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Swine flu death of ‘healthy’ person

July 11th, 2009 | No Comments

• Latest person to die was otherwise healthy – NHS
• Experts say virus has not necessarily mutated

The first death from swine flu of an otherwise healthy individual was announced last night by NHS authorities in Essex.

At the wishes of the family, no details were given of the patient who died at Basildon and Thurrock University hospital. But the case will cause widespread concern. Until now, every adult and child who has died has had serious underlying health problems that made them particularly vulnerable to infections.

But the chief medical officer, Sir Liam Donaldson, has warned that a few apparently healthy people have succumbed to swine flu and become seriously ill abroad. In one case last month, a healthy 15-year-old teenager called Matthew Davis from Buffalo in New York state, fell ill with swine flu and died, apparently because of co-infection with the superbug MRSA, which he may have contracted in the community rather than in hospital.

Speaking last night, Donaldson pointed to the sometimes apparently random behaviour of the infection: “This death underlines that, although the virus is proving generally mild in most people, it is more severe in some cases. As with all flu-like viruses, some people are at higher risk than others. Unfortunately, people who are otherwise healthy could also become seriously ill or, sadly, die.”

But the director of public health for NHS south-east Essex, Dr Andrea Atherton, said she wanted to reassure people that the risk of transmission still remains small.

“It is important to stress that the symptoms of swine flu are, relatively speaking, mild. Unless you have flu-like symptoms and are being tested for swine flu, there is absolutely no need to stop your normal everyday activities,” she said.

Another expert, Prof Robert Dingwall, director of the Institute for Science and Society at the University of Nottingham, also struck a reassuring note. “This is not at all unexpected – there have been a few deaths elsewhere in the world among people with no obvious underlying condition.

“However, it does not really affect the growing body of evidence that the first pandemic of the 21st century is a relatively mild one and that death rates are likely to be broadly comparable with the annual toll from seasonal flu. There certainly will be more deaths like this one – but most deaths will still occur among people who have some serious underlying condition, and are already likely to be under active medical management,” he said.

John Oxford, professor of virology at Queen Mary’s College of Medicine in London and scientific director of Retroscreen Virology Ltd, said the death was to be expected and did not give any extra cause for concern: “We’ve all been gritting our teeth, waiting for this to happen, and now it has. This doesn’t necessarily mean the virus has mutated. Whether more patients with no underlying health problems die … depends on what the virus does next.”

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Swine flu death of ‘healthy’ person

July 10th, 2009 | No Comments

A hospital patient from Essex has become the first person without underlying health problems to die after contracting swine flu, it was announced today.

The patient died today at Basildon and Thurrock University Hospitals NHS Foundation Trust, NHS East of England said.

The patient’s family has asked that no details of their relative are released.

The trust said in a statement it “would like to extend their deepest sympathies to the family affected as they come to terms with their loss”.

News of the death comes as the number of people who had died while infected with the H1N1 virus has doubled in the last week.

It is thought that fifteen people with swine flu have now died since the virus was first identified in the UK in March.

Today’s death marks a new point in the outbreak as all of the previous victims were believed to have serious underlying health problems.

Yesterday Sir Liam Donaldson, the chief medical officer said that on top of the deaths, another 43 people were critically ill with the bug and a further 335 were being treated in hospital.

London and the West Midlands are on the verge of being classed as having epidemics because of the rate at which the virus is spreading.

There are 9,718 confirmed cases of swine flu in the UK but officials fear the real figure could be 10 times higher.

The US has the biggest outbreak, with 33,902 confirmed cases, followed by Mexico, with 10,262, and the UK third.

The World Health Organisation has said there have been 429 deaths from the virus worldwide and nearly 95,000 infections since it was first reported in Mexico.

Earlier today, the government said plans to deal with the pandemic could allow anyone infected with swine flu to stay off work for 14 days without a doctor’s note.

Employees can currently be off for seven days, including weekends and bank holidays, without needing a sick note from their GP.

A spokesman for the Department for Work and Pensions said: “The government is rightly considering possible measures to minimise the risk of further spread of swine-flu and protect public health.

“We don’t want people to feel obliged to leave the home or return to work when they are still unwell or put an unnecessary burden on GPs in a pandemic. Contingency plans therefore include the possibility of extending self-certification to 14 days for a limited period.”

He said the measures would “only be implemented if absolutely needed”, and the decision would be taken by the government’s civil contingencies committee.

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Breast cancer ‘being over-diagnosed’

July 10th, 2009 | No Comments

Screening for breast cancer is leading to over-diagnosis with many women undergoing unnecessary surgery and chemotherapy, scientists say

One in three women who is told she has breast cancer after screening is being diagnosed and treated unnecessarily, scientists say today.

Not all breast cancers are potential killers, say researchers in a paper in today’s British Medical Journal. Some are inconsequential. If they were not picked up, women would not know they had them. But because they are detected through breast cancer screening, women usually undergo surgery and chemotherapy which are traumatic and potentially harmful.

The Nordic Cochrane Centre group, which did the research, has identified over-diagnosis of breast cancer in the past from the original trials carried out before mammography screening was widely introduced. But in today’s paper, it calculates the extent of that over-diagnosis (detecting harmless cancers) in real populations where screening is offered in the UK, Canada, Australia, Sweden and Norway.

It is no longer contested that screening leads to over-diagnosis, according to an editorial published by the BMJ. “The question is no longer whether, but how often, it occurs,” writes Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in the US. “The NHS recently scrapped its leaflet inviting women to undergo mammography in response to criticisms that it failed to mention the major harm of screening – over-diagnosis.”

Some cancers grow so slowly that the person eventually dies of something else, while others are dormant or even regress, he says.

“Because doctors don’t know which patients are over-diagnosed, we tend to treat them all. Over-diagnosis therefore results in unnecessary treatment.

With the advent of widespread efforts to diagnose cancer earlier, over-diagnosis has become an increasingly vexing problem.”

In other cancers, it is well recognised that there is a risk of picking up and treating tumours that would have done no harm. Prostate cancer is an obvious example, where the advice to men in the UK who have a screening test (although it is far from conclusive) is to watch and wait. But neuroblastoma, melanoma, thyroid cancer and lung cancer can also sometimes be detected and yet cause no harm.

“Mammography is one of medicine’s ‘close calls’ – a delicate balance between benefit and harm – where different people in the same situation might reasonably make different choices. Mammography undoubtedly helps some women but hurts others. No right answer exists, instead it is a personal choice,” writes Professor Welch.

The study, by Karsten Jorgensen and Peter Gotzsche, looked at breast cancer trends seven years before and seven years after screening was introduced in the five countries. They also took account of other factors that may have affected the results, such as changes in background levels of breast cancer and any compensatory drop in rates of breast cancer among older, previously screened women.

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Third of breast cancer diagnoses ‘harmless’

July 10th, 2009 | No Comments

BMJ study finds that one third of women identified as having breast cancer may be treated unnecessarily

One in three breast cancer patients identified in public screening programmes may be treated unnecessarily, a new study has found.

Karsten Jorgensen and Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen analysed breast cancer trends at least seven years before and after government-run screening programmes for breast cancer started in parts of Australia, Britain, Canada, Norway and Sweden.

The research, published today in the BMJ, formerly known as the British Medical Journal, found that once screening programmes began, more cases of breast cancer were inevitably picked up.

If a screening programme is working, there should be a drop in the number of advanced cancer cases detected in older women, since their cancers should theoretically have been caught earlier when they were screened.

However, Jorgensen and Gotzsche found the national screening systems, which usually test women aged between 50 and 69, simply reported thousands more cases than previously identified.

Overall, Jorgensen and Gotzsche found that one third of the women identified as having breast cancer didn’t actually need to be treated.

Some cancers never cause symptoms or death, and can grow too slowly to ever affect patients. As it is impossible to distinguish between those and deadly cancers, any identified cancer is treated. But the treatments can have harmful side-effects and be psychologically scarring.

“This information needs to get to women so they can make an informed choice,” Jorgensen said. “There is a significant harm in making women cancer patients without good reason.”

Jorgensen said that for years women were urged to undergo breast cancer screening without being informed of the risks involved, such as having to endure unnecessary treatment if a cancer was identified, even if it might never threaten their health.

“Mammography is one of medicine’s ‘close calls’, … where different people in the same situation might reasonably make different choices,” wrote H Gilbert Welch of the Dartmouth Institute for Health Policy and Research in an accompanying editorial in the BMJ. “Mammography undoubtedly helps some women but hurts others.”

Experts said overtreatment occurs wherever there is widespread cancer screening. The NHS recently ditched its pamphlet inviting women to get screened for breast cancer after critics complained it did not explain the overtreatment problem.

Laura Bell of Cancer Research UK said Britain’s breast cancer screening programme was partly responsible for the country’s reduced breast cancer cases.

“We still urge women to go for screening when invited,” she said, though she acknowledged it was crucial for women to be informed of the potential benefits and harms of screening.

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Wake up to 20/20 vision

July 7th, 2009 | No Comments

Patrick Barkham was amazed to hear about new contact lenses that correct your vision while you sleep, leaving you lens-free all day. So he decided to give them a go

Ewwwcrrsssh! The screech of metal against wood was the moment I began to question the efficacy of miraculous-sounding contact lenses that correct impaired vision while you sleep. I was not asleep, in fact I was reversing my car, but my vision was definitely still impaired because I had just reversed into a telegraph pole. Perhaps I should have blamed my foolish decision to reverse down a dark country lane but I decided to berate my new i-GO contact lenses (“sleep, see, go”). One week into my trial and, by evening, everything was a bit of a blur.

If you have ever worn contact lenses, the idea of wearing them to sleep in is not just revolutionary, it is repulsive. Ask any contact-lens wearer who has woken from a boozy night out to find their eyelids gummed up and lenses screaming to be removed from bloodshot eyes.

But i-GO lenses are deliberately popped in at night, and removed in the morning. A new generation of gas-permeable lens, they allow oxygen into your eyes during wear, preventing your eyes from becoming dry and sore. Crucially, however, they encourage movement of cells in the epithelium, the top level of your cornea, from the centre of your eye to the periphery. These cells are gently shifted by the fluid – the tear film – between contact lens and cornea, temporarily creating a new structure to the eye.

This “overnight vision correction” treatment is called orthokeratology and the lenses are now available in ordinary opticians in major cities across England. It sounds amazing, and means you can see during the day without the need for glasses, contact lenses or laser surgery.

When I meet Kieran Minshull, my optician for the trial, at LK Leon in central London, I wonder why he’s wearing glasses. Minshull, it transpires, has even worse sight than me and i-GO lenses cannot correct short-sightedness worse than -5.0 (Mine hovers at -4.0). And these lenses do not correct serious astigmatism. Are they dangerous? “No more than with normal contact lenses,” says Minshull. “Hygiene is important but there aren’t any side effects.” Unlike laser surgery, there are no permanent changes. If you don’t keep wearing the lenses at night, your eyes readjust and your vision returns to how it was within a few days.

Minshull has treated 18 people since the i-GO lenses were launched in the UK but in the US, 50,000 people are using this technology. The lenses cost from £200 for the initial appointments and fittings and £40 per month for lenses, checkups and solutions.

I begin with a sight test, then Minshull takes a topography of my eye, photographing the curvature of my cornea to obtain the measurements needed to make the lenses.

A week later, Minshull shows me how to put in and remove the lenses – easy if you are familiar with contact lenses. And he tells me that I need to sleep regularly, for six hours, and wear them every night. I have some solution to clean and store them in, and lubricant should they become stuck in my eyes (urgh) and that’s it. Or so I thought.

These lenses, I am told, do not usually work instantly. “We should achieve something like a 70% change within the first night of wear,” says Minshull. In the early days, most users find their eyesight deteriorates by the end of the day. “You may notice a little bit of ghosting in the evening,” he says. I am supplied with some -1.50 daily disposable contact lenses in case my eyesight becomes less than perfect.

After the first night, I wake up and visit the opticians again, for a checkup, with the i-GO lenses still in my eyes. Everything is blurred and very uncomfortable because I am unused to these hard, plastic gas-permeable lenses. It turns out my vision is about 70% better and I return to work wearing soft contact lenses to correct my improving vision. Things are still rather blurry. I accidentally blank people I know. I am not enjoying blurred vision. It makes you appreciate the miracle of sight.

After two nights in the lenses, I wake up and – hosanna! – I can see. Without lenses. Almost perfectly. The problem is at night: when it gets dark, I realise that while I can read car numberplates at a distance, my sight is distorted by electric lights, which are almost as blurry as if I had my normal vision. Street lights and car headlights are fuzzy.

At my weekly checkup, Minshull explains that this “ghosting” or halo effect occurs because, while the lenses have corrected the centre of my pupils, they have not yet altered the periphery. This means that in low light, when my pupils widen, I am seeing with the corrected zone and with a small uncorrected area. With most clients, this passes in time. After my very minor crash, though, I decide to wear my i-GO lenses when I am driving at night. They are not as comfortable as my old soft contact lenses but are tolerable and I can see pin-sharply with them in.

At the end of the four-week trial, my eyesight only declines very slightly during the day but in the dark, bright lights are still distorted. I return for my final checkup ready to give up the lenses but Minshull shows me the progress on reshaping my eye, and says that in some cases it can take longer than four weeks. We continue for two more weeks but the i-GO lenses still leave me with blurred vision at night. Minshull believes they have not worked because I have unusually large pupils.

Sean O’Sullivan, 44, a business manager for a software company, has been using the lenses for three weeks. His prescription (-3.75) is similar to mine and yet his right eye was perfect after one night and his vision in both eyes was perfectly corrected after two nights. He, too, experienced blurry lights after dark but this has steadily lessened. He can still see late at night and, if he has to travel to America, into the next day as well. “It’s an amazing thing to think that by putting a plastic lens in your eye at night you can see for a day and a half,” he says. “I’m surprised more people aren’t trying it. It is very liberating. It feels like a miracle cure. If it works, it’s a great alternative to laser surgery.”

So far, only one other of Minshull’s patients has experienced a similar problem to mine and they loved days without lenses so much they persevered. And I can see the attraction: it was wonderful to hurl myself into the ocean and not worry about contact lenses, do away with the dryness and red eyes from wearing ordinary contact lenses all day, and nice not to worry about treading on, or losing, my glasses again. But I am letting my eyes return to their old prescription because of the blurring at night. I could wear my i-GO lenses after dark, when I am awake, but that that seems little more convenient than using standard contact lenses.

I feel sorry for Minshull, who looks crushed when I tell him they are not working for me. He has taken me through the trial with reassuring thoroughness and admirable patience. But I’ve had it with newfangled contact lenses. On the way out of LK Leon, one of their swish pairs of frames catches my eye and I try them on: I can definitely see myself wearing glasses again.

igolenses.com, 0844 7362579.

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Three more die as UK swine flu cases pass 7,500

July 7th, 2009 | No Comments

• Two children are among the latest fatalities
• All victims had serious underlying health issues

Three more people have died of swine flu it was announced today, taking the death toll in the UK to seven.

All three victims, two of them children, had serious underlying health problems, according to NHS officials. One of the children, a nine-year-old from south London, died at the weekend. The family asked for their privacy to be respected.

The other two were Abdullah Patel, in his 40s, and a nine-year-old girl, Asmaa Hussain, both from Dewsbury, West Yorkshire. Asmaa, who suffered from epilepsy and attended a special school, died on Thursday. Patel, a teacher who was said to have worked at the Institute of Islamic Education in Savile Town, Dewsbury, died on Sunday.

Three children have now died. The first, Sameerah Ahmad in Birmingham, was six and had a rare, life-threatening disease that impaired her immune system. Only one victim has been elderly – a 73-year-old man in Scotland. The others were a 19-year-old man and a woman, aged 38. All had serious underlying health problems.

The virus is more likely to affect younger people than older. The chief medical officer, Sir Liam Donaldson, has said that the flu strain is part animal, part bird and part human, and that the human element had been in circulation in the past, with the result that the immune systems of older people may offer protection.

So far more than 7,500 people have been diagnosed with swine flu in the UK, although the numbers are now rising so rapidly that the Health Protection Agency is no longer providing them on a daily basis. London, the West Midlands and Scotland have been worst hit.

World Health Organisation figures show there have been 94,512 cases and 429 deaths. Many more people will have been infected but will not have been listed, because they did not see a doctor.

The vulnerability of younger people could mean they will be prioritised when a vaccine becomes available in August. The government has made provision for enough doses for the entire population, but they will arrive in batches. “We will have to debate what would be a sensible vaccine programme according to the delivery schedule,” Donaldson has said .

When the order was placed, it was assumed two doses of vaccine would be needed for each person. If it turns out that one dose is enough, it will go further. The first priority is likely to be people with underlying diseases or compromised immune systems, such as those undergoing cancer treatment. “Firstly it will be at-risk groups, then possibly age groups,” said Donaldson.

Most cases of swine flu have been and continue to be mild, except in those children and adults with existing serious health problems. However, there have been cases of severe illness involving hospitalisation, and even death, in some apparently previously healthy people in other countries. For that reason, everybody who is diagnosed with the virus in the UK will continue to be given antiviral drugs, the government said last week.

As of last week, however, when the authorities abandoned their containment strategy, people who fall ill are urged not to go to their doctor or to hospital, but to check their symptoms online at nhs.uk, or call the swine flu information line, on 0800 1 513 513. If they need drugs, a prescription will be issued for a healthy friend to collect.

Last week, the health secretary, Andy Burnham, said contingency planners had estimated the number of new cases could hit 100,000 a day by the end of August. The public health strategy is now to treat those affected rather than attempt to stop the spread. Schools, for instance, will only be closed if too many teachers are off sick to keep classes going, or if they cater for children who are particularly vulnerable.

The disease seems to be spreading faster in the UK than elsewhere. Donaldson said this was possibly because of the traditionally strong travel links between the UK and the US, where the virus has been spreading unchecked for some time.

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Are men a new market for Tampax?

July 6th, 2009 | No Comments

Over the years, advertisers of sanitary protection have tried, repeatedly, to convince us that a woman’s period is a glorious time. A hallowed time. A time to ice skate, bungee jump and rollerblade. A time to leak blue liquid and listen to soft rock. And a time when we feel compelled to wear our tightest, whitest shorts.

Such ads obviously do nothing to prepare girls for the painful reality, so it’s interesting to see a different approach. Over the past few months, a viral campaign has been running online – complete with blog, videos and Twitter feed – which features no bungee jumping at all. It also stars a man. Well, a 16-year-old boy anyway. And one day said boy, Zack, wakes up with a vagina.

The campaign follows his struggle to cope. In some ways, it pops with sexist stereotypes: he starts baking brownies, eating yoghurt and snapping at his best friend, Bryan. Overall though, the story unfolds skilfully, exploring what it’s really like to have your first period, including the shock of cramps and water retention. Zack invites commenters to write about when they had their first period, opening up a public discussion that’s rarely mooted. And it’s only towards the end of the video sequence that he’s shown using a Tampax slot machine.

The campaign is intriguing partly because it’s so difficult to tell who Tampax is targeting. Is it young women in general? (Zack is good looking.) Is it female athletes? (As a footballer, Zack asks sporty women how they cope with their periods.) Or could it be men? Are they the secret, untapped market for sanitary products? Would Tampax sales shoot up if they could convince bashful blokes to buy tampons for their girlfriends? So many questions.

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Man is fourth in UK to die from swine flu

July 3rd, 2009 | No Comments

A 19-year-old man has become the fourth person in the UK to die of swine flu and the first in London.

The teenager, from south London, who has not been identified, had serious underlying health problems, as had all those who have died in the UK so far. He tested positive for the H1N1 virus after his death at Lewisham hospital on Wednesday.

So far there have been four deaths among the nearly 7,500 lab-confirmed cases. On Thursday the health secretary Andy Burnham said projections showed that if cases continued to rise at the current rate there would be 100,000 new cases a day by the end of August.

The number of deaths will inevitably also rise, but extrapolation from the four deaths so far would not be statistically valid because the numbers are too few. A Department of Health spokesman said suggestions that there could be 40 deaths a day by the end of the summer were wrong.

“Scientific and clinical experts can use sophisticated modelling techniques to help us understand how the virus may behave, but that is all they can do – be a guide, not a prediction,” he said.

Those whose immune systems are compromised, for instance through cancer treatment, or who have breathing problems, like asthmatics, or who are otherwise frail are at greatest risk from the virus. The south London teenager is the second youngest victim, after nine year-old Sameerah Ahmad, who was born with a rare life-threatening disease. The first victim was 38-year-old Jacqui Fleming, who died in hospital in Glasgow where she had been in intensive care since giving birth three months prematurely. The baby also later died, but not from swine flu.

The Department of Health said that it was possible to catch swine flu in hospital, where many people might be at risk because of their poor state of health. “Like any other place where there are lots of people, you could get it in hospital,” said a spokesman. “But we’re making sure that people with swine flu are isolated away from other patients and staff are very meticulous in their cleanliness.”

Another death is likely to add to the alarm created by the soaring numbers of cases, but chief medical officer Sir Liam Donaldson warned that people should not attempt to buy antiviral drugs such as Tamiflu over the internet.

Donaldson pointed out that the UK has one of the biggest stockpiles of the drug in the world and certainly enough to treat all cases of the disease here. He warned on Thursday against buying antiviral drugs on the internet.

All those who fall ill will receive Tamiflu, even though some experts think treatment is warranted only for those with other health problems. However, some of those who have become seriously ill and at least one who died elsewhere were apparently healthy before their infection.

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Swine flu ‘can no longer be contained’

July 2nd, 2009 | No Comments

Government moves to ‘treatment phase’ as health secretary says infection rate could reach 100,000 a day by end of August

Swine flu is spreading so rapidly across Britain that there could be 100,000 new cases a day by the end of next month, the health secretary, Andy Burnham, said today.

The UK would immediately move to the “treatment phase” of its plan to combat swine flu, meaning doctors would no longer test for the H1N1 virus and urge anyone with symptoms to stay at home, Burnham told the House of Commons.

The first swine flu vaccine would be made available from August, with 60m doses available by the end of the year, he added.

“We have reached the next stage in management of the disease,” Burnham said. “The national focus will be on treating the increasing numbers affected by swine flu. We will move to this treatment phase across the UK with immediate effect.”

The move does not mean the H1N1 virus, which was declared a pandemic by the World Health Organisation last month, is becoming more deadly, just that it can no longer be contained.

Burnham said there was a “considerable rise” in swine flu cases last week.

“We have always known it would be impossible to contain the virus indefinitely and at some point we would need to move away from containment to treatment.

“Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August.

“The pressure on the system is such that it is the right time to take this step. Scientists can expect to see rapid rises in the number of cases.”

Burnham added that the public should be reassured by the steps being taken to tackle the virus. He said: “We are the only country in the world to be able to offer anti-virals to everyone as well as those at greater risk.”

The government’s chief medical officer, Professor Sir Liam Donaldson, said the production of a vaccine was “at an advanced stage” and denied that the outbreak was out of control.

Speaking at a special briefing at the Department of Health, he said: “We are continuing to take a very firm grip on this situation. We have a big stockpile of anti-virals, the biggest probably in the world. We have vaccine at an advance stage of production.”

Donaldson added that despite its rapid spread, the virus outbreak was “following a predictable path”.

The Health Protection Agency said a further 458 patients in England had been confirmed with swine flu, while the figure for the UK as a whole rose to 7,447.

Efforts to trace people who had been in contact with swine flu cases would now stop and schools no longer needed to close when hit by the virus, unless particular circumstances made it necessary.

The government has said that not everybody with swine flu would receive anti-viral drugs, which may be reserved for at-risk groups.

The daily collation of swine flu cases would also end because it was proving time-consuming. Instead, “more general” estimates of numbers would be given. Other affected countries already update their swine flu numbers less frequently, such as weekly or every other day.

The Scottish health secretary, Nicola Sturgeon, announced a similar shift in swine flu policy at a simultaneous briefing in Edinburgh.

She said: “We’ve always said it would be impossible to limit the spread of what is a contagious virus indefinitely.

“We’ve always said that, when it did start to spread more widely within communities, we would require to make a judgment about when to shift efforts from intense containment to treatment, or mitigation.”

Sturgeon, who is also the deputy first minister of Scotland, said “high-risk” groups such as children under five, pregnant women and the elderly would get priority access to medication.

Scotland’s chief medical officer, Harry Burns, said the country could expect to have a tenth of the UK cases of swine flu. He predicted there would be about 10,000 new cases a day in Scotland by August.

He said: “It could be a bit less, it could be a bit more. It also presupposes that there isn’t a downturn, if it continues to rise at this rate, and it’s doubling approximately every week, you can do the sums yourself.”

However, Scottish health officials said the swine flu infection rate may have already peaked, as the number of new cases in three hotspots in the greater Glasgow area appears to be in decline.

After infection rates peaked at 111 confirmed cases on 25 June, with Scotland experiencing the first two swine flu deaths in Europe, the rate has remained steady at about 60 new cases a day over the last week.

The rapid spread in two of the major hotspots – Dunoon in Argyll and Paisley south of Glasgow – now appears to have stopped and cases have begun to decline sharply.

The official statistics on the virus were likely to underestimate the true scale of infection in the UK because now only a sample of patients in the hotspots had a diagnosis of swine flu confirmed by lab tests. Many people were thought to have such mild symptoms that they were not bothering to contact their doctors while others were being treated in surgeries without being regarded as suspected swine flu cases.

In swine flu hotspots such as London, the West Midlands and parts of Scotland diagnosis of the virus was already being done by doctors rather than laboratory testing, and tracing the contacts of people with swine flu and the use of preventative anti-viral drugs had stopped. Anti-viral drugs were still being offered to all people with symptoms.

Although a bout of swine flu was currently causing less serious illness than traditional seasonal flu, three people with other serious health conditions in the UK have died after catching the virus and there are concerns it could mutate into a more virulent form.

The chief medical officer, Sir Liam Donaldson, has warned that there may be tens of thousands of cases each week this autumn, because the virus is more likely to thrive in a colder climate.

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Vegetarians ‘less likely to get cancer’

July 1st, 2009 | No Comments

• Striking difference found in risk of disease in blood
• Scientists acknowledge more research still needed

For years, they have boasted of the health benefits of their leafy diets, but now vegetarians have the proof that has so far eluded them: when it comes to cancer risks, they have the edge on carnivores.

Fresh evidence from the largest study to date to investigate dietary habits and cancer has concluded that vegetarians are 45% less likely to develop cancer of the blood than meat eaters and are 12% less likely to develop cancer overall.

Scientists said that while links between stomach cancer and eating meat had already been reported, they had uncovered a “striking difference” in the risk of blood cancers including leukaemia, multiple myeloma and non-Hodgkin lymphoma between the groups. The study looked at vegetarians, fish eaters and people who ate meat.

Co-author Naomi Allen, from the Cancer Research UK epidemiology unit at Oxford University, said: “Previous research has found that processed meat may increase the risk of stomach cancer, so our findings that vegetarians and fish eaters are at lower risk is plausible. But we do not know why cancer of the blood is lower in vegetarians.”

She said the differences in cancer risks were independent of other lifestyle factors including smoking, alcohol intake and obesity.

However, Allen urged caution over the interpretation of the findings. “It is a significant difference, but we should be a bit cautious since it is the first study showing that the risk of cancer of the blood is lower in vegetarians. We need to know what aspect of a fish and vegetarian diet is protecting against cancer. Is it the higher fibre intake, higher intake of fruit and vegetables, is it just meat per se?”

The study also reported that the total cancer incidence was significantly lower among both the fish eaters and the vegetarians compared with meat eaters.

The study, published in the British Journal of Cancer, is part of a long-term international study, the European prospective investigation into cancer and nutrition (Epic).

Today’s findings were based on a study of 61,000 people who scientists followed over 12 years. During this time, 3,350 participants were diagnosed with cancer. Of those, 68% (2,204) were meat eaters, 24% (800) were vegetarians and 9.5% (300) ate fish but no meat.

They found that 180 meat eaters developed blood cancers, while 49 vegetarians developed the diseases and 28 fish eaters. They found the risk of being diagnosed with cancers of the stomach, bladder and blood was significantly lower in vegetarians than in meat eaters but, in contrast to earlier work, they found the rate of bowel cancer was slightly higher among vegetarians than meat eaters.

A spokesman for BPEX, the British pig executive, questioned the methodology of the study: “We are unable to take a view on this because there is mixed evidence based on the compounding factors to do with lifestyle that come into it.”

Richard Lowe, the chief executive of Eblex, the English beef and lamb executive, said: “We think that the link between diet and cancer is complex and as scientists themselves say, more research is needed to see how big a part diet plays.”

The Oxford research is the latest in a series of reports to discourage too much meat in the diet. Last year, Dr Rajendra Pachauri, chair of the UN Intergovernmental Panel on Climate Change – which last year earned a share of the Nobel peace prize – urged giving up meat at least once a week as a way of combating global warming. The UN’s Food and Agriculture Organisation has estimated that meat production accounts for nearly a fifth of global greenhouse gas emissions.

Two years ago, the World Cancer Research Fund found a link between red and processed meat and bowel cancer and recommended that the average amount of meat eaten should be no more than 300g a week. In Britain, the current meat intake is about 970g a week for men and about 550g a week for women.

In 2005, the Epic study, funded by the Medical Research Council, Cancer Research UK and the International Agency for Research on Cancer, concluded that eating just two portions of red meat a day – the equivalent of a bacon sandwich and a fillet steak – increased the risk of bowel cancer by 35%. It found that eating fibre, in the form of vegetables, fruit and wholegrain cereals, lessened the risk of cancer and that fish, eaten at least every other day, was also protective.

Annette Pinner, chief executive of the Vegetarian Society, said: “It is widely recognised that a third of cancers are directly related to diet and what’s interesting in this study is the findings on blood cancers. We wouldn’t claim vegetarianism is a panacea for cancer but it is a step in the right direction.”

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My secret life of crime

July 1st, 2009 | No Comments

There are three episodes in his life that Geoff Dyer prefers not to remember. He could have ended up in jail – but thankfully didn’t. So did he just get lucky?

In my first year as an undergraduate at Oxford – this was 1977-78 – I lived on the ground floor of the Corpus Christi New Building, just across the road from the venerable old college itself. During Michaelmas term, at about two in the morning, I was woken up by a gang of people singing Bob Dylan’s Rainy Day Women outside my window. They kept going up and down the narrow lane, singing “Everybody must get stoned.” It went on for ages and eventually I got dressed and went out to confront them. As I did so I met my friend Paul, an American who lived along the corridor. We were both furious. Seeing each other like this meant our fury turned into bravado and made us more furiously brave. “Let’s get those guys,” he said.

On the way out of the new building we armed ourselves with empty milk bottles from the crate inside the gate. By the time we got outside into the lane the stoners were gone but we could still hear them, more faintly now. We followed the sound, crossed over to the college. From a first floor window we could hear them singing the same chorus, the same song. If we had been back in our rooms we would not have heard them and could have slept soundly but we were outside on the street, wide awake, furious and excited. Paul looked at me and said, “Shall we?”

Without another word we threw our four milk bottles through the window. The crash of glass was unbelievable. We tore back into the new building. As we separated, Paul shouted, “Night, Geoff!”, as though we had just done something exciting and mischievous.

As soon as I got back to my room the awful gravity of what we had done came crashing in on me. Four bottles exploding through a window: what physical harm would this have done to a room full of people?

In the morning, after an almost entirely sleepless night, I went out to look at the scene of the crime. The glass had all been cleared up. The windows were unbroken. Miraculously all four bottles had shattered either against the walls or the metal diamonds framing the small windows. Not a single bottle had made it through. It was like a nightmare where you dream that you have done something terrible and then wake up, bathed in sweat, relieved to find that you have not done it in real life.

In the autumn of 1997 I went to Durham, North Carolina, to write about the photographer William Gedney, whose archive had ended up at Duke University. Durham itself is tiny, part of the Triangle Area that also comprises Raleigh and Chapel Hill. In the course of my two-month stay I regularly drove 15 or 20 miles to go to a cinema in the suburbs of one of these affiliated towns. I say suburbs but, at night, it felt like driving in the open country, along deserted roads in complete darkness. I rarely drive in England so the problem of driving on the “wrong” side of the road never came up. Then, on my way back from seeing The Ice Storm, I did exactly that: drove up a totally dark lane on the wrong side of the road. I had no idea I was doing this until a car screamed towards me and, at the last moment, swerved past. There wasn’t even time for the driver to sound the horn. The car swerved around me and was gone and I was unscathed.

Two years later I travelled to the Bahamas with my then girlfriend to write a piece for an American magazine. We had to change in Miami, entering the US before boarding the connecting flight to Nassau and taking a boat to Harbour Island.

After a few days on Harbour Island we started sniffing around, trying to buy grass. The Bahamas is not like Jamaica, where every few minutes someone is asking – to put it mildly – if you would like to buy sensei. There were quite a few dreadlocked young guys with whom we exchanged glances but we never quite approached anyone. Bahamians are big drinkers but Harbour Island didn’t seem like a stoner scene and my policy in these matters is to be cautious to the point of paranoia.

We had been on the island three days. As I was putting on a pair of trousers – cargo pants, to use the correct sartorial term – I had not worn since the flight, I felt something bulky in my pocket: a large bag of skunk complete with pipe. Accidentally I had taken this through what is probably the most drug-alert airport in the world – Miami. There were sniffer dogs everywhere. I had walked though emigration in UK, sauntered through immigration in the US, strolled through US emigration, boarded a plane to Nassau, and entered the Bahamas. And nothing had happened.

This occurred during a phase when I was smoking a lot of the skunk that was in the process of gaining complete market domination in the UK. The immediate cause for my unwitting bit of smuggling was that on the Saturday night before flying out I had worn these trousers to a Return to the Source party.

My girlfriend was understandably furious. How could I have been so stupid, forgetful? Because I was smoking lots of skunk. It was doing to me what it is apparently doing to teenagers up and down the country: rotting the brain. Her anger was understandable and not entirely convincing. My forgetfulness meant that we now had exactly what we wanted: grass. We could get stoned. In fact we had to get stoned because I did not want to repeat, in reverse order, the process of smuggling, especially now that I would be doing so consciously (ie, conspicuously).

What would have been the consequences of each of these episodes turning out not as they did but as, in all probability, they should have done?

In the case of the Oxford incident, apart from the injuries I might have caused, I would almost certainly have been caught due to Paul’s calling out my name. (In the morning the woman who cleaned my room said that whoever had thrown the bottles had run back in to New Building.) I would have been sent down, expelled. If there had been injuries, presumably some kind of criminal prosecution would have followed. So I would have been sent down and I would have been in more trouble with the police (I had actually gone up to Oxford on bail, for criminal damage, but that is another story). Now, students get sent down from Oxford all the time and go on to lead interesting lives. But if I had been sent down I would not have travelled abroad or done anything adventurous; I would have gone back to my home town and reapplied for the boring job in the Mercantile & General Reinsurance Company that I was doing during the nine months between school and university.

In North Carolina the consequences would have been straightforward. I would have been killed, paralysed, brain-damaged or injured. I might have killed, paralysed, brain damaged or injured the other driver. I would have wrecked two cars. If I had survived I would, presumably, have faced some kind of massive lawsuit.

If I had been caught with that big bag of grass in Miami then, most immediately, we would not have had our trip in the Bahamas. I would not have been able to complete my assignment for a prestigious American magazine and so would have forsaken my fee. All small beer compared with what would, surely, have been the eventual outcome: being jailed in the US.

None of these things happened. I didn’t get sent down from Oxford, I didn’t die in North Carolina, and I didn’t go to jail in Florida. I completed my degree, as a result of which my life options expanded to the extent that I ended up becoming a writer who was invited to Durham and sent for a luxurious, all-expenses-paid trip with my girlfriend to the Bahamas. Life turned out extremely nicely, thank you.

When he was considering promoting one of his soldiers, Napoleon famously asked, “And does he have luck?” I have got into the habit of thinking of myself as an extremely unlucky person. I could compile a huge list of all the ways in which my luck has been bad. I mean, how many times has it started raining within minutes of my beginning a tennis match? But these three incidents are examples, obviously, of good luck. They are incidents that you would expect to have quite terrible, life-shattering or life-ending consequences. It’s not just that I was given a second chance, I was given a third and a fourth as well. If I were a cat, each of these incidents would have used up a life: three down, six to go.

As far as I can remember, these are the three luckiest things that have ever happened to me – more exactly, the three luckiest things that have not happened to me. Thinking of any of them now fills me retrospective dread. I have never done anything where the immediate and expected consequences could have been anything like as bad. I had a certain amount of random, unprotected heterosexual sex in the 1980s and 90s, but the chances of getting Aids was minimal compared with the chances of facing the consequences of these actions. Put it this way: given the limited extent of my sexual adventures I would have been extremely unlucky to have contracted HIV. These three incidents, on the other hand, would be the equivalent of having unprotected sex with a promiscuous homosexual IV drug-user – the kind of thing, I guess, that might well befall someone who ends up in prison in Miami.

I would estimate that it was about 99% certain that I would pay the price for my actions. But I didn’t. I got away with all three of them, scot-free, without a scratch. Did I learn anything from them? I don’t think I did. Or at least I didn’t learn anything that I didn’t already know: not to throw bottles through people’s windows, not to drive on the wrong side of the road, not to carry smelly, illegal drugs into the US; in sum, not to be stupid.

So I ask myself the Dirty Harry question: do I feel lucky? “Well do ya, punk?” Not particularly, no.

And what about fate? Or destiny? Can one draw a larger conclusion? Only that most people reading this could put together their own list of three similar episodes. There are a few others who, even by cat standards, have been super-lucky, have not used up even one of their nine lives. And there are some who are not reading this precisely because they could not put a similar list together, because they did not have my kind of luck. Irrespective of whether these things had anything to do with my volition they have turned out to be my three enduring achievements.

• Taken from the Fire volume of Ox-Tales, one of four anthologies by leading contemporary writers to be published by Profile Books on 4 July, price £5. Published to coincide with Oxfam Bookfest (4-18 July), every copy sold raises at least 50p for Oxfam.

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Are fat celebrities a danger to us?

June 30th, 2009 | No Comments

We aren’t taking the war on obesity seriously, claims a new study published by Nuffield Health; and large celebrities, such as James Corden and his Gavin And Stacey co-star Ruth Jones, Beth Ditto and Eamonn Holmes, are encouraging us accept being fat as normal. Apart from the fact that I can’t seem to find the original research that this story is based on, which in itself is pretty interesting, I think we have to be wary of studies coming from a hospital that does gastric band surgery and thus makes money out of designating people as obese.

We are in a culture that is so fat-phobic you wouldn’t have thought fat people could be any more demonised, but Nuffield’s line seems to be that obese people in the public eye really should be. We’ve had – and continue to have – so many struggles about race and disability; but looking at the column inches that scrutinise fat and ageing people, both are heading the way of being illegal categories pretty soon. And if not illegal, then certainly worthy of disdain, contempt and commercial exploitation.

There has been a bit of public discussion about very thin girls and boys on catwalks and advertisements, but the style industries seem to have decided, in the end, that it’s all in the name of art and design, and thus the tyrannous aesthetic of size zero doesn’t really matter. That has left the devastating message that one size – skinny and tall – is good, aspirational and the passport to feeling acceptable. So it’s quite interesting that we’re uncomfortable when people actually rebel against the prevailing standard.

The Nuffield PR machine opens up the whole question of categorising people as fat and therefore somehow to be scorned, derided or unworthy – instead of fat being a description, a neutral one about adiposity. Such moralising categories don’t address the serious underlying issues so many people have with bodies and food. You can be eating when you are hungry and be large, or throwing up into the toilet all the time and be within the so-called normal range. Meanwhile, you can be a world-class movie actor – a gorgeous one like George Clooney – and sit in the ridiculous obesity statistics as they are currently conceived. What we have is a population very, very troubled in its eating habits, a fact that is expressed in both visible and invisible ways. That’s a public health emergency, not the fact that we happen to have a variety of shapes in public space.

• Susie Orbach is the author of Bodies and Fat is a Feminist Issue

I know it’s a problem but it’s my problem, thank you very much

The central tenet of this research is utter rubbish. People do not think its OK to be obese just because Beth Ditto is witty and talented. We are constantly reminded how wrong it is for us to be obese. There is more information available on the obesity crisis in the media than I can recall at any other time in my life. Paradoxically, the general pervasiveness of the perfect body in films and music and TV and advertising imagery is genuinely psychologically damaging and therefore an actual contributory factor to obesity. James Corden wobbling his gut in Mathew Horne’s face once a week is not.

I have been overweight for most of my life and I have been aware that it’s a problem. But it is my problem, thank you very much. I deal with it in my own way. I have never thought that my weight was permissible simply because I listened to Bad Manners or loved Jo Brand. My feeling is that if the popularity of Corden and Ditto can help to stop fat kids being picked on by their peers then they are performing a valuable service. A survey like this just sends people straight back to the fridge. The obesity crisis will only be solved by a radical overhaul of education, health and social policy, and certainly not by pin-headed inflammatory half-arsed “research”.
Phill Jupitus

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‘I’ve seen big men reduced to tears’

June 30th, 2009 | No Comments

Summer is kidney stone season and one in four of us now suffer from them. Kate Hilpern looks at how they are treated and the best ways of preventing them

Already tired of being told to keep drinking water during the heatwave? Well perhaps you will take the advice more seriously when you hear that the number of people suffering from kidney stones, which mostly occur during summer and can be brought on by dehydration, has more than doubled in the last five years. With one in four people now experiencing them, symptoms include agonising abdominal pain, a stabbing pain in the back, sickness and acute soreness and blood when passing urine.

“The pain can definitely be equivalent to labour or the fracture of a long limb,” says Ken Anson, consultant urological surgeon at St George’s Healthcare NHS Trust in south London. “It’s truly ghastly – probably the worst pain most people will ever experience. To top it all, it’s terrifying because people have no idea what’s going on. I’ve seen plenty of big hulky men reduced to tears on the floor, having begged for an ambulance.”

So common are cases during the summer that urologists call it “kidney stone season”. When a person is dehydrated, levels of chemicals in the urine – usually a salt called calcium oxalate, but also calcium phosphate and uric acid – become too high, leading to a build-up of crystals. If lots of these crystals form, they can fuse into a stone. Caffeinated drinks will further increase the chances of your body producing rocks as they add their own stone-forming compounds to urine, and their diuretic effects can exacerbate dehydration.

A high-protein diet is another risk factor because it increases the production of uric acid, and you’re two-to-three times more likely to get kidney stones if you’re male. Other contributing factors include having a genetic predisposition to kidney stones, being obese or inactive (rising obesity is thought to be partly responsible for the increase in cases), having Crohn’s disease or having had a kidney stone in the past. Up to half of those who have a kidney stone will get another within five years and, in some cases, people get them repeatedly.

Nicola Richardson, 46, passed her first two stones during her 20s and is still producing them regularly. “The pain in my back and bladder area has got so bad at times that I’ve had to take time off work, which resulted in me losing my job,” she says. “I’m on morphine a lot of the time now and the specialists are even talking about trying a nerve block around my bladder area to stop the pain.”

Richardson is an extreme example – she makes so many stones that her condition has a special name, medullary sponge kidneys. In the mildest cases, however, a one-off stone can pass through the urine unnoticed. “We are increasingly picking up kidney stones incidentally when people have a CT scan for something else,” says Anson.

The condition only becomes painful, he says, when a stone blocks the normal drainage of urine, usually in the ureter (which carries urine from the kidney to the bladder). “Even if that pain is acute, it’s generally not dangerous. If, however, you get an infection as a result of the obstruction, it can be life-threatening.

I saw a young woman recently who came back from France with a stone and within six hours of being back in theUK, she was in intensive care with multi-organ failure.”

Daron Smith, consultant urologist at University College Hospital in London, says that renal failure is a possibility where an obstruction is not picked up over a long period. “Obstruction to the kidney is clearly not healthy for the kidney, as it responds by shutting down its blood supply and urine production. If this happens for any length of time, that kidney can start to deteriorate.”

While diagnosis rates of kidney stones has improved, Matthew Colfer’s story still occurs: “At first, doctors put my pain down to a hernia, which had been operated on a couple of years ago. Then they wondered if it was related to some problems I had with a prostate gland,” says Colfer, 69. “Next, a GP diagnosed gastric enteritis. It was only when I woke up in the night in excruciating pain and had to go to hospital immediately that they finally discovered I had three kidney stones. The diagnosis took three years.”

Some people are given medication, or even just fluids, that enable stones to pass through the urine. But if they are too large, painful, embedded or infected the usual treatment is extracorporeal shockwave lithotripsy (ESWL). “The patient lies on a machine which delivers a shockwave that shatters the stone into tiny pieces which the patient then passes through,” explains Paul Butterworth, consultant urological surgeon and spokesman for Kidney Research UK.

If that fails, surgery is the next step. This involves inserting a telescope into the ureter or the kidney and either breaking up the stone with a laser or removing it.

People often assume that the greater the pain, the bigger the stone must be, but this isn’t the case. Victoria Chapman, 39, had a kidney stone 4cm in diameter and yet she had virtually no pain. “The only reason it was brought to my attention was because I started peeing blood after exercising,” she says.

“In fact,” says Butterworth, “it’s the smaller stones that can be more painful”.

‘I felt like I was going to die’: Ian Money, 41

“One August bank holiday about 10 years ago, I found myself doubled up in pain on the floor, with no warning whatsoever. I was screaming and felt like I was going to die. My partner was really frightened because I never normally lose control, even when it comes to pain.

“An emergency doctor said I was constipated and to have a hot bath. But the pain persisted and when I started being sick, I got really worried and called an ambulance. At A&E, I was put on medication that immediately stopped the pain and because the stone passed through a couple of days later, I didn’t have to be operated on.

“When I got the pain again two months ago in the middle of the night, on a scale of 1 to 10, the agony was 10, but at least I knew what it was this time. I still called an ambulance, and again I was given painkillers. This time, though, the stone had blocked my ureter, so three weeks ago I was given [non-invasive] extracorporeal shockwave lithotripsy (ESWL) to try to break it up.

“I went back to the consultant a week later, expecting the stone to be gone, but he says it’s still there, so I’m going back on Friday for a second try. Failing that, I’ll have to have surgery.”

• Further information: www.kidneyresearchuk.org or buf.org.uk

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Serious cyclists ‘risk sperm damage’

June 29th, 2009 | No Comments

Intensive cycle training such as that undertaken by triathletes has a negative effect on sperm quality, researchers tell the European fertility conference

Too many hours in the saddle may affect the fertility of serious cyclists, a conference heard today.

Researchers told the European fertility conference that cycle training of the intensity undertaken by triathletes has a significant impact on the quality of their sperm.

But Diana Vaamonde, from the University of Cordoba medical school in Spain, said that she thought the “regular guy” who rides a bike should be fine. “I don’t think he will have to worry about it so long as it’s just like cycling to work. If you cycle to work … you have all day to recover,” she said.

Triathletes push themselves to the limit in three sports – running a marathon, swimming 3,800 metres and cycling 180km. It is known that they tend to have poor sperm quality. Professor Vaamonde and colleagues decided to monitor the impact of all three sports on 15 healthy Spanish triathletes to see whether one was more responsible than another. They found that only cycling had a clear correlation with sperm quality and the more the triathletes trained, the worse it got.

“While all triathletes had less than 10% of normal-looking sperm, the men with less than 4% – at which percentage they would generally be considered to have significant fertility problems – were systematically covering over 300km per week on their bicycles,” she said.

It may be the irritation and compression caused by friction of the testes against the saddle or the heat caused by tight clothing that causes the problem, but it could also be a function of cell changes connected with the amount of physical energy the cyclists are using.

She believes the effect of perhaps eight years of intensive training could cause irreversible changes in men’s ability to produce quality sperm. One of the options might be to freeze sperm while its quality is still high.

Allan Pacey, senior lecturer in andrology at the University of Sheffield, said there had been considerable interest among the cycling community in recent years about whether or not too many hours in the saddle might affect male fertility.

“However, it is important to stress that even if the association between cycling and poor sperm morphology is correct, men training for triathlons are spending much more time in the saddle than the average social cycler or someone who might cycle to and from work,” he said. “There is no evidence that men who ride a bike are less fertile than other males. Indeed, if you look back in our history, only 40 years ago cycling was much more common and there is no evidence from that time that men were less fertile. In fact, quite the contrary! The post-war baby boom proves that.”

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Miscarriages raise premature births

June 29th, 2009 | No Comments

The findings of international experts should make it easier to predict which women may need special care during pregnancy

Women who have a miscarriage are more likely to give birth prematurely in their next pregnancy, doctors have found.

The findings of an international group of experts, to be presented at the annual conference today of the European Society of Human Reproduction and Embryology (ESHRE) in Amsterdam, Netherlands, should make it easier for doctors to predict which women may need special care and attention during pregnancy.

Premature babies can survive from as early as 22 weeks’ gestation, but they are on the border of viability. Every extra week of life in the womb increases chances of survival and improves prospects of long-term health without significant disability.

Dr Robbert van Oppenraaij from the department of obstetrics and gynaecology at Erasmus University medical centre in Rotterdam, Netherlands, and colleagues from the UK, Denmark and Spain reviewed 75 studies carried out between 1980 and 2008, looking at the impact of complications in early pregnancy.

They found that women who experienced complications either early in their current pregnancy or who had had a miscarriage or other problem in a previous pregnancy were more at risk of going into labour prematurely or experiencing other difficulties in later weeks.

Women who had experienced one or more miscarriages had nearly double the risk in their next pregnancy of giving birth prematurely. Those who had suffered three or more miscarriages were at even greater risk.

Termination of a previous pregnancy, for any reason, also increased the risk of premature birth in a subsequent pregnancy.

A whole range of problems in the first three months of a pregnancy were predictive of later complications:

• Vaginal bleeding increased the risk of pre-eclampsia or dangerously high blood pressure in the woman, as well as raising the chances that the baby would be born prematurely and under-weight.

• The survivor of a vanishing twin pregnancy (where one twin miscarries very early on) was more likely to be born prematurely, had three times the normal risk of very low birth weight and was more than three times more likely to die around the time of birth.

• Women who suffered from extreme early morning sickness were three times more likely to give birth prematurely and the baby was nearly three times more likely to be of low weight.

Identifying these women as at high risk of problem births would help to ensure their babies have the best chance of survival through careful monitoring of the baby’s development, said Van Oppenraaij. More studies are needed to confirm the findings, he said.

Events and complications in early pregnancy can be extremely distressing for women, Van Oppenraaij said. For the clinician it is important to interpret the symptoms and to understand not only the short-term consequences, but also the long-term consequences of these early pregnancy complications. This is especially important for reassuring and supporting the couple at a difficult time.

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Scottish man dies from swine flu

June 28th, 2009 | No Comments

73-year-old man from Glasgow, who had been in intensive care for 15 days, is second Briton to die from swine flu virus

An elderly man from the Glasgow area has become the second Briton to die from swine flu.

The 73-year-old, who had other very serious underlying health problems and has not yet been named, died at the Royal Alexandra hospital in Paisley late on Saturday night. He had been in intensive care for 15 days, health officials said.

Nicola Sturgeon, the Scottish health secretary, said: “Our thoughts are with the family and friends of the patient at this tragic and very sad time. The family have asked for the patient’s identity to be kept private.

“Although it is concerning that the patient had swine flu, we are aware that the patient had very serious underlying health issues.”

A family spokesman said: “Our beloved relative was private in life and we would ask that his privacy continues to be respected as we try to come to terms with our loss.”

The first Briton to succumb to the H1N1 virus, Jacqui Fleming, also died at the Royal Alexandra after giving birth prematurely to her third child. She was the first person outside the Americas to die with the virus.

Fleming also had significant underlying health problems, and had been critically ill for several weeks before she died. Her baby, named Jack by her partner, William McCann, died the following day.

Health officials have repeatedly stressed that the virus appears to be relatively mild, despite its rapid transmission around the world.

The latest official figures show that 4,322 Britons have so far contracted the virus, with significant outbreaks now in Birmingham, London and the Glasgow area, but health experts believe the real figure will be much higher.

In the United States, specialists at the Centers for Disease Control in Atlanta estimate that at least one million Americans may have had swine flu and not been diagnosed, although the official figures on Friday put confirmed US cases at 27,717, with 127 deaths.

However, the virus is now spreading quickly in the southern hemisphere, where it is winter – the traditional season for flu epidemics.

In Australia, where confirmed cases stood at 3,280, four people have now died, all with underlying health problems. There have been 21 deaths reported by the World Health Organisation in Argentina and seven in Chile. The last WHO update put total cases at 59,814 with 263 deaths.

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