Obesity may reduce cognitive function

Obesity not only increases the risk of heart disease, diabetes and cancer but might also inhibit brain function.

Psychologists assessed the cognitive skills of obese people before and after weight loss surgery and found that patients scored higher on brain function tests after shedding some pounds.

The participants underwent gastric band surgery, an operation which reduces the size of the stomach and so the amount of food a person requires to feel full. This allows patients to avoid overeating as their appetite is vastly reduced.

Twelve weeks after the procedure the patients had lost an average of 50 pounds each.

Researchers at Kent State University in Ohio also used MRI imaging to study the brain structure of the participants. In particular, they examined nerve bundles that shuttle information through the brain. They found the fatty sheaths which protect the structures and speed up their function were often damaged.

Gastric band surgery decreases the size of the stomach and so a patient's appetite

Lead research fellow John Gunstad, said: “Doctors have known for a long time that being overweight is bad for your body.” The research shows that being overweight can also damage the brain: “especially,” he notes, “the parts of your brain most important for paying attention and learning new things.”

Prior to the surgery several individuals in the group achieved such low marks they could be classified as having a learning disability. The cognitive tests focused on information gathering and analysis, memory and verbal reasoning abilities.

The research is particularly relevant when considering the effects of childhood obesity on learning and development. As the number of overweight children worldwide continues to rise, significant changes to educational curriculum could be required to help them reach their academic potential.

The study’s results also support the use of weight loss surgery to treat obesity and hints at the reversible nature of cognitive impairment associated with the condition.

Gunstad, J., Strain, G., Devlin, M., Wing, R., Cohen, R., Paul, R., Crosby, R., & Mitchell, J. (2010). Improved memory function 12 weeks after bariatric surgery Surgery for Obesity and Related Diseases DOI: 10.1016/j.soard.2010.09.015


GP consortia: How will mental health care be affected?

Dr Sammad Hashmi, a consultant psychiatrist in Humberside, is in favour of GP consortia. He recently published an article which examined the potential benefits GP they will bring to community mental health care provision.

Dr Hashmi said the NHS has become highly bureaucratic and operates via unnecessarily complex systems of service delivery which amount to “an uneconomical way to transform cash into care”.

At present, mental health services straddle the primary and secondary care systems and are subdivided into various teams. These include the generic community mental health team, the assertive outreach team, early psychosis services and crisis resolution.

Many psychiatrists feel the disjoined interaction between these teams reduces overall effectiveness and to some extent the patient just gets lost in the system.

By allowing consortia to commission just one multi-faceted community mental health team Dr Hashmi believes the new system would “minimise the risk of over-inclusive bureaucracy and communication failure within the multiple team structure.”

GP Consortia: What do doctors think?

GP consortia are designed to ensure good clinical care lies at the heart of NHS management and patients are as close to the decision making process as possible.

Doctors, although affected by the fundamental issue of cost, are primarily concerned with delivering high quality, effective care to patients. This makes them key figures to consult when considering the effects GP consortia will have on healthcare in England.

Andrew Lansley defends his proposals by saying “GPs know patients best”. Although many GPs agree they know the needs of individual patients, many are concerned this does not translate into understanding the public health needs of whole communities.

Dr Kate Adams, a GP in Hackney, said public health management is “a very different skill”. She believes improvements to care could have happened “without such a radical shake up”.

Dr Adams expressed concerned over how care of very unwell patients will be funded. If a consortium has a high number of patients with complex health conditions, a significant proportion of their budget might be spent on the care of a few patients.

A list of serious illnesses which will receive extra funding has been produced to try to reduce such disparities in per patient budgets. Yet as more and more expensive treatments emerge for dozens of conditions, uncertainties continue to grow over the management of chronic illness.

Care has already been moved away from hospitals in many circumstances in an effort to reduce costs and allow patients to receive treatment closer to home.Many fear the move towards GP consortia will lead to even more community based treatment of conditions that are better managed in a hospital setting.
Consortia GPs will also handle cancer services for their patients. Dr Adams finds it shocking that general practitioners could be expected to make decisions that are very complex, even to experienced hospital oncologists. However a GP in Bristol, who asked to remain anonymous, is in favour of making such choices. He said: “GPs will not be required to make any decisions beyond their experience.”


Dr Paul Wallang, a specialist registrar in psychiatry at London’s Homerton Hospital, also feels the introduction of GP consortia will improve the NHS. “You can’t just keep pumping money into the system mindlessly and I think Lansley realises that. GP commissioning will improve quality of services as providers will have to compete with each other in order to gain contracts.”

In contrast, a cardiologist at a central London hospital  believes this competition will have a negative effect, driving down cost and ultimately reducing investment in the NHS. Dr Wallang also feels the introduction of patient choice is vital to a modern health service “Where, in any other system, do users have no say over the services they receive?”

The divide in doctors’ opinions about GP consortia is striking. One side argues the changes are a financially motivated move towards privatisation which will ultimately weaken the NHS. Yet many doctors view restructuring as the only practical way to ensure the organisation can improve and remain sustainable.

Printing Body Parts

Scientists might soon be able to manufacture human body parts using a rather unlikely piece of technology: a printer.

Ok, so we’re not talking about your average piece of office hardware here. Three dimensional printers allow any image on a computer screen to be printed as a single object with no assembly required.

A 3-D printer works just like an ordinary desktop printer but instead of laying down ink it produces a very fine jet of particles of a solid like metal or plastic. Each time the printer moves over the object it applies another layer until a solid 3-D item is produced.

In the past 3-D printers have mostly been used in construction and architecture but the technology is now being applied to other areas, including medicine.

Biotechnology companies are exploring how the printers could be used to tailor-make prosthetics such as hip replacements to fit the exact anatomy of a patient.

The technology could also be used to create new body parts. Layers of living cells can be built up into three dimensional structures meaning the printers could be used to create human tissue such as bone and even whole organs.

The technology could one day transform the lives of the thousands of people each year who require an organ transplant.

Organ transplant operations have a high failure rate as the recipient’s immune system often attacks the donated organ: a process known as rejection.

Treatments aimed at reducing rejection rates are costly and unpleasant as they suppress a patient’s immune response making them susceptible to infections and often unable to leave hospital for long periods of time.

By using cells engineered from the patient’s own body 3-D printing offers a chance to eliminate organ rejection altogether. The technology could also reduce long waiting lists for organs which are currently only obtainable by the death of a suitable donor.

The printers were first developed in 1984 and the technology has advanced significantly in recent years. 3-D printing has become more widespread and as a result is now relatively cheap. The process is also becoming quicker and the best machine on the market can now print around 1-2 vertical inches per hour.

The potential medical uses of 3-D printing are wide-ranging. Late last year a patient was admitted to University Hospital Coventry with a badly crushed pelvis. He was in a critical state and needed surgery but doctors had difficultly deciding how to go about the complex operation.

By scanning the patient’s pelvis and converting the image into a 3-D model they were able to plan the operation carefully before they started making the surgery safer and more effective.

As testing continues researchers hope the technique could represent a considerable advance in medical technology and the treatment of dozens of conditions.

NHS could save millions on heart disease drugs

The NHS could save over £200 million a year just by using a cheaper version of one drug, according to a study by the University College London Hospitals Foundation Trust.

Thousands of people in the UK are prescribed angiotensin receptor blockers (ARBs) to treat high blood pressure and heart disease. The most commonly used drug in the group is a branded medicine called candesartan.

A study found that switching patients to losartan, an older generic form of the drug, dramatically reduced the cost of treatment without affecting clinical outcomes.

Researchers compared the price and clinical benefits of the two drugs. Lead scientist Dr Anthony Grosso explains why one is so much cheaper than the other: “When drugs are first launched they are protected by patents and are relatively expensive as the pharmaceutical companies need to recover their research and development costs.”

“Once these patents have expired, the manufacturer loses market exclusivity and generic drugs can be produced, which ultimately drives down the price. This offers significant opportunities for cost savings, but only if the clinical evidence supports the use of the less expensive generic drugs.”

Although candesartan reduced blood pressure slightly more than losartan the difference is unlikely to be cost effective, particularly when it is prescribed in combination with other drugs.

More research is needed to ensure clinicians are not trading short-term savings for a long-term, more expensive increase in cardiovascular risks. However, with budget cuts looming the NHS’s pharmaceutical bill has been tipped as an area where major savings could be made easily, with no effect on patient care.

Teenage Kicks

For many of us our first relationships involved coy, nervous trips to the cinema and inexperienced fumbles at parties. But for many modern teenagers, initial encounters as a sexually active person take a very different course.

In 2009 the NSPCC and Bristol University published a report on intimate teenage relationships which found a significant number of young people in the UK are being abused by their partners.

There was a fantastic documentary by journalist Aasmah Mir on BBC Radio 4 today which explores the issue. Aasmah speaks to young men and women about their relationships and how pornography and social networking sites inflence the way they view their partners. She also speaks to experts to find out why and to what extent violence and sexual assault are becoming a feature of teenage relationships.


Worldwide TB rates plateau

The number of tuberculosis cases worldwide has stabilised for the first time since international records began.

The improvements are thought to be the result of significant reductions in the prevalence of the disease in India and China. The two countries have the highest rates of tuberculosis in the world and together account for over a third of all cases.

In 2009 the incidence of tuberculosis fell or remained around the same level in 21 of the 22 countries with the highest rates worldwide. However, rates in South Africa continue to rise and officials warn that overall progress in the control the disease is still too slow. Mario Raviglione, director of the WHO’s Stop TB unit, said: “There are still 1.7 million deaths a year from a disease that is perfectly curable in 2010.”

Particular strains of tuberculosis bacteria known as multidrug resistant tuberculosis (MDR TB) have adapted to become resistant to available antibiotics. Around 440,000 cases of resistant TB are diagnosed worldwide each year although the actual figure is thought to be much higher.

MDR TB is difficult to detect and genetically advanced strains are now the biggest challenge faced by international bodies trying to control the disease.

A Nation of Oldies

I recently posted a piece about rising numbers of ageing drug addicts in Britain. Drug addiction is a condition most people wouldn’t associate with old age. Yet the rise reflects the growing pressure on all NHS departments to provide services that support our ageing population.

Average life expectancy in Britain rose by thirty years during the 20th century and in 2007 the number of people aged over 65 outnumbered those under 16 for the first time. Advances in medical care are one reason why we are living longer as a nation. However, fertility has declined significantly over the last 40 years and experts cite this as the major factor behind our ageing nation. Despite a recent increase in birth rates, women in Britain are now having an average of 1.9 children compared to 2.9 in 1964.

The baby boom generation have also increased the gap between young and old population figures. The end of World War II saw a sharp rise in birth rates in America, Canada, Australia and the UK as men returned home to their partners and marriage rates rocketed. As the children of post war Britain are now reaching retirement age the increased burden on public services hardly seems surprising. Yet if we assess the figures the finance of the situation seems more complex. Government figures reveal that 80 per cent of the country’s £6.7 trillion wealth is owned by the baby boom generation; somewhat detracting from the protests of exasperated under-65s who claim they are being forced to pick up the bill for our ageing population. In fact, half of the UK population is aged less that 40, but the group only holds around 15 per cent of the country’s financial assets.

In 2007 the United Nations released the World Population Ageing report which stated that the global population is ageing at an unprecedented level. The report also found that fertility levels are unlikely to rise meaning population ageing is irreversible. In 2000 the number of people aged over 60 years stood at 600 million, triple that of 1950. By 2006 the figure had reached 700 million people. The report predicts that by 2050 the number of people in the world aged over 60 years will be around two billion. The UN also highlighted differences in ageing between developed and undeveloped areas of the world. As one might expect average life expectancy is higher in the western world. However, the pace of population ageing is faster in undeveloped countries meaning they will have less time to adapt to the needs of increased numbers of older citizens so will be less able to cope with their demands.

In terms of medical care the demands of old age are wide ranging and expensive. As a person lives longer they are more likely to accumulate multi system diseases that require long term management such as kidney and heart failure. Advances in treatment mean that such diseases can be managed more effectively than in previous times and the interactions between the conditions are now less likely to cause death.

Treatments for mental health conditions of old age such as dementia have not undergone such dramatic improvements meaning care focuses more on patient support than cure or maintenance. The number of people in the UK living with dementia is rising year on year and currently stands at 820,000. As the population ages further the cost of caring for patients with dementia will reach crippling levels. Dementia costs the UK economy £23 billion per year, twice as much as cancer treatments and three times as much as heart disease care. This is because the intense specialist social support patients and their families require is time consuming and expensive to provide.

So what are our options as an ageing population? Several rather unpalatable solutions have been announced, firstly an increase in the legal retirement age which will rise to 66 for both men and women by 2020. The announcement has been met with both anger and scepticism, “This change is motivated not by the phenomenon of population ageing, but by a need to cut the pensions bill,” said Chris Ball, chief executive of The Age and Employment Network (TAEN). “It is a short-term fix without consideration of the longer-term challenges.” Advisors have also recommended a careful look at migration policy with a view to importing an able work force to support the economic demands of an ageing Britain. Perhaps one of the simplest solutions, to encourage people to save more for their retirement, has been significantly weakened by the global economic crisis which has seen many Brits dip into their savings rather than add to them.

Despite the gloomy outlook a ray of hope has been found in recent weeks. A study has found that although the number of over 65s in Britain is rising, their health is declining at a much slower rate than was previously anticipated. Michelle Mitchell, charity director for Age UK, said: “This study clearly shows that viewing older people simply as a ‘burden to society’ is an out-of-date concept. On the contrary, increasing longevity and improved health care mean many older people are able to make a very positive and important contribution to our society.”

Male Cancer Patients Denied Sperm Banking Services

Male cancer patients are being denied the chance to store their sperm, despite regulations which state they should be offered the service. Many cancer treatments put men at risk of infertility. However, a survey of nearly 500 cancer doctors across the UK found that half could not confirm information about sperm banking was readily available at their centres. The study, funded by Cancer Research UK, also found that only a quarter of doctors systematically discussed the service with male patients, yet nearly all thought raising the topic was an important part of their role.

National Institute for Health and Clinical Excellence (NICE) guidelines state that any men or adolescent boys receiving treatment that might put them at risk of infertility should be offered the chance to store their sperm. Dr Ann Adams, who led the research at Warwick Medical School, said: “Our findings are concerning…it appears clinicians are deciding who is offered the chance to bank sperm based on their own personal beliefs, attitudes and assumptions about their patients’ likelihood of starting a family in the future.”

Around 150,000 men are diagnosed with cancer in the UK each year. The toxic nature of many therapies can damage sperm cells, making them less able to fertilise an egg during sex. In some cases sperm production is significantly reduced or stops entirely, either on a temporary or permanent basis. The extent of sperm damage depends on the type of treatment received and the dose at which it is given. Patient age is also a factor, with older patients being more at risk of infertility.

Although developments are reducing the impact cancer therapies have on male fertility, sperm banking provides a unique chance for affected men to have children in the future. With more and more people surviving cancer, the need to ensure quality of life after completion of treatment is becoming increasingly important.

Professor Geraldine Hartshorne, also from Warwick Medical School, said: “Improved awareness and access to training for clinicians would hopefully increase both the opportunity and the uptake of sperm banking for cancer patients.”

Would you have your Grandma’s baby?

In 1990 a couple in America underwent IVF treatment and successfully had a child. They allowed the remaining five fertilised embryos produced to be frozen for another couple to use in the future. Nineteen years later, an unamed woman who had been trying for a baby for ten years took up the offer and gave birth to a healthy child in May. In America there is no limit on the length of time an embryo can be stored for before implantation, in Britain there is a legal limit of 55 years in place.

Several commentators have raised concerns over the ethics of this form of “adoption”. I personally have no real problem with the idea, if the health of the child isn’t compromised by the process and everyone’s alright with it, why should we deny a woman the chance to be happy? Although if there’s no limit to the time embryos can be stored will we face a point in the future where women are having children that are 40, 50, 100 years older than them and beyond? It’s all a bit sci-fi for my liking.