Smoking ban cut child hospital admissions

Thousands of children have been spared serious illness and hospital treatment since the smoking ban was introduced in England in 2007.

Thousands of children have been spared serious illness and hospital treatment since the smoking ban was introduced in England in 2007The study, in the European Respiratory Journal, looked at 1.6 million hospital admissions of under 14s from 2001-12.

The law against smoking in indoor public places saw 11,000 fewer children being admitted to hospital with lung infections every year, it found.

Researchers said it showed anti-smoking legislation was improving child health.

The University of Edinburgh study compared the figures for hospital admissions after the ban with mathematical predictions of the number of admissions that would have occurred without the smoking ban.

It estimated that hospital admissions for children with respiratory infections fell by 3.5% immediately after the ban was introduced.

While the biggest effect was seen in the number of children suffering chest infections – which dropped by almost 14% – the number of admissions attributable to nose, throat and sinus infections also went down. But these effects were more gradual, the study said.

There is a well established link between second hand smoke exposure and bronchitis, bronchiolitis, middle ear infections and respiratory tract infections.

Dr Jasper Been, of the University of Edinburgh and Maastricht University, said: “This study is further demonstration of the considerable potential of anti-smoking laws to improve child health.”

“Although our results cannot definitively establish a cause and effect, the rigorous analysis clearly shows that the introduction of smoke-free legislation was associated with significant reductions in hospital admissions among children.”

Data suggested the ban on smoking in public places had also led to a rise in the number of smoke free homes, reducing second hand smoke exposure among children, the study said.

The ban is estimated to have reduced adults smoking in the home from 65% to 55%.

Health Direct estimates that without the ban on smoking the NHS would be treating more sick children at a significant cost which may approximate to £25 million a year- highlighting the savings from preventative changes.

UK drinks more alcohol than estimated

The amount of alcohol people in England drink has been underestimated according to new research.

amount of alcohol people in England drink has been underestimated according to new research

In England surveys measuring typical drinking habits account for only around 60% of alcohol sold, the medical journal BMC Medicine report said.

Report author Dr Mark Bellis said this was because many studies do not include drinking on special occasions.

More than 6,000 people in England were interviewed for the study.

Accounting for special occasion drinking added more than 120 million UK units of alcohol – equivalent to about 12 million bottles of wine – to the population’s alcohol consumption in England every week, it found.

The results could have important implications for public health, researchers said.

“Nationally, we underestimate how much we drink – and as individuals we can turn a blind eye to our heavier drinking periods when we calculate personal consumption,” said lead scientist Dr Bellis, from Liverpool John Moores University.

“For many people, though, these sessions add substantial amounts of alcohol to their annual consumption and inevitably increase their risks of developing alcohol-related ill health.”

The equivalent of more than three quarters of a bottle of wine- or about three pints of beer per drinker every week goes unaccounted for, he said.

The survey measured a medium glass of 12.5% ABV wine as 2.2 UK units, and a 440ml can of 4.5% ABV beer as 2 UK units, but the amount of alcohol units in drinks varies depending on their size and strength.

Researchers conducted telephone interviews with 6,085 randomly-selected members of the public aged 16 and over in England.

Participants were asked about normal drinking patterns and those outside their usual circumstances, such as summer holidays, bank holidays, and weddings.

Most categories of drinkers, based on age groups and levels of typical consumption, reported increased consumption during holidays or special occasions.

People aged 24-35 drank 18 extra units a week on special occasions, the research suggested. The biggest increase was seen in 25 to 35-year-olds, who had the highest level of typical consumption.

People in this drinking category drank an extra 18 units (144g) of alcohol per week on special occasions, the research suggested.

Last year, the Organisation for Economic Co-operation and Development found that people over the age of 15 in the UK drank an average of 10.6 litres of pure alcohol a year – equal to 115 bottles of wine.

According to the Institute of Alcohol Studies, in 2012, men consumed an average of 17 units in the week before they were interviewed, compared with 10.2 units for women.

Prostate cancer gene targeted by drugs

Scientists have published a comprehensive genetic map of advanced prostate cancer.

Scientists have published a comprehensive genetic map of advanced prostate cancer- which suggests nearly nine in 10 patients with advanced prostate cancer could benefit from targeted treatments
The study, published in the journal Cell, shows that nearly nine in 10 men had gene mutations that could be targeted with drugs.

The study was led in the UK by scientists at the Institute of Cancer Research (ICR) London in collaboration with several teams in the United States.

Researchers analysed the genetic codes of tumours from 150 patients with metastatic – or advanced – prostate cancer, whose disease had spread to other parts of the body.

They found that 89% had genetic aberrations for which there were existing drugs or treatments undergoing clinical trials.

Prof Johann de Bono, of the ICR and Royal Marsden NHS Foundation Trust “This is truly a gamechanger. We are calling this prostate cancer’s Rosetta Stone, because we can now decode the disease for the first time.”

“In the past, we used to treat lethal prostate cancer as a single illness but this shows that it is a group of diseases, each driven by their own set of mutations.”

Prof de Bono said it meant that, using genetic testing, it would be possible to individualise patient care, heralding the arrival of personalised treatment for advanced prostate cancer.

More than 40,000 men are diagnosed with prostate cancer and nearly 11,000 die in the UK each year.

Nearly all men with advanced disease develop resistance to hormone therapy, which is used to prevent prostate cancer cells from growing.

In the study, nearly two thirds of the patients had mutations in a molecule that interacts with the male hormone androgen, which is targeted in current treatments.

Scientists at the ICR believe this could open up new avenues for hormone therapy.

Mutations in BRCA1 and BRCA2 genes were found in nearly one in five patients.

Trials at the Royal Marsden/ICR have already shown prostate cancer patients with BRCA mutations can benefit from drugs called Parp inhibitors which disrupt cancer cells’ DNA repair mechanism.

One of these drugs, called olaparib, is now licensed by the EU to treat women with ovarian cancer, who carry BRCA mutations.

The research is part of a move towards treating cancer – not just by its site of origin – such as breast, lung or prostate – but with medicines which target the individual genetic mutations driving the disease which can be common across several cancers.

Prof Paul Workman, ICR chief executive said: “This major new study opens up the black box of metastatic cancer, and has found inside a wealth of genetic information that I believe will change the way we think about and treat advanced disease.”

End Of Life care letting people down

Thousands of dying patients are being let down by poor End Of Life care provision according to the Parliamentary Health Service Ombudsman (PHSO)

End Of Life care letting people downThe health ombudsman’s report detailed “tragic” cases where people’s suffering could have been avoided or lessened.

The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.

One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.

In another case, a 67-year-old man’s family learned of his terminal cancer diagnosis through a hospital note – before he knew himself. This “failed every principle of established good practice in breaking bad news”, the report said.

“There was an avoidable delay in making a diagnosis,” it added. “An earlier diagnosis would have meant opportunities for better palliative care.”

Ombudsman Julie Mellor said that the report made “very harrowing reading”.

She also urged the NHS to learn lessons from the report, adding: “Our casework shows that too many people are dying without dignity.

“Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones.”

Macmillan Cancer Support chief executive Lynda Thomas said: “The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.

“If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care.”

The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.

He said the CQC would continue to highlight those services that were failing.

Health Direct laments “These are appalling cases – everyone deserves good quality care at every stage of ones life- but at the very end of the life dignity should be paramount.”

Stepping Hill nurse guilty of murder

Stepping Hill nurse Victorino Chua has been found guilty of murdering patients.

Stepping Hill nurse guilty of murderA nurse has been convicted of murdering two patients and poisoning 20 others at a Greater Manchester hospital.

Victorino Chua killed Tracey Arden, 44, and Derek Weaver, 83, at Stepping Hill Hospital in Stockport by injecting insulin into saline bags and ampoules.

These were then unwittingly used by other hospital nurses on Chua’s victims, who were mostly elderly.

The father of two, 49, who was cleared of a third murder charge, left one patient with a serious brain injury.

Chua, who was found not guilty of the murder of 71 year old Arnold Lancaster but convicted of poisoning him, showed no emotion as the verdicts were passed.

Police and prosecutors have also now revealed concerns over whether Chua was even qualified to work as a nurse in the UK.

The poisoning took place on two wards, often used for treating elderly patients with complex illnesses, between June 2011 and January 2012.

After police were called in, Chua was said to have “changed tack” by sabotaging prescription charts, doubling and trebling dosages.

Among the evidence produced by the prosecution was a self penned letter found at Chua’s home in Stockport.

In the letter, described as “the bitter nurse confession” by Chua, he said he was “an angel turned into an evil person” and “there’s a devil in me”, who had things he would “take to the grave”.

The prosecution argued the Filipino national had decided to take out his personal frustrations on patients “for reasons truly known only to himself”.

However, after 11 days of deliberations, the jury at Manchester Crown Court found Chua had indeed murdered two of his patients and caused harm to many others.

Greater Manchester Police (GMP) said it was their “biggest case in a decade”. Police and detectives hugged members of the legal team after the jury left court.

Ben Southam, from the Crown Prosecution Service (CPS), described the “complex case” as an “enormous task” involving thousands of pages of evidence.

It took Greater Manchester Police three years to solve this case, which they said was like putting together a million piece jigsaw. They had to interview hundreds of staff members and monitor hundreds of hours of CCTV.

But every single incident of poisoning had one common denominator – it led to Victorino Chua.

The court was told Chua would become angry with the families of his patients, and when his professionalism was questioned he decided to take it out on the people under his care.

Chua always said he was a great nurse and the patients loved him. But the truth was in a letter found at his home, in which he said “inside of me is a devil and, if pushed, they will be sorry”.

Chua was found guilty of a total of 33 charges: two counts of murder, 22 counts of attempting to cause grievous bodily harm, one of causing grievous bodily harm, seven of attempting to administer a poison and one of administering a poison.

The other victims of saline poisoning were Arnold Lancaster, 81, Josephine Walsh, 69, Jack Beeley, 72, Linda McDonagh, 59, Joseph “Eric” McDonald, 66, Antony Smith, 47, Joyce Atherton, 81, Beryl Hope, 70, Doreen Brace, 87, Kathleen Murray, Lillian Baker, 85, Beatrice Humphreys, 84, Mary Cartwright, 88, Lillian Armstrong, 83, Philip Jones, 67, William Dickson, 82, Daphne Harlow, 86, and 24 year old Zubia Aslam.

Younger people having more strokes

There has been a big rise in the number of working age men and women having stroke.

big rise in the number of working age men and women having stroke.In England in 2014 there were 6,221 hospital admissions for men aged 40-54 – a rise of 1,961 on 14 years earlier according to reserach by the Stroke Association.

Experts said unhealthy lifestyles were partly to blame for the rise, though the growing population and changes to hospital practice also played a part.

Researchers say based on their findings strokes should not be considered as a disease of the old.

Strokes are caused by blood clots or bleeds to the brain and can lead to long lasting disability.

The majority occur in people aged over 65, and though rates are decreasing in this group, this report suggests growing numbers of younger people are at risk.

Experts analysed national hospital admission data spanning 2000 to 2014.

These findings highlight the importance of ensuring your blood pressure and cholesterol are under control, as well as having a health check at the age of 40.

Trends for people in their 40s and early 50s appeared to be getting worse. In women aged 40-54, there were an extra 1,075 strokes recorded in 2014, compared with 2000.

Experts said growing obesity levels, sedentary lives and unhealthy diets – which raise the risks of dangerous blood clots – all played a part.

And they argued strokes among this age group had long lasting personal and financial impacts on individuals and their families, as well as on the economy.

Recovering patients can find it difficult to return to work and should have more support from employers, the report suggests.

Jon Barrick, of the Stroke Association, said: “These figures show stroke can no longer be seen as a disease of older people.”

“There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.”

The Stroke Association said that even younger people should be aware of the warning signs such as dizziness, difficulties with speech and changes in the face.

The NHS- how big should the National Health Service be?

The National Health Service was founded in 1948 with 144,000  health professionals.

The NHS- how big should the National Health Service be?In less than seven decades that figure has risen tenfold to over 1.4 million staff across the UK.

But with all the political parties promising more health workers in the coming years -just how many doctors, nurses, porters, therapists and managers does the NHS need?

Ask the experts and they will say something like 8,000 more GPs, 20,000 more nurses and 3,000 more midwives.

Unsurprisingly, these are the figures that are – more or less – being promised by politicians in this election campaign.

But how certain can we be that this right? After all, we live in an era of huge technological change that surely could revolutionise the way the system works?
NHS staff and workforce pressures in numbers

  • When the NHS was created nearly half of people died before the age of 65, today just 14% do.
  • In 1948 the NHS employed 144,000 staff. There are now about 1.4 million.
  • The consultant workforce grew by 54% between 2002 and 2012 and annual growth of 4% is predicted until 2020.
  • In 2012, almost 50% of the nursing workforce was aged 45 or over, compared to 33% in 2002.
  • The number of over 85s has more than doubled since 1981 to 1.4 million. In 20 years time there will be 3.6 million.
  • The NHS in England spends £5 billion a year on education and training.
  • Currently, face-to-face contact accounts for nearly 90% of all healthcare interactions.

But the potential for digital technologies and even simply increasing the amount of email, Skype and phone consultations could make a big difference.

In the US, the health company Kaiser Permanente has reduced the amount of GP visits being made by a quarter through greater use of phone and email.

Meanwhile, hospital doctors and nurses in West Yorkshire have set up video linkups with local care homes and reduced admissions by 35%.

There is also the potential for more self management of illness, while the use of sensors and alarms in the home can make a big difference to the amount of home visits needed to check in on the frail elderly.

Even so, some have doubts about just how much of a revolution there will be.

Nigel Edwards, chief executive of the Nuffield Trust think tank, says: “It doesn’t look like technology will be the breakthrough it has been in other industries. Health and care is pretty labour heavy – that means having people on hand.”

Instead, he says, perhaps the more pressing issue is what sort of staff are actually needed.

The NHS review is a question posed by Health Education England’s 5 year workforce strategy document published in October and posted by Health Direct at: NHS needs extra cash and overhaul claim health bosses

It doesn’t make any firm predictions and instead acts as a discussion document, listing a host of factors likely to mean more staff have to be taken on, including the ageing population and the high numbers of staff reaching retirement age.

But it says if the drive to move care out of hospital and into the community is to be successful, it will require staff roles to change.