Elderly need more 'sun vitamin'

Spending more time in the sun could help older people cut their risk of heart disease and diabetes say experts. Sun exposure helps the skin make vitamin D - a vitamin older people are generally deficient in due to their lifestyles and ageing processes. A team at Warwick University has shown a deficiency increases the risk of metabolic syndrome, which is linked to diabetes and cardiovascular disease. Their study of more than 3,000 people is published in Diabetes Care.

The researchers say older people would benefit from more sunshine, although it is still important to be sensible in the sun as UV damage is linked with skin cancer. Among the 50 to 70-year-olds living in China that the scientists studied, 94% had a vitamin D (25-hydroxyvitamin D) deficiency or insufficiency and 42% also had  metabolic syndrome.

Lead researcher Dr Oscar Franco says the same can be seen in British and American populations too. "Vitamin D deficiency is becoming a condition that is causing a large burden of disease across the globe with particular deleterious impact among the elderly. "We found that low vitamin D levels were associated with an increased risk of having metabolic syndrome, and was also significantly associated with increased insulin resistance."

Metabolic syndrome's cluster of obesity, high blood sugar, high blood pressure and high cholesterol can lead to heart disease, stroke and diabetes. Vitamin D is mainly obtained from exposure to the sun, as well as from certain foods such as oily fish and eggs. There are concerns that many people, including the elderly, pregnant women and those who wear all-concealing clothing do not get enough of the vitamin.

Dr Franco said there were many factors which could explain why older people had less vitamin D in their blood, including changes in lifestyle factors such as clothing and outdoor activity. "As we get older our skin is less efficient at forming vitamin D and our diet may also become less varied, with a lower natural vitamin D content. "When we are older we may need to spend more time outdoors to stimulate the same levels of vitamin D we had when we were younger."

Lorna Layward from Age Concern and Help The Aged said: "We have always advocated that older people get out into the sunshine for a bit each day if they can. A bit of sun is good for you. "We hear a lot about sun exposure and the risk of cancer, but older people tend to be at the other end of the spectrum. They do not get enough sun and tend to cover up and wear more clothing."

Ed Yong of Cancer Research UK said: "The amount of sunlight it takes to make enough vitamin D is always less than the amounts that cause reddening or burning, so it should be possible to get the benefits of this vitamin without increasing the risk of skin cancer. "Elderly people can also boost their vitamin D levels by eating foods like oily fish, or by using vitamin D supplements on the advice of their GP."

Copyright BBC Health News Monday 18th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8043297.stm

Heart disorder Alzheimer's link

A common heart disorder has been linked to a raised risk of Alzheimer's disease by US researchers. Atrial fibrillation causes the heart to beat chaotically, increasing the risk of blood clots and, if the condition is left untreated, stroke. It has previously been linked to some types of dementia - but not Alzheimer's, the most common form.

The study, by Intermountain Medical Center in Utah, was based on more than 37,000 patients. The study found atrial fibrillation patients under the age of 70 had a 187% greater risk of all types of dementia compared with the general population. But their specific risk of Alzheimer's disease was also up - by 130%. However, the overall risk of Alzheimer's for all patients remained low.

Lead researcher Dr Jared Bunch said: "Previous studies have shown that patients with atrial fibrillation are at higher risk for some types of dementia, including vascular dementia. "But to our knowledge, this is the first large-population study to clearly show that having atrial fibrillation puts patients at greater risk for developing Alzheimer's disease."

Alzheimer's, which accounts for up to 80% of all dementia cases, is known to be linked to age and genetics. It has long been suspected that poor heart health may also play a role.

The researchers said more research was needed to explain why atrial fibrillation may raise the risk of Alzheimer's. They put forward several theories for a possible link. They suspect atrial fibrillation damages the small blood vessels, potentially reducing blood flow to the brain. Alternatively, the condition is linked to tiny micro-strokes, the damage from which may accumulate over time, making Alzheimer's more likely. Thirdly, atrial fibrillation is associated with a general increase in inflammation throughout the body, again a possible risk factor for Alzheimer's.

Researcher Dr John Day said: "Now that we've established this link, our focus will be to see if early treatment of atrial fibrillation can prevent dementia or the development of Alzheimer's disease."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "If research helps us understand the relationship between the two conditions, we will be in a better position to develop desperately needed new treatments. "We can all lower our dementia risk by maintaining a balanced diet and taking regular exercise, which is also good advice for protecting your heart."

Alasdair Little, cardiac nurse at the British Heart Foundation, said: "This is an interesting study which adds weight to previous data indicating a link between atrial fibrillation - a common disturbance of heart rhythm - and dementia. "The risk factors for heart disease and dementia are very similar so it is not surprising that in some people they co-exist. "Further research into both conditions is needed to understand whether there is a causal link between the two."

Details of the study were presented to the Heart Rhythm Society in Boston.

Copyright BBC Health News Monday 18th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8051800.stm

Simulators 'make surgeons better'

Using simulators to train surgeons makes them quicker and better, a study shows. The Danish research comes after calls to introduce strict guidelines for NHS doctors. Unlike many other countries the use of simulators is not a formal part of the training process. But the Copenhagen University Hospital team said it should be after monitoring the performance of 24 junior doctors carrying out keyhole surgery.

The researchers put the obstetrics and gynaecology medics in two groups - one which had the traditional training of working alongside doctors and tutoring and another which supplemented this with seven hours simulator training. They found that those that used the computer simulators were twice as quick, taking just 12 minutes to complete the operation on a patient. They also carried out better procedures, according to a points system used to judge the quality of the work.

Lead researcher Christian Rifbjerg Larsen said: "Simulator training should be incorporated into the curriculum for all surgical trainees before they embark on patient procedures. "This can potentially improve patient safety and improve operation room efficiency."

The publication of the study in the British Medical Journal comes after Sir Liam Donaldson, England's chief medical officer, called for more simulation training in the NHS. In his annual report in March, he said simulators "reduce errors and make surgery much safer".

Simulators are already used in the NHS for everything from practising surgery to administering drugs. But unlike other countries, such as Israel, there are no strict guidelines about how much time doctors should spend on them.  The British Medical Association is also keen on increased use of simulators, although it has said real-life training with consultants should not be compromised.

Roger Kneebone, an expert in surgical education at Imperial College London, agreed. He said: "Simulation offers obvious benefits. Sophisticated virtual reality simulators can provide anatomically realistic recreations of many operations." But he added trainee surgeons also needed to develop communication and leadership skills as well as be ready for the unexpected - all of which required different training to simulators.

Health Minister Lord Darzi said high quality training is essential. "In my own career as a surgeon I have seen the huge benefits which innovations in surgical simulation have made possible so I am pleased but not surprised by these findings which we welcome. "We are working with NHS colleagues to develop a new strategy for simulation-based training in order to ensure the best training for doctors and the best quality of care for our patients." 

Copyright BBC Health News Friday 15th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8050633.stm

Smoking gene link in pregnancy

A gene can explain why some women find it more difficult to stop smoking during pregnancy, say UK researchers. In a study of 2,500 women who smoked before falling pregnant, the "addictive gene" was associated with a lower chance of quitting once pregnant. Overall, 28% of pregnant smokers quit in the first three months compared with 21% of those with two copies of the gene and 31% without the gene. The findings appear in the journal Human Molecular Genetics.

The researchers from Peninsula Medical School say there is no reason why the finding would not also be true in other groups of smokers attempting to quit but they wanted to look at pregnant women because they have a particularly strong incentive to break the habit. They used data on a total of 7,845 women of European descent from the South West of England who took part in the Avon Longitudinal Study of Parents and Children.

A specific genetic variant associated with the nicotine receptor was analysed because it had previously been found to be associated with how much people smoke once they start. By the final three months of pregnancy, 47% of women with two copies of the non-addictive gene said they had stopped smoking, compared with only 34% of women with two copies of the smoking addiction gene. The researchers said pregnant women are under considerable and social pressure to stop smoking but there are a number of factors which influence whether they quit, including age, education, and whether or not their partners smoke.

"However, we were keen to investigate whether the genetic variant that influences increased cigarette consumption also had a role to play as an extra hurdle to quitting smoking during pregnancy, and our study suggests that it does," says researcher Dr Rachel Freathy.

Co-author Professor Tim Frayling, an expert in human genetics, said: "There are parallels with the obesity gene in that people think it's matter of self control but it's more complicated than that. "It's clear that some women with two copies of the addictive gene can give up, it just means it's more difficult for some people than others."

The team are now planning to investigate the same genetic variant in people with Chrohn's disease who are also strongly advised to stop smoking as it makes their condition worse.

Dr Alex Bobak, a GP in Wandsworth, south London, has a special interest in smoking cessation - he said genes had been implicated in nicotine addiction but that there are many other factors which have an impact, including social circumstances. "The positive thing is we can look at this sub-group and see if they benefit more from certain kinds of treatment to help them stop smoking." He added that NHS support was available for pregnant women who are able to take all forms of nicotine replacement therapy.

Copyright BBC Health News Friday 15th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8050240.stm

Folic acid protects baby hearts

Mandatory fortification of bread with folic acid would slash the risk of babies being born with a heart problem, experience from Canada shows.

Rates of severe congenital heart defects among newborns in Quebec fell significantly after the move to fortify flour and pasta began in 1998. The British Medical Journal online study lends support to calls for introducing fortification to Europe. But others argue against this, saying it would inevitably harm some people. The fear is that adding folic acid to products like bread could harm some elderly people if they are deficient in other B vitamins. In extreme cases, this can cause irreversible damage to the nervous system. There is also concern that it may also increase the risk of certain cancers, including bowel cancer, in some people.

In 2007 the UK's watchdog, the Food Standards Agency, agreed with expert recommendations to fortify bread or flour with folic acid. Since then, at the request of the Chief Medical Officer, an expert working group on folate has been considering the results of recent trials looking at the effect of folic acid on the risk of some types of cancer. The group is expected to report back to Sir Liam Donaldson this summer.

Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and green leafy vegetables. Pregnant women and those trying to conceive are already advised to take folic acid supplements to reduce the risk that their baby will have a "neural tube" birth defect like spina bifida. But uptake is not ideal, particularly because some pregnancies are unplanned and can go unnoticed for some weeks.

The latest work suggests folic acid also cuts the risk of baby heart defects. In the seven years after fortification was introduced there was a 6% drop per year in the birth prevalence of severe heart defects. This compares with a 9% drop in neural tube defects.

Writing in the BMJ, lead author Professor Louise Pilote of McGill University in Montreal, said: "Given that severe congenital heart defects require complex surgical interventions in infancy and are associated with high infant mortality rates, even a small reduction in the overall risk will significantly reduce the costs associated with the medical care of these patients and the psychological burden on patients and their families."

The British Heart Foundation said the risks and benefits of fortification must be carefully weighed. A spokeswoman said: "This Canadian study shows that when folic acid was added to flour and pasta the number of babies born with certain severe heart conditions was reduced. "While the decrease in babies born with heart conditions during this time is statistically significant, many children were still born with congenital heart disease. "This must be taken into account when considering the benefits of routinely introducing folic acid to flour and pasta in the UK. "Especially because routine introduction could pose a risk to some elderly people as potentially dangerous vitamin B12 deficiency can be masked by high intake of folic acid."

Dr Sian Astley, a scientist for the Institute of Food Research, said: "Personally, I do not think mandatory fortification is the way forward. It is like using a sledge hammer to crack a nut. "It would reduce ill health in children but there are cautionary issues. "An alternative would be to fortify only certain foods and clearly label them so consumers can make the choice. Co-fortification with other B vitamins would be another sensible option." She said the IFR believes there is still insufficient evidence to make a decision about whether the benefits of fortification would outweigh the risks.

Copyright BBC Health News Friday 15th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8045212.stm

Home light therapy psoriasis hope

A specialist light treatment for psoriasis is just as effective and safe when given at home as in hospital, say Dutch researchers. Phototherapy using UVB light is rarely used in the UK because of limited availability and the number of hospital visits required. But a study of 200 patients found the same results with home treatment. One UK expert said the British Medical Journal study highlighted an important treatment gap in psoriasis care.

Psoriasis is a common disorder caused by too rapid production of new skin cells, causing red scaly patches. Up to 3% of the UK population is affected by the non-contagious condition which can cause significant disability. For those who have access to UVB treatment at their local dermatology unit, a course usually entails three visits each week for between eight to 10 weeks. It works by dampening down the immune overreaction in the skin. One reason that the treatment is usually done in hospital is because most dermatologists believe that home phototherapy is inferior and that it carries more risks.

In the latest study, patients with psoriasis from 14 hospital dermatology departments were randomly assigned to receive either home UVB phototherapy or hospital-based treatment. Home treatment was equivalent to hospital therapy both in terms of safety and the effectiveness of clearing the condition. And those treated at home reported a significantly lower burden of treatment and were more satisfied.

Study leader Dr Mayke Koek, from Utrecht University Medical Centre, said: "We knew a lot of dermatologists are not convinced of the safety and effectiveness of UVB phototherapy but our theory was they should be equally safe." "One of the most important findings was a lot of patients treated at home were more satisfied."

Professor Alex Anstey from the Royal Gwent Hospital in Newport, Wales, said with the exception of Scotland, phototherapy in the UK was limited to people who lived near a big hospital. "In my area there are very large numbers of people who don't have access to phototherapy which is a shame as it's a very effective and safe treatment." He said that the equipment - similar to a tanning bed, but a different type of light - costs between £5,000 and £10,000 but was very cheap compared with some of the new biological therapies in use and could be lent to patients for the duration of their treatment.

Gladys Edwards, chief executive of the Psoriasis Association, said the guidelines on treating psoriasis should be reviewed in light of the new research. "Patient choice is important and for some patients managing their UV treatment at home would clearly be preferable. "It is crucial, however, that there is absolutely clear guidance and information on when this is appropriate and how it should be managed for patients and clinicians."

Copyright BBC Health News Friday 8th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8038206.stm

Smear tests important in over 50s

Cervical screening continues to pick up abnormalities in women over 50, say UK researchers, despite calls to cut the programme in older women. There has been "much discussion" about whether to continue smear tests in 50 to 64 year olds, the Institute of Cancer Research team said. But a study of two million women found serious cases would not be picked up if screening was removed in this group.

Around 2,700 women are diagnosed with cervical cancer each year in the UK. The disease is the second most common cancer in women under 35 and in 99% of cases is caused by the common sexually transmitted infection HPV. The idea behind screening is to pick up pre-cancerous changes and treat them before they become an invasive disease. Women over 50 have a lower incidence of these changes or "lesions" with 10% of women in their 20s having abnormalities but only 1% in those over 50.

Previous studies have concluded that because the risk is lower in older women, screening may be causing more harm than good. But a study of smear tests done in women aged 20 to 64 years between 1988 and 2003 found that screening does in fact pick up serious abnormalities, the British Journal of Cancer reported. It showed two-thirds of abnormal smears were picked up in women who had two previous negative results in their 40s.

Removing screening in older women, even in those who have had no prior signs of lesions, would miss a group of women who develop abnormalities later in life, the researchers said. The study was carried out in the south of England where the risk of cervical cancer is less than average and so even more cases might be missed in other areas of the country they said. Currently, women aged 25 to 49 are invited for screening every three years, and 50 to 64 every five years in England. The government is reviewing the age at which screening starts as women are invited for tests at age 20 in other UK countries.

Study leader Dr Roger Blanks said if you could stop screening at 50 that would save a huge amount of money and anxiety. "But the data we have is there is not this dramatic decrease so we can't say they are no longer at risk." He added further research was needed to see if there were any "very low risk groups" where screening could be stopped.

Dr Anne Szarewski, clinical consultant for Cancer Research UK, said that sexually transmitted infections are rising at a faster rate in people over 45 than in any other age group. "We know that screening saves lives - this message has been loud and clear for younger women in recent months. "This large study adds to the recent evidence that women over 50 should continue to be screened, as they continue to be at risk of developing cervical cancer."

Copyright BBC Health News Friday 8th May 2009

Source: http://news.bbc.co.uk/1/hi/health/8038318.stm

UK young lack awareness on HIV

Too many young people are unaware of the risks of HIV, Unicef has warned. Those aged 16 to 24 account for 10% of all new diagnoses in the UK and young men who have sex with men are most at risk, a report said. More strategies to encourage young people to practise safe sex and have better access to sexual health clinics are needed, it concluded.

The UK has the highest number of new HIV infections in Western Europe - more than 7,700 in 2007. People who move to the UK from sub-Saharan Africa are also particularly at risk. Globally, girls and young women remain far more vulnerable to HIV infection than young men, accounting for two-thirds of the 5.5 million 15 to 24-year-olds with HIV worldwide. The report, which looked at problems faced in all areas of the world, said the majority of young people still lack comprehensive and correct information on HIV infection, or do not have the power to act on that knowledge.

Anita Tiessen, deputy executive director of Unicef, UK said many young people had heard of HIV and Aids but they did not know how it spread or whether they were at risk. "More attention has to be given to preventing the spread of HIV by working alongside young people to make sure that prevention work is designed and delivered in a way that is 'youth friendly' and really meets their needs. "HIV can be best avoided through a three-pronged approach - by making sure people have the right information, can access health services, and get protection when they need it," she added.

The Unicef report also pointed to recent research which shows that some young people in the UK, especially young women, find it hard to access sexual health services experiencing difficulties in making appointments and long waiting times. Sexual health services designed to address the needs of young people are urgently needed, it concluded.

Lisa Power, head of policy at the Terrence Higgins Trust, said young people knew less about HIV now than they used to and a lack of sex and relationships education in schools was partly to blame, although there are now plans to add it into the curriculum. "We need to up the level of public information on HIV and it's partly about encouraging safe sex and partly about decreasing stigma of HIV. "By next year there will be 100,000 people living with HIV in the UK and one in four of those are undiagnosed and we need to support those who are undiagnosed to get tested." She added the UK had made great advances in the treatment of HIV but that had contributed to making it "invisible".

A Department of Health spokesperson said HIV prevention remained a priority. "That is why we continue to provide funding for the Terrence Higgins Trust and for the African HIV Policy Network for work with the groups most at risk of HIV in the UK - gay men, and African communities. "This is additional to our Condom Essential Wear campaign and joint awareness campaigns with the Department for Children, Schools and Families for young people which target other sexually transmitted infections."

Copyright BBC Health News Friday 8th May 2009

'Self-monitoring device' for HIV

People living with HIV could soon monitor their own condition at home using a hand-held device, similar to ones used by diabetics . Scientists at three of London's largest research centres have been granted £2m to develop a hi-tech, finger prick blood-testing gadget. The device's tiny mechanical sensors - microcantilever arrays - measure HIV levels to warn of impending flare ups. A display then alerts the user if there is any need for them to visit a doctor.

Investigator Dr Anna-Maria Goretti, an NHS consultant and co-investigator based at the Royal Free Hospital, said: "If patients neglect to take their treatments or need prompting to see their GP the device will provide a simple way of letting them know. "It will really empower HIV patients to keep a close eye on their health and their treatments."

Instead of routinely seeing a specialist every three or so months "just in case", they would only need to see their doctor when things were going wrong. As well as reducing visits to the doctor, it could also be of real benefit in developing countries where rapid and affordable ways to monitor HIV patients are urgently needed, say the researchers. The microcantilever arrays are each coated with substances that stick to the HIV and other proteins, which are markers associated with disease progression.

Accommodating these markers causes the highly-sensitive sensors to bend like a diving board and this bend indicates the level of virus in the body, explained lead investigator Dr Rachel McKendry of University College London and the London Centre for Nanotechnology. "We have used microcantilever arrays to investigate drug resistance in superbugs such as MRSA, and are excited by the opportunity to extend this approach to detecting HIV markers," she said.

Dr McKendry is working with Imperial College London, Cambridge Medical Innovations, Sphere Medical Ltd and BionanoConsulting on the three-year project to develop the prototype hand-held device for clinical trials.

Lisa Power of the Terrence Higgins Trust said: "This is certainly a very good idea. If you have diabetes you can check your blood sugar levels. "Similarly, it would be very useful if HIV patients could check their own viral measures, say, once a month." "It would not replace specialist advice, but it would be a way to reduce a patient's dependence on doctors."

Copyright BBC Health News Thursday 7th May 2009 11:01

Source: http://news.bbc.co.uk/1/hi/health/8034336.stm

Scientists pinpoint fats danger

Scientists have identified a genetic mechanism which appears to determine which fatty deposits in the arteries have the potential to kill us. Most of these plaques pose no risk to health, but a minority burst, forming blood clots, which can cause heart attacks or strokes. A Columbia University team pinpointed a gene which seems to make plaques more vulnerable to rupture. The American study appears in the journal Cell Metabolism.

Fatty deposits begin to form in the arteries of most people in their teens, but the vast majority are harmless. However, it is thought that around 2% of plaques have the potential to burst. This can lead to the development of a clot, which can restrict blood supply to the heart or brain, with potentially grave consequences.

Scientists believe one of the key factors determining whether a plaque will burst is the make up of its inner core. The inner core of plaques vulnerable to rupture often contains a lot of dead cells. These cells release substances that can weaken the surface cap of the plaque, making rupture more likely. The Columbia team identified a gene thought to play a key role in the build up of these dead cells.

The researchers bred mice prone to develop plaques, and fed them a high-fat diet for 10 weeks. The animals which lacked the key gene tended to produce smaller plaques, and to show markedly lower levels of cell death and plaque degradation. The gene in question produces a protein which plays a central role in a mechanism used by the body to kill off cells that are damaged and unhealthy. This mechanism is key to ensuring our tissues remain in good working order. But there is some evidence to suggest that the process may sometimes become too aggressive, and may lead to problems such as neurodegenerative diseases and diabetes. And the latest study suggests it may also turn benign plaques potentially deadly.

Lead researcher Dr Ira Tabas said that previous research had suggested that this mechanism might be involved in plaque rupture, but the magnitude of the effect uncovered in the latest study was a surprise. He said: "The fact that we were able to isolate one gene encoding one protein with such a profound effect on plaque necrosis (death) was a big surprise." Dr Tabas said the finding raised hopes of new drugs which could act on the key gene, or the associated mechanism, to cut the risk of dangerous plaques. "Just about everybody in our society has atherosclerosis (thickening of the arteries) by the time we reach 20," he said. "So the wave of the future in treating atherosclerosis will be in preventing harmless lesions in young people from becoming dangerous ones, or soothing dangerous plaques so they don't rupture as we age."

Alasdair Little, a cardiac nurse at the British Heart Foundation, said: "This is a very interesting biological study to identify why some plaques that cause coronary artery disease may lead to a heart attack and others do not. "However, many more years of investigation and study will be needed before it informs clinical practice for the treatment of heart disease."

Copyright BBC Health News Thursday 7th May 2009 10:50

Source: http://news.bbc.co.uk/1/hi/health/8033205.stm