Umbilical cord blood could slow brain"s ageing, study suggests

Scientists have reversed memory and learning problems in aged mice with infusions of a protein found in human umbilical cord blood.

The striking results have raised hopes for a treatment that staves off mental decline in old age, but researchers stressed that more studies, including human trials, are needed before the therapy can be considered for clinical use.

Tests on frail rodents found that the protein therapy rejuvenated an area of the brain called the hippocampus, which is crucial for memory formation, and one of the first and most important regions to deteriorate in old age.

Older mice that received the treatment reacted like younger animals in a series of behavioural tests, according to researchers at Stanford University in California. They escaped from a maze faster than before, had better memories, and started building nests again, a skill the animals tend to lose in old age.

Researchers led by Tony Wyss-Coray made the discovery after they noticed that human umbilical cord blood had unusually high levels of a protein called TIMP2 when compared with blood from older people. When injected into mice, the protein ramped up the activity of a group of genes that revitalised the hippocampus, and made it more able to adapt to new information. Details of the study are reported in Nature.

The work is the latest in a string of studies that suggest molecules found in young blood may be able to rejuvenate old brains and other tissues. If the therapies are effective in humans, they could become a potent weapon against the cognitive decline that comes with old age, and also neurodegenerative diseases such as Alzheimer’s.

But until the treatment has proved itself in humans, scientists are roundly cautious of the work. The lesson from Alzheimer’s research on mice is that almost everything works in the animals, and so far nothing works in humans, said Rob Howard, professor of old age psychiatry at University College London. “Having taken that on on board, this is a really interesting way to understand how we might help people who are aged or in the early stages of the disease,” he said. The protein therapy might not reverse brain ageing, or halt Alzheimer’s, but it might boost what remains of the healthy brain to at least offset some of the decline that accompanies old age.

Jennifer Wild, a clinical psychologist at Oxford University, said that while the results were interesting, it was too early to consider it as a therapy for humans. “It’s exciting for mice who have cognitive ageing, but it’s way too early to start extrapolating that to say we can help humans,”, she said.

Umbilical cord blood could slow brain"s ageing, study suggests

Colds feel worse to lonely people, study suggests

Having a cold can be a miserable experience, but it turns out that the symptoms may seem worse if you feel lonely.

A study by a team of US researchers has found while loneliness does not appear to have any impact on an individual’s chance of falling ill with a cold, or the actual severity of the symptoms, it does seem to be linked to feeling more under the weather.

But results show that feeling worse was not linked to the size of a person’s social network.

“When it comes to our health it seems that it is the quality of our social relationships that may be more important than just the quantity,” said Angie LeRoy, a co-author of the study from Rice University.

Writing in the journal Health Psychology, LeRoy and colleagues from a clutch of US universities describe how they probed the link between cold symptoms and loneliness by asking 213 healthy adults to complete questionnaires related to loneliness, their social networks and their mood before being infected with the common cold through nasal drops.

The participants were quarantined for five days, during which time they were asked to record their symptoms, such as sneezing, a runny nose or sore throat, and log the severity of their symptoms on a five point scale. In total, 159 of the participants developed a cold and had complete data.

After taking into account factors including age, sex, the season, education, income and mood markers, analysis of results from these participants revealed that those who scored higher on loneliness were no more likely to get a cold than those with low scores, but they did report symptoms of greater severity.

Delving deeper, the team found that the link was not down to the size of individuals’ social networks. “It doesn’t matter if they had a large social network,” said LeRoy. “It mattered about how they felt about their social network.”

However, when the researchers looked at the weight of mucus produced by each participant in the study, they found that there was no link to loneliness, suggesting that while loneliness was linked to how rotten participants felt, lonelier individuals were not more physically sick.

“Loneliness wasn’t necessary associated to how biologically ill they were in terms of the severity of their cold but it was associated with how severe they perceive their symptoms to be,” LeRoy told the Guardian. The authors say that helping those who are lonely build ties to others could help to reduce how bad they feel when they catch a cold.

LeRoys admits that the study does not show that loneliness is causing the perception of worse symptoms – indeed the authors note that, for example, those who are lonely often have poorer sleep. But, she says: “We measured loneliness before we exposed them to the cold and then we measured their symptoms, which infers that the loneliness came first.”

LeRoy adds that, combined with previous studies highlighting the link between loneliness and negative impacts on health, doctors and other medical professionals should take note of their patients’ mental state both when patients register and when they are unwell.

“How [patients] feel before [they are unwell] obviously could influence how they feel when they are sick, even with something as simple as a cold,” she said.

Colds feel worse to lonely people, study suggests

Womb cancer risk grows with extra waist weight, study suggests

Women who have a higher waist to hip ratio could have an increased risk of womb cancer, a study suggests.

Researchers writing in the British Medical Journal (BMJ) found that for every increase of 0.1 units in the ratio between waist and hip, the risk of developing the disease increased by 21%.

Experts from the World Cancer Research Fund (WCRF), which part-funded the study, said the results showed a strong relationship between cancer and carrying extra weight around the waist.

The waist to hip ratio is worked out by dividing waist circumference by hip measurement. For example, a person with a 28-inch (71cm) waist and 40-inch (102cm) hips would have a ratio of 0.7.

A woman with a ratio of 0.7 which then increased to 0.8 would have a 21% greater risk of developing womb cancer, the study suggests. For the person in the example above, this would be the equivalent of an increase from a 28-inch (71cm) waist to a 32-inch (81cm) waist, with the hip measurement remaining the same. Another 0.1 increase would raise that risk even further.

A ratio above 0.85 for women or 0.90 for men is a sign of obesity.

The WCRF estimates that about 25,000 cancer cases could be prevented every year in the UK if people were a healthy weight.

Prof Konstantinos Tsilidis, from Imperial College London, said: “These results demonstrate how important it is for women to make sure they maintain a healthy weight in order to reduce their cancer risk.”

Dr Panagiota Mitrou, director of research funding at the WCRF, said: “We know that extra weight around the waist increases the risk of a range of health conditions, such as diabetes, but this important study is helping us shine a light on how body fat around the waist could affect cancer risk.

“It is incredibly important that people are aware of the dangers of excess body fat, particularly around their waist. After not smoking, maintaining a healthy weight is the best thing people can do to help prevent cancer.”

The study also found associations between waist to hip ratio and bowel and pancreatic cancer, although these were not as strong.

Womb cancer risk grows with extra waist weight, study suggests

Parenthood can help you live longer in older age, research suggests

Parenthood could boost your chances of living longer in your later years, according researchers who believe the effect could be down to children helping with care and support.

While previous research has shown that adults with children live longer than those without, the new study unpicks how the effect plays out in older age.

“We started first at the age of 60 and we looked all the way up to the age of 100,” said Karin Modig, a co-author of the research from Sweden’s Karolinska Institute.

Modig and colleagues used national registry data to follow almost 1.5 million Swedes born between 1911 and 1925 as they aged. The team found that while the risk of death increased with age for all adults, having children was linked to greater longevity. The results are published in the Journal of Epidemiology and Community Health.

At the age of 60, men who had children had almost two years more on their remaining life expectancy than those without, at 20.2 and 18.4 years respectively. A similar trend was seen for women aged 60, with life expectancies of 23.1 years for those without children and 24.6 years for mothers.

By contrast at the age of 80, parents had a life expectancy of 7.7 years for men and 9.5 years for women, compared to 7 years for men without children and 8.9 years for women without children.

The team also looked at the risk of dying within a year for each age, taking into account factors such as education and marital status.

The findings reveal that the benefits of having children became more pronounced with age – an effect that was greater for men than women. Furthermore, the team found that having children had a stronger impact on the longevity of men who were not married than those with a spouse.

The researchers suggest that could be because unmarried men are more dependant on their children for support than men who are married, adding that previous research has suggested that men benefit more from marriage when it comes to survival than women do, possibly explaining why the effect is not seen for women.

Unlike some previous research, the authors found that the sex of the child had no influence on their parent’s longevity – however the finding was based only on families with one child. “Perhaps being the only child is related to a greater responsibility of parents, reducing the difference in the amount of help given by sons and daughters,” they write.

While it is not clear why having children is linked to a longer life, the researchers suggest it might be down to children helping to look after their ageing parents, be it through physical care, emotional support or even arguing for better treatment.

However there are other explanations, including that adults with children might have healthier lifestyles, or that there are other factors that could decrease an individual’s chances of having children and raise their risk of death.

But while having children might boost the years left on your clock, Modig says it is far from the only factor influencing longevity.

“In terms of all other causes that would affect your death risk in these old ages, having a child is not among the greatest ones,” she said. “But it is still a 1.5% difference [for 90-year-old men] which is still substantial.”

Parenthood can help you live longer in older age, research suggests

Antibiotics, not surgery, could treat appendicitis in children, study suggests

Antibiotics could be an effective alternative to surgery for treating children with appendicitis, research suggests.

According to the NHS, appendicitis affects an estimated one in 13 people at some point in their life, with appendix removal the most common reason for emergency surgery in children.

But researchers say using antibiotics alone might offer a less invasive alternative – an approach that has already had some success in adult patients.

“It has become clear in recent years that in adults there are some patients with appendicitis who can recover from the disease without an operation, and we are frequently asked by parents of children with an appendicitis whether their child really needs an operation to get better,” said Nigel Hall, associate professor of paediatric surgery at the University of Southampton and co-author of the study.

While surgery remains the “gold standard” tried and tested treatment, often with some antibiotics, said Hall, “we are keen to explore the role of non-operative treatment for these children.”

Published in the journal Pediatrics by a team of scientists from the UK and Canada, the research involved a review of 10 existing studies published within the last decade. In total the studies involved 766 children from countries around the world – but not including the UK – of whom 413 were treated for uncomplicated, acute appendicitis with antibiotics alone rather than surgery.

Six of the studies compared the use of antibiotics alone with surgery, while the other four looked only at results for children treated with antibiotics. Different antibiotics and course durations were used in the studies, with both intravenous and oral regimes employed.

Overall, the authors found that the use of antibiotics alone was effective for 97% of children undergoing non-surgical treatment, while none of the studies reported any adverse effects of treating appendicitis with antibiotics.

However, appendicitis recurred in 14% of the children who did not have surgery. Overall, 82% of children who were treated with antibiotics alone avoided having surgery by the end of the various studies, a period that ranged from eight weeks to four years, depending on the research.

“While the benefit of non-operative treatment might be that you can avoid an operation, if you get a recurrence of your appendicitis it is likely that you will then be recommended to have an operation to remove the appendix in the long run,” said Hall. “So the benefit of avoiding an operation in the short term is gone.”

With only one of the ten studies considered in the review a randomised control trial, further rigorous research is needed to compare the effectiveness of antibiotics alone versus surgery for appendicitis, as well as to evaluate costs and quality of life for the different treatments.

“We really do need to do the prospective, comparative, randomised studies in order to be able to find out which is the better treatment option,” said Hall, adding that initial steps towards such studies are already underway in the UK by a team including Hall.

Furthermore, he noted, the review only covers simple, acute appendicitis and does not include children with complicated appendicitis, such as those with a perforated appendix or an appendix mass.

“We would very much not recommend that all children with appendicitis are treated with antibiotics and also very much that treatment of appendicitis remains a condition that needs to be treated by a specialist surgeon in a hospital,” said Hall.

Anthony Lander, a consultant surgeon at Birmingham Women’s and Children’s Hospital who was not involved in the study, acknowledged that both surgery and antibiotics alone have their benefits and drawbacks.

“Operations are expensive and have complications but there is no recurrent appendicitis. Antibiotics are cheap and very safe but may fail to treat the illness and surgery may still be required,” he said.

While Lander agreed with the need for large, rigorous studies to compare which approach might be best for treating early acute appendicitis, he added that the condition differs from person to person.

“A more valuable question would be “ What is the nature of the appendicitis which can be treated by antibiotics alone, safely and without a high recurrence rate?” and “Which cases should have an operation?”,” he said “The challenge is to design a study to answer this question.”.

John Abercrombie, a consultant colorectal surgeon and spokesperson for emergency general surgery at the Royal College of Surgeons, welcomed the study. “What this shows is quite similar to similar publications looking at appendicitis in adults where antibiotic treatments are being shown to be safe for selected cases,” he said.

“It is an important treatment option that needs to be discussed and for suitable children it seems like a very reasonable thing to do and may offer the chance to avoid an operation,” he added.

Antibiotics, not surgery, could treat appendicitis in children, study suggests

Footballers could be at risk of dementia from blows to the head, study suggests

Years of heading balls and colliding with other players could be damaging footballers’ brains and putting players at risk of developing dementia, scientists have suggested.

The claim comes from the researchers behind a small study which examined the brains of six footballers who developed dementia after long careers in the sport.

Postmortems found that all six had Alzheimer’s disease, while four also showed evidence of chronic traumatic encephalopathy (CTE) – a degenerative disease linked to repeated blows to the head. Both CTE and Alzheimer’s disease are linked to the build up of clumps of particular proteins in the brain – although the location of these proteins is crucial in diagnosing CTE, which can only be done after death.

“Our findings suggest that there is a potential link between repetitive sub-concussive head impacts from playing football and the development of CTE,” said Helen Ling, a co-author of the study from Queen Square Brain Bank for Neurological Studies at the University College London Institute of Neurology.

However, others were quick to warn of the study’s limitations, pointing out that it showed no clear evidence that playing football could increase the risk of developing dementia. What’s more, neither genetic or wider aspects of the players’ lifestyle were taken into account – factors which are known to influence the risk of developing dementia.

The authors admit that it was also not clear whether the players would have gone on to develop dementia if they hadn’t spent time on the pitch.

“The most pressing question now to ask following up [on] this study would be how common dementia is among retired footballers,” said Ling. “If we can demonstrate that the risk is higher than the normal population that we will know we really need to urgently look at who is at risk and put protective strategy in place.”

The impact of blows to the head on the health of those who take part in sports has received growing attention in recent years, most notably in American football and boxing. According to research from the Boston University CTE centre, 90 of 94 former NFL players whose brains were studied tested positive for the disease, and last year the NFL officially acknowledged the link between head trauma and CTE.

In football – or soccer – the issue has received less attention, although the situation is beginning to change. In 2002 an inquest found that veteran player Jeff Astle died from “industrial disease”, ruling that the player’s dementia was the result of repeatedly heading the ball.

Published in the journal Acta Neuropathologica by a team of British researchers and funded by the Drake Foundation – an organisation dedicated to exploring the impact of concussion in sport – the new study found that the six men who underwent postmortems had a variety of other conditions present among them that would have contributed to symptoms of dementia, with all six showing signs of Alzheimer’s. All six showed tearing of the septum pellucidum, a thin membrane in the centre of the brain. “This is a feature very common in professional boxers and it’s been linked to repetitive traumatic brain injury,” said Ling.

With previous studies having shown the rate of CTE in the general elderly population to be around 12% and tearing of the septum pellucidum around 6% in the general population, the scientists say the higher prevalence in the new study could be down to impacts to the head during the men’s football careers.

The authors admit that it is not known how frequently, or with what force, blows to the head could trigger CTE. With only five of the six who underwent postmortem reported to have had concussions during their career, and then only once each, the study suggests sub-concussive blows could take their toll.

But Huw Morris, another author of the research from UCL, played down the need for concern among those who enjoy a kickabout. “I don’t think that in general terms these are findings that can be extrapolated to the general population,” he said. “These are people with very high amount of playing and exposure to whatever the head injury risks are within football.”

The team say more research, and larger studies, will be needed to unpick the issue further and welcomed research attempting to pick up signs of CTE before death.

Peter Jenkins, a neurologist and researcher in traumatic brain injury from Imperial College London, who was not involved in the study, emphasised the small scale of the research, adding that it does not tackle the issue of how common CTE is in footballers, or what sort of blows could cause it. “We need to spend more time really determining how many people get dementia who have a history of head injuries and then how we can determine what is actually attributable to the head injuries and what is just going to happen anyway,” he added.

Morris agreed that people should not hang up their boots just yet. “One of the really important risk factors for dementia is cardiovascular risk. Ex-footballers have much lower cardiovascular mortality – hypertension, heart attacks and strokes – than do the general population,” he said.

“So it remains the case that football is overall beneficial for your overall health. Ex-footballers have a lower mortality than the general population, but nevertheless we need to understand a lot more about these brain diseases, especially as we are all part of an ageing population.”

Footballers could be at risk of dementia from blows to the head, study suggests

A&E in England sees worst ever delays in January, leak suggests

A&E patients in England experienced the worst month of delays in January since a four-hour target was introduced 13 years ago, leaked figures suggest.

Provisional data passed to the BBC says an unprecedented number of patients spent longer than the target time waiting to be seen in emergency wards in January.

It showed that more than 60,000 people waited between four and 12 hours for a hospital bed. And more than 780 waited more than 12 hours. Both figures are record highs since the introduction in 2004 of a target that 95% of patients must be seen and either admitted or discharged in under four hours.

The leaked document from NHS Improvement suggests that out of 1.4m visits in January, only 82% were dealt with within the four-hour target.

The NHS Providers chief executive, Chris Hopson, said: “These figures have not been verified and should therefore be treated with caution, but they are in line with the feedback we have been getting from trusts.

“NHS staff have responded magnificently to increased winter pressures, but the situation has become unsustainable. The rise in long trolley waits is particularly worrying, as there is clear evidence they can lead to worse outcomes for patients.”

Hospitals have not hit the target nationally since the summer of 2015.

A Department of Health spokesman said the January data was yet to be verified and that official figures, due out on Thursday morning, only covered December.

He said: “We do not recognise these figures – it is irresponsible to publish unverified data and does a disservice to all NHS staff working tirelessly to provide care around the clock.

“Despite the pressures of winter, the vast majority of patients are seen and treated quickly and hospitals have detailed plans in place to manage busy periods – supported by an extra £400m of funding.”

Dr Mark Porter, chair of the British Medical Association council, said delays in A&E were a symptom of a bigger crisis in social care, which the government was failing to grasp.

“When social care isn’t available, patients experience delays in moving from hospital to appropriate ongoing care settings – preventing patients being admitted at the front end in A&E,” he said.

“The prime minister cannot continue to bury her head in the sand as care continues to worsen.”

A&E in England sees worst ever delays in January, leak suggests

Facebook break can boost wellbeing, study suggests

Taking a break from Facebook can boost emotional wellbeing and life satisfaction, with the effects particularly pronounced among people who “lurk” on the social network without actively engaging with others, a study suggests.

The research, by the University of Copenhagen, showed the effects of quitting for a week were also strong among heavy users and those who envied their Facebook friends, suggesting people who pore irritably over the posts of others may benefit the most.

Report author Morten Tromholt, from the university’s sociology department, said the findings suggested that changes in behaviour – for example, heavy users reducing their time spent on Facebook, or lurkers actively engaging – could yield positive results.

But he indicated that people could find it difficult to change their behaviour – 13% of the study’s participants who were supposed to be taking a break admitted to using the social network – and so quitting may be necessary.

The study, published in the journal Cyberpsychology, Behavior, and Social Networking, involved 1,095 people, 86% of whom were women. They were randomly assigned to two groups: one which continued using Facebook as normal and one which stopped using the social network for a week.

On average, the participants were aged 34, had 350 Facebook friends and spent just over an hour a day on the social network, which had 1.79 billion monthly active users in the third quarter of this year.

Questionnaires conducted at the beginning and end of the week indicated that taking a break from the site increased life satisfaction and positive emotions. The effects of quitting were found to be greater among heavy users, passive users and those who envied others on the social network. There was no positive effect of taking a break for light users.

Tromholt wrote: “To make things clear, if one is a heavy Facebook user, one should use Facebook less to increase one’s well-being. And if one tends to feel envy when on Facebook, one should avoid browsing the sections (or specific friends) on Facebook causing this envy. And if one uses Facebook passively, one should reduce this kind of behaviour.

“Due to habits, practicalities … it may be difficult to change one’s way of using Facebook. If this is the case, one should consider quitting Facebook for good.”

Previous studies have had mixed results on the link between Facebook use and wellbeing. Some have garnered similar findings, but others have found no link and some have even found that time spent on the social network can boost wellbeing.

Brenda Wiederhold, editor-in-chief of Cyberpsychology, Behavior, and Social Networking, said: “This study found that ‘lurking’ on Facebook may cause negative emotions. However, on the bright side … previous studies have shown actively connecting with close friends, whether in real life or on Facebook, may actually increase one’s sense of wellbeing.”

Tromholt suggested future studies should investigate the effect of quitting Facebook for a greater length of time and look at other social networks, including Instagram, Snapchat and Twitter.

Facebook break can boost wellbeing, study suggests

"Angelina Jolie effect" boosted genetic testing rates, study suggests

Angelina Jolie’s revelation that she underwent a double mastectomy to reduce her chances of developing breast cancer boosted rates of genetic testing among women, but might have failed to reach those most at risk, new research suggests.

In a 2013 article for the New York Times, Jolie explained her decision to undergo a double mastectomy after finding that she had a mutation in a gene known as BRCA1 that greatly increased her risk of breast and ovarian cancers.

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“I am writing about it now because I hope that other women can benefit from my experience,” she wrote. “Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.” After surgery her risk of developing breast cancer in later life fell from 87% to 5%.

The actor’s decision to tell her story was welcomed by medical experts and campaigners worldwide. But did women heed Jolie’s call?

Writing in the British Medical Journal, Sunita Desai and Anupam Jena of Harvard Medical School describe how they sought to answer the question by scrutinising data on US health insurance claims from more than nine million women aged between 18 and 64 .

These revealed that in the 15 working days following Jolie’s article, daily rates of testing for harmful mutations in BRCA1 and BRCA2 genes rose by 64%, compared with the 15 working days before. After six months, average monthly testing rates were still 37% higher than in the four months before the article’s publication.

But the study also reveals that while genetic testing rates increased, there was no change in average, overall mastectomy rates in the six months following the article’s publication – and showed a slight drop in mastectomy rates among those who had BRCA tests.

“The fact that mastectomy rates dropped after Angelina Jolie’s editorial suggests that that denominator of women who started getting the BRCA test became less appropriate for the BRCA test because they had a lower pre-test probability of having the mutation in the first place,” said Desai.

However, Douglas Easton, professor of genetic epidemiology at the University of Cambridge, noted that the study did not offer insights into the BRCA test results – meaning it was not possible to say whether women taking the test received negative results, or whether they had tested positive, but decided not to undergo surgery.

But Jennifer Litton, associate professor in the department of breast medical oncology at the University of Texas, said the results reflected what had been seen in clinics.

“The ‘Jolie effect’ was real, and we did have many more breast cancer patients ask about the test,” she said. “As only a small proportion of breast cancer patients harbour an abnormal gene, those that met national guidelines for testing had already had testing, so it did not change that group with the highest risk of a positive test.”

The research is not the first to explore the impact of Angelina Jolie’s declarations, although previous UK-based studies found that both testing among women at risk, and subsequent preventative surgery, increased.

A co-author of the UK-based research, Tony Howell, professor of medical oncology and director of scientific research at Prevent Breast Cancer, says the new US study looked at too short a period after publication of Jolie’s article to truly reflect its impact. “It takes weeks or months to get through the testing process in proper centres,” he said. “Same applies to risk-reducing breast surgery. This takes one to three years to filter through to surgery if all the checks and counselling are performed properly.”

Overall, says Howell, the 2013 article was valuable in raising awareness. “Jolie did a terrific job,” he said.

"Angelina Jolie effect" boosted genetic testing rates, study suggests

All that training suggests doctors should know best | Letters

As a team of physicians and social scientists studying how choices are made during consultations, we were disturbed to read that the Royal College of Surgeons agrees with Lady Hale that doctors should not be making treatment recommendations (Report, 27 October). While a “paternalistic” approach is clearly inappropriate for the 21st century, decades of health communication research point to shared decision-making as the best alternative. This is categorically not the same as the “information-only” approach advocated in the new guidance, which requires doctors to withhold their views even when they have good grounds for making a recommendation, and even when the patient asks for one.

In our research, we found numerous problems with the enactment of patient choice, including patients not knowing how to decide, patients seeking the neurologist’s recommendation when it was not offered, and the near impossibility of providing information in a fully neutral fashion. Moreover, we found that there was no evidence that being offered choice was associated with higher levels of patient satisfaction.

Patients vary widely in their knowledge, preferences and decision-making capacity. Part of enacting shared decision-making is to work sensitively with the patient to establish what role they wish to play at that particular time. Certainly, patients should be given clear, balanced information about the range of available options, and the potential risks and benefits of each. But imposing choice on patients who do not want it is just as paternalistic as insisting that they follow doctors’ orders.
Dr Paul Chappell Department of sociology, University of York
Professor Roderick Duncan Associate professor of neurology, University of Otago, New Zealand
Dr Clare Jackson Department of sociology, University of York, UK
Professor Markus Reuber Professor of clinical neurology, University of Sheffield
Dr Merran Toerien Department of sociology, University of York

• It is clearly right that patients are given all the information they need to make a decision concerning their treatment options, but could I have the temerity to suggest that, quite often, doctor does know best? It would be a matter for concern were it not so – we are trained for 12 or more years at taxpayers’ (and, increasingly, our own) expense, and if we didn’t know more about illness and its treatment than the patient, all that money would have been wasted.

Some decisions are so complex that it is not possible to give the patient sufficient insight and knowledge to be able to choose between two courses of action. To fail to take a decision on their behalf in that situation would be an abdication of responsibility, and a betrayal of their trust.
Dr Bob Bury
Leeds

• Re your article (Leading doctors list dozens of procedures that ‘give no benefit’, 24 October), the Academy of Medical Royal Colleges research is a welcome contribution to the debate about the pressures faced by doctors daily. The headlines, however, focus predominantly on the 40 specific treatments and procedures the AMRC consider should no longer be in routine use, when perhaps we should be looking at what underlies GPs’ decisions on their use.

In the study, about 60% of doctors said their decisions were driven by a fear of litigation. A similar proportion said interventions were a result of increasing pressure and expectations from patients. I would argue that these statistics are in fact the most striking and concerning, and they concur with our own research. A survey of 600 GP members showed 67% are fearful of being sued – and of those, 85% say this fear impacts negatively on the way they practise. Furthermore, 86% of our members said they sometimes, most of the time or always encounter challenging experiences with patients when they do not provide the prescription, treatment or referral to a specialist they request.

This paints a clear picture of the increasingly challenging environment in which doctors are working, and highlights the need for doctors to understand and be supported on how to manage patients’ expectations. When expectations are not met, it can lead to dissatisfaction, a breakdown in trust and a greater risk of the patient pursuing a complaint or claim. This is an important debate for all in healthcare today, and for society as a whole.
Dr Pallavi Bradshaw
Senior medicolegal adviser, Medical Protection

• Polly Toynbee (Our nurses are being cast into a perfect Brexit storm, 25 October) suggests cuts were made to the trainee nursing workforce by Health Education England. In fact HEE has increased adult nurse commissions significantly in the past three years. Since our establishment, we have grown adult nurse training places by almost 15%.

Decisions were made in the system prior to HEE’s creation to reduce nurse commissions. Our priority has been to grow this vital workforce and can been seen in our published Workforce Plan for England.

Although our remit is primarily for the future workforce, we have also taken decisive short-term action to help the service. Our return-to-practice campaign has already secured on programmes a further 1,900 nurses. The new nursing associate role and more flexible training pathways into nursing will help to support the service. We are also working with NHS partners to reduce turnover and improve retention in the existing nurse workforce.

Our aim is to make sure that future patient needs are met and that we have enough people with the right skills, values and behaviours available.
Professor Ian Cumming
Chief executive, Health Education England

• Join the debate – email guardian.letters@theguardian.com

All that training suggests doctors should know best | Letters

Test cholesterol of one-year-olds to prevent early heart attacks, study suggests

Screening one-year-olds for high cholesterol during routine vaccination visits could prevent hundreds of heart attacks in young adults each year, researchers in England said on Wednesday.

Their study in the New England Journal of Medicine aimed to uncover a silent killer in young adults known as familial hypercholesterolemia (FH), a genetic disorder that often leads to early heart disease.

FH runs in families, and if left untreated can raise the risk of heart disease at a young age as much as 100 times, the report stated.

In the largest screening study to date, more than 10,000 children around a year old were tested for high cholesterol and genetic mutations known to be associated with FH at 92 facilities across England.

Forty children tested positive for FH, at a rate of about one in 270 children.

Their parents were then contacted for screening, revealing an additional FH-positive parent, the report said.

“Overall, one person at high risk of early heart attack was identified for every 125 people tested,” it said.

Such screening throughout Britain could prevent about 600 heart attacks in people under 40, according to the researchers from Queen Mary University of London’s Wolfson institute of preventive medicine.

“This is the first demonstration that child-parent screening works on a large scale,” lead researcher David Wald said.

“It’s the only screening method that stands a reasonable chance of covering the whole population and identifying those at highest risk of an early heart attack.”

Once high-risk children are identified, they can take steps to lower cholesterol, including exercise, avoiding smoking, maintaining a heathy diet, and – when older – taking statin medication.

“Now that we’ve demonstrated this as being effective across England, the next step is for public health agencies to consider offering this routinely at the time of childhood vaccination to test all children aged one to two years,” Wald said.

“No extra clinic visits are needed and uptake is high because parents are already focused on the future health of their children and the family as a whole.”

Test cholesterol of one-year-olds to prevent early heart attacks, study suggests

Vaping could help prevent ex-smokers piling on the pounds, research suggests

E-cigarettes might help smokers who are quitting keep the pounds off, say researchers, suggesting that vaping could be harnessed in the fight against obesity.

Weight gain is a major concern among smokers looking to quit. On average individuals put on 5kg in the first year they go without cigarettes. Nicotine is known to suppress appetite and increase metabolic rate, among other effects.

While nicotine replacement therapies (NRT) can help to control weight gain and help smokers to quit, researchers have suggested that nicotine-containing e-cigarettes might be a better option.

“People can change their nicotine content, so to quit smoking they might start off on a higher strength e-liquid and then they can taper down really quite gradually in a much more sophisticated way than they can with NRT, which is probably good for weight maintenance and for weight loss,” said co-author Linda Bauld, professor of health policy at the University of Stirling and deputy director of the UK Centre for Tobacco and Alcohol Studies. The huge range of e-liquids available, she adds, could also help prevent snacking, particularly given the number of sweet and fruit flavours on offer.

The authors note that a drop in the prevalence of smoking is among the factors that have been linked to increasing rates of obesity, meaning new approaches to manage weight gain could prove valuable.

Published in the journal Nicotine and Tobacco Research by scientists from New Zealand and Stirling, the paper looked at a range of studies exploring the influence of nicotine on the body, as well as the relationships between aroma, taste and flavour and the feeling of fullness, to moot the potential for e-cigarettes in managing weight gain among smokers trying to kick the habit.

The authors suggest that e-cigarettes, with their myriad flavours, could potentially help to tackle cravings for certain foods. What’s more, the study suggests that the physical processes involved in filling an e-cigarette could reduce the urge to eat.

“You are re-filling the e-liquids, you might be mixing your own liquids, you are trying different flavours, you are doing things with your hands that take up time which means maybe you are not reaching for the bowl of M&Ms,” said Bauld.

Despite noting concerns raised by some around the safety of long-term e-cigarette use, Bauld says the research points to the benefits of using nicotine-containing products for smokers planning to quit.

“One of the things this paper says is [that] probably we shouldn’t be so worried about longer-term nicotine use, particularly if it can help people not put on weight – which we know is a bit risk factor for diabetes and a lot of other things,” she said.

But, the authors note, much more research is need. They highlight a number of avenues that should be explored, from trials into the effects of vaping on weight gain among smokers attempting to quit, to the impact of different e-liquids on feelings of fullness.

“We are not suggesting that we should promote e-cigarettes to people who haven’t smoked,” said Bauld. “But for people who are thinking about the best way to stop smoking and are concerned about weight gain, I think what we are suggesting is that e-cigarettes should certainly be considered.”

Paul Aveyard, professor of behavioural medicine at the University of Oxford, said it was “almost certain” that nicotine-containing e-cigarettes would reduce weight gain among smokers attempting to quit. But, he cautioned, the possible benefits of e-cigarettes in managing weight gain among ex-smokers did not mean that they could benefit non smokers’ attempts to lose weight.

What’s more, he added, with some evidence that nicotine could play a role in the development of diabetes, there may be down sides to the use of such devices, even if they do help smokers keep the weight off. “That balance between the two effects is not known,” he said.

Amanda Sandford, from Action on Smoking and Health said: “The risk of putting on weight when quitting smoking is a common concern and can discourage smokers from trying to stop. E-cigarettes are a safer alternative to tobacco and if they can also help people avoid piling on the pounds as well as helping them to stop smoking that is a real bonus.”

Vaping could help prevent ex-smokers piling on the pounds, research suggests

Exercise can cut risk from alcohol-related diseases, study suggests

Drinkers who do the recommended amount of exercise can reduce their risk of dying from alcohol-related cancer, according to new medical research.

Undertaking two and a half hours a week of physical activity can also reduce, but not banish, someone’s chances of dying from any cause, according to the study of 36,370 British patients.

The findings, published on Wednesday in the British Journal of Sports Medicine, found that: “Stratified analysis showed that the association between alcohol intake and mortality risk was attenuated (all-cause) or nearly nullified (cancer) among individuals who met the physical activity recommendations.”

The authors added: “Meeting the current physical activity public health recommendations offsets some of the cancer and all-cause mortality risk associated with alcohol drinking.”

The study, by academics in London, Canada, Norway and Australia, examined the health of men and women over the age of 40 who had provided data for six editions of the Health Survey for England up to 2006, and the 1998 and 2003 editions of the Scottish Health Survey.

“In this large British general population cohort we found that the association between alcohol intake and mortality risk was moderated by physical activity,” says the study.

The researchers found that risk of death from either cause increased more slowly among Britons who followed the government-backed advice and did five lots of moderate-intensity exercise a week than those who undertook less physical activity, although the effect was more noticeable for cancer.

Kevin McConway, emeritus professor of statistics at the Open University, said: “Does this mean that I don’t have to worry about the effect of drinking on my health, as long as I get enough exercise? Well, no, it doesn’t, for a long list of reasons.”

McConway advised caution. “It’s possible the changes in risk patterns in people who exercised were not because of the exercise, but because of something else that just happened to be different.”

Matt Field, professor of psychology at Liverpool University, said the “rigorous piece of research” showed that “it appears that physical activity may partially offset some of the harmful effects of drinking, particularly alcohol-attributable cancers”.

The findings have prompted calls for fitness trainers to work in pubs to encourage drinkers to be more active.

“From our Let’s Get Moving physical activity initiative, we’ve seen the benefits of linking exercise professionals to GP surgeries to improve the health of at-risk patients. This research suggests we should look at similar measures in pubs to help engage harder-to-reach sections of society in physical activity,” said Steven Ward, executive director of ukactive, which represents the exercise industry.

“This research might sound like great news for Sunday league footballers everywhere, but as the recently updated chief medical officer’s guidelines show, excessive drinking remains a major health risk,” Field added.

However, the researchers found that 27.5% of the patients studied took no exercise at all and almost 61% did not achieve the target of 150 minutes a week.

Nonetheless, the authors believe their findings show that physical activity can promote good health and reduce at least some of the associated harmful effects of drinking, even among those who do no more than the minimum 150 minutes. “Our results provide an additional argument for the role of [physical activity] as a means to promote the health of the population even in the presence of other less healthy behaviours,” they say.

Exercise can cut risk from alcohol-related diseases, study suggests

Young children copy parents" sugary drinks habits, study suggests

Children aged four to eight whose parents regularly consume fizzy drinks are almost three times as likely to drink them as other children their age whose parents don’t, research suggests.

The Drink as I Do report suggests that young children copy the drinking behaviour of their parents, whatever they are consuming, but that the effect is most worrying when it comes to consumption of beverages linked to health problems.

Four- to eight-year-olds whose parents drank fizzy drinks were 192% more likely to consume them than other children their age. They were more than twice as likely (115%) to drink fruit juices if their parents consumed those and more than six times as likely (529%) to have smoothies if their parents indulged.

The report was compiled by Emma Derbyshire, children’s nutrition adviser to the Natural Hydration Council, a not-for-profit organisation backed by producers of bottled water.

She said:“Clearly children emulate their parents. With water, children were only drinking about three cups a day when they should be drinking between five and eight glasses. They’re under-consuming water in favour of calorific drinks. It’s a concern given problems with obesity and tooth decay. The thing is [for parents] not just to tell children to drink water but to do it themselves and ideally be seen to enjoy it.”

The report, based on responses from 1,000 parents and, in each case, one of their children, found that 37% of children do not drink water on any given day but this fell to13% when their parents drank water often.

Where parents drank squash, their children were 1.4 times more likely to drink them than other children and the “copycat” effect was even more pronounced for sports drinks (11 times more likely), although for the latter the small sample size means it should be treated with caution.

Children in the UK consume three times more sugar than is recommended, and soft drinks are the biggest source, accounting for 29% of the sugar intake of 11- to 18-year-olds and 16% for younger children. After concerns about the impact this is having on children’s health, a two-tier sugary drinks tax is to come into force next year based on the level of sugar per 100ml in a soft beverage.

Public Health England’s Eatwell guide, which was published earlier this year, advises that intakes of fruit juice and/or smoothies should be limited to a total of 150ml a day as they are a source of excess sugars.

Psychologist Emma Kenny, who is backing the report, said: “It’s that ‘do as I say not do as I do culture’. If you’re giving children water and drinking fizzy drinks, it’s natural for them to want to taste your drink and the moment the child can get their hands on a fizzy drink they will do so. You’re not going to stop them having other drinks but the tastes they form early on are compelling.”

Young children copy parents" sugary drinks habits, study suggests

Research Suggests there are Multiple Paths Towards Autism

A new study has challenged the long-held belief that alterations in the social brain networks have an influence on autism development. The new research suggests that variations in the brain of infants with autism risk, may be widespread and may influence multiple systems.

What is Autism?

A neurodevelopmental disorder, autism is characterized by impairments in non-verbal and verbal communication, social interaction, and repetitive and restricted behavior. The signs of autism are usually noticed by parents during the first two years of a kid’s life. The development of these signs often occurs gradually. However, some autistic children reach the milestones of development at normal pace, but then regress. The criteria for diagnosis requires the symptoms to be apparent during early childhood, usually before the age of 3 years.

The diagnosis of autism is done on the basis of impairments in communication and social behaviors. The symptoms usually surface when the child is 2 years old. Research conducted over the last decade, was focused on detecting autistic abnormalities during early infancy.

Experts are of the belief that improved knowledge about how the development of autism occurs can potentially enable clinicians to predict autism prior to its emergence.

Attempts for identifying precursors have concentrated primarily on social behaviors, on the basis of the assumption that social brain network abnormalities occur early in life, and they compound throughout development.

Now, Dr. Mark Johnson of Birkbeck, University of London and Dr. Mayada Elsabbagh of McGill University, Canada, believe that the recent studies don’t support the idea that there’s a singular pathway to autism development.

The studies evaluating infants with autism risk were reviewed by Johnson and Elsabbagh, as published in Biological Psychiatry, a journal. They uncovered behavioral research that supported evidence for some general abnormalities in the first year of a child’s life.

These abnormalities include poor attention flexibility, higher perceptual sensitivity, and motor maturation. The authors have also highlighted studies of brain imaging that offer evidence of broad alteration throughout the brain networks, instead of focal deficits inside the social networks.

The imaging and behavioral studies have challenged the assumption of social network abnormalities occurring early in life that continue throughout one’s development, and result in occurrence of autism.

Elsabbagh stated that their review discloses low support for localized deficits within the social brain network, during the first year of one’s life. Instead, their review is in favor of the opinion that atypical development that involves social, motor, attentional, and perceptual systems precede the emergence of autism, and result in noticeable behavioral symptoms by second year of life.

The review shows that it may not be enough to focus on only one deficit to detect the early warning signs, and is likely to adjust the way researchers conceptualize autism.

Editor of the journal Biological Psychiatry, Dr. John Krystal, said that efforts have been put to identifying the common, final neural pathways lying underneath the deficits and symptoms of psychiatric disorders.

Yet the opinion of Johnson and Elsabbagh indicate that widespread disturbances exist in brain development in ASD (Autism Spectrum Disorder), and the social deficits either show that the circuits beneath social behaviors are one among the many affected circuits, or that some of the functional deficits are properties emerging from multiple affected circuits.

Research Suggests there are Multiple Paths Towards Autism

Stem cell trial suggests damaged heart tissue could be regenerated

People suffering from heart disease have been offered hope by a new study that suggests damaged tissue could be regenerated through a stem cell treatment injected into the heart during surgery.

The small-scale study, published in the Journal of Cardiovascular Translational Research, followed 11 patients who during bypass surgery had stem cells injected into their hearts near the site of tissue scars caused by heart attacks.

One of the trial’s most dramatic results was a 40% reduction in the size of scarred tissue. Such scarring occurs during a cardiac event such as a heart attack, and can increase the chances of further heart failure. The scarring was previously thought to be permanent and irreversible.

At the time of treatment, the patients were suffering heart failure and had a very high (70%) annual mortality rate. But 36 months after receiving the stem cell treatment all are still alive, and none have suffered a further cardiac event such as a heart attack or stroke, or had any readmissions for cardiac-related reasons.

According to the British Heart Foundation, while there are several treatments to help people with heart failure, there is no known cure, and in some cases a heart transplant may be the only option.

Twenty-four months after participants were injected with the stem cell treatment there was a 30% improvement in heart function, 40% reduction in scar size, and 70% improvement in quality of life, as judged by the Minnesota living with heart failure (MLHF) score.

Related: Brain damage could be repaired by creating new nerve cells

“Quite frankly it was a big surprise to find the area of scar in the damaged heart got smaller,” said Prof Stephen Westaby from John Radcliffe hospital in Oxford, who undertook the research at AHEPA university hospital in Thessaloniki, Greece, with Kryiakos Anastasiadis and Polychronis Antonitsis.

Westaby began theorising about the impact of stem cells on regenerating heart tissue and reducing scarring after observing how scar tissue on the hearts of babies who have had heart attacks and undergone heart failure disappeared by the time they reached adolescence, suggesting that residual stem cells might be able to repair the damaged tissue.

“It’s an early study and it’s difficult to make large-scale predictions based on small studies,” said Ajan Reginald, the founder of Celixir, the company that produces the treatment. “But even in a small study you don’t expect to see results this dramatic.

“These are 11 patients who were in advanced heart failure, they had had a heart attack in the past, multiple heart attacks in many cases. The life expectancy for these patients is less than two years, we’re excited and honoured that these patients are still alive.”

Related: Nearly 2m people may have undiagnosed killer disease

Jeremy Pearson, the associate medical director at the British Heart Foundation (BHF), said: “This very small study suggests that targeted injection into the heart of carefully prepared cells from a healthy donor during bypass surgery, is safe. It is difficult to be sure that the cells had a beneficial effect because all patients were undergoing bypass surgery at the same time, which would usually improve heart function.

“A controlled trial with substantially more patients is needed to determine whether injection of these types of cells proves any more effective than previous attempts to improve heart function in this way, which have so far largely failed.”

Westaby conceded that the improvement in patients’ health was partly due to the heart bypass surgery those in the study were undergoing, and said the next study would include a control group who undergo bypass but do not receive stem cell treatment, to measure exactly what impact the treatment has.

“These patients came out of heart failure partly due to the bypass grafts of course, but we think it was partly due to the fact that they had a smaller area of scar [as a result of the stem cell treatment]. Certainly this finding of scar being reduced is quite fascinating,” he said.

Westaby will commence a large-scale controlled study later this year at the Royal Brompton hospital in London, and Celixir hopes to make the Heartcel treatment available to patients in 2018 or 2019.

Stem cell trial suggests damaged heart tissue could be regenerated

Prevent Alzheimer"s by vaccinating at forty, scientist suggests

Speaking at the Cheltenham Science Festival, he explained: “We do know that people are not impacted by Alzheimer’s till later in life but it requires a good 20 many years for the disease to emerge.

“So we would most likely want to begin vaccinating people in their 50s or 40s.

“It’s attainable that the amyloid-beta accumulation causes a cascade of issues which you can’t reverse.

“But could we vaccinate prior to that started out? For me that is the most fascinating and exciting query. It could avert the accumulation in the very first place.”

A study in Columbia is at the moment testing the theory on a family who are genetically predisposed to Alzheimer’s condition. But it will be decades just before scientists know if the vaccine has been effective.

Some 800,000 folks in Britain presently have Alzheimer’s Condition, costing £23 billion a yr to the economic climate.

In separate analysis, Professor Clive Holmes, professor of biological psychiatry at Southampton University, warned that Alzheimer’s could be brought on and exacerbated by common infections such as gum condition and flu.

He suggested that the apathy experienced many dementia sufferers is caused by the very same brain mechanism that tends to make individuals really feel listless and unsociable when they are fighting an infection.

The amyloid plaques in the brain cause a heightened response to irritation that make men and women really feel completely, ‘under the climate.’

“Low grade infections can be a catastrophe in individuals with Alzheimer’s Disease,” stated Prof Holmes.

“In care houses across the nation you will see patents who are disinterested in daily life. It is practically like they are encountering flu in their brains.

“We think that infections are contributing to the improvement of Alzheimer’s but could they actually be triggering the illness in the very first place?

“We are getting growing evidence to recommend this may well be the case.”

Prevent Alzheimer"s by vaccinating at forty, scientist suggests

A lot more girls must give birth at property, advice suggests

Presently just 2% of the 800,000 births a year in the United kingdom take place at house. Photograph: Danny Lawson/PA

Far more women should give birth with only midwives current, which includes at property, since that is much better for them and their babies than labour wards where medical doctors are in charge, the government’s health advisers say on Tuesday.

Midwives ought to advise mothers-to-be who presently have at least a single kid and whose newest pregnancy appears simple to opt for a midwifery-led unit (MLU) or a house birth when deciding where to have their little one, the National Institute for Well being and Care Excellence is urging.

The forty% of women providing birth who are 1st-time mothers ought to also be advised to choose either place, Good is recommending in draft recommendations to the NHS in England and Wales.

Each groups of women should decide on either location “since the charge of interventions is reduce and the outcome for the baby is no diverse compared with an obstetric unit”, Great says.

If the NHS follows the new tips, it could lead to a huge shift in patterns of childbirth in which hundreds of 1000′s much more females pick these spots alternatively of advisor-led obstetric units, exactly where most births arise.

At present just 2% of the 800,000 births a 12 months in the Uk get area at property.

One in 4 hospital births ends in a caesarean-section delivery and a more 1 in eight involves the use of either forceps or ventouse suction cups.

Great mentioned it had revised its guidance on location of birth, which had been in force because 2007, in the light of fresh proof about the security of delivery in MLUs and at house. The only caveat it included was that midwives need to inform first-time mothers that “if they program birth at house there is a little boost in the danger of an adverse end result for the child”.

The Royal College of Midwives (RCM) and the NCT, the parenting charity, welcomed Nice’s proposals. Nonetheless, maternity doctors voiced some unease.

The Royal College of Obstetricians and Gynaecologists (RCOG), which represents the UK’s 10,000 maternity doctors, mentioned it did not object to far more girls going via low-threat pregnancies possessing a house birth. But it warned that transport had to be obtainable to consider this kind of girls to hospital at quick recognize if they created problems or required soreness relief.

The RCOG urged females at threat of issues to steer clear of freestanding midwife-led units, which are not located at hospitals, and use instead so-referred to as alongside units, exactly where these whose labour gets to be problematic can get virtually immediate aid from physicians. It extra that assessments as to which pregnancies are minimal-threat are not usually correct.

Prof Cathy Warwick, the RCM’s chief executive, said: “The proof exhibits that for reduced-danger women, offering birth in a midwife-led unit or at property is protected certainly might be safer than hospital.” Ladies who birthed there usually had larger fulfillment charges and a greater birth encounter than in hospitals, she additional.

Great explained neighborhood NHS organisations should ensure that women in their area could decide on among all four spots to give birth. Warwick referred to as for far more investment in midwife-led care and house births.

NCT chief executive Belinda Phipps said Nice’s tips “are evidence-based mostly and confirm what we have been saying for decades – that birth in a midwife-led unit or at home is a protected decision, especially for people expecting a 2nd or later infant.” But much more midwives were needed to flip Nice’s proposals into actuality, she extra.

A lot more girls must give birth at property, advice suggests

Top quality of life in retirement a lot more critical than typical pension revenue, minister suggests

Mr Webb induced controversy the day soon after the Spending budget when he explained that he was “relaxed” about the thought of pensioners paying their savings on a Lamborghini.

Appearing yesterday before MPs on the Commons Function and Pensions Committee, Mr Webb said that in potential pensions will be ready to have a “mixture” of capital and earnings to enable them to get pleasure from their retirement.

Mr Webb mentioned: “The significance here is that in the previous we’ve thought about what we want in retirement [is] a normal cash flow but actually what you want in retirement is good quality of lifestyle and that may possibly be a mixture of capital and cash flow and it may be different at different factors in retirement.”

He also explained that the changes to pensions will allow elderly individuals to shell out off debts that have been “getting them down”.

Mr Webb explained: “One of the excellent factors about these new freedoms is some folks will spend off debts that have been hanging more than them, that have been obtaining them down, that they wouldn’t have been capable to pay out off. They’ll be capable to do that and they’ll come to feel excellent about it.”

The minister also insisted that his reforms have not dealt a “death blow” to the annuities industry.

He stated that around a hundred,000 to 200,000 annuity revenue could still get area every single yr and explained these goods are likely to become competitive as companies will know that retirees have a better option of choices accessible to them.

Controversy in excess of annuities has been developing amid tumbling costs in current many years and issues that folks are not acquiring the best deal they could by purchasing close to. Up till now, about 400,000 folks a 12 months have bought an annuity.

Mr Webb stated: “I never believe it is a death blow to annuities. Plainly there is a set of men and women, and we can argue and discuss how big that will be, who will not buy annuities now, and estimates, and they are only guesstimates truly, differ significantly.

“But obviously an awful great deal of people even now require an earnings in retirement.”

Mr Webb explained: “It depends who you pay attention to, but it really is still considered a hundred,000, 200,000 annuities a year will be offered… I will not believe that the approach is irredeemable.”

Top quality of life in retirement a lot more critical than typical pension revenue, minister suggests

twelve Million Americans Misdiagnosed Each and every 12 months, Examine Suggests

Synthesizing the final results of 3 separate research, researchers from Houston Veterans Affairs Healthcare Center and Baylor University of Medicine estimate that 12 million Americans a 12 months, or more than five % of all individuals, are misdiagnosed as a result of medical professionals failing to adhere to up on “red flags” for cancer and other serious illness.

“We estimate the frequency of diagnostic error to be at least five% in US outpatient adults, a quantity that entails a significant patient safety danger,” writes lead author Hardeep Singh, MD, who holds dual appointments in the Area of Health Solutions Investigation at Baylor University of Medicine and at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Security.

“This population-based estimate should supply a foundation for policymakers, healthcare organizations and researchers to strengthen efforts to measure and lessen diagnostic errors.”

The research, published on the web April 17 in BMJ Quality and Safety, The Worldwide Journal of Healthcare Improvement, provides only an estimate, based mostly on an extrapolation. Nevertheless, it is an intriguing one, specifically when you appear at how Hardeep and colleages came up with it.

And it provides an additional piece of an previously devastating puzzle, coming just months soon after a examine out of Johns Hopkins University found that 160,000 individuals a 12 months die or suffer permanent harm as a outcome of healthcare error.

Hardeep and group combined data from 3 prior research, which they chose because they used comparable definitions of what constitutes a medical error.  (There is surprising variation in how this term is utilised.) All 3 studies concerned health care mistakes that had been unveiled by a patient’s later diagnosis.

The very first examine employed laptop algorithms to detect uncommon patterns of return visits following a patient was witnessed by a principal care medical professional. The second examine also utilized electronic algorithms to uncover lack of stick to-up after abnormalities have been detected in colorectal cancer screening. The third review, similar to the 2nd, involved lung cancer cases which did not receive sufficient follow-up and remedy after preliminary screening.  “Diagnostic errors have been confirmed by way of chart overview and defined as missed possibilities to make a timely or proper diagnosis based mostly on obtainable evidence,” create the authors.

The researchers then mixed the outcomes of the studies and extrapolated the price of outpatient diagnostic error to the whole U.S. grownup population, coming up with an yearly price of 5.08%, or about 12 million American adults a year.

“Based on preceding operate, we estimate that about half of these mistakes could potentially be harmful,” the authors publish.

Looking much more closely, the researchers in fact came up with three diverse diagnostic error percentages. For primary care misdiagnoses, the rate was five.06 percent, even though for lung cancer it was just .013% and for colorectal cancer an even smaller sized .007 %. Translated, this indicates you can possibly fret much less about physicians missing indicators of cancer than indicators of other illnesses.

Nonetheless, the authors note, since even modest delays can have a profound effect on the good results of cancer remedy, missed cancer diagnoses are the “most harmful and costly types of diagnostic error in the outpatient setting.” In other phrases, when it comes to cancer, even .007 % is not great.

twelve Million Americans Misdiagnosed Each and every 12 months, Examine Suggests