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By John MacInnes, University of Edinburgh and Jeroen Spijker, University of Edinburgh

Stories about “population ageing” often have a number of things in common – it is bad, it is new, and it will overwhelm us all. The major fear is a burden of cost and caring that more older people will create.

“Population ageing” has been taking place for almost two centuries in the UK and kicked in about half a century ago in developing countries. It starts whenever decent sanitation systems, diet and public health measures start to reduce very high levels of infant mortality.

The fastest increases in life expectancy actually occurred in the UK between about 1850 and 1950, and contrary to the idea that population ageing particularly affects rich countries, it is proceeding faster in developing nations as life expectancies catch up with the levels achieved in the west.

Population ageing, then, is nothing new. And we have been well able to “afford” ageing so far because so many of its effects are positive. Imagine you make widgets. You can choose between (a) machines that are rather more expensive, but much more versatile, and highly reliable for 40 years or more, and (b) cheaper machines which often fail before they’ve even been delivered, and have a rather unpredictable lifespan: some last 20 years, others soldier on until 50 or even 60, although much after 40 they are pretty worn out.

Machines are not people, but we only need to reflect on the social and economic cost of high fertility and mortality to see why population ageing is so positive. Lower mortality is a tremendous economic bonus for the simple reason that it reduces the amount of social effort devoted to reproduction.

False notions of dependency

So long sucker (Amsterdamised)

So long sucker

We’ve got to watch how “old” is defined. Putting aside the argument that getting old is a good thing – we all want to live longer don’t we? – and that we’re actually getting younger (if you count the years left we actually have to live), over time we can expect people of successive generations to be healthier and fitter and have longer to live at any age than their predecessors.

Sweden was one of the first countries where the majority of a generation (that born in 1818) lived to 50 years old. Spain was almost a century behind (in 1903). An age in years that we might think of as “old” now may not be in 50 years time.

Most old people are not “dependent”. For the first time, a million people aged 65 or over are still in paid work. Indeed if we define dependency as “not in paid work” then there are more dependents of “working age” in the UK than there are people over state pension age who don’t work.

A great many older people report their health as good. And at the time of the 2011 census there were about 300,000 people aged over 64 in care homes (including public and private, with or without nursing) – just over half a percent of the population of England and Wales. Many are affluent and support younger family members. Grandparents are the most important source of childcare after parents themselves; more important than either public or private childcare.

Increase in older population providing unpaid care. ONS

We confuse old with poor

Those who are poor are rarely poor because they are old: they are poor now because they were poor when they were younger, unable either to accumulate assets or pension rights to draw on in later life.

We can get a sense of trends in the potential burden of dependency by looking at the ratio of the numbers of those in employment (and so who pay tax or social insurance) and the numbers of the population who have an average life expectancy of 15 years or less – what we call the Real Elderly Dependency Ratio.

Real Elderly Dependency Ratio and Old Age Dependency Ratio Selected Countries 1950 to 2010. Author’s calculations. Human Mortality Database

As the figure above shows, this ratio has been falling in the UK and the US for 30 years or more. The only affluent country where this ratio has been steadily rising is Japan. And the reason for this is not the longevity of the Japanese but Japan’s snail-like progress on gender equality (so that very few mothers work) and its refusal to accept immigration (which keeps the population younger by drawing in workers from developing countries with higher fertility rates).

The commonly used Old Age Dependency Ratio (also shown in the figure above), which simply compares the number of people aged over 65 with numbers aged 16 to 64, has been rising steadily, but tells us nothing about either “dependency” or how many people are actually working. All it tells us is something we already know: that fertility and mortality are falling.

We can’t afford pensions!

A little over a century ago, annual working hours in the UK were double what they are now (at around 3,000 hours per year). Working lives were also longer: boys and girls might leave school at 12 or 13, whereas now employment rates don’t peak till the mid-20s as students leave higher education, and most retire from work before reaching the state pension age.

Over that century, trend growth in productivity has nevertheless delivered phenomenal increases in living standards. There is no economic reason, apart from the failure of political will and imagination, why continued economic growth cannot continue to fund decreases in the relative length of working lives just as it funded the shortening of the working day, week and year. And the progress towards greater gender equality in employment and the dismantling of the old “male breadwinner” system has actually increased the length of many women’s working lives.

Only the affluent will retire early

There is a yet more pernicious aspect to the state pension age rise. Only those who have not accumulated the assets necessary to choose retirement will be forced to work on.

The affluent will continue to be able to afford to retire early. Worst of all, it is those most likely to end up working up to the state pension age who will be least likely to survive to enjoy a long retirement. The poor, those in manual jobs, or living in areas of social deprivation, have life expectancies five to ten years below their more privileged peers.

None of this means that older people shouldn’t be encouraged to work longer – if that is what they choose to do. However, to suggest that an economy as productive as that of the UK “cannot afford” to let its least affluent members leave work till they are 68 or 70 is grotesque. This is not about a policy driven by economic or demographic pressure but the slow political asphyxiation of the welfare state.


Definitions vary across time and place (at what point does the general weakening of cognitive function that accompanies “normal” ageing cross the threshold to dementia?) but there is a close connection to age and “early onset” dementia is very rare.

As life expectancy increases we could expect many more older people to live with, and die with, dementia. If it is mostly mild and compatible with independent living it has few implications. If it is severe it has the potential to rapidly increase demand for social and healthcare.

Dementia charities have done an excellent job of summoning up bleak scenarios in order to persuade governments to fund more research. The G8 recently held the Dementia Summit in London where leading nations have committed to developing a cure or treatment for dementia by 2025, while our own government’s Department of Health has since 2009 its own national dementia strategy that aims to “achieve better awareness of dementia, early diagnosis and high quality treatment”. However, these aren’t necessarily sober estimates. For example, a recent test on the 880,000 estimated 20 years ago to have dementia by now suggested the figure was closer to 670,000 – a fall of nearly a quarter.

What we really do not know, because the evidence isn’t good enough, is how the relationship between age and dementia prevalence is changing. The dream scenario is that longer lives also mean later dementia, the nightmare one is that longer lives come with a fixed relationship between age and dementia, so that a rapidly increasing proportion of the extra years in longer lives are spent with the condition. We do know of factors that appear to delay the age at dementia onset, including more mental, physical, or social activity: something vibrant communities can provide. We know of no good evidence for the nightmare scenario, and with political will, we can surely avoid it.

Hard Evidence is a series of articles in which academics use research evidence to tackle the trickiest public policy questions.

John MacInnes is ESRC Strategic Advisor on Quantitative Methods Training.

Jeroen Spijker does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

The Conversation

This article was originally published at The Conversation.
Read the original article.

by Stephen Duncan MSc
Managing Director, Balanced Fitness Ltd

The importance of dealing with the whole person and not just individual symptoms or conditions

Most of us want to lose weight. That is a given even for the majority of people who don’t even regularly exercise. However we are all different – so we all work differently. This means some people who want to lose weight may also have constant headaches, back pain and struggle to get a good night’s sleep. It would be quite common to find that same person also has bloating and irregular bowel movements. Some others will also want to lose weight but have a chronic medical condition such as diabetes or arthritis. The question then becomes should we all exercise and eat in the same way to lose weight?

Stephen Duncan Balanced Fitness

Stephen Duncan
Balanced Fitness

There is a well-known phrase: “If you always do what you’ve always done, you’ll always get what you’ve always got.”
Henry Ford (1863-1947), American founder of the Ford Motor Company.

So eating less and exercising more, looking at the examples above, may not be the answer for everyone. You need to look at the whole person. Back pain will affect the choice of exercise and even the fun in exercising. Digestive problems can impact on how the muscles of the midsection function, the core muscles.

Food allergies can lead to the nerves surrounding the digestive system to basically switch off the deep stomach muscles – the result: bloating and a distended tummy. So instead of exercising endlessly to burn fat off your stomach, this “pooch belly”, your health could be improved by finding out if some of the food you eat every single day is creating a kind of ‘two steps forward one step back’ approach to your exercise and diet plan.

Getting the balance right between diet and exercise

Getting the balance right
between diet and exercise

Even those with medical conditions will typically follow the long held view of weight loss — just cut calories and exercise more. However, here again the subtleties of the condition need to be considered. If you have arthritis, the exercises need to be carefully selected and the intensity and effort you put in to your workouts managed. This means the basic arithmetic of calories in versus calories out has to be shifted to the cutting calories side.

Now, what if this person also has digestive issues? There have been many links researched between the function of your digestive system and the amount of inflammation in your body – arthritis is considered an autoimmune condition. In an autoimmune condition, the body in essence attacks itself and causes inflammation which leads to the breakdown of tissue in that area. Certain foods can increase inflammation in your digestive system and this can ultimately contribute to an increase in arthritic symptoms. So eating the wrong food leads to more inflammation and further reduces the ability to exercise. Those on calorie counting diets soon could have nothing left to cut if the inflammation gets bad enough from eating the wrong food!

Knowing the limitations of your own body  is vital to good health

Knowing the limitations of your own body
is vital to good health

Eating an anti-inflammatory diet, free from foods you are intolerant to, would be one major step towards losing fat and placing less emphasis on the need to cut calories or constantly upping the amount of exercise.

Knowing more about the whole person will modify the program for weight loss. Different people can have the same symptoms but for different reasons. You can have digestive issues not just as a result of a food intolerance but from poor posture which alters how the digestive system functions and in turns processes or digests your foods. The digestive issue could also be caused by a response to stress or a digestive infection such as H.Pylori. Some figures indicate over 50% of the world’s population could be infected by this bacterium. It is the main cause of inflammation in the digestive system and in turn this effects protein digestion.

So if you start to look at your weight loss program as all about how to improve how you function as a whole person, taking in to account your hormones, immune system, detoxification and also digestive system, you will know the bigger picture. Maybe this time, finally, you will have the missing pieces to the jigsaw that is you, helping explain why cutting calories and exercising more was merely helping you contribute to the same repeating cycle of failure and worsening condition.

There are people who study the field of nutrition and use lab tests aimed at getting to the bottom of how you function as a whole person. Finding out what is going on in the inside will provide the answers to why your weight loss program has yet to work for you. A more whole person approach makes for a more holistic weight loss program.


About the author: Stephen Duncan is an Executive Health Coach. He holds a BSc Hons degree in Developmental Biology and an MSc in Coaching Studies. A certified Advanced Metabolic Typing™ Advisor, Stephen is the Founder of Balanced Fitness and has 20 years in health & fitness.

Dr Ian Clarke

Dr Ian Clarke

By Andrew Macdonell in South Africa

With the exception of David Livingstone, probably the most well-known white doctor associated with Uganda is Nicholas Garrigan, the fictional Scottish doctor in the 2006 film The Last King of Scotland.

The Garrigan character, played by James McAvoy, was a young, naïve, but ballsy medic seduced into the corrupt court of Idi Amin during one of the most turbulent periods of Uganda’s post-colonial history.

Now, however, a new contender for the title has emerged in the unlikely form of Dr Ian Clarke, a wiry 59-year-old physician originally from South Armagh.

Dr Clarke arrived in Uganda in 1987 soon after the country emerged from the six-year bush war that followed the ousting of Amin in 1980. While the brutality and terror of the Amin years is well known, the subsequent bush war was equally devastating and resulted in the deaths of an estimated 500,000 Ugandans.

Dr Clarke started out by establishing a small rural hospital north of Kampala, the capital of Uganda. His next major venture was to establish a private hospital providing health care to the emerging Ugandan middle-class. This urban hospital, the International Hospital Kampala, was opened in 1996 and was followed by the establishment of an air ambulance service and a teaching hospital for nurses.

Had Dr Clarke stayed within the bounds of the medical profession he would surely have remained a largely unknown, if very successful, local health services businessman. He did also write a weekly column for the New Vision, Uganda’s biggest-selling daily newspaper; but it was his next move that brought him to the attention of the wider world.

In 2010, frustrated at the poor level of government services, Dr Clarke decided to “put his money where his mouth was” and enter Ugandan politics. He sought to run as an independent for the chairmanship of Makindye division, one of the five municipal authorities within the city of Kampala.

Many were sceptical that a white man would be an acceptable representative for the local community, but the response was overwhelmingly positive. At campaign rallies, his modest personal introduction delivered in broken Lugandan – “Ladies and gentlemen, my name is Dr Ian Clarke and I am running for the position of chairman of Makindye division” – was not really necessary. Everyone had heard of the mzungu with the local name, Busuulwa, who was running for mayor.

His campaign priorities of “good roads, good health and economic development” were also just what the 800,000 residents of Makindye wanted to hear. Eager for a fresh approach, the community voted overwhelmingly for Dr Clarke over the incumbent Moses Kalungi, and on 3 March 2011 he was elected chairman – or mayor – of the area.

Five months later, however, Dr Clarke admits that getting elected has turned out to be the easy part. The task of dealing with the bureaucratic jungle that is Kampala’s political system, and sorting out problems such as Uganda’s numerous potholes, is a challenge of a different magnitude. Nonetheless, he is keen to press on and believes that he can make a difference during his five-year term.

While Dr Clarke is not unique as an elected white politician in post-colonial Africa, he does join a fairly exclusive club. Outside of South Africa, others include Dr Richard Leakey, the acclaimed paleo-anthropologist and conservationist who was, for a time, cabinet secretary to the Kenyan government; and Roy Bennett, a prominent member of Zimbabwe’s opposition Movement for Democratic Change.

Only time will tell if this particular doctor can make a success of his political career, but he will certainly need all the luck that his native land can spare.

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Sir Robert Peel, 1788–1850

Sir Robert Peel, 1788–1850

By Elizabeth McQuillan

Scottish physicians, as early as the eighteenth century, recognised that poverty was inextricably linked with poor health. Whether in the overcrowded industrial centres, or working the land, the effects of poor diet, overwork and inadequate shelter led to “debility”.

In 1846, the potato blight that had caused the Irish poor to suffer the pain of starvation arrived in Scotland. The areas hardest hit were the Highlands and Islands, where the people relied on a successful crop for sustenance. The result was a Highland famine.

The humble potato provided a high yield on the small plots of land left for cultivation due to the Highland Clearances. With little other food being grown to sustain the local people, the failure of the potato crop proved disastrous.

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The crofters looked to their chiefs to provide help at their time of greatest need, but help was often not forthcoming, with the landlords by now looking to replace their tenants with sheep at the earliest opportunity. Many turned a blind eye, some simply evicted their tenants (many were reduced to living on the streets of Inverness), and a few hired boats to transport their tenants off their own land to foreign territories.

The government did eventually intervene and provided rations of oatmeal – 680 grammes for men, 340g for women and 280g for children – but not without the crofters showing that they were still working for their food. Despite having a calorie input that barely sustains basic physiological function, the crofters were expected to work eight hours per day, six days per week.

Unsurprisingly, the people suffered terribly with the many medical problems that famine brings: malnutrition, scurvy, typhus and cholera. This lasted for a full ten years while the crops failed. There was little, if any, medical help available.

The Poor Law in Scotland did not make provision for the care of the walking sick (which most of the victims were) in the local parish. William Pulteney Alison, Professor of Medicine at Edinburgh University, along with other Scottish social reformers of the time, demanded in the House of Commons that the Poor Law must be altered to ensure that every parish had the services of a resident medical officer.

Sir Robert Peel, the prime minister, was not keen, but the pressure remained on and Peel eventually (in 1848) conceded a compromise. An annual grant of £10,000 was made to the Board of Supervision of the Poor Law to finance a subsidy for any parish that agreed to finance the formal appointment of a medical officer.

The people of the Highlands and Islands needed particular help. Following the Napoleonic wars, cattle prices had dropped to make their meagre stock worthless, the kelp industry that provided employment collapsed, herring fishing failed and there was a general recession in Scotland. The potato blight simply compounded the problem of abject poverty.

Ultimately, the Poor Law did not help much. The doctors who relocated to the Highlands and Islands as medical officers, hoping to make a living, soon realised that life was tough. Attending patients was difficult due to the large distances and inhospitable landscape, as well as bad weather and the problems of having to often travel by boat. Most patients were so poor that they could not afford to pay. Many doctors returned home.

Sympathy for the plight of the suffering Highlanders was not overwhelming from lowland and English quarters, and the notion of state handouts was not encouraged. Many ideas were put forward to deal with the problem, but the physician Coll MacDonald could see the way forward:

“The simplest and cheapest plan to give medicines and medical aid to tens of thousands living in the Hebrides would be to employ a few sober men of good character and energy, provided with medicines and instruments and a small steamboat (as the Marquis of Salisbury has done for Rum) to move constantly about among the people when they could conveniently assemble to be cured of their diseases. By this plan [salaried medical practitioners] would more economically and efficiently be brought into contact with the sick and the maimed than by the establishment of stationary practitioners.”

This idea was ahead of its time, but in 1913, the same ideas reappeared in the creation of the Highlands and Islands Medical Service, the first comprehensive and free state health service in Britain. Though the advent of world war one delayed the roll-out of the Highlands and Islands Medical Service, more than 300,000 people across Scotland were covered by the 1930s. It offered a model for the wider national scheme, the National Health Service, which finally came into being on 5 July 1948.

Reference: Royal College of Physicians, Edinburgh

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<em>Picture: A Gude</em>

Picture: A Gude

Children who eat a diet rich in healthy foods at the age of three are more likely to have a higher IQ when they are older, according to researchers.

Conversely, youngsters who live on processed foods high in fats and sugars appear to have a lower IQ at the age of eight and a half, regardless of whether their diet has improved later in childhood.

Writing the in the Journal of Epidemiology and Community Health, the authors say that it’s possible that good nutrition in the crucial first three years of life may encourage the brain to grow to its best possible capacity.

The findings are based on the Avon Longitudinal Study of Parents and Children (ALSPAC), which tracks the health and wellbeing of approximately 14,000 children born in 1991 and 1992. Previous ALSPAC research has shown an association between early childhood diet and later behaviour and performance at school.

For this study, the authors, including Dr Kate Northstone at Bristol University’s Department of Social Medicine, looked at questionnaires, which had been completed by parents, listing the types and frequency of the food and drink their children took at ages three, four, seven and 8.5.

The IQ of around 4,000 children, for whom there was complete dietary data, was measured at age 8.5.

The authors identified three dietary patterns. These were “processed”, which was high in fats and sugar intake; “traditional”, which was high in meat and vegetable intake; and “health conscious”, which was high in salad, fruit and vegetables, and rice and pasta. The researchers calculated scores for each pattern for each child.

Even after potentially confounding factors were taken into account, the authors found that a predominantly processed food diet at age three was associated with a lower IQ at age 8.5, irrespective of whether the diet had improved after three. Every one point increase in the dietary pattern score was associated with a 1.67 fall in IQ.

There also appeared to be a positive, if modest, effect in eating a healthy diet, with every one point increase in that dietary pattern being associated with a 1.2 increase in IQ, while dietary patterns between ages four and seven did not appear to have an impact.

The authors say that the brain grows at its fastest rate during the first three years of life, which could explain the findings. The results also chime with other research which shows that head growth in the early years is also linked to intellectual ability.

“This suggests that any cognitive/behavioural effects relating to eating habits in early childhood may well persist into later childhood, despite any subsequent changes (including improvements) to dietary intake,” they say.

“It is possible that good nutrition during this period may encourage optimal brain growth,” they suggest, adding that there should be further research to determine the extent of the effect early diet has on intelligence.

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By Elspeth Atkinson – director for Scotland, Macmillan Cancer Support

“Treatment is the easy part of cancer. Living with it is the hard part. Treatment for me took six months, living with it is going to take 40 years. As soon as the treatment finishes, the NHS is finished with you and pushes you back into society. That’s when the real stress and pressure begins.”

These are the sentiments of Alan Clarke, a father of two young children who was diagnosed with head and neck cancer just over a year ago.

Alan is far from alone in feeling abandoned by a health system that took such good care of him when his cancer was being treated. People who have survived a cancer diagnosis frequently tell Macmillan that they feel isolated once they stop attending hospital, with little idea where to begin getting their lives back on track.

As a result of better treatment and screening is that the number of cancer survivors is growing. In less than 20 years, this number is set to double – from two million to an incredible four million people in the UK.

This opinion piece is part of The Caledonian Mercury’s ongoing debate about Scotland’s national life and is part of our commitment to raise the level of debate in Scotland. If you or your organisation would like a platform to voice your views then please contact us at stewart AT caledonianmercury DOT com.

The sheer size of this population brings into sharp focus the pressures that will be brought to bear upon the National Health Service. It is apparent then that cancer services will require an overhaul to cope with the ever increasing – and indeed changing – demands upon them.

At the moment, cancer patients who survive initial treatment attend regular hospital appointments to check that the cancer has not returned. However, this one-size-fits-all programme of clinical appointments does not meet the needs of individual patients, such as their emotional well-being or any practical support they might need to get their lives back on track.

There is also little evidence that this method is the best way to spot recurrences of cancer or the other possible long-term health consequences of cancer treatment.

We know that the needs of cancer survivors do not end when their hospital treatment finishes. That is why it is imperative that the NHS moves away from the current model of follow-up care which focuses solely on physical symptoms and illness to one that also considers health and well-being.

Reform of the health service is needed to ensure that patients are given the tools to understand their illness. If patients are equipped with the information to know when they need to see a health professional or when they may need a diagnostic test, then this will reduce the need for unnecessary follow-up appointments at hospital.

This development would free up resources which could be reinvested in new services that support people with cancer in the long run. It costs much less to provide a person with the skills and knowledge to self-manage their condition, and provide support if needed from a nurse in the community, than it does to make them travel to hospital for a follow-up appointment that doesn’t take into account all of their needs.

Effective rehabilitation services are also needed to support people back into work. As well as improving the quality of life of the cancer survivor, helping people who are able to go back into the workplace would also mean fewer people claiming benefits, more people paying taxes and employers retaining experienced staff.

To be efficient and effective, the health service must start treating cancer survivors as individuals. The key to this is providing every patient with a personalised assessment and post-treatment plan which should ensure that their emotional and practical, as well as their health needs are being met.

As part of this new plan, patients would also learn where support is available, whether they need a listening ear, more information about their diagnosis and the consequences of their treatment, help to get back to work, or assistance paying their mortgage or fuel bills.

We know that the challenge of creating cancer services to meet the needs of patients in the future is significant. That is why reform will require the support and collaboration of health and social care providers, the charity sector, and of course the Scottish Government.

Macmillan is highlighting this issue in a short film we are launching today called Change Cancer Care Today (see above.

The video, which features several patients, including Alan Clarke, calls on the next Scottish Government to commit to transforming the cancer care to meet the challenge of cancer as it is today.

We hope the video will inspire people to join our e-campaign and flag up the need to transform cancer care after treatment to candidates ahead of the Scottish Parliament elections in May. Certainly, with the population of cancer survivors growing at such a speedy rate, their collective voice is one that politicians cannot afford to ignore.

What we’re proposing makes sense. The cancer care system must move with the times to meet demands on it – the lives of cancer patients and their families, and the sustainability of the health service, depends on it.

To find out more or to join the e-campaign, visit macmillan.org.uk/scottishelection

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<em>Picture: Bernard Goldbach</em>

Picture: Bernard Goldbach

The way that high blood pressure is treated should be radically changed in order to produce better and faster results, potentially cutting numbers of strokes, according to researchers.

A study published in The Lancet medical journal today, suggests that the current “start low, go slow” approach should be replaced and that patients should be given two drugs in combination from the start.

Doctors usually start with one drug and then add others as required to control blood pressure, in order to minimise side-effects. But this is not the speediest and most effective way of treating high blood pressure, the study has shown, and delays the protective effect that treatment can have against stroke.

The research, led by Cambridge University in collaboration with the Universities of Dundee and Glasgow and the British Hypertension Society, could change the way that millions of people across the UK are medicated.

High blood pressure, or hypertension, affects around 10 million people in the UK – around one in three adults. Left untreated, it increases the risk of heart disease and stroke, two of Scotland’s biggest killers.

The ACCELERATE study of 1,250 patients with hypertension shows that a new way of treating patients lowers blood pressure faster and more effectively, with fewer side-effects than conventional treatment.

The researchers found that patients who start treatment with a single tablet containing a combination of two drugs will have a 25 per cent better response during the first six months than those receiving conventional treatment, and are less likely to stop treatment because of side-effects.

The blood pressure in the research cohort given conventional treatment did not catch up with the other group, even when all the patients in the study were being treated with the same combination of drugs.

The researchers believe that starting with one drug allows the body to neutralise it, partially, but hitting the body harder and faster prevents this from happening.

Professor Morris Brown, of the University of Cambridge and Addenbrooke’s Hospital, said, “The ACCELERATE study breaks the mould for treating hypertension. Most patients can now be prescribed a single combination pill and know that they are optimally protected from strokes and heart attacks.”

Professor Tom MacDonald, of the University of Dundee, said: “The research is a great result for patients with high blood pressure. Starting with two medicines is clearly better than starting with one and amazingly there were fewer side effects and not more.”

The study was designed by the British Hypertension Society and was conducted in partnership with the pharmaceutical company Novartis. This allowed the treatment programme to be tested in ten countries on four continents.

The British Heart Foundation is now funding a similar study with different medicines to ensure that these results are generalisable and not just applicable to the drugs tested.

Prof Brown explained that the collaboration with Novartis was formed because it was “no longer possible to undertake such a trial expeditiously in the UK”. He added: “Indeed, we mention in our paper that our replication study funded by the BHF is not due to finish until 2013 at the earliest. It took almost two years to obtain regulatory approval for all sites.”

Meanwhile experts are calling for a change in guidelines. Prof Bryan Williams, of the British Hypertension Society, said, “This study is important and the findings could change the way we approach the treatment of high blood pressure.”

Gordon McInnes, Professor of Clinical Pharmacology at the University of Glasgow, said: “The results of this trial are of huge importance to doctors and people treated for high blood pressure. Future treatment will be more effective and, since fewer side effects will lead to better acceptance of therapy, many fewer heart attacks and strokes are likely.”

ChlamydiaWomen who have had the common sexually transmitted infection chlamydia are more likely to have an ectopic pregnancy due to lingering effects of infection, Scottish scientists have revealed.

Researchers at Edinburgh University have found evidence that women who had contracted the infection were more likely to produce a protein, called PROKR2, in the Fallopian tube.

Production of this protein makes an embryo more likely to implant outside the womb, in the Fallopian tube. Ectopic pregnancies, in the vast majority of cases, are not viable, are dangerous for the pregnant women and can even be fatal.

Chlamydia is already known to cause infertility because it can lead to scarring and blockages in the Fallopian tube, which can prevent an egg travelling from the ovary to the uterus. But this research shows that the damage can be more insidious, increasing risks of ectopic pregnancy even if there are no signs of scarring.

The researchers say that the study, published in the American Journal of Pathology, adds weight to public health messages on safer sex and chlamydia testing.

Dr Andrew Horne, of the university’s Centre for Reproductive Biology, said: “We know that chlamydia is a major risk factor for ectopic pregnancy but until now we were unsure about how the infection led to implantation of a pregnancy in the Fallopian tube.

“We hope this new information allows healthcare providers to give women accurate information about risks following chlamydial infection and to support public health messages about the importance of safer sex and chlamydia testing.”

Around one per cent of pregnancies are ectopic. This study follows on from other Edinburgh University research which showed that smokers were more likely to have an ectopic pregnancy, also because of production of this particular protein.

The study was funded by the Wellbeing of Women charity and the Medical Research Council.

By Stuart Crawford

The Scottish Government has just announced its performance targets for access to mental health services in the NHS. These HEAT targets (the acronym stands for “health improvement, efficiency, access and treatment”) reflect the government’s priorities for the health services in Scotland and are set for all aspects of healthcare delivery.

The aim is to deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013; and 18 weeks referral to treatment for psychological therapies from December 2014.

The rationale is that timely access to healthcare is a key measure of quality and that applies equally in respect of access to mental health services. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the impact on other aspects of their development such as their education, so improving their wider social development outcomes.

The intention is to agree a target of 18 weeks referral to treatment for specialist CAMHS services from December 2014 for inclusion in HEAT next year. Psychological therapies have an important role in helping people with mental health problems, who should have access to effective treatment, both physical and psychological. It is generally accepted that these therapies can have demonstrable benefit in reducing distress, symptoms, risk of harm to self or others, health related quality of life and return to work.

The announcement has been given a qualified welcome by the British Association for Counselling and Psychotherapy (BACP), the leading professional body for counselling and psychotherapy in the UK, which has over 1,500 members in Scotland. Members are employed in a range of services and work with people who have wide ranging needs such as relationship problems, addiction, stress and bereavement through to mental health problems such as depression and anxiety.

Its welcome is qualified because BACP has concerns that the new target refers only to a narrow range of psychological therapies for specific diagnosed conditions. Therefore, an unintended consequence of the HEAT target is its potential to draw funding away from services offering a range of therapies. BACP is committed to patient care as the centrepiece of mental health service design, and is therefore strongly encouraging the Government to widen its view of the mental health and wellbeing needs of the population and the therapies that meet these needs.

Shane Buckeridge, BACP Lead Advisor for Scotland, said: “It is admirable to see that the Scottish Government has developed a target for access to mental health services. It is estimated that at any one time there are some 850,000 Scottish people with mental health problems, and until now it has been a postcode lottery in terms of what is available, leading to a huge disparity in service provision across Scotland.

“The new target makes health boards accountable, and will hopefully ensure that all patients have access to the services they need in a timely manner. However, BACP is concerned that existing services which are excluded from the narrow range of acceptable therapies within the target, may find themselves under threat. These services are often used by GPs to help people with multiple issues which do not fit the referral criteria for current secondary care mental health services.”

BACP points out that many users report wanting choice about what is most appropriate to their needs. The research evidence also suggests that no one approach in this field will be effective with all patients. The Association is therefore continuing to urge the Government to incorporate choice into the new targets to make mental health service provision accessible for all.

Photo by: MestreechCity

Photo by: MestreechCity

The number of deaths in newborn babies could be slashed dramatically if all areas had the same neonatal mortality rates as the most affluent, according to research published today.

Deaths in newborns are over twice as high in the most deprived areas compared to the least deprived, research from the University of Leicester, published today on bmj.com, has found.

Around eight out of 10 of these additional deaths are due to premature birth and congenital anomalies (birth defects) – suggesting that more needs to be done to address these, the researchers, led by Dr Lucy Smith, say.

Although the research was based on births in England, the findings are relevant to Scotland, where, earlier this week, reports showed that health inequalities persist despite efforts to close the gap.

The reports, from the Information Services Division of NHS Scotland and NHS Health Scotland found that life expectancy differed widely according to where people live and that inequalities have largely remained “unchanged” in the last decade.

The authors of the Leicester research warn that a UK government target of reducing the relative gap between the affluent and deprived populations in England and Wales (by 10 per cent by 2010) is unlikely to be achieved and that the deprivation gap appears to be widening.

The researchers assigned a deprivation score to all neonatal deaths in England from 1 January 1997 to 31 December 2007, depending on where the mother lived.

More than 18,500 newborn babies died during this time, most commonly due to premature birth and birth defects, and were twice as high in the most deprived areas.

“Neonatal deaths would be 39 per cent lower if all areas had the same neonatal mortality rates as the least deprived areas,” the authors say. “Almost 80 per cent of the deprivation gap in neonatal mortality in England is the result of differences in deaths related to either immaturity or congenital anomalies.

“The current implementation strategy in England to reduce the relative deprivation gap does not adequately tackle these two main causes of death.

“Similar patterns probably exist in other developed countries,” they add.

Government initiatives (in England) have been successful to some extent, the authors say, because the number of neonatal deaths in deprived areas has fallen.

But they point out that measures to reduce the deprivation gap have focused on increasing breastfeeding rates and reducing obesity, smoking and teenage pregnancy, warning: “Unless interventions target specifically the risk of very premature birth and potentially lethal congenital abnormalities, the effect on the deprivation gap is likely to be minor.”