This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

ME ‘could be caused by a virus’ is a post from: Medical Business Cafe

By Eleanor Bradford

Jozef Mackie diagnosed with ME when he was 11 after being labelled a “school refuser”

A study on children has found further evidence that ME, or Chronic Fatigue Syndrome, could be caused by a virus.

Scientists at the University of Dundee study found abnormalities in the white blood cells of children with ME/CFS, suggesting they had been fighting off infection.

ME (Myalgic Encephalomyelitis), also know as Chronic Fatigue Syndrome (CFS), causes debilitating tiredness.

About 150,000 people in the UK have ME/CFS, 15,000 of whom are children.

The condition is characterised by physical and mental exhaustion following normal activities. Symptoms can include muscle pain, sore throat, tender lymph nodes, multi-joint pain and headaches.

In the study, funded by ME Research UK and The Young ME Sufferers (Tymes) Trust, 25 children aged between seven and 14 with ME/CFS were assessed, along with 23 children of a similar age in a control group.

The report, published in the Archives of Paediatrics and Adolescent Medicine, said abnormalities were found in the blood of all the children with ME/CFS.

The results were similar to those previously identified in adults with the condition.

Samples taken from youngsters with ME/CFS contained higher than normal levels of free radicals – molecules that can damage cells, tissues and organs.

A much greater number of neutrophils, the most common type of white blood cells, were also found to be at the end of their lifecycle.

The report said the high turnover of neutrophils indicated the body’s need to fight infection.

“It’s also important because some people do suggest that ME is a disease of the mind and here we are showing that it is a disease of the body”

Professor Jill Belch Ninewells Hospital, Dundee

There is a continuing debate among scientists over whether ME/CFS is caused by a virus.

Several studies in adults have found evidence of a virus in people with the condition, but so far research has not proved conclusive.

Some doctors have said that the idea that different types of chronic fatigue are all caused by a single virus is not plausible.

Professor Jill Belch, an expert in vascular medicine at Ninewells hospital in Dundee who led the latest research project, said: “What we’ve found are blood changes that suggest chronic inflammation.

“This is important because it’s showing an abnormality that we might be able to devise a treatment for, but it’s also important because some people do suggest that ME is a disease of the mind and here we are showing that it is a disease of the body.”

Dr Neil Abbot, of ME Research UK, said it was ” fascinating to discover evidence of a persistent or reactivating viral infection”.

“Although the cause of ME is unknown, more than half of all patients say their illness started with an infection,” he said.

“The study undoubtedly adds greater scientific weight to the existence of a condition which, sadly, many still fail to acknowledge in spite of its severity.”

According to Tymes Trust, children with ME can be treated with “scepticism” by the healthcare system.

Jozef Mackie, 14, from Fortrose, near Inverness, was a sporty child who loved skiing, until the symptoms of ME began when he was nine years old.

His mother, Donna, said: “He was the boy who’s battery wasn’t working very well. He had to take more and more time off school.

“The other children were able to run around and do things after school and Joseph had to come home and lie on the settee.”

For two years Jozef was labelled a “school refuser” and told it was “all in his head”.

He was finally diagnosed with ME when he was 11.

“I haven’t been treated very well,” said Jozef. “I haven’t been believed. They just think I’m putting it on.

“It’s sore to get in and out of the car and I can’t walk long distances.”

Jane Colby, from Tymes Trust, added: “The medical profession must now take the consequences of ME in children seriously, and research into prevention and treatment must be given a high priority.”

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

ME ‘virus link’ found in children is a post from: Medical Business Cafe

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

‘Genetic link’ to breast cancer is a post from: Medical Business Cafe

Scientists are concerned that exposure to chemicals used in non-stick frying pans could raise cholesterol levels in children after finding a link.

They have no proof, but the West Virginia team says further research is needed to rule it out.

They studied over 12,000 children involved in a lawsuit regarding a water supply contaminated with the same chemicals used on non-stick pans.

Experts stressed that the children’s exposure was much higher than typical.

Most people are exposed to the man-made perfluoroalkyl acid chemicals because they are used commonly in manufacturing.

Perfluoroalkyl acids like PFOA and PFOS give non-stick pans heat resistance, and also come from the breakdown of compounds used in commercial food packaging and factory treatments for fabrics, carpets and stain-resistant clothing.

Experts know these chemicals can get into the body and travel to the liver – the organ responsible for making cholesterol and handling any fat that comes from the diet.

And other studies have already suggested that PFOA and PFOS may change how well the body deals with these fats.

Stephanie Frisbee and colleagues at West Virginia University School of Medicine set out to investigate this further, looking at a group of children who had been exposed to particularly high levels of PFOA through an industrial accident.

Blood tests from the children showed that they did have much higher levels of PFOA than would be expected – their levels were 69.2 nanograms per millilitre on average compared to the 3.9ng/ml national average.

And their higher PFOA levels were associated with increased total cholesterol and LDL or “bad” cholesterol.

The one-fifth of children and teenagers with the highest PFOA levels had total cholesterol levels 4.6 milligrams per decilitre higher and LDL cholesterol levels 3.8mg/dl higher than the fifth of children with the lowest PFOA levels.

The children’s PFOS levels were only slightly raised, yet were also linked with higher cholesterol levels.

High cholesterol, particularly LDL cholesterol, is linked to heart disease.

But the experts told the journal Archives of Pediatrics and Adolescent Medicine that it was too early to say if their findings meant that the children in the study would be at increased risk of heart disease as a result.

Cathy Ross, senior cardiac nurse at the British Heart Foundation, urged caution in interpreting the findings.

“This study was carried out in a specific area in the USA where the levels of these substances were excessively high due to contaminated water.

“It does not show a link to these substances when they are used in coatings for frying pans where they appear in considerably lower levels.

“While the study found that where there were high blood levels of PFOAs and PFOSs there was also a modest increase in cholesterol levels, this is not the same as saying that they caused the rise in cholesterol.

“More research is needed to identify whether the small quantities of these chemicals that UK children are exposed to actually affect their cholesterol levels.”

She said children’s heart health was at greater risk from what goes into the frying pan and from an increasingly inactive lifestyle than from what the lining of the frying pan is made of.

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Non-stick pan ‘cholesterol link’ is a post from: Medical Business Cafe

By Hywel Griffith

The Welsh NHS faces making £380m worth of cutbacks by April next year, with managers saying it is the biggest challenge they have faced in 20 years.

BBC Wales research shows savings targets have been imposed on staff pay and changes made to hospital services to reduce costs this financial year.

More cuts may be necessary depending on the outcome of the UK Government’s public spending review in October.

The assembly government said the review was “profoundly important for Wales”.

Some health boards predict fundamental changes to reduce costs.

Some have already imposed “rigorous vacancy controls” and said there would be “fundamental service reconfiguration” in years to come.

One health board document warns that “tension will increase” between what patients will expect and what the NHS can provide.

The largest health organisation in Wales, Betsi Cadwaladr University Health Board has an annual budget of over one billion pounds, but faces a savings target of more than £70m in 2010-11.

“I wouldn’t pretend that its easy, but there are opportunities.” says vice-chair Dr Lyndon Miles.

A special season of coverage on TV, radio and online ahead of the Comprehensive Spending Review on 20 OctoberSpending Review: Making It Clear

“We are looking at lots of areas – we are looking at the way we spend at the moment, for example employing locums and agency staff and the way we recruit.”

Reforming the workforce and reducing the wage bill is a common theme across the seven health boards and three NHS trusts – with Betsi Cadwaladr UHB hoping to save £14m in 2010-11.

The health board has already introduced changes to its services, such as the plan to close HM Stanley hospital in St Asaph, Denbighshire, with more services being moved into the community.

“It is a challenge. A lot of people are working hard to meet the challenge. It is clear that we can’t stay as we are – we do need to change,” admits Dr Miles.

The Welsh Assembly Government said the outcome of the spending review in October “will be profoundly important for Wales – and undoubtedly the most important since devolution”.

In terms of the likely future impact on the Welsh NHS, it says it is “continuing to consult closely, openly and seriously with front-line workers and engaging with communities the length and breadth of Wales to ensure we work together to protect essential public services”.

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

NHS in Wales faces £380m cutbacks is a post from: Medical Business Cafe

Nearly one in four junior doctors drop out of their NHS training in England after two years, figures show.

The data from the Medical Programme Board, which oversees training, showed 23% of 6,000 doctors did not apply for the next training stage last year.

Although not all are lost to medicine as some take gaps years or continue working in other parts of the NHS.

Unions said the issue was linked to high workloads, but the government said there was no evidence of this.

It is the first year data like this has been compiled so it is not possible to compare the 23% figure to previous years.

But the board is concerned enough to have launched a review to find out why so many are leaving training at the end of year two when they should be starting to pursue specialities, such as surgery.

Natural break

While they are not applying for the next stage of the junior doctor course, it does not necessarily mean they are lost to medicine.

Some doctors take a gap year, while others end up working for the NHS but in posts that do not count towards their training.

Meanwhile, others head abroad to work in places such as Australia.

The British Medical Association said while for many the end of the first two years – known as the foundation course – may represent a natural break, the demands being placed on junior doctors could still be playing a role.

They believe shifts have become more demanding because of the EU working time directive which was introduced into the NHS last summer and limits the working week to 48 hours.

It ended the era of junior doctors working day and night shifts to staff wards, but according to the union has led to those on shift being stretched much further and thus unable to spend time in areas where they want to specialise.

Dr Shree Datta, chairman of the BMA’s junior doctors committee, said: “Understaffing makes our work much more intense and does not go unnoticed by our patients.”

But a Department of Health spokeswoman said there was no evidence of this.

She pointed out that virtually all the training posts in the NHS were filled – there are always more medics in training than there are training posts to ensure a healthy competition for places.

And she added while the government was looking at how the working-time directive had been introduced there would be no return to “tired doctors working excessive hours”.

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Junior medics ‘leaving training’ is a post from: Medical Business Cafe

People with a severe mental illness are no more likely to be violent than anyone else – unless they abuse drugs or alcohol, a study has suggested.

The relationship between bipolar disorder and violence largely came down to substance abuse, researchers said..

The study compared the behaviour of people with the disorder with their siblings and the wider population.

One of the authors said it was probably more dangerous to walk past a pub at night than a mental health hospital.

The study, led by Oxford University’s Department of Psychiatry, examined the lives and behaviour of 3,700 people in Sweden who had been diagnosed with bipolar disorder, commonly known as manic depression.

The disorder leads to sudden and unpredictable mood swings which are more severe than the normal ups and downs of life.

The team, led by consultant forensic psychiatrist Dr Seena Fazel, wanted to examine the public perception that there is a link between the disorder and violent crime.

They did this by comparing the experiences of the patients with some 4,000 siblings of people with bipolar disorder – and a further group of 37,000 people selected from the general population.

The research, published in the Archives of General Psychiatry, found that the rates of violent crime among people who were mentally ill and abused substances were no different to those among the general population who abused substances.

In each group, the rate of violent crime was between six and seven times higher than in the general population.

“Most of the relationship between violent crime and serious mental illness can be explained by alcohol and substance abuse,” said Dr Fazel.

“That tends to be the thing that mediates the link between violence and the illness.”

He said that if the substance abuse was taken away, the illness itself had a “minimal” or non-existent role in violence.

Dr Fazel said: “It’s probably more dangerous walking outside a pub on a late night than walking outside a hospital where patients have been released”

The study said that people with bipolar disorder were 10 times more likely to abuse drugs or alcohol than those in the overall population because they tended to turn to substances to counter the effects of their medication or to get other relief from their symptoms.

A previous paper on schizophrenia, written by several of the same researchers, came to similar findings.

The findings of both studies support the view of mental health charities who argue that the stigma attached to illnesses is not justified by medical evidence.

In 2009 the BBC joined forces with mental health charities for a story line in which one of the characters in the Eastenders soap came to terms with bipolar disorder.

Paul Farmer, chief executive of the mental health charity Mind, said the research would reassure people with severe illnesses such as bipolar disorder and schizophrenia.

“The link between mental illness and violence is often grossly exaggerated when in fact people with mental health problems are far more likely to be the victims of crime than the perpetrators

“This kind of stigma damages lives,” he said.

The charity Sane said it was “surprised” the research appeared to overlook the “realities of severe mental illness”.

Its chief executive Marjorie Wallace said: “We accept that alcohol and drug abuse can exacerbate the more acute symptoms and that such abuse is more widely responsible for criminal acts.

“We also accept that the majority of people with mental illness are never violent and the chances of a member of the public being attacked at random extremely rare.

“However, we do not believe it is helpful to underplay the extreme pain, paranoia and denial of symptoms such as command voices which those with psychosis can experience and which may trigger damaging behaviour.”

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Bipolar ‘not linked to violence’ is a post from: Medical Business Cafe

Chemotherapy is perceived as the ‘backbone’ of cancer treatments, while radiotherapy is perceived as ’second best’.

But in this week’s Scrubbing Up, cancer specialists Dr Ricky Sharma and Professor Gillies McKenna of the Medical Research Council’s Gray Institute for Radiation Oncology and Biology warn that the UK risks falling behind the rest of the world in developing effective treatments for cancer and say funding new forms of radiotherapy must be a priority.

It is over a century since Wilhelm Roentgen “photographed” his wife’s hand, including her wedding ring, with the very first X-ray picture.

Later, the Nobel prize-winning research of Marie Curie and other pioneers demonstrated that radiation could be used not only to diagnose diseases, but to treat cancer effectively, creating the field of radiotherapy – the use of radiation to treat cancer.

Following these discoveries, British scientists and physicians led the world in developing new treatments for cancer.

Although cancer specialists in the UK prescribe both chemotherapy and radiotherapy, the public has been led to believe that new chemotherapy drugs offer the greatest promise as the ‘magic bullet’ for the effective treatment of cancer.

The reality is that surgery and radiotherapy are the main curative treatments for cancers in adults. Over half a century later, we are still waiting for any chemotherapy to be as effective as radiotherapy for curing cancer.

Despite its effectiveness, the image of radiotherapy has been stigmatised in society. When it is offered, patients often wrongly assume they will be getting ’second best’ and will suffer lots of unpleasant side-effects.

Unfortunately, when radiotherapy does hit the headlines the story is about the very rare occasions when there have been mistakes. In reality, millions of patients are successfully treated each year with few ill-effects.

In fact, radiotherapy has among the highest level of quality assurance of all the medical specialties.

The status of radiotherapy as an ‘orphan’ speciality has been made worse by a decline in funding available for research over the last two decades.

A national report published in 2003 warned that if this situation was not reversed, the study of the biology underlying radiotherapy – radiobiology – would no longer be sustainable as an academic discipline in the UK.

Since this report was published, Europe’s largest charity, Cancer Research UK, and the Medical Research Council have combined forces to inject significant amounts of funding into radiobiology research, particularly at the Gray Institute of Oxford University.

But however successful this initiative might be – and first reports look promising – this fundamental science cannot be translated into a genuine benefit for patients in the NHS unless drastic improvements are made in the delivery of routine radiotherapy in the UK.

In day-to-day clinical practice the UK lags behind other developed countries in delivering radiotherapy that is targeted directly on the tumour and affecting less of the normal surrounding tissue.

This means that the long-term side effects of radiotherapy treatments are worse for many patients than they need be.

Similarly, particle therapy is a special type of radiotherapy where protons or other atomic ions are used to treat cancer.

At present, adults and children with cancer who need particle therapy have to travel abroad to receive this treatment. Many of these patients are funded by the NHS because this therapy is the best treatment for them.

But they can’t get it in the UK.

As the UK rediscovers the scientific potential of radiobiology, exciting new frontiers of biologically directed radiotherapy treatments are opening up in UK laboratories.

When UK scientists make great leaps forward in the laboratory, we want patients in NHS hospitals to take part in the clinical trials of these new treatments.

We don’t want to see other countries run trials to show that our scientific discoveries are effective treatments for patients with cancer.

The funding provided by charities and research councils for basic science in radiobiology has to be matched by government initiatives to create a clinical trials network which can rapidly convert laboratory breakthroughs into new treatments for NHS cancer patients.

Historically, the UK was a leader in this form of cancer treatment. Now is the time for it to become one again.

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Cancer treatment is a post from: Medical Business Cafe

Too few UK cancer patients are receiving state-of-the-art radiotherapy care, experts say.

Cancer Research UK (CRUK) warns only 7% of patients receive a new type of radiotherapy, compared with 20% in Europe.

Writing in the BBC’s Scrubbing Up column, CRUK experts said patients were receiving older types of radiotherapy – or having to travel abroad for care.

The UK’s cancer tsar said plans were being developed to improve care.

The number of people receiving radiotherapy in the UK tripled between 2000 and 2009, and the number of radiographers (the health service staff who delivers radiotherapy) rose by 40% between 2000 and 2006.

But CRUK estimates that, in total, only 38% of cancer patients in England are getting radiotherapy – although research shows that up to 50% might benefit.

The charity says differences in staffing levels and equipment means UK health care trusts are failing to offer equal opportunities for patients to receive radiotherapy.

And for those patients who are being offered radiotherapy, many suffer unacceptably long waiting times before receiving their treatment, the charity says.

It believes a lack of public awareness about radiotherapy’s importance in treating cancer is affecting treatment provision.

A survey of 2,000 people for the charity found only one in 10 knew radiotherapy helps cure 40% of cancer patients.

The survey showed the public is more likely to rate other treatments – surgery, chemotherapy or targeted drugs – as “cutting edge” treatments.

Experts say the UK is lagging behind the US and Europe in introducing new, more targeted radiotherapy technology, such as intensity modulated radiotherapy (IMRT) or image guided radiotherapy (IGRT).

IMRT uses computers to control the radiotherapy machine to vary the intensity of the radiation beams, helping to closely match the three dimensional shape of the tumour.

It gives very precise doses to a cancer or to specific areas within the tumour while minimising the dose to nearby tissues.

IGRT takes images of the cancer before and during radiotherapy so the doctor can make sure the treatment is precise and accurate.

Professor Gillies McKenna, director of the Gray Institute for Radiation Oncology and Biology at the University of Oxford, said: “Radiotherapy is a critical part of cancer treatment.

“We know that around 20% of cancer patients receive IMRT in Europe, while the UK is only delivering it to 7% of patients.

“This newer type of radiotherapy is more effective in delivering targeted treatment, minimising side-effects to other parts of the body.”

Harpal Kumar, chief executive of CRUK said: “Radiotherapy has improved substantially over the last 10 years, but there are vital areas that need to be addressed to help deliver the best treatment for patients.

“Radiotherapy needs the same level of public support that new drugs have. We have seen awareness helping steer priorities with other treatments and believe this should happen with radiotherapy.”

He said: “It’s important that all areas of the UK offer the same opportunities for patients to have radiotherapy wherever they live.”

Professor Sir Mike Richards, the government’s national cancer tsar, said: “Delivering state of the art radiotherapy is a complex operation.

“We are now planning ways to boost services to meet the needs of future cancer patients so we can offer radiotherapy to all those who would benefit from it.”

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

UK radiotherapy ‘lagging behind’ is a post from: Medical Business Cafe

Scientists say they have established one reason why gum disease may increase the risk of heart disease.

The link between gum and heart problems has long been recognised but it is unclear if poor oral health is simply a marker of a person’s general wellbeing.

UK and Irish experts now say bacteria enter the bloodstream via sore gums and deposit a clot-forming protein.

The findings are being presented at a meeting of the Society for General Microbiology.

Earlier this year a Scottish study of more than 11,000 people found people who did not brush their teeth twice a day were at increased risk of heart disease.

It backed up previous findings suggesting a link, but researchers stressed the nature of the relationship still needed further analysis.

Protective platelets

Scientists from the University of Bristol working with the Royal College of Surgeons in Ireland now suggest it is the Streptococcus bacteria – responsible for causing tooth plaque and gum disease – which may be to blame.

Their work shows this bacteria, once let loose in the bloodstream, makes a protein known as PadA which forces platelets in the blood to stick together and clot.

“When the platelets clump together they completely encase the bacteria.

“This provides a protective cover not only from the immune system, but also from antibiotics that might be used to treat infection,” said Professor Howard Jenkinson, who led the research.

“Unfortunately, as well as helping out the bacteria, platelet clumping can cause small blood clots, growths on the heart valves, or inflammation of blood vessels that can block the blood supply to the heart and brain.”

While maintaining good dental hygiene could minimise the risk, the team is also investigating how the platelet-activating function of the protein PadA can be blocked.

Professor Damian Walmsley, scientific adviser to the British Dental Association, said: “Research such as this makes a welcome contribution to further understanding the nature of the relationship between gum disease and heart disease.

“It also underlines the high importance of brushing twice a day with fluoride toothpaste, restricting your intake of sugary foods and drinks and visiting the dentist regularly in order to maintain good oral health.”

The British Heart Foundation said that were other factors besides oral health which had a greater impact on heart health.

But their senior cardiac nurse Cathy Ross added that combining good oral health care “with a healthy diet, not smoking and taking part in plenty of physical activity will go a long way in helping you reduce your overall risk of heart disease”.

This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Gum and heart link ‘breakthrough’ is a post from: Medical Business Cafe