Divorcees 'have more heart attacks'

Divorcees are more likely to have a heart attack than their peers who stay married, US research suggests.

An analysis of 15,827 people showed women were worst affected, and barely reduced the risk if they remarried.

The study, published in the journal Circulation, argued that chronic stress, linked to divorce, had a long-term impact on the body.

The British Heart Foundation called for more research before divorce is classed as a major heart risk.

We already know that the death of a close loved one can greatly increase the risk of a heart attack.

Now a team at Duke University has shown a similar effect after divorce.

During the course of the study, between 1992 and 2010, roughly one in three people divorced at least once.

Women who divorced once were 24% more likely to have had a heart attack in the study than women who were continuously married. The figure was 77% for those having multiple divorces.

In men, there was a modest 10% extra risk for one divorce and 30% increase after multiple divorces.

One of the researchers Prof Linda George said: "This risk is comparable to that of high blood pressure or if you have diabetes, so it's right up there, it is pretty big."

When it came to remarriage, the risk was only marginally reduced for women while men bounced back.

"I think this is the most interesting bit in the paper," Prof George added.

She told the BBC News website: "We joke around here and call it the 'any-women-will-do orientation' for men.

"They're more comfortable being married than not married and cope with different women being their spouses.

"First marriages are protective for women and it's a little dicey after that."

The researchers found that changes in lifestyle, such as loss of income, could not explain the heightened risk.

Prof George told the BBC News website: "My educated speculation is that we know that psychological distress is a constant stress on the immune system, higher levels of inflammation and stress hormones increase.

"Immune function is altered for the worse and if that continues for many years it does take a physiological toll."

She argues the sex-difference is also found in depression and that divorce is a greater "psychological burden" for women although "we don't know exactly what's going on".

While tablets can reduce the risks caused by high blood pressure, there is no easy solution for the pain of divorce.

The researchers recommend close, supportive friends.

Prof Jeremy Pearson, from the British Heart Foundation, commented: "We have known for some time that our mental health can affect our heart health.

"This study suggests that divorce might increase a person's risk of a heart attack.

"But the results are not definitive so further evidence would be needed before divorce could be considered a significant risk factor for causing a heart attack."

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Ebola survivors 'safe sex warning'

The WHO has urged Ebola survivors to be even more cautious during sexual contact to ensure the virus is not passed on to their partners.

The warning comes after a survivor was found to have traces of Ebola in his semen almost six months after recovery.

This is some 90 days later than previously documented.

It is unclear whether Ebola can still be spread at this point. But officials have launched further investigations to evaluate the risks.

There have been no proven cases of Ebola being transmitted through sexual contact with survivors during this or previous outbreaks.

But according to Dr Nathalie Broutet, a medical officer at the World Health Organization, the recent case prompted experts to strengthen their advice.

Dr Broutet told the BBC: "The patient is the first we have seen where there is a trace of virus present in semen beyond three months.

"This made us change our recommendations to go beyond three months."

The new advice says: "For greater security and prevention of other sexually transmitted infections, Ebola survivors should consider correct and consistent use of condoms for all sexual acts beyond three months until more information is available."

It builds on previous guidance suggesting abstinence or safe sex up to 90 days after symptoms first develop.

But Dr Broutet cautioned further analysis must be done.

"Even though the sample was positive for fragments of the virus this does not prove it was passed on sexually.

"We need to be very careful and need more clarity about this," she said.

Scientists are planning to send the sample to the Centres for Disease Control in the United States to see if the traces of Ebola they found are active and capable of being spread.

And Dr Broutet is helping to set up studies in Sierra Leone and Guinea to offer male survivors further checks.

According to the WHO, there is no current evidence to suggest that active Ebola virus is present in vaginal fluids once someone has recovered.

Ebola is known to spread through close contact with the bodily fluids of a person who has the active virus and shows symptoms of the disease - such as a high fever.

Experts emphasise that people who have recovered from Ebola do not pose any risks to the general public and should not be isolated.

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Dementia 'halted in mice brains'

Tweaking the brain's immune system with a drug has prevented mice developing dementia, a study shows.

The team at Duke University, in the US, showed immune cells which start attacking nutrients in the brain may be a trigger for the disease.

They say their findings could open up new avenues of research for a field that has not developed a single drug to slow the progression of the disease.

Experts said the findings offered new hope of a treatment.

The researchers indentified microglia - normally the first line of defence against infection in the brain - as major players in the development of dementia.

They found some microglia changed to become exceptionally adept at breaking down a component of protein, an amino acid called arginine, in the early stages of the disease.

As arginine levels plummeted, the immune cells appeared to dampened the immune system in the brain.

Stopping dementia

In mouse experiments, a chemical was used to block the enzymes that break down arginine.

They showed fewer of the characteristics of dementia such as damaged proteins collecting in the brain and the animals performed better in memory tests.

Microglia, in black, start consuming arginine

One of the researchers, Dr Matthew Kan, said: "All of this suggests to us that if you can block this local process of amino acid deprivation, then you can protect the mouse, at least from Alzheimer's disease.

"We see this study opening the doors to thinking about Alzheimer's in a completely different way, to break the stalemate of ideas in Alzheimer's disease."

However, the findings do not suggest that arginine supplements could combat dementia as the boosted levels would still be broken down.

'Hope'

Dr James Pickett, from the Alzheimer's Society said the study was "offering hope that these findings could lead to new treatments for dementia".

He added: "This study in animals joins some of the dots in our incomplete understanding of the processes that cause Alzheimer's disease, in particular around the role played by the immune system."

Dr Laura Phipps, from Alzheimer's Research UK, said the study was "interesting" and shed "more light on the mechanisms of immune system involvement in Alzheimer's".

But she cautioned clinical trials in people were still needed and that "the findings do not suggest that supplementation of the amino acid could mirror the benefits seen in these mice".

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Greens urge: 'Join our revolution'

The Green Party launched its General Election manifesto with a call for a "peaceful political revolution" to end austerity and tackle climate change.

It pledged to stop the "creeping privatisation of the NHS" and increase the minimum wage to £10 an hour.

Leader Natalie Bennett and Caroline Lucas, the party's only ever MP, unveiled a plan to help the two million children growing up in cold homes.

They want an insulation programme for the worst-affected nine million homes.

Introducing the manifesto at the Arcola Theatre in Dalston, east London, Ms Bennett said it represented a "genuine alternative" to "business as usual politics".

She said she wanted to "take back" the NHS and the railways from the private sector.

The 84-page manifesto, entitled "For the common good" sets out the Greens' main policy pledges, including:

• Creating one million jobs that pay at least a living wage
• 60% rate of income tax
• A new wealth tax on the top 1%; a "Robin Hood tax" on the banks
• Banning fracking; investment in renewable energy
• Scrapping university tuition fees
• Cutting rail fares by 10%
• Abolishing the bedroom tax

The Greens are fielding a record number of candidates - 571 - on 7 May and claim a surge in membership numbers to 59,000 - more than UKIP and the Lib Dems.

Ms Lucas said a free nationwide insulation programme to tackle cold homes, specifically in areas blighted by fuel poverty, would help two million children.

She also called for extra £1.3bn on the NHS budget to deal with the associated costs of cold homes.

Key priorities

Green

Main pledges

• End austerity and restore the public sector, creating jobs that pay at least a living wage
• End privatisation of the National Health Service
• Work with other countries to ensure global temperatures do not rise by more than 2C
• £85bn programme of home insulation, renewable electricity generation & flood defences
• Provide 500,000 social homes for rent by 2020 and control rent levels
• Return the railways to public hands

"We believe if we invest in insulating people's homes, we can get their fuel bills down on a permanent basis," Ms Lucas told BBC Radio 4's Today programme

"It would also get our climate-change emissions down and could create hundreds of thousands of jobs.

"And crucially, for every £1 invested in this programme, it's estimated that £1.27 comes back to the economy in terms of the benefit in jobs and reduction on the NHS bill."

Ms Lucas said the government had "a woeful record on energy insulation", with the installation of energy-efficient measures in UK homes falling by 80% over the last two years.

The Green Party has called for a "progressive alliance" with the SNP, if it has MPs at Westminster in the next Parliament.

Ms Lucas ruled out backing a Conservative government, but said Green MPs could support a minority Labour administration on "a case-by-case basis".

The Green Party's manifesto is full of big promises: a pension of more than £300 a week for a couple, renewable energy taking over from fossil fuels, a million new public sector jobs.

But they are having difficulty defending their numbers robustly. They claim they'll raise a massive £30bn extra from clampdowns on tax avoidance; very, very optimistic. And the man behind the manifesto's numbers, Brian Heatley, told me they couldn't really be sure how much their new wealth tax would raise because it hasn't been tried before.

They say they could make up any shortfall by reducing their planned cut to employers' national insurance contributions.

In one sense, refreshingly candid. In another way, extremely problematic for a party that wants to be taken seriously on a tax that they need to raise £20bn.

The Greens also say they would carry on spending more each year than the government gets from revenue. Does that mean deficits for ever? The party won't say.

In other news, Natalie Bennett has told Newsnight they don't want to ban the Grand National after all - more straightforward than working out government spending.

"That would give us a real opportunity to push Labour on the policies we know the public wants and which are at the heart of our manifesto," she said.

"Whether that's scrapping nuclear weapons or reversing the privatisation in our NHS, whether that's returning local schools to local control or bringing rail back into public ownership."

'Scrap road building'

Recently, Ms Bennett said the party's policy of a Citizens' Income of £72 a week for every adult in Britain would feature in the manifesto, but that it would take longer than one parliament for it to be implemented.

The cut in public transport fares would be paid for by scrapping new road-building programmes, while the party is also expected to pledge free social care for the elderly.

At the weekend, Ms Bennett said the 60% top rate of tax would apply to people earning over £150,000 and that it would raise £2bn a year.

Subscribe to the BBC Election 2015 newsletter to get a round-up of the day's campaign news sent to your inbox every weekday afternoon.

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Breath test for stomach cancer risk

A simple breath test could help predict whether people with gut problems are at high risk of developing stomach cancer, an early study shows.

It detects chemical compounds in people's breath, in an attempt to distinguish unique "breath prints" in those with risky pre-cancerous changes.

Experts say if proven in large trials, it could spot patients on the brink of cancer so they can be treated earlier.

But more work is needed to validate the test, which appears in the journal Gut.

Stomach cancers affect about 7,300 people each year in the UK.

But in most Western countries it is diagnosed late when the chance of survival is poor. This is partly because symptoms - such as indigestion and pain - can be mistaken for other diseases.

Scientists believe earlier detection may help improve the prognosis.

The new "nanoarray" breath test builds on earlier work from researchers in Israel, Latvia and China.

It relies on the idea that people with cancer may have unique breath signatures - containing minute chemical compounds that are not found in the breath of people free from the illness.

Researchers studied breath samples from 145 patients. Around 30 of these were already known to have stomach cancer.

The rest had been referred for investigations because of concerning symptoms. They did not have full-blown cancer - but some had worrying changes that doctors call "pre-cancerous" that could develop into malignancies.

Scientists tried out the test on a number of different scenarios.

It was fairly good at spotting cancerous samples from non-cancerous ones.

And it showed some promise at identifying worrying pre-cancerous changes that were at high risk of developing into the disease.

But it was not accurate in every case - some patients were misdiagnosed as being at high risk.

Scientists say more work is needed before it is ready to use in clinics.

Dr Emma Smith of Cancer Research UK, said: "Diagnosing cancer in its early stages offers patients the best chance of successful treatment, so research like this has potential to help save lives.

"But we would need to be sure the test is sensitive and accurate enough to be used more widely."

Research involving thousands of European patients is now under way.

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Scots man tests 'negative' for Ebola

A Scottish man who had recently returned from west Africa has tested negative for the Ebola virus.

The man was admitted to a hospital in Glasgow in the early hours after showing possible symptoms of the virus.

He was taken to the Brownlee Centre for infectious diseases at Gartnavel Hospital at about 02:20, after being transferred from Ayrshire.

Health officials had previously said they thought it was "very unlikely" that he would have the virus.

An NHS Greater Glasgow and Clyde spokesman earlier said: "A man has been admitted to hospital this morning and is being tested for Ebola. He had come from Liberia."

An update issued later stated: "A test for Ebola has come back negative."

A year after the outbreak in West Africa was officially declared, the virus has killed more than 10,000 people.

Most deaths occurred in the worst-affected countries of Guinea, Liberia and Sierra Leone.

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'Action needed' to boost nurse numbers

The report said there was a lack of political will to train nurses

Immediate action must be taken by the next government to increase the number of NHS nurses, a report has warned.

The Royal College of Nursing (RCN) said there were fewer nurses now than in 2010 if midwives, health visitors and school nurses were not included.

It said government cuts to nurse training places in 2010 were a significant factor in the shortage.

The Conservatives and Liberal Democrats said they were committed to investing £8bn each year in the NHS.

'Wrong course'

The RCN said that while the government claimed the number of nursing posts has increased, the headcount figure for nurses fell from 317,370 in May 2010 to 315,525 in December 2014.

It described this as "remarkable" given the continued increase in demand for the NHS.

While 50,000 people applied to become nurses last year, there were only 21,000 places - meaning there is no shortage of people wanting to do the job, the RCN said in its report.

It said cuts the coalition government made to student nursing commissions in 2010 led to a reduction of 3,375 places.

The report said that as it takes three years for student nurses to qualify, these cuts are impacting on the supply of nurses right now.

Dr Peter Carter, chief executive and general secretary of the RCN, said: "We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

"The cuts were so severe that we are only just catching up with where we were five years ago.

"Many areas, like district nursing and mental health, are even worse off.

"While the health service has spent the last five years running on the spot, demand has continued to increase.

"Whoever forms the next government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long-term plan."

Ageing workforce

The report also said the community nursing workforce had been cut by more than 3,300, despite NHS plans to move care from hospitals to the community.

From May 2010 to December 2014 there has been a 28% reduction in the number of specialist district nurses, a loss of 2,168 posts across England.

A reliance on using agency nurses means that the NHS would have spent an estimated £980m on them by the end of the 2014/15 financial year, the RCN said.

As with GPs, the nursing workforce is ageing, with around 45% being over 45, the RCN added.

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Natural childbirth expert dies

Sheila Kitzinger was an advocate of home birth and had her own five children at home

Prolific author and anthropologist Sheila Kitzinger - who wrote more than 25 books on childbirth - has died at her Oxfordshire home at the age of 86.

In the 1960s and 70s she developed the concept of a "birth plan", which aimed to give more choice to pregnant women.

She believed mothers, not clinicians, should be the focus during childbirth.

She came to be seen as a pioneer in her field and received an MBE for her work. Her publisher Pinter & Martin said she died on Saturday after a short illness.

'Freedom and choice'

Born in a thatched cottage in Taunton, Somerset, in 1929, Ms Kitzinger studied social anthropology at the University of Oxford, then taught and carried out research at the University of Edinburgh.

A strong advocate of home birth and natural birth, Ms Kitzinger had her own five children at home and believed midwives played a crucial role.

In her 1962 book The Experience of Childbirth she also argued that birth had the potential to be a "psychosexual experience".

Among her other books were The Complete Book of Pregnancy and Ourselves as Mothers. Her autobiography is due to be published next month.

Her husband Uwe Kitzinger, who she met while studying at Oxford and married in 1952, said she was "a woman of great spunk".

"She was an icon of home birth who decided to have a home death," he said.

Sheila Kitzinger in 1958 with two of her five children, twins Nell and Tess

"She took to her bed three months ago, but she was drinking Kir Royale and champagne and eating chocolates three days ago, knowing she didn't have long.

"She was great to be married to, and she was a wonderful mother. She and I were married for 63 years. We said goodbye with a prayer."

Her eldest daughter, Celia Kitzinger, said her mother taught her from an early age that "the personal was political".

She said: "As I was growing up I learnt from her campaigns for freedom and choice in childbirth that passionate and committed individuals can create social change.

"She never hesitated to speak truth to power."

'Natural birth guru'

Prof Kitzinger said her mother had campaigned on a wide range of issues including female genital mutilation, prisoners giving birth in handcuffs and human rights in midwifery in Eastern Europe.

She added: "She is so much more than a 'natural birth guru'."

Her publisher Pinter & Martin said her work had had enormous impact on millions of women around the world.

An active writer and campaigner into her eighties, Ms Kitzinger set up the Birth Crisis Network, a helpline for mothers who had experienced a traumatic birth.

Writing on her website, she said: "The romantic image of a radiant mother, a beautiful baby in her arms, her golden hair lit by the sun's rays, displayed on the jackets of many birth books is far removed from reality.

"New mothers are often unhappy. This major life transition is made incredibly difficult by poverty, poor housing, overcrowding, and social isolation.

"But one reason why many women have low self-esteem and cannot enjoy their babies is that care in childbirth often denies them honest information, the possibility of choice, and simple human respect."

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Non-EU patients face NHS charges rise

Visitors from outside the EU who receive treatment in NHS hospitals in England are now being charged 150% of the cost under changes brought in to discourage "health tourism".

Non-EU citizens settling in the UK for longer than six months are also being required to pay a "health surcharge" as part of their visa applications.

The new rules from the Department of Health came into force on 6 April.

Primary care and A&E care continues to remain free.

Permanent residents of 32 European countries qualify for NHS treatment, which is then billed to their country of residence, but this new ruling applies to foreign migrants or visitors based in other countries, mainly those outside the EU.

These patients can be treated in an NHS hospital but are expected to repay the cost of most procedures afterwards.

But up to now, the DoH has only sought to reclaim the actual costs, without adding any extra charges.

The DoH hopes the changes will help it recoup up to £500m a year by 2017-18.

Analysis

Hugh Pym, health editor, BBC News

The new guidelines do not require patients on trolleys in hospitals to produce passports before getting access to urgent care. Nor do they apply to accident and emergency or a visit to a GP.

What is covered is ongoing treatment on the NHS after an initial diagnosis or referral - for example an outpatient appointment.

The Department of Health is incentivising hospitals to be more vigilant in checking patient credentials by allowing them to charge more for treatment of people "not ordinarily resident" in the UK.

The department can recoup those costs from the patient's member state if they are from the European Economic Area.

In the paperwork filled in by the patient before the appointment they will be asked for proof they are "ordinarily resident".

This could be a utility bill, national insurance number or passport details. Some hospitals were doing this already but many were not.

The guidelines are designed to increase the chances that the treatment costs for a non-UK resident can be recovered. Critics may ask why it has taken so long for the initiative to be launched.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.

Similar charges can be imposed by the NHS in Northern Ireland, Scotland and Wales for hospital care received by non-EU residents.

Exemptions

Patients using hospital services have been required to show their passports and other immigration documents if their UK residence status was in doubt.

The "health surcharge" on visa applications for non-EU citizens comprises an annual fee of £200-a-year, which is reduced to £150 for students.

Certain individuals, such as Australian and New Zealand nationals, are exempt from the surcharge.

And non-EU citizens who are lawfully entitled to reside in the UK and usually live in the country will be entitled to free NHS care as they are now.

Andrew Bridgen, the Tory MP for North West Leicestershire in the last Parliament, told the Daily Mail: "This is not the International Health Service, it's the National Health Service.

"Non-UK nationals seeking medical attention should pay for their treatment.

"The NHS is funded by UK taxpayers for UK citizens and if any of us went to any of these countries we'd certainly be paying if we needed to be treated."

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'Action needed' to boost nurse numbers

The report said there was a lack of political will to train nurses

Immediate action must be taken by the next government to increase the number of NHS nurses, a report has warned.

The Royal College of Nursing (RCN) said there were fewer nurses now than in 2010 if midwives, health visitors and school nurses were not included.

It said government cuts to nurse training places in 2010 were a significant factor in the shortage.

The Conservatives and Liberal Democrats said they were committed to investing £8bn each year in the NHS.

'Wrong course'

The RCN said that while the government claimed the number of nursing posts has increased, the headcount figure for nurses fell from 317,370 in May 2010 to 315,525 in December 2014.

It described this as "remarkable" given the continued increase in demand for the NHS.

While 50,000 people applied to become nurses last year, there were only 21,000 places - meaning there is no shortage of people wanting to do the job, the RCN said in its report.

It said cuts the coalition government made to student nursing commissions in 2010 led to a reduction of 3,375 places.

The report said that as it takes three years for student nurses to qualify, these cuts are impacting on the supply of nurses right now.

Dr Peter Carter, chief executive and general secretary of the RCN, said: "We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

"The cuts were so severe that we are only just catching up with where we were five years ago.

"Many areas, like district nursing and mental health, are even worse off.

"While the health service has spent the last five years running on the spot, demand has continued to increase.

"Whoever forms the next government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long-term plan."

Ageing workforce

The report also said the community nursing workforce had been cut by more than 3,300, despite NHS plans to move care from hospitals to the community.

From May 2010 to December 2014 there has been a 28% reduction in the number of specialist district nurses, a loss of 2,168 posts across England.

A reliance on using agency nurses means that the NHS would have spent an estimated £980m on them by the end of the 2014/15 financial year, the RCN said.

As with GPs, the nursing workforce is ageing, with around 45% being over 45, the RCN added.

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Being overweight 'cuts dementia risk'

Those who were overweight had an 18% reduction in dementia, researchers found

Being overweight cuts the risk of dementia, according to the largest and most precise investigation into the relationship.

The researchers admit they were surprised by the findings, which run contrary to current health advice.

The analysis of nearly two million British people, in the Lancet Diabetes & Endocrinology, showed underweight people had the highest risk.

Dementia charities still advised not smoking, exercise and a balanced diet.

Dementia is one of the most pressing modern health issues. The number of patients globally is expected to treble to 135 million by 2050.

There is no cure or treatment, and the mainstay of advice has been to reduce risk by maintaining a healthy lifestyle. Yet it might be misguided.

'Surprise'

The team at Oxon Epidemiology and the London School of Hygiene and Tropical Medicine analysed medical records from 1,958,191 people aged 55, on average, for up to two decades.

Their most conservative analysis showed underweight people had a 39% greater risk of dementia compared with being a healthy weight.

But those who were overweight had an 18% reduction in dementia - and the figure was 24% for the obese.

"Yes, it is a surprise," said lead researcher Dr Nawab Qizilbash.

He told the BBC News website: "The controversial side is the observation that overweight and obese people have a lower risk of dementia than people with a normal, healthy body mass index.

"That's contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision."

Loss of tissue in a demented brain compared with a healthy one

Any explanation for the protective effect is distinctly lacking. There are some ideas that vitamin D and E deficiencies contribute to dementia and they may be less common in those eating more.

But Dr Qizilbash said the findings were not an excuse to pile on the pounds or binge on Easter eggs.

"You can't walk away and think it's OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits," he added.

Heart disease, stroke, diabetes, some cancers and other diseases are all linked to a bigger waistline.

Analysis

By James Gallagher, Health editor, BBC News website

These findings have come as a surprise, not least for the researchers themselves.

But the research leaves many questions unanswered.

Is fat actually protective or is something else going on that could be harnessed as a treatment? Can other research groups produce the same findings?

Clearly there is a need for further research, but what should people do in the meantime?

These results do not seem to be an excuse to eye up an evening on the couch with an extra slice of cake.

The Alzheimer's Society and Alzheimer's Research UK have both come out and encouraged people to exercise, stop smoking and have a balanced diet.

Dr Simon Ridley, of Alzheimer's Research UK, said: "These new findings are interesting as they appear to contradict previous studies linking obesity to dementia risk.

"The results raise questions about the links between weight and dementia risk. Clearly, further research is needed to understand this fully."

The Alzheimer's Society said the "mixed picture highlights the difficulty of conducting studies into the complex lifestyle risk factors for dementia".

Prof Deborah Gustafson, of SUNY Downstate Medical Center in New York, argued: "To understand the association between body mass index and late-onset dementia should sober us as to the complexity of identifying risk and protective factors for dementia.

"The report by Qizilbash and colleagues is not the final word on this controversial topic."

Dr Qizilbash said: "We would agree with that entirely."

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Natural childbirth expert dies

Sheila Kitzinger was an advocate of home birth and had her own five children at home

Prolific author and anthropologist Sheila Kitzinger - who wrote more than 25 books on childbirth - has died at her Oxfordshire home at the age of 86.

In the 1960s and 70s she developed the concept of a "birth plan", which aimed to give more choice to pregnant women.

She believed mothers, not clinicians, should be the focus during childbirth.

She came to be seen as a pioneer in her field and received an MBE for her work. Her publisher Pinter & Martin said she died on Saturday after a short illness.

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Plucking hairs 'can make more grow'

Plucking hairs in a precise pattern can make even more pop up in their place, a US study suggests.

Playing with the density of hair removed altered how serious an injury the body recognised and in turn how much hair regrew.

The team managed to regenerate 1,300 hairs by plucking 200, in the study using mice reported in Cell journal.

Experts said it was "really nice science" but were uncertain if it could lead to a cure for human baldness.

Half of men have male-pattern baldness by the age of 50.

The team at the University of Southern California were investigating how hair follicles communicate with each other to decide on the scale of repair job needed.

Inflammation

In a series of experiments they removed 200 hair follicles from a circular patch of skin in mice.

A low-density pluck - removing follicles from a patch 6mm in diameter - led to no regeneration at all.

A medium-density pluck, with 200 removed from a 5mm circle, led to 1,300 new hairs.

A higher-density effort, with the same number of hairs but from a 4mm diameters circle, led to 780 new hairs.

Pulling every hair out led to every hair coming back, but no extra regeneration.

Hair comes back thicker after thorough plucking

The researchers showed that the level of inflammation under the skin was finely tuned to the scale of the damage.

And through a cascade of chemical signalling and immune responses, this controlled the amount of regeneration.

The team say it is like each hair gets a vote about what happens next and when it reaches a critical threshold it can trigger regeneration. They call the concept "quorum sensing".

Lead researcher Dr Cheng-Ming Chuong said: "It is a good example of how basic research can lead to work with potential translational value.

"The work leads to potential new targets for treating alopecia, a form of hair loss."

What the findings means for people plucking their eyebrows is uncertain.

Pathway

Chris Mason, professor of regenerative medicine at University College London, told the BBC: "It's a really nice piece of science. The idea of quorum sensing is smart."

But it is not known whether it will cure human baldness.

Prof Mason added: "That's the million-dollar question. I'm not sure. As it stands here, you've got to have some hair to pluck.

"A lot of studies have produced hair, but it's too fine - it's baby hair, it's light-coloured and it just doesn't look right. But here we can infer they are adult hairs so that is something that is a step change.

"Could you tap into the pathway with a cream or injection? That could well be possible - or maybe don't wait until you're totally bald?"

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Ebola survivors 'face health issues'

The WHO said the risks of the Ebola virus spreading from country to country were reducing

Many Ebola survivors are likely to face further health issues including eye and joint problems, the World Health Organization has warned.

And a recent case may have caught Ebola through sexual contact with someone who had recovered, experts said.

The WHO has decided the crisis still constitutes as a public health emergency of international concern.

But said there had been "real, substantive progress" in the drive to end the outbreak in the last few weeks.

Health aftermath

Officials announced they are attempting to set up clinics in Sierra Leone, Liberia and Guinea to monitor the health consequences Ebola survivors face.

Patients have reported problems with their vision, joints and on-going fatigue.

But Dr Bruce Aylward, assistant director general of the WHO, admitted not much was known about the long-term implications of the virus.

He said the information gathered at these clinics would help the mental and physical health needs of people recovering from the disease.

Experts from the organisation also said a recent Ebola patient was "likely to have been infected following sexual contact involving a survivor some months after his recovery".

Meanwhile reports suggest Liberian medics have been investigating whether a patient may have contracted the disease in this way.

WHO scientists are now considering whether it would be feasible to offer screening to check if the virus is still present in semen 90 days after male survivors have been declared Ebola free.

Current WHO advice says survivors should practice safe sex for three months following recovery as the virus can linger in these bodily fluids.

International spread

At a meeting convened to review whether the WHO should continue to describe the outbreak as an international emergency, Dr Aylward said real progress had been made.

He said the worst-affected countries were on track in clearing the disease, despite the advancing rainy season which had threatened to make logistics harder.

And the WHO said the risks of international spread of the virus were abating.

But Dr Aylward warned numbers were "not at zero by any stretch".

Challenges continue, including new cases that are not on registered lists of known Ebola contacts.

Just 30 confirmed infections were recorded in Guinea, Liberia and Sierra Leone in the previous week.

But the decline in numbers posed a challenge for those developing vaccines and therapies, the WHO warned.

There have been 25,532 cases during this Ebola outbreak and 10,584 deaths.

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Being overweight 'cuts dementia risk'

Those who were overweight had an 18% reduction in dementia, researchers found

Being overweight cuts the risk of dementia, according to the largest and most precise investigation into the relationship.

The researchers admit they were surprised by the findings, which run contrary to current health advice.

The analysis of nearly two million British people, in the Lancet Diabetes & Endocrinology, showed underweight people had the highest risk.

Dementia charities still advised not smoking, exercise and a balanced diet.

Dementia is one of the most pressing modern health issues. The number of patients globally is expected to treble to 135 million by 2050.

There is no cure or treatment, and the mainstay of advice has been to reduce risk by maintaining a healthy lifestyle. Yet it might be misguided.

'Surprise'

The team at Oxon Epidemiology and the London School of Hygiene and Tropical Medicine analysed medical records from 1,958,191 people aged 55, on average, for up to two decades.

Their most conservative analysis showed underweight people had a 39% greater risk of dementia compared with being a healthy weight.

But those who were overweight had an 18% reduction in dementia - and the figure was 24% for the obese.

"Yes, it is a surprise," said lead researcher Dr Nawab Qizilbash.

He told the BBC News website: "The controversial side is the observation that overweight and obese people have a lower risk of dementia than people with a normal, healthy body mass index.

"That's contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision."

Loss of tissue in a demented brain compared with a healthy one

Any explanation for the protective effect is distinctly lacking. There are some ideas that vitamin D and E deficiencies contribute to dementia and they may be less common in those eating more.

But Dr Qizilbash said the findings were not an excuse to pile on the pounds or binge on Easter eggs.

"You can't walk away and think it's OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits," he added.

Heart disease, stroke, diabetes, some cancers and other diseases are all linked to a bigger waistline.

Analysis

By James Gallagher, Health editor, BBC News website

These findings have come as a surprise, not least for the researchers themselves.

But the research leaves many questions unanswered.

Is fat actually protective or is something else going on that could be harnessed as a treatment? Can other research groups produce the same findings?

Clearly there is a need for further research, but what should people do in the meantime?

These results do not seem to be an excuse to eye up an evening on the couch with an extra slice of cake.

The Alzheimer's Society and Alzheimer's Research UK have both come out and encouraged people to exercise, stop smoking and have a balanced diet.

Dr Simon Ridley, of Alzheimer's Research UK, said: "These new findings are interesting as they appear to contradict previous studies linking obesity to dementia risk.

"The results raise questions about the links between weight and dementia risk. Clearly, further research is needed to understand this fully."

The Alzheimer's Society said the "mixed picture highlights the difficulty of conducting studies into the complex lifestyle risk factors for dementia".

Prof Deborah Gustafson, of SUNY Downstate Medical Center in New York, argued: "To understand the association between body mass index and late-onset dementia should sober us as to the complexity of identifying risk and protective factors for dementia.

"The report by Qizilbash and colleagues is not the final word on this controversial topic."

Dr Qizilbash said: "We would agree with that entirely."

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Being overweight 'cuts dementia risk'

Those who were overweight had an 18% reduction in dementia, researchers found

Being overweight cuts the risk of dementia, according to the largest and most precise investigation into the relationship.

The researchers admit they were surprised by the findings, which run contrary to current health advice.

The analysis of nearly two million British people, in the Lancet Diabetes & Endocrinology, showed underweight people had the highest risk.

Dementia charities still advised not smoking, exercise and a balanced diet.

Dementia is one of the most pressing modern health issues. The number of patients globally is expected to treble to 135 million by 2050.

There is no cure or treatment, and the mainstay of advice has been to reduce risk by maintaining a healthy lifestyle. Yet it might be misguided.

'Surprise'

The team at Oxon Epidemiology and the London School of Hygiene and Tropical Medicine analysed medical records from 1,958,191 people aged 55, on average, for up to two decades.

Their most conservative analysis showed underweight people had a 39% greater risk of dementia compared with being a healthy weight.

But those who were overweight had an 18% reduction in dementia - and the figure was 24% for the obese.

"Yes, it is a surprise," said lead researcher Dr Nawab Qizilbash.

He told the BBC News website: "The controversial side is the observation that overweight and obese people have a lower risk of dementia than people with a normal, healthy body mass index.

"That's contrary to most if not all studies that have been done, but if you collect them all together our study overwhelms them in terms of size and precision."

Loss of tissue in a demented brain compared with a healthy one

Any explanation for the protective effect is distinctly lacking. There are some ideas that vitamin D and E deficiencies contribute to dementia and they may be less common in those eating more.

But Dr Qizilbash said the findings were not an excuse to pile on the pounds or binge on Easter eggs.

"You can't walk away and think it's OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits," he added.

Heart disease, stroke, diabetes, some cancers and other diseases are all linked to a bigger waistline.

Analysis

By James Gallagher, Health editor, BBC News website

These findings have come as a surprise, not least for the researchers themselves.

But the research leaves many questions unanswered.

Is fat actually protective or is something else going on that could be harnessed as a treatment? Can other research groups produce the same findings?

Clearly there is a need for further research, but what should people do in the meantime?

These results do not seem to be an excuse to eye up an evening on the couch with an extra slice of cake.

The Alzheimer's Society and Alzheimer's Research UK have both come out and encouraged people to exercise, stop smoking and have a balanced diet.

Dr Simon Ridley, of Alzheimer's Research UK, said: "These new findings are interesting as they appear to contradict previous studies linking obesity to dementia risk.

"The results raise questions about the links between weight and dementia risk. Clearly, further research is needed to understand this fully."

The Alzheimer's Society said the "mixed picture highlights the difficulty of conducting studies into the complex lifestyle risk factors for dementia".

Prof Deborah Gustafson, of SUNY Downstate Medical Center in New York, argued: "To understand the association between body mass index and late-onset dementia should sober us as to the complexity of identifying risk and protective factors for dementia.

"The report by Qizilbash and colleagues is not the final word on this controversial topic."

Dr Qizilbash said: "We would agree with that entirely."

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Plucking hairs 'can make more grow'

Plucking hairs in a precise pattern can make even more pop up in their place, a US study suggests.

Playing with the density of hair removed altered how serious an injury the body recognised and in turn how much hair regrew.

The team managed to regenerate 1,300 hairs by plucking 200, in the study using mice reported in Cell journal.

Experts said it was "really nice science" but were uncertain if it could lead to a cure for human baldness.

Half of men have male-pattern baldness by the age of 50.

The team at the University of Southern California were investigating how hair follicles communicate with each other to decide on the scale of repair job needed.

Inflammation

In a series of experiments they removed 200 hair follicles from a circular patch of skin in mice.

A low-density pluck - removing follicles from a patch 6mm in diameter - led to no regeneration at all.

A medium-density pluck, with 200 removed from a 5mm circle, led to 1,300 new hairs.

A higher-density effort, with the same number of hairs but from a 4mm diameters circle, led to 780 new hairs.

Pulling every hair out led to every hair coming back, but no extra regeneration.

Hair comes back thicker after thorough plucking

The researchers showed that the level of inflammation under the skin was finely tuned to the scale of the damage.

And through a cascade of chemical signalling and immune responses, this controlled the amount of regeneration.

The team say it is like each hair gets a vote about what happens next and when it reaches a critical threshold it can trigger regeneration. They call the concept "quorum sensing".

Lead researcher Dr Cheng-Ming Chuong said: "It is a good example of how basic research can lead to work with potential translational value.

"The work leads to potential new targets for treating alopecia, a form of hair loss."

Pathway

Chris Mason, professor of regenerative medicine at University College London, told the BBC: "It's a really nice piece of science. The idea of quorum sensing is smart."

But it is not known whether it will cure human baldness.

Prof Mason added: "That's the million-dollar question. I'm not sure. As it stands here, you've got to have some hair to pluck.

"A lot of studies have produced hair, but it's too fine - it's baby hair, it's light-coloured and it just doesn't look right. But here we can infer they are adult hairs so that is something that is a step change.

"Could you tap into the pathway with a cream or injection? That could well be possible - or maybe don't wait until you're totally bald?"

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Ebola survivors 'face health issues'

The WHO said the risks of the Ebola virus spreading from country to country were reducing

Many Ebola survivors are likely to face further health issues including eye and joint problems, the World Health Organization has warned.

The organisation said there had not been enough focus on this so far.

It added there had been "real, substantive progress" in the drive to end the outbreak in the last few weeks.

But experts remained "absolutely firm" the crisis still constituted a public health emergency of international concern.

The WHO announced it was attempting to set up clinics in Sierra Leone, Liberia and Guinea to monitor the health consequences Ebola survivors face.

Dr Bruce Aylward, assistant director general of the organisation, admitted not much was known about the long-term implications of the virus.

But he said the information gathered at these clinics would help the mental and physical health needs of people recovering from the disease.

According to WHO doctors, a substantial proportion of patients have reported problems with their vision and joints.

Dr Andrew Ramsay, working for the WHO in Sierra Leone, previously said: "Eye problems might be caused by damage to the cornea, to the nerves or something else.

"At this point we do not have enough information to know exactly what is going on.

"But we need to find out urgently so we can do whatever we can to preserve the eyesight for people who have to try to pick up their lives again."

Experts said they were also considering whether it was feasible to offer screening to male survivors to check if the virus was still present in semen after they recovered.

Current advice suggests survivors should practice safe sex for 90 days after they have been declared free of the virus, as it can linger in some bodily fluids.

At a meeting convened to review whether the WHO should continue to describe the outbreak as an international emergency, Dr Aylward said real progress had been made.

He said the worst-affected countries were on track in clearing the disease, despite the advancing rainy season which had threatened to make logistics harder.

And the WHO said the risks of international spread of the virus were abating.

But Dr Aylward warned numbers were "not at zero by any stretch".

Challenges continue, including new cases that are not on registered lists of known Ebola contacts.

Just 30 confirmed infections were recorded in Guinea, Liberia and Sierra Leone in the previous week.

But the decline in numbers posed a challenge for those developing vaccines and therapies, the WHO warned.

Dr Aylward said: "A lot of thought by a lot of smart people is going on to make sure we have the tools we need going forward."

There have been 25,532 cases during this Ebola outbreak and 10,584 deaths.

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Short people's 'heart risk greater'

The shorter you are, the greater your risk of heart problems, a team at the University of Leicester says.

The study, of nearly 200,000 people, found sections of DNA that control both height and heart health.

The findings, published in the New England Journal of Medicine, showed every extra 2.5in (6.4cm) cut coronary disease incidence by 13.5%

The British Heart Foundation said short people should not be unduly worried and everyone needed a healthy lifestyle.

Coronary heart disease, which includes heart attacks and heart failure, is the leading cause of death in the UK.

More than 73,000 people die from the disease each year.

'Small' risk

The idea that height plays a role in heart health was first proposed more than 50 years ago, but researchers did not know why.

Some thought the relationship was a consequence of other factors, such as poor childhood nutrition stunting height and also affecting the heart.

But the study at the University of Leicester suggests the answer lies deeper - inside our DNA.

They analysed 180 genes that have a known link to height.

The results showed that every 2.5in of height affected the risk by 13.5%, so the difference in heart risk between a five-footer and a six-footer would be around 64%.

Professor Sir Nilesh Samani, from the University of Leicester, told the BBC News website: "In the context of major risk factors this is small - smoking increases the risk by 200-300% - but it is not trivial.

"I wouldn't say shorter people need to take greater precautions, because if you're 6ft 1in (1.85m) you still need to stop smoking.

"This is only one of many factors affecting risk, everybody should be cautious."

Genetic clues

The study also showed those genes cutting height were also increasing the amount of cholesterol and fats in the bloodstream.

The researchers believe some of the height genes may also be controlling both growth and blood vessel development.

"Understanding these pathways may lead to new treatments and that may be more valuable in the longer term," Prof Samani added.

But it is worth remembering it is not all good news being tall. as height increases the risk of cancer.

Prof Peter Weissberg, the medical director at the British Heart Foundation, said: "This study does not suggest that short people should be unduly worried about their health or that doctors need to focus on the health of shorter patients.

"Everyone, regardless of their height, should do everything in their power to reduce their risk of future heart disease by eating a healthy diet, exercising regularly and not smoking.

"Currently available health checks are designed to help you understand what measures you need to take to reduce your personal risk."

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Breast cancer risk test devised

Scientists have predicted the odds of women developing breast cancer by looking for tiny errors in their DNA.

The international team analysed 77 genes. Individually they each had a low impact on cancer risk, but were a powerful combination.

The findings, in the Journal of the National Cancer Institute, could eventually transform screening, preventive treatments and even HRT.

Cancer charities said the field was developing rapidly.

The genetic tests that have already been developed are restricted, in the UK, to those women with the very highest risk of developing breast cancer.

They look for changes such as mutations in the BRCA genes that led the Hollywood actress Angelina Jolie to have her breasts and ovaries removed.

They can give up to a 90% chance of cancer in a woman's lifetime, but are rare.

'Very exciting'

The team, led by the Institute of Cancer Research in London and the University of Cambridge, looked at the parts of the genetic code that have a more subtle effect yet will influence every woman's chance of cancer.

Of the 77 cancer-risk sites in the DNA inherited from the mother and the matching 77 from the father, an average woman would have 66.

It allowed the team to calculate the probability of women developing breast cancer.

• In women with no family history of breast cancer, the highest-risk group had a 16.6% lifetime risk
• In women with no family history of breast cancer, the lowest-risk group had a 5.2% lifetime risk
• In women with a family history of breast cancer, the higher-risk group had a 24.4% lifetime risk
• In women with a family history of breast cancer, the lowest-risk group had a 8.2% lifetime risk

"These are quite substantial risks," said Prof Montserrat Garcia-Closas, of the Institute of Cancer Research.

She told the BBC News website: "I think it's very exciting at the moment. The discovery of these variants has progressed very quickly in the last five years and I think it's reaching a plateau. And at that point it's time to start designing a genetic test that includes all these elements. That's likely to be reached within a year."

The ability to accurately predict the risk of breast cancer could have a powerful impact on medicine.

It could clearly show which women need drugs, such as tamoxifen and raloxifene, to reduce the risk of breast cancer.

The lowest-risk women may not need breast cancer screening, while those at highest risk might need to start earlier.

Hormone replacement therapy has many benefits, but it does increase the risk of cancer. So knowing the background genetic risk could also inform who should and should not have HRT.

'Major step'

But one of the great challenges will be to combine these tests with current techniques.

Prof Douglas Easton, of the University of Cambridge, said: "We've now reached a crucial stage at which all this research can be combined to help target screening and advice to those women who need them the most.

"There's still work to be done to determine how tests like this could complement other risk factors, such as age, lifestyle and family history, but it's a major step in the right direction that will hopefully see genetic risk prediction become part of routine breast screening in the years to come."

Dr Matthew Lam, of the charity Breakthrough Breast Cancer, said: "In recent years we've learnt so much about genetic risk factors of breast cancer. What's great to see now is that these findings are starting to be translated into practical methods to predict risk."

Nell Barrie, of Cancer Research UK, said: "This study shows how the genetic map of breast cancer that scientists have been building up over the years might be used to identify women most at risk, so we can take steps to reduce their chances of developing the disease or catch it at the earliest possible stage."

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UK pollution forecast prompts warning

Parts of the UK could reach the highest level of air pollution on Friday, prompting heath warnings.

Warm, still conditions are expected to combine with traffic fumes, pollution from the continent and Saharan dust from the south as it rises to level 10.

Much of the South East and eastern England will see high levels of pollution, although the problem is expected to be short-lived.

Defra said overnight Atlantic winds will disperse polluted air by Saturday.

Last month, Public Health England issued a warning after smog appeared in parts of England, Wales and Northern Ireland.

In areas experiencing very high levels of air pollution, adults and children with lung problems, adults with heart problems and older people are advised to avoid strenuous activity.

People are also advised to reduce physical exertion, particularly outside, and asthma sufferers may need to use their reliever inhaler more often.

How concerning?

By James Gallagher, Health editor, BBC News website

Healthy people tend to notice air pollution as a dry throat, sore eyes or a tickly cough.

But it can have a more serious impact on health by being the trigger for a heart attack or by making asthma worse.

Even low levels of air pollution can harm the health of people who are particularly sensitive.

But on Friday pollution will hit "level 10" or "very high" - the highest category of air pollution in the UK.

It does not mean people need to stay indoors.

But it is the only category of air pollution at which at-risk people - those with heart or lung problems and the elderly - are told to completely avoid strenuous physical activity.

Even healthy people are told to cut down on the amount of physical exertion.

However, the pollution will be brief and levels will drop to low/moderate by Saturday.

'National embarrassment'

People are also advised to avoid busy roads and those who carry a reliever inhaler should always have it with them.

Dr Penny Woods, chief executive of the British Lung Foundation, said: "This latest high air pollution episode, coming so soon after the last, is troubling, and could again put people living with respiratory conditions at risk of worsening symptoms."

A Defra spokeswoman said: "This is expected to clear on Saturday and pollution levels will return to low throughout the morning."

A case brought by environmental lawyers Client Earth against the government over levels of air pollution that breach European Union rules is shortly to return to the Supreme Court.

Philip Insall, director of health for cycling charity Sustrans, described the state of air pollution in Britain as "criminal" and a "national embarrassment".

He said: "The next government will need to get a grip on air pollution.

"That will mean serious, dedicated investment and an effective programme of action to help more people out of their cars and choosing walking and cycling for short journeys."

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Review of case against NHS manager

The General Medical Council is to review an investigation into a senior executive at NHS England, Dame Barbara Hakin.

She has faced claims she endangered patients by ordering a hospital trust to meet performance targets whatever the cost, while she was head of the East Midlands Strategic Health Authority.

Dame Barbara, now national director for commissioning operations, was cleared by the GMC in 2013 after an investigation.

But that will now be reviewed.

Allegations of bullying and endangering patient safety had dogged Dame Barbara since 2009, when she ran the East Midlands authority.

They relate in particular to the treatment of the former chief executive of United Lincolnshire Hospitals turned whistleblower, Gary Walker, who lost his job after being told waiting time targets had to be met despite his concerns over patient safety.

A year-long GMC investigation cleared Dame Barbara of 17 separate allegations in 2013, all of which she had denied.

That investigation is now being reviewed, but the GMC says Dame Barbara is not facing a fresh inquiry.

Documents seen by the BBC suggest the decision may "in part be materially flawed" - including concerns that the evidence gathered did not go far enough in relation to the allegations around patient safety - and say a review is in the public interest.

A General Medical Council spokesperson said: "We don't comment in detail on individual doctors. But we can confirm that Dame Barbara Hakin is not under investigation by the GMC.

"We are however reviewing a decision made as part of our original investigation. This process, known as Rule 12, enables the GMC in certain circumstances to review a decision previously made."

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Care for dying 'needs overhaul'

Palliative care is about providing the right support at the end of life

The UK's care system for dying patients with terminal illnesses is lacking and needs a major overhaul, says a damning new report.

According to London School of Economics researchers, more than 100,000 people a year who would benefit from palliative care are not getting it.

Patients are being left without sufficient pain relief and respite.

NHS England said it was committed to ensuring terminally-ill patients got the support and services they needed.

Ageing population

The report found inequalities in access to good care, with certain groups of patients more likely to miss out.

With an ageing population and demand for care increasing, the problem looked set to worsen, it warned.

Those who currently miss out include:

• the "oldest old" (aged 85 and over)
• people living alone
• people living in deprived areas
• black, Asian and ethnic minority groups

Most palliative care goes to cancer patients, even though the diseases account for less than a third of deaths.

Only a fifth of new referrals to specialist end-of-life services are for people with non-cancer diagnoses.

According to the report, commissioned by the Marie Curie charity, providing palliative care to those that need it could improve the quality of life for thousands of patients and save the NHS money by preventing unwanted and distressing hospital treatment.

By their calculations, the net potential savings are more than £30m in England, at least £2m in Wales, more than £1m in Northern Ireland and more than £4m in Scotland.

Meanwhile, a separate MORI poll of 500 health professionals who look after terminally-ill patients - also commissioned by Marie Curie - reveals that many feel there is insufficient funding and staffing to provide the level of care needed.

Likewise, a recent poll of 1,067 carers - mostly family members, friends or neighbours of terminally-ill people - felt the current care system did not offer enough support.

'System under strain'

Denis McKnight, 68, from Northern Ireland, cared for his wife, Georgina, who had motor neurone disease.

A district nurse would visit once a week, but Mr McKnight said this was nowhere near enough to meet their care needs.

He said: "I felt alone. I felt almost abandoned, except for my family.

"Palliative care as it is provided by the nursing system is the best that they can possibly do. Most nurses would want to do the very best job possible. They just don't have the resources to do it.

"It's the system that is cracking under the strain."

When Mr McKnight struggled to cope with his wife's increasingly demanding care needs as her disease progressed, a friend suggested he ask Marie Curie for help.

Mrs McKnight was unable to walk or move for herself and could not swallow, so needed to be fed via a tube.

Mr McKnight said: "I'm more than grateful for what Marie Curie did, even for that short period of time. They stepped in as specialists and gave specialist help.

"They were able to step into the breach - a breach that's been created through lack of resources in the ordinary healthcare system."

Dr Jane Collins, chief executive of Marie Curie, said: "Everyone affected by terminal illness should have access to all the care and support they need, regardless of their personal circumstances. This report shows that this is not the case, and some groups are getting a worse deal than others. We don't think this is good enough."

Katherine Murphy, chief executive of the Patients Association, called the current situation a "national disgrace".

"These findings mirror many of the inquiries to our national helpline. It is unacceptable that we continue to fail the most vulnerable in our society."

Dr Bee Wee, national clinical director for end-of-life care at NHS England, said: "NHS England is committed to ensuring that all patients get the support and services they need towards the end of life."

A Welsh government spokesperson said: "Whether a person wishes to die in hospital, in a hospice or at home, we want to make sure the right level of professional, caring support is available.

"Ensuring that care and support is effectively planned and co-ordinated across health and social care to meet people's needs is one of the priorities being taken forward through our work on integration."

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Coalition 'undermined NHS' - doctors

The government has "undermined and weakened" the NHS in England, a letter signed by 140 doctors says.

The letter - published in the Guardian - said the coalition's approach has been characterised by broken promises, cuts and destructive legislation.

And it warned the squeeze was "hitting patients" with pressures growing on A&E units and hospital waiting lists.

But the Conservatives rejected the claims - and suggested it had been orchestrated by Labour.

The letter was organised by Dr Clare Gerada, a Labour member and former chair of the Royal College of General Practitioners, but she denied the party had had any input into it.

Signatories include Sir George Alberti, who worked as an emergency care tsar under Labour, Dr Laurence Buckman, a London-based GP and former senior member of the British Medical Association, and Prof John Ashton, a retired director of public health and president of the Faculty of Public Health.

Dr Helena McKeown, a GP from Wiltshire and Liberal Democrat councillor, also signed the letter.

The letter said: "The NHS is withering away and if things carry on as they are then in future people will be denied care they once had under the NHS and have to pay more for health services.

"As medical and public health professionals our primary concern is for all patients. We invite voters to consider carefully how the NHS has fared over the last five years."

In particular, the letter went into detail about the government's reforms, saying they had led to a "rapid and unwanted expansion of the role of commercial companies".

A Conservative Party spokeswoman described the group as a "small number of doctors" and pointed out that some of them were Labour supporters and advisers.

"The facts are clear: we have cut the number of managers and increased funding for the NHS so we can have 9,500 more doctors and 6,900 nurses treating patients.

"The NHS in England continues to perform better than other parts of the UK, with patients more likely to be seen within four hours in A&E than in Wales, Scotland or Northern Ireland."

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