Parasite 'resistant to malaria drug'

28 April 2013 Last updated at 20:03 ET By Rebecca Morelle Science reporter, BBC World Service

New drug-resistant strains of the parasite that causes malaria have been identified by scientists.

Researchers found parasites in western Cambodia that are genetically different from other strains around the world.

These organisms are able to withstand treatment by artemisinin - a frontline drug in the fight against malaria.

Reports of drug resistance in the area first emerged in 2008. The problem has since spread to other parts of South East Asia.

The study is published in the journal Nature Genetics.

The lead author, Dr Olivo Miotto, of the University of Oxford and Mahidol University in Thailand, said: "All the most effective drugs that we have had in the last few decades have been one by one rendered useless by the remarkable ability of this parasite to mutate and develop resistance.

"Artemisinin right now works very well. It is the best weapon we have against the disease, and we need to keep it."

Genetic fingerprint

Western Cambodia has been described by scientists as a hotspot for malaria resistance.

Continue reading the main story

It could be a tool for detecting in real time the emergence of drug resistance"

End Quote Dr Olivo Miotto University of Oxford

They do not understand why, but since the 1950s parasites there have developed a resistance to a succession of malaria drugs. The problem has spread to other parts of Asia and Africa.

Now scientists are worried the same thing will happen with artemisinin. This drug is used widely around the world against the mosquito-borne disease and can treat an infection in a few days when it is used in combination with other drugs.

To investigate, scientists sequenced the genomes of 800 malaria-causing parasites (Plasmodium falciparum) collected from around the world.

"When we compared the DNA of the parasites in Cambodia, they seem to have formed some new populations that we have not really seen elsewhere," Dr Miotto said.

The international team found three distinct groups of drug-resistant parasites present in the area.

The researchers said they did not yet understand what genetic mutations had occurred that enabled the parasites to withstand artemisinin treatment.

But they said that understanding their genetic fingerprint would help them to quickly spot and track these strains if they spread further.

Dr Miotto said: "It could be a tool for detecting in real time the emergence of drug resistance."

The World Health Organization has stated that a major objective is to stop the spread of malaria parasites resistant to drugs.

According to its latest estimates, there were about 219 million cases of malaria in 2010 and 660,000 deaths.

Africa is the most affected continent: about 90% of all malaria deaths occur there.

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MS patients missing out on drugs

28 April 2013 Last updated at 21:42 ET

Only 40% of people eligible for drugs to combat multiple sclerosis in the UK are actually taking them, says a report from the MS Society.

A survey of more than 10,000 adults with MS showed that many were missing out on the seven licensed medicines approved for use.

The charity said a lack of information and access to specialists was to blame.

It is calling for the government to provide a personalised care plan to every person with MS.

The MS Society's survey and accompanying report showed that there were differences in access to disease-modifying treatments (DMTs) across the four nations of the UK.

These are medicines that can reduce the frequency and severity of MS attacks, and in some cases can slow the progression of the disabling condition.

Someone living in Northern Ireland with MS was twice as likely to be taking a DMT (68%) than someone with the condition in Wales (30%), for example.

Access to treatment in Scotland and England was only a little higher at 36% and 40%.

Continue reading the main story

What is multiple sclerosis?

Multiple sclerosis (MS) is a neurological condition that affects around 100,000 people in the UK.

Most patients have it diagnosed between the ages of 20 and 40, but it can affect younger and older people too.

Almost three times as many women as men have MS.

In Europe, additional research shows that only Poland and Romania have a smaller proportion of people with MS taking licensed medicines.

Routine assessment

The charity's report said that being well informed about the medicines available was crucial.

Those who felt they had enough information about medicines were 32% more likely to be taking a DMT, the survey found, and those with access to a specialist MS nurse or neurologist were more than twice as likely to be taking the appropriate drugs.

Northern Ireland is the only place in the UK where most people with MS are routinely invited every six months to see a neurologist or MS nurse for a review.

This means that people with MS are constantly having their treatment options assessed, the report says.

As a result, they are more likely to get the information they need and discuss issues such as side-effects.

Continue reading the main story

UK licensed medicines for MS

• Avonex, Betaferon, Rebif and Copaxone were all made available on the NHS in 2002 throughout the UK.
• Extavia was licensed in 2009 and reduces relapses by a third.
• Tysabri is a monthly infusion administered by a healthcare professional. It can reduce the number of relapses by an estimated 67% and slow disability. It was approved for use on the NHS across the UK in 2007.
• Gilenya, the first pill for MS, is said to reduce relapse rates by 54-60% and slows disability progression by around 30%. It was approved in 2012.

Yet this may not be the only solution. Forty-one per cent of those who said they did have enough information about drug treatments still did not take a disease-modifying treatment.

The report concluded: "This could be due to barriers to accessing medicines; because individuals make an informed decision not to take them; or because they don't know what information is out there that they could have access to, such as around new treatments or new evidence of efficacy."

New policy

Nick Rijke, director for policy and research at the MS Society, said people with multiple sclerosis were facing a lottery.

"These findings worryingly suggest that the likelihood of someone receiving a life-changing treatment is often based on luck - like where they live or how helpful their healthcare professional is - rather than their genuine clinical need.

"When it comes to prescription rates, the UK ranks 25th out of 27 European countries. Given the relative wealth of the UK this is simply unacceptable."

The MS Society is now calling on all four governments in the UK to ensure every person with MS has a personalised treatment, care and support plan, with two comprehensive reviews each year.

Ed Holloway, head of care and services research at the MS Society, said that because some MS drugs were costly, they were often not offered when they should be because of restricted NHS budgets.

'Speak to doctor'

A spokesman for NHS England, which has recently taken on the commissioning of treatment for MS from primary care trusts, said a new policy from 1 April would mean that people across England would have the same access to treatment.

"By making decisions nationally about specialist treatments, we are confident that patients will now be able to receive the treatment they need, irrespective of where they live.

"As with all policies, we will continue to collect and review the outcome of treatments for patients and consider them when our policy is reviewed.

"If a patient has concerns about the treatment they are receiving we would urge them to speak to their GP or consultant."

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MMR schools vaccinations stepped up

29 April 2013 Last updated at 01:49 ET

Immunisation against measles is being carried out in schools west of the main Swansea epidemic area for the first time.

The MMR vaccination is being offered to up to 4,000 secondary school pupils in Carmarthenshire, Pembrokeshire and Ceredigion over the next few weeks.

Vaccinations are also continuing in schools around Swansea.

Over 940 cases have been confirmed since the outbreak began in November, with 83 needing hospital treatment.

The Hywel Dda Health Board school nursing service is visiting secondary schools in Carmarthenshire, Pembrokeshire and Ceredigion to offer the vaccine to pupils who have not yet received the first or both MMR vaccinations.

Letters and consent forms are being sent, with the first vaccinations taking place on Monday, initially in east Carmarthenshire.

Continue reading the main story

This programme can only be a success if parents sign and return the consent form to allow us to vaccinate and protect their child"

End Quote Teresa Owen Hywel Dda Health Board

Teresa Owen, Hywel Dda director of public health, told BBC Wales: "We're a neighbouring area and Llanelli is very close with people travelling back and forth so it's a focus for us but we're keen to protect all the children across Hywel Dda.

"We're very grateful to parents for immunising their children as much as they have done already. It's the best thing that they can do."

The vaccinations will be carried out at all secondary schools but primary school pupils will also be targeted through their GPs.

"We continue to ask parents to make sure that all their children are vaccinated," said Ms Owen.

Vaccinations are also continuing in schools in the Abertawe Bro Morgannwg health board area, which consists of Swansea, Neath Port Talbot and Bridgend.

Further tests

Other health boards are also targeting schools, including Cwm Taf which covers Rhondda Cynon Taf and Merthyr Tydfil.

Meanwhile, more than 2,500 people received MMR vaccinations in another weekend of special clinics.

Sessions were held in the Abertawe Bro Morgannwg area, while a first clinic took place in Llanelli, Carmarthenshire.

The high turnout was welcomed by health board officials.

The measles outbreak has been linked to one death so far - that of 25-year-old Gareth Colfer-Williams from Swansea - but further tests are to be carried out after a post-mortem examination proved inconclusive.

Mr Colfer-Williams, who had measles, was known to have had other health problems including asthma, his family has said.

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Cutting cord early 'risk to babies'

26 April 2013 Last updated at 06:39 ET

Cutting the umbilical cord immediately after birth - currently standard practice - puts the baby at risk of iron deficiency, experts say.

Official guidelines are currently being examined - and professionals and campaigners say they should change.

Leaving the cord attached for a few minutes allows the blood in the cord to transfer to the baby,

The National Institute for Health and Care Excellence (NICE) says it will publish new guidelines next year.

Developmental concerns

The existing guidance on cord-clamping was published in 2007, when the consensus was that cutting the cord immediately was the best option - something which had been the case for decades.

But since then, researchers have questioned whether that is still the case.

A paper from the Royal College of Obstetricians and Gynaecologists (RCOG) published in 2009, stated that babies whose umbilical cords are clamped immediately have lower iron stores for up to six months.

Low iron levels have been linked to brain development problems.

The suggestion is that the cord should not be cut until it has stopped pulsating naturally - anywhere between two and five minutes after birth.

Some hospitals have already changed their practice.

'No good evidence'

Commenting on the current re-evaluation of the guidance, an RCOG spokeswoman said: "The college recommends that the umbilical cord should not be clamped earlier than necessary and should always be based on clinical assessment of the situation.

Continue reading the main story

Our recommendation will represent what we believe is best possible practice and will put mother and baby's safety first"

End Quote Prof Mark Baker NICE

"Research has shown that delayed cord clamping of more than 30 seconds may benefit the newborn in reducing anaemia.

"It also allows time for the transfusion of placental blood to the newborn, especially in cases of premature birth."

But she said there could be some cases where complications meant it was better to clamp the cord immediately.

Belinda Phipps, chief executive of the National Childbirth Trust (NCT) said: "When a baby is born about a third for the baby's blood is still in his/her cord and placenta.

"With no good evidence to support it, accepted practice is to accelerate the arrival of the placenta with an injection and clamp and cut the cord immediately, depriving the baby of this blood.

"The NCT would like to see the default position become leaving the cord for a few minutes until it stops pulsating, unless the mother chooses to have an injection to speed the arrival of her placenta or unless the blood loss from the mother means her uterus must be encouraged, with drugs, to contract and expel the placenta quickly."

Prof Mark Baker, director of the centre for clinical practice at NICE, said all its guidelines were regularly updated to take into account developments in research.

He added: "All available evidence on the right time to clamp a newborn baby's cord is being considered.

"Our recommendation will represent what we believe is best possible practice and will put mother and baby's safety first."

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New MMR jab clinic in measles fight

26 April 2013 Last updated at 23:38 ET

Another health board is opening a drop-in measles vaccination clinic in south Wales later, amid warnings of a likely outbreak in north Wales.

It comes as a million pupils in England who missed MMR jabs are targeted in a catch-up campaign to curb the threat.

A drop-in clinic opens in Llanelli on Saturday, the centre of 65 cases since the beginning of the year.

Four hospitals in and around Swansea are hosting MMR drop-in vaccination clinics for a fourth weekend.

The number of cases in the Swansea-based epidemic could pass 1,000 over the weekend if current trends continue.

Continue reading the main story

Whilst I understand why people have historically had reservations about immunising their children we now have a very different situation"

End Quote Andrew Jones Director of public health for north Wales

The outbreak is centred on the Abertawe Bro Morgannwg University Health Board area - which covers Swansea, Neath Port Talbot, Bridgend, southern parts of Powys and eastern parts of Carmarthenshire.

High rates of the disease have also been seen in Neath Port Talbot and north Powys.

Eighty-three of the 942 confirmed cases have needed hospital care since the outbreak began in November.

Further tests will be carried out on a 25-year-old Swansea man who died at his flat in the city while suffering from measles after post-mortem examination results were inconclusive.

Special measures to tackle the disease are also in place in Llanelli on Saturday with a drop-in centre at the town's Elizabeth Williams Clinic.

It follows a drive launched on Friday to vaccinate an estimated 4,000 schoolchildren across the three counties of neighbouring Hywel Dda Health Board area.

Health board director Teresa Owen said youngsters in all secondary schools in Carmarthenshire, Ceredigion and Pembrokeshire will be offered the MMR jab.

She said: "Due to Llanelli's close proximity to the outbreak centred in Swansea the programme will begin in the east of Carmarthenshire and is due to be completed across all three counties within four weeks."

Two other health boards - Anuerin Bevan and Cardiff and Vale - have held drop-in MMR clinics on previous weekends.

Meanwhile, Public Health Wales has warned that is is "was only a matter of time" before the Betsi Cadwaladr University Health Board area in north Wales sees measles cases unless more children and young adults are vaccinated against the disease.

The health board has arranged vaccination sessions at all secondary schools in north Wales. Primary schools that have a vaccination rate of less than 90% are also being targeted.

Andrew Jones, director of public health for north Wales, said: "I'm worried that 10% of our young people are at risk of catching this potentially fatal disease.

"Whilst I understand why people have historically had reservations about immunising their children we now have a very different situation.

We are very vulnerable and if we wait until cases start to appear here it will be too late to prevent the spread across the north.

Epidemics

"The vaccine is safe, the needles are tiny and the jab takes seconds; it is never too late to catch up on missed jabs.''

Health officials have warned epidemics similar to the one in Swansea could occur anywhere.

A £20m catch-up campaign in England already has 1.2 million vaccines ready to go amid concerns that that a generation of children have low levels of protection against measles after the MMR scare more than a decade ago.

The campaign aims to vaccinate children yet to be protected with the MMR - measles, mumps and rubella - jab by September.

Run through GPs, schools and community groups, it will focus on children aged 10 to 16.

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HIV warning over illegal tattooists

27 April 2013 Last updated at 01:01 ET

Illegal unlicensed tattoo parlours are putting customers at risk from HIV and hepatitis, council bosses in England and Wales have warned.

The Local Government Association (LGA) said such operators were more likely to use substandard equipment and conduct inadequate sterilisation techniques.

They were also less likely to check the person's age or medical history.

The LGA said unregulated tattooists were working in homes, garden sheds or pubs and clubs.

'Unscrupulous bid'

The organisation said people were being lured away from reputable establishments by cheap deals - but there was an increased danger of contracting serious skin disorders, hepatitis or HIV.

Mehboob Khan, chairman of the LGA's Safer and Stronger Communities Board, said: "Unlicensed tattooists and parlours continue to operate across the country in an unscrupulous bid to cash in on the growing popularity of body art.

"People looking for a cheap tattoo by using them run the real danger of picking up a serious infection such as hepatitis or HIV or permanent scarring from botched procedures that are often delivered by these dangerous imposters."

Mr Khan said people who took the risk could end up with a "disfigurement or life-changing health condition".

He added: "Anyone who is thinking of having a tattoo should do their research and use a registered tattooist.

'Unrelenting crackdown'

"We would also encourage anyone who has visited an unregistered tattooist to seek medical advice from their GP and report the parlour to their local authority.

"Councils and the police will continue their unrelenting crackdown on these illegal parlours to continue shutting them down and bringing the perpetrators to justice."

Tattoo artist Kevin Paul told the BBC that anyone with tattoo equipment should have register with their local council and follow health and safety guidelines.

He said: "Some of the stories we've had are really bad. Like this girl - she had something on her foot.

"She thought it was a professional person who'd done it. He went far too deep. It swelled up and went really sore.

"She went back to get their advice after a week. They told her that that was normal. That's not normal. Two weeks down the line, it got that bad she could hardly walk on it. She went to hospital. They told her that if she'd have left it any longer she'd have lost her foot."

The LGA said there were more than 1,500 licensed tattoo parlours in the UK, with almost three in 10 people aged between 25 and 34 having at least one piece of the body art.

Unlicensed tattooists face a prison sentence of up to two years and unlimited fines, and local authorities can seize their equipment under the Health and Safety at Work Act.

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Closed windows 'increase infection'

25 April 2013 Last updated at 21:03 ET By Neil Bowdler Health and science reporter, BBC News

Keeping the windows open on traditional NHS wards can dramatically reduce the risk of infection, say researchers.

The University of Leeds study suggests closing windows, for example to cut heating bills, increases the risk of infection fourfold.

The researchers used experiments and computer modelling to map the passage of air and germs through wards.

They say fitting household extractor fans to windows could maintain sufficient air flow in winter.

The study looked at air flow in traditional "Nightingale wards", built as open wards of around 30 beds with opening windows and named after Florence Nightingale, who set out the principles of ward design in the 19th Century.

Balloons filled with carbon dioxide - to represent an airborne pathogen - were popped and the gas followed throughout the ward using tracer devices.

Smoke sticks were also used to visually track the passage of air and wind streams.

The results showed that while the modern trend to partition wards to increase patient privacy changed the air-flow dynamics within a ward, good ventilation could be maintained if windows remained open.

"One of the biggest problems we have in the UK at the moment is that we don't have the money to just knock down every hospital and rebuild it," said Dr Cath Noakes, who led the study.

"We have to deal with what we've got, and many of the wards we've got are going to remain in use for a number of years to come.

"Our research was looking at these big naturally ventilated spaces to see what the risk of infection might be in there.

"What we found was that when the windows are open, these wards are very good.

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Dr Cath Noakes explains how keeping windows open may reduce infection

"But if you close the windows and don't provide any alternative ventilation, the risks go up and they go up about fourfold.

"People are being told to seal up their buildings to save energy.

"We found, if you do that without alternative ventilation systems, you could be increasing the airborne infection risk significantly."

The researchers also looked at what could be done to maintain ventilation in winter months, when the windows had to be shut to keep patients warm.

"We actually used the little extractor fans - the type of thing you get in your bathroom at home.

"We installed those into the window and when we ran those, we found the risks became comparable to a naturally ventilated system."

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David Docherty, Royal London Hospital: "The building has more than 3,000 rooms"

Co-author Dr Miller Camargo-Valero said: "These simple, low-energy and low-cost solutions could also be of significant benefit for hospitals in the developing world, particularly in countries where airborne diseases such as tuberculosis are a major concern."

Funded by the Engineering and Physical Sciences Research Council, the study was published in the Building and Environment Journal.

Hermetic seals

While the research could help inform practices in older NHS buildings, many newer UK hospital buildings feature no opening windows and complex computer-controlled ventilation systems.

David Docherty, head of estates at the Royal London Hospital, part of Barts Health NHS Trust, told the BBC there were other considerations when it was decided to move the hospital from its old Whitechapel premises to a new adjacent building - namely, air pollution.

"Obviously, the air quality of London meant that we had to consider our patients first and we have to consider the quality of the air that's coming to them," he said.

Instead of opening windows, the new Royal London Hospital has 200 units that bring clean filtered air into the hospital's 3,500 rooms.

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Cancer 'threat' to Latin America

25 April 2013 Last updated at 21:05 ET

Cancer is threatening to overwhelm Latin American countries, experts writing in Lancet Oncology warn.

There are far fewer cases of cancer in the region than in the US or Europe - but the proportion who die is far higher, they say.

Late diagnosis and poor access to treatment are the main reasons for the disparity, they add.

They said as life expectancy increased, cancer would become more common, and many countries would not cope.

The experts looked at cancer incidence and care in the Latin American and Caribbean region, including the following countries: Argentina, Bahamas, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, French Guiana, Guyana, Honduras, Haiti, Mexico, Nicaragua, Panama, Peru, Puerto Rico, Paraguay and El Salvador.

Risk factors

Writing in a Lancet Oncology report that is being officially launched at a specialist conference in Sao Paulo, Brazil, they say as the economies of these countries grow, and standards of living increase, people are increasingly adopting the habits of more developed countries.

Continue reading the main story

This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America "

End Quote Prof Paul Goss Harvard Medical School

They are living more sedentary lifestyles, eating more unhealthily, smoking more and drinking more alcohol.

Sun exposure and indoor pollution from burning solid fuels are also risk factors.

The researchers say that in Latin America, there are around 163 cases of cancer per 100,000 people.

In the US, the comparable figure is 300 cases per 100,000, while in Europe it is 264 cases per 100,000.

But the death rate is much higher. In Latin America it stands at 13 deaths for every 22 cancer cases, while it is 13 deaths for every 37 cases of cancer the US, and approximately 13 deaths for every 30 cases in Europe.

Researchers estimate that in 2030, there will be 1.7 million cases of cancer diagnosed across Latin America and the Caribbean, and there will be more than 1 million deaths.

Paul Goss, professor of medicine at Harvard Medical School in Boston, who led the research team, said: "More widespread adoption of lifestyles similar to those in developed countries will lead to a rapidly growing number of patients with cancer, a cost burden for which Latin American countries are not prepared.

"This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America.

"The region is poorly equipped to deal with the alarming rise in cancer incidence and disproportionately high mortality rates compared with other world regions, underscoring the magnitude of the cancer-control problem."

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Cutting cord early 'risk to babies'

26 April 2013 Last updated at 06:39 ET

Cutting the umbilical cord immediately after birth - currently standard practice - puts the baby at risk of iron deficiency, experts say.

Official guidelines are currently being examined - and professionals and campaigners say they should change.

Leaving the cord attached for a few minutes allows the blood in the cord to transfer to the baby,

The National Institute for Health and Care Excellence (NICE) says it will publish new guidelines next year.

Developmental concerns

The existing guidance on cord-clamping was published in 2007, when the consensus was that cutting the cord immediately was the best option - something which had been the case for decades.

But since then, researchers have questioned whether that is still the case.

A paper from the Royal College of Obstetricians and Gynaecologists (RCOG) published in 2009, stated that babies whose umbilical cords are clamped immediately have lower iron stores for up to six months.

Low iron levels have been linked to brain development problems.

The suggestion is that the cord should not be cut until it has stopped pulsating naturally - anywhere between two and five minutes after birth.

Some hospitals have already changed their practice.

'No good evidence'

Commenting on the current re-evaluation of the guidance, an RCOG spokeswoman said: "The college recommends that the umbilical cord should not be clamped earlier than necessary and should always be based on clinical assessment of the situation.

Continue reading the main story

Our recommendation will represent what we believe is best possible practice and will put mother and baby's safety first"

End Quote Prof Mark Baker NICE

"Research has shown that delayed cord clamping of more than 30 seconds may benefit the newborn in reducing anaemia.

"It also allows time for the transfusion of placental blood to the newborn, especially in cases of premature birth."

But she said there could be some cases where complications meant it was better to clamp the cord immediately.

Belinda Phipps, chief executive of the National Childbirth Trust (NCT) said: "When a baby is born about a third for the baby's blood is still in his/her cord and placenta.

"With no good evidence to support it, accepted practice is to accelerate the arrival of the placenta with an injection and clamp and cut the cord immediately, depriving the baby of this blood.

"The NCT would like to see the default position become leaving the cord for a few minutes until it stops pulsating, unless the mother chooses to have an injection to speed the arrival of her placenta or unless the blood loss from the mother means her uterus must be encouraged, with drugs, to contract and expel the placenta quickly."

Prof Mark Baker, director of the centre for clinical practice at NICE, said all its guidelines were regularly updated to take into account developments in research.

He added: "All available evidence on the right time to clamp a newborn baby's cord is being considered.

"Our recommendation will represent what we believe is best possible practice and will put mother and baby's safety first."

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Measles jab plan targets 1m children

25 April 2013 Last updated at 04:40 ET By James Gallagher Health and science reporter, BBC News

One million schoolchildren in England who missed MMR jabs are to be targeted by a vaccination plan aimed at curbing the growing threat of measles.

Health officials warn epidemics similar to the one in Swansea, which has seen nearly 942 cases, could occur anywhere.

There are fears that a generation of children have low levels of protection after the MMR scare a decade ago.

The catch-up campaign, run through GPs, schools and community groups, will focus on children aged 10 to 16.

The campaign is expected to cost £20m and the Department of Health already has 1.2 million vaccines ready to go.

It will aim to vaccinate children yet to be protected with the MMR - measles, mumps and rubella - jab by September.

Measles is a highly contagious disease characterised by a high fever and a rash. In one in 15 cases it can lead to severe complications, such as pneumonia and inflammation of the brain, and can be fatal.

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In 2012, there were nearly 2,000 cases of measles in England - the highest figure for nearly two decades.

This year could be another record with cases already higher than at the same point last year.

Discredited research

Children aged between 10 and 16 are the most likely to have missed jabs when research linked MMR with autism and caused vaccination rates to plummet. The research has since been discredited.

Continue reading the main story

Analysis

Travel back in time to the mid-90s and measles was not a worry. It had been effectively eradicated in the UK with cases only coming from abroad.

It seems remarkable that two decades later such campaigns are needed.

Discredited claims by Andrew Wakefield of a link between MMR and autism led to vaccination rates falling to 80% by 2005, far below the level needed to prevent the spread of the disease.

Those unvaccinated children are now entering a vulnerable period in their lives as they move to secondary school.

It is a significant moment as mixing with far more pupils significantly increases the risk of infection.

Being older also means the dangers of complications will be higher.

Vaccination rates have since recovered to record levels. It suggests measles will be confined to the Wakefield generation and not be a long-term problem.

The most urgent need for vaccination is in the third-of-a-million completely unprotected children in that age group. They should be given their first MMR jab before the next school year and a booster jab later.

A similar number of children who had only their first MMR vaccine will be targeted with their booster.

The aim is to give a further third-of-a-million children in other age groups, who are not totally protected, their vaccines as well.

Prof David Salisbury, the director of immunisation at the Department of Health, said parents needed to act to prevent outbreaks on their doorstep.

"Swansea is the wake-up call for parents and it tells us just how infectious measles is - it just spreads like wildfire.

"If you think your child has not had one or even two doses of MMR, for goodness' sake contact your GP and get it sorted out.

"The message from Swansea is very clear and it is trivialised at the risk of your children's health."

Similar plans are already under way in Wales.

Both Scotland and Northern Ireland maintained relatively high MMR uptake but NHS boards in Scotland are to write to parents of all unvaccinated or partially vaccinated children aged 10 to 17 with an invitation to attend for vaccination over the next few weeks.

Danger zones

Figures from Public Health England show there have been 587 confirmed cases of measles in the first three months of 2013.

Measles outbreak: In graphics

A fifth of cases needed hospital treatment and 15 people developed complications such as pneumonia, meningitis and gastroenteritis.

The cases were mostly in the north-east and north-west of England, even though the north of the country generally maintained high levels of vaccination at the height of the MMR scare.

Dr Mary Ramsay, head of immunisation at Public Health England, said: "We have potential for school outbreaks in many areas of the country.

Continue reading the main story

Mandatory vaccination

Scientist Dr Craig Venter, who was one of the first to sequence the human genome, has called for all unvaccinated children to be banned from school.

He told the Times that said such children were a "hazard to society".

It echoes calls Dr Paul Offit, a US-based measles expert, that vaccination should be mandatory.

He says such a policy, which can affect school admittance and job offers in the US, had prevented similar outbreaks there.

It is not compulsory as people can object on health, philosophical and religious grounds.

A similar scheme is not expected in the UK and schools cannot independently choose to exclude those who have not been vaccinated.

"The areas most likely to be affected would be London and the south and east of the country, where we know that the historical coverage was not as high."

Prof Salisbury said he worried about London because of the high density of people, who were rapidly moving.

He warned that children who received single jabs, instead of the combined MMR, may also need additional protection as there had been "major problems" with the quality and storage of some of the vaccines handed out.

He added that nobody should be considering single jabs now.

Dr Paul Cosford, the director for health protection at Public Health England, said: "Although nationally the numbers needing catch-up vaccination is quite large, there are relatively few in each local area.

"We are confident that local teams have the resources to identify and vaccinate those children most at risk."

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Diabetes warning over soft drinks

24 April 2013 Last updated at 22:11 ET

Drinking one or more cans of sugary soft drinks a day is linked to an increased risk of diabetes in later life, a study suggests.

A can a day raises the relative risk of diabetes by about a fifth, compared with one can a month or under, say European scientists.

The report in the journal Diabetologia mirrors previous US findings.

A diabetes charity recommends limiting sugary foods and drinks as they are calorific and can cause weight gain.

The latest research was carried out in the UK, Germany, Denmark, Italy, Spain, Sweden, France and the Netherlands.

Some 350,000 individuals were questioned about their diet, as part of a large European study looking at links between diet and cancer.

"The consumption of sugar sweetened soft drinks increases your risk of diabetes - so for every can of soft drinks that you drink per day, the risk is higher," lead researcher Dora Romaguera from Imperial College London told BBC News.

She called for clearer public health information on the effects of sugary soft drinks.

Continue reading the main story

In and of themselves, sugary soft drinks are only part of the picture - they're just one of the potential risk factors for Type-2 diabetes"

End Quote Professor Patrick Wolfe University College London

"Given the increase in sweet beverage consumption in Europe, clear messages on its deleterious effect on health should be given to the population," Dr Romaguera and colleagues conclude in their research paper.

'Not definitive evidence'

An increased risk of diabetes was also linked to drinking artificially sweetened soft drinks, but this disappeared when body mass index was taken into account.

Fruit juice consumption was not associated with diabetes incidence, however.

Commenting on the results, Dr Matthew Hobbs, head of research at Diabetes UK, said the link between sugar-sweetened soft drinks and Type-2 diabetes persisted even when body mass index was taken into account.

This suggests the increased risk is not solely due to extra calories, he said.

"Even so, it is not definitive evidence that sugar-sweetened soft drinks increase the risk of Type 2 diabetes, other than through their effect on body weight," he added.

"We do, though, already recommend limiting consumption of sugary foods and drinks as these are usually high in calories and so can lead to weight gain if you have too many of them.

"This is important for Type 2 diabetes because we know that maintaining a healthy weight is the single most important thing you can do to prevent it."

Statistics expert Professor Patrick Wolfe, from University College London, said the absolute risk of Type-2 diabetes is low at about 4% of the adult UK population.

"In and of themselves, sugary soft drinks are only part of the picture - they're just one of the potential risk factors for Type-2 diabetes," he said.

"But since they are one we can easily eliminate - by switching to diet soft drinks or, even better, cutting them out of our diets altogether - it makes good sense to do so."

Gavin Partington, director general of the drinks industry body the British Soft Drinks Association said: "Soft drinks are safe to consume but, like all other food and drink, should be consumed in moderation as part of a balanced diet."

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Festival MMR plea as cases reach 942

25 April 2013 Last updated at 10:19 ET

Thousands of adults and children planning to attend the Urdd Eisteddfod next month are being urged to make sure they are vaccinated against measles.

Public Health Wales (PHW) said if people are not immunised before going to the festival in Pembrokeshire the infection could spread throughout Wales.

Another 56 measles cases have been reported to PHW since Tuesday.

The total figure for the epidemic in the Swansea area now stands at 942.

The size of the Urdd festival, and the fact it involves children travelling from across Wales, has led to the immunisation warning.

With around 15,000 competitors and 100,000 visitors expected to converge for the youth event, public health officials fear it could result in the infection being spread to other parts of Wales.

"We know that measles is highly contagious - it spreads from person to person very easily," Dr Rhianwen Stiff, PHW speciality registrar in public health told BBC Radio Cymru.

"What we suggest is that everyone who is going to compete in the Urdd, or will be visiting, has checked with their GP before they go that they have had two MMR jabs," she added.

The 2013 Urdd Eisteddfod will be held in Cilwendeg, just south of Cardigan, from 27 May to 1 June.

Urdd chief executive Efa Gruffudd Jones said organisers were in constant contact with PHW to discuss the best way of advising visitors.

The event's website also has a message from PHW warning people about the outbreak and urging everyone to check they are immunised.

The Urdd Eisteddfod claims to be Europe's largest arts youth festival, with thousands of young people from across Wales visiting the event every year for music, dance, performance, art and poetry competitions in the Welsh language.

Latest figures show the number of measles cases in the Hywel Dda health board area, which includes Pembrokeshire, have passed 100.

However, the bulk of the 942 cases in mid and west Wales are around Swansea.

Dr Marion Lyons, PHW director of health protection, said the increase of cases on Thursday shows the outbreak is not easing up, especially in the 10 to 18 year old age group.

She added: "Young people have important examinations coming up and we need to make sure that those aged between 10 and 18 are vaccinated so their preparation for these examinations are not affected.

"Vaccination sessions are continuing in schools throughout Wales and I urge pupils and their parents to take advantage of these.

"We have seen that measles can be potentially fatal and no one should be complacent about the severity of measles. It can kill but can be prevented by a simple, safe vaccine."

A third week of MMR clinics at schools in Swansea and Neath Port Talbot will begin on Monday and drop-in vaccination sessions will again be held across the outbreak area this Saturday.

Tests are also taking place to establish whether the epidemic has claimed its first victim.

Gareth Colfer-Williams, 25, found dead at his home in Swansea a week ago, had measles but suffered other health problems including asthma.

Health area/board	Cases 1-24 April	Total cases 1 Nov 2012-24 April
Source: Public Health Wales Measles statistics
Bridgend	17	32
Neath and Port Talbot	125	192
Swansea	221	534
Abertawe Bro Morgannwg HB total	363	758
Carmarthenshire	20	48
Ceredigion	3	8
Pembrokeshire	11	50
Hywel Dda HB total	34	106
Powys Teaching HB total	37	78
Mid and west Wales total	434	942
All Wales total	194	1053

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'Cosmetic crisis' waiting to happen

23 April 2013 Last updated at 21:05 ET By James Gallagher Health and science reporter, BBC News

Injections to plump up the skin are a "crisis waiting to happen" and should be available only on prescription, a UK review of cosmetic procedures has said.

It warned that dermal fillers, covered by only the same level of regulation as toothbrushes, could cause lasting harm.

The independent review added cosmetic surgery had been "trivialised". It also attacked "distasteful" companies for putting profit ahead of care.

The review has recommended a series of measures to better protect patients.

It was commissioned by the Department of Health in England, but the findings will be passed to health ministers throughout the UK.

From fillers to breast implants - the cosmetic procedures industry is booming. It was worth £750m in the UK in 2005, £2.3bn in 2010 and is forecast to reach £3.6bn by 2015.

But there is considerable concern that regulations have failed to keep pace - leaving patients vulnerable.

Continue reading the main story

"Start Quote

Anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre"

End Quote Sir Bruce Keogh NHS Medical Director

The biggest growth is in non-surgical procedures such as fillers to tackle wrinkles, Botox and laser hair removal - the area the report describes as "almost entirely unregulated".

The advisory panel said the procedures, which could go horribly wrong, were being treated as casually as having highlights done at a lunchtime hairdresser's appointment and had become commonplace at "beauty parties".

Please turn on JavaScript. Media requires JavaScript to play.

Former beauty clinic manager Sarah Payne recalls how a dermal filler treatment went badly wrong

Sir Bruce Keogh, the NHS medical director for England who led the review, said: "The most striking thing is that anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre."

At a European level, both medical devices such as breast implants and Botox, which is classed as a medicine, are regulated.

Fillers are deemed to have no medical purpose so are regulated in the same way as toothbrushes and ball-point pens. There are 190 different fillers available in Europe compared with just 14 in the US.

Bad practice

Continue reading the main story

Analysis

James Gallagher Health and science reporter, BBC News

---

When you go for cosmetic surgery, you expect the same standard of care as for any other operation. The review makes it clear that this is not the case.

There have been widespread calls for reform since a health scare caused by faulty breast implants, made by the French firm Poly Implant Prothese (PIP).

Data on which women had been given PIP implants, let alone what had happened to them, was not kept. It was described as a "data-free zone".

And the problems are wider. Botox should be available only on prescription, but is far more readily available.

Calf and buttock implants are barely regulated at all. The same goes for dermal fillers.

The European Union is making moves to tighten the rules. However, changes are not expected for five more years.

Sir Bruce Keogh says: "I don't think we can wait, keeping our citizens at risk."

Sir Bruce also said cosmetic surgery deals, such as buy-one-get-one-free offers and handing out free breast surgery as prizes in raffles, were a "particularly distasteful" way of incentivising people to go under the knife.

There were also questions of safety. The review said there were no checks on surgeons' qualifications in some parts of the private sector, an issue made worse by more than half of cosmetic surgery being performed by "fly in, fly out" doctors - surgeons based abroad who fly into the UK to perform operations and then fly back out again.

The review recommends:

• Legislation to classify fillers as prescription only
• Formal qualifications for anyone who injects fillers or Botox
• Register of everyone who performs surgical or non-surgical cosmetic interventions
• Ban on special financial offers for surgery
• Formal certificate of competence for cosmetic surgeons
• A breast implant register to monitor patients
• Patients' procedures must be approved by a surgeon not a salesperson
• Compulsory insurance in case things go wrong
• A pooled fund to help patients when companies go bust - similar to the travel industry

Dan Poulter, Health Minister for England, said he agreed "entirely" with the principles of the recommendations and there would be a full response in the summer.

"There is a significant risk of people falling into the hands of cowboy firms or individuals whose only aim is to make a quick profit. These people simply don't care about the welfare of the people they are taking money from.

"It is clear that it is time for the government to step in to ensure the public are properly protected."

Common sense

The review was started after a global health scare caused by breast implants made by the French firm Poly Implant Prothese (PIP).

The implants were filled with industrial grade silicone and had double the rupture rate of other implants.

Continue reading the main story

"Start Quote

Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong"

End Quote Michael Saul TJL solicitors

Catherine Kydd, 40, from Dartford in Kent, had ruptured PIP breast implants.

She said: "Why is it acceptable that I have to live with industrial silicone in my lymph nodes for the rest of my life due to this industry that is not properly regulated?"

Her story is far from unusual. Michael Saul, from TJL solicitors, represents the victims of botched cosmetic procedures, including one patient who went blind in one eye immediately after being injected with a dermal filler.

"Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong.

"I think it is very difficult for there to be any rational and reasonable opposition to [the recommendations], they're really sensible common sense suggestions."

Sally Taber, director of the Independent Healthcare Advisory Services, which represents the cosmetic surgery industry, praised the review.

"There has been so much bad practice out there, it's very welcome," she said. But she remained "concerned" at a lack of extra protection for people having laser procedures.

Ms Taber added: "Surgeons being on a specialist register will be an issue because we have got a lot of surgeons who fly in, fly out, as such, so that will be an issue that will be controversial."

The British Association of Aesthetic Plastic Surgeons welcomed the report saying it was "thoroughly relieved" with the findings and that there was an "urgent need" for dermal fillers to be classed as prescription medicines.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons said there had been an exponential increase in the number of cosmetic interventions and that it hoped "they achieve parliamentary approval and support quickly".

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Walk-to-burn-calorie menu 'diet aid'

24 April 2013 Last updated at 06:03 ET By Michelle Roberts Health editor, BBC News online

Menus displaying the exercise needed to burn calories in meals can help people consume less, a US study suggests.

Diners given this extra information ordered and ate less calorific food than other customers, a team at Texas Christian University found.

Knowing it takes two hours of brisk walking to burn off a cheeseburger may be more of a warning than being told how many calories it contains, the researchers say.

They now plan larger trials.

Continue reading the main story

"Start Quote

While displaying the amount of exercise needed to burn calories is an interesting idea, there's more to a heart-healthy diet than calorie counting"

End Quote Victoria Taylor British Heart Foundation

Researchers Dr Meena Shah and Ashlei James divided 300 volunteers aged 18 to 30 randomly into three groups.

One received a menu without any calorie information, another menus with the calories displayed, and the third menus that showed both calories and the amount of exercise needed to burn them off.

All of the menus offered the same choice of food and drink, which included burgers, sandwiches, salad, chips, soft drinks and water.

Continue reading the main story

Calories

• Calories (kcal) are a measure of the amount of energy in food
• Exercising burns calories
• An average man needs about 2,500kcal a day
• An average woman needs about 2,000kcal a day
• The values can vary depending on age and levels of physical activity
• The study assumed a brisk walking pace of 3.5mph (5.5km/h)

None of the volunteers was aware of the reason for the study and the researchers took into account hunger levels when interpreting their findings.

The group given the menus with the extra information about how much brisk walking would be needed to burn off the food ordered and ate much less than the group who had menus with no calorie information.

They consumed 100 fewer calories, on average, as a result.

Dr Shah said: "This is the first study to look at the effects of displaying minutes of brisk walking needed to burn food calories on the calories ordered and consumed.

"This study suggests there are benefits."

The researchers say brisk walking is something nearly everyone can relate to.

Calorie counting

"We can't generalise to a population over age 30, so we will further investigate this in an older and more diverse group," Dr Shah added.

They will present their findings at the Experimental Biology 2013 meeting in Boston.

Victoria Taylor, senior dietician at the British Heart Foundation, said clearly signposting healthy options and nutritional content helped people make informed choices when ordering food.

But she added: "While displaying the amount of exercise needed to burn calories is an interesting idea, there's more to a heart-healthy diet than calorie counting.

"Restaurants can also take steps to make meals healthier by serving appropriate portion sizes and reducing the amount of salt, saturated fat and sugar in their dishes.

"Whether eating at home or dining out, a balanced diet with plenty of fruit and veg is the best way to protect your heart."

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Taiwan reports first bird flu case

24 April 2013 Last updated at 08:53 ET

A 53-year-old businessman in Taiwan has the first case of the H7N9 bird flu virus outside mainland China, health officials there have confirmed.

The man is in a serious condition in hospital days after returning from the Chinese city of Suzhou, officials say.

China has confirmed 108 cases of H7N9 since it was initially reported in March, with at least 22 people dead.

The World Health Organization (WHO) says this strain appears to spread more easily from birds to humans.

The man in Taiwan was brought to hospital three days after he arrived from Suzhou via Shanghai, officials say.

He was not in contact with poultry, nor had he eaten undercooked birds while in Suzhou, Taiwanese Health Minister Chiu Wen-ta told local media.

Taiwan's President Ma Ying-jeou has ordered the health department to step up prevention measures, says the country's Central News Agency.

'Unusually dangerous'

Experts are still trying to understand the H7N9 virus, and it has not yet been determined whether it could be transferred between humans.

"This is definitely one of the most lethal influenza viruses we have seen so far," WHO flu expert Dr Keiji Fukuda said at a news conference in Beijing.

"When we look at influenza viruses this is an unusually dangerous virus."

He added that the WHO team was just beginning its investigation. But he said that based on the evidence, "this virus is more easily transmissible from poultry to humans than H5N1", a strain which spread in 2003.

Dr Fukuda led a team from the WHO on a one-week China visit to study H7N9, along with Chinese officials from Beijing and Shanghai.

The WHO believes that poultry is still the likely source of the H7N9 outbreak in China.

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Family seek ban on toxic slimmer aid

23 April 2013 Last updated at 05:40 ET

The family of a medical student who suffered from bulimia and died after taking a pesticide sold as a weight-loss drug want it made illegal.

An inquest heard 23-year-old Leeds University student Sarah Houston died after taking the toxic slimming pill DNP mixed with antidepressants.

Her family say it is "incomprehensible" such a drug can be bought online.

Recording a verdict of misadventure, coroner David Hinchliff said ministers should call for a change in the law.

He said: "That would be the first step on the long road to trying to get substances controlled and I hope it becomes a campaign."

'DNP-related deaths'

Although banned for human consumption, DNP is easily available online - in capsule form - because it is a legitimately-used pesticide.

However, Ms Houston's family said the promotion of it also being a slimming aid is simply about exploiting people for profit.

In a statement after Monday's inquest in Wakefield, Sarah's family said: "To lose someone so young in this way only adds to our devastation.

Continue reading the main story

Michelle Roberts Health editor, BBC News online

---

DNP (2,4-dinitrophenol) is banned from human consumption but is used as a chemical pesticide.

It is sold online as a slimming aid in tablet or powder form, but doctors say the 'fat-burner' is extremely dangerous to human health.

The death of Sarah Houston, a medical student in Leeds, serves as a stark reminder of this.

Anyone who believes they may have taken DNP should seek medical advice immediately.

Signs of acute poisoning include nausea, vomiting, restlessness, flushed skin, sweating, dizziness, headaches, rapid breathing and irregular heart-beat, which can lead to coma and death.

Consuming lower amounts over longer periods can cause cataracts and skin lesions and effects on the heart, blood and nervous system.

"There have been at least 62 further deaths related to DNP.

"We as a family are distraught and are keen to make sure no other family suffer in this way.

"Whilst the FSA has banned it from human consumption, its risks are not widely known and it does not seem to affect the ease at which it can be bought from the internet.

"It seems incomprehensible to us that such a toxic substance can be available in tablet form to be sold in the UK for human consumption across the internet."

Wakefield coroner Mr Hinchliff said: "The only motive for manufacturing a toxic substance as a slimming aid would be to profit from people who have the misfortune of having a condition such as Sarah's.

"Anyone who professionally manufactures capsules to be taken as a drug have the intention of people using it as a drug. Sarah's death is a consequence of that.

"I'm aware it may have reacted with [the antidepressant] Fluoxetine but I lay the blame entirely at the door of DNP.

"I intend to make recommendations to the relevant government departments to call for a change in the law."

'One secret'

Sarah, from Chesham, Buckinghamshire, was the fifth member of her family to become a doctor.

Her father Geoff Houston said: "It's going to be a slow process but hopefully approaching the Home Office to begin with will be the right step and hopefully it will be made illegal.

"For those who are selling it, if you have any ounce of decency you must stop."

He added: "Sarah had made tremendous strides to overcome her condition. She was the best she'd ever been.

"She was very open about her condition but she did keep one secret - that she was acquiring DNP."

Police, who believe the drug was imported from Spain, said it would be difficult to ban outright because of its legitimate use as an effective pesticide.

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NHS bosses consider hospital hotels

23 April 2013 Last updated at 08:11 ET

Plans for hospital hotels to care for patients who no longer need 24-hour medical care are being considered by NHS managers.

Under the proposals, patients such as the elderly waiting to be discharged, new mothers and stroke patients would recover in hotel-style facilities.

The idea is being reviewed by the new commissioning body, NHS England.

Supporters say the scheme, based on a Scandinavian model, would ease demand on hospital beds.

Patient hotels are common in Scandinavia, especially in Sweden and Norway.

They cater for patients who do not need to be on an inpatient ward, such as couples staying overnight after the birth of a baby or recovering stroke patients.

As well as offering more freedom for patients, the buildings are designed to save money, since a hotel room is cheaper than the price of a hospital bed.

The issue has been investigated by Baroness Greengross, a cross-bench peer.

Continue reading the main story

The patient hotel concept offers advantages to some types of patient...But it may not be appropriate for all patients, and it is important to ensure that it is used only where most clinically and cost effective."

End Quote Candace Imison The King's Fund

A Department of Health spokeswoman said: "Proposals for health hotels were submitted to the department by Baroness Greengross. Ministers have forwarded the proposals to NHS England so they can review them."

NHS England is the new body responsible for overseeing the commissioning of services by local doctors.

An estimated 30,000 patients each year are kept in hospital despite being well enough to be discharged.

They include elderly patients waiting for a place in a nursing home or those with dementia.

Some UK hospitals already provide accommodation for patients who need to stay close to hospital premises but do not need constant medical care.

University College London Hospitals (UCLH) provides hotel rooms where patients, such as those needing daily cancer treatment, can stay with relatives near to the hospital.

UCLH says the cost, which is paid for by the NHS, is cheaper than 24-hour hospital care.

According to figures from 2010, the cost of keeping a patient in a hospital bed overnight is more than £300 compared with around half that for a hotel room.

Commenting on the proposals, Candace Imison, The King's Fund's deputy director of policy, said:

"The patient hotel concept offers advantages to some types of patient, such as those who receive cancer treatment a long distance from home.

"But it may not be appropriate for all patients, and it is important to ensure that it is used only where most clinically and cost effective."

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Swansea measles cases rise to 886

23 April 2013 Last updated at 09:18 ET

The number of measles cases in the Swansea epidemic has increased to 886.

Public Health Wales (PHW) said 78 more cases had been reported since last Thursday with 80 hospitalised since the outbreak began last November.

Meanwhile parents have been warned against having single measles jabs at private clinics.

The British Medical Association (BMA) says single jabs are not as effective on people as the measles, mumps and rubella (MMR) vaccine.

Dr Mark Temple, co-chair of the BMA public health medicine committee, told BBC Wales Today that people taking single jabs remained at risk for longer.

He said: "They don't get the protection as quickly and because you have to have six injections with intervals between them, the period to which they're susceptible to one or other of the diseases is elongated.

"They are therefore at risk and, more importantly, others are at risk from them."

Health workers

Hospital staff are the latest group to be targeted for immunisation against measles.

Clinics will be open at all health units to ensure staff are protected and do not pass the disease on.

Continue reading the main story

The hardest-hit age group is those between 10 and 18 so we would remind those young people and their parents that now is the time to be vaccinated"

End Quote Marion Lyons Public Health Wales

As health workers are in the front line of the efforts to control the outbreak, they could be considered at greater risk of meeting people either suffering with the disease or incubating it.

Health chiefs are concerned that if hospital workers fall ill it can have a double impact as they will need care while reducing the number of staff available to deal with measles and all other demands.

Immunisation clinics are being run from 08:00 BST to 20:00 BST to ensure all staff are immunised, particularly those in children's units.

Health officials have thanked parents who have arranged MMR vaccinations for their children but warn there is an urgent need for more children to be vaccinated.

Thousands of non-routine MMR vaccines have been given in the last few weeks, including more than 10,000 across Wales in the last week alone.

But PHW says the outbreak is showing no signs of ending.

"The hardest-hit age group is those between 10 and 18 so we would remind those young people and their parents that now is the time to be vaccinated," said Dr Marion Lyons, director of health protection for PHW.

Of the new total of 886 cases, 712 have been in the Abertawe Bro Morgannwg area - which covers Swansea, Neath Port Talbot and Bridgend; 99 were in the Hywel Dda region - Ceredigion, Carmarthenshire and Pembrokeshire; and 75 in the Powys health board area.

Abertawe Bro Morgannwg University Health Board has announced that 10 schools in Swansea and Neath Port Talbot are to be visited this week with the MMR jab being offered to more than 1,700 pupils.

Measures are also being taken in many other health authority areas around Wales.

Hywel Dda Health Board, which serves mid and west Wales, has announced plans to offer MMR jabs to all children and young people at secondary schools in Carmarthenshire, Ceredigion and Pembrokeshire from next Monday.

School clinics will also be held at all comprehensive schools in Powys, while the Vale of Glamorgan council is asking schools to help the Cardiff and Vale University Health Board organise sessions.

Vaccination drop-in sessions will also be held at the Elizabeth Williams Clinic, Llanelli, on Saturday.

Meanwhile tests are taking place to establish whether a man found dead at his home in Swansea last Thursday died from measles or other causes.

Gareth Colfer-Williams, 25, was known to have other health problems including asthma.

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Green spaces 'boost city wellbeing'

21 April 2013 Last updated at 20:55 ET

Parks, gardens and green space in urban areas can improve the wellbeing and quality of life of people living there, says a University of Exeter study.

Using data from 5,000 UK households over 17 years, researchers found that living in a greener area had a significant positive effect.

The findings could help to inform urban planners and have an impact on society at large, they said.

The study is published in the journal Psychological Science.

The research team examined data from a national survey that followed more than 5,000 UK households and 10,000 adults between 1991 and 2008 as they moved house around the country.

They asked participants to report on their own psychological health during that time to estimate the "green space effect".

Dr Mathew White and colleagues at the European Centre for the Environment and Human Health found that individuals reported less mental distress and higher life satisfaction when they were living in greener areas.

This was true even after the researchers accounted for changes over time in participants' income, employment, marital status, physical health and housing type.

Benefits for society

Dr White compared the scale of the effects of living in a greener area to "big-hitting" life events such as marriage.

"We've found that living in an urban area with relatively high levels of green space can have a significantly positive impact on wellbeing, roughly equal to a third of the impact of being married."

The effect was also found to be equivalent to a tenth of the impact of being employed, as opposed to unemployed.

Even when stacked up against other factors that contribute to life satisfaction, living in a greener area had a significant effect, the study said.

Continue reading the main story

For people living busy lifestyles in densely populated areas, being able to get outdoors and access green space is a great way to escape the stresses of day-to-day life"

End Quote Beth Murphy Mind

"These kinds of comparisons are important for policymakers when trying to decide how to invest scarce public resources, such as for park development or upkeep, and figuring out what bang they'll get for their buck," said Dr White.

While the effect for an individual might be small, he pointed out that the potential positive effects of green space for society at large might be substantial.

"This research could be important for psychologists, public health officials and urban planners who are interested in learning about the effects that urbanisation and city planning can have on population health and wellbeing."

Beth Murphy, information manager at the mental health charity Mind, said: "For people living busy lifestyles in densely populated areas, being able to get outdoors and access green space is a great way to escape the stresses of day-to-day life.

"Our research has shown that 94% of people who took part in outdoors 'green exercise' said it benefited their mental health and can have huge impacts on physical health.

"We believe this is food for thought for any policymaker involved in urban planning, or local authority developing its public health strategy."

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Cameron defends plans for nurses

22 April 2013 Last updated at 07:50 ET By Nick Triggle Health correspondent, BBC News

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RCN general secretary Dr Peter Carter: "The government would be well advised to take this seriously"

Prime Minister David Cameron has defended plans to get trainee nurses to first work as health care assistants to improve patient care.

He acknowledged that the proposals were controversial but said the NHS needed to focus on the level of care it provided.

The Royal College of Nursing called the health care assistant idea "stupid".

Delegates at the RCN's annual conference also heard how nurses were over-stretched by low staffing levels.

Unsafe staffing

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"It is not just about making sure we have the facts and the figures, and the money spent well, it's about the level of care"

A total of 71% of 2,000 senior nurses surveyed said they were not confident that staffing levels were always adequate, with more than a third saying they were unsafe on a weekly basis.

The RCN said the findings illustrated the need for minimum staffing levels to be set - echoing a call made by Unison last week.

The idea of setting minimum staffing quotas was put forward as an option by the Francis inquiry when it published its final report in February into the failings at Stafford Hospital - one of the biggest scandals in the history of the NHS.

Mr Cameron said the NHS had to "do better in the level of care" and that ensuring nursing staff got more training in basic skills was part of this.

He said: "We have said that nurses should spend some time when they are training as healthcare assistants in the hospital, really making sure that they are focused on the caring and the quality, and some of the quite mundane tasks that are absolutely vital to get right in hospital.

"It is going to be controversial, but in the end the sort of health service we want is not just about making sure we have the facts and the figures, and the money spent well, it's about the level of care, so when our elderly relatives go in there, we know they are going to get a really good quality of care."

Patients first

The Francis inquiry highlighted appalling neglect, abuse and incompetence in the four years up to 2009. There were between 400 and 1,200 more deaths at the hospital in that period than would have been expected.

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The report accused the NHS of putting corporate self-interest ahead of patients, concluding the failings went from the top to the bottom of the system, and made 290 recommendations for the future.

But when the government published its response in March there was no commitment to set staffing-to-patient ratios.

RCN general secretary Peter Carter said that along with the refusal to introduce other recommendations, including a registration system for healthcare assistants, it was "very disappointing".

"We know that some of the most important recommendations from the Francis inquiry are being ignored, potentially leaving in place the systemic failures which allowed such a tragedy to happen in the first place."

One proposal is to get nurses to work for 12 months as a healthcare assistant before their training.

It was put forward by ministers despite it not featuring on the list of 290 recommendations made by the inquiry. RCN president Andrea Spyropoulos said she was astounded when she heard it.

She also said it would "waste taxpayers money".

"I don't believe it will happen. I believe it is a really stupid idea that will not benefit patients."

Mr Carter said: "Student nurses in their training spend over 50% of their time in clinical areas.

"There seems to be a view out there that somehow they spend all of their time in universities. That simply isn't the case. "

Referring to concerns raised about staffing levels in the RCN's survey, he said: "They [nursing staff] made it clear that they felt, sometimes on a daily basis, sometimes on a weekly basis, the number of staff that were available on wards and other departments were simply inadequate in order to provide the safe and satisfactory level of care patients need.

"And it's a really worrying return and we think the government would be well advised to take this seriously."

He said reports of unsatisfactory care tended to be predominantly "but not exclusively" in relation to elderly care.

"And you will find that often there is one nurse or one healthcare assistant to maybe nine or 10 older people, often requiring full nursing care."

He called for legislation to ensure minimum staffing levels.

Trust responses

Meanwhile, a survey by The Daily Telegraph reveals a rise in hospital managers and consultants paid six-figure sums. Over 7,800 NHS staff were paid more than £100,000 last year. The highest paid executive earned £340,000 - almost 16 times the pay of ward nurses.

Shadow health minister Jamie Reed accused the government of betraying the NHS.

"Hospitals are struggling to cope and patients are paying the price," he added.

A Department of Health spokeswoman said: "As individual trusts respond to the Francis inquiry we expect them to look at the issue of nursing numbers in their hospitals.

"However, if the RCN wants to have credibility in this debate then they must first set out how they are going to respond to the criticism levelled at them in the Francis report."

The RCN was criticised for not doing enough locally to support staff while its dual role of union and professional body was also questioned.

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Labour launches care commission

22 April 2013 Last updated at 08:13 ET

Labour is to set up an independent commission to investigate how best to integrate health and social care.

It says without such co-ordination there will be a £29bn gap in the health budget by 2020 because of "a rising need for care as society gets older".

Ed Miliband said a Labour government would have to make money spent on the NHS go further.

It follows former leader Tony Blair's warning to avoid promising ever more public spending.

Earlier this month, Mr Blair urged Mr Miliband against "tacking left on tax and spending" amid a debate on Labour plans before the next election.

The independent commission will be led by former Department of Health specialist Sir John Oldham.

Launching it in Lancashire, Mr Miliband said NHS faced "the biggest challenge in its history". He cited figures from the Nuffield Trust, which suggest growing care needs will leave a shortfall of up to £29bn a year unless services can be delivered more efficiently.

"The toughest financial pressures for 50 years are colliding with our rising need for care as society gets older and we see more people with chronic illnesses like cancer, diabetes and dementia," Mr Miliband said.

"The NHS will always be a priority for expenditure under a Labour government, but we must make every pound we spend go further at a time when our NHS faces the risk of being overwhelmed by a crisis in funding because of care needs by the end of this decade."

Labour has said it will seek to "protect" NHS funding if re-elected while acknowledging that increasing budgets is unlikely in the current economic climate.

The coalition government has ring-fenced the NHS from spending cuts elsewhere and criticised Labour for not being prepared to match its commitment to a real-terms increase in funding every year.

However, the NHS is also having to find £20bn in efficiency savings between 2011 and 2015.

'Working together'

BBC political correspondent Gary O'Donoghue said Mr Milband wanted to contrast the approach of the Blair government - which was able to put large amounts of money into the NHS - with the reality that there will not be anything like the resources for a future Labour administration to do the same.

Continue reading the main story

It means a greater focus on preventing people getting ill and more care being provided directly in people's homes so they avoid unnecessary hospital visits"

End Quote Ed Miliband on Labour plans

Mr Miliband said services should be organised "around the needs of patients, rather than patients around the needs of services.

"That means teams of doctors, nurses, social workers and therapists all working together."

Care should be arranged by one person, which would end "the frustration of families being passed around between different organisations and having to repeat the same information over and over again", he said.

He added: "It means a greater focus on preventing people getting ill and more care being provided directly in people's homes so they avoid unnecessary hospital visits."

Mr Miliband attacked coalition health reforms, saying that "attempts to integrate care are being harmed by David Cameron's push to turn the NHS into a full-blown market".

'No privatisation'

The government's NHS shake-up in England came into force on 1 April with GP-led groups put in charge of a large chunk of the care budget.

The changes were partly designed to encourage greater involvement from the private sector, which has opened up the government to claims it is going to privatise the health service.

Ministers have responded by saying the changes will introduce competition in a managed and balanced way.

On Monday, health minister Dan Poulter said: "The government is putting doctors and nurses at the forefront of delivering more integrated and community-based care, and thousands of patients across the country, particularly the frail elderly, are already benefiting from these changes, and will continue to do so.

"There is absolutely no government policy to privatise NHS services. Our NHS will stay free for everyone, and it's right that patients should get the best care available, regardless of who provides it, giving patients more choice of where and how they are treated."

The government has also called for closer working between the NHS and the social care sector as part of its health service reforms and changes to care for the elderly, which will bring a £75,000 cap on lifetime care costs being introduced after 2017.

At present, up to 40,000 people every year are forced into selling their homes because they face unlimited care bills.

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Warning over private ambulances

21 April 2013 Last updated at 05:58 ET

An apparent increase in the use of private ambulances in the NHS is a risk to patient safety, Labour has warned.

It says freedom of information requests show spending on private vehicles by three English ambulance services rose by millions over two years.

Shadow health secretary Andy Burnham said the services were "being privatised without proper debate".

The government accused Labour of "rank hypocrisy", saying private ambulances were introduced by the last government.

The figures showed an increase in spending of £5.4m on private contractors by the South East Coast Ambulance Service, from £1.9m, in 2010/2011, to £7.3m, in 2012/2013.

In London, that figure rose by more then £3.8m, from less than £400,000, in 2010/2011, to £4.2m, in 2012/2013.

In Yorkshire the figure rose £1.3m, from £500,000 to £1.8m.

'Crude privatisation'

Mr Burnham is asking Health Secretary Jeremy Hunt for "urgent assurances about the safety and quality" of private ambulances.

He said people would be "stunned to learn that even blue-light 999 services are being privatised".

"It is proof that the coalition sees no limits on privatisation in the NHS," he added.

"They are driving the private sector into the public core of the NHS, offering up essential emergency provision to the lowest bidder."

Continue reading the main story

Using a variety of healthcare providers to deliver patient transport services is a system which was started under the last Labour government but is an approach they now criticise"

End Quote Spokesman for Jeremy Hunt

He said Labour had evidence from whistleblowers that "even the most serious 999 calls are being handled by private ambulances without properly-trained staff and equipment.

"This is cost-cutting privatisation at its crudest, with a real risk that patient safety will be compromised."

Referring to a House of Lords debate taking place on Wednesday over controversial rules which could open the NHS up to more competition, Mr Burnham said peers were being asked "to call a halt to David Cameron's mad dash to privatise the NHS".

"The prime minister needs to be reminded that the British people have never given him permission to put their NHS up for sale," he said.

A spokesman for Mr Hunt said contracts to deliver patient transport were decided locally "and should be based on what is required to meet patient demand".

"As we know the NHS is seeing an extra one million more patients in A&E compared to two years ago and, despite the additional workload, it is coping well.

"Using a variety of healthcare providers to deliver patient transport services is a system which was started under the last Labour government but is an approach they now criticise."

He said "this rank hypocrisy" showed that "the Labour Party is more concerned with playing party politics than meeting the needs of patients."

The trade body which represents private ambulance services, the Independent Ambulance Association, said patients are well served by both the public and private sector.

"It is disappointing that politicians appear not to know that since April 2011 independent ambulance services have been regulated by the government's Care Quality Commission and are legally required to comply with exactly the same rules as all NHS ambulance trusts in respect to the care, well-being and safety of patients," it said.

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NHS car parking savings 'pass £13m'

21 April 2013 Last updated at 04:34 ET

Patients and NHS staff have saved some £13m since hospital car parking charges were abolished more than four years ago, the Scottish Government says.

Parking has been free for patients, visitors and staff at most Scottish hospitals since 31 December 2008.

But charges remain at car parks built under the private finance initiative (PFI) at three hospitals in Edinburgh, Glasgow and Dundee.

Ministers said families had been put under an "unneeded financial burden".

The savings figure was based on the amount of cash collected in the 12 months before fees were abolished, when they were capped at £3 a day.

Health Secretary Alex Neil said: "In Scotland, we are sticking by the founding principles of the NHS - we want services that are free for everyone, not out to make profits.

"That's why I am glad to see that getting rid of hospital car parking charges has saved patients and staff so much money over the last four years.

"Charging to park at hospital was an unneeded financial burden on families and those needing treatment at a difficult time."

Mr Neil added: "I would like to be able to abolish charging at the three PFI car parks too but, unfortunately, these boards are locked into long-term contracts with operators.

"That is why this government is committed to new models of funding which mean that the private sector can't make excessive profits at the taxpayers' expense."

The three car parks which still have charges are based at Ninewells in Dundee, Glasgow Royal Infirmary and the Royal Infirmary of Edinburgh.

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Nurses 'drowning in paperwork'

21 April 2013 Last updated at 06:50 ET

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Janet Davies from the RCN said administrative work "takes time away from the patients"

Nurses are "drowning in a sea of paperwork" with more than one-sixth of the working week taken up doing non-essential paperwork, a survey suggests.

The Royal College of Nursing poll of 6,000 nurses found 17.3% of their hours were spent on tasks such as filing, photocopying and ordering supplies.

Most reported the amount of paperwork was getting worse and was now stopping them providing direct patient care.

The government has said it wants to reduce bureaucracy by a third.

Health Secretary Jeremy Hunt has already announced a review of bureaucracy, which is being carried out by the NHS Confederation and is due to report back in the coming months.

'Too much duplication'

NHS Confederation chief executive Mike Farrar said: "We recognise very much the survey and we are concerned about it. I think it's critical that we make sure our staff have got the maximum amount of time to be with our patients.

"We're still doing far too much on paper, far too much duplication and it really is taking away the time nurses could have with patients."

The union said its survey showed a culture of "ticking boxes" had developed.

The survey, which is being released on the eve of the start of the RCN's annual conference on Monday, also found more than a quarter of nurses said their workplace did not have a ward clerk or administrative assistant to help with clerical duties.

RCN general secretary Peter Carter said: "These figures prove what a shocking amount of a nurse's time is being wasted on unnecessary paperwork and bureaucracy.

"Yes, some paperwork is essential and nurses will continue to do this, but patients want their nurses by their bedside, not ticking boxes."

The union's Janet Davies said: "Ordering supplies and ordering food is a terrible waste of a nurse's salary and nursing skills when actually you could have an admin assistant doing that routine work."

District nurse Irene Macpherson, from Inverkip, Renfrewshire, said: "I am sick to the back teeth of demands on my time, and that of my staff, which mean that other staff in the organisation can tick a box to say they are doing their jobs.

"We now have to fill out an assessment page which doesn't reflect the work that the nurses do. For example, we have to draw maps of the number of steps or actions we take to find a piece of equipment and then work out a quicker way of doing it, by better organising our work area."

Labour says the current government should take the blame for the nurses' increased workload.

Shadow health minister Andrew Gwynne said: "David Cameron is cutting the NHS front line and wasting billions on a chaotic re-organisation, leaving hospitals to operate without enough staff.

"Now form-filling is taking nurses away from their patients for longer and longer."

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Glaxo accused of market 'abuse'

19 April 2013 Last updated at 03:54 ET

GlaxoSmithKline (GSK) has been accused of market "abuse" by the consumer watchdog, the Office of Fair Trading (OFT).

The OFT alleges that the pharmaceutical giant paid rivals to delay the release their own versions of GSK's Seroxat treatment.

Alpharma, Generics UK and Norton Healthcare all received money not to enter the market with their copies of Seroxat, it said.

GSK said it "acted within the law".

"GSK supports fair competition," it said.

"In fact, these arrangements actually resulted in generic versions of paroxetine entering the market before GSK's patents had expired," the company said in a statement.

Moreover, it added that "the OFT investigation covers matters that have already been investigated by the European Commission in 2005-2006".

"In March 2012 the Commission announced that it had formally concluded its enquiry with no further action," it said.

"The issues were also reviewed in the European Commission's 2008-2009 Sector Inquiry. Neither investigation resulted in any sanctions against the company."

Dominant player

The generic drug makers were attempting to supply the UK market with their versions of paroxetine, which GlaxoSmithKline brands as Seroxat, the OFT said. Seroxat is used to treat depression.

GSK accused them of infringing its patent, so to resolve this dispute Glaxo effectively paid the three companies off, according to the OFT.

"The paroxetine supply agreements under investigation were terminated in 2004," GSK said.

If proven, the allegations would be an infringement on the part of all the parties of competition law and on the part of GlaxoSmithKline an abuse of its dominant place in the market.

"The introduction of generic medicines can lead to strong competition on price, which can drive savings for the NHS, to the benefit of patients and, ultimately, taxpayers," said Ann Pope, senior director of services, infrastructure and public markets at the OFT.

"It is therefore particularly important that the OFT fully investigates concerns that independent generic entry may have been delayed in this case."

The firms will now be asked to respond to its allegations, before the OFT makes a decision on whether or not competition law has been infringed.

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