receiving cancer later in daily life

Abnormal cells displaying up in a cervical smear check, which aims to detect modifications. Photograph: Tony Stone

Women who have been discovered to carry abnormal cells in their cervix are at significantly better danger of later developing and dying from cervical or vaginal cancer, new analysis suggests.

A Swedish research of 150,883 women who had been treated for CIN3, cells that can be a precursor to cancer, located that they have been the most at chance from cancer when their reached their 60s or 70s.

A paper on the British Health-related Journal’s site reviews: “Ladies previously taken care of for CIN3 are at increased risk of building and dying from cervical or vaginal cancer, in contrast with the common female population.

“Females previously diagnosed with, and handled for, CIN3 had been at considerably elevated chance of developing cervical or vaginal cancer when they reached 60. The threat accelerated with further ageing.”

Among Swedish ladies the lifetime or background threat of developing either cancer is eight.9 cases per a hundred,000 females, and 10.two cases per one hundred,000 in ladies who are aged at least 70.

But amid the ladies in the examine who had CIN3 the fee was a lot more than 70 per 100,000 ladies aged 70 – 7 times that of the general population of that age.

The authors pressure that even though cervical cancer screening assists avert several cases of, and deaths from, the disease, individuals taken care of for CIN3 nevertheless face “a steep boost in threat of death with enhanced age after prior diagnosis of CIN3″. The risk far more than doubled thirty years soon after the treatment, they explained.

In the Uk about 2,851 women were diagnosed with cervical cancer in 2010, generating it the 12th most frequent female cancer, even though 972 females died from it for the duration of 2011. Although all females aged 25 to 64 are presented screening, just underneath four in five consider up the offer, and attendances have been falling because 2003, according to Public Wellness England. Although 4.24 million were invited to screening in 2012-13, just three.32 million (78.3%) produced the appointment. The most significant fall in attendance has been with girls aged 25 to 49.

In these 3.32m exams 6.5% gave abnormal final results and .six% of the women had CIN3. The NHS cancer screening programme could not say how several ladies a yr are treated for CIN3. Women handled for CIN3 have a colonoscopy plus one particular of five procedures, this kind of as a cone biopsy, cryotherapy or laser treatment.

Sarah Williams, Cancer Research UK’s wellness data officer, stated cervical screening saved 1000′s of lives. “This research highlights how important it is to keep an eye on girls who’ve had abnormal cells in their cervix. In the Uk, these females have follow-up screening tests and exams for the HPV infections that trigger cervical cancer, to lessen the chance of the abnormal cells coming back.”

Robert Music, chief executive of Jo’s Cervical Cancer Trust, said the review highlighted a want to look at the stick to-up therapy of females with CIN3.

Meanwhile, girls more than 50 are currently being urged to have normal smear tests right after separate study scientific studies by Cancer Research United kingdom indicated that these who did not attend have been six times more very likely to build cervical cancer than individuals whose check outcomes had been regular.

In England and Northern Ireland women aged 25 to 49 are provided screening each 3 many years, and each 5 many years amongst 50 and 64.

Julietta Patnick, director of the NHS Cancer Screening Programmes, said girls could control their threat of cervical cancer by way of normal screening.

“Any abnormalities that may well be discovered can then be taken care of in buy that they do not go on to produce into cancer. Where a cervical cancer is found by way of screening it is usually at a quite early stage in which treatment has a greater opportunity of good results. It is crucial that women are aware of this when determining whether or not or not to be screened.”

Abnormal cervix cells linked to threat of receiving cancer later in daily life

Discover Wilderness Survival Skills While Receiving Match - In Luxury Style

Canyon Ranch Tucson’s Outside Sports activities Manager Randy Kinkade teaches visitors how to start fires in the wild without having tools as portion of the resort’s new outside “primitive skills” classes.

Enjoy Television demonstrates like Survivorman, Man vs. Wild and Dual Survival? Or maybe you just worry about how you’d fare following surviving a plane crash, getting misplaced hiking or operating out of fuel in the middle of nowhere? Either way, this may well be the ideal trip for you.

Tucson’s Canyon Ranch is well-known as a luxury fitness retreat, a white glove boot camp of kinds the place people go to get into shape swiftly under the eye of specialist trainers supplying a enormous slate of workout courses although staying in posh accommodations, enjoying spa remedies and consuming healthily, but without having sacrifice.

Now it is tackling wilderness survival.

Hiking is a massive element of the fitness offerings at Tucson’s Canyon Ranch, in which hikers can also now learn better wilderness survival and security abilities.

The initial Primitive Outdoor Survival Capabilities session is currently being held at the Tucson Canyon Ranch place (there are also Canyon Ranch locations in the Berkshires, Miami Seashore, Las Vegas and at Sea) from January 22-25, 2014. If that’s too short recognize, just hang onto this info as the Primitive Outdoor Survival Skills will be repeated, whilst numerous elements of the plan are now permanent offerings guests can enjoy at any time. The resort not too long ago added a “Primitive Technology” part to its checklist of “Sports &amp Outdoors” classes, with Animal Tracking and Make Your Personal Arrowheads from stones portion of Canyon Ranch’s slate of paid extra-curricular classes, while other essential expertise, such as Primitive Fire Making and Normal Awareness (“Develop Your Outdoor Senses”) have been added to the roster of cost-free, integrated courses.

The real scheduled session is a bit much more immersive and consists of these over aspects plus partaking in a Spirit Lodge, a session on Naturopathic Medicine, and understanding the psychology of ecology. It concludes with the “The Ultimate Check,” exactly where the group operates collectively to attain a shock challenge using their newly acquired abilities. Participants also get access to all of Canyon Ranch’s several extra actions such as an outdoor rock climbing wall, hiking, biking and a lot more fitness courses than you can envision.

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Discover Wilderness Survival Skills While Receiving Match - In Luxury Style