World population reaches 7 billion today- The Guardian, Independent, BBC News

A baby born in the Philippines has been given the title of the 7 billionth baby by the EU. Today has been named seven billion Day to try and draw attention towards population growth. Through a campaign of woman's rights, reproductive health and inequalities, the UN population fund hopes to raise awareness.

A consultant of infectious disease has expressed that media about population always focuses on poorer countries even though more resources are used my babies born in First World countries. If resources were distributed equitably the whole population could be healthy, fed and sheltered well.

Dr Thapa from WHO reported that we are too focused on the numbers rather than quality and that if the population decreases this will not necessarily improve lives. It is believed that quality and quantity are both important.
A doctor from Ethiopia believes population has risen due to an inequality of healthcare spending and the lack of available contraceptive. 

More family planning and important information on sexual health is required but religious and cultural sensitivity must be respected.

Alzheimer's breakthrough

Early research has investigated the reason for the toxicity of beya amyloid peptides and whether it is linked to heredity.

In Alzheimer's disease beta amyloid plaques form in the brain alongside tau proteins which form tangles. Researchers at Whitehead Institute for Biomedical Research have created a GM yeast model and used it to screeb for genes which could alter the toxicity of amyloid beta. These genes idenified also affected the toxicity of beta amyloid peptides in worms and rat brain cells.

The model has also demonstrated that beta amyloid also disrupts endocytosis (absorbing and moving substances into the cell using vesicles) in yeast cells. Interestingly, the genes which regulate endocytosis in humans has already been identified as a risk factor for Alzheimer's.

Researchers are confident that these finding with the yeast model will be applicable to humans, however we are only at the early stages of research and will need to run experiments using human cells before this we can look at how to use the results to diagnose and treat the disease.

You may have noticed that over time I have made several posts on Alzheimer's disease. After attending Medlink and writing a medical report on the disease with a friend, I have become very interested in the news regarding treatment and diagnosis. I also decided to do my Year 12 biology coursework on Alzheimer's which gave me further opportunity to look at drug developments and the NICE recommendations.

This is the link for my medical report published on the web:
http://www.medlink-uk.org/Site/documents/Alzheimers2010/DayJ&BiggsK.pdf





http://www.nhs.uk/news/2011/10October/Pages/alzheimers-disease-genes-yeast.aspx

Latest stories surrounding euthanasia

Firstly let's look at the law regarding the topic:

The 1961 Suicide Act makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales. Anyone breaking this law could serve 14 years in prison.

There is no specific law on assisted suicide in Scotland, creating some uncertainty although in theory someone could be prosecuted under homicide legislation.

To date, more than 100 UK citizens have travelled to Dignitas in Switzerland to end their lives.

Although some cases have been considered by the DPP, no relative has yet been prosecuted.

http://news.bbc.co.uk/1/hi/programmes/hardtalk/9577291.stm

Sept 11

http://www.telegraph.co.uk/health/healthnews/8830679/Cliff-Richard-why-I-would-consider-euthanasia.html 17/10/11

An assisted suicide machine is being auctioned later this month in the US, alongside the personal possessions of Dr. Kevorkian. 2 different machines has been used to help end the lives of 130 people; 'the death machine, where users pressed a button to inject themselves with lethal drugs and the 'mercy machine' which used a gas mask attached to CO canister. In 1999 he was convicted of second degree murder and served 8 years in prison and was famously known for saying 'dying isn't a crime'. A film on Kevorkian's life was broadcasted on television in the States last year. I am currently trying to find a copy of the film.

(http://www.5newsonline.com/news/sns-rt-us-usa-kevorkian-auctiontre79a4rp-20111011,0,6641049.story?track=rss)

Interesting articles regarding abortion and fertility treatment

An article in the Guardian on family planning states that 1/4 of births in the world are unplanned. Also 42 million abortions have occurred with over 68 000 women killed.

The Abortion Act 1967 (mainland UK) states that abortions must be carried out up to 24 week from the point of conception in licensed clinics or hospitals. Legally two doctors must agree that the abortion would cause less damage to the mother that continuing with the pregnancy (physically and mentally). However an article published last April in the Telegraph reported of an Italian baby who survived 20 hours after being aborted at 22 weeks. The hospital chaplain discovered the baby, who had been aborted after it was discovered that he was disabled, still breathing and was transferred to a specialist neo-natal care unit. As an Italian citizen, the baby boy now has the right to health and legally has the right to life.

This article has highlighted how a child at 22 weeks (2 weeks short of the upper limit of abortion) is able to survive outside the mother's body. In 2005 a mother who had tried to abort her son three times gave birth at 24 weeks to her son who is still alive today. Should the upper limit of abortion be lowered? If a foetus of 24 weeks can survive as an individual, are they considered a person with potential rather than a potential person? By 24 weeks a foetus is nearly fully developed; it has little fat but has fully formed taste buds and it's brain is rapidly growing. This brings up ethical issues looking at what age does a foetus become a child? Philosopher, Glover uses a cake analogy to illustrate the difficulties of differentiating between the two. When you are baking a cake, when do you consider it to be a cake? Is it a cake when it's eggs, flour, butter and sugar? How about when it's a tin full of smooth cake mixture? Or is it not a cake until it comes out of the oven fully baked and ready to eat? From this analogy you can see that it is not logically possible to pinpoint the moment an unborn child goes from a cluster of cells to a foetus to a human being.

(http://www.telegraph.co.uk/news/worldnews/europe/italy/7646540/Baby-boy-survives-for-nearly-two-days-after-abortion.html)

In June 2010, an article against lowering the upper limits of abortion states that at 24 weeks a foetus cannot feel pain. According to the Royal College of Obstetrics and Gynaecologists, at this stage the brain is not developed enough to experience pain or consciousness. The studies have suggested that when a child is aborted at the upper limits (due to foetal abnormalities or risk to the mother's health) the chemical environment in the uterus induces 'a continuous sleep-like unconsciousness' and the foetus does not suffer. I think there are however still issues around whether this is ethically right, considering that they may be fit enough to survive outside the uterus.

(http://www.guardian.co.uk/lifeandstyle/2010/jun/25/human-foetus-no-pain-24-weeks)

One particular article more recently in the news (The Guardian 23/09/11) which caught my attention looks at an American couple who have made the decision to reduce their pregnancy from twins to a single foetus.

After 6 years of fertility treatment, a 45 year old lady became pregnant with twins and at 14 weeks decided to abort only one of her unborn children. She explained that since she had created her children artificially, she felt she had the choice to terminate one of their lives. For her the decision was easy, she believed that of she had 2 children she would only be able to give them half the love that they deserved. I can imagine that mothers who have more than one child may argue that it doesn't matter how many children you have, you will still have unconditional love for that child. If you have 4 children, does that mean that you only love each child a quarter of the amount that a single child would receive.

The procedure requires injecting potassium chloride into one of the foetus' chest. Over time it then shrivels overtime and remains in uterus until birth. The physicians need to view the procedure under an ultra sound scanner, which is visually explicit and can be quite disturbing.

There is something about separating twins that we seem to find more controversial than aborting a single child. Is this because we see twins as being lifelong best friends? Or is it because we can not imagine having to select one child over another. For that surviving child, finding out that you had a twin brother or sister who your parents chose to kill, must be something overly difficult. When the child realises that there was a 50% chance that they themselves would be terminated, I cant even start to imagine how that might affect them psychologically.

Some may say that aborting only one child is somewhat better than aborting both twins as this would mean the loss of only one life. However others believe that choosing one over the other is actually worse. I think this story is complicated by the fact that fertility treatment has been used. The family must have had some idea that there was a chance of having a multiple pregnancy when they decided to have the fertility treatment. Now they believe that they can pick and choose to reduce the pregnancy. Some may argue that this is just a step to far, however others may question why this is unacceptable when abortion is becoming increasingly accepted in society.

(http://www.guardian.co.uk/world/2011/sep/23/pregnancy-reduction-fertility-abortion-america)

An exciting new media- 'Medikidz' Medical Superhero Comics (BMJ)

After the article I read the other week about the bad press the NHS were receiving, I was pleasantly surprise to come across these new comics which education patients about medical conditions. There are 5 superheroes (Axon, Pump, Chi, Skinderella and Gastro- can you guess which areas?!) which specialise in a certain part of the body and take the child through the causes, symptoms and possible treatment. With 23 different titles, each issue addresses one single condition by using fun analogies to help children understand medical jargon.

Alongside these comics they are working on a children's online network so children around the world can talk to others with similar conditions and share their experiences in a safe environment. Student BMJ reports that 'having this sense of community can have a positive influence on their psychological state, thus enhancing their confidence and further improving their condition'.

This is a nice idea and hopefully will be used to teach children about medicine in a way which is both friendly and fun. I think it would be useful for doctors to inform parents of those suffering from life changing conditions about this magazine so they can make the decisions whether to get involved online and purchase the comics.

(www.medikidz.com/)

Animal articles and treating disease

In October's issue of Student BMJ, I found a couple of interesting articles relating to the use of animals in benefiting human health.

An animal discovery reported in the Student BMJ looks at how a chemical called Squalamine, found in shark livers could potentially be used to treat dengue fever, yellow fever, hepatitis B, C and D. The researchers became interested in the potential use of sharks after it was found they have more resistance to viruses than expected.
Squalamine can be easily produced synthetically and has already seen positive effects (with no major side effects) when used on patients in clinical trials to stop blood vessel growth in cancers.
It is thought that the chemical disrupts the membrane interactions required in viral replication. The inhibition of infection to blood vessel cells by dengue virus and human liver cells by hepatitis B and D has shown to be effect in tissue cultures.
This story can also be found on http://www.bbc.co.uk/news/health-14974605.


Another research article including animals looks at cancer. According to an article, sniffer dogs can now be trained to detect lung cancer. Three sets of volunteers were used; those who were healthy, those with lung cancer and those with chronic obstructive pulmonary disease. They we asked to exhale into a glass tube with fleece in. The dogs were presented with 5 glasses at a time (one 1 was cancerous) and were trained to touch the one containing lung cancer with their noses. They correctly identified 71/100 cancer samples and 372/400 non cancerous samples.

At the weekend I read an article on the BBC website which was also looking at lung cancer. A vaccine used alongside the chemotherapy treatment appears to slow the cancer's progression.
Vaccines for cancer work on the same ideas as vaccines against infection. They strengthen the body's immune system by producing memory cells so the individuals can tackle the infection themselves. However instead of protecting against invading pathogens, they train the body to attack tumours. As a cell divides uncontrollably and becomes cancerous, the surface proteins change shape. In theory this therefore allows the immune system to recognise the cell as foreign and destroy it.

Researchers in Strasbourg have conducted trials with 149 patients which had advanced lung cancer. Half were given a pox virus, which had been genetically modified to make a cancerous surface protein. All of the patients received standard chemotherapy treatment. 43% of those who received the vaccine experienced 6 months of 'progression free survival' and 35% of those who were in the control group.
Although the early stage study has indicated some success, we are still uncertain to the degree of the benefits.

This BBC article has come from a report in The Lancet Oncology; a trusted peer reviewed medical journal. (http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70259-5/abstract)
(http://www.bbc.co.uk/news/health-15401739)

Blood pressure meds can half the risk of Alzheimer's

Although those suffering from high blood pressure are at a higher risk of suffering from Alzheimer's disease, the newer drugs given to treat the condition are thought to provide added protection.

Bristol University have found that the drugs target a biochemical pathway, the renin angiotensin system, which us thought to be linked to the onset of Alzheimer's. When looking at 40 000 patients over 60 who were treated for hypertension, there was a decrease in risk by 53% from ARBs and 24% ACE inhibitors. This was compared to those with older hypertension treatments such as calcium channel blockers and beta blockers.

The drugs work by blocking the effects of the hormone angiotensin II; this results in the destruction of the amyloid plaques which build up in the brain of someone suffering from Alzheimer's.

The next step is to conduct clinical trials to see how ARBs and ACE inhibitors can prevent cognitive decline. They will be looking to see if they can stop mild cognitive impairment from progressing to dementia and if they can delay the progression of this degenerative disease.

After doing my pathology project on Alzheimer's disease and then my year 12 Biology coursework, I find articles on dementia of particular interest. I understand the pathology well enough to understand the effects of the medication and with my job at the nursing home can see the day to day application of the disease.

Article cited from The Daily Mail

Media can often be Misleading - BMJ Blogspot

Regularly national newspapers publish surveys where around 80% of people who haven't used the NHS for 5 years, rate the NHS as being poor however 80% of those who have used it praise it highly. (Blogs BMJ Patient editor P. Lapsley).

Non-users can not draw on personal experience and therefore have to place their judgements from stories in the media. Unfortunately, stories which shock and disgrace tend to make the headlines rather than tales of kindness and dedication. These occasional sad stories can be very damaging for the NHS's reputation and can undermine the morale of staff who are only trying to care for patients to the best of their ability in the majority of cases. Sometimes the care provided is with more modest resources than desired but care remains professional in a vast majority of cases.

I am not suggesting that we ignore cases where allegations have been made about neglect, as this is something that needs addressing, however I do believe that popular media should also show the fantastic work that the organisation does. I imagine some might argue that the healthcare professionals are merely 'doing their jobs' so should not be accredited by society in the media. However people would have more confidence in local healthcare services if the media could expose the remarkable commitment of the staff rather than only exposing these 'horror stories'

Are current EU rules putting patients at risk?

On the way to work I heard about the language issues which are thought to be affecting the quality of patient care on the radio. The House of Lords committee and the GMC believe that patients may be at risk due to free movement of GPs.

This was a bit issue in the news in 2008 when a German doctor gave a fatal overdose of painkillers to a patient on his first (and only) working shift in Britain. The doctor was accused of negligence and was given a sentenced suspension in Germany but was still able to practice in UK. This has lead people to believe that the current rules and questioning patient safety. Ministers and the GMC have expressed frustration at the current situation. The European commision have planned a review of the guidelines and we are to expect 'firm proposals' by the end of the year.

Andrew Lansley spoke on the BBC news about the changes which need to occur. When a doctor comes to the UK they need to be first registered with the GMC and then assessed for skills (and language) before they are put on the performers list and are able to work in general practice. Language tests can be used for this assessment; it is not against EU rules becasue it is for NHS employment. Therefore language tests can legally be applied to foreign doctors as an employment check; this is also the same for nurse, midwives and pharmacists.

Under the current European law we can not put a restraint on the movement of European doctors. However we can assess them in terms of employment; if there are questions about someone's fitness to practice this should be flagged up.

Garden House Hospice

I have been volunteering at Garden House, Letchworth, since May 2010 and have found it a valuable experience to understand end of life care both for the patient and their families.

Last Saturday, whilst I was cleaning the small kitchen towards the end of my shift, a lady came in for a chat. Her husband was critically ill and was rapidly going downhill. Previous to admission, he had been cared for at home, with his wife getting up at 4am to attend to his needs. It was a very stressful time for her and they had to rearrange their home and their routine. She explained how although she knew that his condition must be getting worse when he was admitted to the hospice, she felt a great deal of relief and comfort in knowing he was in safe hands. At the hospice he was receiving 24hour nursing care with access to medication for extreme pain relief.

I could see this was a very difficult time for her and tried to reassure her that she was doing the very best she could for him. She told me how the drugs he was on for pain relief had slowed his thinking processes making it harder to interact with him. She said that she really appreciated that there are not set visiting times, alike in a hospital ward, and that she is able to come in at meal times to help feed him. This way she could still feel connected to him.

We shared some moments and I had the opportunity to express how I felt when my Gran had been cared for by Garden House. We took some time to appreciate the successful nature of the hospice. The atmosphere is so calm and it is very clear that the staff are so dedicated to caring for the patients and their families. Being able to contribute to this organisation is such as honour. When my Gran was placed in a nursing home, where until she sadly passed away in January, she continually expressed how she missed Garden House. It was obviously somewhere that she felt safe and loved. As a family we decided to request that all donations at the funeral would go to the hospice as a token of our gratitude.

I think locally we are very lucky to have this service available. People who have no experience of a hospice environment often have a misconception that they are morbid places where people come to die. However from my experiences i have found this is certainly not the place.

Night Shifts

I've been working the 12 hour night shifts, and i'm not going to lie, I've found them quite challenging! I have enjoyed being able to learn the routine at night as it is quite different to the day, however it has taken a bit of adjustment. So has becoming nocturnal; sleeping during the day and staying up all night does feel a bit strange. I have found that it disrupts your usual eating routines and I also had several nose bleeds this week.

Although I'm not in a hospital setting, I have had to stay up all night, attend to clients at the early hours of the morning and get used to a totally different routine. I think getting the opportunity to work nights as a care assistant will help to prepare me for my future career in medicine. It has taught me about the nature of the work and also shown me that I can manage it!

Recruitment Crisis in Psychiatry - Student BMJ Oct 11

A negative image of psychiatry, plagued by the lingering stigma, has put future medics off the speciality. With 1/3 of core training posts, there were only 0.7 applicants place. The RCPsych and BMA are concerned with these statistics and believe that there are several issues which need addressing.

One reason for these figures are so low is likely to be due to the lack of early exposure to psychiatry in medical school and foundation programmes. Also undergraduate students perceive it as not being as scientific as other specialities and wrongly view the treatment as being less effective and evidence-based. As well as the stigma of the field of medicine, often being bad-mouthed by other medics, it can be seen as being separate from the rest of medicine. It could also be due to the low level of academic psychiatrists leading to reduced exposure.

A former member of BMA junior doctors committee, explains how even if medics do not want to go into a career in psychiatry, it is important that they learn about it. She writes in the article how an experience in psychiatry has helped her in her current job as an obs and gynae trainee. For example, she now understands the effects of anorexia and depression on fertility.

The lack of exposure is affecting students' interest in the field; most students are not exposed to a psychiatry placement until they are a F2 doctor and by then most people have almost made up their choice where they want to specialise.

However with no new money available for foundation year posts, they would need to reconfigure existing tracks as psychiatry would have to come out of existing resources. The BMA, psychiatry taskforce and RCPsych hope that their efforts to improve the perception of psychiatry through earlier exposure will lead to an increase in recruitment figures and reduce the stigma.

Daily Mail claims that 'Mustard Makes Your Muscles Massive'

An article on NHS Choices website explains how a plant based steroid, used to promote plant growth, has been used to increase the muscle protein of rats in laboratories. Feeding rats HB (28-homobrassinolide) for 24 days caused them to gain body weight and overall lean muscle mass. These effects did not increasing the level of androgen hormones unlike illegal anabolic steroids.

This article is interesting from a scientific point of view, however it currently lacks application to the human population. Brassinosteroids are plant chemicals found in pollen, seeds, leaves and other young vegetation. They are structurally similar to cholesterol-derived animal steroid hormones but have no function in animals. They are used to stimulate plant growth and regulate gene expression. Mustard seeds contain HB, however that does not mean that if human eat mustard, their lean muscle mass will increase. The Daily Mail has drawn false conclusions from the results to produce an article which is considered misleading.

I found this article interesting as it links back to the work I did on hormones, steroids and performance enhancing substances in preparation for my Unit 5 Biology exam.

'Let's Talk About....Recovery Star' interactive lecture 28/09/11

I attended an interactive lecture by SEPT on the mental health services in my local area and how the 'Recovery Star' framework works.

The star has 10 domains (each rated from 1-10 by service user/service provider):

1. managing mental health

2. identity and self esteem

3. trust and hope

4. relationships

5. work

6. responsibilities

7. social networks

8. living skills

9. self care

10. addictive behaviour

The service user can rate how they feel they score (out of 10) at the snapshot that they are assessed at, rather than scoring 'on general'. This star is hoped to be used by SEPT to improve care plans to make them more meaningful. They hope to look at the whole person rather than just their mental state and their medication. I am a true believer that a holistic approach is very important to give personal care. This will be offered to every service user, however no one will be forced to under take. The idea of the framework is to show development and to help the individual to improve, set targets and reflect on the progress that they have already made. Also it is important to remember that each service user's star is personal to them; not everyone will have the same end goal. One person may aim to raise their social skills from a 2/10 to 3/10, however someone else's target might be to reach 10/10.

Service users, SEPT members, carers and mental healthcare professionals attended the meeting and had a range of different views on a number of topics. At the meeting there was a large discussion about who should fill out the recovery star. Some believed that the service user should fill out the star with their carer together whereas others believed that the service provider and service user should fill out the stars separately and then compare. Someone else pointed out that if the service provider rated the person as being lower than they thought they were it could be damaging. It would therefore depend on the vulnerability of the service user and the relationship they had with the carer/ service user.

Registered mental health charity 'Mind', has their own version of the Recovery Star. This could help them work alongside SEPT. Also if GPs were trained in how to use the Recovery Star, it could bring mental health services to local surgeries as well as psychiatric hospitals. Carers at the lecture commented that they would find the star useful to use at home whilst looking after their relative/partner. SEPT said they would take this into consideration.

At the lecture there was also a discussion over the success of day centres. Some of the people at the meeting had strong feelings against these institutions saying they were merely containing those with mental health issues and stopping them from getting their real lives back. One service user explained how she has been using the day centre services for the last 10 years and how it had played a strong part in her recovery. She told us how she integrates back into her 'normal' life for 6 out of 7 days but once a week she really benefits being with like minded people. For example, in everyday conversation people asked her what she do for a living; after being out of employment due to have bipolar disorder, it was a constant reminder that she was different. Having the link back to mental health services served as a secure place where she wasn't on show and could relax and express herself.

The different ideas around the day services have come from person experiences; this has shown me that like everything in the world, people are different and will recover in varied ways.

Overtime these day services have improved to provide service users a safe environment where they can interact with others, drink coffee, access the internet and play interactive computer games. In a SEPT day centre in Germany, they offer these modern services to give a comfortable setting to bridge the gap between integrating back into society. They have found that teaching the service users about their mental health problems (e.g. the pathology and how the medication works) they feel more involved in their recovery and that they can be in charge of their own lives. They have also been teaching the service users presentational skills so they can teach others about their conditions and even go on to starting a career in that field. I think it is really important that the service user is treated like a respected adult. The German day centre have seen an amazing 70% decrease in the relapse rates of the day centre users!

I found the interactive lecture a brilliant learning opportunity, it was informative and full of personal opinions and views from a range of different people involved in mental health services, be it service users or providers. As a member of SEPT, I will be checking my emails regularly in hope to attend other upcoming lectures.

Stem Cells progression

On the BBC news last night a story on a new method regarding the production of stem cells caught my interest. In the New York Stem Cell Foundation Laboratory they have had little success with the old somatic cloning technique. When they removed the genetic material from the egg and replaced it with skin cell chromosomes, the egg divided but then failed to go beyond the 6-12 stage.

However when they left the egg's own genetic material in place and added skin chromosomes, the egg developed. It developed to reach the blastocyst level which is the usual source of embryonic stem cells (with about 100 cells contained).

.

Because there are large ethical issues around producing and using embryos for therapeutic uses and then discarding the potential life form, a different route to stem cells has been used. A chemical baths can be used to 'reprogramme' an adult cell into a stem cell; the method does not require an egg. There are however concerns that these stem cells could not be used therapeutically as they are more prone to expressing cancer causing genes.

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