Study backs chest compressions in resuscitation

 

Official guidelines show that 30 chest compressions should be followed by two rescue breaths

 

Concentrating on chest compressions rather than mouth-to-mouth when giving emergency resuscitation can produce better results, says research published in The Lancet.

A study of 3,000 patients found that chest compressions alone increased chances of survival by more than 22%.

But training in how to give both chest compressions and mouth-to-mouth breaths is the best option, experts say.

The UK Resuscitation Council is due to produce new CPR guidelines next week.

Cardiopulmonary resuscitation (CPR) is a combination of chest compressions and mouth-to-mouth breaths, given in a life-threatening emergency like a cardiac arrest or heart attack.

The study, compiled by doctors from the Medical University of Vienna in Austria, looked at the survival rates of people treated by untrained members of the public taking instructions from the emergency services over the phone.

Dr Peter Nagele, from the department of anaesthesiology, critical care and pain therapy at the Medical University of Vienna, said that if untrained bystanders avoided mouth-to-mouth breaths during CPR, they were more likely to perform uninterrupted chest compressions.

That then increased the probability of CPR being successful.
 

Different techniques
The research in The Lancet involved two analyses.

The first used data from three randomised trials involving more than 3,000 patients.

It showed that chest-compression-only CPR was associated with a slightly improved chance of survival compared with standard CPR (14% v 12%).

In the second analysis of seven observational studies, researchers found no difference between the two CPR techniques.

The study authors maintain that continuous, uninterrupted chest compressions are vital for successful CPR.
Dr Jas Soar, chair of the Resuscitation Council from Southmead Hospital in Bristol, said: "Any CPR is better than no CPR. If you witness a cardiac arrest, dial 999 immediately. Those trained in CPR should follow existing guidance of 30 chest compressions followed by two rescue breaths.

"Those not trained should start compressions and follow instructions until an expert arrives," Dr Soar said.
Dr Meng Aw-Yong, medical adviser at St John Ambulance, acknowledged that rescue breaths could be off-putting.

"The current advice is that if you're unwilling or unable to do full CPR then chest compressions are better than nothing.

"The best solution, however, is for people to get trained in how to carry out chest compressions and rescue breaths so they can be the difference between a life lost and a life saved," he said.

The British Heart Foundation says that being able to do CPR more than doubles the chances of survival.
Claire O'Neill, community resuscitation programme lead at the BHF, said: "For someone who is untrained in cardiopulmonary resuscitation, doing both chest compressions and rescue breaths really can be difficult.

"We also know that uninterrupted chest compressions are very important for increasing the chance of survival. So being directed to focus solely on chest compressions could make people more willing to attempt resuscitation, which could ultimately save lives," she said.

 

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Deadly disease major threat to global public health

 

 

The number of cases of a deadly disease has more than doubled in the last decade, according to the World Health Organization (WHO).

Dengue outbreaks are now a major threat to global public health.
The UN health agency warned that unless countries act now then the situation will only get worse.

Two fifths of the world's population are at risk of the disease, with the majority living in the Asia Pacific region.
 

Cases double
Dengue is a serious flu-like illness that is transmitted by mosquitoes, and can develop into dengue haemorrhagic fever, which can be fatal.

The disease is spread by the aedes aegypti mosquito.
The WHO has warned that the increased number and size of dengue outbreaks in some countries in the Western Pacific region, as well as cases recorded in previously unaffected areas, are signs that firmer action cannot be delayed.

The WHO's regional director for the Western Pacific, Dr Shin Young-soo, said:

"National resources need to be mobilized to sustain dengue prevention and control, and the disease's profile needs to be raised on the global health agenda to stimulate the interest of international agencies and donors.
"The fight against this disease is everybody's problem."

The number of cases in the Western Pacific Region has more than doubled over the past 10 years.
 There has been a significant increase in many countries this year alone.

The Lao People's Democratic Republic and the Philippines appear to be particularly affected.
2.5 billion at risk

Two-fifths of the world's population is at risk of the disease. Out of these 2.5 billion people, more than 70% live in Asia Pacific countries. The warning was delivered at the WHO's Regional Committee for the Western Pacific. The increased number of outbreaks may be caused by a number of factors; including higher temperatures and rainfall which produce perfect breeding conditions for the mosquitoes that carry the disease.

Growing populations, particularly in cities, and greater international travel by infected individuals could also explain the rise.

The WHO says there is as yet no clear evidence that the increase in cases was due to global warming.
But changes in climate do affect mosquitoes which spread the disease.

At a local level eliminating breeding sites like water jars, building sites and discarded garbage is essential in reducing the number of mosquitoes.

But a concerted international effort is vital, with urban planning and improving sanitation essential to reducing the number of dengue cases.
 

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Love can ease pain, say brain researchers

 

Love hurts, at least according to many a romantic songwriter, but it may also help ease pain, US scientists suggest.

Brain scans suggest many of the areas normally involved in pain response are also activated by amorous thoughts.

Stanford University researchers gave 15 students mild doses of pain, while checking if they were distracted by gazing at photos of their beloved.

The study focused on people early in a romance, journal PLoS One reported, so the "drug of love" may wear off.

The scientists who carried out the experiment used "functional magnetic resonance imaging" (fMRI) to measure activity in real-time in different parts of the brain.

It has been known for some time that strong feelings of love are linked to intense activity in several different brain regions.

These include areas linked to the brain chemical dopamine, which produces the brain's feel-good state following certain stimulants - from eating sweets to taking cocaine.

"Light up"

The Stanford University researchers had noticed that when we feel pain, some of the same areas "light up" on the scans - and wondered whether one might affect the other.

They recruited a dozen students who were all in the first nine months of a relationship, defined as "the first phase of intense love".

Each was asked to bring in a picture of the object of their affection and photos of what they deemed an equally attractive acquaintance.

While their brains were scanned, they were shown these pictures, while a computer controlled heat pad placed in the palm of their hand was set up to cause them mild pain.

They found that viewing the picture of their beloved reduced perceptions of pain much more than looking at the image of the acquaintance.

Dr Jarred Younger, one of the researchers involved, said that the "love-induced analgesia" appeared to involve more primitive functions of the brain, working in a similar way to opioid painkillers.

"One of the key sites is the nucleus accumbens, a key reward addiction centre for opioids, cocaine and other drugs of abuse.

"The region tells the brain that you really need to keep doing this."

Professor Paul Gilbert, a neuropsychologist from the University of Derby, said that the relationship between emotional states and the perception of pain was clear.

He said: "One example is a footballer who has suffered quite a painful injury, but who is able to continue playing because of his emotionally charged state."

He added that while the effect noticed by the Stanford researchers might only be short-lived in the early stages of a love affair, it may well be replaced by something similar later in a relationship, with a sense of comfort and wellbeing generating the release of endorphins.

"It's important to recognise that people who feel alone and depressed may have very low pain thresholds, whereas the reverse can be true for people who feel secure and cared for.

"This may well be an issue for the health service, as patients are sometimes rushed through the system, and perhaps there isn't this focus on caring that might have existed once."

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Hunger index shows one billion without enough food

By Ania Lichtarowicz Health reporter, BBC News

 

 

One billion people in the world were undernourished in 2009, according to a new report.

The 2010 Global Hunger Index shows that child malnutrition is the biggest cause of hunger worldwide, accounting for almost half of those affected.

Countries in sub-Saharan Africa and South Asia were shown to have the highest levels of hunger.

The report's authors called on nations to tackle child malnutrition in order to reduce global hunger. The Global Hunger Index is produced by the International Food Policy Research Institute (IFPRI), Welthungerhilfe and Concern Worldwide.

The UN Food and Agriculture Organization (FAO) defines hunger as the consumption of fewer than 1,800 kilocalories a day - the minimum required to live a healthy and productive life.

Despite the number of undernourished people in the world falling between 1990 and 2006, the report's authors say in that number has crept up in recent years, with the data from 2009 showing more than one billion hungry people.

The most recent figures from 2010 suggest the number may again be falling but this data is not yet complete.
The Global Health Index (GHI) is calculated for 122 developing and transition countries. Twenty-nine countries - mostly in sub-Saharan Africa and South Asia - have levels of hunger described as "extremely alarming" or "alarming".

The GHI shows hunger increasing in nine countries; North Korea and eight sub-Saharan African nations. The Democratic Republic of Congo saw the biggest increase; GHI rose by more than 65%.

The scores are based on the proportion of people who are calorie deficient, the proportion of children under five who are underweight and the child mortality rate.

The global food price crisis and the worldwide recession have contributed to the recent rise, says the report.
Children under the age of two are considered to be at most risk. Malnourishment at this stage harms physical and mental development and its effects are mostly irreversible causing life long damage.

In some sub-Saharan African countries, for example Burundi and Madagascar, about half the children have stunted growth because of they do not have access to an appropriate diet.

The authors argue that improving child nutrition would have the biggest effect on reducing global hunger.
They estimate that child malnutrition could be cut by about a third by providing improved health care and nutrition, not only to young children but also to mothers during pregnancy and breastfeeding.

Marie Ruel, director of IFPRI's Poverty, Health and Nutrition Division and co-author of the report, said many countries had to accelerate progress in reducing child malnutrition.
"Considerable research shows that the window of opportunity for improving nutrition spans from conception to age two," she observed.

"After age two, the negative effects of undernutrition are largely irreversible."
The report adds that reducing the numbers of hungry people will also significantly improve productivity and economic development.

 

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First human trial of embryonic stem cells

US doctors have begun the first official trial of using human embryonic stem cells in patients after getting the green light from regulators.

The Food and Drug Administration has given a license to Geron to use the controversial cells to treat people with spinal injuries.

The cells have the potential to become many of the different cell types found in the body, including nerve cells.

The trials at a hospital in Atlanta will check if the treatment is safe.Pivotal research

Geron, a biotech company based in "silicon valley" south of San Francisco, has spent $170m on developing a stem cell treatment for spinal cord injury.

The research will use cells coaxed to become nerve cells which are injected into the spinal cord.

In animal trials of the treatment, paralysed rats regained some movement.

But it is not yet known if it will offer any benefit to people with spinal cord injuries.

Every year around 12,000 people in the US sustain spinal cord injuries. The most common causes are automobile accidents, falls, gunshot wounds and sports injuries.

In the trial, patients who have sustained such an injury within the last 14 days will be given the experimental stem cell treatment.

Geron president Dr Thomas Okarma said: "When we started working with human embryonic stem cells in 1999, many predicted that it would be a number of decades before a cell therapy would be approved for human clinical trials.

"This accomplishment results from extensive research and development and a succession of inventive steps."

But it will take some time to get the results.

And there are many years of rigorous testing ahead before it can be known if the therapy is safe and effective.

Professor Sir Ian Wilmut, director of the Medical Research Council Centre for Regenerative Medicine at the University of Edinburgh, said: "This is very exciting news, however, it is very important to appreciate that the objective of trials at this stage is to confirm first of all that no harm is done to patients, rather than to look for benefits.

"Once that has been confirmed then the focus moves on to development and assessment of the new treatment."

Ben Sykes, executive director of the UK National Stem Cell Network, said: "This is indeed a significant milestone in our journey towards the promise of stem cell-based medicines.

"The global stem cell and regenerative medicine community will be awaiting the results of this safety trial with much anticipation."

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Molecule structure offers clue to HIV and cancer treatments

 

Scientists have created an image of an important molecule linked to HIV infection and cancer which may help treat the diseases.

Researchers from California used an X-ray technique to find out the structure of the CXCR4 molecule and how it works.
The findings could open up new areas for drug discovery, says the study published in Science.
But experts say we still need to understand more about the activity of CXCR4.
The molecule is part of a large family of proteins called G-protein coupled receptors (GPCRs).
These molecules span the cell's membrane and transmit signals from the external environment to its interior.
They help control practically every bodily process, including cell growth, hormone secretion and light perception.

Normally CXCR4 helps activate the immune system and stimulate cell movement.

Mixed signals But when the signals that activate the receptor are not properly regulated, CXCR4 can spur the growth and spread of cancer.
To get a picture of this important molecule, scientists used a method called X-ray crystallography.
But this method proved difficult because membrane proteins are tricky to coax into the crystal form required for the X-ray technique, the study says.
In the end it took three years to produce the right conditions to get a clear picture of the CXCR4 molecule's structure.
Scientists then managed to generate five distinct structures of CXCR4.
The structures showed that CXCR4 molecules form closely linked pairs, confirming data from other experiments.
'Wine glass' structure Professor Raymond Stevens, lead researcher from Scripps Research Institute in California, said: "The structures open up entire new areas for understanding fundamental principles in chemokine GPCR signalling," he said.
The images also showed that CXCR4 is shaped like two wine glasses touching in a toast.
Researchers said the pictures suggest how to design compounds that regulate CXCR4 activity or block HIV entry into cells.
If developed into drugs, the study says, such compounds could offer new ways to treat HIV infection or cancer.
Keith Alcorn is senior editor at NAM, a charity that supports people living and working with HIV.
"HIV uses a number of receptors to gain entry to cells. Most people with HIV start out with a virus that uses a receptor called CCR5.
"Over time their virus population may switch to using CXCR4, for reasons we still don't fully understand. Several companies have already developed drugs which block the CCR5 receptor.
"A combination of drugs that block both CCR5 and CXCR4 might prove to be a very successful form of HIV treatment, but we need to understand more about the consequences of blocking the activity of CXCR4, because this receptor is also involved in some of the normal immune system functions," he said.
Josephine Querido, senior science information officer at Cancer Research UK, welcomed the research findings.
"This is exciting research as CXCR4 has been linked to the growth and spread of a variety of different cancers. Unravelling the structure of this molecule is a vital step towards designing new drugs to help treat cancer."

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Parasite disease rises in Sudan

The number of cases of a potentially fatal parasitic disease has increased six-fold in southern Sudan.

Visceral leismaniasis- also known as kala-azar - is the most severe form of the disease.

More than 6,000 people have been infected and over 300 have died in the last year.

The World Health Organization and the Sudanese ministry of health are leading the distribution of treatments and testing equipment to affected areas.

Deadly form

Visceral leishmaniasis is caused by the Leishmania parasite and transmitted via the bite of an infected sand fly.

It is the most dangerous form of the disease because the parasite migrates into the spleen and liver.

It causes high fever, significant weight loss, enlargement of the spleen and liver, and anaemia. If left untreated visceral leishmaniasis is nearly always fatal.

The number of cases from September 2009 until now is more than six times higher than in 2007-08.

The counties of Old Fangak and Ayod in the south of the country are particularly affected.

Dr Abdi Aden, head of the WHO's office for Southern Sudan said "The increased number of cases in Old Fangak, Ayod and surrounding areas is very disturbing and it is becoming difficult to contain the outbreak.

"Before the situation becomes uncontrollable, we must do something about it."

Funding needed

To keep responding to the outbreak over the next six months an additional $700,000 is needed.

This will buy more treatments, diagnostic kits as well as food supplies.

Kala-azar suppresses the immune system making patients vulnerable to other infections like pneumonia and malaria. Those that are malnourished are at particularly high risk of dying.

The disease is difficult to treat - daily injections for a month are needed, so patients need to stay close to health facilities.

But many patients still cannot reach treatment centres due to insecurity, flooding and distance.

Dr Mounir Christo Lado of the Sudanese ministry of health said the kala-azar outbreak could worsen between now and next spring.

"Insecurity, flooding and the lack of health facilities across a vast geographical area are all playing a part in limiting access to treatment for this deadly disease."

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Light drinking 'no risk to baby'

Drinking one or two units of alcohol a week during pregnancy does not raise the risk of developmental problems in the child, a study has suggested.

Official advice remains that women abstain completely during pregnancy.

A study of more than 11,000 five-year-olds published in the Journal of Epidemiology and Community Health found no evidence of harm.

There were more behavioural and emotional problems among the children of heavy-drinking women.

When a pregnant woman drinks alcohol, it passes through the placenta and reaches the baby, which is less well-equipped to break it down.

Researchers have strongly linked heavy drinking to an increased risk of lifelong damage.

However, the evidence about the risks to lighter drinkers has been far less clear.

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Mothers at a toddler's music group in Leeds received mixed messages

The study, led by University College London but involving three other UK universities, is the second by this group examining large numbers of children looking for signs that brain development had been affected.

No extra risk

The first had found no evidence of problems at age three, but the latest study extended the checks until school age to make sure nothing had emerged later.

The same result appeared, with no extra risk of behavioural and emotional issues compared with children whose mothers had abstained during pregnancy.

In fact, the children born to light drinkers appeared slightly less likely to suffer behavioural problems, and scored higher on cognitive tests, compared with women who stopped during pregnancy.

Dr Yvonne Kelly, from UCL, said : "There's now a growing body of robust evidence that there is no increase in developmental difficulties associated with light drinking during pregnancy."

She said that women could make "better decisions" with this information.

However, a spokesman for the Department of Health said that its advice would remain unchanged to avoid confusion among pregnant women.

"After assessing the available evidence, we cannot say with confidence that drinking during pregnancy is safe and will not harm your baby..

"Therefore, as a precautionary measure, our advice to pregnant women and women trying to conceive is to avoid alcohol."

Additional advice from the National Institute of Health and Clinical Excellence urges women to avoid alcohol, particularly in the first three months of pregnancy.

This advice was backed by Chris Sorek, the chief executive of alcohol awareness charity Drinkaware.

He said: "Despite these findings, it is important to remember that 'light drinking' can mean different things to different people.

"There is a risk that if pregnant women take this research as a green light to drink a small amount, they could become complacent, drink more than they think they are and inadvertently cause harm to their unborn child.

"Excessive drinking during pregnancy can carry serious consequences and lifelong damage to children and should be avoided."

But Dr Tony Falconer, the president of the Royal College of Obstetricians and Gynaecologists, said that while the "safest choice" was abstinence, the current evidence suggested that drinking one or two units, once or twice a week was acceptable.

"The key public health message, whether or not a woman is pregnant, is that light drinking is fine, but heavy and binge drinking should be avoided."

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British Supermarket Tesco To Sell Viagra By Next Week!

According to recent reports, Viagra will soon be available at a British supermarket.

Tesco will turn the primary supermarket in the British market to sell anti-impotence drug Viagra.

This will give males a chance to buy the drug without a prescription.

Viagra will be available at 300 British stores by next week at just 52 pounds for eight in place of the usual 55 pounds for four tablets.

Shona Scott, Tesco commercial manager for pharmacy services stated, "The service is available to men aged between 40 and 65. They will have to complete a questionnaire and we will then carry out a blood pressure test, diabetes screen and cholesterol test."

Erectile dysfunction (ED) has affected more than 2.3 million males in the United Kingdom.

Half of all males aged more than 40 will experience this problem at some point in their lives.

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Malaria funding 'falling short'

There is a 60% global shortfall in funds for malaria control, according to a report by UK and African experts.

Researchers found only 21 out of 93 countries where malaria is common have received enough money to implement effective control measures.

African countries have seen the biggest funding increases but billions are still needed elsewhere, the experts say in the Lancet medical journal.

The Roll Back Malaria Campaign warned $4.9bn (£3.1bn) was needed this year.

The researchers, led by Professor Bob Snow of Oxford University and Kenya's Kenyatta National Hospital, found that annual international funding had increased by 166% - from $730m to $1.94bn - since 2007.

They said: "Any decline in malaria-funding commitments will run the risk of a resurgence of malaria in countries that have enjoyed the benefits of this funding to provide protection from malaria since 2002.

"Sustained funding in these countries is crucial or $9.9bn invested since 2002 will have been in vain."

While financing for malaria control has increased as part of international efforts to reach the Millennium Development Goals, the amount received from domestic sources varies greatly.

Twenty-one countries, 12 of them in Africa, now receive adequate donor money, according to the research.

But a further 50, including Niger and Sierra Leone,as detailed in the Lancet paper, do not get enough from the international community.

Professor Snow said: "Poor countries with inadequate donor assistance and large sectors of their population at risk of malaria must remain the focus of attention if global ambitions for malaria control are to be realised.

"The challenge will now be on finding more money, making sure funding is linked to performance and putting pressure on malaria-endemic countries with large domestic incomes to do more for themselves.

"A failure to maintain the momentum will mean money spent so far will have been for nothing."

The authors also argue that some countries like China and India, which have their own space programmes, could perhaps contribute funds to help other countries rather than being recipients, thereby increasing the financial support available.

But the work only assesses external funding.

Commenting on the study, Professor Anne Mills, from the London School of Hygiene and Tropical Medicine in the UK, said that external funding may be low because a country may be funding its own malaria programmes.

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Link Between Genetic Alteration And Human Male Infertility

One in seven couples worldwide has difficulty conceiving a child, and male infertility is thought to account for nearly half of those cases. Although the cause of male infertility is often unknown, scientists have now discovered a genetic alteration that disrupts sperm production in otherwise healthy men. The research, published by Cell Press in the American Journal of Human Genetics, provides new insight into one cause of male infertility.

"Many genes are known to be essential for the production of sperm, but there are surprisingly few single gene changes that have been conclusively demonstrated to cause a failure of sperm production in humans," explains senior study author, Dr. Ken McElreavey from the Pasteur Institute in France. Dr. McElreavey, along with co-authors Dr. Anu Bashamboo and Dr. John Achermann, a Wellcome Trust Senior Fellow from UCL Institute of Child Health London, examined whether the NR5A1 gene might be involved in some cases of male infertility.

The NR5A1 gene codes for a key protein called steroidogenic factor 1 that regulates fetal, prepubertal and adult sexual development. Previous work had shown that NR5A1 mutations are associated with severe defects in the development of the testes or ovaries as well as significant anomalies of the male external genitalia. Dr. McElreavey's group sequenced the NR5A1 gene in 315 healthy men seeking infertility treatment, who exhibited an unexplained failure to produce sperm.

"We identified seven men with severe failure to produce sperm who carried changes in the NR5A1 gene," says Dr. Bashamboo. The researchers went on to show that the mutations impaired the ability of the steroidogenic factor 1 protein to regulate the transcription of key reproductive genes. The mutations were associated with altered levels of sex hormones and, in the one case studied, mild abnormalities in the cellular structure of the testes. Similar genetic alterations were not observed in more than 2000 control samples.

These findings suggest that changes in NR5A1 are not just associated with severe and obvious defects in reproductive development. "We conclude the approximately 4% of men with otherwise unexplained failure to produce sperm carry mutations in the NR5A1 gene," says Dr. Bashamboo. "Our data also suggest that some forms of male infertility may be an indicator of a mild abnormality in testicular development, underlining a need for careful clinical investigation of men presenting with infertility and abnormal levels of sex hormones."

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NHS reform plans will strengthen NHS, says government

The government has rejected a warning by doctors' leaders that its planned health reforms could undermine the long-term future of the NHS in England.

It set out plans in July to give GPs control of much of the budget, while scrapping two tiers of managers.

The British Medical Association said it was not against the whole vision, but had concerns the changes could affect the service's "stability and future".

Health Secretary Andrew Lansley said it was right to proceed with the reforms.

He said: "There are many GPs across the country who are keen to make the transition quickly, others want to know more about how it's going to work before they implement it," he said.

"This is what the consultation process is about, everyone coming forward to say how can we make this work."

He added that the plans were aimed at making care better for patients.

But the BMA's warning sparks the start of what promises to be a delicate balancing act for ministers.

The union's criticisms - made in its official response to July's White Paper - contrast with its initial response over the summer when it said it was "ready, willing and able".

And they come as the government faces a legal challenge from the union Unison.

The public sector union is seeking a judicial review over the way the government is handling the changes.

The official consultation period will end later this month, after which ministers are likely to start formal talks with BMA negotiators about implementing the changes.

The government wants to start piloting the GP consortiums, which will take charge of the budget from the soon-to-be abolished primary care trusts, this financial year. Full roll-out will follow within two years.

But it is this pace of change which is one of the problems, according to the BMA.

It said the timetable could threaten the £20bn savings the health service has to make by 2014.

The BMA also took issue with the "obsession" with competition, saying GPs would be set against hospitals - one of the objectives of the changes is to get more care done more cheaply outside hospitals.

Private sector

Many doctors also fear the plans will lead to the increased involvement of the private sector - and ultimately damage the doctor-patient relationship as the public could start viewing their own GPs as rationers of services.

The BMA said there needed to be a clear distinction between individual GPs and the consortiums.

Dr Richard Vautrey, deputy chairman of the BMA's GPs committee, told BBC Radio 4's Today programme that his organisation had "serious concerns".

He added: "Patients want to see their doctors and other healthcare professionals, in general practice and in hospitals, collaborating with one another - not competing with one another."

BMA chairman Dr Hamish Meldrum said that there "were proposals in the White Paper that doctors can support and want to work with".

He added: "But there is also much that would be potentially damaging.

"The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency."

However, some doctors remain supportive of the planned changes, such as Dr Simon Brown, of Huntingdon, Cambridgeshire, who is taking part in one of the pilot schemes.

He told BBC Breakfast that control of the NHS's budget and purchasing decisions would benefit from the "clinical input" that doctors bring, something he said "had been largely absent until now".

Dr Brown added: "I'm confident that actually we can introduce some changes that will make a very positive impact on my patients."

Shadow health secretary Andy Burnham said: "This backs up Labour's warnings since the White Paper was published."

He warned that, if Health Secretary Andrew Lansley pressed on with his plans, he could expect the "fight of his life".

And Jennifer Dixon, chief executive of the Nuffield Trust, a health think tank, suggested the BMA was right to highlight some of the issues.

"I think there is quite a lot of worry in the health service that these changes are too much too fast," she said.

"The principle of giving GPs, or doctors, budgets to manage is a quite good one, I think there is a lot of agreement about that.

"But the speed at which these changes are occurring - the fact that £70bn of public funds is going to be given to practices who are not used to handling this amount of money - is, I think, worrying."

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Painless laser device could spot early signs of disease

Researchers say that the technique could become widely available in about five years.

The method, called Raman spectroscopy, could help spot the early signs of breast cancer, tooth decay and osteoporosis.

Scientists believe that the technology would make the diagnosis of illnesses faster, cheaper and more accurate.

Raman spectroscopy is the measurement of the intensity and wavelength of scattered light from molecules.

It is already being used in the chemical and pharmaceutical industries. For instance, Raman lasers are used to measure flame characteristics. By studying how fuels burn, pollution from the products of combustion can be minimised.

Michael Morris, a chemistry professor at the University of Michigan, US, has been using Raman for the past few years to study human bones.

So far, he has been working on cadavers, but he says that Raman could prove effective in living patients.

"You can replace a lot of procedures, a lot of diagnostics that are out there right now. The big advantage is that it's non-invasive, pretty fast - much faster than classical procedures - and more accurate," he told BBC News.

When a person is sick, or about to become sick, the chemical mix in the tissue is quite different from that in healthy tissue, scientists say. So the Raman spectrum changes depending on the tissue it analyses, Professor Morris explained.

"Raman gives you a molecular fingerprint, a composition of whatever it is you're measuring," he said.

"In diseased states, the chemical composition is either slightly abnormal or very markedly abnormal, depending upon the diseases."

Non-invasive

The diagnoses could be carried out in a matter of minutes and without need for an X-ray.

"A patient simply puts his or her wrist on a table and then we have the optical fibres delivering laser light... connected to a holder, a sort of a bracelet made out of silicon, that is strapped to the patient's wrist," explained Professor Morris.

"We turn on the laser and after we've collected enough signal in a few minutes, we turn it off. In principle, it will take a couple of seconds to interpret the results."

Besides bone diseases, the tool could prove effective in detecting early tooth decay, say researchers.

And drawing blood might become unnecessary in some cases. For instance, to determine the levels of cholesterol, one would simply have to point the laser "where you would be looking to draw a blood sample at the crook of the arm, where the blood vessels are very close to the skin," said Professor Morris.

New applications

Another application could be using Raman as a non-invasive alternative to a typical mammography - a process that uses low-dose X-rays to screen patients for signs of breast cancer.

The laser would "look" into the tissue and generate different spectra - a distribution of colours reflecting differences in the properties of the tissue. This could reveal benign or malignant tumours, depending on characteristic changes in the protein structure and in the relative amounts of protein, lipids and nucleic acids in the tissue.

British researchers at the Rutherford Appleton Laboratory in Didcot and at the Gloucestershire Royal Hospital have been using Raman to analyse calcifications in breast tissue that might be early signs of cancer.

"We could target those calcifications and make a decision about whether they're benign or malignant," Nicholas Stone, head of the biophotonics research unit at the Gloucestershire Royal Hospital told the magazine Chemical and Engineering News.

"If they're malignant, or look like they are, you would come back for a biopsy. If they're benign, which is 80 to 90% of the cases, you would not come back for a biopsy."

"In the UK alone, that would save about 80,000 patients from having secondary procedures."

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How Injured Nerves Grow Themselves Back

Unlike nerves of the spinal cord, the peripheral nerves that connect our limbs and organs to the central nervous system have an astonishing ability to regenerate themselves after injury. Now, a new report in the October 1st issue of Cell, a Cell Press publication, offers new insight into how that healing process works.

"We know a lot about how various cell types differentiate during development, but after a serious injury like an amputation, nerves must re-grow," said Allison Lloyd of University College London. "They need a new mechanism to do that because the developmental signals aren't there."

That kind of regrowth isn't easy to pull off. Peripheral nerves are long cells; their nucleus is in the spinal cord and the axons that extend from them and relay nerve messages can reach all the way down a leg. "When a nerve gets cut, all the axons downstream degenerate," Lloyd said. Regrowth requires that the two ends somehow find their way back to each other through damaged tissue.

Scientists knew that Schwann cells were important to that process. Those cells are found wrapped around axons, where under normal circumstances they are rather "quiet" cells. All of that changes when an injury occurs; those Schwann cells de-differentiate back to a stem-cell-like state and play an important role in bridging the gap to repair damaged neurons.

"Schwann cells could sit on a nerve for years and then, at any point, switch states," Lloyd said. "They are quite unusual cells." (There are other examples of cells that can return to a stem-cell-like state, she said. For instance, cells in the liver and the endothelial cells that line blood vessels.)

But, the new study shows, the Schwann cells need help to repair the nerves properly. That help comes from a well-studied cell type known to play a role in wound healing: fibroblasts.

"This is a new role for fibroblasts," Lloyd said, an exciting find given that the cells are the type that grows when you place animal tissue in cell culture and have been very well studied as a result. "There is lots known about them, and they are always present at wounds. This shows that they act in a completely new way."

The fibroblasts send a signal to the Schwann cells, causing them to sort themselves into clumps, or cords, that make their way out of the nerve stump as a group. Those cords guide the regrowth of axons across the wound. Lloyd's team found that the response to the so-called ephrin-B signal issued by the fibroblasts depends on a factor called Sox2, best known for its central role in embryonic stem cells. Sox2 is also one of a handful of ingredients that can help reprogram adult cells to behave like embryonic stem cells.

Without the ephrin-B signal, Schwann cells fail to migrate in an organized fashion and the axons don't grow back properly.

Lloyd said the new findings might lead to ways to improve the repair of peripheral nerves, noting that the natural process isn't all that efficient. "It's not perfect, but if a hand is cut off and sewn back on, you can get some movement," Lloyd said. Her team is actively exploring ways to improve upon the natural nerve-healing mechanism now.

The researchers also have plans to investigate whether similar mechanisms might be involved in the movement and spread of cancers of the peripheral nervous system. "We don't know yet, but it wouldn't be surprising if this is relevant to the movement of other cells," Lloyd said.

The researchers include Simona Parrinello, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK; Ilaria Napoli, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK; Sara Ribeiro, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK; Patrick Wingfield Digby, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK; Marina Fedorova, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK; David B. Parkinson, University of Plymouth, Plymouth, UK; Robin D.S. Doddrell, University of Plymouth, Plymouth, UK; Masanori Nakayama, University of Munster, Munster, Germany; Ralf H. Adams, University of Munster, Munster, Germany; and Alison C. Lloyd, MRC Laboratory for Molecular Cell Biology and the UCL Cancer Institute, University College London, London, UK.

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Faulty Gene Causes Common Migraines

A new study led by researchers from Canada and the UK suggests that a faulty gene causes common migraines: when the gene is not switched on, it inhibits a protein that regulates the threshold of sensitivity of pain centres in the brain.

You can read how the study, led by researchers from the University of Montreal and the University of Oxford, with contributions from other members in the UK and Canada and also Portugal and Australia, arrived at this result in the 26 September online issue of the journal Nature Medicine.

Migraine headaches are a debilitating condition that affect one in five women and one in ten men worldwide; the World Health Organization rates it as a leading cause of disability worldwide and it is also thought to be the most costly neurological disorder in Europe.

The headaches are severe and long-lasting and usually start as a throbbing pain on one side or the front of the head. Sometimes the pain is preceded by a visual disturbance called an "aura", often experienced as blind spots, zigzag lines, flashing lights, visual hallucinations, or tingling in an arm or leg.

The headache itself can also be accompanied by other symptoms such as sensitivity to light and smells, as well as nausea and occasional vomiting.

While previous studies have linked certain parts of human DNA to increased risk of migraines in the general population, none has yet, before this study, found genes directly responsible for common migraines.

In this latest study, the researchers found that a mutation in the KCNK18 gene inhibits the function of a protein called TRESK, which plays an important part in nerve cell communication: it helps to regulate the sensitivity threshold of pain centres in the brain.

The team compared the DNA of people who suffer from migraines with that of people who do not. They found that one large family of sufferers of migraine with aura carried the mutation.

Lead author Ron Lafreniere, Associate Director of the Centre of Excellence in Neuromics of the Université de Montréal (CENUM), said in a statement that:

"We found a mutation in the KCNK18 gene that interrupts TRESK function in one large family suffering from migraine with aura."

"When we tested everyone in the family, all those who suffered from migraine also had the mutation," he added.

Before this study, genes for migraine have only been found in a rare form of the disorder that is accompanied by limb weakness on one side of the body.

"We focused on the more common types of migraine, without this muscle weakness, in our study, and looked at genes controlling brain excitability," explained Lafreniere.

Co-author Dr Zameel Cader, from the MRC Functional Genomics Unit at Oxford, told the press that:

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