Jimmy Kimmel reveals the heartlessness of healthcare in America | Arwa Mahdawi

I don’t know why everyone in America is so obsessed with health care reform and why it causes endless debate. It seems obvious that there is a very simple and very fair solution to this endless reform rigmarole: let poor people die.

This may sound sort of harsh but bear with me. I didn’t arrive at this conclusion without a rigorous analysis of the facts and a long hard look at cold hard reality. And it’s this sort of objective thinking that’s really needed when it comes to health care reform. The one thing we must be careful not to do is get emotional about things like life and death to push a political agenda.

Take Jimmy Kimmel for example. On Monday the talkshow host delivered an emotional monologue about his new son, who was born with severe heart defects requiring emergency surgery. At the end of this he urged Americans to support the Affordable Care Act.

Kimmel noted that before the ACA was introduced, “if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition and if your parents didn’t have medical insurance you might not live long enough to even get denied because of a pre-existing condition. If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”

While Kimmel’s story is obviously tragic he’s not exactly qualified to decide important policy issues for America. I mean, the guy is a celebrity, not a politician. Further, it is selfish to suggest that Americans should feel some sort of responsibility for their fellow citizens. It doesn’t matter how sick someone might be or how many pre-existing conditions they might have, if they’re hardworking and motivated they can pull themselves up by their bootstraps and find a way to pay for themselves.

As Joe Walsh, a former Congressman, tweeted on Tuesday afternoon: “Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.” Walsh, by the way, doesn’t even want to pay for his own kids’ healthcare – at one point he owed $ 117,000 in child support. Now there’s a guy who truly understands the American values of individual freedom and choice.

Oh, you know what? I give up. There’s no point attempting to satirize the sick state of America’s attitude towards health care – it’s already beyond parody. I mean, on Monday, Republican Congressman Mo Brooks of Alabama implied that people with pre-existing health conditions just aren’t living their lives “the right way.” Kimmel’s son may have been fresh out of the womb but he must have done something wrong to be landed with heart problems, right?

And remember when Utah Republican Jason Chaffetz compared heath care to iPhones? “Americans have choices,” Chaffetz explained. “Maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest it in their own health care.” An iPhone costs around $ 800. A simple appendectomy can cost up to $ 180,000. But making your own choices? That’s priceless.

And then there’s the imitable Paul Ryan who reminded us that “Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.” He forgot to add the bit about freedom being the option to die when you can’t afford to buy what you want to fit what you need.

Health insurance simply doesn’t work on the free market. It’s not a bloody iPhone. In a free market, it makes no sense for insurers to cover people with pre-existing conditions. In a free market, it makes sense for CEOs of insurance companies to earn millions of dollars while poor people die.

Health insurance also isn’t efficient on a truly free market. According to the Bloomberg Health-Care Efficiency Index America has one of the least efficient health care systems in the world because it is so fragmented. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower in the countries assessed.

For decades, Americans have been aggressively sold the idea that a national health care system is a socialist nightmare that runs counter to American values of freedom and choice. This started after the Second World War, when President Truman proposed a universal national health insurance program. His project failed in large part because it was fiercely attacked by the once-influential American Medical Association.

The AMA invoked fears about communism and branded the idea of universal healthcare as “socialized medicine” and un-American. Truman retorted “I put it to you, it is un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.” Well, it’s not the sort of Christianity that Republicans practice it seems.

You must have been born with un-operable heart defects not to agree with Kimmel’s statement that “if your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”

The fact that Kimmel can make headlines for pointing out what should be the obvious – in a supposedly civilized country – is just mind-boggling. The health care debate may seem complex but at its core it boils down to a simple question of who matters and who doesn’t. And it seems very clear that, in America, if you’re poor you don’t matter.

Jimmy Kimmel reveals the heartlessness of healthcare in America | Arwa Mahdawi

Postpartum psychosis: research reveals full recovery possible within weeks

Sarah West says in the days after the birth of her son in 2012, she felt the emotions many new mothers describe – a mixture of joy combined with anxiety about breastfeeding and whether she was doing everything right.

But around one week after the birth, West’s new-mum anxiety went into overdrive. Despite the exhaustion that comes with being a new parent, she was unable to sleep when her baby slept. Her thoughts raced.

Her doctor diagnosed her with postpartum depression and prescribed West antidepressants. But her symptoms worsened and she began experiencing delusions and hallucinations.

She was experiencing postpartum psychosis, a severe, rare and little-understood condition that can place both mothers and their children in serious danger. It is markedly different to postpartum depression, because mothers experience symptoms such as loss of reality, delusions and hallucinations. This can be accompanied by either mania or depression.

The temporary condition is debilitating, yet research into it is scarce, especially in Australia.

But new research being presented at the annual congress of the Royal Australian and New Zealand College of Psychiatrists on Thursday found that if properly recognised and treated, women experiencing postpartum psychosis could make a full recovery within weeks and successfully bond with and care for their babies at home.

This is critical because left untreated or misdiagnosed, the consequences of postpartum psychosis can be fatal. In a small number of cases mothers may harm or kill themselves or their baby due the condition, which is beyond their control. The condition nearly always requires hospitalisation to protect the mother and her baby.

The study examined women admitted with postpartum psychosis to a mother-baby unit, Helen Mayo House, in South Australia, over a five-year period from 2012 to 2016.

It found the women often required one-on-one nursing care, and all patients received antipsychotic medication. A few also required lithium, a mood stabiliser.

This treatment saw almost all of the women make a complete recovery and able to return home to care for their babies after an average stay of four weeks, similar to the average stay for other mental health conditions. A key finding was the treatment saw 77% of the women still breastfeeding at the time of their discharge.

West received treatment after a friend told her she was not behaving like her usual self and called the National Perinatal Anxiety and Depression Helpline [Panda]. They advised that West should be taken to hospital immediately for psychiatric care, and West is now a strong advocate for the helpline.

After a four-week hospital stay which included being taken off antidepressants and prescribed antipsychotics, and visits from her baby for bonding, West was able to return home and care for her baby.

Her time in hospital and her period of postpartum psychosis remains a blur, and West says she is still not ready for her family to fill in the gaps for her.

“People can mistakenly describe what women like me go through as ‘baby blues’ or ‘depression’, but I was definitely not depressed,” West says.

“My anxiety went into overdrive, I was experiencing delusions and hallucinations, and really irrational thinking. But so few people know about the condition, and my obstetrician said I was only the second case of postpartum psychosis he had ever seen.

“I think all of the gaps in my memory is my body’s way of protecting me.”

As well as taking medication, West made changes to her lifestyle and learned to recognise when she needed time to de-stress. She has fully recovered and she and her son are now doing well. But West is still fearful of reactions when she shares her story, given the lack of understanding and empathy from some towards mothers who experience the condition.

Postpartum psychosis occurs in about one to two of every 1,000 births, and there is a 50% chance of recurrence in subsequent pregnancies. West wants other women who have experienced it to know there is support and treatment available. She also wants people around new mothers, including healthcare professionals, to be more aware of the symptoms so they can make an accurate diagnosis.

“I know women who are so traumatised from experiencing this that they won’t have another child because they’re terrified,” West says.

“I have to speak up because I don’t like the thought of other families going through what we did. This has to change and to do that we need better recognition of the condition.”

Dr Rebecca Hill from the Women’s and Children’s Health Network in Adelaide led the Helen Mayo House study, and says she believes a key part of the treatment of her patients’ was that the unit accommodated both mothers and their babies.

“While we didn’t specifically study this, my intuition is that it’s better for the mother and the baby to avoid separation because the attachment relationship is vulnerable to trauma when separation occurs,” Hill says.

“It’s distressing to think some mothers may be separated from their babies longer than necessary because they could not access proper treatment. Even a few days’ delay in treatment can expose them to substantial risk.”

But not all states have mother-baby units. In New South Wales for example, there is only one mother-baby unit, and it is only available to private hospital patients who are admitted to hospital voluntarily. Most patients Hill sees with postpartum psychosis are involuntarily admitted, and even Helen Mayo House only has six mother-baby beds.

West, who lives in NSW, agrees more mother-baby units are needed. She believes they may be able to help mothers with bonding and would see women receive more specialised treatment from clinicians familiar with the condition. She says general mental health wards cannot always provide the specialised care postpartum psychosis patients require.

The president of the Royal Australian and New Zealand College of Psychiatrists, Professor Malcolm Hopwood, says the study shows the importance of identification and early intervention for women with postpartum psychosis.

“The good news for these women is that with the right care they can bond with their babies and care for them like any other new mother,” he says.

Hill says the causes of postpartum psychosis are unknown, with most of those experiencing it having never shown psychiatric symptoms before. It usually presents within the first six weeks after birth. Some research is under way into genetic causes, but this is in its early stages. An accurate diagnosis also means early intervention and monitoring measures can be put in place for any subsequent pregnancies, Hill says.

“For the vast majority of women they will only have susceptibility to this at the postpartum period,” Hill says. “Something at this time makes them exquisitely vulnerable. But the key is that once postpartum psychosis is identified, it is so, so treatable.”

• PANDA National Helpline, Mon to Fri, 10am-5pm AEDT, 1300 726 306


• Lifeline, 24 hours, 13 11 14

Contact the author at melissa.davey@theguardian.com

Postpartum psychosis: research reveals full recovery possible within weeks

Smoking causes one in ten deaths globally, major new study reveals

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”

Smoking causes one in ten deaths globally, major new study reveals

Few foods on track to meet salt reduction targets, survey reveals

Bread rolls are the only manufactured foodstuff likely to meet stringent 2017 salt-reduction targets, research has revealed.

The food industry will miss almost every salt target set to lower the amount of the “hidden killer” in processed food.

A survey carried out by Consensus Action on Salt and Health (Cash) found that the only food group likely to scrape into the 2017 target range is “bread and rolls”. This means that by the end of this year they should contain no more than 1.13g of salt per 100g.

After examining all 28 categories of processed food, researchers could not find any other foodstuff coming close to meeting that target.

The government set up the public health responsibility deal in 2011 with the aim of encouraging manufacturers to self-regulate.

Targets for 2017 were set out in 2014 and Cash agreed to monitor the scheme independently by recording the salt content of common foodstuffs in UK shops and supermarkets.

The recommendations were designed to get British consumers eating no more than 6g of salt a day.

Health campaigners are now calling on Public Health England (PHE) to urgently set new targets for 2020 and push food companies to meet this year’s recommendations.

In their latest survey, doctors and scientists assessed salt levels on the typical supermarket shelf. In one of their more surprising findings they discovered that Galaxy Ultimate Marshmallow Hot Chocolate is saltier than seawater. A single serving contains more salt than a packet of crisps.

Looking at a shopping basket of everyday food items, the group found that for every unhealthy high-salt option, healthier lower sodium alternatives were also available.

In comparing the two sets of groceries overall, they found that there was a difference of 57g of salt between them.

Graham MacGregor, a professor of cardiovascular medicine at Queen Mary University of London and chair of Cash, said the findings were a national scandal.

“The UK was leading the world in salt reduction, but PHE are doing nothing to ensure that the 2017 salt targets are met,” he said.

Katharine Jenner, a nutritionist and Cash’s campaign director , described salt as the forgotten killer.

“The findings from our FoodSwitch shopping basket survey are alarming and we are shocked to see that many food manufacturers and retailers are still failing to meet the salt reduction targets, despite having had years to work towards them,” she said.

“We congratulate the other, more responsible manufacturers that have successfully achieved them, or are on track to meet them by the end of the year – which shows it is possible. With only nine months to go, action must be taken now.”

PHE’s chief nutritionist, Dr Alison Tedstone, defended the decision to allow the industry to self-regulate.

“The food industry has reduced the amount of salt found in our foods by 11% in recent years, which is encouraging progress,” she said.

“We know there is more to do. This is why we’re talking to retailers, manufacturers, and the eating out of home sector on how they go further and faster to reaching the 2017 salt reduction targets.”

A diet high in salt has been linked to high blood pressure, heart disease and stroke. NHS guidelines say that adults should aim to eat less than 6g of salt a day.

Last year, Cash recorded dangerously high levels of salt in dips and spreads commonly seen as healthy options.

It revealed that one supermarket brand of the hummus contained 1.6g per 100g.

Few foods on track to meet salt reduction targets, survey reveals

Novelist Marian Keyes reveals fight against constant "suicidal impulses"

The novelist Marian Keyes has revealed how she battled constant suicidal urges at the height of her mental illness.

The Irish writer opened up to Kirsty Young about her struggle with alcoholism and depression on BBC Radio 4’s Desert Island Discs on Sunday.

At her worst – an 18-month period beginning in 2009 – Keyes said she struggled not to harm herself.

She had stopped being able to eat, sleep and interact with others, and was eventually hospitalised.

“Then the suicidal impulses started and it was very hard to physically to stop myself from going through with it,” she said. “For months and months, every day was an enormous effort not to do the acts of wounding myself.”

Her recovery was “really speedy”, but the experience altered her perception of what it meant to be depressed.

“Nothing worked but the passage of time … It’s an illness and it ran its course.

“I had always described myself as melancholy or depressive but I hadn’t a clue. Anything I had before was a blue day by comparison. This was altered perceptions, a mental illness.”

She wrote her novel The Mercy of Mystery Close in that period. She told the Guardian in 2013 that a scene in which the heroine planned to kill herself in a hotel room was inspired by her own experience.

“I had two goes going out assembling the whole kit and buying paper and Sellotape to write the note,” she said. “The conversation Helen has with the man in the shop, I actually had that, with him asking: ‘What is it you’re proposing to cut?’

“It was so bizarre to be standing in a DIY shop, buying a knife to open my veins with. I was absolutely going through who would find me, leaving money for her to apologise … I wasn’t in my right mind.”

Keyes, 53, also told Young about her experience of alcoholism while living in London in her 20s.

“Alcohol was the love of my life. It was my best friend and, in the end, my only friend … I had stopped eating, stopped hoping, I was constantly suicidal. There was only one way it would go. I couldn’t stop drinking and was preparing to go under.”

Writing was her “rope across the abyss”: she wrote her first short story, then a few months later began a rehabilitation program for alcoholism. She has now been sober for more than 20 years.

“It was that primal urge in all of us to stay alive, saying ‘I can give you this, will you live for this?’ It didn’t get me sober but gave me something to hope for.”

Keyes’ debut novel, Watermelon, was published in 1995.

Her 12 novels to date have sold 35m copies worldwide and been published in 33 languages.

Her 13th book, The Break, will be released in the UK and Ireland on 7 September.

• In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. Hotlines in other countries can be found here

Novelist Marian Keyes reveals fight against constant "suicidal impulses"

Prison study reveals high rate of self-harm after release and mental health failures

One in 15 newly-released prisoners attend hospital for self-harm but emergency departments are failing in their obligations to conduct comprehensive mental health assessments, new research shows.

A groundbreaking study of former prisoners, published in the Australian and New Zealand Journal of Psychiatry this month, has revealed high rates of self-harm following release from prison.

The post-release period is often seen as one of high risk for prisoners. It can be a time of significant upheaval and difficulty, leaving them without the intensive support services offered in prison, and exacerbating isolation, anxiety and other mental health issues.

The study examined the experiences of more than 1,300 prisoners by linking in-depth, pre-release interviews to emergency department and state correctional records.

The researchers found 83, or 6.4%, of the prisoners presented to emergency departments for self-harm. Twenty were hospitalised for self-harm twice and 14 presented three or more times.

Self-harm accounted for 5% of all emergency department presentations by the prisoners. That is 10 times higher than the proportion for the general population.

Eight had self-harmed within three months of release, 27 between three months and a year, and 48 after more than a year.

The study also revealed that only 29% of prisoners who had self-harmed were given a comprehensive mental health assessment.

The study’s authors described that as “extremely concerning” and as potentially in breach of the Royal Australian and New Zealand College of Psychiatrists’ guidelines.

One of the report’s authors, Murdoch Children’s Research Institute research fellow and psychologist Rohan Borschmann, said the guidelines required those assessments to be conducted when a patient presented with signs of self-harm.

“They state clearly that every person who presents to an emergency department following self-harm should be given some form of psychiatric assessment,” Borschmann said. “Our finding that only three in 10 people were receiving that was quite disturbing.”

Before this study, there had been no published data about rates of self-harm among newly-released prisoners.

Borschmann said the data showed the need for the provision of continuous healthcare services to prisoners before and after release.

“First and foremost there needs to be a better link-up between the healthcare provided in prison and the healthcare provided after release from prison,” he said.

“Ideally, that would involve continuity of healthcare beginning before they’re released from prison … and working with them through that often difficult period of transition.”

Borschmann urged governments to avoid making moral judgments on who should or should not receive proper healthcare.

“People who end up in prison typically have very complex lives and they’re often victims of things themselves,” he said. “It’s a moral issue to comment on who deserves treatment more than others. There really needs to be a shift away from that ‘they’re just bad people’ style of thinking.”

• Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia1300 78 99 78; Beyond Blue 1300 22 4636

Prison study reveals high rate of self-harm after release and mental health failures

Study Reveals #1 Natural Bacteria Killer

Study Reveals #1 Natural Bacteria Killer

Model Hanne Gaby Odiele reveals she is intersex

Belgian fashion model Hanne Gaby Odiele has revealed she is intersex and that she has gone public in an attempt to reduce the stigma around the condition and encourage other people to embrace their status.

The 29-year-old was born with internal testes and without a uterus or ovaries due to a condition called androgen insensitivity syndrome, which causes girls to have XY chromosomes usually found in boys. This means her biological sex characteristics do not conform to typical notions of male or female.

According to the United Nations, up to 1.7% of the world’s population is born with intersex traits, a figure roughly equivalent to the number of people with red hair. Many keep their condition secret.

“It’s very important to me in my life right now to break the taboo,” Odiele told USA Today. “At this point, in this day and age, it should be perfectly all right to talk about this.”

The model, who has starred in campaigns for Dior, Alexander Wang, Mulberry, Balenciaga and walked the runway for huge fashion houses including Chanel, Givenchy and Prada, is one of the first high-profile people to disclose her intersex status.

Odiele also wanted to highlight the invasive surgeries that she said are often carried out on intersex people because of a fear of non-binary bodies rather than any pressing medical need.

She had surgery to remove her undescended testicles at the age of 10 after doctors warned that they could cause cancer. At 18, she had additional surgery to reconstruct her vagina.

She said the procedures caused her distress, and that she was speaking out in part to discourage parents from putting their children through unnecessary surgery in an effort to make them appear more typically male or female.

“I am proud to be intersex, but very angry that these surgeries are still happening,” she said. “It’s not that big of a deal being intersex. If they were just honest from the beginning … it became a trauma because of what they did.”

Odiele’s husband, John Swiatek, also a model, told USA Today he was “incredibly proud of his wife” for speaking out. He added: “I am very impressed with her decision to advocate for intersex children in order to give them an opportunity to make up their own minds about their bodies, unlike the lack of options and information Hanne and her family (and many others) were given.”

There are at least 40 intersex variations, ranging from genetic, chromosomal, anatomic and hormonal. The UN and the World Health Organisation have condemned nonconsensual genital surgeries on intersex children as human rights violations.

Last year a landmark directive on intersex rights was announced by Chile. The country’s ministry of health issued guidance to stop “normalisation” surgeries on intersex children. The only other country that has produced any formal guidelines preventing medical interventions is Malta, which in April 2015 became the first country to prohibit these surgeries by law.

In December, the first US birth certificate reading “intersex” in the gender field was issued in New York. The city’s department of health and mental hygiene corrected the original birth certificate of Sara Kelly Keenan, born in Brooklyn 55 years ago.

Kimberly Zieselman, executive director of interACT Advocates for Intersex Youth, said Odiele will partner with her group. “I think her speaking out, having her voice added to the mix is going to culturally raise awareness in the mainstream,” she said.

Model Hanne Gaby Odiele reveals she is intersex

Green buildings make you work smarter and sleep sounder, study reveals

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Improved light, ventilation and heat control can boost workers’ productivity by thousands of dollars a year and reduce instances of sick building syndrome

People working in green buildings think better in the office and sleep better when they get home, a new study has revealed.

The research indicates that better ventilation, lighting and heat control improves workers’ performance and could boost their productivity by thousands of dollars a year. It also suggests that more subjective aspects, such as beautiful design, may make workers happier and more productive.

Continue reading…

Green buildings make you work smarter and sleep sounder, study reveals

Child obesity rising again, NHS report reveals

A growing number of children are becoming obese as young as four or five years old, NHS figures have shown, sparking renewed concern about the obesity crisis.

Obesity is rising among children both in their first and last years at primary school, according to the latest annual measurements of child body mass index (BMI) in England.

Overall, 9.3% of four and five-year-olds in primary reception class in England in 2015-16 were classed as obese, up from 9.1% the previous year, according to the national child measurement programme (NCMP).

The number of obese ten and 11-year-olds in their last primary school year also rose from 19.1% to 19.8% last year – nearly one in five.

Richmond upon Thames in south-west London has the fewest fat children in England. In the borough, 11% of year six pupils are classed as obese. In contrast, in the east London borough of Barking and Dagenham 28.5% of children that age were found to be obese.

More boys are dangerously overweight than girls. Among reception pupils, 9.6% of boys were obese compared to 9.1% of girls. Similarly, 21.7% of boys in year six were obese compared to 17.9% of girls, according to the latest NCMP results published by NHS Digital.

The figures reveal that child obesity is rising again after falling slightly in 2014-15.

The statistics also underlined the stark class divide. NHS Digital’s report found thatobesity prevalence for children in reception living in the most deprived areas (12.5%) was more than double that of those living in the least deprived areas (5.5%). In year six, 26% of children living in the most deprived areas were obese compared to 11.7% in the least deprived areas.

Nationally, the number of reception children who are either overweight or obese has also risen, from 21.9% to 22.1%. The same picture emerges with year six pupils, the number of whom found to be overweight or obese rose from 33.2% to 34.2%.

The figures come after Theresa May’s government was criticised for watering down the childhood obesity strategy that her predecessor, David Cameron, intended to publish. Health organisations, charities and campaigners such as Jamie Oliver have accused May of putting the interests of big business above those of public health and letting down children and families by publishing a “weak” action plan in August.

Experts voiced deep unease at the figures and upward trend. “It is deeply worrying that more children are leaving primary school overweight or obese than ever before and levels are increasing”, said Professor Kevin Fenton, the national director for health and wellbeing at Public Health England, which advises the government.

The number of obese ten and 11-year-olds is the highest since children began being routinely weighed and measured in 2006-07. In that year 17.5% Year 6 pupils were found to be in that category. Last year it was 19.8%, even higher than the previous record of 19.2% in 2011-12.

Alison Cox, Cancer Research UK’s director of prevention, said: “Our nation has hit a devastating record high for childhood obesity. The trend over the last decade is showing no signs of slowing down, and this worrying news is something that could have been prevented with more government action.

“But the government still has a chance to save lives. It has already recognised the influence of junk food marketing on children by banning junk food advertising during children’s programmes. It’s time now to stop this influential marketing before 9pm.”

The Obesity Health Alliance, a coalition of health charities and medical organisations, said the figures should act as a wake-up call to ministers. “Year upon year, we are faced with sobering figures that reveal an increasingly worrying trend – the number of obese and overweight children in the UK is not falling and is in fact rising,” a spokesperson said.

“Today’s figures provide yet another wake-up call for all those intent on stemming the obesity epidemic – the alarm bells are ringing and there’s simply no time to hit the snooze button. These poor health outcomes mean we are failing our children, and future generations, if this trend continues”, said an alliance spokesman.”

It wants the government to introduce its levy on highly-sugared soft drinks on time as planned in 2017 and “without dilution”, to restrict the marketing of junk food to children, both online and before the 9pm TV viewing watershed, and to push food manufacturers to introduce “ambitious” targets to reduce the amont of sugar i their products.

Child obesity rising again, NHS report reveals

Sick pay and work assessments to be reviewed, Jeremy Hunt reveals

The system of sick pay and GP “fit notes” is to be reviewed by the government, as Jeremy Hunt, the health secretary, highlighted the growing cost of long-term sickness to the NHS and suggested getting people back to work had major benefits for health.

The review will be announced in a draft consultation document published by the Department for Work and Pensions (DWP) on Monday, which will also examine changes to the controversial work capability assessments (WCA) undergone by disabled people in order to obtain welfare.

Ministers released little detail about how sick pay and fit notes, previously known as sick notes, would be changed, but said they wanted to “support workers back into their jobs faster and for longer”. It could involve a greater move towards people having a phased return to work after they are signed off sick and more contact between employers and sick employees.

Hunt said there was a £7bn cost to the NHS of treating long-term health conditions that keep people out of work, and suggested that employment could be a part of recovery. “This green paper launches a wide-ranging debate about recognising the value of work as a health outcome,” he said. “With all the evidence showing that work is a major driver of health, this is a big opportunity: to make sure that people get the support they need, improve their health, and benefit the NHS all at the same time. I hope that health professionals will contribute their expertise so that we can ensure the best possible outcomes.”

Hunt was backed by Duncan Selbie, the chief executive of Public Health England, who said health, wellbeing and happiness were “inextricably linked to work”. Selbie said: “People in work generally have better health, so it makes perfect sense for the government to do all it can to support employers to close the gap around employment, disability and illness and to enable people to work when they can.”

The consultation document is aimed at helping to get disabled people and those with long-term conditions back into work, with a specific focus on mental health and musculoskeletal conditions such as arthritis.

Damian Green, the work and pensions secretary, appears to be unwinding some of the policies of his predecessor, Iain Duncan Smith, by reconsidering the work capability assessment. He announced at the Conservative party conference that people with severe, long-term health conditions would no longer have to be reassessed for their benefits under the WCA.

The new review will consult on scrapping the process that puts disabled people into two groups of being unable to work or capable of some work.

“When things need improving, like the work capability assessment and fit notes, we mustn’t shy away from big decisions,” he said. “We must be bold in our ambition to help disabled people and those with health conditions. This green paper marks start of our action to confront the attitudes, prejudices and misunderstandings that, after many years, have become ingrained within the welfare state, within the minds of employers and across wider society.”

However, Debbie Abrahams, the shadow work and pensions secretary, said the review of the disability benefit assessment process did not go far enough. “For Damian Green to claim that this Tory government is confronting the negative ‘attitudes and prejudices’ that it has spent six years encouraging is ridiculous,” she said. “It is an insult to the hundreds of thousands of disabled people who have been on the receiving end of their callous social security regime, like my constituent who was sanctioned after having a heart attack during his jobcentre appointment.

“I have announced that Labour will scrap the work capability assessment and the Tories’ punitive sanctions; anything less is tinkering at the edges.”

Sick pay and work assessments to be reviewed, Jeremy Hunt reveals

300 million children live in areas with extreme air pollution, data reveals

Three hundred million of the world’s children live in areas with extreme air pollution, where toxic fumes are more than six times international guidelines, according to new research by Unicef.

The study, using satellite data, is the fist to make a global estimate of exposure and indicates that almost 90% of the world’s children – two billion – live in places where outdoor air pollution exceeds World Health Organisation (WHO) limits.

Unicef warned the levels of global air pollution contributed to 600,000 child deaths a year – more than are caused by malaria and HIV/Aids combined. Children are far more vulnerable to air pollution, Unicef warned, pointing to enduring damage to health and the development of children’s brain and urging nations attending a global climate summit next month to cut fossil fuel burning rapidly.

“The magnitude of the danger air pollution poses is enormous,” said Anthony Lake, Unicef’s executive director. “No society can afford to ignore air pollution. We protect our children when we protect the quality of our air. Both are central to our future.”

Deaths of under-fives linked to air pollution

Air pollution is world’s single biggest environmental health risk, according to the WHO, and is getting worse, with levels of toxic air rising 8% in the last five years. Over three million people a year die as a result of outdoor air pollution – six every minute on average – and this is set to double by 2050 as fast growing cities expand. Indoor air pollution, mainly from wood or dung stoves, causes another three million deaths a year.

Children are especially at risk, the Unicef report says, because they breathe more rapidly than adults and the cell layer in their lungs is more permeable to pollutant particles. The tiny particles can also cross the blood-brain barrier, which is less resistant in children, permanently harming cognitive development and their future prospects. Even the unborn are affected, as the particles inhaled by pregnant women can cross the placental barrier, injuring fetuses.

Prof Jos Lelieveld, at the Max Planck Institute in Mainz, Germany, said the report was excellent: “Air pollution is typically a problem in developing countries, where infants have little resistance due to poor nutrition and where health care is insufficient.”

The Unicef study combined particle pollution data from a range of satellites with ground-level monitors to estimate the number of children in polluted areas. Of the 300 million exposed to levels of pollution six times over WHO limits, 220 million live in south Asia, where India hosts many of the world’s most polluted cities.

Another 70 million children living with very toxic air live in east Asia, mainly in China. But more children are exposed to air pollution levels above the WHO limit in Africa – 520 million – than in east Asia.

The air pollution crisis is worst in low and middle income nations, where 98% of cities do not meet WHO guidelines, but over half the cities in rich countries also fail to meet the guidelines. In Europe, 120 million children live in areas where outdoor air pollution exceeds international limits, and 20 million suffer levels over double the limit.

Dr Penny Woods, chief executive of the British Lung Foundation, said: “In the UK, we know that children’s health is being put at risk every day by unsafe levels of pollution in many of our towns and cities. At least 3,000 schools are located within illegal levels of pollution. Yet very few of these schools have monitors around them. It’s time for the government to enact a new clean air act to tackle this modern pollution problem and protect all our health.”

In the report, Unicef urges all countries to cut air pollution by reducing fossil fuel burning in power plants and vehicles, which also helps tackle climate change. This double benefit has led to significant action in China in recent years. Tackling air pollution is also cost-effective: the World Bank estimates that the welfare losses from air pollution are more than $ 5tn a year.

Unicef also recommends minimising children’s exposure by ensuring sources of pollution such as busy roads and factories are not sited near schools and playgrounds and by the roll-out of cleaner cooking stoves.

300 million children live in areas with extreme air pollution, data reveals

Robin Williams"s widow reveals how dying actor fought "chemical warfare in his brain"

The widow of Robin Williams has lifted the lid on the actor’s struggle with a debilitating neurological disease in the months before he took his own life, likening it to “chemical warfare in his brain”.

Writing in the journal of the American Academy of Neurology, Williams’ wife Susan Schneider Williams has detailed the final months of her husband’s life as the couple struggled to respond to his devastating decline in health.

Williams took his own life in August 2014.

Three months before his death Williams was diagnosed with Parkinson’s, but Schneider Williams has previously revealed the autopsy identified that he had suffered from Lewy body disease (LBD).

In her essay, “the terrorist inside my husband’s brain”, she said doctors would later discover it was instead one of the worst cases they had ever seen.

LBD is an incurable form of neurodegenerative disease. It is the second most common form of dementia after Alzheimer’s, with which it shares many symptoms, and can be misdiagnosed as Parkinson’s disease.

In October 2013, on the couple’s second wedding anniversary, Williams experienced gut discomfort, and fear and anxiety which “skyrocketed to a point that was alarming”, Schneider Williams wrote.

He had already been experiencing various physical ailments, which had been intermittent and which the couple and doctors had believed were unrelated. By December he would suffer from increasing levels of “paranoia, delusions and looping, insomnia, memory, and high cortisol levels”.

After his death doctors found that a high concentration of Lewy bodies in his brain’s amygdala had caused the acute paranoia and “out-of-character emotional responses”.

Schneider Williams described it as “chemical warfare in his brain”.

“How I wish he could have known why he was struggling, that it was not a weakness in his heart, spirit, or character,” she said.

Over the following months Williams suffered from panic attacks and memory loss, struggling to remember lines during the shooting of Night at the Museum 3.

He kept saying, ‘I just want to reboot my brain’.

His mental state declined, and Schneider Williams found herself increasingly unable to reassure his anxieties and insecurities.

“Robin was losing his mind and he was aware of it. Can you imagine the pain he felt as he experienced himself disintegrating? And not from something he would ever know the name of, or understand? Neither he, nor anyone could stop it – no amount of intelligence or love could hold it back,” she said.

“He kept saying, ‘I just want to reboot my brain’.”

While had been diagnosed with Parkinson’s disease, Schneider Williams wrote that after his death it became apparent that, pathologically, he suffered from diffuse LBD.

“One neuropathologist described LBD and [Parkinson’s disease] as being at opposite ends of a disease spectrum. That spectrum is based on something they share in common: the presence of Lewy bodies – the unnatural clumping of the normal protein, a-synuclein, within brain neurons,” she said.

Schneider Williams said four doctors examined her husband’s autopsy report and final two years of medical records and they “indicated his was one of the worst pathologies they had seen”.

“He had about 40% loss of dopamine neurons and almost no neurons were free of Lewy bodies throughout the entire brain and brainstem.”

She said the medical team had been on the right track in diagnosing and treating Williams before he died, but she would never know if that would have made a difference.

“I am not convinced that the knowledge would have done much more than prolong Robin’s agony while he would surely become one of the most famous test subjects of new medicines and ongoing medical trials,” she said.

“Even if we experienced some level of comfort in knowing the name, and fleeting hope from temporary comfort with medications, the terrorist was still going to kill him.”

Schneider Williams, who was last week appointed to the American Brain Foundation’s board of directors, said she wrote the essay to increase neurologists’ understanding of patients and caregivers and to “add a few more faces” to the reasons they conduct research.

• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Robin Williams"s widow reveals how dying actor fought "chemical warfare in his brain"

Seven-day NHS: Labour demands inquiry as leak reveals crisis warning

Labour is demanding an inquiry into revelations that senior civil servants fear the government’s push for a “truly seven-day NHS” may be derailed because it faces staffing and money problems.

Tom Watson, the party’s deputy leader, claimed that leaked Department of Health documents obtained by the Guardian and Channel Four News showed Jeremy Hunt had misled the public by pushing ahead with expanding the NHS in England despite his own mandarins’ concerns.

“Leaked secret papers show that junior doctors’ concerns were right. This warrants an inquiry. Hunt misled the public,” Watson tweeted in response to the disclosures, which have prompted renewed scrutiny of a policy that the Conservatives have pledged to deliver in full by 2020.

Senior Tories have responded to the publication of the department’s own risk assessment of the seven-day plan and other papers by making clear that they share the civil servants’ previously private worries.

Dr Dan Poulter MP – who until last year was a health minister alongside Hunt and is also an NHS doctor – tweeted his view that the documents constituted “a warning of the dangers of putting soundbites ahead of properly costed and resourced plans for our NHS”.

Dr Sarah Wollaston MP, the ex-GP who chairs the influential Commons health select committee, tweeted: “Cannot keep piling ever greater responsibilities on to an overstretched service without realistic resource and workforce to cope.”

In a swipe at Hunt she added: “Expect problems when thin evidence is used to bolster an under-resourced political objective instead of policy following the evidence.”

Diane Abbott, the shadow health secretary, said: “This is a scandal. The government is undermining the NHS with plans it knew to be unworkable. I will be writing to Jeremy Hunt to ask him to explain why [he] has contravened his civil servants’ advice and to ascertain whether he has misled parliament.”

Professor Jane Dacre, the president of the Royal College of Physicians, also warned that the drive to expand medical services at weekends was unrealistic because of the NHS’s worsening shortage of doctors, which is leading to more and more gaps in rotas and expensive use of locum medics.

“At the moment we are struggling to deliver care over five days, so to extend that to seven days and expect doctors to be able to provide high quality of care is not realistic. Doctors are working hard and they want to do the best they can for patients, but it is difficult to deliver the quality of care needed seven days a week without extra people to deliver it”, she told C4 News.

“There are just not enough doctors available to run a seven-day service at the moment. We all want to provide better patient care but to provide a seven-day service in our hospitals we need more doctors, and probably more nurses too. We also need pharmacists, occupational therapists and physiotherapists working at weekends as well.”

Hunt has made clear he expects the NHS to fund the expansion of services that he wants by 2020 from within the £10bn rise in its budget it will receive by then.

However, health experts such as Nigel Edwards, chief executive of the Nuffield Trust think-tank, have made clear that with the £10bn only bringing a 0.9% annual increase in NHS funding, the entire amount will be needed to help the service cope with growing pressures, and it will not cover the costs of having more doctors on duty in hospitals and GP surgeries by the end of this parliament.

Seven-day NHS: Labour demands inquiry as leak reveals crisis warning

New "care atlas" reveals disparity in dementia care across UK

The government has begun to publish detailed information about which areas of England give people with dementia the best support, in an effort to reduce wide variation in the quality of care provided.

The Department of Health’s online “dementia atlas” will show, for example, how many sufferers have their care reviewed every year, as they all should, and how likely they are to end up dying where they normally live, usually at home or in a care home.

It will also reveal how many people with dementia end up being admitted to hospital as an emergency and how many “dementia friends” each area has.

Ministers hope that publication of the information will prompt local NHS bodies in parts of England which are not doing as well as others to step up their efforts to prevent dementia, diagnose the condition earlier and support those who have it.

Related: What happens to older people who can’t afford good care?

The information exposes wide differentials in aspects of dementia care that some may conclude reveal a postcode lottery in a patient’s chances of getting good care.

For example, while in some parts of England, 85.8% dementia patients have their care looked at every year, in others just 49.3% receive the same service. Those checks are seen as important because, as dementia is a long-term and degenerative condition, “reviewing those with a diagnosis at least annually will ensure that the needs of people with dementia and their carers are discussed and appropriate care plans can be implemented”, the atlas says.

Similarly, while some areas have as many as 8,000 “dementia friends” available to help sufferers, others have none at all. There is also a more than three-fold variation in the number of those with dementia being admitted to hospital as an emergency. That ranges from 1,840 for every 100,000 people aged 65+ to as many as 6,046 for every 100,000.

Related: The Observer view on dementia care | Observer editorial

“Making more user-friendly information on dementia accessible online is a step in the right direction”, said George McNamara, head of policy and public affairs at Alzheimer’s Society. “People can now see which parts of the country are leading the way with developing dementia-friendly communities, and how many dementia friends there are in each area.”

However, the atlas should be expanded to become even more useful by including the experiences people with dementia have had of the health and care systems, in order to enable NHS bosses to make improvements in areas which are lagging behind, McNamara added.

The atlas shows that care is unsatisfactory in some places, the Alzheimer’s Society added. “The atlas exposes varied care, with some areas reporting much higher numbers of emergency hospital admissions. We must urgently explore why people with dementia’s needs are escalating to this point and what can be done in the community to prevent crisis admissions among this vulnerable group. It’s currently easier to find out about your hospital’s finances than the quality of dementia care they provide. To make hospitals more transparent and accountable, we are calling for them to publish an annual statement on dementia care.

Related: Could music projects cut the cost of dementia care?

“Additionally, in some parts of the country, people with dementia were much less likely to have had their care reviewed in the last 12 months than in others – something which is extremely important given that dementia is a progressive condition and a person’s needs become more severe over time. The causes of variation need to be investigated to ensure care is never a gamble”, added McNamara.

The new tool will also outline how many people in each area smoke – the average across England is 18% – in the hope that this will spur GPs and other health professionals to redouble their efforts to get people to quit smoking, which is recognised as a major risk factor for dementia.

Jeremy Hunt, the health secretary, is also seeking to improve NHS early diagnosis of dementia by ensuring that people aged between 40 and 64 are asked about it when they have an NHS health check. The new component of the health check will now be trialled through more than 250 GP surgeries in four places: Birmingham, Bury, Manchester and Southampton.

New "care atlas" reveals disparity in dementia care across UK

What OKCupid Reveals About Flirting On the web

OKCupid, the popular and free on the internet dating web site, is in the news. Their dormant research weblog “oktrends” has returned with a report from latest experiments performed on unsuspecting legions logging-in searching for really like, or some thing. This kind of investigation will liklely increase ethical questions about privacy and informed consent, like what happened in the course of the current Facebook secret-study hullabaloo. At the identical time, it also provides me a opportunity to report some “results” from the ongoing “natural experiment” on online dating that routinely will take place in my clinical office.

In excess of the years I have invested tons of time in my psychology practice hearing single patients—as nicely as the occasional not so single patient—talk about online dating experiences. It goes with the territory of performing psychotherapy. I’ve even presented at specialist conferences on the topic. Two “results” leap out.

One particular finding, and the subject of this submit, is that online dating includes pleasures that share a typical psychology with the far more general knowledge of sexual enjoyment. On-line flirtation can be more like closing one’s eyes for kiss that in no way comes than several recognize. In contrast, bodies collectively initial dates are eyes wide open messy fleshy human encounters.

Second, and the subject for a subsequent publish, lots of emotional agendas are in play on dating web sites, meeting the “right person” getting just 1 of them. Confident, some folks truly do want to locate a unique someone so they can get off OKCupid. But tons of other individuals just want to discover an individual so they can get off. And some want to remain on simply because on the internet is the only location they can get what they want.

(Please note that clinical confidentiality has been strictly protected in all the clinical circumstances I discuss in this and the subsequent on the internet dating post. All identifying info has been eliminated or disguised and all permissions have been secured.)

Take into account a skilled 43 yr previous divorced girl who began dating soon after the end of a 15 yr marriage. Right after several disappointing blind dates she “got pro-active” by reading suggestions manuals and plotting online dating techniques with her girlfriends. They had no notion what they were unleashing. Her profile attracted lots of interest. Athletic and photogenic, she was a playful writer. She quickly became captivated by her screen relations. She advised me she “gave great profile” and “gave great message,”  and loved undertaking so. Her online flirtations have been lengthy, intelligent, and sensual. She needed her partners to be the identical. Only when somebody started out to bore her simply because she pushed the limits of his expertise at fantasy and language would she give in and meet him in individual. Often a fling resulted, but rarely. Most occasions there have been a single or two rather disappointing dates.

No guy ever matched up, or even came near, to the individual she met on-line. In-individual flirtation was just not as considerably enjoyable as have been her display relations. She and I invested time exploring how on the web was where she felt validated, hopeful and at times turned-on. As her story unfolded the process organizing her online knowledge commenced to become clear. She would invest these guys, or rather their on the internet presentation, with all the qualities and emotions she wanted them to have and then expertise individuals qualities as coming from them, not her. Their position was not to get in the way with discordant responses—and if they did, watch out, they may possibly then have to meet in individual. They had been like a blank canvas for her desire. She felt their notes and messages have been pleasure-filled discoveries. She felt they had specifically the emotions for her she desired them to have and that they have been becoming specifically the kind of man she necessary them to be. She was not conscious that the minimal data display relations offers allowed her to use their responses to verify her own internally-created fantasies. Of program, when they met in person the messy fleshy actuality of these men interfered with the fantasies she spun in the course of the on-line flirtation. The went from getting a blank canvas to a paint-by-numbers cliche, and that was not anything she desired back in her lifestyle, specifically after a disappointing marriage.

Despite how “today” her story looks, it resonates with the very first experiences of intimate communication at a distance: the telegraph. In 1879, Ella Cheever Thayer, herself a telegraph operator, wrote a novel titled Wired Enjoy (public domain, offered here) about two telegraph operators falling in really like by exchanging dots and dashes. In this novel Nattie and Clem, two telegraph operators, fall in enjoy without ever meeting. And when they do meet, right after a wonderfully melodramatic episode of mistaken identity in which one more telegraph operator who “listened-in” posed as Clem—much to Nattie’s horror since the imposter was “oily” and with “tangled teeth”—they meet in man or woman and uncover the attraction is real. Yet there is this remarkable obstacle to conquer: “I had far more of your company on the wire,” Nattie mentioned. Right here once more, this time in fiction, the actuality of the other, even though promising all the joys of being with a person else, also constrains and limits the imagination.

This method of wish flowing from the self to the other prior to receiving reflected back is not just existing on-line. It is is element of sexual enjoyment in basic. In fact, the experience of pleasure from these technologically-mediated encounters has the identical psychological dynamic as the pleasures of sex. The following quotation from Peter Fonagy appeared in the Journal of the American Psychoanalytic Association titled “A Genuinely Developmental Concept of Sexual Enjoyment” and illustrates the stage. He wrote:

“ The pleasure is by means of the possession of the emotions and concepts that have originated in the self but consciously are recognized only as of the other. Nevertheless, as I have explained, the other’s actual emotions and tips (the ones that we did not place there) can interfere with this illusion. Closing one’s eyes in sexual pleasure is perhaps partly done to preserve the fantasy merger with the other mind so the physical (facial) expression of the other are not able to give clues contradictory to the fantasy.”

And in a sense, when you are on-line your eyes are often closed.

Closed eyes are created in. Fantasies get place into phrases across what is a really narrow channel of data. It provides sharply restricted access to the enigma and extra of adult sexuality. In contrast, in-particular person flirting is a broad open channel. Meeting in man or woman, even though promising all the pleasures daily life can provide, also tends to make unavoidable the mysterious puzzles, demands to stay away from or possess, and too-muchness of entire body-to-entire body sexual enjoyment. Imagination will get swamped by the flood of the other. But when flirting online, fantasies run cost-free simply because the encounter of the other is comparatively unconstrained by who they are. Wishes and wishes are protected from the disappointments that come from seeing, touching, smelling, and interacting with the totally of who an individual is. And for numerous, that is sufficient, which keeps on the web dating internet sites in company.

————

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What OKCupid Reveals About Flirting On the web

Survey reveals managers" concerns about integrating wellness and care

Integration requirements mechanisms that assistance interaction – vertically amongst generalists and professionals, and horizontally between acute, main and social care. Photograph: Harish Tyagi/EPA

Moves to integrate overall health and social care are regarded by many to be the turnkey remedy to take the strain off our healthcare system. The drive in direction of closer integration of solutions does makes sense – with an ageing population and 1 in three older people residing with a persistent situation, it is vital that we seem at the architecture in area to supply great top quality, successful and compassionate care. Anything at all that can counter the ongoing fragmentation of providers, reduce duplication and allocate assets in a far more efficient way is to be welcomed, specifically as it must lead to improvements in patient care. The situation has been made rather convincingly by the leaders in our healthcare system.

However, producing integrated care a reality will fall to our overall health and social care managers. Making sure that they really feel relaxed, indeed good, about the move towards closer integration is paramount. It was relatively regarding that in spite of the case becoming created for integration, in our most recent survey of Institute of Healthcare Management (IHM) members, more than half stated they didn’t think that integrated care would take the pressure off the NHS. If we are to make integrated care a actuality it is critical that we pay attention to managers’ considerations. Digging beneath this statistic there lay a lot of reputable worries about integrated care that need to be addressed.

Doubts were raised about whether the Greater Care Fund will be utilized for its intended function, to assist lessen occupancy in expensive acute companies and increase care pathways. Health and wellbeing boards in England have to approve proposals on how the money are used locally, but managers doing work for acute providers, particularly basis trusts, are concerned about their lack of involvement as proposals are designed, and are wary that the funds would not be utilized to accomplish the significant step changes necessary.

Yet another nervousness centred close to the heavy workloads designed by the want to set up new infrastructures for collaborations and integration amongst the overall health and care sectors. Managers pointed out that staffing and monetary resources have been currently stretched to breaking stage. There was a prediction that there could be some “patch protection” on various sides and each and every would want to shift the cost to the other. This may well lead to delays in integration.

A lot of IHM members also signalled their anxiousness about whether everybody concerned in the integrated care agenda was becoming completely consulted and, provided the considerable changes that had been currently underway in the NHS, whether or not the timescales envisaged for its implementation have been reasonable.

Such concerns are to be expected, however. Managers did make clear their total assistance for the ideas behind the move to integration, as nicely as their belief in its prospective to provide a much more co-ordinated strategy to the way solutions had been delivered, but they also flagged considerations and our leaders have to get note.

There is significantly that we can do to help managers on the journey in the direction of integrated care. It is crucial that well being and social care leaders produce an setting in which managers can act a lot more collaboratively. Integration will require mechanisms that help ongoing interaction between practitioners and managers throughout well being and social care – vertically among generalists and specialists, and horizontally amongst acute, principal and social care.

This will need help which includes the creation of networks to facilitate studying and improvement. For instance, managing integrated teams requires a diverse kind of skills and expertise than managing single teams. It may possibly also require the creation of new roles doing work across specialist boundaries, to assistance integrated delivery.

Integration rightly has the likely to increase patient care and outcomes for the public considerably in a way that all managers are completely signed up to, but appropriate leadership, co-ordination and sources are going to be essential to make sure the complete prospective of the initiative is realised.

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Survey reveals managers" concerns about integrating wellness and care

HIV breakthrough reveals virus hidden in immune program cells

Danish researchers have used an anti-cancer medicine to to activate HIV hidden in the cells of patients taking anti-HIV medication, exposing the virus to the immune program and making it vulnerable to assault.

The final results uncovered on Tuesday have been hailed as a single of the key scientific breakthroughs to come from the Aids 2014 conference in Melbourne, as considerably of the language shifts away from obtaining a cure to focusing on breakthroughs in HIV treatment and prevention.

HIV hides in a state of hibernation in CD4 cells, an crucial element of the immune program. Nevertheless CD4 cells are unable to battle HIV themselves – that function lies with the immune system’s killer T-cells.

But simply because killer T-cells can’t detect the HIV hidden inside of CD4 cells, they are unable to attack and eradicate it from the entire body. Whilst HIV patients on antiretroviral drug remedy usually go on to have undetectable levels of HIV in their system, it is in no way eliminated.

There is usually a reservoir left hiding in cells, undetectable to existing screening tools and ready to consider hold of the immune system again must sufferers quit their antiretroviral therapy.

But a investigation team led by Ole Søgaard at Aarhus University’s department of infectious ailments in Denmark has utilised the anti-cancer drug romidepsin to activate the virus and deliver it out of hiding.

In principle, this implies that the killer T-cells need to be ready to detect the virus, since it leaves a trace on the outside of CD4 cells as it is activated and moves in the direction of the bloodstream, Søgaard mentioned.

“Despite really powerful antiretroviral remedy, there is still this reservoir left of HIV cells that are infected but not producing the virus,” he mentioned.

“Once you activate them, these particles will go to the surface and signal to the immune method that this cell is contaminated and wants to be cleared from the entire body. So this is a two-phase program where we bring the cells to the surface, and then rely on the immune method to kill them.”

In the pilot examine, researchers gave 6 individuals 3 doses of romidepsin above three weeks.

Just before each dose, no viral particles have been detectable in the patients.

“But after the dose was provided we simply measured the virus becoming launched into the plasma in 5 of these six individuals,” Søgaard mentioned.

“We also saw the virus go back to undetectable levels following 7 days, so it came up, then hid away yet again, returning back to a non-energetic state until the subsequent dose of cancer drug was provided.”

Nonetheless, the researchers identified the immune technique did not appear to assault the virus following detecting it. Researchers located no considerable reduction in the variety of infected cells each and every time the cancer drug brought the virus out of hiding.

“This suggests when you do this reactivation, you also need to also target and activate the immune technique and educate it to recognise these cells and assault,” Søgaard mentioned.

“That’s what we’re undertaking following in this examine. We will teach and prime the immune program to recognise HIV ahead of we give individuals the cancer drug, and we hope there will be a better possibility the immune program can clear these cells when the HIV is reactivated.”

Søgaard emphasised it was unknown how a lot of the HIV reservoir the immune method would be able to clear even if it could be taught to recognise the virus and attack it. Virus left in just a single cell may be ample to permit HIV to thrive once again.

“We’re nonetheless understanding about this disease and the place it hides, and it is a truly, genuinely difficult condition to cure since it hides in so many locations in the body, it hides genuinely properly and can hide for an indefinite time period of time,” he explained.

The trouble of an HIV cure grew to become particularly apparent with the now popular situation of the Mississippi infant, born to an HIV-good mom.

The youngster was placed on a powerful program of antiretroviral drugs inside thirty hours of birth. She continued the therapy for 18 months and when she stopped taking these drugs, she had no detectable virus in her system. It gave hope other infants taken care of early might be cured.

But 27 months later on, the virus was detected and she was placed on antiretroviral medication once again.

In a equivalent situation, two Boston patients acquired bone marrow transplants that appeared to rid them totally of HIV. They also relapsed, and are now back on antiretroviral remedy.

These instances have been referred to regularly throughout the AIDS 2014 conference, at times brandished as setbacks. But the cases reveal how far HIV therapy has come.

Attaining much more than two years with no antiretroviral therapy in an infant is unprecedented, especially because the Mississippi little one had no existing immunity to HIV. It has given researchers a new emphasis on exactly where to battle HIV, as they now know it requires just a small amount of dormant virus for HIV to become energetic once more.

The circumstances have shown that doing work out precisely in which dormant HIV virus resides in the body, and being in a position to measure it, will be essential to future research.

The development of HIV into lethal Aids was after regarded inevitable, and much less than thirty years following the epidemic started – not a extended period in medical science – individuals residing with HIV are able to lead prolonged and healthier lives.

But that all depends on entry to treatment, which has the extra advantage of safeguarding towards the transmission of HIV throughout unprotected sex by up to 96%.

The president of the International Aids Society, Françoise Barré-Sinoussi, won a Nobel prize for her function in discovering HIV and mentioned she would not be drawn into talk about how far away a remedy for HIV/Aids may possibly be.

“I bear in mind in 1984 a person mentioned we would have a vaccine inside of two years, and we are now 30 many years later,” she explained.

“We should move on from this. We will need to have to collaborate and combine distinct approaches to HIV – work on cures as effectively as therapies, prevention and vaccines – and strengthen the relationship among researchers to carry on to make progress in tackling HIV.”

HIV breakthrough reveals virus hidden in immune program cells

Millennials Favor Quality More than Ease, Reveals New Survey

Taco Bell, McDonald’s and KFC may need to rethink their recipes if they want to a piece of the $ 1.3 trillion Millennial market place, according to Buyer Reports’ latest quickly-meals report. All three of the nationwide quickly-meals kings’ signature dishes – McDonald’s burgers, KFC chicken sandwiches and Taco Bell burritos — were ranked final in taste in their respective classes.

Most notably, McDonald’s scored “significantly worse” than twenty competitors, including Hardee’s, White Castle and Carl’s Jr., by its own buyers in the best burger group.

The report asked consumers to rank the tastiness of rapidly-meals chains’ signature dishes from 1 to 10 (from least delightful to most delicious), and acquired rankings about 96,208 meals consumed at 65 chains.

Customer Reviews

The customers indicated that the high quality of the meals has become a lot more important to them than respondents of Buyer Reports’ 2011 survey. According to a press release, this has led to a substantial increase in approval scores for quickly-casual restaurants, this kind of as Chipotle, Firehouse Subs and Five Guys Burgers and Fries, due to the fact of the premium ingredients and better assortment of dishes.

The rise of rapidly-casual dining can be largely attributed to Millennials, the report says, who are more probably to go out of their way for a meal that’s larger top quality, more genuine and more healthy, even for a larger cost.

Quick-informal dining in spots like Chipotle and Panda Express lets the consumer manual the workers to put together their meal just the way they like it, notes Darren Tristano, executive vice president of Technomic, a food-services analysis and consulting firm, in a press release.

“I will spend a couple added bucks on a Chipotle burrito simply because they supply several of their elements, like steak, from pretty sustainable farms. In America, our foods technique is far behind significantly of the globe in terms of sustainable farming practices,” says Anne Gibbons, 21, from Evanston, Sick. ”We worth inexpensive, fast food and flip a blind eye to where it comes from. As a customer, I want to support eating places, organizations and corporations that are striving to modify our meals system for the far better.”

This comes on the heels of a report by RBC and the NPD Group, which also discovered that Millennials prefer chains like Panera Bread, Noodles &amp Co. and Chipotle, lately deemed the most favored brand by Millennials according to a Nielson survey. These chains are somewhat far more high-priced, but successfully marketed towards the health aware, “adventurous” Gen Y.

“I decide on to go to Chipotle because the firm has demonstrated a dedication to large top quality ingredients that contribute to a comparatively healthier meal,” says Nick Ellis, 21, a pupil at the University of Michigan. “And Chipotle has guac.”

The report also notes that breakfast offerings are becoming more and more important for income – hello Waffle Taco – and that Americans in standard are investing in excess of $ 680 billion per year dining out, the most money ever.

Comply with me on Twitter: @AliciaAdamczyk

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Millennials Favor Quality More than Ease, Reveals New Survey

The PIP chaos reveals the government"s contempt for disabled people | Sharon Brennan

Last yr, when I was waiting for a double lung transplant, my existence felt terrifyingly unpredictable. My lungs were failing, and it was challenging to cope emotionally, but a single factor that created factors slightly less difficult was the fast approach to secure disability residing allowance (DLA). This allowed me to make immediate decisions about getting carers to assist at home, getting the heating on far more, and taking taxis to appointments. It made a extremely hard time that tiny bit a lot more bearable.

Evaluate my encounter to that of Malcolm Graham, a 56-12 months-old from Romford. He was diagnosed with oesophageal cancer in September 2013 and applied for private independence payments (PIPs) on advice from Macmillan Cancer help and his nearby Citizens Suggestions. Pips are changing DLA and are supposed to assist individuals, regardless of whether in or out of work, to meet the added fees their disability triggers.

Graham says he has called the suitable department almost every single day in the eight months considering that he applied, and is nevertheless awaiting a last choice. Throughout that period he has endured 10 weeks of chemotherapy and a 10-hour operation in which big portions of his stomach and oesophagus were removed. He has had to rely on family and friends for monetary help, but is now in arrears on his electricity payments and has lately been visited by a debt recovery firm. With out the PIP mobility help he has utilized for, he is struggling to get out and about and says the wait has manufactured him feel ineffective and worthless. Following working for a lot more than 40 many years, he can not understand why the help he wants has been so far unattainable.

Graham is not alone in his wait for a selection. Last week, the public accounts committee report on the disastrous implementation of PIP however once more showed the cold-hearted contempt of the Division for Work and Pensions towards disabled folks. This has permitted us to be treated like guinea pigs, with an unwell-regarded and poorly trialed policy unleashed with tiny concern for the consequences.

PIPs had been at first trialed in the north of England in April 2013 just before currently being rolled out nationally just two months later on. In a very vital report on PIPs, published in February 2014, the Nationwide Audit Office mentioned this rush to implementation meant the DWP “did not allow ample time to test whether or not the assessment procedure could deal with big numbers of claims. As a result of this poor early operational efficiency, claimants face long and uncertain delays.”

By October 2013 only sixteen% of expected PIP choices had been created, partly because assessments by Atos and Capita, the private companies contracted by the government to approach these claims, have been only in a position to meet the anticipated 30 working-day turnaround of applications in 55% and 67% of situations respectively. The DWP had projected that 25% of assessments would avoid encounter-to-face consultations and be carried out solely on paper in actuality this figure is three%.

What is the result of this departmental failure? Terminally unwell folks, defined as those with less than 6 months to dwell, have waited for up to a month – 180% longer than expected – for a response as to regardless of whether they are entitled to government support in the final months of their lives. Beneath DLA the wait was 7 days. Ministers disingenuously protest that PIPs are a various benefit to DLA, when in fact the concepts for giving help to the terminally ill are the identical. What kind of government would make advantage changes that make terminally unwell people’s lives that bit harder anyway?

Mike Penning, minister for disabled individuals, protests that these delays have now been diminished to ten days, but there is no reply for those who are entitled to help but are not terminally ill. Last week’s report states that as a end result of delays of up to six months (despite the fact that charities have found that many candidates wait far longer), “some claimants have been forced to turn to meals banks, loans and charitable donations” although they wait for the rewards they are entitled to.

The DWP is lurching from 1 crisis to an additional, with genuine folks suffering genuine discomfort as a end result. David Cameron needs to urgently get to grips with what is taking place inside of that division. That procedure must start off these days, with a demand to Iain Duncan Smith that he publicly accepts accountability for the struggling that Graham, and the thousands of others like him, have gone through due to his department’s incompetence. Graham says he will get choked up just pondering about his predicament. He demands a determination – and an apology.

The PIP chaos reveals the government"s contempt for disabled people | Sharon Brennan