Understanding addiction

25 July 2011 Last updated at 13:30 GMT Amy Winehouse's struggle with drink and drug addiction was well known, reflected in her music and widely reported in the media.

But how much do we understand addiction?

What causes it and why do some people become addicts while others do not?

Addiction is naturally associated with drink and drugs, but that is not the whole story.

The NHS points out that people can "become addicted to anything, from gambling to chocolate".

First contact

Addiction has to start with exposure, and at some point casual use shifts to dependence.

Dr Gillian Tober, president of the Society for the Study of Addiction, said all addiction has to start with first use.

"It is usually for social reasons - boyfriend, girlfriend, group of friends - it's usually not pleasant but there is a social reward."

This then becomes reinforced. "People say their first cigarette is disgusting. Some say never again, some break through and reveal the pharmacological effect."

Drugs directly feed the reward circuitry of the brain, and even in cases such as gambling the brain can learn to look forward to the thrill.

The brain adapts to the drug, becomes tolerant to it and demands more each time. Physiological dependence - addiction - emerges.

Resisting addiction

But not everyone becomes addicted. A great many people drink, even fewer are heavy drinkers, and even fewer become dependent.

Ilana Crome, a professor of addiction psychiatry at Keele University, said great progress had been made in recent years in understanding why that is.

"We're beginning to understand the variety of mechanisms in the addictive process, but do we know exactly what causes addiction? We don't.

"It seems to touch the very essence of behaviour, making it very difficult to research and understand."

Doctors cannot point to a 'single cause' of why addictions develop. There are however some risk factors.

The chair of the Faculty of Addictions at the Royal College of Psychiatrists, Dr Owen Bowden-Jones, puts the risks into three categories.

"One way to describe addiction is to think about it as a disorder with biological, psychological and social aspects."

He said that research suggests "people who are vulnerable to addiction may be 'wired' differently" particularly in the brain's orbito-frontal cortex.

"This part of the brain is involved in the weighing up of the pros and cons of a particular action, in other words, decision making."

Psychological trauma, such as through childhood neglect or bereavement, is common, he said.

On the social level he lists living where drugs are easily available or having friends who are addicted as well as poor housing and social deprivation.

However there are clearly many cases which do not fit these risk factors.

Harry Shapiro, from the charity Drug Scope, said addiction was a "complicated phenomenon with a combination of risk factors".

He said it was "impossible to pick people most likely to become addicted, it's such an individual thing."

Prof Crome said: "We can't predict exactly who will become addicted, but many people who are from a difficult background who might be predicted to develop a problem don't and that is a fascinating thing."

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Drivers get organ donor 'nudge'

31 July 2011 Last updated at 00:53 GMT Less than a third of people are registered as organ donors Drivers will have to state whether they want to be an organ donor when they apply for a new or replacement licence.

The move has been put forward by the government's "nudge unit", which has been set up to encourage changes in behaviour through gentle persuasion.

The Driver and Vehicle Licensing Agency already asks if applicants want to be donors - but from Monday an online form will require that the answer is stated.

Ministers hope it will help improve organ donation rates.

Less than a third of people are signed up to be organ donors - despite research suggesting that nine in 10 would he happy to be one.

Debate

The situation has prompted much debate in recent years about how best to improve rates.

Some have called for presumed consent, where it is assumed an individual wishes to be a donor unless he or she has opted out by registering their objection.

Continue reading the main story It is an idea based on a book by Richard Thaler and Cass Sunstein which advocates influencing behaviour by altering the context or environment in which people choose. It differs from traditional approaches to changing lifestyles which tend to be more overt.Conventional measures might include steps such as bans, using tax to increase price or promotional campaigns.But nudge tends to be more subtle, perhaps involving the provision of information about social norms or changing the environment, such as installing fewer lifts in a building to encourage people to use the stairs more.As well as working on organ donation, the Cabinet Office "nudge unit" will be looking at tax self-assessment and stop smoking services.The government has so far rejected presumed consent and instead the Cabinet Office's behavioural insight team has suggested the driving licence idea as part of its "nudge" drive.

The DVLA's existing scheme is already responsible for about half of the 1m new donor registrations each year.

As well as becoming compulsory to answer the question, the section will be moved from the end to the start of the DVLA process, so when applicants from England, Wales and Scotland apply for new or replacement licences they will have to say whether they want to become an organ donor or not.

When a similar scheme was introduced in the US state of Illinois, donor registration jumped from 38% to 60%.

Public health minister Anne Milton said the move was aimed at encouraging people to discuss the issue more and make it easier for them to sign up.

"Being an organ donor is a truly selfless act and a life-saving gift to someone in need," she added.

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'Super antibody' fights off flu

29 July 2011 Last updated at 07:49 GMT By James Gallagher Health reporter, BBC News A jab protecting against all flu viruses is considered a holy grails of vaccine research The first antibody which can fight all types of the influenza A virus has been discovered, researchers claim.

Experiments on flu-infected mice, published in Science Express, showed the antibody could be used as an "emergency treatment".

It is hoped the development will lead to a "universal vaccine" - currently a new jab has to be made for each winter as viruses change.

Virologists described the finding as a "good step forward".

Many research groups around the world are trying to develop a universal vaccine. They need to attack something common to all influenza which does not change or mutate.

Human source

It has already been suggested that some people who had swine flu may develop 'super immunity' to other infections.

Scientists from the Medical Research Council's National Institute for Medical Research at Mill Hill and colleagues in Switzerland looked at more than 100,000 samples of immune cells from patients who had flu or a flu vaccine.

They isolated an antibody - called FI6 - which targeted a protein found on the surface of all influenza A viruses called haemagglutinin.

Sir John Skehel, MRC scientist at Mill Hill, said: "We've tried every subtype of influenza A and it interacts with them all.

"We eventually hope it can be used as a therapy by injecting the antibody to stop the infection."

Professor Antonio Lanzavecchia, director of the Institute for Research in Biomedicine, Switzerland, said: "As the first and only antibody which targets all known subtypes of the influenza A virus, FI6 represents an important new treatment option."

When mice were given FI6, the antibody was "fully protective" against a later lethal doses of H1N1 virus.

Mice injected with the antibody up to two days after being given a lethal dose of the virus recovered and survived.

This is only the antibody, however, not the vaccine.

A vaccine would need to trigger the human body's immune system to produce the antibody itself.

Sir John said the structure of the antibody and how it interacted with haemagglutinin had been worked out, which would help in the search for a vaccine, but that was "definitely years away".

Professor John Oxford, a virologist at Queen Mary, University of London, said: "It's pretty good if you've got one against the whole shebang, that's a good step forward."

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NHS funds 'moved to rich areas'

31 July 2011 Last updated at 08:32 GMT The Department of Health says NHS spending will rise in real terms this year Labour is accusing the government of moving NHS spending in England away from poorer areas towards richer parts of the country.

It says this is because of changes to the funding for primary care trusts.

For years, areas which have higher incidences of poor health have been given a higher per-capita funding but this weighting is set to be reduced.

Health Secretary Andrew Lansley called the claims "nonsense" and said all areas were getting budget increases.

He said NHS spending was going up in real terms across England as a whole and that Labour would not have matched that commitment if it had won the election.

"We're not taking money away from any parts of England, we're increasing the budget for the health service in England," said Mr Lansley.

"The average increase in each primary care trust is 3%, compared to [its] provision the previous year.

"The minimum increase is two and a half percent, and actually the minimum increase is going to Kingston upon Thames in London, which is hardly a poor area."

Labour, however, says the changes will mean less well-off areas such as Manchester and Tower Hamlets in east London losing out in the allocation of health funding, while more prosperous parts of the country - such as Surrey and Hampshire - will benefit.

Its claims are based on an assessment of funding changes made by public health bodies in Manchester.

Shadow health minister, Diane Abbott, stood by the report and said the NHS was under pressure because of a "misconceived reorganisation" by the Conservative-led government.

"A responsible government, which cared about health and equalities, that cared about the health of the poor, would not be taking money away from inner city areas.

"This isn't politics. This is about people's lives. This is about how quickly you can expect to get an operation, whether you get it as quickly as possible, whether you're made to wait artificially long - 15 weeks - rather than as quickly as possible."

The government said the funding changes were based on independent advice and that Labour's figures were misleading.

The Department of Health said the primary care budgets in Surrey and Tower Hamlets would, in fact, increase this year by a similar amount.

It added that a greater emphasis on the prevention of illness in future would assist those living in poorer parts of England.

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Child health

29 July 2011 Last updated at 13:29 GMT By Dominic Hughes Health correspondent, BBC News The Teddy Bears' Picnic in Lister Park is an annual event for the Born in Bradford families In Bradford's Lister Park, hundreds of families are getting ready for a summer picnic.

On the grass next to the Edwardian splendour of the Cartwright Hall art gallery they lay out their picnic rugs under a sunny West Yorkshire sky.

But these are no ordinary families.

For this is the annual Teddy Bears' Picnic for families taking part in one of the country's biggest research projects, studying the health of around 14,000 children born in the city.

It is an attempt to get to the bottom of why illness blights the lives of so many families in Bradford, which is home to some of the most deprived communities in the UK.

Blood samples

Between 1996 and 2003, the number of children dying in Bradford before they reached their first birthday was almost double the average for England and Wales.

Levels of childhood illness are higher as well, along with much higher rates of heart disease, diabetes, cancer, obesity, asthma and eczema in the city's population as a whole.

Jacob Robinson, the youngest and final recruit to the Born in Bradford project, takes a well-earned snooze

So the project, known as Born in Bradford, is looking at every aspect of a child's development to try to get an idea of how factors like environment, education, diet, ethnicity and genes interact together to affect our health.

Since March 2007, every pregnant woman who attended the Royal Bradford Infirmary has been asked to take part and - amazingly - nearly nine out of 10 said yes.

Parents give blood and saliva samples, babies are measured and weighed and their progress will be tracked across the years.

Future health

Making his first appearance at this year's picnic is Jacob Robinson, born at the beginning of June to Nicola and Duncan.

Jacob is the last recruit to the study and his parents are thrilled to be taking part.

"I just think it is an incredible study," says Nicola.

Continue reading the main story

The more we understand about adult health the more we understand how important the early origins of illness are”

End Quote Prof John Wright Born in Bradford "The fact they are speaking to so many mums across the whole area and compiling all of the data and using it for the future health of babies, I just thought it was a really important study so I was quite excited to be involved."

By lunchtime, more than a thousand people have gathered in the park where stalls promote everything from the Bradford Bulls rugby league side to how to practise good teeth-cleaning.

At the centre of it all, chatting to parents and children, is Professor John Wright, the man in charge of the project.

"Bradford's got some major health problems. We have some of the highest infant mortality rates in the country, we have high levels of childhood asthma, childhood obesity, and we have a diabetes epidemic that is happening in this city as we talk.

"So what we wanted to do was to set up a study to understand what the causes of this were and in particular the early origins of these diseases, as they track through to adulthood.

Ethnic diversity

"The more we understand about adult health the more we understand how important the early origins of illness are.

Ali and Battul Agha and their youngest son Rayan are taking part in the project

"There is particular interest in the first origins of early development of disease - in the womb and the first couple of years of life - and these seem to predict who gets sick later on in life."

The Born in Bradford families reflect the city's ethnic diversity and around half of them are from an Asian background, a community that has some distinct health problems.

For example, around a quarter of Asian adults in Bradford are diabetic, while another quarter are pre-diabetic, putting them at high risk of developing the disease.

Battul Agha is one mother for whom diabetes is a serious worry.

Her son Rayan is one of the Born in Bradford children, but his mum says diabetes has already affected the family.

"I had gestational diabetes while I was pregnant but generations have got it - my children's grandparents, my own grandparents, my mum, some uncles have even developed it.

"So therefore we are particularly cautious about the children's health and what we feed them. We try and give them as much exercise as we can - lots of outdoor time and a healthy lifestyle."

So now the last families have been recruited, the hard work for the researchers begins.

Over the coming years they will track lives of thousands of children across Bradford and hope to provide some clues about the illnesses that affect many more millions of adults.

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DVT linked to video gamer's death

30 July 2011 Last updated at 15:44 GMT Chris Staniforth would spend up to 12 hours playing on the console. A man whose son died after playing video games for long periods is campaigning for greater awareness of the risk posed by their excessive use.

Chris Staniforth, 20, who would play his console for up to 12 hours, died in May from deep vein thrombosis (DVT).

His father David believes the condition may have been triggered by long gaming sessions.

DVT can form during long periods of immobility and can kill if the clots travel to the lungs.

Computer records showed his son would sometimes play online on his Xbox for periods up to 12 hours.

The coroner said a clot formed in Chris' left calf before moving to his lungs.

Once there, it caused a fatal blockage, known as a pulmonary embolism.

Mr Staniforth said: "After my research I saw there was no difference to Chris sitting at a desk on his Xbox and someone on a long-haul flight.

"Sitting still is literally the danger zone. Chris loved to play and would stay up all night.

"Millions of people worldwide are playing these games for hours, and there is a risk."

While Mr Staniforth has no problem with games consoles, he wants to highlight the heightened risk of DVT associated with being immobile, and is in the process of setting up a website.

In a statement, Microsoft, who manufacture the Xbox console, said: 'We have always encouraged responsible game play through our education campaigns such as Play Smart, Play Safe.

"We recommend that gamers take periodic breaks to exercise as well as make time for other pursuits."

David Staniforth calls for greater awareness of DVT after the death of his son, Chris

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Wellcome at 75

25 July 2011 Last updated at 01:53 GMT

When Sir Henry Wellcome died on 25 July 1936, his will made provision for the establishment of a trust that would invest in biomedical research and into the history of medicine.

The resulting Wellcome Trust grew to become one of the UK's biggest charities, investing ?600m each year. Ross MacFarlane from the Wellcome Library looks at the humble beginnings of the young man from America's Wild West who inspired it all.

Continue reading the main story To see the enhanced content on this page, you need to have JavaScript enabled and Adobe Flash installed. All images subject to copyright. Click show captions for image information. Music by KPM Music.

Slideshow production by Paul Kerley. Publication date 25 July 2011.

Related:

Wellcome Trust at 75

The BBC is not responsible for the content of external websites.

More audio slideshows:

The secret of life

Beautiful science

Foraging for food

Books and babies

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Pregnancy stroke surge in the US

29 July 2011 Last updated at 14:29 GMT Pregnancy carries a small risk of stroke The numbers of US women having a stroke during pregnancy has surged, according to doctors.

The incidents increased from 4,085 in 1994-5 to 6,293 in 2006-7, the journal Stroke suggests.

It is thought other risk factors such as obesity, heart disease and diabetes may be to blame.

The Stroke Association said it was concerned by the sharp increase. Pregnancy is a known - if small - risk factor for stroke.

This study compared data from more than 1,000 hospitals in 1994-5 with 2006-7.

More common

During pregnancy itself, the proportion of women having a stroke increased by 47%, going from 0.15 to 0.22 strokes per 1000 deliveries.

In the 12 weeks after birth there was an increase from 0.12 to 0.22 strokes per 1000 deliveries, an 83% increase.

Dr Elena Kuklina, lead researcher from the US Centers for Disease Control and Prevention, said: "I am surprised at the magnitude of the increase, which is substantial. Our results indicate an urgent need to take a closer look."

The researchers suggest that two conditions - high blood pressure and heart disease - "explained almost all of the increase" in stroke after birth.

Dr Kuklina said: "Now more and more women entering pregnancy already have some type of risk factor for stroke, such as obesity, chronic hypertension, diabetes or congenital heart disease.

"Since pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk."

Many of these conditions are also increasing in the UK.

Dr Sharlin Ahmed, research liaison officer for The Stroke Association, said: "We're concerned that this study has found such a sharp increase in pregnancy-related stroke over the past few years.

"It is so important for woman wanting to start a family to understand the risks associated with pregnancy and to take steps to make sure they are as healthy as possible before they become pregnant."

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Miliband nose op 'fails in most'

28 July 2011 Last updated at 12:59 GMT Ed Miliband has had nasal surgery Nasal surgery does not always relieve snoring and sleep problems, a survey has suggested.

Labour leader Ed Miliband underwent surgery to correct a deviated septum earlier this week - aimed at curing his sleep apnoea.

But a survey of 2,000 patients by the British Snoring and Sleep Apnoea Association found 80% said surgery had not worked for them.

A spokeswoman said their survey showed other treatments help more.

Mr Miliband is currently recovering at home after his operation before leaving for a summer holiday.

Loud snoring

Sources close to the Labour leader dismissed media speculation he he was hoping the operation would make his voice sound less nasal.

Sources who spoke to the Labour leader after the procedure had been carried said he sounded "exactly the same".

The "gold standard" treatment for sleep apnoea is CPAP (continuous positive airway pressure), where patients wear a mask at night to help them breath.

The BSSAA website survey in June this year found 10% reported their snoring worsened after the procedure.

And 14% said their snoring stopped initially - but for half of this group it started again within six months.

It is estimated that around four in 100 middle-aged men and two in 100 middle-aged women have OSA (obstructive sleep apnoea) in the UK.

It is a respiratory condition in which the throat repeatedly narrows or closes during sleep, stopping air getting into the lungs and waking the person up.

Extremely loud heavy snoring, often interrupted by pauses and gasps, is one of the main symptoms.

The NHS Choices website states: "Surgery to treat OSA is usually not recommended because evidence shows that it is not as effective as CPAP in controlling the symptoms."

A spokeswoman for the BSSAA said: "For snoring and sleep apnoea, there are other treatments that are non-invasive. We advise trying everything else, including CPAP which is the gold treatment, before surgery.

"There is no guarantee that will work".

But she added: "As Ed Miliband has gone to one of the best hospitals to deal with this, there must have been reasons he had this procedure.

"We hope it works for him."

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Castlebeck care 'concerns' raised

28 July 2011 Last updated at 16:14 GMT Rose Villa home in Bristol was mentioned in the CQC report There are "serious concerns" about care at four Castlebeck-run services for people with learning difficulties, the Care Quality Commission has said.

It named Croxton Lodge, Leicestershire; Rose Villa, Bristol; Arden Vale, West Midlands; and Cedar Vale, Nottingham.

But the CQC said the problems it had found were not on the scale of those that led to the closure of Castlebeck's Winterbourne View home, near Bristol.

The company said it would "urgently address" the CQC concerns.

They included questions over training quality, levels of staff experience, inadequate governance reporting systems, a failure to include people in decisions about their care and a lack of interesting activities, Castlebeck said.

The care regulator launched an investigation following the closure of Winterbourne View after a BBC Panorama investigation had captured footage of some of its most vulnerable patients being repeatedly pinned down, slapped, taunted and teased.

Twelve people have been arrested and released on bail in connection with the alleged abuse, pending further inquiries.

'Demanded improvements'

In addition to the four locations providing serious concerns, a further seven hospitals or care homes run by Castlebeck do not fully comply with essential standards of quality and safety, said the CQC report.

Twelve Castlebeck-run services were found to be compliant.

The commission said it could not comment on the specific concerns it had raised.

Winterbourne View, near Bristol, was closed after secret filming by Panorama

CQC chief executive Cynthia Bower said: "Our inspections have found a range of problems, many of which are found in a number of different services.

"This clearly suggests that there are problems that Castlebeck needs to address at a corporate level - the company needs to make root-and-branch improvements to its services and processes."

She said the commission had demanded improvements and where it had immediate concerns about people's safety it had taken action, such as closing Winterbourne View.

Prime Minister David Cameron called on the CQC to take a tough stance with home operators.

"If care home providers aren't up to shape then they should be properly criticised and have those homes taken away from them," he said.

'Zero tolerance'

The BBC learned in July that four members of staff had been suspended at Rose Villa, a nine-bed rehabilitation centre in the Brislington area of Bristol, following allegations of misconduct.

Continue reading the main story

These hospitals should only be used when they are really needed for assessment and treatment”

End Quote Mark Goldring Mencap Castlebeck chief executive Lee Reed acknowledged some of its services had "not met the high standards we would expect to achieve" and apologised to those affected.

"We are committed to addressing all of these shortcomings as a matter of urgency."

He said an internal review was being carried out and that action had already been taken.

"The safety and well-being of people in our care will always be of paramount importance to us and we will have a zero tolerance policy towards inappropriate behaviour directed against those who use our services."

The company remained "deeply sorry" for events at Winterbourne View, added Mr Reed.

The chief executive of charity Mencap, Mark Goldring, said: "These types of facilities... have been used by the authorities as a dumping ground for more vulnerable adults.

"These hospitals should only be used when they are really needed for assessment and treatment. For most people, smaller, local services, which are built around the needs of the individual, are more suitable."

Helga Pile from the public service workers union Unison said a review into elderly care in England by the Department of Health "must lead to a properly-resourced regulation and inspection system and tougher standards on workforce training and support".

Care Services Minister Paul Burstow said the government was working to ensure such a situation did not emerge again.

He told the BBC it was working with the local councils and the local NHS who arrange placements "to make sure that they're now taking the necessary steps to assure us that they are safeguarding the welfare of people living in these institutions".

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Hospital student nurses withdrawn

29 July 2011 Last updated at 15:05 GMT The hospital has been recently criticised by the Care Quality Commission About 100 student nurses have been removed from Boston's Pilgrim Hospital after the Nursing and Midwifery Council expressed "serious concerns" about it.

The Universities of Nottingham and Lincoln, and the Open University, have confirmed their students are affected.

The Patients Association said the move was a "damning condemnation" of care at the hospital.

The United Lincolnshire Hospitals Trust said patient safety was not affected as students only supported core staff.

'Support students'

Fifty-two of the affected nurses are from courses run by the University of Nottingham, with another seven from the University of Lincoln and the rest from The Open University.

In a statement, the Nursing and Midwifery Council (NMC) said: "Following serious concerns that have formally been raised with the NMC, we have asked The University of Lincoln, The University of Nottingham and The Open University to withdraw around 100 nursing and midwifery students with immediate effect.

"We are working with the universities to review the suitability of the learning environment at Pilgrim Hospital and to support all students affected at this time."

Sylvia Knight, director of nursing and patient services at United Lincolnshire Hospitals Trust, said: "Although students form a valuable part of the nursing teams, they work in addition to our core staff, therefore our ability to deliver safe services for patients is not reliant on the presence of student nurses and midwives.

"At the present time, we are seeking further clarification from the NMC regarding the reason for their actions."

'Lack of care'

NHS East Midlands said: "We are now working closely with the Nursing and Midwifery Council, NHS Lincolnshire and the hospital itself to understand the concerns of the NMC that have led to them removing student nurses and midwives from the Pilgrim Hospital site."

The chief executive of the Patients Association, Katherine Murphy, said: "How many times do we have to hear about the lack of essential care in this hospital before something is done?

"Patients deserve better - if this hospital is performing so badly that it is not thought suitable to train nurses then it is certainly not suitable to care for sick and vulnerable patients.

"What is the trust going to do about this?," she said.

Last month the hospital was criticised by the Care Quality Commission (CQC), which said it had not met required standards in 12 of 16 categories.

'Normal working relationship'

In a statement, the CQC said it had shared information about the United Lincolnshire Hospitals NHS Trust with the NMC.

"This is part of our normal working relationship and the information had previously been shared with the trust.

"The CQC is carrying out a wider investigation into the trust and we will publish the findings of this in due course," a CQC spokesperson said.

Police have confirmed a separate inquiry into reports of mistreatment of patients by a member of staff is continuing.

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Fewer teenagers drinking alcohol

28 July 2011 Last updated at 08:49 GMT Fewer teenagers say they have tried alcohol There have been falls in the numbers of teenagers drinking, smoking and taking drugs in England, a survey suggests.

Between 2009 and 2010 the percentage of 11-15 year olds who had tried alcohol fell from 51% to 45%.

And 27% of pupils said they had smoked at least once, while 18% had tried drugs.

The NHS Information Centre figures also suggested "a shrinking number think that drinking and drunkenness is acceptable".

The report surveyed 7,296 pupils from 246 schools.

The proportion of those drinking alcohol in the week before the study fell from a peak of 26% in 2001 to 13% in 2010.

When they did drink, six in 10 pupils said they consumed more than four units.

Continue reading the main story

To see that fewer children are tolerant of their peers drinking is an early sign of a change in the nation's drinking culture”

End Quote Chris Sorek Drinkaware Smoking One in 20 pupils said they were a regular smoker and girls were more likely to smoke than boys.

Smokers were also more likely to have drunk alcohol or to have taken drugs.

In 2001, 29% of those surveyed said they had used other drugs. That figure has fallen to 18%.

The most commonly used drug was cannabis, taken by 8.2% of pupils.

The survey also suggested a shift in attitudes.

Between 2003 and 2010, the percentage of pupils saying it was "okay" for someone their own age to drink once a week went from 46% to 32%.

Tim Straughan, chief executive of the NHS Information Centre, said: "Our figures point to an increasingly intolerant attitude among young people in today's society when it comes to the use of cigarettes, alcohol and drugs.

"As well as a reduction in the percentage who say they partake in these behaviours; a shrinking number think that drinking and drunkenness is acceptable among their peers."

The chief executive of Drinkaware, Chris Sorek, said: "These statistics are not just encouraging because they show a drop in the number of children who have tried alcohol, but also because they show a positive shift in attitudes.

"To see that fewer children are tolerant of their peers drinking is an early sign of a change in the nation's drinking culture."

A Department of Health spokesperson said: "There is no room for complacency. Dangerous drug use, alcohol misuse and smoking are still major problems that need to be tackled and we will continue to do so."

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NHS trusts abuse system - Lansley

29 July 2011 Last updated at 09:46 GMT Insisting patients wait a certain length of time before treatment has been used as a way to save money NHS managers are abusing the system by making patients wait longer for treatment, the health secretary says.

Andrew Lansley was speaking out after a competition watchdog criticised the way non-emergency operations, such as knee and hip replacements, were being run.

The Co-operation and Competition Panel said some primary care trusts had introduced minimum waiting times to save money and level-down performance.

It said some patients were forced to go private or died before they got care.

But managers reacted angrily to the claims.

David Stout, director of the Primary Care Trust Network, said: "Making claims without evidence that patients are dying as a result of longer waiting lists will cause unnecessary public anxiety and alarm.

"Commissioners take very seriously their role to ensure that patient health is not put at risk waiting for the care they need."

The panel was unable to say how many places were adopting such practices and the report did not name any individual trusts.

It is also unclear what patients were dying from as the treatment they were waiting for was not life-saving care.

But the report cited an anonymous example where one trust was insisting patients wait at least 15 weeks for treatment. Such a time frame is within the 18-week limit, but many hospitals can see patients more quickly than that.

'Delay treatment'

Mr Lansley said the findings justified his reform programme, which aims to put doctors in charge of decision-making.

"This is exactly why we need to put patients' interests first," he said.

Continue reading the main story

Too many PCTs have been operating in a cynical environment where they can game the system”

End Quote Andrew Lansley Health Secretary "Too many PCTs have been operating in a cynical environment where they can game the system - and in which political targets, particularly the maximum 18 week waiting time target, are used to actually delay treatment.

"When GPs, specialist doctors and nurses are making the decisions, as they will under our plans, they will plan care on the basis of the clinical needs of patients and their right to access the best service, including the least possible waiting time."

The effect of minimum waiting times is two-fold. Firstly, it can be used to save money if treatment is knocked into the next financial year.

And private health firms seeing NHS patients have argued it erodes their competitive advantage. Since 2006 patients have had a right to choose where they go for treatment including private hospitals given official approval.

They tend to be able to see people more quickly than NHS centres and therefore making patients wait longer negates one of their selling points, some firms have argued.

The CCP report also looked at a whole host of other anti-competitive and patient unfriendly practices being employed by NHS trusts.

As well as introducing minimum waiting times, these included giving local NHS hospitals guaranteed levels of treatment, rationing the range of treatments private hospitals could provide to the NHS and capping the number of patients that could go outside the local area.

PCTs had argued the measures were needed to protect local hospitals.

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'Abuse' hindering ME research

29 July 2011 Last updated at 08:52 GMT An estimated 250,000 people in the UK suffer from Chronic Fatigue Syndrome Scientists working on Chronic Fatigue Syndrome (CFS), or ME, say they are being subjected to a campaign of vicious abuse and intimidation that is hampering research into the causes of the condition.

The harassment has included death threats, vilification on internet websites, and a series of official complaints alleging both personal and professional misconduct to universities, ethical oversight committees and the General Medical Council (GMC).

"It's direct intimidation in the sense of letters, emails, occasional phone calls and threats," says Professor Simon Wessely, of King's College London, who has received a series of death threats and threatening phone calls, and now has his mail routinely scanned for suspect devices.

"But more often indirect intimidation through my employer or the GMC. All of it intended to denigrate and try and make you into a leper."

Behind the vitriolic nature of the attacks, the core objection, by some activists, is the association of Chronic Fatigue Syndrome with mental illness.

They claim the real cause is biological and want research to focus exclusively on identifying the - as yet undiscovered - virus responsible.

"Sadly some of the motivation seems to come from people who believe that any connection with psychiatry is tantamount to saying there is nothing wrong with you, go away, you're not really ill," says Dr Wessely.

"That's profoundly misguided. They fall victim to the label, and believe that the mere involvement of psychiatry denigrates them and denigrates the condition."

Chronic Fatigue Syndrome is a debilitating condition involving severe fatigue, painful muscles and joints, gastric complaints and poor memory and concentration. It is estimated there may be as many as a quarter of a million sufferers across the UK, but exactly what causes it is still a mystery.

That has been incredibly frustrating for patients who have often received short-shrift from doctors, and been branded as malingerers - the victims of "yuppy flu" - in the media. Even the existence of the condition has only recently received widespread acknowledgement by the medical establishment.

Speaking on the programme on Friday, ME Association's Dr Charles Shepherd condemned the abuse of researchers, but said sufferers had a justifiable complaint that almost no government-funded research was looking at the bio-medical aspects of the illness.

"The anger, the frustration, is the fact that all this effort, all this government-funding, has just been going to the psychological side," he said.

Hostility towards a psychiatric explanation for Chronic Fatigue Syndrome reached a peak in 2009 when research published in the journal Science appeared to show a link to the XMRV retrovirus.

But a series of follow-up studies failed to replicate the finding, unleashing another torrent of abuse - this time aimed at virologists, including Professor Myra McClure, of Imperial College, London.

"It really was quite staggeringly shocking, and this was all from patients who seemed to think that I had some vested interest in not finding this virus," she said. "I couldn't understand, and still can't to this day, what the logic of that was. Any virologist wants to find a new virus."

Chronic Fatigue Syndrome or ME (Myalgic Encephalopathy)is a debilitating condition involving severe fatigue, painful muscles and joints, gastric complaints and poor memory and concentration It can leave patients bed-ridden in severe cases.Up to a quarter of a million people suffer from the disorder in the UK.

Professor McClure says she will not be doing any further research in this area, and that may be the single most important consequence of this campaign of abuse and intimidation.

According to the Wellcome Trust's Dr Mark Walport it would be a tragedy if serious researchers are put off working on Chronic Fatigue Syndrome.

"We clearly don't yet understand exactly what's going on, and if we're going to find out it needs good scientists to work on it," he says.

"But why would any scientist work on it if they know that all they're going to receive is a torrent of abuse?"

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Impact of breast checks queried

29 July 2011 Last updated at 00:05 GMT The benefits of breast screening are being scrutinised Screening has not had a significant impact on the fall in deaths from breast cancer, a study claims.

Researchers compared three pairs of European countries, where one had introduced a screening programme much earlier than the other.

But the British Medical Journal paper found similar death rates.

The authors say better treatment and efficient health systems were likely to explain the improvements, and suggest a move away from universal screening.

It has been shown that cervical cancer screening has led to a fall in deaths from that disease, and the researchers from France, the UK and Norway wanted to see if the same was true for breast cancer.

They compared the Netherlands with Belgium and Sweden with Norway, as well as Northern Ireland and the Republic of Ireland - each pair of countries had similar healthcare services and risk factors for breast cancer.

Mammography screening was implemented around 10 to 15 years later in the second country of each pair.

'Saddened'

The researchers expected that a reduction in breast cancer mortality would appear sooner in countries with earlier implementation of screening.

They studied data from the World Health Organization (WHO) mortality database on cause of death covering the period 1980 to 2006 and data sources on risk factors for breast cancer death, mammography screening, and cancer treatment.

Breast cancer death rates varied little between countries where women had been screened by mammography for a considerable time compared with those where women were largely unscreened during that same period, say the authors.

And the greatest reductions were in women aged 40-49, regardless of the availability of screening in this age group, they said.

From 1989 to 2006, deaths from breast cancer fell by 29% in Northern Ireland and 26% in the Republic of Ireland; by 25% in the Netherlands, 20% in Belgium and 25% in Flanders; and by 16% in Sweden and 24% in Norway.

Dr Philippe Autier, director of the International Prevention Research Institute in Lyon, France, who led the study, told the BBC he was "sad" to see its results.

"There is a real question about the benefits of breast screening. It's clear from the data that screening is not a panacea for reducing women's risk of dying from breast cancer."

Dr Autier said there should no longer be a "blanket offer" of screening, and that the process should be "much more targeted".

And he said the findings would apply to other countries, including the rest of the UK which has the same screening policy as Northern Ireland.

'Early detection'

But a spokeswoman for Northern Ireland's breast screening programme said: "Evidence shows that breast screening reduces deaths from breast cancer.

"It is the most reliable way of detecting early breast cancer at a stage where treatment can be more successful."

Professor Julietta Patnick, director of the NHS Cancer Screening Programmes in England, said: "Here in England we do know that the best evidence available shows that women aged 50-69 who are regularly screened are less likely to die from breast cancer.

"The WHO's International Agency for Research on Cancer (IARC) estimates that there is a 35% reduction in mortality from breast cancer among screened women aged 50-69 years old; and in England, the independent Advisory Committee on Breast Cancer Screening estimates breast screening saves 1,400 lives each year."

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Stem cell trial for MS treatment

29 July 2011 Last updated at 05:00 GMT By Pallab Ghosh Science correspondent, BBC News Bone marrow stem cells may be able to protect and repair A major clinical trial will investigate whether stem cells can be safely used to treat multiple sclerosis (MS).

It is hoped eventually to slow, stop or even reverse the damage MS causes to the brain and spinal cord.

The trial, involving up to 150 patients across Europe, is due to start later this year.

Dr Paolo Muraro from Imperial College London said: "There is very strong pre-clinical evidence that stem cells might be an effective treatment."

Researchers will collect stem cells from the bone marrow of patients, grow them in the laboratory and then re-inject them into their blood.

The stem cells will make their way to the brain where it is hoped that they will repair the damage caused by MS.

Continue reading the main story

These experiments have confirmed that these stem cells hold that potential - but these need to be confirmed in large scale clinical trials”

End Quote Dr Doug Brown MS Society The research has been part-funded by the UK's MS Society, which is concerned about the availability of unproven stem cell treatments.

In recent years many people living with MS have been attracted to overseas stem cell clinics which claim to cure long-term conditions in exchange for large amounts of money.

But there is no proven stem cell therapy available for MS anywhere in the world.

The MS Society hopes these new trials will eventually lead to a proven treatment - and a reduction in the draw of overseas treatments.

Common condition

MS is the most common neurological condition to affect young people in the UK.

Three million people are thought to be affected worldwide and up to 100,000 in the UK.

The condition is caused by the body's own immune system attacking and damaging a substance called myelin in the brain and nerve cells.

Continue reading the main story

I am delighted that we have at last progressed stem cell research to this stage, which will bring much-needed hope to so many people affected by this devastating condition”

End Quote Sir Richard Sykes Chair, UK Stem Cell Foundation The myelin damage disrupts messages from the brain to the body which leads to a number of symptoms such as sight loss, bladder and bowel problems, muscle stiffness and eventually physical disability.

Drugs are available to alleviate the symptoms - but they do not prevent the progression of the condition.

Experiments in test tubes and laboratory animals suggest stem cells extracted from bone marrow may be able to offer a more effective treatment.

Their role in the bone marrow is to protect the cells that make blood. But they also seem to protect myelin from attack by the immune system.

There is also some evidence that these cells might also be able to repair damaged tissue.

Hold potential

Dr Doug Brown, of the MS Society, said: "These experiments have confirmed that these stem cells hold that potential - but these need to be confirmed in large scale clinical trials."

There is some way to go, however, before laboratory promise can be translated into a treatment that can be offered to patients.

The international team will begin so-called phase two clinical trials in six months' time designed to determine whether the treatment is safe and effective.

It will take five years to carry out and assess the results of the trials after which large phase three trials may be required.

But Dr Muraro believes that the stem cell approach has real potential.

He said: "The great hope is the fact that we are exploiting a biological system that has evolved over millions of years and harnessing it for treatment that takes advantage of the stem cells' flexibility."

Sir Richard Sykes, chair of the UK Stem Cell Foundation, said Dr Muraro's research was the first of its kind to take place in the UK.

"Given the high incidence of MS in the UK in comparison to other countries, I am delighted that we have at last progressed stem cell research to this stage, which will bring much-needed hope to so many people affected by this devastating condition."

Correction 29 July 2011: This story has been amended after the MS Society corrected a statement it had made suggesting stem cells from the brains of aborted foetuses had been used in research it was funding. The society said that adult neural cells were in fact being used.

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'Legal' drug addict

27 July 2011 Last updated at 10:01 GMT By Katy Takatsuki Face the Facts, BBC Radio 4 More than a million people in the UK are estimated to be addicted to prescription drugs known as benzodiazepines. But with withdrawal symptoms similar to those experienced by heroin addicts, those who find themselves addicted are calling for more help and a change in the way the drugs are prescribed.

Josh says he gets sweats and a sense of going mad if he stops taking his prescription drugs

"Being addicted is hellish. When I get up in the morning I need to take my meds so I can function, so I can be a whole person."

Josh, 50, was first prescribed a benzodiazepine, a tranquiliser, as a hyperactive eight-year-old and has been addicted ever since.

He is among the 1.5m people across the UK the All Party Parliamentary Group on Involuntary Tranquilliser Addiction (APPGITA) estimates are addicted to this group of drugs, which are also known as 'benzos'.

Benzos include diazepam and temazepam, and are commonly prescribed by GPs for a range of conditions such as anxiety and insomnia.

They act by enhancing the effect of a brain chemical transmitter called gamma-aminobutyric acid (GABA), which depresses or calms the central nervous system, slowing down mental activity to cause relaxation and sedation.

But some experts say that coming off benzos can be harder than stopping taking heroin.

"I estimate about 20-30% (of people) who are on benzos have problems coming off, and about a third have very distressing symptoms," says Professor Malcolm Lader of the Institute of Psychiatry.

"The anxiety comes back or sleeplessness comes back and they feel physically ill.

"Then they get bizarre symptoms.

"Essentially, the brain wakes up and then over-wakes, sounds appear louder, lights appear brighter, and they feel unsteady. It's then they're in a bad withdrawal state."

Continue reading the main story

It's an issue that's fallen through the cracks, it's a silent addiction”

End Quote Anne Milton Public health minister for England Josh has tried to stop taking the drug many times.

"You sweat, hot and cold sweats, you get diarrhoea and a sense of going mad," he says.

"It's horrendous. I've never found a cut-off point where I've said, 'It's better', because the symptoms persist.

"The longest time I've been off benzos was eight weeks.

"I know that sounds like a short time but I can assure you that eight weeks is a really long time to be experiencing those symptoms every day, and they don't get better.

"And without the support, in the end my body said, enough, I must take a tablet, I can bear this no longer."

Lack of services

The support Josh longs for is the kind that is already provided in drug addiction centres for users of heroin and cocaine.

"We didn't wake up and say, 'Lets get addicted'," says Josh.

"We got addicted involuntarily and those who have been brave enough to try and address our addiction and have failed, we're still as stuck in that cycle.

Continue reading the main story

We're volunteers in all this. Where are the services to help these people?”

End Quote Barry Haslam Tranx addiction support group "Please help us. Give us some support. Don't abandon us now."

Tranx, a support group based in Oldham, Manchester, run by ex and partially-withdrawn addicts, is unique in bringing together two charities - one with NHS funding - to provide two nurses.

"In Oldham I've seen six suicides and 50 attempted suicides," says Barry Haslam, who runs the support group, and is himself a former benzo addict.

"One weekend there were people wanting to commit suicide on the Friday, Saturday and Sunday night. It's just so sad there's nothing out there.

"We're volunteers in all this. Where are the services to help these people?" he says.

But as Professor Malcolm Lader, of the Institute of Psychiatry says: "The facilities are simply not available."

He adds: "The great scandal is addicts are referred to illegal drug addiction centres, and they're sat next to an illegal drug user who's been injecting heroin, and of course a housewife who's been prescribed by her doctor will be very upset by this."

Anne Milton, England's public health minister, admitted to BBC Radio 4's Face the Facts that there there had been some denial of the problem, but added the Department of Health is trying to "get a grip" of it and provide help for those who want to withdraw.

"I'm taking this very seriously, it's an issue that's fallen through the cracks, it's a silent addiction. Not many people know about it.

"We want to make sure training and awareness is raised so GPs can prescribe well, and then we've got to make sure we've got the right services in place to help them enjoy lives as they should be able to."

Rise in prescriptions

The potential dangers of withdrawing from benzos have long been known.

The number of benzo prescriptions rose by 8% last year

The recommended maximum time benzos should be prescribed is four weeks, according to government guidance.

Yet in England, the number of prescriptions issued last year rose by 8% to almost 11.5 million.

A recent report by the National Addiction Centre, Kings College London, which looked at prescribing in England for the 19 years up to 2009, found over a third of prescriptions during this period were for more than eight weeks.

But the Royal College of General Practitioners defends the prescription of these drugs, saying the way GPs have been dealing with patients in recent years is a "prescribing success" story.

Dr Clare Gerada, the organisation's chair, says that benzodiazepines are effective drugs, adding that most patients can withdraw easily, but that for others, staying on the drug may be a better option.

"Patients that I see, on the whole, do not have problems coming off. Some patients may be on them for life.

"It's not a good thing, but if you balance the risks and benefits then sometimes the benefits of staying on them far outweigh the risks."

You can hear more on Face the Facts: Prescribed Addiction on BBC Radio 4 at 1230 BST, on Wednesday, 27 July, repeated at 2100 BST on Sunday, 31 July, or catch up on BBC iPlayer.

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Ear op cures man of eyeball noise

27 July 2011 Last updated at 16:50 GMT Stephen Mabbutt had experienced unusual symptoms for six years A man with a medical condition which meant he heard his eyeballs move in their sockets has been cured.

Stephen Mabbutt, 57, from Charlton, near Banbury, also heard his own heart beating and was finding it increasingly difficult to hear the world around him.

Ear expert Richard Irving diagnosed superior canal dehiscence syndrome (SCDS) and carried out the surgery.

Mr Mabbutt told the BBC: "It's made a big difference to my life. I feel a different person all round."

He first experienced symptoms six years ago, in the form of a dull ache in the side of his head.

Successive GPs treated him with nasal sprays and antibiotics, but his hearing deteriorated.

He then experienced new symptoms - loud noises caused dizziness and his vision pulsated to every rhythm of his speech.

"When I raised my voice I could hear it reverberating in my head and the vibrations made my vision vibrate.

"Eventually I could hear my heart beating and my eyes moving in their sockets. It was really distracting."

Rare condition

He was eventually referred to Martin Burton, a surgeon from the Oxford Radcliffe Hospital who helped establish the Cochrane Ear, Nose and Throat Disorders Group.

Continue reading the main story

Some patients, as their eyes move from side to side, hear that friction movement of the muscle as a noise in their ear ”

End Quote Richard Irving Ear, Nose and Throat Consultant Mr Burton conducted a CT scan and noticed perforations inside the semicircular canals inside Mr Mabbutt's ear. He then brought it to the attention of Richard Irving at the Birmingham Ear Clinic.

Mr Irving diagnosed SCDS, a rare condition discovered by American surgeon Lloyd B Minor in 1995.

He said: "There may be an annual incidence of one in 500,000 a year in the UK population.

"Symptoms include hearing loss and balance problems, particularly provoked by loud noises or pressure changes in the head.

"I've had a patient who fell over whenever they burst out laughing.

"You hear all interior sounds of the body particularly loud.

"The actual muscles that move the eyes are connected to the bones of the skull and there is an element of friction as these muscles move. Some patients, as their eyes move from side to side, hear that friction movement of the muscle as a noise in their ear.

SCDS affects the semicircular canals in the ear (right) causing the body's interior sounds to be heard loudly

"It destroys their quality of life.

"The symptoms were so confusing that those of us in the medical profession just scratched our heads and didn't understand it until this was described."

The operation to cure the problem involved a 5cm (2in) incision behind the ear, making a channel through the bone to find the "balance organ" and using the patient's own bone to create a seal around the defect.

The results for Mr Mabbutt were life-changing.

He said: "I was just hoping and hoping somebody would put their finger on it at some point and tell me what was going on.

"It was getting me down not knowing what it was and whether or not it could be cured.

"It feels great now. I feel like I've got a new lease of life. I've got more energy and I feel brighter. It's an amazing difference."

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Heart patients hepatitis B 'risk'

21 July 2011 Last updated at 14:13 GMT An investigation has started and people have been sent letters asking them to get in touch so they can be given blood tests

More than 150 patients who underwent heart surgery in Swansea earlier this year have been told they may have been exposed to the hepatitis B virus.

Managers said there was a "low risk" involving patients who had surgery at the cardiothoracic unit at Morriston Hospital between 11 March and 17 April.

A patient treated at the unit at this time was later diagnosed with an acute hepatitis B infection and died.

A health watchdog said the family are now pursuing a complaint.

All non-emergency cardiac surgery has been postponed temporarily.

Continue reading the main story

Although the risk to other patients who were in the unit is low, they are being offered blood tests to rule out transmission of the virus or to enable proactive treatment if a result was positive”

End Quote ABM University Health Board Patients at risk have been sent letters offering blood tests to check if they have been infected.

The ABM University Health Board said there was "a low risk" they may have been exposed to the virus during their stay at the unit.

Hepatitis B is a viral infection of the liver spread through blood and body fluids.

The virus can cause an acute illness that resolves itself quickly but it can cause a chronic illness that lasts more than six months.

In rare cases it can cause serious liver damage and may eventually be fatal however treatments are available.

The health board said it was alerted to the problem when a patient who received treatment and was discharged as planned was later newly diagnosed with an acute Hepatitis B infection. The patient has since died.

External review

The health board and Public Health Wales are carrying out an investigation and have commissioned an external review.

Transmission from staff, family members and blood products has been ruled out.

The board said it is likely that the virus had been indirectly transmitted from another patient at the unit who was known to be Hepatitis B positive.

The health board said it was "extremely rare" for blood borne viruses like hepatitis B to be passed between patients because of "robust precautions and procedures" in place.

Continue reading the main story

I was reassured that the risk to the 150 or so patients is low but nevertheless I hope that they will all take up the offer of further screening as a matter of urgency”

End Quote Phil Williams Abertawe Bro Morgannwg Community Health Council It said as well as screening staff, reinforcing training and switching to more single-use surgical instruments it had redecorated and deep cleaned both cardiac theatres and wards.

Routine surgery has been postponed until new equipment arrives.

In a statement the health board said: "We anticipate this temporary suspension of non-urgent cardiac surgery will be for a few days only, until the new equipment arrives, and we apologise for any inconvenience this will cause patients.

"We will also be commissioning an external review as soon as possible, to review the processes we have in place.

"Although the risk to other patients who were in the unit is low, they are being offered blood tests to rule out transmission of the virus or to enable proactive treatment if a result was positive.

"Only patients who were cardiothoracic patients at Morriston Hospital during this time period are being contacted.

"Patients who have not received a letter do not need a blood test."

Phil Williams, chief officer of Abertawe Bro Morgannwg Community Health Council (CHC) said the matter was of deep concern.

"I was reassured that the risk to the 150 or so patients is low but nevertheless I hope that they will all take up the offer of further screening as a matter of urgency," said Mr Williams.

"I can confirm that the family of the patient who sadly died have been in contact with the CHC and are pursuing an official complaint."

Mr Williams said family members had expressed a wish to be left alone.

A helpline has also been set up for patients who receive letters.

Any other patients who may have concerns should contact their GP or NHS Direct Wales on 08454647 for further information.

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Swine flu jab 'narcolepsy risk'

21 July 2011 Last updated at 17:47 GMT More than 30 million doses of swine flu vaccine have been given in Europe A swine flu jab has been linked to rare cases of a sleeping disorder and should be the last line of protection for young people, European regulators say.

The European Medicines Agency (EMA) said Pandemrix should only be given to children and teenagers at risk of H1N1 flu if other jabs are unavailable.

More than six million doses of the vaccine have been given in the UK.

Ten suspected cases of narcolepsy linked to the vaccine have been reported to the UK's drug regulator.

Pandemrix, made by GlaxoSmithKline (GSK), was the most widely used in the UK during the 2009/10 flu pandemic.

However, the vaccine is no longer in use and the remaining stocks will be destroyed this autumn.

The EMA's investigation followed reports, mainly from Finland and Sweden but also from Iceland and the UK, of children and adolescents suffering the sleep disorder narcolepsy, which causes people to fall asleep suddenly and unexpectedly.

It said studies had shown a six to 13-fold increased risk of narcolepsy in children and adolescents vaccinated with Pandemrix compared with unvaccinated children.

In a statement, the EMA said it had "noted that the vaccine is likely to have interacted with genetic or environmental factors which might raise the risk of narcolepsy, and that other factors may have contributed to the results."

Unknown factors

Overall, Pandemrix has been given to more than 31m people worldwide.

In a statement, GSK said it had received reports of 335 cases of narcolepsy in people vaccinated with Pandemrix by the start of July.

Continue reading the main story Narcolepsy is a rare illness, with around 10 new cases per million people every yearThe main symptom is falling asleep suddenlyThe cause of narcolepsy remains unclearSome people may be predisposed to the condition by their genetics Suggested initial triggers include infections such as measles or mumps, accidents and the hormonal changes that take place in puberty It most often begins between the ages of 15 and 30The company added: "GSK is committed to patient safety and will continue to work closely with the EMA and other national regulatory organisations in the best interest of patients."

A spokesperson for the UK's drug regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) said: "The annual seasonal flu vaccines have not been associated with the development of narcolepsy, and there are no new safety concerns associated with these vaccines.

"These vaccines remain recommended for protection against seasonal influenza."

She added: "The MHRA has been fully involved in the European safety review of Pandemrix vaccine.

"It is possible that other geographical factors in Sweden and Finland, at the time of the pandemic, have contributed to the cases of narcolepsy seen after vaccination with Pandemrix.

"These factors remain unknown, and further studies are ongoing to explore this.

"The regulatory action for Pandemrix vaccines recognises the potential seriousness of H1N1 infection and ensures that the vaccine remains a licensed alternative to protect children and adolescents in need of protection against H1N1, if seasonal vaccines are not available."

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Injured brains linked to dementia

21 July 2011 Last updated at 03:56 GMT By Eleanor Bradford BBC Scotland Health Correspondent The study suggests a brain injury can spark a process in which the brain is damaged in other ways Research carried out in Scotland and the US has established a link between a single head injury and dementia.

The study was done by researchers at the Southern General Hospital in Glasgow and the University of Pennsylvania.

It is thought to be the first to find a physical abnormality in brain tissue of people who have had head injuries.

A link had previously been established between dementia and sports which involve repetitive blows to the head.

These contact sports include boxing and football.

Further studies have also shown a similar link with people who have had other kinds of head injury.

Dr William Stewart, who led the team in Glasgow, said: "We know from clinical studies that there's a link between sustaining a head injury and developing dementia, and what we're interested in is trying to understand what might be happening in the brains of these patients."

Brain abnormalities

Researchers examined brain tissue from 39 people who had recovered from a brain injury, and 39 people who had never had a brain injury.

They found abnormalities in one third of those who had had a head injury.

Continue reading the main story

Part of the challenge in dementia is that a lot of the work we do is with people who already have it”

End Quote Dr William Stewart Dr Stewart said: "What's quite remarkable, and causing much excitement, is that the patients who'd had a head injury had quite large numbers of proteins - or abnormalities - in their brain.

"That's very similar to what we'd see in older patients and, in particular, people with Alzheimer's, yet these patients were in their 40s and 50s and the only thing which marked them apart from the control group was that they'd had a head injury."

More than 150,000 people in the UK suffer a head injury every year.

This study suggests a brain injury can spark a process in which the brain is damaged in other ways.

Dr Stewart hopes that this will lead to further research that could reveal how and why dementia develops.

He explained: "Part of the challenge in dementia is that a lot of the work we do is with people who already have it.

"What we don't understand is how they get to that stage and what sets off the process in their brain. What we might be able to do is study patients after a head injury and work out what's happening inside their head."

It is hoped that learning more about this process could lead to new and better treatments for dementia.

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Libya's mountain hospital

20 July 2011 Last updated at 00:25 GMT By Bill Law BBC Radio 4, Crossing Continents The almost-deserted Libyan town of Nalut is still a frequent target for Colonel Gaddafi's Grad rockets. It is not hard to get to Nalut these days. The town is in the rebel-held Nafusa Mountains in western Libya, about 40km (25 miles) from the border with Tunisia.

We make a quick dash, once we have cleared Tunisian customs, through the empty town of Wazin on to the open road. We pass the risk of Gaddafi's "Grad" rockets that can come at you from the valley below.

Just outside Nalut we are waved through a rebel checkpoint, the men on guard lounging in plastic chairs under tarpaulins that ward off the fierce heat.

There is a pick-up truck with an anti-tank gun mounted and pointing for no apparent reason back down the highway we have just come up.

Nalut is like a ghost town. In the late afternoon sun a few cars drive by, but the houses are shuttered and empty, the shops and restaurants closed.

The town of Nalut is situated in western Libya, amid the Nafusa mountains

The men are off in the mountains. Sometimes they attack chaotically, sometimes they retreat in utter confusion. Most of the time they sit and watch.

The women, the children and the old folk are across the border in Tunisia where the heat in the desert is stifling. Here in this mountain town, the air is cooler.

I'm travelling with Saleyha Ahsan, a British doctor I first met in 1998, when she was a captain in the British Army and the first Muslim woman to graduate from Sandhurst.

When she left the army she went into medicine. Now in Libya she is volunteering with other doctors, most of them Libyans, helping refugees and the wounded from both sides of the conflict.

Continue reading the main story

You can listen to the full report on Crossing Continents on BBC Radio 4 on Thursday 14 July at 1100 BST and Monday 18 July at 2030 BST

"I found on organisation online called Global Relief Libya - doctors organising themselves and getting involved," she says.

"I want to be part of this Arab Spring, even though I was born in Britain and my roots are in Pakistan and Afghanistan."

As we make our way to the hospital, the streets are virtually empty.

We drive past a newly painted wall with slogans in Arabic that say things like, "God is great and Nalut is free" and "For all dictators there is an end".

North Korean staff

The hospital is large, with 300 beds. It was built by Colonel Gaddafi as a showpiece, intended to underline how his efforts were benefiting the Libyan people.

Ironically he chose to staff it mainly with foreigners - Filipinos, Bangladeshis and, bizarrely, North Koreans.

The North Koreans are very wary of publicity, but Dr Ahsan has a natural ability to get people to talk.

They and the rest of the staff have not been paid, we are told, since November.

The rebel leaders from the National Transitional Council say they will be paid sometime. So they wait and tend to the wounded.

British doctor Saleyha Ahsan wants to return and volunteer at the hospital again

One day in June it was very busy here. A rebel attack on Gaddafi's forces backfired badly and 15 people were killed. Another 48 were injured. The more seriously wounded have been evacuated to hospitals in Tunisia, the others have been patched up and sent back to the front lines.

We walk down the halls with the locum doctor who happens to be Libyan. Our feet echo through empty halls. In all of this hospital there are only three patients.

Dr Ahsan has asked if she can examine them.

The patients are kept behind a locked door. The hospital staff say this is for security reasons but these three are not going anywhere - they were all fighting on the Gaddafi side.

All have suffered severe bullet wounds. One has lost a foot, another was wounded badly in an arm and a leg.

Homesick boy

The third is a boy, no more than 16 years old. He lies in a freshly made bed with crisp, clean linen. His eyes catch you first. They are brown, very big, and full of sorrow.

He tells Dr Ahsan he had gone to a pro-Gaddafi rally in February from his home in the south of Libya. It probably seemed a bit of a lark at the time.

After the rally he was press ganged, he says, given a gun - but no training - and forced to join Gaddafi's soldiers at a checkpoint. In early June the rebels attacked the checkpoint. He was shot in the back and the leg and brought here.

Continue reading the main story

I want to become another little link in that massive chain that has sprung out of the revolution”

End Quote Dr Saleyha Ahsan Dr Ahsan examines his dressings. The boy complains of some pain.

She notes that he is dehydrated but overall is satisfied with the quality of care he is receiving. She asks the Libyan doctor to keep an eye on his fluid intake and recommends painkillers and physiotherapy.

When asked if his family knows where he is, the boy shakes his head and says "no".

He says, "When I get out of the hospital, I want to go home to my family."

But for now the war is grinding into a stalemate. Gaddafi cannot budge the rebels from their strongholds like Nalut.

But equally, the rebels, a rag-tag army of civilians, seem unable to advance toward Tripoli from the Nafusa Mountains. That is understandable - they are up against some of Gaddafi's best brigades.

So the North Korean nurses and the boy with sad eyes wait in the empty hospital in the deserted town of Nalut for the end of a war that seems set to continue through the Muslim holy month of Ramadan and into the autumn.

Dr Saleyha Ahsan is only working with the refugees and fighters there for a week but she is determined to return.

"I want to become another little link in that massive chain that has sprung out of the revolution."

You can listen to Crossing Continents on BBC Radio 4 on Thursday 21 July at 1100 BST and Monday 25 July at 2030 BST. You can also listen via the BBC iPlayer or the podcast.

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Children 'risk sunburn at school'

15 July 2011 Last updated at 00:30 GMT By Michelle Roberts Health reporter, BBC News Young skin is sensitive to the sun's strong rays All UK schools should be required to have a comprehensive sun safety policy to protect children from skin cancer, a charity campaigner says.

A recent survey of 1,000 parents, commissioned by MPs on the All-Party Parliamentary Group on Skin, found almost 40% of pupils have suffered sunburn while at school.

Richard Clifford of Skin Cancer UK says this is "entirely unacceptable" and wants mandatory sun rules for schools.

Current guidelines are not compulsory.

The call comes as parents of a 10-year-old girl who attends a school near Swansea complained their daughter had suffered severe sunburn at a sports day.

Pennard Primary School said parents could come in at lunch-time to apply cream, but that it would be impossible for teachers to apply suncream to the 200 children attending the school.

Advice from the National Institute for Health and Clinical Excellence (NICE) says schools should encourage children to seek shade whenever possible, particularly when out playing in the midday sun.

And it says sunscreen (of at least SPF 15 strength) should be applied liberally half an hour before and after going out in the sun and reapplied every two hours thereafter.

Child safety

Nurseries and pre-schools have higher staff-child ratios to deal with such demands.

But what is not clear is exactly how schools are expected to deliver this.

Mr Clifford said: "Admittedly teachers cannot be expected to apply sunscreen due to simple time pressures.

Continue reading the main story

Children have delicate skin and getting sunburnt as a child increases the risk of skin cancer later in life”

End Quote Dr Claire Knight of Cancer Research UK "There is also the inevitable question regarding their concerns over child abuse and the strong advice they receive from local authority education departments and trade unions.

"However, there is no reason whatsoever why they should not supervise the application, perhaps with the assistance of the school nurse or indeed parents who attend on a pre-arranged rota system."

NICE suggests parents could provide sunscreen for their children who could, in turn, be taught how to apply it for themselves and their school-friends.

The guidelines also recommend schools run awareness campaigns to alert children to the harms of too much sun exposure.

But Mr Clifford says in reality too few do.

"Instead, it is left to the individual teacher to decide as to whether or not to introduce the subject of UV awareness. This is simply not good enough."

Over-exposure

Cancer Research UK has produced information to help schools develop a sun safe policy, but so far only 621 English primary schools have registered to receive this sun protection policy pack.

Dr Claire Knight, health information officer at Cancer Research UK, said: "It's important that children are protected from sunburn while at school.

"Children have delicate skin and getting sunburnt as a child increases the risk of skin cancer later in life."

Prolonged over-exposure to the sun and episodes of sunburn under the age of 15 are major risk factors for skin cancer in later life.

The British Association of Dermatology estimates that four out of five skin cancer deaths are preventable.

Dr Knight said: "Cancer Research UK encourages schools to develop their own sun protection policy, and recommends that children should be allowed to bring sunscreen of at least SPF 15 with four or five stars into school and be supervised whilst applying it.

"Using shade and clothing is also crucial to any policy designed to promote the safe enjoyment of the sun."

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Spinal repair restores breathing

13 July 2011 Last updated at 17:02 GMT By James Gallagher Health reporter, BBC News Damage to the spinal cord in the neck can result in problems breathing The ability to breathe has been restored to mice with spinal cord injuries, in what US researchers describe as a medical first.

Some patients with damaged spinal cords need ventilators as they are unable to breathe on their own.

A report in the journal Nature showed a nerve graft, coupled with a protein, could restore breathing.

Human trials could begin soon, which the charity Spinal Research said could be "potentially life-changing".

Damage at the top of the spinal cord, around the neck, can interrupt messages to the diaphragm - a layer of muscle involved in breathing.

Challenge

The cord is notoriously resistant to repair. Techniques such as nerve grafts, which worked in the arms and legs, had shown limited success with the spinal cord, doctors at the Case Western Reserve University said.

The spinal cord scars after it is damaged, and molecules - chondroitin sulphate proteoglycans - prevent nerves repairing and forming new connections.

Continue reading the main story There are approximately 800 spinal cord injuries in the UK each yearRoughly half are in the neckThe majority of these patients will have some degree of impaired breathing

Source: Spinal Research

The researchers used a nerve graft to form a bridge across the scar at the same time as injecting an enzyme - chondoitinase ABC - which attacked the inhibitory molecules.

Three months later, tests showed the mice had recovered 80-100% of breathing function.

Professor of neuroscience and lead researcher Jerry Silver said: "The use of the enzyme, that's helped get the nerve fibres out and we were amazed at, once they get out, how well they can reconnect.

"The spinal cord can just figure things out and restore really beautiful functional breathing patterns."

Researchers hope to begin trials in humans. They are also investigating whether bladder function can be restored, which can be lost when the lower spine is damaged.

Dr Mark Bacon, from the charity Spinal Research, said: "Long distance regeneration has remained quite elusive in the field of spinal cord injury repair, so to achieve this and at the end of it establish functional connections that actually do something useful - restore breathing - is remarkable.

"It is potentially life-changing if this or similar techniques can be translated to the clinic."

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Four in 10 get cancer - charity

14 July 2011 Last updated at 02:01 GMT By Adam Brimelow Health Correspondent, BBC News Cancer charity says four in ten will get the disease Rising cancer rates mean four in 10 people in the UK get the disease at some point in their lives, a health charity says.

Macmillan Cancer Support says the figure has risen significantly in the past decade.

The charity says the rise poses a "massive challenge" for the NHS.

Ministers in England say they are working to improve cancer survival rates and the quality of life after diagnosis and treatment.

Macmillan Cancer Support says a decade ago about a third of people, or 33%, developed cancer at some point in their lives. The charity says that figure has risen to more than 40%.

The estimates are drawn from projections published two years ago in the British Journal of Cancer, which concluded that at the end of 2008 there were two million cancer survivors in the UK and that the figure was rising every year.

Macmillan also looked at recent cancer incidence and mortality statistics for the UK, indicating that 310,000 people were diagnosed with cancer in 2008.

About 157,000 people died from the disease, and 89,000 who had been diagnosed with cancer died from other causes, making a total of 246,000 who died "with" cancer.

The charity says this accounted for 42% of total deaths in the UK - which stood at 580,000.

Macmillan says the increase is partly down to an ageing population - older people are more likely to develop cancer. It says lifestyle factors, such as diet and exercise, and improved diagnosis have also contributed to the rise.

'Massive challenge'

Continue reading the main story

We have a massive challenge ahead if we are to keep up with the relentless toll cancer takes on people's health, and the NHS must rise to it”

End Quote Ciaran Devane Macmillan Cancer Support The chief executive of Macmillan Cancer Support, Ciaran Devane, said the calculations had important implications for the health service.

"It is really alarming that the number of people who will get cancer is now well past one in three and that there are so many more people with cancer today than even 10 years ago," he said.

"There are currently two million people living with cancer in the UK and that number is doubling to four million over the next 20 years. Yet no-one thinks the country can afford to double its spending on cancer. We've therefore got to become twice as effective in how we spend that money."

The charity says there is growing evidence of the long-term health problems many cancer patients are experiencing long after initial diagnosis and treatment. It says there is a need for more services to help people stay well at home, rather than waiting until they require emergency hospital treatment.

Major issue

The Care Services Minister for England, Paul Burstow, said it was absolutely right for Macmillan to raise this as a major issue.

"We agree with Macmillan. That's why we are working to deliver more personalised care and more help to keep people well in their own homes. We are investing more than ?750m over four years to improve cancer outcomes," he said.

The chair of the Royal College of GPs, Dr Clare Gerada, said the figures highlighted the increasing impact of cancer on many people's lives.

"What is clear from this study is that cancer survival is not the whole picture. All healthcare professionals have a duty to see that patients receive the best possible care, and aftercare, following a diagnosis of cancer, and to ensure their patients are not just living, but living well," she said.

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UK 'has too many hospital births'

14 July 2011 Last updated at 01:27 GMT By Branwen Jeffreys Health correspondent, BBC News Dr Anthony Falconer: 'We all have a moral responsibility to create the best services we can'

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.

It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

'Serious complications'

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

RCOG president Anthony Falconer told the BBC that most out-of-hours care was being provided by junior doctors.

Continue reading the main story

You need the right person, as senior person, there immediately”

End Quote Dr Tony Falconer Royal College Obstetricians and Gynaecologists The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: "There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately."

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

'Joined-up care'

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women's gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

"Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change."

That has not always been the case, with two ministers in the last Labour government campaigning against the closure of units in Greater Manchester.

Hundreds of people turned out to a rally to oppose the closure of maternity services in Salford last autumn. After a review under the coalition, the NHS is pressing ahead with plans to reduce the number of units across the area from 12 to eight.

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

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School sun care policy 'must change'

15 July 2011 Last updated at 00:30 GMT By Richard Clifford Skin Cancer UK charity Who should be responsible for making sure a child is protected? Should schools be insisting that teachers and dinner-ladies supervise the application of sunscreen on pupils before they go out to play? Similar policies are in place in nurseries and pre-schools, but there is often no such provision in primary and secondary schools, despite good evidence that sunburn in childhood can lead to skin cancer in later life.

We all need a little bit of sunshine in our lives. It not only boosts our wellbeing but also helps our body to make vitamin D.

But too much sun is damaging, and children are particularly vulnerable to over-exposure.

For example, more than 80% of exposure to the sun occurs during childhood.

Time spent playing outdoors at breaks and lunchtime as well as during sports lessons means children spend, on average, one and a half hours outside during school time.

And a recent survey of 1,000 parents, commissioned by MPs on the All-Party Parliamentary Group on Skin, found almost 40% of pupils have suffered sunburn while at school.

Unprotected

Prolonged over-exposure to the sun and episodes of sunburn under the age of 15 are major risk factors for skin cancer in later life.

The British Association of Dermatology estimates that four out of five skin cancer deaths are preventable.

Simple measures like seeking shade, covering up and using sunscreen, can prevent these dangers.

But there is no real onus on schools to provide these basic things.

Guidelines do recommend that schools have a sun policy, but they are not prescriptive or mandatory.

The National Institute for Health and Clinical Excellence says children should be encouraged to seek shade whenever possible.

But provision of shade is seemingly disregarded in many UK schools.

And it says sunscreen (of at least SPF 15 strength) should be applied liberally half an hour before and after going out in the sun and reapplied every two hours thereafter.

Lessons from Australia

But how can schools realistically achieve this?

Admittedly teachers cannot be expected to apply sunscreen due to simple time pressures.

There is also the inevitable question regarding their concerns over child abuse and the strong advice they receive from local authority education departments and trade unions.

However, there is no reason whatsoever why they should not supervise the application, perhaps with the assistance of the school nurse or indeed parents who attend on a pre-arranged rota system.

NICE suggests parents could provide sunscreen for their children who could, in turn, be taught how to apply it for themselves. Children could even be encouraged to help their school-friends put theirs on, says NICE.

The guidelines also recommend schools run awareness campaigns to alert children to the harms of too much sun exposure.

In Australia over 75% of schools qualify for Sunsmart status - a code of conduct which even includes making sunglasses part of the school uniform.

Similar support schemes are available to UK schools, but uptake is patchy.

Again, in Australia, sun protection is now an accepted part of the educational programme. But in the UK it is not part of the curriculum.

Instead, it is left to the individual teacher to decide as to whether or not to introduce the subject of UV awareness. This is simply not good enough.

Skin cancer and UV awareness have always been regarded as a public health issue and not educational - the fact is that they are inextricably linked and if only the two government departments would "get together", in the long-term huge health cost savings can be achieved.

The resource for this change which has lain dormant for far too long, is after all, already in place - the school, the classroom and the teacher - applying the subject at the appropriate times to the huge long term benefit of our children.

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