Med Blog

Expectant mums who are low in a hormone made by the thyroid gland in the neck are more likely to struggle in labour, findings suggest. Too little of the hormone thyroxine is already known to complicate pregnancy, increasing the risk of miscarriage, premature birth and pre-eclampsia.

Now a Dutch team has found even “low to normal” levels of thyroxine may cause problems, Clinical Endocrinology says. Babies were more often positioned wrongly, making labour more difficult. Although still head down, the babies tended to face the wrong way – towards their mother’s back rather than stomach.

Not only are these labours generally longer and harder, they are also more likely to end in an assisted delivery with forceps, ventouse or a Caesarean. It does highlight the importance of checking thyroid hormone levels in pregnancy.

The researchers from the University of Tilburg believe the hormone problem is so common – affecting about one in 10 pregnancies – a blood test for it should become a routine part of the antenatal check. In their study of nearly 1,000 apparently healthy mums-to-be, lower levels of thyroxine at 36 weeks of pregnancy was strongly linked to abnormal positioning of the baby’s head and risk of assisted delivery.

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Professor Victor Pop and his team believe the relative lack of hormone might stop the unborn child moving as well as it should. This means that instead of getting into the optimal position for labour, the baby is stuck in a more awkward one.

The thyroid gland in the neck makes hormones that regulate metabolism. Too much of these hormones speeds up metabolism causing symptoms like weight loss and anxiety. Too few of the hormones slows metabolism causing problems like fatigue and weight gain. Medication can correct the imbalance

Professor Pop said: “Recent findings have shown that motor development in children at the age of two is related to low levels of thyroid hormone in pregnancy.
“It follows that impaired maternal thyroid function could also influence foetal movement.” The baby is unable to make its own thyroid hormones until 20 weeks into the pregnancy. Before this, it is entirely reliant on its mother’s stores, he said.

Professor Pop said more work was needed to explain the link found and to see if giving pregnant women extra thyroxine, even if they do not have full-blown thyroid disease, would be beneficial. Professor John Lazarus, an expert in endocrinology at Cardiff University School of Medicine, said the link found was not necessarily causal. “However it does highlight the importance of checking thyroid hormone levels in pregnancy.”

Hospitals are fiddling a four-hour A&E wait target by using other wards as dumping grounds, the Conservatives say. Data from 114 NHS trusts in England found many patients faced long waits in assessment units which did not count towards the waiting time. Over a fifth of units reported keeping patients longer than the recommended 24 hours with the average wait being 17. Doctors agreed the system was being abused in places, but the government said the research was “misleading”.

The Conservatives asked hospitals to provide data on their use of these wards under the Freedom of Information Act.We expect assessment units to be used to improve patient care, not as a ‘holding area’ or to avoid breaching the A&E four-hour standard. The units are commonly known as emergency assessment or clinical decision units. They effectively act as a half-way house between A&E and hospital to allow patients to continue to be monitored before a decision is taken to continue treating them or discharge them.

Many are mixed-sex and do not have proper beds, leaving patients to rest on trolleys. Shadow health secretary Andrew Lansley said: “Labour complacently claim that they have abolished long waits for patients being admitted to hospitals, but these figures show that all they have really done is fiddle the figures.

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It is not the first time the way the target is being met has been criticised. Both the British Medical Association and academics at London’s City University have raised concerns over the last few years about the use of assessment units. John Heyworth, from the College of Emergency Medicine, said the four-hour target, introduced in 2004, was not working as well as people believed it was. “There is a continuing amount of gaming going on,” he said. “We know these areas are being used frequently purely to admit patients to meet the target and quite often they are not properly equipped or staffed.” He adds doctors would like to see more flexibility in the target to allow them to continue monitoring patients for longer than four hours when appropriate.

Nigel Edwards, policy director of the NHS Confederation, which represents hospital trusts, said it was likely patients were being moved to provide more time for tests, as the four-hour target did not give medical staff “very much leeway”.

Health minister Gillian Merron pointed out before Labour came to power patients were facing long waits. She said the Tory figures were “misleading” as some of the units were observational wards which had been designed and equipped to care for patients for a while. But she added: “We expect assessment units to be used to improve patient care, not as a ‘holding area’ or to avoid breaching the A&E four-hour standard.”

It would seem that the NHS is under so much pressure to change to many things at once, no wonder they are overstretched due to the sheer number of people they have to see when they have a mountain of paperwork to complete. So we shouldn’t blame them for attempting to modify procedure so that they appear to conform to the standards set by the government as they are aware that they risk funding being reduced if they don’t conform.

Sedentary lifestyles are making children less fit – even among those who are not obese, a study suggests. Essex University staged fitness tests on 600 10-year-olds a decade apart in an area with low levels of obesity.

They found significant falls in fitness levels, concluding the average 10-year-old in 1998 could beat 95% of youngsters in 2008 in running tests. The researchers said the focus on obesity was obscuring the health risks of wider declines in fitness levels. Children are routinely weighed and measured in schools in England as part of the government’s drive to tackle rising obesity rates, but there is no equivalent for fitness.

The measurement of obesity alone may not be sufficient to keep an eye on children’s future health. The Essex team of sports experts chose to focus on Chelmsford, an affluent town with traditionally low levels of obesity, to illustrate how being a normal weight did not necessarily equate to having good fitness. In 1998, they carried out 20m shuttle run tests – commonly known as the bleep test – on 303 children from six schools. In 2008, the tests were repeated on a similar number of 10-year-olds, the Archives of Disease in Childhood reported.

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While obesity levels had hardly changed, there was a significant shift in fitness which was “large and worrying”. Researchers said similar if not worse findings would be expected in areas with high levels of obesity.

Lead researcher Dr Gavin Sandercock said: “The measurement of obesity alone may not be sufficient to keep an eye on children’s future health. We need some form of monitoring of fitness. “We have a generation of children who are spending more and more time in front of a screen, whether it is a TV or a computer.

“Schools are now trying to do more, but it is the lack of unstructured activity outside that is the problem.” Professor Alan Maryon-Davis, president of the Faculty of Public Health, said: “We have been concerned about the sedentary lifestyles of children for some time.The focus on obesity is right at the moment because it is more directly linked to chronic conditions such as diabetes and heart disease.”

A Department of Health spokesman said promoting physical activity remained a “top priority” and a key part of the obesity drive. She added Change4Life, the government’s campaign to promote healthy lifestyles, had “kick-started a lifestyle” revolution since it was launched in January.

A 30-year-old man thought to have died in January from vCJD belonged to a genetic group that had not shown any signs of the disease, scientists say. In the UK, 166 people have died of variant CJD, linked to eating BSE-infected beef, and all were thought to have shared a certain gene. Writing in the Lancet, the scientists say Grant Goodwin, of Lanarkshire, had a different version of the gene.

They estimate that up to 350 people in this group could get vCJD.
Scientists have always thought that a second wave of vCJD cases would emerge some time after the first.
This is the first indication that this theory is being borne out with the identification of the first probable vCJD patient outside of the initial genetic group.

Thomas Goodwin believes his son Grant was incubating the disease for much of his life. It is probable because the diagnosis is based on observations of the progression of the disease rather than post-mortem tests which would have provided absolute confirmation of the disease, he adds.

The case report written by Professor John Collinge, of the National Prion Clinic, and colleagues is a reminder that the disease has not gone away. Many thousands of people may be carrying the infection and although they will never show any symptoms, they have the potential to infect others. The majority of the UK population have potentially been exposed to BSE prions but the extent of clinically silent infection remains unclear

vCJD is caused by infectious agents called prions. Prion diseases affect the structure of the brain or other neural tissue and are currently untreatable. Disease-causing prions are thought to consist of abnormally folded proteins, which spread by encouraging the normal healthy prion protein found on the surface of most cells in the body to change shape.

Tests showed that Mr Goodwin had a heterozygous version of the gene which codes for the human prion amino acids valine (V) or methionine (M). People can be V V (homozygous), M M (homozygous) or M V (heterozygous).

Since 1994, around 200 cases of vCJD have been identified worldwide, and all those tested have been M M homozygous.However, Mr Goodwin was M V heterozygous. It is thought that 47% of the population have this version of the gene. “About a third of the UK population are M M homozygous. “If individuals with other genotypes are similarly susceptible to developing prion disease after BSE prion exposure, but with longer incubation periods, further cases would be expected.”

The scientists have previously looked at another prion disease in New Guinea, called kuru, which is induced by eating infected human tissues. The original cases were all M M but more recently M V have appeared.
They say this indicates that M V people can get prion diseases like kuru but have a much longer incubation period.

A Department of Health spokesperson said: “”The Spongiform Encephalopathy Advisory Committee (SEAC) have noted this finding, which confirms the need for ongoing vigilance and robust surveillance of CJD.
“We are continuing to provide resources for CJD surveillance and research, and the development of a test for vCJD remains a priority.”

Israel is to become the first country to give donor card carriers a legal right to priority treatment if they should require an organ transplant. The law has been changed to try to boost donation rates, as there is a shortage for organs for donation. Partners and close relatives of those with signed donor cards will also move up the queue, The Lancet medical journal reports.

Critics say patients should be treated on the basis of clinical need. Writing in The Lancet, Professor Jacob Lavee, of the Sheba Medical Centre, one of the leading advocates for the reform, describes Israel’s organ donation statistics as “grim”. We would have serious concerns about a system that would move away from treating patients on the basis of clinical need

Only one in 10 adults in Israel carries a donor card. In the UK about one in four adults is on the organ donor register. In 2006, the Israel National Transplant Council established a special committee, including ethicists, philosophers, religious representatives and transplant surgeons to review the problem.

Their proposal to bring in non-medical criteria for organ allocation required legislation by the Israeli parliament.
Under the planned point-based system, people who have signed a donor card will be given priority for a transplant. However, there will be no preference for live donors who give to a chosen recipient rather than the wider waiting list.

Patients requiring an urgent transplant because of their serious condition will continue to have priority, regardless of the new points-scheme. But if there are two people in this situation who are equally suitable for a donated organ, the priority system will come into play. Professor Lavee said the new policy “provides an incentive for individuals to agree to help each other”.

It is important that donated organs are available for those who need them most. Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, voiced strong misgivings.”We would have serious concerns about a system that would move away from treating patients on the basis of clinical need,” she said. “Once you start prioritising certain groups, for example those that sign up to the organ register, patients who are really sick and in danger of dying if they don’t receive an organ may end up being pushed to the back of the queue”.

Mubeen Bhutta, Policy Manager at the British Heart Foundation, said: “This interesting new law in Israel highlights the challenges facing countries around the world seeking to increase the availability of donated organs. “However, it is important that donated organs are available for those who need them most. The BMA and BHF both support the introduction of presumed consent, where instead of opting into donation by signing a register – as happens in the UK – people would be required to state if they did not want their organs to be used for transplantation.

This approach also has the strong backing of the Chief Medical Officer for England, Professor Sir Liam Donaldson, who announced this week that he would step down from the post next May. “I would love to see presumed consent on organs,” he said. “This prissiness about the idea of giving organs to somebody after you have died – I think it’s something that’s not supported by the public.” The Department of Health in England says the UK’s organ donation system has to ensure that patients are treated equally and fairly, based on their need and the importance of achieving the closest possible match.

A spokesman said: “More people are signing up to the organ donor register than ever before but, despite this, three people die every day while waiting for a transplant and more donors are needed. “We aim to see donor rates increase from 800 donors to 1,400 donors per year by March 2013, and 20 million people on the organ donor register by 2010, working towards 25 million by 2013.”

Preparations for the new policy in Israel will start in the new year with a publicity campaign.
The new arrangements will come into force in January 2011, with priority going to all those who have had a signed donor card for at least a year.

High levels of a hormone that controls appetite appear to be linked to a reduced risk of developing Alzheimer’s disease, US research suggests. The 12-year-study of 200 volunteers found those with the lowest levels of leptin were more likely to develop the disease than those with the highest. The JAMA study builds on work that links low leptin levels to the brain plaques found in Alzheimer’s patients.

The hope is leptin could eventually be used as both a marker and a treatment. The hormone leptin is produced by fat cells and tells the brain that the body is full and so reduces appetite. It has long been touted as a potential weapon in treating obesity. But there is growing evidence that the hormone also benefits brain function.

Research on mice – conducted to establish why obese patients with diabetes often have long-term memory problems – found those who received doses of leptin were far more adept at negotiating their way through a maze. The latest research, carried out at Boston University Medical Center, involved regular brain scans on 198 older volunteers over a 12-year period.

A quarter of those with the lowest levels of leptin went on to develop Alzheimer’s disease, compared with 6% of those with the highest levels. “If our findings our confirmed by others, leptin levels in older adults may serve as one of several possible biomarkers for healthy brain ageing and, more importantly, may open new pathways for possible preventive and therapeutic intervention.”

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “Previous studies have shown that obesity in mid-life is associated with an increased risk of dementia, but this new research suggests that leptin might have a role to play. “There is evidence that leptin has functions in the brain – further studies in this area could lead to the possibility that this hormone plays a role in new treatments for Alzheimer’s.” Susanne Sorensen, head of research at the Alzheimer’s Society, described the research as “important”.
She said: “Further investigation is now needed to understand this relationship. This could move us closer to understanding the causes of the disease and provide vital information for drug development.”

A Study suggest that a widening class gap is likely to be seen in the coming years in childhood obesity.
Previous research suggested rates in England may be levelling off, however the University College, London team found this was happening most in children aged two to 10 from wealthier backgrounds.

Research suggests that obesity rates among the lower classes were likely to be significantly higher by 2015 – for girls the levels may even be double. They analysed data gathered by the government-funded Health Survey for England. Currently 6.9% of boys and 7.4% of girls are obese – with the difference between the lower and higher classes 0.6% and 1.5% respectively for boys and girls.

The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups. Using historical trends, they predicted that by 2015 obesity rates could be above 10% for boys and 8.9% for girls.

Depending on the extent of the “levelling off” reported last month, the overall rates could be even lower.
However, it is the findings for social class that have shed even more light on the obesity problem.
The obesity rates for girls are likely to diverge from now on, the team said. Among those from lower classes it is expected to keep rising to 11.2%, while for those from professional backgrounds it is likely to fall to 5.4%.

Among boys, both groups are likely to see a rise, but it will be faster in the lower class group, meaning 10.7% of this class boys will be obese compared with 7.9% of those from wealthier backgrounds. Similar trends will also be seen in older aged children.

Lead researcher Dr Emmanuel Stamatakis said: “This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.” “The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups.”
Tam Fry, of the National Obesity Forum, agreed awareness was more likely to be greater among wealthier families.

But he added: “It is also often quite expensive and time-consuming to buy healthy food and that puts wealthier parents at an advantage.” He said it was not clear why the differences were so marked in girls, although he said he suspected it was partly to do with the fact that boys tend to be more active generally.
The Department of Health said there was still more to do despite the levelling off which had been seen.
A spokesman said: “Obesity levels are still too high. We’ll only turn the tide on obesity for good if everyone – government, families and industry – play their part.”

A major trial of a vaginal microbicide has produced no evidence that its use reduces the risk of HIV infection in women. The gel, PRO 2000, is intended for use before sexual intercourse to help reduce HIV infection.
It was tested in a trial involving 9,385 women in four African countries. The risk of HIV infection was not significantly different among women supplied with the gel than in women given a placebo gel.

It was hoped microbicide gels would prove to be an effective way to limit the spread of HIV, as experts admit that condom promotion alone has not controlled the epidemic. New ways of curbing the spread of HIV are badly needed, particularly in sub-Saharan Africa, where nearly 60% of those infected with the virus are women.

Women are often forced to take part in unsafe sex, and are biologically more vulnerable to HIV infection than men – so in theory a gel they could apply themselves could be effective. A previous, smaller trial suggested PRO 2000 could reduce the risk of HIV infection by 30%. But the latest study, carried out by the Microbicides Development Programme, a not-for-profit partnership of 16 African and European research institutions, failed to find any positive effect.

And the researchers say the trial was large enough to provide conclusive results. The women who took part were given the gel together with free condoms and access to counselling about safe sex. Lead researcher Dr Sheena McCormack, of the Medical Research Council, which part-funded the study, said: “This result is disheartening. Nevertheless, we know this is an important result and it shows clearly the need to undertake trials which are large enough to provide definitive evidence for whether or not a product works.”

Professor Jonathan Weber, from Imperial College London, who also took part in the study, said: “It is unfortunate that this microbicide is ineffective at preventing HIV infection, but it’s still vital for us as scientists to continue to look for new ways of preventing HIV. Now that we know this microbicide is not the answer, we can concentrate on other treatments that might be.”

To some extent this trial could be viewed as being unethical due to the fact that it used African women, who are living in very poor conditions, I am aware that Some parts of Africa have the highest rates of HIV but this does not meant that it is ok to exploit this factor. Using only African women in the study also creates biased results because the population does not contain only African women and we know that certain ethnicities are prone to some diseases more so than others so just because it didn’t work with African women who’s to say that it wont work with other women?

University of Sheffield researchers claim that NHS walk-in centres near railway stations are not popular with commuters and are a waste of money.

A five-year pilot programme of six centres near stations in London, Newcastle, Manchester and Leeds was set up in 2004 as part of a £50m programme. But a study has found they are seeing as few as 30 patients a day and cost twice as much as other GP surgeries. The government said the clinics offered a “valuable service”.
The commuter walk-in centres were initially funded by the Department of Health as part of an expansion of GP services.

Unlike other nurse-led walk-in centres, the commuter clinics – which open from 0700 to 1900 Monday to Friday – also offer access to a doctor. While they are paid for by the NHS, they are actually run by private health firms. The Department of Health-funded evaluation found that the clinics were seeing between 33 and 101 patients a day, despite having capacity for 150 to 180 patients.

Four of the centres were in a poor location away from the beaten track, the study – reported in the British Journal of General Practice – concluded. It was estimated that the price per attendance at the clinics was £33 compared with an estimated £13 for walk-in centres provided by the NHS. At some centres, the cost per patient was as high as £62.

Study leader Dr Alicia O’Cathain said the results showed that walk-in centres should be provided by the NHS, rather than private companies. And she added that they needed to be placed near where people work, rather than at train stations. “One of the problems was location, so one for example was near the train station but wasn’t on the commuter track and there were very few people who went through that way. At the start and end of the day people are in a rush, but the way that people use walk-in centres is to go in their lunchtime.”

She said the contracts, which were paid up-front regardless of the number of patients seen, would not expire until next year. Professor Steve Field, chairman of the Royal College of GPs, said it was right the scheme was piloted before being rolled out further, but a five-year contract was probably too long. “Access to quality general practice is important, but clearly these pilots have shown this is not an effective use of resources.
“We still need to look at how we can provide care where patients need it.”

A spokesman for the Department of Health said: “It will be for primary care trusts to decide whether to continue providing these services and whether they offer the best value for money. These centres have proved a valuable service to young, mobile patients who we know struggle to access existing GP services.”

It would seem that the study has shown that these clinics are not viable. The idea in theory makes sense as it provides commuters an potentially more convenient access to healthcare but commuters are usually rushing to work and are usually exhausted when they finish, the clinics location may be better situated in the city centres so that they can be accessed when the commuters are on their lunch breaks.

NHS figures show that over one in five children in England start their school life overweight or obese. Shockingly this rises to 1 in 3 by the end of primary school, which makes the child approximately 11. The statistics showed that obesity levels were higher in London, the North East and West Midlands than elsewhere in 2008-9.

The data revealed that more boys than girls were overweight in both reception and year six, 24% of boys aged four to five were overweight or obese, while 21.5% of girls were. In the 10 to 11-year-old age group, 34.5% of boys and 30.7% of girls weighed too much.

Public health minister, Gillian Merron, said evidence is stacking up to suggest that child obesity is “levelling off. It’s important to monitor children’s weight and wellbeing, and I’m glad that we achieved a 90% take up of the scheme. But we need to keep the momentum going.We’ll only turn the tide on obesity for good if everyone plays their part.”

It is already known that obesity can cause health problems such has heart disease and diabetes but the scary factor is that we could out live our children should this problem not be addressed and measures put in place to correct the problem.