“Personalised” treatments for breast cancer are a step closer, according to research scientists at Cardiff University.The scientists used gene technology to compare and contrast specific genetic errors in particular types of mouse breast cells. They were able to replicate “almost the entire spectrum” of aggressive breast cancer coming from one cell type.

It helps understanding of the disease, which has at least 10 different forms.

The research was led by Matt Smalley from the European Cancer Stem Cell Research Institute at Cardiff University and conducted in collaboration with colleagues from Spain, Brazil and the UK.

He said the work involved a genetic “trick” to study how one generic error manifested itself in two different cell types and what happened when different errors were in just one cell type.

“We now have strong evidence that here is one particular cell type in the breast associated with the most aggressive form of human breast cancer,” said Dr Smalley.

Breast cancer is the most common female cancer

• Around 50,000 women and 400 men are diagnosed with breast cancer each year
• One woman in eight will be diagnosed with breast cancer in their lifetime
• Around 12,000 women and 80 men will die from breast cancer each year
• More than 80% of women with breast cancer are still alive five years after diagnosis

Source: Breast Cancer Campaign

“In one part of the study, we created the same cancer-predisposing genetic errors in each of the two cell types. In another part, we created different genetic errors in the same cell type.”

He said is was remarkable that some of the cancers that formed in one cell type – oestrogen receptor negative luminal cells – resembled common human breast cancer types.

Dr Smalley said the cell type concerned responded to both normal menstrual cycles and the hormones of pregnancy by dividing to generate the extra cells needed for breast feeding.

Scientists suspected breast cancer occurs when these cells go wrong and start to divide at an inappropriate time, he said.

“These results add to our understanding of the origins of breast cancer diversity and emphasise the importance of understanding the biology of this cell type to better understand how breast cancer develops,” said Dr Smalley. “It takes us towards a way of personalising medicine, where “drugs X” is good for that particular type of breast cancer.”

Cancer Research UK senior science information manager Nell Barrie said: “This research takes us one step closer to understanding why we see so much diversity in breast cancer, and will help expose each cancer’s weakness so we can develop more effective and kinder treatments.”

With the weekend coming up Health Direct again warns- hospitals in the UK have a fraction of the number of doctors on site at weekends as they do during the week.

On average, doctor staffing levels at weekends were only 16% of those during the week. The figures also showed a difference in terms of the grades of doctors on duty.

Hospitals in England had an average of 86 consultants on a Wednesday, compared to just over eight in the afternoon at the weekend.

One medium-sized hospital, St Marys on the Isle of Wight, had 63 consultants in the building during the week, but none on a weekend afternoon.

The NHS published its last figures about patient mortality in 2011.

The survey of 14 million admissions showed that a patient is 11% more likely to die if admitted on a Saturday and 16% more likely to die if admitted on a Sunday than during the week.

Overall, patients stay longer in hospital when they are admitted at weekends.

They wait longer for a diagnosis and part of the reason for that is that there are not the senior doctors around in the departments that do the blood tests, X-rays and scans.

Prof Sir Bruce Keogh has set out a 10-point plan to achieve 24-hour, seven day a week staffing in hospitals. He wants to see it in place by 2017.

“It’s a bold plan because the NHS, like other parts of society, has not functioned the same at the weekend as it has in the week – but we need to do it with urgency.  The rest of society has moved on, all other service industries are starting to address how they provide more routine services at the weekend and it’s time we did so in health”.

But Sir Richard Thompson of the Royal College of Physicians thinks it will take longer.

“I think we’re heading in the right direction but I think the plan is optimistic. Without getting a large extra number of staff of all grades and all types I cannot see how we can get a full equal service on Monday, Tuesday, Wednesday, Thursday, Friday, Saturday and Sunday”.
‘Bit of a rest’

According to the research the Royal Liverpool Hospital has 7% of the level of staffing for doctors at the weekend compared to a Wednesday afternoon.

Another sticking point for Dr Williams is the attitude of staff:

“There may be some reluctance. It becomes more difficult when you tell people they will be on call 24/7 on site. That’s a big step.”

“Some of our specialties have already done it, but if I’m going out to consultants in their late 40s and 50s and saying, ‘I know you’ve been on your contract for 15 years, but I would now like you to be up all night on a Saturday or Sunday’, that’s a big ask”.

Laws banning smoking in public places have had a positive impact on child health, an international study in the Lancet suggests.Researchers found a 10% reduction in premature births and severe childhood asthma attacks within a year of smoke-free laws being introduced.

A research team analysed 11 previous studies from North America and Europe.

The Royal College of Obstetricians and Gynaecologists said smoking bans benefitted adults and children.

This is one of the first large studies to look at how anti-smoking laws in different countries and states are affecting the health of children living in those regions.

Laws that prohibit smoking in public places, such as bars, restaurants and workplaces, have already been shown to protect adults from the dangers of passive smoking.

In this study, researchers from the University of Edinburgh, Maastricht University, Hasselt University in Belgium, Harvard Medical School and Brigham and Women’s Hospital looked at more than 2.5 million births and almost 250,000 hospital attendances for asthma attacks in children.

Dr Jasper Been, lead study author from the Maastricht University Medical Centre in The Netherlands, said the research on children under 12 was revealing.

“Our study provides clear evidence that smoking bans have considerable public health benefits for perinatal and child health, and provides strong support for WHO recommendations to create smoke-free public environments on a national level.”

The study also found a 5% decline in children being born very small for their age after the introduction of smoke-free laws.

Co-author Professor Aziz Sheikh, of Brigham and Women’s Hospital, in Boston, Massachusetts, and the University of Edinburgh, said there was potential to improve the health of more children.

“The many countries that are yet to enforce smoke-free legislation should in the light of these findings reconsider their positions on this important health policy question.”

Previous research suggests that 40% of children worldwide are regularly exposed to second-hand smoke, which has been shown to be a cause of respiratory disease and a trigger for asthma attacks in children.

Recent European research also showed that passive smoking causes thickening of children’s arteries which can increase the risk of heart attacks and strokes in later life.

Experts say children are particularly vulnerable to the negative effects of second-hand smoke because their lungs and immune systems are still developing.

At present, 16% of the world’s population is covered by smoke-free laws.

Commenting on the study, Professor Ronnie Lamont from the Royal College of Obstetricians and Gynaecologists said the study provided further evidence that smoking bans had substantial health benefits for adults and children.

“Smoking during pregnancy has been shown to have adverse effects on foetal development and pregnant women need to be informed of the risks and should be offered advice and support to help them give up. It is important that healthcare professionals encourage women to lead a healthy lifestyle.”

Two people in England have developed tuberculosis after contact with a domestic cat, Public Health England has announced.The two human cases are linked to nine cases of Mycobacterium bovis infection in cats in Berkshire and Hampshire. Both people were responding to treatment, PHE said.

M. bovis is the bacterium that causes tuberculosis in cattle, known as bovine TB, and other species.

Transmission of M. bovis from infected animals to humans can occur by breathing in or ingesting bacteria shed by the animal or through contamination of unprotected cuts in the skin while handling infected animals or their carcasses.

The nine cases of M. bovis infection in cats in Berkshire and Hampshire were investigated by PHE and the Animal Health and Veterinary Laboratories Agency (AHVLA) during 2013.

Tuberculosis (TB) is an infectious disease caused by a germ which usually affects the lungs.

Symptoms can take several months to appear and include:
•Fever and night sweats
•Persistent cough
•Losing weight
•Blood in your phlegm or spit

Almost all forms of TB are treatable and curable, but delays in detection and treatment can be damaging.

TB caused by M. bovis is diagnosed in less than 40 people in the UK each year. The majority of these cases are in people over 65 years old.

Overall, human TB caused by M. bovis accounts for less than 1% of the 9,000 TB cases diagnosed in the UK every year.

Those working closely with livestock and/or regularly drinking unpasteurised (raw) milk have a greater risk of exposure.

Public Health England

Screening was offered to people who had had contact with the infected cats. Following further tests, a total of two cases of active TB were identified.

Molecular analysis showed that M. bovis taken from the infected cats matched the strain of TB found in the human cases, indicating that the bacterium was transmitted from an infected cat.

Two cases of latent TB were also identified, meaning they had been exposed to TB at some point, but they did not have the active disease.

PHE said it was not possible to confirm whether these were caused by M. bovis or something else.

No further cases of TB in cats have been reported in Berkshire or Hampshire since March 2013.
‘Uncommon in cats’

Dr Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at PHE, said: “It’s important to remember that this was a very unusual cluster of TB in domestic cats.

“M. bovis is still uncommon in cats – it mainly affects livestock animals. These are the first documented cases of cat-to-human transmission, and so although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed M. bovis infection should be assessed and receive public health advice.”

Out of the nine cats infected, six died and three are currently undergoing treatment.

Being overweight is increasingly seen as the norm, England’s chief medical officer warns.
In her annual report on the state of health, Dame Sally Davies said this was concerning, pointing out many people did not recognise they had a problem.

Parents of overweight children were also failing to spot the signs too, she said.

Dame Sally blamed the way weight was being portrayed by the media and clothes industry.

•     Body mass index (BMI) is used to calculate whether a person is underweight, a healthy weight, overweight or obese for their height.
•     It is calculated by measuring weight (in kilograms) and dividing it by height (in metres) squared to give a BMI score
•     A BMI of 25 to 29.9 is considered overweight and one of 30 or above is considered obese.

“I have long been concerned that being underweight is often portrayed as the ideal weight, particularly in the fashion industry.

“Yet I am increasingly concerned that society may be normalising being overweight.

“Larger mannequins are being introduced into clothes shops and “size inflation” means that clothes with the same size label have become larger in recent decades.

“And news stories about weight often feature pictures of severely obese people, which are unrepresentative of the majority of overweight people.”

Dame Sally also reiterated her belief that a sugar tax may be necessary to combat obesity.

At the start of March she told the Health Select Committee it may be needed, although she hoped not.

This caused some controversy as the government’s approach has been characterised by working with industry to get them to make food and drink products healthier.

In her report she says this should continue, but if it fails to deliver a tax should be “considered”.

She said children and adults of all ages are consuming too much sugar.

Nearly two thirds of adults and a third of children are overweight or obese – classed as a body mass index of above 25. This is about double the numbers in the early 1990s.

A campaign group has been formed to reduce the amount of sugar added to food and soft drinks in an effort to tackle obesity and diabetes in the UK.
Action on Sugar has been set up by the team behind Consensus Action on Salt and Health (Cash), which has pushed for cuts to salt intake since the 1990s.

The new group aims to help people avoid “hidden sugars” and get manufacturers to reduce the ingredient over time.

Sugar is a widespread presence in our food and it’s often found in unexpected places, for example a can of cola contains nine teaspoons of sugar.  Some tins of tomato soup and bottles of flavoured water have four teaspoons of sugar crammed inside. And seemingly healthy fat free yoghurt often has a high sugar content.

The primary concern is obesity- being high in sugar also means being high in calories.

Nearly two thirds of people in the UK are overweight or obese – leading to other health problems such as type 2 diabetes and heart disease. Some argue that the problems with sugar are even deeper than the calorie content, and that high doses of the sweet stuff can increase the risk of diseases such as a fatty liver.

The cmapaigners believe that a 20% to 30% reduction in three to five years is within reach.

Like Cash, Action on Sugar will set targets for the food industry to add less sugar bit by bit so that consumers do not notice the difference in taste.

It says the reduction could reverse or halt the obesity epidemic and would have a significant impact in reducing chronic disease in a way that “is practical, will work and will cost very little”.

The group listed flavoured water, sports drinks, yoghurts, ketchup, ready meals and even bread as just a few everyday foods that contain large amounts of sugar.

Action on Sugar chairman Graham MacGregor, who is professor of cardiovascular medicine at the Wolfson Institute of Preventive Medicine and set up Cash in 1996, said: “We must now tackle the obesity epidemic both in the UK and worldwide.

“This is a simple plan which gives a level playing field to the food industry, and must be adopted by the Department of Health to reduce the completely unnecessary and very large amounts of sugar the food and soft drink industry is currently adding to our foods.”

Well known food and drink products and their sugar content:

•     Starbucks caramel frappuccino with whipped cream with skimmed milk (tall): 273kcal; 11 teaspoons of sugar
•     Coca Cola Original (330ml): 139kcal; 9 teaspoons of sugar
•     Muller Crunch Corner Strawberry Shortcakre Yogurt (135g): 212kcal; 6 teaspoons of sugar
•     Yeo Valley Family Farm 0% Fat Vanilla Yogurt (150g): 120kcal; 5 teaspoons of sugar
•     Kellogg’s Frosties with semi-skimmed milk (30g): 4 teaspoons of sugar
•     Glaceau Vitamin Water, Defence (500ml): 4 teaspoons of sugar
•     Heinz Classic Tomato Soup (300g): 171kcals; 4 teaspoons of sugar
•     Ragu Tomato & Basil Pasta Sauce (200g): 80kcals; 3 teaspoons of sugar
•     Kellogg’s Nutri-Grain Crunchy Oat Granola Cinnamon Bars (40g): 186kcal; 2 teaspoons of sugar
•     Heinz Tomato Ketchup (15ml): 18kcal; 1 teaspoon of sugar

Source: Action on Sugar

Dr Aseem Malhotra, a cardiologist and science director of Action on Sugar, said: “Added sugar has no nutritional value whatsoever and causes no feeling of satiety.  Aside from being a major cause of obesity, there is increasing evidence that added sugar increases the risk of developing type 2 diabetes, metabolic syndrome and fatty liver.”

Changes to GPs contracts will allow them to spend more time with patients.
The money GP surgeries received until now depended on how they performed against 969 different measures but under the new contract 300 measures will be cut- reducing form filling to free more time with patients, says the British Medial Association (BMA).

There will also be new financial incentives to encourage surgeries located close to each other to work together.

The new contract also aims to provide better care for people with early-stage cancer, for those at the end of their lives or the frail or elderly.

The Welsh government also says the changes should also help reduce the pressure on hospital A&E departments.

Charlotte Jones, chair of the BMA’s Welsh GP committee, said the contract has “removed some of the bureaucratic tick-boxing type of medicine and targets that we’ve had to provide”.

Speaking on BBC Radio Wales, she said doctors will be able to return to “looking after the individual patient, which will then mean that there will be more capacity within general practice surgeries to provide more care for the patients”.

“The whole GP practice team will see the benefits of this which should increase additional capacity because, as we know, GP practices are under enormous strain like the emergency departments are at this current time.”

“We do hope that the feedback from patients will be that they have seen the positive effects of it as well as the GPs going back to being able to manage the individual and not chasing targets.”

However the deal, which comes into effect in April, will not lead to weekend surgeries or more out-of-hours opening, but it should mean that patients will find it easier to get appointments with reduced red tape.

Highlighting the 19m appointments made with GPs last year in Wales, she said: “So actually patients are seeing GPs in huge numbers but sometimes you do wait.  In some ways the opening hours issue is a bit of a distraction to the more fundamental question of how people get to see their GPs when they need to.”

The deal should not mean GPs getting more money. In 2011/12 the average salary for a GP responsible for running a practice was £92,300, while the average pay for a family doctor employed by the surgery stood at £55,000.

“The global sum, the total amount of money, remains the same. It’s just that what people get paid for and how they get paid has been re-negotiated to allow us to modernise the contract and to prioritise those things which we know really matter to patients.”

Some patients are going to Accident and Emergency (A&E) units more than 50 times a year.
Data from 183 sites obtained under the Freedom of Information Act revealed nearly 12,000 people made more than 10 visits to the same unit in 2012-13.

And a small number of those – just over 150 – attended more than 50 times.

Doctors warned that the issue, while confined to a minority of patients, was adding to the mounting pressures on the system this winter.  Many hospitals are already struggling to hit their waiting time targets- without these extra issues.

In England, the four hour target was missed in the first two weeks of December, but the numbers attending A&Es eased over the Christmas period and the target has been met for the past fortnight.

However, that overall figure masks the struggle the biggest units are facing.

Of the 144 major centres, more than 60 failed to hit the target during the Christmas week despite the number of patients dropping by nearly 10%.

Patients Association chief executive Katherine Murphy said: “These figures are of great concern and provide yet more proof that our already overstretched A&E services are being put under increasingly severe strain.

“It needs to be recognised that every inappropriate attendance at the A&E would detract health professionals from attending to the genuine and often life-threatening emergencies,” she added.

She said improving access to GPs could make a big difference – before Christmas, official NHS data showed the number of people waiting longer than a week to be seen by a GP was growing.

A spokeswoman for NHS England said the figures should be seen in context – in England alone there were more than 21 million visits to A&E units last year.

“The figures presented here suggest that the number of people attending A&E frequently is relatively small when considered against the big picture.”

Meanwhile, a spokeswoman for the Department of Health said steps were being made to improve access to community care through the launch of a £3.8 billion joint pot in April 2015 to encourage the NHS and local government to work together.

Health Direct wishes you a healthy New Year.
Health Direct wishes you a healthy New Year for the year ahead in 2014.

Health Direct wishes you a Merry Christmas.
Health Direct wishes you a Merry Christmas- though a happy and health one- rather than an intoxicated one.