Life-saving alcohol services face devastating cuts

When a man in his early 20s, who was an alcohol-dependent heroin user, turned up at hospital with a gastrointestinal bleed, Helene Leslie didn’t think he had long left to live.

Yet three weeks later, Leslie, an alcohol liaison nurse at the Royal Infirmary of Edinburgh, saw him in intensive care and was tasked with trying to get him to give up drinking: “I was surprised that he was alive given how sick he’d been,” she remembers. “I thought I wouldn’t get anywhere, but amazingly, with support, the guy’s really turned his life around and hasn’t drunk for 10 years. People like that keep me going.”

Leslie, 53, who has been an alcohol liaison nurse for 24 years, was one of the very first. But in 2001, the Royal College of Physicians called for there to be an alcohol specialist nurse in every hospital in the UK. What has happened since then, and have they had an impact?

“On the whole, it’s been a success,” says Prof Sir Ian Gilmore, ex- president of the Royal College of Physicians and chair of the Alcohol Health Alliance. “They keep patients out of hospital. There’s good evidence that the nurses are able to send patients home. They can deliver interventions that have been shown to be highly cost-effective.”

Dr Kieran Moriarty, consultant gastroenterologist at Bolton NHS foundation trust and alcohol lead for the British Society of Gastroenterology, did an evidence-based review looking at the impact of specialist alcohol workers. It cited a study at St Mary’s hospital in Paddington, London, which showed that for every two referrals to an alcohol health worker, there was one fewer reattendance to A&E the following year.

Gilmore says that in 2000 there were fewer than 10 alcohol care teams, whereas now the majority of acute hospitals have some sort of service.

Alcohol-related admissions are still rising – more than 1 million were related to alcohol consumption in 2013-14 – despite a fall in per capita consumption in the UK in the past few years. And it’s not just people getting drunk and fighting, says Gilmore. The NHS estimates that about 9% of adult men and 4% of adult women in the UK show signs of alcohol dependence. Alcohol is also a contributing factor in many diseases, including cancers – and the number of people with alcohol-related brain damage is rising.

Amid this pressure, however, cuts are being made to public health budgets responsible for alcohol services. In 2015-16, 46% of local authorities implemented cuts in alcohol services, and this has risen to 72% for 2016-17.

Moriarty is concerned: “A lot of the good is going to be lost. Alcohol nurses can play a major role in prevention and identification of alcohol problems at an early stage.”

Gilmore is keen to emphasise their impact: “A brief intervention – a semi-structured interview of up to 20 minutes by a health worker – is highly effective in changing behaviour even six months down the line.”

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Life-saving alcohol services face devastating cuts

DNA study lays bare devastating damage caused by smoking

The devastating impact of cigarette smoke on the body’s DNA has been laid bare by the first comprehensive study into the damage tobacco inflicts on human cells.

People who smoke a pack of cigarettes each day for a year develop on average 150 extra mutations in every lung cell, and nearly 100 more mutations than usual in each cell of the voice box, researchers found. More still build up in the mouth, bladder, liver and other organs.

While chemicals in tobacco smoke have long been known to raise the risk of at least 17 forms of cancer, the precise molecular mechanisms through which they mutate DNA and give rise to tumours in different tissues have never been clear.

“This is about running down the root cause of cancers,” said David Phillips, a professor of environmental carcinogenesis at King’s College London and a co-author on the study. “By identifying the root causes, we gain the sort of knowledge we need to think more seriously about cancer prevention.”

More than 70 of the 7,000 chemicals found in tobacco smoke are known to cause cancer. Some damage DNA directly, but others ramp up mutations in more subtle ways, often by disrupting the way cells function. The more mutations a cell acquires, the more likely it is to turn cancerous.

The reason why some people can smoke for years without getting cancer, while others develop the disease, is down to the way mutations arise. When a person smokes, the chemicals they inhale create mutations at random points in the genome. Many of these changes will be harmless, but others not so benign. The more smoke a person is exposed to, the greater the chance that the accumulating mutations will hit specific spots in the DNA that turn cells cancerous.

“You can really think of it as playing Russian roulette,” said Ludmil Alexandrov, a theoretical biologist at Los Alamos National Lab in New Mexico and the first author of the study. “You can miss the right genes. But if you smoke you still play the game. It’s a very strong message for people not to start smoking. If you smoke even a little bit you’ll erode the genetic material of most of the cells in your body.” Smoking is the most preventable cause of cancer in the world and accounts for more than 1 in 4 UK cancer deaths.

With researchers at the Wellcome Trust’s Sanger Institute near Cambridge and others, Alexandrov analysed the DNA of more than 5,000 cancers. The team then turned to pattern recognition software to tease apart the various mutational signatures found in tumours from smokers versus non-smokers. To find the signatures – the patterns of mutations present in cancer cells – researchers performed the genetic equivalent of recording the chatter at a party and then extracting individual conversations from the hubbub.

The scientists spotted more than 20 mutational signatures in 13 types of cancer linked to tobacco smoking. But only five of these were more common in smokers’ tumours. One pattern of mutations, dubbed signature four, was found to be a major driver for lung cancer. It is thought to be caused by benzopyrene, a chemical found in tobacco smoke.

More intriguing was how tobacco caused mutations in tissues that are not directly exposed to smoke, such as the bladder, kidneys and pancreas. The study found that chemicals from tobacco smoke found their way to different organs and tissues and then sped up the molecular clocks in the cells. This ramped up the natural rate at which mutations built up in the tissues.

“We knew there was direct damage from smoking in the lungs. What we didn’t expect was to see smoking speed up the molecular clocks inside cells,” said Alexandrov, whose study appears in the journal Science. “In bladder cancer, the only thing that causes the extra mutations in smokers is the speeding up of the clock, and that will be very dependent on the intensity of smoking. For every pack of cigarettes you smoke per year, you accumulate 18 mutations in all of your bladder cells,” he added.

Scientists hope that by understanding how the individual ingredients of tobacco smoke raise the risk of various cancers, they can develop new ways to prevent the disease. The same techniques used in the latest study will now be used to tease apart how alcohol, obesity and other factors also increase a person’s cancer risk.

“There is a message here for people who are occasional or social smokers who think it doesn’t do anything,” said Alexandrov. “If you smoke four to five packs of cigarettes in your lifetime it doesn’t sound that much, but you still get several mutations in every cell in your lungs and these are permanent, they do not go away. There are a lot of things that do revert back when you stop smoking, and this shouldn’t discourage people from giving up, but the specific mutations in the lung cells are like scars. If you stop smoking, they’ll still be there.”

DNA study lays bare devastating damage caused by smoking

Breast cancer isn"t attractive. Nipnominate"s cleavage shots trivialise a devastating sickness | Daisy Buchanan

The pictures Beth Whaanga posted after she underwent a double mastectomy ‘show us that women’s bodies can represent their strength and personalized power’. Photograph: Nadia Masot

Neknomination, the online drinking game that has led to cases of hospitalisation and death, has inspired a range of social media responses. You’d have to be rather churlish to choose on one particular that has raised thousands of pounds for breast cancer care. Nipnominate urges ladies to post photos of themselves in their bras hashtagged #bangerstocancer, it back links to a Just Providing page in which these enjoying the pictures can donate to the campaign – like a feelgood, charity edition of Nuts or Zoo. Michelle Kent, the founder, has currently raised £2,500.

But to me there is one thing offensive about seeing photographs of healthful women in push-up bras posting cleavage shots to assistance breast cancer sufferers. Breast cancer is a devastating illness. It isn’t sexy. Attempting to “fight” it with amateur glamour shots is an exercising in narcissism, and trivialises a significant healthcare matter. The model Brandy Brewer was praised for lending her help to the campaign and introducing a significant number of Twitter followers to the fundraising hard work, but the lacy bra, lip gloss and open-mouthed expression on her selfie would seem to say “Hello boys”, not “I’m right here for the women”.

Women who haven’t suffered from a debilitating illness, but declare that a attractive selfie is a good way to boost their entire body self confidence, want to feel tough about their motives. From where I am standing it doesn’t seem like a demonstrate of assistance, but an try to titillate. If I would had a mastectomy, I wouldn’t feel comforted or supported if a group of attractive, healthful women tweeted images of their bouncing breasts to enhance the profile of breast cancer care. I would feel alienated and angry. We tacitly deal with breasts as the greatest feminine attribute, which tends to make it all the far more traumatic and bewildering if you lose them. If we’re going to help breast cancer survivors, we need to challenge and criticise this way of considering. Why are we celebrating breasts, when we ought to be celebrating females?

If we’re going to increase awareness of the problems surrounding breast cancer, we genuinely do not want to begin by raising awareness of breasts. They’re all over the place. You can see them on Television in the afternoon, and in some of our national newspapers. The issue is that virtually all the breasts on display are ornamental. They’re currently being provided up for someone else to look at. We nonetheless can not make our minds up about whether or not it really is Ok to breastfeed in public, but we have become utilised to consistently seeing breasts, or the suggestion of breasts, in a sexual context. The problems with nipnominate is that it isn’t showing breasts and bodies in a revolutionary or new way.

We may well sigh if we noticed photographs like these in a magazine, but we would not increase our eyebrows. Raising cash for breast cancer care is admirable. But it’s a pointless endeavour if the fundraising action contributes to and compounds the culture in which our breasts are only pertinent if they are currently being admired by an individual else’s eyes.

Final week Beth Whaanga posted topless images of herself soon after she underwent a double mastectomy. At the end of 2013, the Mimi Basis designed a film documenting what occurred when a group of cancer sufferers underwent “blind” makeovers, and have been only permitted to seem at the results when they had been completed. These pictures are effective and critical since they display us that women’s bodies can signify their strength and private electrical power. When your physique bears the scars of life-conserving surgery, and you have the courage and confidence to share those photographs with other people in buy to comfort and inspire them, the concept of posing with a pout and a pushed-up cleavage is laughable.

I will not be saying bangers to cancer, and I will urge every woman I know to weigh up no matter whether or not it is actually a very good notion to publish a nipnominate shot. But I will do every thing I can to current my personal entire body in a optimistic way, and to show that my breasts have a significantly bigger purpose and significance than the pursuit of sexiness. If I do submit any photos of myself online, I want them to demonstrate what my physique does, rather than focusing on what it seems like. I am keen to repost and spread the images shared by the brave, inspiring surgery survivors who have the guts to demonstrate us what they have gone by way of.

Whaanga mentioned: “My scars are not ugly, they indicate I’m alive” – and to me they are considerably more impressive than a excellent, pert cleavage. For also extended we’ve noticed women’s bodies exclusively presented in a way that is supposed to please. Nipnominate will succeed only if it modifications our viewpoint on our breasts. But that won’t happen if it’s just an excuse for us to get paid to get ‘em out – even if it is for charity.

Breast cancer isn"t attractive. Nipnominate"s cleavage shots trivialise a devastating sickness | Daisy Buchanan