Can air quality damage athletes?

Emma Wilkinson
Health reporter, BBC News

Imagine you are an Olympic athlete who has spent most of your life training towards what could be your one shot at a gold medal.

A finely tuned training programme has enabled you to acclimatise to conditions you are unaccustomed to, such as heat or altitude.

But on the big day there is one aspect you have no control over - the quality of the air you are breathing in.

BBC tests suggest the level of pollution in Beijing is currently well outside international air quality standards.

"The organisers have to take a responsible attitude to endurance events and be brave enough to change the start time if needed "
John Brewer, Lucozade Sports Science Academy

It has been reported that the International Olympic Committee is being flooded with applications from athletes to use asthma medication during the Games.

But is this an over-reaction or can pollution really affect an athlete's chances?

John Brewer, performance director at the Lucozade Sport Science Academy in Slough, says it absolutely can but the extent of the effect will depend on the event.

Endurance

The outdoor competitors least at risk of suffering from the effects pollution will be the sprinters who barely take a breath before the race is over and others doing short sharp intensive events such as the shot put and javelin.

Athletes competing for longer lengths of time, such as rowers and medium distance runners may notice the effects more, he says.

And those playing team sports should not be forgotten - hockey players for example have short bursts of activity from which they need to recover quickly.

But competitors who should be most worried are those doing endurance races, such as cycling and most notably the marathon.

"Marathon runners take about 40 to 50 breaths per minute and there is a real need for oxygen to be transported to the muscles.

"In normal conditions oxygen makes up about 21% of the air, if that's compromised, because the very complex transport process in the lungs is compromised, there will be less oxygen getting to the muscles.

"Add in the heat and the humidity and there could be some major implications," says Brewer.

No one has done a study comparing the effects of say running a marathon in clean air and in a polluted environment.

But what evidence there is suggests there will be an impact.

"If the pollution is still at the level that has been recorded by the BBC on the day of a distance endurance event then it is almost certain that performance times will be affected," Brewer says.

PM10 LEVELS IN CENTRAL BEIJING

• WHO maximum: 50 micrograms/cubic metre
• 01/07/08: 121
• 02/07/08: 172
• 03/07/08: 122
• 04/07/08: 351
• 05/07/08: 112
• 06/07/08: 27
• 07/07/08: 242

"The organisers have to take a responsible attitude to endurance events and be brave enough to change the start time or withdraw athletes if needed - they need to protect the health and wellbeing of the competitors."

The BBC has measured the levels of tiny particles (known as PM10) in the air for 10 minutes at the same time each day.

Research shows the size of the particles enables them to get right down into the part of the lungs where oxygen is transferred into the bloodstream.

Once there they cause irritation and inflammation in healthy people and are liable to exacerbate existing conditions such as asthma.

High levels of PM10 have also been directly linked with higher mortality rates by the World Health Organisation.

Undesirable

Professor Sir Malcolm Green, vice president of the British Lung Foundation said it was important to measure air pollution over 24 hours because it can be affected by rush hour traffic or weather conditions.

"But if the 24-hour average for PM10 is 100 or 150, it is unacceptably high and it would be highly undesirable for people to be doing marathons with that level of pollution.

"And particularly for Olympic athletes who are pushing their heart and lungs to the absolute maximum."

"If the 24-hour average for PM10 is 100 or 150, it is unacceptably high and it would be highly undesirable for people to be doing marathons with that level of pollution"
Professor Sir Malcolm Green

He said closing the roads before the start of the Olympics, as was planned by the Beijing authorities should help.

Such pollution can cause greater problems in those with underlying respiratory conditions.

Paula Radcliffe, who is still hoping to compete despite recovering from a stress fracture, is one athlete who famously suffers from asthma.

"Anything that causes irritation of the lungs is likely to exacerbate an existing condition," Sir Malcolm warned.

For their part the British Olympic Association is increasingly confident that the air quality in Beijing is improving.

They have warned athletes that the heat and humidity are likely to have more of an impact on performance and have taken expert advice on how to mitigate the effects.

Brewer adds: "I was in Seoul in 1998 when they banned the traffic and the problems that had been predicted didn't materialise.

"I hope that's the case this time and don't forget the athletes will have been prepared for it."

Virus helps show cancer spread

Scientists have used a common cold virus to "light up" prostate cancer tumours in different parts of the body.

It could make it easier for doctors to track the spread of the disease, and check the effectiveness of treatment.

A University of California at Los Angeles team found the virus "infected" prostate cancer cells in mice, then made them visible to scanners.

UK experts welcomed the Nature Medicine study, and said a more sensitive scan would be "very valuable".

"We now know we can reach these prostate cancer metastases at an earlier stage than before"
Dr Lily Wu
UCLA

If a cancer has spread beyond the original site - a process called metastasis - it usually means that treatment has to be far more aggressive, and reduces the chance of a cure.

However, in some cancers, including prostate, the most common cancer in men, it can be hard to detect these new tumours using conventional scanning.

This can mean that some patients do not get aggressive treatments quickly enough, or that others are given powerful treatment they do not actually need.

One of the first signs of metatasis in prostate cancer is tumours in the tiny lymph nodes in the pelvis.

Lymph nodes are part of the immune system, filled with cells which trap invading bacteria and viruses.

Common cold viruses, or adenoviruses, circulating in the body, tend to end up at these nodes.

Lighting up cancers

The UCLA team , led by Dr Lily Wu, used a virus modified to go to work only when inside a prostate cancer cell.

Once inside, they expressed a protein which could be shown up on a PET scan, which meant that even relatively small prostate cancer tumours within a node would be more easy to identify.

Dr Wu said: "We now know we can reach these prostate cancer metastases at an earlier stage than before, and we know we can deliver genes to those cancer cells that produce proteins that can be imaged."

The technique could help doctors plan treatments, she said, and see quickly if they were effective at killing cancer cells.

However, her eventual aim is to add an extra payload to the cold virus - which would aim to target prostate cancer cells and help destroy them.

Dr Chris Parker, a prostate cancer researcher, based at the Institute of Cancer Research, said: "A more sensitive method for detecting prostate cancer spread would be very valuable, as the current methods for detecting smaller prostate cancer deposits in the lymph nodes are limited.

"The initial findings of this study in mice suggest this approach might detect very early signs of cancer spread, before it is apparent on conventional scans.

"This new method - using a virus that is transported to prostate cancer in the lymph nodes, and which carries a marker gene that can be detected on imaging - is very interesting, but further development work is needed before the technique will be ready for testing in humans."

Malaria gene 'increases HIV risk'

A gene which apparently evolved to protect people from malaria increases their vulnerability to HIV infection by 40%, say US and UK scientists.

People of African descent have a variation of the "DARC" gene which may interfere with their ability to fight HIV in its early stages.

The Cell Host and Microbe study says the gene accounts for millions of extra HIV cases in sub-Saharan Africa.

However, people with the gene appear to live longer with HIV than others.

"There has always been this myth that people in sub-Saharan Africa were more likely to get HIV because of differences in their sexual behaviour, or that they are more promiscuous"
Dr Ade Fakoya
International HIV/AIDS Alliance

While the differences in HIV prevalence in different parts of the world can be partly explained by different social conditions and sexual behaviour, scientists have long suspected that there may be genetic reasons why the virus is rife in certain communities.

Research at University College London and the University of Texas focused on the Duffy Antigen Receptor for Chemokines (DARC) gene.

The gene influences the levels of chemicals called chemokines, which play a role in the body's defences against viruses, and a variation is held by approximately 90% of Africans.

The origins of the variation are unclear, but it is thought to have evolved in response to widespread malaria outbreaks by offering protection against that disease.

The researchers did not use volunteers living in Africa, but analysed data from a 25-year study of Americans from different ethnic backgrounds with HIV.

They calculated that, after taking account of social and economic differences, people with the genetic variation were 40% more likely to be susceptible to the illness.

If the gene variant were not present in sub-Saharan Africa, they said, they would expect to see approximately an 11% lower burden of HIV in the region.

An estimated 24.5 million people are living with the disease there, and there are approximately 2 million deaths per year.

Survival mystery

However, paradoxically, having the variant could mean that the disease, once caught, does not advance as quickly.

People who carry it survive on average an extra two years longer than those who do not, said the researchers.

The precise reasons for both the any extra vulnerability to HIV, and the increased lifespan of HIV-infected people, are not clear, with the scientists suggesting a "complex interplay" between levels of the protein expressed by DARC, levels of chemokines, and levels of the virus.

Professor Robin Weiss, from UCL, one of the researchers, said: "The big message here is that something that protected against malaria in the past is now leaving the host more susceptible to HIV."

Dr Ade Fakoya, from the International HIV/AIDS Alliance, said that the findings could explain why some countries had a much higher prevalence of the disease.

He said: "There has always been this myth that people in sub-Saharan Africa were more likely to get HIV because of differences in their sexual behaviour, or that they are more promiscuous.

"This shows that it's not that simple, and I think it will be an important message for education programmes in these areas."

People who carry a gene for the blood cell abnormality sickle cell trait are also known to be protected against malaria.

Breast check confusion a problem

Women remain confused about the right way to check their breasts for early signs of cancer, says a charity.

Experts say there is no evidence that rigorous monthly "self-examination" reduces breast cancer deaths and it can lead to unnecessary biopsies.

In the UK, the focus is on breast "awareness", rather than more complex and involved checks.

However, Breast Cancer Breakthrough says some UK women rely on US-based websites recommending self-examination.

"There is a lot of information out there from the US, and this is easily obtained on the internet"
Dr Sara Cant
Breakthrough Breast Cancer

The Department of Health has not endorsed breast self-examination since the early 1990s, but US authorities still do.

Women who follow the programme often closely check their breasts on the same day in each monthly cycle, feel them using a certain pressure, in a standing and lying position, and can view them from different profiles using a mirror.

They are told to write down details of anything they find in a diary.

The Cochrane review looked at all the available evidence on the success of self-examination programmes, principally two large studies of a total of 388,535 women in Russia and China, half of whom self-examined, while the other half did not.

The death rates from breast cancer were the same in both groups, while there were almost twice the number of biopsy operations - used to take a tissue sample for analysis - in the self-examination group.

This, said the researchers, suggested that self-examination could be leading to more women receiving unnecessary biopsies.

"At present, screening by breast self-examination or physical examination cannot be recommended," they wrote.

'Unaware of advice'

Despite recommendations against self-examination in the UK, charity Breakthrough Breast Cancer said there were still likely to be many women who believed this was the right way to check their breasts.

Dr Sara Cant said: "There is a lot of information out there from the US, and this is easily obtained on the internet - and there are UK sites where this advice is given, usually with the best of intentions.

"On top of this, some women who started examining their breasts this way before the advice changed in the 1990s may be unaware that new advice has been issued."

She said that the best way for a woman to check her breasts was not to follow a strict examination routine, but to get to know what is normal for her, and feel them regularly for signs of any changes.

"We call it TLC - touch, look and check. This approach, coupled with regularly attending breast screening when invited, and modern treatments, has significantly reduced breast cancer mortality."

A Department of Health spokesperson said: "The Department of Health's policy on breast awareness, which has strong support from the nursing and medical professions, encourages women to check their breasts for what is normal for them but does not recommend routine self examination to a set technique.

"There is no scientific evidence to show that a formally taught, ritual self examination, performed at the same time each month, reduces the death rate from breast cancer or is more effective than a more relaxed breast awareness."

Obesity 'hikes' pancreatic risk

Obese women, who carry most of their excess weight around the stomach, are 70% more likely to develop pancreatic cancer, research suggests.

Obesity was thought to increase the risk - but more in men than women.

However, the new study, of more than 138,000 postmenopausal US women over seven years, suggests it is a significant risk factor for women too.

The study, by Sweden's Karolinska Institute, appears in the British Journal of Cancer.

"Pancreatic cancer is associated with particularly poor survival, so it is crucial that we learn more about how to prevent the disease"
Dr Lesley Walker
Cancer Research UK

In total 251 women in the study developed pancreatic cancer.

After taking account of other risk factors such as smoking, the researchers calculated that the disease was 70% more likely in women with the highest waist-to-hip ratios - a measure of obesity.

Lead researcher Dr Juhua Luo said: "We found that the risk of developing pancreatic cancer was significantly raised in obese postmenopausal women who carry most of their excess weight around the stomach."

Pancreatic cancer is the UK's sixth most common cause of cancer death.

In 2004, around 7,400 cases of pancreatic cancer were diagnosed in the UK, and there are around 7,000 deaths from the disease each year.

Usually, the disease is diagnosed only once it has spread and is difficult to treat successfully.

Only 2-3% of people survive beyond five years after being diagnosed.

Insulin theory

The researchers believe obesity may increase the risk of pancreatic cancer by affecting insulin levels.

Dr Luo said: "We know that carrying a high proportion of abdominal fat is associated with increased levels of insulin, so we think this may cause the link between obesity and pancreatic cancer."

Dr Lesley Walker, of the charity Cancer Research UK, said: "Pancreatic cancer is associated with particularly poor survival, so it is crucial that we learn more about how to prevent the disease.

"About a quarter of all cancer deaths are caused by unhealthy diets and obesity and it's important that people are aware of this risk."

Lucie Galice, of World Cancer Research Fund, said: "Looking at all the studies that have been done on this subject, overall there is convincing evidence that excess body fat increases risk of pancreatic cancer.

"There is also convincing evidence that being overweight increases risk of post-menopausal breast cancer, bowel cancer and cancers of the kidney, oesophagus and endometrium.

"In fact, scientists now say that, after not smoking, maintaining a healthy weight is the most important thing you can do for cancer prevention."

Pancreatic cancer develops from the cells within the pancreas, a gland located high up in the abdomen just behind the stomach.

If pancreatic cancer is not treated, cancer cells can spread into nearby organs or lymph nodes, or, eventually, break away and spread to other parts of the body.

Asthma risk from pregnancy nuts

Mothers-to-be who eat nuts every day may increase their child's risk of developing asthma by 50%, claim Dutch researchers.

Nearly 4,000 pregnant women completed diet questionnaires, and their children were monitored for eight years.

The results, published in a US journal, suggest that potent allergens found in some nuts might prime the foetus to be allergy-prone.

Other studies, however, have been less conclusive about nuts and asthma risk.

"It's important for pregnant women to eat healthily, and what is true for many foods is that too much is never good"
Dr Saskia Willers
University of Utrecht

The factors during pregnancy, or early life, that cause some children to develop asthma while others are unaffacted are still unclear.

Asthma runs in families, suggesting a strong hereditary link, but the environment still plays a significant role.

However, comparing women who ate nuts daily during pregnancy to those who ate them "rarely" consistently pointed to an increased risk, with between a 40% and 60% rise in the chances of wheeze, asthma symptoms in general, and use of steroids.

Dr Saskia Willers, from the University of Utrecht, who led the study, said: "While it is too early to make recommendations of avoidance, it is important for pregnant women to eat healthily, and what is true for many foods is that too much is never good."

The study examined the effect of eating different types of nuts, including peanuts, which botanically are not a true nut.

Peanuts have been closely associated with allergy.

"Peanut is a potent allergen, and peanut allergy is associated with anaphylactic shock and is less likely to be outgrown than other allergies."

The research also found lower asthma rates in the children of mothers who ate more fruit during pregnancy.

However, researchers suggested that other aspects of a healthier lifestyle followed by these women might be responsible.

Vitamin puzzle

The study was published in the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Professor John Heffner, a past president of the society, said there was not enough evidence that the nut diet had caused the problem, and he called for more studies.

"These findings emphasise the critical importance of additional investigations into the environmental exposures for both mother and child."

Leanne Male, from Asthma UK, also said that further studies would be needed before firm dietary advice could be given to pregnant women, as other research had thrown up contradictory results.

She said: 'Some studies say that the vitamin E and other health properties nuts contain, especially when consumed as part of a healthy Mediterranean-style diet, can be protective against asthma."

Exercise 'slows down Alzheimer's'

Being physically fit could hold back the advance of Alzheimer's disease, US researchers have suggested.

Their study, published in the journal Neurology, looked at 121 people aged over 60, around half of them in the early stages of the disease.

Those with Alzheimer's who were less fit had four times more signs of brain shrinkage than those who were fit.

The Alzheimer's Research Trust said other research showed exercise reduced the risk of dementia.

"People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly"
Dr Jeffrey Burns
University of Kansas School of Medicine

Some 700,000 people in the UK are living with dementia, with this number predicted to grow quickly over the next two decades, as the proportion of older people in the population increases.

Other studies looking at the relationship between dementia and exercise tend to focus on whether being active can reduce the risk of the condition developing in the first place.

Dr Jeffrey Burns, from the University of Kansas School of Medicine, said his was one of the first to look at whether exercise could affect the progress of the illness.

His volunteers underwent a treadmill test to see how fit they were and then their brains were scanned for shrinkage, which is one way of measuring the severity of their Alzheimer's.

Brain volume

While there was no relationship between brain size and exercise in people tested who did not have Alzheimer's, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.

He said: "People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

"Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance."

Susanne Sorensen, head of research at the Alzheimer's Society, said: "Exercise increases blood flow to the brain, delivering oxygen and nutrients to brain cells.

"This is one possible explanation why dementia progresses slower in people who are physically fit.

"Exercise also reduces your risk of developing dementia so it's important to take regular exercise. A healthy heart means a healthy brain."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "This adds to previous research showing that exercise helps reduce the risk of dementia and slows down its onset.

"A balanced diet and regular exercise can improve the quality of life of older people with dementia, as well as those who do not have the condition."

Lab boost for spinal injury rehab

A chemical used by bacteria to invade other cells may boost the chance of successful rehabilitation from spinal and brain injury, research suggests.

A team from the Centre for Brain Repair in Cambridge treated rats with the enzyme chondroitinase.

They found the treatment increased the length of time that the nervous system was responsive to rehab.

The study raises the possibility of faster and more effective treatments for neurological patients.

"These results can only be seen as extremely encouraging for the many thousands of people left paralysed after a spinal cord injury"
Dr Mark Bacon
Spinal Research

After damage to the nervous system, patients go through a rehab programme to try to regain some of the neurological function that they have lost.

This usually helps them regain some useful function but they need to work hard for a long time in order to be successful.

Rehab works by encouraging the nervous system to make new connections between cells to replace those that have been lost through injury.

However, the ability to make new connections - known as plasticity - is very limited.

Scar tissue

Part of the problem is that molecules called chondroitin sulphate proteoglycans (CSPGs), which are laid down around nerve cells to form protective scar tissue, prevent the formation of new connections.

But scientists have discovered that chondroitinase specifically targets these molecules for destruction.

The Cambridge team used the enzyme to treat rats with a spinal cord injury which meant that they lost the ability to grasp objects in their paws.

They found that chondroitinase treatment or rehab alone had little impact on the animals.

But when the two treatments were combined, they noted a large improvement in the ability of the animals to use their paws.

The researchers, led by Professor James Fawcett and Dr Guillermo Garcia-Alias, said: "The discovery opens up the possibility that rehabilitation for neurological conditions can be made much faster and much more effective by giving treatment such as chondroitinase to make the nervous system plastic."

Dr Mark Bacon, of the charity Spinal Research, said the joint approach - pharmacological and rehabilitative - appeared to stimulate nerve tissue and fine tune new growth.

However, he stressed that it was vital that rehab programmes were chosen carefully to maximise the therapeutic impact.

He said: "These results can only be seen as extremely encouraging for the many thousands of people left paralysed after a spinal cord injury but the next step is to work out how to deliver this bacterial protein to humans in a safe and effective way."

Details of the research will be presented to a Federation of European Neuroscience Societies conference in Geneva.

40 years older than his real age

By Sarah Wood
Series producer, BBC Three

Earlier this year a good night out for Stewart Burton might have started on a Saturday afternoon in his home town of Brighton and could easily have carried on for 18 hours, well into Sunday.

Stewart, 25, would get through up to 60 cigarettes, down nine bottles of beer, followed by several shots and more beer. He would also dabble in drugs.

That was a good night out for Stewart - but he was starting to notice his lifestyle was having a detrimental impact on his body.

He wasn't as fit as he used to be and he often shunned the healthy food in his fridge for yet another take-away.

Stewart was often drinking more than 100 units of booze a week - the government recommends men should drink no more than 21 units.

Bad drunk

And when Stewart got drunk, those around him felt he became a different person.

His mother, April, said: "He is a demon. He becomes evil - and it all starts when he starts drinking."

Stewart's lifestyle was also starting to take its toll on his relationship with his live-in girlfriend Donella.

She had given him an ultimatum: "Stu needs to clean up his act. He needs to cut back on his drinking.

"If he doesn't do that, then I will have to seriously review the situation of our relationship, because he is going to lose everything if he doesn't stop."

With his relationship on a knife-edge, Stewart put himself forward for Make My Body Younger's "living autopsy".

Extensive tests

Every inch of Stewart's body was examined and his vital organs were tested.

"The sperm one was shocking, really bad - I was close to tears"
Stewart Burton

He even had a fertility test, though he felt confident about the outcome.

"I know I've got no problems," he said.

"I've got a daughter already. I know everything is working properly."

At his "living autopsy", Stewart was laid out and the first "incision" was made in front of girlfriend Donella, Stewart's mother and his brothers.

It was a demanding and emotional time for all involved as presenter George Lamb and Dr Andrew Curran revealed Stewart's results.

One of the most shocking moments for Stewart, Donella and his family was when his brain age was revealed, following a series of cognitive function tests.

Stewart is only 25 but all his hardcore partying resulted in a brain age of 68.

Donella's shock at him "having the brain of a pensioner" was something his entire family shared.

Fertility under threat

But for Stewart the greatest surprise was the state of his sperm.

Due to his excessive partying lifestyle, Stewart's fertility test showed his sperm had 91% deformed heads.

This left a serious question mark over his fertility as normal fertility allows for less than 70% deformed heads.

Stewart was left stunned by the news. "The sperm one was shocking, really bad," he said. "I was close to tears."

Back at home in Brighton, the surprises didn't end for Stewart.

He got his very own live-in medic in the shape of Dr Leanne Hayward.

She moved in with Donella and Stewart for three days and gave Stewart valuable information about how to live his life differently - but without having to become a party-free zone.

New start

Stewart initially wanted to stop drinking and smoking altogether but this concerned Dr Hayward.

"We need to be really careful with Stewart that he doesn't totally stop everything because he could run into more problems," she said.

"He may be more likely to fall off the wagon if he tries to cut out absolutely everything."

Stewart and Donella found the early days a struggle and had a few rows.

But slowly Stewart started to feel the benefits of not drinking or smoking as much.

After several weeks, he went back to London for tests to find out the new biological ages of his key organs and the state of his sperm.

Because of Stewart's improved lifestyle his new brain age came in at 18 years, a massive drop and a testament to his hard work.

But probably the best news for Stewart and Donella was that his fertility test results showed the level of deformity of his sperm was back within the normal range.

Stewart was relieved by the results: "All the hard work has definitely paid off."

Donella too was delighted. "I've got my dream guy," she said. "Hopefully we will have a really long and happy future together."

'I'm so glad he died at home'

Campaigners have long been calling for families to be given more support to help their loved ones die at home.

Now the government in England is setting out how it plans to achieve this.

But why is it so important to spend your final days in familiar surroundings?

Ever since Paul Gleeson was diagnosed with cancer his wish was that he could die at home.

But in the final weeks of his life, his wife, Maria, thought it was not going to be possible.

The 50-year-old, from Henley-on-Thames, says: "I really didn't think I was going to cope. It was all getting too much. He need round the clock help.

"He was bed-ridden and physically I was exhausted."

Mrs Gleeson said her husband's consultant simply assumed he would die in a hospice.

But then a family friend told her about nurses from Marie Curie Cancer Care who could provide help to people in her situation.

After contacting the charity, she was given a nurse during the night to help her care for her 51-year-old husband in what turned out to be his final week in March following a year-long battle with colon and stomach cancer.

"This should be a right, it is about dignity"
Maria Gleeson

"She was wonderful. She just tended to his needs, making him a cup of tea, providing his personal care.

"It was at a point when I was beginning to struggle. Without that help I am not sure he would have been able to stay at home.

"But what upsets me is that you have to ask for these services. This should be a right, it is about dignity."

Mrs Gleeson said being at home was important for the whole family - she has three daughters aged between 10 and 16.

With Paul being at home he was able to help them with their music practice - and concerts in which they were taking part - right up to the end.

"He heard the music, instructed their practice.

"Home was where he felt comfortable. And it meant his children could see him for two minutes or two hours. Whatever they wanted.

"He and they would not have had that if he had been in hospital or hospice. We were with him right until the end and the children will always know that.

"I hope in future years when my children look back they will remember they had the last hug, last gasp with their dad.

"They will have fond memories they helped care for him.

"There is no doubt in my mind that it was the right thing to do - for him and for the family."

30th birthday for first IVF baby

By Fergus Walsh
Medical correspondent, BBC News

It is 30 years since scientists held their breath as they waited for news of the world's first test tube baby. When Louise Brown was born - so was IVF treatment.

Today, more than three million babies have been born around the world thanks to the technology which was pioneered in Britain.

Louise's birth has been celebrated by IVF families and some of the clinical staff involved in the breakthrough.

The celebrations were held at Bourn Hall fertility clinic in Cambridgeshire - set up by the fertility pioneers Patrick Steptoe and Robert Edwards - the team responsible for Louise's birth.

Families of 30 children - one from each year since 1978 - gathered to mark the event.

Louise's birth was one of the most remarkable medical breakthroughs of the 20th Century, and not surprisingly it generated worldwide media interest.

Media star

Louise says as a child in Bristol, she got used to all the media attention.

She was recognised in the street and got used to some strange questions.

She said: "When I was growing up they would ask things like how do you fit in a test tube and things like that!"

These days she rarely thinks about her iconic status as the first of more than three million IVF babies born worldwide.

"It's quite scary to think I'm the first of them all, but it's also a nice feeling that perhaps if I hadn't been born then all those people wouldn't be here, and IVF has helped so many couples."

Louise is now a mother herself, to 18 month old Cameron, although he was conceived naturally.

Patrick Steptoe died in 1988 but Professor Edwards joined the celebrations and helped Louise cut the cake.

Professor Edwards remembers how, once the news of the pregnancy leaked out, Louise's mother had to go into hiding.

"We were concerned that she would lose the baby, the fetus, because the press were chasing Mrs Brown all over Bristol where she lived.

"So secretly Patrick Steptoe hid the mother in his car and drove her to his mother's house in Lincoln - the press didn't know where she was."

Louise's mother said that once she was in Oldham hospital reporters tried a variety of methods to sneak into her room from a bomb hoax to posing as cleaners.

Once Louise was born it made front-page headlines all over the world.

Mrs Brown went on to have another daughter by IVF and is delighted that Steptoe and Edwards helped her.

"I'm just so grateful that I'm a mum at all because without IVF I never would have been and I wouldn't have my grandchildren."

Routine

Since Louise Brown's birth IVF has become a routine procedure.

More than 30,000 women a year in Britain now undergo IVF and eleven thousand babies annually are born.

IVF was a British breakthrough, but the majority of treatment in the UK is still paid for privately and costs couples between £4,000 and £8,000 a time.

Professor Edwards is saddened that IVF is not more widely available on the NHS.

"Every couple should be allowed to have three babies on the health service because this is the greatest gift that you can give any man or woman."

Sex infections in young up again

By Nick Triggle
Health reporter, BBC News

Sex infections continue to rise with experts issuing a stark warning over the behaviour of young people.

There was a 6% rise in sex infections in the UK in 2007 compared to 2006, but this comes at a time when the numbers being tested is rising rapidly.

Half of the total were in people aged 16-24, despite the fact they represent just one in eight of the population, the Health Protection Agency said.

The HPA said youngsters needed to be tested regularly, and take more care.

See figures for sexually transmitted infections

Professor Peter Borriello, director of the HPA's Centre for Infections, said: "It is increasingly the case that many young people see a casual shag as part of the territory, it is part of life."

"Young people still aren't getting the education and the services they need to manage their health and relationships"
Lisa Power, of the Terrence Higgins Trust

But he added: "Increasingly a shag now stands for syphilis, herpes, anal warts and gonorrhoea."

He said the solution was more regular screening and for young people to take more responsibility for themselves.

Across all age groups 397,990 new STIs were diagnosed in UK sexual health clinics in 2007 - an increase from 375,843 in 2006.

The 16-24-year-old age group accounted for 65% of all new chlamydia cases diagnosed in 2007, 55% of genital warts and 50% of gonorrhoea.

But to put this in context just over 1% of this age group tested positive for chalmydia, which is the most common type of infection.

Overall chlamydia and genital warts were up 7%, while herpes increased by 20% - although this was partly put down to a better testing technique. Both gonorrhoea and syphilis fell slightly.

More tests

However, some of the rises have been attributed to more people being tested.

A national chlamydia screening programme has been in the process of being rolled out since 2003.

And overall the number of screens has risen by 10% in the past year and by 61% since 2003.

Lisa Power, of the Terrence Higgins Trust, acknowledged better testing was playing a key role.

But she added: "Young people still aren't getting the education and the services they need to manage their health and relationships."

The opposition parties both said the government had been complacent.

Shadow health minister Anne Milton said the figures showed the "cost of failure", while the Lib Dem's Norman Lamb linked them to cuts in public health budgets.

But health minister Dawn Primarolo said while the figures were a concern, it was important to remember there had been an increase in screening.

"That means more people are being screened and therefore detected."

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SEXUALLY-TRANSMITTED DISEASES

Diagnoses through Genito-Urinary Medicine clinics

	2006 new episodes	2007 new episodes	Change	2007 new episodes (16-24 yrs)	Prop among 16-24 yrs (as % of all new diagnoses)
Chlamydia	113,783	121,986	7%	79,557	65%
Gonorrhoea	18,898	18,710	-1%	9,410	50%
Syphilis	2,684	2,680	-0.15%	447	17%
Herpes	21,797	26,062	20%	11,252	43%
Genital warts	83,624	89,838	7%	49,250	55%
All new STIs*	375,843	397,990	6%	N/A
Source: HPA

* Includes infections not in above table

'Breakthrough' in malaria fight

By Phil Mercer
BBC News, Sydney

Australian scientists have identified a potential treatment to combat malaria.

Researchers in Melbourne believe their discovery could be a major breakthrough in the fight against the disease.

The malaria parasite produces a glue-like substance which makes the cells it infects sticky, so they cannot be flushed through the body.

The researchers have shown removing a protein responsible for the glue can destroy its stickiness, and undermine the parasite's defence.

The malaria parasite - Plasmodium falciparum - effectively hijacks the red blood cells it invades, changing their shape and physical properties dramatically.

Among the changes it triggers is the production of the glue-like substance, which enables the infected cells to stick to the walls of the blood vessels.

This stops them being pased through the spleen, where the parasites would usually be destroyed by the immune system.

Painstaking tests

The Australian team developed mutant strains of P. falciparum, each lacking one of 83 genes known or predicted to play a role in the red cell remodeling process.

Systematically testing each one, they were able to show that eight proteins were involved in the production of the key glue-like substance.

Removing just one of these proteins stopped the infected cells from attaching themselves to the walls of blood vessels.

Professor Alan Cowman, a member of the research team at the Walter and Eliza Hall Institute of Medical Research, said targeting the protein with drugs - or possibly a vaccine - could be key to fighting malaria.

"If we block the stickiness we essentially block the virulence or the capacity of the parasite to cause disease," he said.

Malaria is preventable and curable, but can be fatal if not treated promptly. The disease kills more than a million people each year. Many of the victims are young children in sub-Saharan Africa.

Nicotine drug 'may slow dementia'

Nicotine-based drugs may help delay the moment a person with dementia has to enter a care home, say researchers.

Nicotine has toxic effects, and carries a strong risk of addiction, but scientists have shown it can also boost learning, memory and attention.

The effect is small, but it may help give dementia patients up to six extra months of independent living.

A team at King's College London have demonstrated the positive effects of nicotine in experiments on rats.

"It may be possible for medicinal chemists to devise compounds that provide some of the beneficial effects of nicotine while cutting out the toxic effects"
Professor Ian Stolerman
Institute of Psychiatry

They showed that nicotine boosted the animals' ability to carry out a task accurately - particularly when they were also distracted.

When able to give full concentration, the animals responded correctly to stimuli about 80% of the time. Nicotine boosted the accuracy rate by about 5%.

However, when distracted, the animals' success rate fell to about 55%. In this case nicotine brought it back up to around the 85% level.

Biochemical mechanisms

The King's team, based at the Institute of Psychiatry, studied the mechanisms which underpin the effects produced by nicotine.

They showed how proteins on the surface of cells respond to the compound, and pinned down the role of several key chemicals in the brain, including dopamine and noradrenaline.

It transpired that there are only subtle biochemical differences in the way nicotine stimulates the brain, and triggers addiction.

Several nicotinic drugs are already in development, but the King's team hopes its work will speed up the discovery of agents which give the brain a bigger boost than nicotine, with longer lasting effects.

Lead researcher Professor Ian Stolerman said: "Nicotine, like many other drugs, has multiple effects, some of which are harmful, whereas others may be beneficial.

"It may be possible for medicinal chemists to devise compounds that provide some of the beneficial effects of nicotine while cutting out the toxic effects."

Professor Stolerman stressed that the positive effects produced by nicotine were small, and would be of no benefit to most people.

However, he said they could potentially make a difference to dementia patients.

He added that the "cognitive boost" that many smokers experience from nicotine may contribute to the pleasure they get from their habit.

'Don't smoke'

Professor Clive Ballard, of the Alzheimer's Society, said: "Although nicotine has therapeutic qualities, when it is absorbed through smoking the health risks outweigh the benefits.

"Smoking increases risk of vascular dementia, the second most common form of dementia and is associated with a number of other health risks.

"More research is now needed to find a safe and effective treatment for dementia, with the potential benefits of nicotine, but without the health risks."

Rebecca Wood, of the Alzheimer's Research Trust, agreed that people should not be tempted to smoke to try to ward off dementia. She said the best way to minimise risk was to eat a balanced diet and exercise regularly.

Professor Stolerman said there was no reason to believe that nicotine or smoking reduced the risk of getting dementia - it only helps to reverse symptoms.

It is estimated that 700,000 people in the UK live with dementia.

The research will be presented to a Federation of European Neuroscience Societies conference in Geneva.

Happiness 'immune to life events'

Momentous events in your life such as having children, or getting married, may make you happier, but only temporarily, say researchers.

Our basic happiness level essentially stays the same throughout adult life, the Economic Journal reports.

Economists from the UK, US and France based their conclusions on a 20-year analysis of the life satisfaction of hundreds of people from Germany.

Even after traumatic events, overall mood dipped but then recovered.

"There is the concept of a 'thermostat' of happiness - when a big event happens to you, whether it is positive or negative, the spring stretches, but returns back to its former state quite quickly"
Francois Moscovici
White Water Strategies

The study looked at a psychological process called "adaptation" - the way in which humans adjust to new circumstances, good or bad.

The German volunteers, aged between 18 and 60 at the start of the study, were then questioned again regularly over the following two decades and asked to rate their own happiness.

They were also asked to report any major events so that the researchers could plot the relationship between the event and overall levels of satisfaction.

They found that only unemployment gave a long-lasting decline in overall mood in the five years after the event.

In other traumatic events, such as widowhood or divorce, overall mood dipped, but then recovered.

Negative events

For positive events, such as marriage or childbirth, the effect was equally transient - the researchers calculated that the happiness increase delivered by the birth of a child lasted for two years before the volunteers ratings were back to normal.

Dr Yannis Georgellis, a senior lecturer at Brunel University, and co-author of the report, said that it suggested that old adages such as "time heals" were true in many cases.

He said: "It's consistent with other findings that people recover from negative events very quickly - there was some literature on people who became paraplegic, who, when interviewed a few years later, had similar levels of happiness to those who had not been affected this way.

"Likewise, there are studies of lottery winners who are no happier in the long term."

Francois Moscovici, director of psychological consultancy firm White Water Strategies, said that there was plenty of evidence that people had a fixed, underlying "range" of happiness, which could be temporarily affected by major events, but not usually for long periods.

"There is the concept of a 'thermostat' of happiness - when a big event happens to you, whether it is positive or negative, the spring stretches, but returns back to its former state quite quickly."

Sleeping soundly 'boosts memory'

A refreshing night's sleep may be the best way to boost memory, a study suggests.

Researchers found sleep appears to have a dramatic impact on the way the brain functions the next day.

It appears to strengthen connections between nerve cells in the brain - a process key to both learning and memory.

The University of Geneva study was presented to a Federation of European Neuroscience Societies conference.

"Now with the 24/7 society and information overload we need our sleep more than ever"
Dr Neil Stanley
Norfolk and Norwich University Hospital

The researchers studied a group of 32 volunteers who were taught a new skill or shown images they would later have to remember.

The skill tasks included trying to follow a moving dot on a computer screen using a joy stick.

One group of participants was then allowed to sleep normally for eight hours, while others were deprived of sleep or only permitted a nap.

The next day they were asked to repeat the tasks or recall the images while their brains were scanned using a technique known as functional magnetic resonance imaging (fMRI).

Those who had slept properly performed better, and this was reflected in their brain activity.

Lead researcher Dr Sophie Schwartz said: "Our results revealed that a period of sleep following a new experience can consolidate and improve subsequent effects of learning from the experience.

"This improvement comes from changes in brain activity in specific regions that code for relevant features of the learned material."

Dr Schwartz said sleep helped the brain consolidate learned experiences and harden up weak memories which otherwise might fade in time.

However, she said much more research was required. For instance, it was unclear how much sleep was required to have optimum impact.

"We now want to know which brain circuits are involved in these learning effects during the night and if we can experimentally enhance such effects.

"We want to assess how sleep disorders affect emotional and cognitive functioning, and what are the biological factors responsible for these effects."

Important part of life

Dr Neil Stanley, a sleep expert at Norfolk and Norwich University Hospital, said the findings proved just how important it is to get a good night's sleep.

However, a recent poll of 4,000 adults in the UK found only one in five sleep for eight hours a night.

Dr Stanley said: "Sleep is not just a waste of time, it is a very active time and we need it for things like memory and learning.

"During the day we acquire information, but at night we sort that information.

"People complain about sleep deprivation, but now with the 24/7 society and information overload we need our sleep more than ever."

No alcohol for young drivers call

The legal blood alcohol limit should be cut to zero for drivers aged 17 to 20, England's chief medical officer says.

Sir Liam Donaldson said in his annual report that although there was a risk the move would be unpopular among young people, it would improve road safety.

Drink-drive laws are under review in the UK with data showing 14 youngsters die each week in car accidents.

His report also highlights a range of teenage health issues as well as surgery safety and high cancer rates.

"Young people have enough difficulty when they first start driving learning the skills on the road, they don't need the complication of drink as well"
Professor Sir Liam Donaldson
Chief Medical Officer for England

The legal limit in the UK is 80 milligrams of alcohol per 100 millilitres of blood, which is much higher than many other European countries.

Alcohol bans for young drivers are also in place across the continent, while states in Australia and the US have similar rules.

Sir Liam said such a move here would not require a major increase in policing and would represent a "sensible public health measure".

There were over 1,000 drink-drive accidents involving teenagers last year, while transport accidents are a leading cause of death for that age group.

Research shows that alcohol use increases the risk of a crash for young drives 2.5 times more than it does for older drives.

Sir Liam told the BBC: "Young people have enough difficulty when they first start driving learning the skills on the road, they don't need the complication of drink as well."

There have been several calls in recent years to tighten up the UK's drink driving laws led by the road safety charity Brake and British Medical Association.

A Department for Transport spokeswoman said: "Drink-driving ruins lives and we take it extremely seriously.

"We know more can be done and are currently considering a range of options."

But Lib Dem transport spokesman Norman Baker said: "Young drivers could face legal problems because they have had a couple of drinks the night before or used alcohol in cooking. The answer is a lower limit for all drivers."

Habits

Sir Liam's report also dealt with wider teenage health issues.

He called for a national summit to address high levels of risky behaviour in what he called the big six - smoking, alcohol and drugs, accidents and violence, diet, physical activity and sexual health.

He said: "Habits adopted in the teenage years can form behaviour for a life time."

It comes as the Department of Health in England launched an internet-training programme for doctors and nurses to help them treat teenagers more effectively.

TIPS TO KEEP YOUNG HEALTHY

• Have a close friend you can talk to
• Eat five portions of fruit and vegetables a day
• Do not smoke
• Eat lots of bread, rice and pasta
• Stay in control of your drinking
• Wait to have sex and when you do take precautions
• Eat fish once a week
• Exercise regularly
• Do not do drugs
• Tell someone if you being bullied or abused

And Sir Liam's report called for more research into why the UK has some of the highest rates of oesophageal cancer in Europe. The disease kills 6,000 people a year - double the European average.

He pointed out that the rate was rising and experts were struggling to understand the causes for this trend.

And his report also said more attention should be paid to surgical errors.

Sir Liam admitted the UK has some of the safest practices, but added there were still nearly 130,000 errors last year.

It comes after he spoke on Sunday about another theme in his report - hospital infections.

He said a vaccine for MRSA and Clostridium difficile could be just 10 years away.

Concern over GP skin cancer ops

Potentially dangerous skin cancers are being treated by family doctors, despite guidance telling them to refer them to hospitals.

Surveys of GP skin cancer surgery found that even melanomas - the most lethal form of skin cancer - were being cut out at English surgeries.

The research found GPs often removed too little tissue, allowing cancer to return or delaying necessary treatment.

Extra training was needed, said the British Association of Dermatologists.

"The cancer could recur if not fully removed."
Dr David Shuttleworth
British Association of Dermatologists

The majority of skin cancers are not dangerous if caught at a relatively early stage, and many can be removed safely at the GP surgery.

However, it is crucial that enough healthy tissue is "excised" around the edges of the cancer to stop the cancer growing back.

In 2006, the National Institute for Clinical Excellence issued guidance in England and Wales which said that appropriately trained GPs could remove most 'basal cell carcinomas', which are the most common and least threatening skin cancers.

However, it said that they needed to work as a team with hospital-based dermatologists, and make sure that if they suspected other types of skin cancer - including squamous cell carcinoma and malignant melanoma - they should refer them onwards.

Separate guidelines in Scotland also suggest urgent referral of melanoma and squamous cell carcinoma to hospital.

The studies presented at the British Association of Dermatologists Annual Meeting in Liverpool suggests that the NICE guidance is not being followed, and that GPs are not as good as hospital specialists at cutting cancers out.

In Derbyshire, an audit of tissue specimens sent for analysis after surgery revealed that nearly a third of skin cancers operated on by GPs had not been completely removed.

A separate study of skin cancer biopsies sent by GPs to a London teaching hospital showed that 14% of the tumours involved were "high risk", and should have been referred straight to a hospital specialist.

'Cancer could recur'

In Norfolk, analysis of the records of 80 patients with melanoma found that 13% of them had been incompletely excised or biopsied in primary care.

Similar problems were found with squamous cell carcinoma patients, many of whom ended up waiting far longer for the cancer to be fully removed compared with those referred immediately to hospital.

Dr David Shuttleworth, the clinical vice-president of the British Association of Dermatologists, called for extra training for GPs: "Incomplete excision of melanoma makes it more difficult to establish the true depth of the tumour, which in turn makes it trickier to plan the surgery and give a precise diagnosis.

"In the case of melanoma or squamous cell carcinoma, the cancer could recur if not fully removed.

"Incomplete excision of course also delays definitive treatment and causes additional worry to the patient."

Professor Steve Field, chairman of the Royal College of GPs, said: "This study highlights the need for GPs to follow NICE guidelines, particularly those regarding melanoma.

"The majority of GPs in this country are following these guidelines, and this should serve as a wake-up call for the rest."

Malaria drug may hit antibiotics

Widely used anti-malaria drugs may have an unwanted side-effect - decreasing the power of many antibiotics.

Remote South American rainforest villagers were found to carry bacteria resistant to antibiotics which had never been used there.

Canadian scientists believe the malaria drug chloroquine - chemically similar to the antibiotics - may have caused the problem.

The study was published in the Public Library of Science journal.

"This means that chloroquine use for malaria may make the fluoroquinolones less effective for many common tropical diseases"
Dr Michael Silverman
Lakeridge Health Centre, Ontario

Antibiotic resistance is a major problem in Western countries, where strains of disease-causing bacteria such as Staphylococcus have adapted to beat some of the most commonly-used drugs.

However, for a resistant strain to develop, bacteria usually need to be exposed to the drug involved, or a drug similar to it.

The researchers from the Lakeridge Health Centre in Oshawa, Ontario, travelled to the remote rainforest regions of Guyana, in the north of the South American continent.

They took rectal swabs from more than 500 villagers, and checked the bacteria found, including E.coli and Salmonella, for their resistance to ciprofloxacin, one of the most commonly used antibiotics in the world.

They found more than 5% of the swabs had ciprofloxacin-resistant E.coli, which compares to the 4% found in US intensive care units where the drug is used intensively.

The degree of resistance found was so high that it was likely that other antibiotics in the same "family" as ciprofloxacin would also have been affected.

Malaria outbreak

Although antibiotics had not been used in these areas, anti-malarial drugs, particularly chloroquine, had been.

Ciprofloxacin is from a family of antibiotics called fluoroquinolones, which are chemically related to chloroquine.

The theory of the Canadian team was that exposure to this, although effective at destroying the malaria parasite, created resistance in gut bacteria not only to chloroquine, but to the fluoroquinolones as well.

A widespread malaria outbreak a year before the tests meant that a high proportion of the villagers said they had been given the drug in the preceding two years.

Further evidence for the link was found in the laboratory back in Canada, where E.coli exposed to the drug became resistant to ciprofloxacin and similar antibiotics, and from Guyanese public health records, which revealed an upsurge in bacterial infections resistant to these antibiotics in the months following a major malaria outbreak in 2002.

Tropical warning

Dr Michael Silverman, who led the study, said: "This means that chloroquine use for malaria may make the fluoroquinolones less effective for many common tropical diseases such as typhoid fever, diarrhoeal illnesses, and possibly also tuberculosis and pneumonia in the developing world.

"Together, these data suggest that we must focus our efforts on prevention of malaria using mosquito-control measures such as bednets and by developing vaccines.

"For the short term, however, we still will have no choice but to use these lifesaving antimalarial drugs."

Professor Laura Piddock, a researcher into antibiotic resistance at Birmingham University, said that the paper was "intriguing", but did not yet prove that the presence of the resistant strains was caused directly by the antimalarial drug.

She said: "These antimalarials have been co-administered with antibiotics for many, many years, and I would have expected that something like this would have been seen before."

Gene tags 'fuel obesity epidemic'

The obesity crisis could deepen as the womb chemicals of increasingly overweight mothers set their baby's future risk, say US scientists.

A study, in the International Journal of Obesity, showed mice genetically prone to obesity getting fatter generation by generation.

"Epigenetic" tags, which affect the function of our genes, may be responsible, they say.

However, the researchers countered this effect in the mice through diet.

"There is now a lot of information that foetal environment - be it malnourished or over-nourished - has an permanent impact on the metabolism of that foetus as it tries to cope"
Dr Karen Lillycrop
Southampton University

Our genes alone do not fully explain why we turn out the way we do - why some people will develop cancer or Alzheimer's disease, while others become obese.

Researchers increasingly believe that the effect of conditions in the womb on the developing foetus can play an important role in setting our future health.

While nothing can change our genes themselves, there is evidence that the womb environment can change the way our genes work.

Specifically, it may be able to produce chemical changes which control the level at which certain genes function. This process is called "epigenetics".

While there is strong evidence that a mother's weight has an impact on the future weight of her children, the reasons for this are not fully understood.

The researchers at the Baylor College of Medicine in Houston, Texas, used a type of mouse which, if offered a normal diet, will tend to put on weight.

Gene silencing

While one population of mice was fed this normal diet, another was fed a diet fortified with vitamins and folic acid, designed to alter the epigenetic process by "silencing" genes.

The mice on the normal diet gained weight, as expected, and subsequent generations were progressively more obese.

But those on the supplemented diet did not gain weight through successive generations.

Dr Robert Waterland, who led the project, said he believed that the womb environment could alter the function of genes controlling the development of the part of the brain controlling appetite.

He said: "Why is everyone getting heavier and heavier? Maternal obesity could be promoting obesity in the next generation."

He said: "What we have shown is that in each generation, the maternal obesity of the previous generation influences the establishment of the body weight regulatory mechanism."

Dr Karen Lillycrop, from Southampton University, said that the paper was "interesting", but stopped short of proving that an epigenetic effect was responsible for the effects seen in the mice.

"There is now a lot of information that foetal environment - be it malnourished or over-nourished - has an permanent impact on the metabolism of that foetus as it tries to cope."

She said that while folic acid supplementation in the lab mice had stopped mice increasing in weight, there would be possible risks in similar fortification in humans.