The smoking ban has led to a sharp fall in heart attacks

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking.

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking
Heart attack rates in the UK have fallen by up to 42 per cent since the 2007 smoking ban, major research suggests.

A review of 77 studies found that reduced exposure to passive smoking has caused a “significant reduction” in heart problems across the population.

Several of the studies found that non smokers and ex-smokers gained most the benefits.

The Cochrane study examined a range of health outcomes in 21 countries, including the UK, which have introduced bans in recent years.

Researchers concluded that there was strong evidence that reduced exposure to passive smoking reduced the number of people suffering from cardiac problems.

The studies examined included a Liverpool study of 57,000 hospital patients. This found admissions for heart attacks fell by 42 per cent among men and 43 per cent among women in the five years since the ban was introduced in 2007.

And US research reviewed found a 14 per cent reduction in strokes in counties which introduced a ban, compared with those which did not.

Some 33 out of the 44 studies reviewed on heart disease found a “significant reduction” following the introduction of smoking bans.

Researchers said the studies took account of other trends over the period – such as a large increase in rates of statin prescribing, to protect against heart disease.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations.”

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “This review strengthens previous evidence that banning smoking in public places leads to fewer deaths from heart disease and that this effect is greatest in the non-smoking population.

He said the studies were observational and all had their limitations, but it would be difficult to study the effects of passive smoking in a more robust scientific way.

Researchers said the evidence was less clear about whether the introduction of bans had actually helped people to give up smoking.

Nonetheless, smokers seemed to benefit from some reduction in exposure to passive smoke.

One Scottish study, which found no fall in smoking rates after a ban was introduced in 2006, found a 14 per cent reduction in hospital admissions for heart problems among smokers, and a 21 per cent reduction in admissions among non-smokers.

The research found the impact of the ban on respiratory health, and conditions such as asthma, was less clear cut, though seven of 12 studies on asthma found reduced hospitalisations since the ban.

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 air pollution causing deadly public health crisis

The Environmental Audit Committee argues air pollution is a “public health crisis” causing nearly as many deaths as smoking.

UK air pollution causing deadly public health crisisThe committee suggested a scrappage scheme for diesel cars to cut emissions as there are an estimated 29,000 deaths annually in the UK from air pollution.

Nitrogen dioxide is known to cause inflammation of the airways, reduce lung function and exacerbate asthma. Particulate matter – tiny invisible specks of mineral dust, carbon and other chemicals – are linked to heart and lung diseases as well as cancer.

Some particulate matter lodges in the lungs, while the finest particles can enter the bloodstream, risking damage elsewhere in the body.

Joan Walley, the committee chairwoman, said “There is a public health crisis in terms of poor air quality. There are nearly as many deaths now caused by air pollution as there are from smoking, so the main thing is we stop a new generation of children being exposed.”

She said government “should make it impossible” for new schools, care home or health clinics to be built in pollution hotspots. She added that “well over a thousand” schools were already near major roads and that it “made sound economic sense” to filter the air coming into the buildings.

The committee’s report says traffic is responsible for 42% of carbon monoxide, 46% of nitrogen oxides and 26% of particulate matter pollution.

It said government had promoted diesel vehicles as they produced less of the greenhouse gas carbon dioxide. But the committee said diesel was now seen as “the most significant driver of air pollution in our cities”.

They called for government to pay for diesel drivers to upgrade their engines or for a national scrappage scheme to take the most polluting vehicles off the road.

Other measures suggested include:

  • The Met Office and BBC producing high pollution forecasts alongside ones for pollen and UV.
  • A national plan for “low emission zones” to tackle heavily polluting vehicles, like the one in London.
  • Changes to fuel duty to encourage low nitrogen dioxide vehicles as well as low carbon dioxide.
  • Financial incentives for alternative fuels.
  • Encourage walking and cycling as the “ultimate low emission” option

Dr Ian Mudway, a lecturer in respiratory toxicology at King’s College London, told the BBC: “The evidence is there. The 29,000 figure is very solid, so really it is a case of acting.

“But it is a strange one, because it’s their third [report] in five years and it is an attempt to get the government to do anything.”

The British Lung Foundation said the recommendations “may seem drastic”, but air pollution was so bad they were necessary “to protect the nation’s health.  Our dirty air will simply not clean itself, and this issue is one that will, without the government’s intervention, continue to impact on current and future generations,” said Dr Penny Woods, the charity’s chief executive.

Asthma UK said air pollution increased the risk of a life-threatening attack and “urgent and concerted action” was needed to bring pollution levels down.

Chief executive Kay Boycott said: “In the short term some of the measures recommended in this report, such as the publicising of high air pollution forecasts, could help people with asthma know in advance if they should seek advice from their GP or asthma nurse.”

Simon Gillespie, the chief executive of the British Heart Foundation, said: “The government cannot continue to ignore this issue. Enough is enough. The government must act on these recommendations quickly if we are to improve the quality of the air we breathe and protect the nation’s heart health.”

NHS surgery restriction for smokers and obese

The NHS in Devon is to deny routine surgery to smokers and the morbidly obeseunless they quit smoking or lose weight.

NHS surgery restriction for smokers and obesePatients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5 million deficit and says the cuts are needed to help it meet waiting list targets. The measures were announced the same day government announced an extra £2 billion of annual NHS funding.

The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.

It announced a range of cost-cutting measures yesterday including only providing one hearing aid, instead of the normal two, to people with hearing loss. Shoulder surgery will also be restricted.

In November, the CCG said it would take “urgent and necessary” measures to prioritise major treatment. That included delaying hip and knee operations for the morbidly obese, but Wednesday’s announcement applies to all routine procedures.

NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.

A statement said all the decisions were “interim commissioning positions” and would require further consultation. Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.

Dr Tim Burke, Chair of NEW Devon CCG, said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”

NEW Devon CCG said it would announce another round of cost-cutting measures “in due course”.

“We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them,” said Dr Burke.

“The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”

In a statement the Royal College of Surgeons said it was “concerned” by the move and warned the region was merely storing up “greater pressures” for the future.

It said: “The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery – not determined by arbitrary criteria.”

“Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.”

“A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible.”

Smoking bans cut asthma and premature births by 10%

Laws banning smoking in public places have had a positive impact on child health, an international study in the Lancet suggests.Smoking bans cut asthma and premature births by 10%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.”

Dementia- priorities for avoidance and treatment

Dementia has been described as a “global disaster waiting to happen” and the biggest health and care problem of a generation.Dementia- priorities for avoidance and treatmentSomeone is diagnosed with the disease every four seconds and cases are expected to soar from 44 million now to 135 million by 2050.

The disease already costs the world £370 billion each year. This week ministers from the G8 major economies are meeting in London to discuss how to tackle this devastating disease.

What is dementia?

  • It’s an umbrella term that describes around 100 diseases in which brain cells die on a huge scale.
  • All damage memory, language, mental agility, understanding and judgement.
  • Alzheimer’s disease is the most common form, affecting 62% of those living with dementia.
  • It gets worse with time and eventually people are left completely dependent on carers.
  • It is incurable.

So what are the key actions required?

1) Diagnose dementia early

Early diagnosis will be key to tackling dementia. On the day your doctor tells you that you have dementia you might think that’s the early stages of the disease, but it’s not

It takes 10 to 15 years of brain cells dying before memory problems become noticeable and memory tests lead to a diagnosis.

By this stage a fifth of the core memory centres of the brain will be dead.

It’s why doctors think drug trials have failed, they’re simply trying to treat the disease way too late.

However, developments are being made. It is now possible to see one of the damaged proteins closely tied to Alzheimer’s disease in brain scans, but the challenge is to use these tools to predict the development of dementia.

Other methods, such as finding chemicals in the blood which might predict the onset of dementia, are being investigated as well.

Dementia is also not one disease, but many. Alzheimer’s disease, vascular dementia and dementia with Lewy bodies all have similar symptoms, but may need different treatments. Scientists will need to come up with techniques which can readily distinguish between different forms of dementia.

2) Stop brain cells dying

Currently, there is no drug which can halt or even slow the progression of any form of dementia.

A lot of hope was placed on two potential Alzheimer’s drugs – solanezumab and bapineuzumab – but they failed in trials which showed no benefits for cognition.

However, there were hints that solanezumab may work in people with the earliest stages of the disease. A new trial has started looking at patients with mild dementia.

A cure is obviously the dream, but just slowing the pace of the disease would deliver massive rewards. Delaying dementia by five years could halve the number of people living with the disease.

3) Develop drugs to treat the symptoms

There are dementia drugs, which help people to live with the condition, but there are not enough.

Medication can boost the chemical signalling between surviving brain cells. But the last new medicine, memantine, was approved by the US in 2003. Since then there’s been nothing.

4) Find ways to reduce the risk

Want to massively cut the risk of lung cancer? Don’t smoke. Want to avoid a heart attack? Then exercise and have a healthy diet. Don’t want dementia? Then the answer is less certain.

Age is the biggest risk factor. In the UK, one in three people over the age of 95 has dementia, but there’s not much that you can do about that.

Many of the familiar messages – exercise and eat healthily – have been linked to preventing or delaying the onset of dementia. But the full picture of how family history, lifestyle choices and the environment combine to result in dementia is still unclear.

Prof Peter Passmore, from the British Geriatrics Society and Queen’s University Belfast, says the best advice so far is: “To do what’s healthy for the heart to reduce blood vessel damage to the brain.

So avoid obesity, don’t smoke, regular exercise, control blood pressure, sugar and cholesterol.

5) Work out the best care

Dementia has huge costs for society, but medical bills account for only a small fraction of the overall bill. The real cost is in time in care homes and the lost income of families quitting work to care for relatives.

Research will also need to focus on the best ways to care for patients with dementia and to keep them independent for as long as possible.

Studies have already shown that antipsychotic prescriptions can be halved with the correct training for staff.

NHS told to ban all smoking in hospitals

The NHS must stop turning a “blind eye” to smoking and ban it in all hospital grounds in England, according to new guidance.NHS told to ban all smoking in hospitalsThe National Institute for Curbing Expenditure (NICE) said that it wanted to see smoking shelters scrapped so patients, visitors and staff could not light up.

Staff should also stop helping patients out of their beds to go for a smoke. And patients who smoke must be identified and offered help to quit, the guidance added.

It said nurses, doctors and other staff could give brief advice and then refer smokers on to NHS stopping smoking services.

Smoking rates are particularly high among mental health patients with one in three smoking, rising to 70% in psychiatric units.  That compares with the one in five among the general population who are smokers.

The guidance, which is voluntary for the NHS to follow, even suggested staff caught smoking should be disciplined.

NICE conceded some parts of the NHS had already adopted these approaches, but said the idea of the guidance was to make sure it became consistent across the health service.

NICE public health director Prof Mike Kelly said the NHS had turned a “blind eye” for too long.

“It has been tolerated by the NHS and it is high time that stopped.  NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services. We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances.”

In practice, he said, doctors and nurses could provide nicotine replacement therapies and advise patients about counselling to ensure they were not “going up the wall” with nicotine cravings.

He acknowledged that stopping a determined smoker from going outside to light up was “clearly very difficult”.

“This is not about imposing some sort of penal regime in which doctors, nurses, administrators spend all their time trying to enforce a series of rules and regulations.

He said it was about a culture shift and removing smoking shelters would help eliminate any subliminal message that it was ok to smoke around a hospital.

Lung cancer overtakes breast cancer as most deadly form of disease among UK women

Deaths from lung cancer have overtaken deaths from breast cancer as it becomes the most lethal form of the disease among British women, new research has shown.Lung cancer overtakes breast cancer as most deadly form of disease among UK womenLung cancer kills 16,000 women a year in the UK, compared with 12,000 for breast cancer.

The rise in lung cancer is attributed to the rise in young women taking up smoking the late 1960s and 1970s.

The Europe wide study shows that despite an overall decline in cancer deaths, mortality rates from lung cancer among women continues to rise across the continent, up seven per cent to around 82,000 since 2009.

This year experts predict breast cancer to kill 88,886 women in Europe and lung cancer to kill 82,640.

Professor Carlo La Vecchia, one of the study authors from the University of Milan in Italy, said if trends continue lung cancer will become the most lethal form of the disease in Europe.

She said: “If these opposite trends in breast and lung cancer rates continue, then in 2015 lung cancer is going to become the first cause of cancer mortality in Europe.”

“This is already true in the UK and Poland, the two countries with the highest rates: 21.2 and 17.5 per 100,000 women respectively.”

“This predicted rise of female lung cancer in the UK may reflect the increased prevalence of young women starting smoking in the late 1960s and 1970s, possibly due to changing socio-cultural attitudes at that time.”

“However, fewer young women nowadays in the UK and elsewhere in Europe are smoking and, therefore, deaths from lung cancer may start to level off after 2020 at around 15 per 100,000 women.”

There has also been a steady reduction in breast cancer deaths across Europe in the last four years.

Prof La Vecchia added: “This reflects the important and accumulating advances in the treatment, as well as screening and early diagnosis, of the disease.”

The study, published in the Annals of Oncology, looked at cancer rates in all 27 European Union member countries, as well as six individual countries – France, Germany, Italy, Poland, Spain and the UK.

It looked at all cancers but focused on stomach, intestine, pancreas, lung, prostate, breast, uterus (including cervix) and leukaemias.

The study found that an estimated 1.3 million people will die from cancer -737,747 men and 576,489 women- in the 27 countries of the EU in 2013.

Though that number has increased since 2009, as there have been more cases in that period, the rate at which people have died has actually declined, six per cent in men and four per cent in women.

Lung cancer is still the main cause of cancer death among men, with nearly 187,000 deaths predicted for 2013, giving a death rate of 37.2 per 100,000 men.

FromL: http://www.telegraph.co.uk/Lung-cancer-overtakes-breast-cancer-as-most-deadly-form-of-disease-among-UK-women

Tax fizzy drinks and ban junk food ads say doctors

Fizzy drinks should be heavily taxed and junk food adverts banished until after the watershed, doctors have said, in a call for action over obesity.Tax fizzy drinks and ban junk food ads say doctorsThe Academy of Medical Royal Colleges, which represents nearly every doctor in the UK, said ballooning waistlines already constituted a “huge crisis”.

Its report said current measures were failing and called for unhealthy foods to be treated more like cigarettes.

The UK is one of the most obese nations in the world with about a quarter of adults classed as obese. That figure is predicted to double by 2050 – a third of primary school leavers are already overweight.

Doctors fear that a rising tide of obesity will pose dire health consequences for the nation.

The Academy of Medical Royal Colleges is a “united front” of the medical profession from surgeons to GPs and psychiatrists to paediatricians. It says its doctors are seeing the consequences of unhealthy diets every day and that it has never come together on such an issue before.

Its recommendations include:

  • A ban on advertising foods high in saturated fat, sugar and salt before 9pm
  • Further taxes on sugary drinks to increase prices by at least 20%
  • A reduction in fast food outlets near schools and leisure centres
  • A £100 million budget for interventions such as weight-loss surgery
  • No junk food or vending machines in hospitals, where all food must meet the same nutritional standards as in schools
  • Food labels to include calorie information for children

Prof Terence Stephenson, the chair of the Academy, evoked parallels with the campaign against smoking.

“That required things like a ban on advertising and a reduction in marketing and the association of smoking with sporting activities – that helped people move away from smoking.”

He said there was no “silver-bullet” for tackling obesity, instead the entire culture around eating needed to change to make it easier to make healthy decisions.

“I choose what I eat or whether I smoke, what people have told us is they want help to swim with the tide rather than against the current to make the healthy choice the easy one,” he said.

While the report makes a raft of recommendations, Prof Stephenson attacked sugary drinks for being “just water and sugar” and lambasted a culture where it was deemed acceptable to drink a litre of fizzy drink at the cinema.

A tax was needed to help “encourage people to drink more healthy drinks,” he said.

“Doctors are often accused of playing the nanny state, we didn’t hear from a single person who said they liked being overweight, everybody we met wanted help from the state and society.

“If we didn’t have things like this we wouldn’t have speed limits that save lives, we wouldn’t have drink-driving limits that save lives, there’s a host of things that society and state does to help us live long, healthy fulfilling lives and we’re just suggesting something similar.”

Number of children with asthma admitted to hosptal falls since smoking ban

The number of children with symptoms of asthma who have been admitted to hospital  has fallen since the ban on smoking in public places came into effect.Number of children with asthma admitted to hosptal falls since smoking banResearch shows there was a 12.3% fall in admissions in the first year after the law came into place in July 2007, and these have continued to drop in subsequent years, suggesting that the benefits of the legislation were sustained over time.

NHS statistics analysed by researchers at Imperial College London showed the fall was equivalent to 6,802 fewer hospital admissions in the first three years of the law coming into effect.

The findings Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England have been published in the journal Pediatrics.

Asthma affects one in every 11 children in the UK.

Before the ban was implemented, hospital admissions for children suffering a severe asthma attack were increasing by 2.2% per year, peaking at 26,969 admissions in 2006/07.

The findings show the trend reversed immediately after the law came into effect, with lower admission rates among boys and girls of all ages, in both wealthy and poor neighbourhoods and in cities and rural areas.

Previous studies have shown that hospital admissions for childhood asthma fell after smoke-free legislation was introduced in Scotland and North America.

The smoking ban in England has also been found to have reduced the rate of heart attacks.

Dr Christopher Millett, from Imperial College London’s School of Public Health, led the study.

He said: “There is already evidence that eliminating smoking from public places has resulted in substantial population health benefits in England, and this study shows that those benefits extend to reducing hospital admissions for childhood asthma.

“Previous studies have also suggested that the smoke-free law changed people’s attitudes about exposing others to second-hand smoke and led more people to abstain from smoking voluntarily at home and in cars.

“We think that exposing children to less second-hand smoke in these settings probably played an important role in reducing asthma attacks.

“The findings are good news for England, and they should encourage countries where public smoking is permitted to consider introducing similar legislation.”