Fifth Bristol university student takes own life this academic year

A third-year languages student is understood to have killed herself in the fifth case this year of suspected suicide involving students at the University of Bristol.

Elsa Scaburri, who was studying for a degree in French and Italian, was halfway through her year abroad. According to a statement released by the university, she died last week near her home, which is understood to be in Wiltshire.

An inquest has been opened and adjourned. A University of Bristol spokesperson said: “We were very saddened to hear that one of our third-year students, Elsa Scaburri, sadly died near her home last week.

“We understand from her family that Elsa took her own life, although it will be for the coroner to determine the cause of death.

“Elsa was halfway through a year abroad as part of her French and Italian degree. The university offers its condolences to her family and friends and our thoughts are with them at this very sad time.”

Her death will once again raise concerns about mental health among students and the capacity of universities to address growing demand for support.

Three Bristol students – philosophy student Miranda Williams, 19, history student Daniel Green, 18, and Kim Long, 18, who was studying law, died late last year in their first term at university. Final-year neuroscience student Lara Nosiru, 23, also studying at Bristol and originally from Essex, was found dead in Avon Gorge in January.

Following last year’s deaths, the university said it did not believe there was a link between any of the incidents and insisted annual figures did not show any trends. In the last academic year Bristol had one death by suicide; there were none the year before that, and one the previous year.

A review has been under way at Bristol to find out how best to support students with mental health needs. The number of staff in support services has been increased and additional funding has been put into the system to meet growing demand.

A Guardian investigation last year revealed that the number of students seeking counselling at university has risen by 50% in the past five years. And a report in September by the Higher Education Policy Institute thinktank said some institutions needed to triple their spending on mental health services to meet increased demand.

Students have a lower suicide rate than the general population, but it appears to have grown. Figures from the Office for National Statistics show that in 2014 there were 130 deaths by suicide of full-time students aged 18 and over in England and Wales. This compares with 112 in 2011, and 75 in 2007. The increase can be explained in part by the growing university population, which has doubled since 1997 and now stands at 2 million.

“The welfare of our students and staff continues to be our highest priority and it is distressing for all members of the university community that one of our students has died,” the University of Bristol spokesperson said. “We would urge any students affected by this tragic incident to seek support from university services, friends or family.

“In the context of increasing national concerns about student mental health we have been working with our staff and students to review how best to support all students including those with enduring mental health difficulties.

“We have increased staffing levels in our support services and have committed to invest an additional £1m per year to provide wellbeing support for students in each academic school. We will also be signing the Time to Change pledge to help reduce the stigma of discussing mental health issues.”

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

Fifth Bristol university student takes own life this academic year

Northern Ireland woman takes NHS to court over abortion law

A Northern Irish teenager who as a fifteen year old had to go to England to terminate a pregnancy, is challenging the NHS’s refusal to fund abortions for women from the region in the supreme court on Wednesday.

The health service has so far refused to pay for abortions for women from Northern Ireland who travel to England for terminations.

The girl, identified as “A”, and her mother are appealing to the supreme court to force the NHS to fund abortions. Their lawyers have described the refusal to financially help women from Northern Ireland who are in crisis pregnancies as “perverse and unlawful”.

Abortion is only available in Northern Ireland’s hospitals when there is a direct threat to the mother’s life if the pregnancy continues. In all other cases abortion is illegal.

Last November, a high court judge ruled that, as it stands, Northern Ireland’s abortion laws violate the rights of women and girls in cases of fatal foetal abnormalities or where a pregnancy is the result of a sexual crime.

An estimated 2,000 women travel to English hospitals and clinics from Northern Ireland every year to have terminations. All of these women have to raise money to go to private clinics in England for abortions.

There is strong opposition to liberalising the province’s strict anti-abortion laws across the floor of the Northern Ireland assembly. The 1967 Abortion Act was never extended to Northern Ireland, and a bid to ease the country’s termination laws to include cases of fatal foetal abnormalities and pregnancy via sexual crime was rejected earlier this year.

In the supreme court on Wednesday judges will be told that in 2012, then 15-year old “A travelled to Manchester from Northern Ireland with her mother (B), where she paid £600 for an abortion, on top of £300 in travel costs.

They received charitable assistance from the Abortion Support Network in the sum of £400 without which they could not have afforded the treatment. A and B have since argued in the high court and court of appeal that the cost of the treatment should have been free for them as UK citizens, and that by not enacting this change, Jeremy Hunt, the secretary of state for health, has failed in his duty to make NHS procedures reasonably available.

Abortion in Northern Ireland: ‘Why don’t we trust women to make the right choice?’

Angela Jackman, a partner at law firm Simpson Millar, has been representing A & B throughout the legal process.

Jackman said: “For women in Northern Ireland who are pregnant and seek a termination, the status quo is almost unbearable. I believe the legal arguments of the secretary of State are perverse and contrary to its international obligations. Many women face the choice between an unlawful termination using dangerous and illegal pills, with the prospect of prosecution to follow, or a costly journey to England where they must pay privately for an abortion. For many women, those costs are prohibitive.”

She continued: “This is the end of a long and significant domestic journey. I am pleased that the issue is finally being given due consideration by the supreme court, the importance of which cannot be underestimated.”

The supreme court has recently granted six national charities the right to intervene in the A and B case.

The British Pregnancy Advisory Service, the Family Planning Association, Alliance for Choice, Abortion Support Network, Birthright and the British Humanist Association have been granted permission to provide their perspectives on the issue in the supreme cCourt hearing.

Jackman added: “I am pleased that the court has permitted these six charities to provide submissions in this case. Through their efforts in providing advice and assistance to women like ‘A’, and campaigning for the reproductive choices of women, these charities can offer invaluable insight into the reality of the situation for the court’s consideration.”

The British Humanist Association’s director of public affairs and policy, Pavan Dhaliwal, said denying women from Northern Ireland in crisis pregnancies support was putting their lives at risk.

“Our government’s stance in refusing women from Northern Ireland safe and legal abortion on the NHS is shameful and we believe it is a breach of human rights laws. The supreme court judges have an opportunity to rectify a situation which currently causes undue distress to hundreds of women and leaves many more with no choice but to buy illegal abortion pills online,” he said.

The case will concern A and B versus the secretary of state for health. The arguments will be heard in front of five judges at the one-day hearing.

Northern Ireland woman takes NHS to court over abortion law

Kea simply takes its share of nature’s bounty | Brief letters

From your report (22 September) on the endangered New Zealand parrot the kea: “its destructive habits such as … attacking stock and habitually stealing food”. A wild creature has no concept of harm or property, so both “attacking” and “habitually stealing” are demonising anthropomorphism. The kea, like any other predator species, is simply and instinctively taking its share of nature’s bounty, the only way it could have survived until now. By any rational criterion, a wild animal is beyond human conceits of blame and responsibility.
Alex Watson
North Nibley, Gloucestershire

• Samuel Gibbs fingers a poor battery as the iPhone 7’s big weakness (Technology review, 24 September). This after five hours’ music, three hours’ browsing, photos, emails, etc. Allowing for seven hours sleep where do, you know, people, fit in?
Bill Steedman
Edinburgh

• It’s autumn. Cue creeper-clad cottage at Llanrwst (Autumn’s glow, 19 September), red deer in Richmond Park (Stag in a green scene, 23 September) again. Wales has hundreds of picturesque cottages next to rivers and Britain six species of deer. Any chance of some variety in 2017?
Kate Gibbs
Llanfairfechan

• Homa Khaleeli’s article “Snap, crackle and filth” (Family, 24 September) reminded me of my father’s oft-repeated “Nothing wrong with good clean dirt.” This was in the 1950s, and 60 years later my brother and I are in excellent, unmedicated health.
Stephen Lee
Ryde, Isle of Wight

• Re the obituary of Sir Trevor Jones (24 September), please note that a Bootle accent is not a Liverpool accent.
Joyce Blackledge
Formby, Merseyside

• I was taught to drive by a Welsh woman fluent in both English and Welsh. I asked her what she thought of bilingual signage (Letters, 24 September). “Terrible,” she said. “I have to read everything twice.”
John Shimwell
London

• Join the debate – email guardian.letters@theguardian.com

Kea simply takes its share of nature’s bounty | Brief letters

GMC takes wellbeing of doctors seriously | Letters

The tragic death of Dr Wendy Potts, a GP from Derbyshire who took her own life late last year, was shocking and our thoughts are with her family and friends.

In response to the letters from Professor Jeffrey Tobias, Dr Peter Hayward and Jenifer Bright (2 September), at the time of her death she was registered with a licence to practise. She had not been suspended from practising nor had any restrictions placed on her practice by the GMC.

We take the wellbeing of doctors extremely seriously, particularly those with health concerns. Earlier this year we, along with Professor Louis Appleby, one of the UK’s leading mental health experts and professor of psychiatry at the University of Manchester, developed proposals to reduce, as far as possible, the inevitable stress that our process can have on doctors.

These proposals aim to avoid full investigations whenever possible in cases that are primarily about a doctor’s health. We are pressing for legislative change that would allow us to resolve more investigations consensually where doctors are willing to accept any action needed to protect patients, and would like to pursue this as the preferred outcome. We are also establishing a team of specially trained GMC staff to handle cases where unwell doctors are subject to an investigation.

In addition we are pushing for the NHS to provide improved services for doctors with mental illnesses or addictions.

A doctor’s ill health is not in itself a matter that would require investigation. We would only intervene if we identified a risk to a doctor’s patients because they are not seeking or complying with medical treatment or not taking steps to protect patients, for example working when not fit to do so.

The GMC is here to protect patients, not to punish doctors, and wherever possible we aim to support doctors’ recovery and help them return to safe practice.
Niall Dickson
Chief executive, General Medical Council

• Join the debate – email guardian.letters@theguardian.com

GMC takes wellbeing of doctors seriously | Letters

PrEP HIV drugs: fight for limited NHS funds takes unedifying turn

The fight in the courts over who should pay for drugs to protect against HIV infection has taken an unedifying turn. There have been allegations that gay men will become more promiscuous if NHS England pays for the pills as a result of the high court ruling and that children with cystic fibrosis will be deprived of a drug that could help them breathe.

The issues are as emotive as they could be, just as they have always been over the battles for access to new cancer drugs that might give women with young children a few more weeks of life. But the problem is exactly the same one. Hard decisions have to be taken as long as the NHS has a limited pot of money to spend.

The high court action was brought by the National Aids Trust because NHS England was trying to hand the bill for pre-exposure prophylaxis (PrEP) drugs – taken in successful trials by gay men to protect themselves against HIV infection during sex – to the local authorities, who were given responsibility for public health. The local authorities, also responsible for tackling obesity, alcohol and smoking, said they did not have the cash.

NHS England lost. Although it intends to appeal, it has set out its plans for what it will do if the appeal fails. That will involve incredibly difficult decisions. PrEP will have to come out of the specialist commissioning budget, which is £15.6bn in 2016/17. There are 146 different services competing for that pot of money, ranging, the court heard, from renal dialysis and secure in-patient mental health services, through to treatment for rare cancers and life-threatening genetic disorders – as well as a drug for children with cystic fibrosis.

NHS England has prioritised some of these services into levels 1 and 2. Those will go ahead, come what may, it said after the judgment. But decisions on levels 3 and 4 have been postponed until after the appeal. If NHS England loses, it must then decide which services to fund – and it still may not include PrEP.

Simon Stevens, the head of NHS England, flagged up the problem to the health select committee in June. “PrEP has great potential and all of us would like to see it more widely available in this country,” he said.

But Truvada, the drug used in the trials, has not yet been assessed for cost-effectiveness, although the National Institute for Health and Care Excellence (Nice) has been asked to look at it.

But, Stevens went on: “This particular drug is not yet licensed for prophylactic treatment for HIV.

“Frankly, the prices that the manufacturer is seeking to charge probably also need to take a substantial haircut to represent value.”

Truvada is a drug that has been used in treating HIV infection for years and was licensed in 2005. But in the two months since Stevens spoke, Gilead, the manufacturer, has received approval from the European Medicines Agency to change and extend its licence for PrEP use. That will be rubber-stamped by the European commission in six to eight weeks. When that happens, it can charge what it thinks the market will bear and nobody will be able to make a cheaper copy until the new patent expires – and that could be a decade or two.

The cost at the moment is about £400 a month, or £4,800 a year for each person treated. The NAT and other Aids campaigners rightly argue that is low compared with the estimated average of £360,000 over a lifetime for treating somebody with HIV. There are about 103,700 people with HIV in the UK. The numbers of gay men becoming infected in the UK hit a record high of 2,800 in 2014, which is about eight every day. NAT told the court that is accruing £2.88m in extra costs to the NHS daily. In that context, PrEP looks very cost-effective.

But for NHS England it is a case of finding the money. There are thought to be 10,000 to 15,000 people considered to be at high risk of infection because they have multiple partners and sometimes do not use condoms.

Interestingly, NHS England intends to go on the offensive. It says it will call in the manufacturers of the various drugs competing for funds – including Gilead – and ask for a “best and final” price. Just possibly some of the companies will take a cut in their profits rather than lose sales. And just maybe this will lead to the naming and shaming of drug companies – holding them responsible for the men at risk of HIV and the children who cannot breathe, rather than the NHS.

PrEP HIV drugs: fight for limited NHS funds takes unedifying turn

Why Some Athletes Bite: Luis Suarez Takes Center Stage

As word spread about Uruguay’s Luis Suarez biting the shoulder of Italy’s Giorgio Chiellini yesterday for the duration of a Planet Cup match, supporters have been surely caught off guard.  However, as shocking and disgusting as this behavior was, this became the third episode in four years that Suarez has been accused of biting one more athlete.

Biting in sports activities is certainly not common–we can don’t forget Mike Tyson biting off a chunk of Evander Holyfeld’s ear in 1997–but it reminds us of the animalistic actions that sports activities competition can ilicit in specific men and women who are susceptible to aggression.

Whilst most achieved and elite athletes have the capability to management their emotions in frustrating situations and practice impulse handle, some athletes unfortunately resort to such actions in these substantial-pressure, large-stakes competitions.

Harnessing sheer anger and disappointment in a constructive way is how most athletes can carry their game to a new level.  Intense, substantial level competitions this kind of as the Planet Cup and other sporting occasions that convene periodically such as the Olympics create this kind of heights of emotional anxiety that people athletes who are susceptible to aggression-this kind of as Suarez-plainly have problems channeling their anger in this kind of conditions.

Eventually, humans biting other people reminds us of our ancestral connection with primates–and how though evolution and improvement of organized cultures and societal norms–such behavior became unacceptable.

Health-related Implications of Human Bites

Our mouths are host to almost 200 species of bacteria, and so the concern for building a bacterial infection right after a bite is a genuine concern.  Staphylococcus and Streptococcus are commonly accountable for infections as properly as other so-called anaerobic bacteria which thrive in reduced oxygen problems.  A notably concerning anerobic bacteria in human bites is Eikenella corrodens, which can lead to persistent infection as effectively as abscesses. The significance of thorough wound cleaning, irrigation and debridement is critical to prevent a wound infection. Tetanus immunization need to be up to date as properly.

If the obvious bite is much more consistent with an abrasion–with no violation of the epidermis or any broken skin—prophylactic antibiotics are not vital assuming the damage does not involve the joints, hands or feet or any  framework containing cartilage.  (the ear). Regional Local wound care with a lot of soap and warm water and  antibacterial ointment will suffice.

Specific types of bites are higher risk and prophylactic antibiotics are recommended. These contain bites to the hand as well as those that break by means of the superficial layer of skin–known as the epidermis– along with bites that involve joints and structures which contain cartilage.   All Bites to the hand are at large chance for infection and ought to be offered antibiotic prophylaxis. The importance of neighborhood wound care in these circumstances is paramount and a health-related expert must be consulted in these situations.

It is possible to transmit both Hepatitis B and C, as well as Syphilis and TB via human bites.  In uncommon cases, it is also attainable to transmit tetanus as nicely.   And, even though it is not frequent, studies and situation reviews have documented transmission of HIV by means of human bites.

Although the HIV virus is contained in the saliva of these impacted by the disease, it is existing at significantly decrease amounts in contrast to the blood stream.  In addition, there are actually distinct inhibitors in the saliva that make the virus non-transmissible or ineffective in the majority of situations. Therefore, the danger of transmission of HIV by means of human bites is really low.

 

 

Why Some Athletes Bite: Luis Suarez Takes Center Stage

Reliving the war takes a toll on veterans

Sixty-1 many years later and aged 92, he retraced that journey and recorded his ideas and memories in a series of articles or blog posts for the Telegraph. Bill often had a basic matter-of-reality use of language but, increasingly, the tone of the content articles was unrelentingly bleak. The images that accompanied the daily reports seemed to recommend his rising frailty. It was clear that the journey was shining an all-also-vibrant light into his memory, highlighting items that had been laid to rest there for decades.

Bill was in no way one to throw in the towel. So, when many would have come home early, he pressed on. His war had appeared to finish in triumph with the award of the Military Cross and a citation that highlighted personal bravery and loyalty to his males. But for him it was a catastrophe. In April 1945, one month before VE Day, Bill’s organization were led by faulty intelligence into an ambush at a bridge above the Twente Canal. His actions led to his MC, but in the engagement 22 of his males have been killed and another 20 wounded. The dead incorporated Bill’s two favourite subalterns, each in their early twenties. The death of these youthful males, who so almost survived the war to develop new lives with the ebullience of youth, traumatised their commanding officer, who regarded their reduction as his duty.

Bill privately regarded as his years as a soldier to have been the most admirable of his profession surprising, maybe, for the only man to have ever been a cabinet minister and editor of a nationwide daily newspaper. But his recollections of the war many years had been hardly ever uncovered – and only to shut loved ones. They have been sealed up by scars inflicted at the finish.

Before Bill left for his VE Day memorial expedition, he was still formidably engaged with daily life. Only a yr earlier he had marked his 90th birthday by flying to Darfur in Africa to report on that country’s humanitarian crisis. But from his return home in 2005 till his death two many years later on, the enthusiasm and tenacity that had driven him on ebbed inexorably away.

So as their ranks thin like falling leaves, we should think cautiously about how we assume our veterans to engage with ceremonies and anniversaries. For us it is a proper and laudable marking of history. For some of them, as with Bill, it can be a journey into a previous that they have been relieved to depart behind. They were there, we had been not.

George Plumptre is chief executive of the Nationwide Gardens Scheme

Reliving the war takes a toll on veterans

Competition in healthcare doesn"t have to be a case of winner takes all

Like opponents in a judo match, neighborhood NHS providers are interdependent with every single other in spite of currently being in competition. Photograph: David Finch/Getty Images

Numerous commentators market competitors within the NHS as a key lever in efforts to boost good quality. However, the continued policy route toward competitors has also been met with resistance given that its inception in the 1990s.

Most just lately, this was illustrated by criticism of the government’s draft laws for commissioners on procurement of NHS providers, patient selection and competition under section 75 of the Well being and Social Care Act 2012. The laws empower financial regulator Keep track of to ensure clinical commissioning groups act to shield patients’ rights and prevent anti-competitive behaviour.

Many take into account competition as a “winner takes all” proposition, rather than seeing the prospective for a number of winners in the marketplace. Distinct forms of competitors can exist in business, and healthcare is no various. Competition in the market place exists exactly where individuals are ready to decide on the ideal place or physician for their therapy. Competition for the market can also exist for instance various providers doing work collectively to supply longer-term integrated care contracts for systems, as implemented in musculoskeletal care in Bedfordshire, or the care of older individuals, as implemented in Cambridgeshire and Peterborough and Oxfordshire.

Commissioners may possibly in truth maximize value for money by embracing a nuanced technique encouraging each competition and co-operation. In their guide Co-Opetition, Adam Brandenburger and Barry Nalebuff offer the analogy of a judo match – rivals use their personal strengths and their opponents’ weaknesses as they face each and every other. The fate of 1 individual is interdependent with the other the move one particular person can make influences the moves produced by the other. Suppliers will fare far better if they function with each other rather than working in isolation.

They say co-operation and competitors are each needed and desirable when undertaking business. Co-operation might advantage all players by escalating the size of the market place although competitors divides the benefits.

With this strategy in thoughts, commissioners should generate a strategic framework for each pathway or bundle of care, in order to help them comprehend which providers can supply the very best well being outcomes specifically for their nearby population.

Commissioners provide a flow of sufferers to the providers inside of their nearby health economic system. Rivals are individuals companies who supply the very same elements of the pathway of care. For instance, imagine two hospitals delivering joint replacements to the very same population of patients needing musculoskeletal care. Improvements in worth are developed when the competition amongst the two drives up good quality in that element of the care pathway for the very same or lower fees.

Complementors include worth to a services by providing diverse actions in the all round pathway of care – for illustration, podiatrists and diabetologists complement every other in the care of people with diabetes. Their personal merchandise are more valuable when combined simply because they provide far more of the care pathway together than they do individually.

Suppliers should comprehend that they could have more than 1 position concurrently. A support can be the two a competitor and complementor at the identical time. For illustration, in the management of low back pain, both physiotherapy and spinal surgical procedure can be efficient interventions both simultaneously, or at distinct points on the care pathway – and 1 supplier might supply both services.

So, competition in healthcare is not automatically a “winner will take all” situation. Providers can concurrently have a competitive and a co-operative partnership with each and every other. As commissioners start to use new contracting types, such as prime contracts and final result-based contracting, suppliers will increasingly need to define their spot in the co-opetition market landscape if they are to obtain the very best outcomes for sufferers.

Dr Na’eem Ahmed (@DrNaeemAhmed) is a clinical fellow at the Faculty of Healthcare Leadership and Management. Dr Diane Bell is director of strategy and technique redesign at NHS Bedfordshire Clinical Commissioning Group and advisor at Far better Worth Healthcare. Dr Farooq Rafique is a London GP companion with a background in method consulting.

This write-up is published by Guardian Skilled. Join the Healthcare Pros Network to acquire normal emails and exclusive provides.

Competition in healthcare doesn"t have to be a case of winner takes all