SURGICAL TOOLS TOO OFTEN LEFT BEHIND IN PATIENTS

You go in for surgery, and only find out later that one of the surgeon's tools -- a sponge, a needle, a surgical implement -- has been left behind in your body.

A rare occurrence? Not really. "Leaving a foreign object after surgery is a well-known problem, but one that can be prevented," Dr. Ana McKee, the commission's executive vice president and chief medical officer, said during an early afternoon press briefing. Her group believes that this is an all-too-common problem -- one that can even prove fatal or leave severe damage to patients, both physically and emotionally. According to the commission, there have been more than 770 reports of retained foreign objects in surgical patients over the last seven years. These cases resulted in 16 deaths and in almost 95 percent of the cases patients had to have their hospital stay extended. The objects most often left inside patients include sponges and towels, broken parts of instruments, and stapler parts and needles or other sharp pieces. "It is critical for organizations to develop and comply with policies and procedures to make sure all surgical items are identified and accounted for as well as to ensure there is open communication by all members of the surgical team about any concern," McKee said.

Certain patients or procedures seem more prone to having implements unaccounted for after surgery. According to McKee, these include overweight patients, more rushed or urgent procedures, having more than one surgical procedure and multiple surgical teams, or having staff turnovers during the procedure.

But there are ways to reduce the problem. Among the commission's recommendations:

• Create a reliable, standardized operating room counting system to ensure all surgical items are accounted for.
• Develop effective, standardized policies and procedures to prevent the problem that includes counting procedures, wound opening and closing procedures, and directions on when X-rays should be done during the operation to help spot stray items.
• Team briefings and debriefings would also help, with team members feeling free to express any concerns about the safety of the patient.

Too often, "problems with hierarchy and intimidation in the surgical team, failure in communication with physicians, failure of staff to communicate relevant patient information and inadequate or incomplete staff education," are a part of the problem. If any discrepancy is found between the objects counted and those remaining after the surgery, action must be taken and placed into the record. The problem occurs nine times more often during emergency operations than in planned ones and was four times more likely to happen if the procedure was unexpectedly changed, the commission said.

By Steven Reinberg

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PREMATURE BABIES LIKELY TO UNDERPERFORM AT SCHOOL

Children who are born prematurely should have their school starting date set by their due date rather than their actual birthday, a UK study suggests. Researchers from the University of Bristol found that preterm infants perform more poorly in primary school testing than classmates who were born at around 40 weeks. This educational disadvantage was particularly noticeable among summer born children who went to school a year earlier as a result of a premature birth.

'Change school entry rules'

Professor Sir Al Aynsley-Green, former first Children's Commissioner for England and Professor Emeritus of Child Health, University College London, says in a statement: "Education experts must look at these data and argue for a change in policy so that the school entry age for children born prematurely is based on their expected due date rather than their premature date of birth."

Special educational needs

After adjusting for other factors which might skew the results, almost a third of children born prematurely (31.5%) were found to record a low score at KS1 compared to just over a fifth (21.2%) of those born at term. Furthermore, those in the premature group were more likely to need special educational support (35.5%) than those born around 40 weeks (23.3%). Also, those placed in the correct school year based on their estimated due date achieved more highly than those whose school entry year was determined by their actual date of birth.

Delaying school entry

The researchers say that delayed school entry may benefit August born premature children and that this finding fits other studies done in the UK. Speaking about the findings, lead author Dr David Odd, senior clinical lecturer at the University of Bristol’s School of Clinical Sciences and a clinician based at Southmead Hospital NICU in Bristol, says in a statement: "Our research indicates that children who were born prematurely are at higher risk of poor school performance and in greater need of additional educational support at primary school. Some of the social and educational difficulties these children face may be avoidable by recognising the impact that their date of birth has on when they start school."

Changes to admissions code

A spokesperson for the Department for Education says in an emailed statement: "We have changed the Schools Admissions Code to make it easier for parents to defer their child’s entry or request they attend part time until they reach their fifth birthday. "Schools should make this clear in their own admissions arrangements so that parents are fully aware of the options available for their children."

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IVA AND THE GREAT FERTILITY REVOLUTION

Last week, a woman who suffered an early menopause gave birth. We report on the new frontiers of making babies.

Even the late Prof Sir Robert Edwards, godfather of assisted reproduction, would be astonished by the experimental treatments that today’s fertility scientists keep coming up with.

Could the Nobel prizewinner who developed in-vitro fertility (IVF) treatment – which led to the birth of the first “test-tube baby”, Louise Brown, in 1978 – have imagined the latest leap forward? IVA, or in-vitro activation, seems to offer hope in the most impossible cases: women who have passed through the menopause. According to the Daisy Network, the support group for those who experience menopause prematurely, some 110,000 women in Britain between the ages of 12 and 40 are affected.

The Japanese-American team behind IVA announced last week that they have pioneered a technique that can find – like a needle in a haystack – primordial cells in the ovaries of women who have undergone menopause in their early thirties. These cells, which researchers from Stanford University School of Medicine in California and St Marianna University School of Medicine in Kawasaki, Japan, describe as “residual follicles”, contained immature eggs that could be nurtured into life, fertilised and then grown into embryos for implantation.

The study reported that the scientists’ work has already led to the birth of one baby boy, with another healthy pregnancy underway. Further case work is ongoing.

Truly no stone is being left unturned in the great fertility revolution. Every year seems to bring advances in this branch of gynaecology. Some are straightforward; for example, scientists at the University of Southampton, led by Nick Macklon, professor of gynaecology and obstetrics, have just discovered that a “choosy” uterus can reject poor quality embryos, preventing implantation. The team’s work could have a real impact on IVF success rates, Prof Macklon explains: “The big problem in IVF is still the low chance of getting embryos to implant. These new insights into how an endometrium (the lining of the womb) chooses an embryo may open new avenues to develop treatments.”

Other breakthroughs sound like science fiction – and are just as controversial. “Three-person IVF”, developed at the University of Newcastle, can create embryos from the genetic material of two women and one man to prevent life-threatening disorders. This technique aims to replace faulty mitochondria, the body’s tiny power stations, thus preventing the birth of children with mitochondrial disorder, which causes muscle weakness, blindness and heart failure. The technique already has ethical critics, and a team of scientists at the University of Sheffield, the University of Sussex and Monash University in Australia has warned that mixing DNA could lead to damaging side-effects for the baby, not least in its learning, behaviour and fertility in adulthood. Britain is set to be the first country to use three-person IVF as early as next year. Ministers are drawing up legislation in the face of condemnation from members of the Council of Europe, including eight MPs and peers, who liken the treatment to eugenics.

IVA, by comparison, is a more straightforward development. Women naturally have hundreds of thousands of primordial follicles, each containing one immature egg. Usually, only one follicle develops to maturity each month and releases an egg into the fallopian tube for possible fertilisation.

However, one in 100 women go through early menopause, also known as POI (primary ovarian insufficiency), meaning they can no longer produce eggs or support a pregnancy. Until now, their hopes for motherhood lay in egg donation, surrogacy or adoption.

But, in 2010, Prof Aaron Hsueh, professor of obstetrics and gynaecology at Stanford, found that blocking a protein called PTEN in mouse and human ovaries was enough to stir dormant follicles into producing mature eggs. Although it’s not known why follicles stop developing in women with POI, Prof Hsueh found that some patients still had smaller follicles but were not producing enough sex hormones for ovulation to occur. “Our treatment was able to activate or awaken some of the remaining primordial follicles and cause them to release eggs,” he says.

The procedure involves removing an ovary or piece of ovarian tissue, which is treated to stimulate follicle growth. When this is detected, the tissue is re-implanted into the woman’s body, and hormones used to encourage the egg to grow. When large enough, the eggs are collected as in any IVF procedure, fertilised and allowed to develop until big enough to re-implant. Hormone therapy for the mother supports the pregnancy to term.

Prof Kazuhiro Kawamura, of St Marianna University, who last week delivered the first baby conceived through IVA, said: “I could not sleep the night before the Caesarean operation, but when I saw the healthy baby my anxiety turned to delight. The couple and I hugged each other in tears. I hope IVA will be able to help patients with primary ovarian insufficiency throughout the world.”

Interestingly, a similar needle-in-a-haystack procedure is already being carried out in men who are classified as infertile and produce no sperm at all. It was developed in the 1990s by Dr Sherman Silber of the Infertility Centre of St Louis, a urologist and expert in cutting-edge IVF, who pioneered the ovarian-transplant techniques used in IVA. The “sperm retrieval” is allied with intra-cytoplasmic sperm injection (ICSI) – introducing a sperm directly into an egg to fertilise it.

Sperm retrieval requires a single gamete to be retrieved by microsurgery directly from the client’s epidydimus (the curved structure at the back of the testicle in which sperm matures). The procedure, which is available privately in Britain at a cost of around £2,000, is successful even in men who have been unable to ejaculate a single sperm normally or have a genetic disorder that would typically confer infertility. “If there are stem cells that might produce sperm,” Dr Silber explains, “they are found in tubules which connect the centre to the outer edge of the testis. So we don’t dissect the whole organ, but closely examine the periphery instead. This way, we find any sperm that might be 'hiding’ in the testis without doing any harm to it. Best of all, the patient can just get up and walk away painlessly when it is finished.”

According to Prof Dr Geeta Nargund, medical director of Create Health Clinics in London, “Essentially, IVA is an exciting new scientific development but it needs further productive randomised studies to see its effectiveness and ensure it is safe. At this stage, it is too early to say whether it is clinically applicable for treatment of patients.”

Prof Nargund, who is working with a Belgian team from the Genk Institute for Fertility Technology to simplify IVF techniques, dramatically reducing cost, is keen that false hope is not generated for those women who have undergone premature menopause. “Those who are at risk of early menopause,” she says, “due to genetic or other reasons should seriously consider freezing their eggs. There has been huge improvement in success rates using frozen eggs thanks to the introduction of vitrification – or fast-freezing – techniques.”

IVA will not be available in Britain for some years – and the experimental treatment won’t come cheap. Prof Kawamura explains: “In Japan, when the treatment becomes routinely available, it will cost around US$15,000 (£9,400) to harvest the egg, and more to have it fertilised using IVF.”

Inevitably, there is speculation that IVA could be used to extend the window of fertility for all women, not just those who experience early menopause. Could it benefit women who have passed through menopause in their early fifties?

Prof Hsueh is emphatic: “By 51 years of age, there are no follicles left. The IVA procedure does not correct for age-related increases in genetic defects, it only allows the possibility of getting more oocytes [immature eggs].”

So it seems our primordial cells don’t survive beyond “natural”, age-related menopause, but fade away in women with normal reproductive patterns. Older would-be mothers may have to wait a little longer for the next breakthrough in the great fertility revolution.

HIV IN CELLS ERADICATED WITH ANTIFUNGAL DRUG

New research by an international team finds that Ciclopirox, an antifungal cream used all over the world, completely eradicates HIV - the virus that leads to AIDS - in cultured cells, and the virus does not return when the treatment stops.

The study also found Deferiprone, a systemic drug used to remove excess iron from the body in people who have beta-thalassaemia major, has the same effect.
The researchers, including a team from Rutgers New Jersey Medical School, wrote about their findings in a paper published online. As both drugs are already approved for use in humans - both in the US and Europe - the researchers say this means the normally lengthy process of drug development should be less costly and time-consuming, bringing closer the prospect of global elimination of HIV and AIDS.

The cells of our body have a natural way of stopping this - they kill themselves. When the immune system detects the presence of a virus, it triggers a cell process called apoptosis that makes infected cells commit suicide. But the human immunodeficiency virus (HIV) has a way around this: it disables the host cell's ability to commit suicide, allowing it to continue to exploit cellular resources to fuel its growth and spread.

In this new study, the researchers found the drugs work against HIV in two ways: they inhibit expression of certain HIV genes, and they also jam up the host cell's mitochondria, the little powerhouses that supply them with energy. Both these effects reactivate the cell's suicide pathway. Healthy cells not infected with HIV were not affected. And remarkably, the virus did not bounce back when treatment stopped.

Thanks to these previous results confirmed in this new study, and the fact the systemic drug is already known to be safe in humans, testing the effectiveness of Deferiprone against HIV has already moved directly from cell culture to human trial in South Africa, bypassing the need for animal testing. Ciclopirox is not approved for systemic use, as it is a topical cream. But the discovery that both drugs, each well-tolerated in humans, are also able to eradicate HIV in cell culture renews hope that HIV and AIDS will one day, in the not too distant future, be wiped from the face of the Earth.

Written by Catharine Paddock PhD

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WHY PILING ON THE POUNDS MAY HELP YOU LIVE LONGER

It was Wallis Simpson who famously remarked that “you can never be too rich or too thin”. But the latest research suggests the former Duchess of Windsor got it wrong, at least where weight is concerned. The new study, the biggest on the topic to date, has found that those with a little extra padding are likely to outlive their slimmer counterparts.

The research, published in the Journal of the American Medical Association last week, found, as might be expected, that people who were very obese (a Body Mass Index of over 35) had 30 per cent higher mortality than those of a “healthy” weight (a BMI between 18.5 and 25). However, those who were just overweight (a BMI between 25 and 30) were around 6 per cent less likely to die during the study than those who fell into the “healthy” weight range. Even people usually classified as mildly obese (a BMI between 30 and 35) seemed to be at no risk of dying early.

While severe obesity is an established risk for conditions like heart disease and diabetes, some modest extra poundage is linked with increased longevity – a phenomenon known to experts as the “obesity paradox”. “We don’t fully understand why it occurs, but one explanation is that overweight people may be more likely to have health problems, like high blood pressure and diabetes, flagged up and treated,” says Paul Gately, professor of exercise and obesity at Leeds Metropolitan University. “Having a higher BMI seems to be protective for some chronic conditions like heart failure, too, and research is underway to explain this.”

What the latest research does highlight is the shortcomings of the BMI, a rough estimate of body fatness based on weight and height, as an overall gauge of health (to work yours out, divide your weight in kilograms by your height in metres squared – or use an internet BMI calculator). Although a BMI between 18.5 to 25 is regarded as the ideal, most experts now accept that those who carry a stone or two more can remain perfectly well, provided they eat a balanced diet and take some exercise to keep heart, arteries and blood glucose levels healthy.

BMI is also an imprecise tool because it does not take into account where body fat is deposited. Studies have shown that people who lay fat around their hips and thighs are at lower risk than those who deposit it around their stomachs (the apple shape), whatever their BMI, which is why doctors think waist measurement is key (the ideal being less than 32” for women and less than 37” for men). The measurement is also inaccurate for those with a muscular build who will register a high BMI despite being fit and healthy.

“What the latest research is telling us is that the biggest risks are with the very obese, and this is where we should be focusing our funding and research,” says Prof Gately.

Lucy Aphramor is a Coventry-based registered dietitian who has pioneered the Health at Every Size approach, which is based on the premise that good health is best realised regardless of weight. She argues it is healthier to be a little plump than pursue weight loss through yo-yo dieting – now thought to increase inflammation, a risk factor for heart disease. “A healthy weight is the weight you stabilise at when you have a healthy relationship with food and we can’t guess at that from numbers on a scale,” she says.

However Prof Gately warns against complacency. “You may be fine right now with a BMI of 27,” he says, “but a false sense of security can lead to your weight creeping up over time – which can become a problem.”

By Angela Dowden

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COCA-COLA RECOMMENDED AS 'MEDICAL CURE' FOR STOMACH BLOCKAGES

Doctors now commonly use the soft drink to treat patients with a nasty condition called gastric phytobezoar with a success rate of more than 90 per cent, a study said.

This is because the fizzy favourite has chemical ingredients that do a similar job to gastric acid while the bubbles help speed up the process, said researchers. Even the Diet and Coke Zero options work, because they have the same basic ingredients as the full fat version, said the report.

The researchers went through openly published academic papers that detailed 46 patients with the ailment who were treated with Coke in hospitals worldwide over the past 10 years.

A phytobezoar is a stomach blockage which, unless it is successfully removed or destroyed, can subsequently lead to a bowel obstruction. It is often caused by certain fruits which do not digest properly – for instance, in Asia many cases are a result of eating persimmons which are particularly prone to form blockages. A variety of treatments are available to treat it, from lasers and non-surgical endoscopies to the last resort of full surgery. But of the 46 cases patients given Coca-Cola, exactly half saw the drink destroy the blockage completely and a further 19 only needed non-invasive treatments as a result of Coke's help. Only four needed full surgery giving Coca-Cola a success rating of 91.3 per cent. They reported: "Coca-Cola administration is a cheap, easy-to-perform and safe procedure that can be accomplished at any endoscopy unit."

Coca-Cola has an acidity rating of 2.6 on the pH scale because it contains both carbonic and phosphoric acid.

The researchers added: "It resembles gastric acid, which is thought to be important for fibre digestion. "In addition the bubbles enhance the dissolving mechanism."

If the Coke does not completely destroy whatever is causing the blockage then it is likely to make it smaller and soften the phytobezoar making it easy to remove without the need for full surgery, the report said.

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DOCTORS SEEK COURT ORDER TO CARRY OUT ABORTION ON MENTALLY DISABLED WOMAN

The woman, who is not being named for legal reasons, suffers from sickle cell disease which has already caused her to have a string of strokes.

The medical team treating her say they are concerned that allowing her pregnancy to continue any further could endanger her life. They describe the situation as “urgent” and say that they must act quickly to reduce the risk.

Lawyers from an NHS trust in the south of England are due to take their case to the Court of Protection, sitting at the High Court in London later this week. The judge will be asked to make an order allowing doctors to treat the woman without her consent.

She is described as having a “significant learning impairment” and doctors believe she does not have the capacity to make a decision for herself.

Sickle cell disease is an inherited condition in which the red blood cells which supply oxygen to the body develop abnormally. The cells, shaped like a crescent sickle rather than being round, have a tendency to clog sections of blood vessels. The blockages, which can last for weeks at a time, can cause anaemia which leaves patients tired and breathless. In more severe cases, they can cause severe breathing problems and strokes.

Last year, the court effectively banned a young autistic woman from having sexual intercourse because she does not understand the risks involved. The judge said that the court had a responsibility to protect people’s freedom to make “unwise decisions” but must occasionally restrict it in their best interests.

Hospitals and councils have previously asked judges to force women to take contraception and undergo surgery. One woman with dementia was almost prevented from taking a cruise after social workers said it was too dangerous.

The latest case contrasts markedly with that of Savita Halappanavar, the Indian woman who died after allegedly being refused an abortion which it has been claimed could have saved her life by a hospital in Ireland.

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PARKINSON'S DRUGS LEAD TO COMPULSIVE GAMBLING & SHOPPING, NOT THE DISEASE ITSELF

Parkinson's disease, the neurodegenerative condition that can cause shakes and tremors, has been linked with alterations in behaviour in patients ranging from compulsive shopping and gambling to being obsessed with taking technical equipment apart, sorting objects or for taking long aimless walks.

Researchers have found that these side effects are caused by the drugs used to treat Parkinson's rather than the disease itself. In a small study, a group of newly diagnosed Parkinson sufferers who were not taking any medication, were asked about their compulsive behaviour and the results compared to a similar group of people who were healthy. It was found that one in five of both groups showed compulsive behaviour. "We've known for some time that these behaviours are more common in people taking certain Parkinson's medications, but we haven't known if the disease itself leads to an increased risk of these behaviours," said study author Dr Daniel Weintraub. "These results provide further evidence that impulse control disorders that occur in people with Parkinson's disease are related to the exposure to the dopamine-related drugs, not just the disease itself," he said. "More long-term studies are needed to determine if the 20 per cent of people who have some symptoms of these disorders are more likely to develop impulse control disorders once they start treatment for Parkinson's."

The symptoms can be controlled by altering doses of medication but drugs should not be changed or stopped without help from medical professionals. Experts have said the behaviours are particularly associated with drugs known as dopamine agonists, but can also affect people who take other Parkinson's drugs, in particular levodopa.

Parkinson's symptoms are caused by a decrease in the levels of the chemical in the brain, dopamine, due to the death of the nerve cells in the brain that make it. Dopamine agonists act in a similar way to natural dopamine in the brain and are particularly effective against the movement symptoms of Parkinson's.

Article by Rebecca Smith, Medical Editor of The Telegragh, UK.

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COMMON BLOOD PRESSURE DRUGS MAY LOWER RISKS OF DEMENTIA

It was found that people who had taken blood pressure drugs, particularly a class known as beta blockers, showed fewer changes in the brain linked to Alzheimer's disease.

Findings of a new study were presented at the American Academy of Neurology Annual Meeting in San Diego. Researchers examined the brains of 774 men after they had died, 610 of whom had been treated for high blood pressure. Aroound one in seven of those had been given only beta blockers, 18% had received beta blockers and another drug and the others had been given different drugs. It was found that the men who had received beta blockers as their only blood pressure medication had fewer abnormalities in their brains compared to those who had not been treated for their hypertension, or who  had received other blood pressure medications. Those who had been given beta-blockers in combination with other drugs also had fewer brain leisons and less shrinkage but not to the same extent at those who had used them alone.        

In 2011, more than 30m prescriptions were dispensed for beta blockers in England, showing that millions of patients have used the drugs. Lead researcher Dr. Lon White, of the Pacific Health Research and Education Institute in Honolulu, said: "With the number of people with Alzheimer's disease expected to grow significantly as our population ages; it is increasingly important to identify factors that could delay or prevent the disease; these results are exciting, especially since beta blockers are a common treatment for high blood pressure."     

Earlier research has shown that high blood pressure in middle age is a strong risk factor for dementia. The number of people with dementia is expected to explode to 1.7m by 2050. Dr. Simon Ridley, head of research at Alzheimer's Research UK, said: "Hypertension is a known risk factor for Alzheimer's and other causes of dementia, and keeping high blood pressure in check could be important for preventing these diseases; this study suggests a link between the use of beta blockers and fewer signs of dementia, but as the results of this study have yet to be published in full, it is not clear what caused this link; it is important to note that this study only looked at Japanese-American men, and these results may not be applicable to the wider population; while we cant conclude from this study that beta blockers can prevent dementia, a better understanding of the links between high blood pressure and dementia could be crucial for developing new treatments or approaches to prevention; with 820,000 people affected by dementia in the UK, and that number increasing, we urgently need to find ways to prevent the disease that causes it - that requires a massive investment in research."

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HERBAL ALTERNATIVE TO VIAGRA DISCOVERED

A study found men with erectile dysfunction managed to improve their performance in the bedroom after taking the tablets for just a few weeks.

Although some previous studies have suggested ginseng can help tackle impotence, many have been conducted in mice. The latest research, carried out in South Korea, involved more than 100 men who had been diagnosed with erection problems. 

Impotence affects one in 10 men in the UK at some point in their lives. Although drugs such as Viagra, Cialis and Levitra have revolutionised treatment in the last 10 years, around 30 per cent of men who take them see no improvement.

While herbal remedies like ginseng have been touted as alternative treatments, the evidence to support their use has been lacking. Ginseng is a plant that has been used for thousands of years to bolster overall health. The root contains several active substances, called either ginsenosides or panaxosides, that are thought to be responsible for the medicinal effects of the herb. 

Scientists at the Yonsei University College of Medicine in Seoul, South Korea, recruited 119 men with mild to moderate erectile dysfunction. The group was split into two and while half took four tablets a day containing extracts of Korean ginseng berry, the rest took identical dummy pills. After eight weeks, researchers measured improvements by using a recognised scale called the International Index of Erectile Dysfunction. The results, published in the International Journal of Impotence Research, showed a small but significant improvement in sexual function in the ginseng group compared to those on the dummy tablets. In a report on their findings the researchers said: "Korean ginseng berry extract improved all domains of sexual function. It can be used as an alternative to medicine to improve sexual life in men."

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EARTH DAY: TO MEAT OR NOT TO MEAT?

Today we should pause and reflect on the survival of our planet; what we as an industrialized society have done to damage it and what we can do to repair it so that future generations can prosper as we have. A whole day to celebrate and bring awareness of the by-products of our civilization: deforestation, pollution, ozone depletion, the amount of garbage we generate every single day.

As individuals there are things we can do, such as recycle, use public transportation (or our own two feet), plant drought-resistant gardens to reduce water use, give up smoking, and even cutback on the amount of meat we eat. Blasphemous, you say? Given that we eat approximately 250 pounds of meat per person, per year, it probably is. But the effects of all that meat, not only on your digestive system and your waistline but on the world as a whole, is taking its toll.

An in-depth report by the United Nations Food and Agricultural Organization (FAO), titled Livestock's Long Shadow-Environmental Issues and Options, reported that cattle-rearing generates more global warming greenhouse gases, as measured in CO2 equivalent, than transportation (planes, trains and automobiles). Cattle-rearing is also a major source of land and water degradation. “Livestock are one of the most significant contributors to today’s most serious environmental problems,” senior U.N. official Henning Steinfeld said in support of the paper he co-authored. Livestock utilize approximately 30 percent of the Earth’s surface, mostly permanent pasture but also 33 percent of the global arable land. In some countries in South America, deforestation is taking place to make room for grazing land and the deforestation has an additional impact on our environment. It takes 2,400 gallons of water and 7 pounds of grain to raise 1 pound of beef.

While you and I both know that the act of giving up meat is probably not going to happen for most individuals, you can take a small step to minimize the impact that livestock has on our planet. How about going vegetarian one day a week? That’s not so hard is it? I’m not saying you have to learn to love tofu (although it is quite healthy for you), but there are so many alternatives. Switch to a hearty bean or vegetable soup, cheese lasagne or pasta primavera, portobello mushroom burger, bean and cheese enchiladas, an Asian stir fry over rice.

Try something new. Help save our planet.

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CANCER VICTIMS COULD BE HINDERING TREATMENT BY TAKING MULTIVITAMINS

Nutritional supplements containing antioxidants like vitamins A, C and E have long been the subject of debate in the field of cancer, with some studies suggesting they could offer moderate protection against cancer. But now Prof Watson, who with Francis Crick discovered the "double helix" structure of DNA in 1953, has argued that the pills could be doing more harm than good. In a new paper he claimed that the reason late stage cancers often become untreatable is that they produce high levels of antioxidants which stop treatments like chemotherapy and radiotherapy from working.

In healthy people antioxidants can be helpful because they attack molecules known as “free radicals” which can damage DNA. But many cancer treatments use free radicals to kill tumour cells, meaning antioxidants could prevent them doing their job. Prof Watson said studies should be carried out to test his theory which he described as "among my most important work since the double helix." Writing in the Royal Society's Open Biology journal, he said: "For as long as I have been focused on the understanding and curing [of] cancer, well-intentioned individuals have been consuming antioxidative nutritional supplements as cancer preventatives if not actual therapies. "In light of the recent data strongly hinting that much of late-stage cancer's untreatability may arise from its possession of too many antioxidants, the time has come to seriously ask whether antioxidant use much more likely causes than prevents cancer. "Blueberries [which are high in antioxidants] best be eaten because they taste good, not because their consumption will lead to less cancer."

Professor Nic Jones, Cancer Research UK’s chief scientist, said: “We know from many large studies that, far from being potent cancer-fighters, [antioxidant supplements] seem to be ineffective for cancer prevention in healthy people, and some can even slightly increase the risk of cancer. This should give people good reason to think twice about relying on them.”

Steve Williamson, consultant pharmacist and cancer spokesman for the Royal Pharmaceutical Society, added: “A lot of people having cancer treatment pick up on the idea of antioxidants which they have read might protect them against cancer. “I always advise patients not to take antioxidants while they are having chemotherapy in case it counteracts it.”

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BABIES WITH ANXIOUS MOTHERS 'FEEL MORE PAIN' DURING JABS

Psychologists found heightened levels of pain could come as a result of the mother's anxiety about the procedure. It suggested that new mothers could pass on their fears about vaccinations to their children, because the youngsters can sense their anxiety. ''Most mothers tend to feel a bit apprehensive about taking their baby to their first immunisations but for first-time mums it is a bit more daunting," said Dr Nadja Reissland, of Durham University, who led the study. ''These results show that a mother's anxiety and distress is somehow 'felt' by the baby, who in turn shows more pain. ''It is possible that first-time mothers get more stressed about taking their baby for their immunisations due to the unfamiliarity of the process, and how much pain they believe their babies are in could stop them from taking their babies for follow-up vaccinations." She added: "This could result in children having incomplete immunisations. ''It is important that first-time mothers feel reasonably comfortable about the experience to reduce theirs and their babies' anxiety.''

The preliminary study examined 50 mothers and their two-month-old babies during routine vaccinations. Researchers analysed the pain expression of the babies before, during and after the injections.

Infants of first-time mothers showed significantly more pain before the needle insertion as well as during the first vaccination, compared with children of experienced mothers.

After the procedure, mothers were asked to estimate the level of pain felt by their baby. The results, published in the Journal of Reproductive and Infant Psychology, further suggest that both new and experienced mothers overestimated their child's pain.

Dr David Elliman, immunisation expert for the Royal College of Paediatrics and Child Health, added: ''Vaccinating children is extremely important in order to protect them from infectious diseases. ''It's extremely common for children to become nervous just before doctors carry out these vaccinations, so the mother's behaviour during this time is very important in reducing the pain felt by their baby when being immunised – something this study emphasises.''

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OXYGEN BUBBLES INTO FACIAL CARE PRODUCTS

OXYGEN bars may be a relic of the late 1990s, but the element is popping up as a beauty-industry buzzword of the early 21st century — no plastic hose necessary.

The skin-care company Philosophy, known for its food-scented body washes and minimalist packaging, has begun selling Oxygen Boost Daily Energizing Oxygen Elixir, which will cost $24.50, and Take a Deep Breath Oil-Free Energizing Oxygen Gel Cream Moisturizer ($34). The company’s In-Home Oxygen Peel ($55) has been a top seller since its introduction in 1996, said Robin White, the director of international education and global press for Philosophy, adding: “Oxygen is known to give skin brightness and clarity. It works on clogged pores and dullness, and brings back radiance and freshness.” The new products contain a conditioning agent, perfluorodecalin, “which allows us to diffuse oxygen into the skin where it’s most needed,” Ms. White said. Natura Bissé, a skin-care company based in Barcelona, has been offering an oxygen-themed line of six products, including the addition of a jell ($85) and a foaming cleanser ($48), in October 2012. "As we age, the oxygen in our body is depleted, which results in lifeless skin," said Michael Ann Guthrie, vice president for retail for Natura Bissé. "Our oxygen products are based on stabilized hydrogen peroxide, which delivers molecules directly into the skin. This active ingredient breaks down into water and oxygen, and then supplies the skin with oxygen, which enables it to breathe." In 2009, the brand introduced a portable "oxygen bubble," a sealed environment purportedly containing 99.9% pure air that has been used as a promotional gambit before red-carpet events; V.I.P. customers have also been receiving complimentary treatments in the bubble as it floats through various spas, boutiques and luxury department stores. Bliss has also created a number of oxygen-infused products. In 2010 and 2011, they introduced the Triple Oxygen Instant Energizing Mask ($54), Triple Oxygen Instant Energizing Cleansing Foam ($28), and Instant Energizing Eye Mask ($50). In the spring of this year, two new items will be added to the line, including a rich oxygenating cream. The company's spas also offer two oxygen facials, a 75-minute treatment and a 30-minute one. Both promise luminosity, include an oxygen spray, and are among the spa's most popular, said Susan Grey, regional vice president of spa operations for New York Bliss Spas. "Oxygen increases circulation, which increases the delivery of nutrition to the skin, and gives your skin energy, it also kills bacteria which keeps post-facial breakouts away. As oxygen travels through the body, the skin is the last to receive it. So by the time it gets there, it's a little tired" she said. But not everyone is inhaling. "There is no evidence that oxygen can penetrate the skin or that it can stay in the product" said Dr. Bruce Katz, a clinical professor of dermatology at the Mount Sinai School of Medicine and the director of the Juva Skin and Laser Centre in New York. He added that very few products can penetrate the strtum corneum, the outer layer of the skin.

The word “oxygen” conveys cleanliness, freshness and revitalization, though, and that is probably why spas other than Bliss are adding it to their menus. The Kimara Ahnert Makeup Studio, at Madison Avenue and 83rd Street, offers three oxygen-themed treatments. As with a shot of espresso or wheatgrass at a beverage bar, you can also add an oxygen blast (an enriched serum spray with pure blue oxygen) to any facial.

Meanwhile, in Toronto, a company called Oxygen Pür produces Oxygen Pur Spa, a water oxygenation system used to transfer high levels of dissolved oxygen (20 to 30 times the average amount) into water for supposed anti-aging, beauty and therapeutic benefits. The Spa at Mandarin Oriental offers this system in its therapeutic vitality pools, and the company’s products in its oxygen facials.

As people age, their capillaries break down and there is less blood flow and less oxygen delivered to the skin, said Gerry Merz, the president and chief executive of Oxygen Pür, which also recently began selling oxygen-infused skin serums. “This lack of oxygen within leads to less collagen production, fine lines, wrinkles and age spots, " he said. “Our serums enter the dermis, and immediately elevate tissue-oxygen levels in excess of 15 times the norm."Mr. Merz cited a peer-reviewed paper published by the Canadian Journal of Physiology and Pharmacology in April, attesting that oxygen can indeed be absorbed into the skin. "Many practitioners haven't caught up to the advanced technology yet. The reason there are naysayers is because they're unaware of the research conducted. The biggest hurdle was creating the technology to deliver oxygen to the skin. The next hurdle is getting people to accept and understand it's real," he said.”  

Celeste Hilling, the chief executive of Skin Authority, a skin-care company in San Diego, is one cosmetics-industry professional who needs convincing; she believes better results can be achieved with other elements, like vitamin D or peptides. "Oxygen is an inert ingredient, meaning it's nonactive. We need it in the bloodstream to breathe and to live, but oxygen is what's ageing our skin. It's oxidizing it. Plus, skin can't absorb it," Ms. Hilling said.

The apothecary giant Kiehl’s is another dissenter. “Oxygen is a gas and cannot be incorporated as a stand-alone ingredient,” said Chris Salgardo, the company’s president. “Products on the market that speak to ‘oxygenating’ usually use hydrogen peroxide, or other ingredients that will generate oxygen as the product is applied to skin.” To obtain the benefits oxygenating products are typically used for, like dark spots, wrinkles, pore size and elasticity, Kiehl’s uses other ingredients like vitamin C and calcium. But products promising oxygen continue to make appearances. According to the NPD Group, a market research company, total oxygen-infused facial skin care products generated $4.1 million in department store sales from January through October 2012 in the United States, an increase of 54%, compared with the same time in 2011. "Oxygen is appealing in concept because everyone knows it's very good for you, but it's not clear that adding oxygen to the skin is going to improve someone's appearance. We also get enough oxygen to our skin by having healthy lungs and not smoking" said Dr. Jeffrey Spiegel, a facial plastic surgeon and the director of advanced facial aesthetics in Chestnut Hill, Mass.

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REALLY? SUGAR-FREE GUM HELPS PREVENT CAVITIES?

THE FACTS

Cleans and protects teeth. Helps prevent cavities. So say the most popular brands of sugar-free gum. But do their claims stand up to scrutiny?

Many brands contain an additive called xylitol, a natural sweetener known to fight cavity-causing bacteria. In practice, though, it’s not clear that xylitol has much impact. Some research suggests that while sugar-free gum does prevent cavities, xylitol per se is not responsible. Instead, it is the act itself of chewing gum that seems to prevent cavities. 

One new study, published this month in The Journal of the American Dental Association, seems to confirm this. The largest and most thorough look at the subject to date, the study tracked 691 adults recruited from dental clinics around the country for three years. The subjects were randomly assigned to groups consuming xylitol lozenges five times a day or a similar tasting placebo.

Ultimately, those who received the xylitol had no statistically significant reduction in cavities, a finding that came as a surprise, said Dr. James D. Bader of the University of North Carolina at Chapel Hill. “We assumed there was a reasonably good chance that xylitol was going to be effective,” he said.

While xylitol itself may not be so protective, the increased salivary flow caused by chewing gum may be beneficial, as it rinses away plaque and acid. And chewing sugar-free gum beats chewing gum made with sucrose, which is definitely detrimental, Dr. Bader said.

THE BOTTOM LINE

There is evidence that sugar-free gum reduces cavities, though that may have nothing to do with the gum’s additives.

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LEGALISING OF MARIJUANA RAISES HEALTH CONCERNS

In the ’60s, marijuana was a hallmark of the counterculture, along with free love, bell bottoms, long hair and bandannas. But marijuana has had the most staying power.

This month, in a remarkable first, the recreational use of marijuana became legal (depending on your definition) in Colorado and Washington. Over a dozen other states have decriminalized possession of small amounts, and Massachusetts recently became the 18th state to allow its use for medicinal purposes. Though federal law still bans both the sale and possession of marijuana, President Obama has said the federal government has “bigger fish to fry” and won’t aggressively prosecute tokers in states where its use is legal.

The rise of marijuana as an adult pastime is a victory for those who’ve always felt that its hazards were overblown. Proponents of legalization argue that marijuana is much safer to use than alcohol, pointing out that it is virtually impossible to overdose on marijuana.

While marijuana can be addictive, scientists generally agree that fewer than 10 percent of marijuana smokers become dependent on the drug, compared with 15 percent for alcohol, 23 percent for heroin and 32 percent for tobacco. Marijuana does contain carcinogens, including tar and other toxins similar to those found in tobacco, but people generally do not smoke marijuana in the same amounts as cigarettes.

Still, legalization takes health consumers into murky territory. Even though marijuana is the most commonly used illegal drug in the United States, questions about its health effects remain.

For starters, this is not your parents’ pot. Today’s marijuana is much more potent: The mean concentration of THC, the psychoactive ingredient, in confiscated cannabis more than doubled between 1993 and 2008. 

Increased potency may be having unforeseen consequences. The human brain’s cannabinoid receptors are typically activated by naturally occurring chemicals in the body called endocannabinoids, which are similar to THC. There is a high density of cannabinoid receptors in parts of the brain that affect pleasure, memory and concentration. Some research suggests that these areas continue to be affected by marijuana use even after the “high” dissipates.

“It’s much more potent marijuana, which may explain why we’ve seen a pretty dramatic increase in admission to emergency rooms and treatment programs for marijuana,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. “When we hear, ‘Well, I smoked and nothing happened to me,’ we need to think about the context of when these people started to take it, how frequently they used and how active the marijuana was.”

Those in favor of legalizing marijuana say the increase in potency has been exaggerated, and that when users have more powerful pot, they adjust their consumption and actually smoke less.

Teenagers may be more vulnerable to addiction, however, and those who start smoking pot at a younger age are at higher risk. Approximately one in six will become addicted, Dr. Volkow said. Young adults who start smoking marijuana at earlier ages also tend to smoke much more, and more often, than those who start in their later teens, researchers say.

In users who develop a dependence or addiction, quitting can cause intense withdrawal symptoms, like anxiety, trouble sleeping, lack of appetite, mood swings, irritability and depression, experts say.

Both Colorado and Washington restricted marijuana use to adults age 21 and over when they legalized recreational use in November. But experts worry that the perception of marijuana is changing because its stigma as an outlawed drug has eroded. “When people can go to a ‘clinic’ or ‘cafe’ and buy pot, that creates the perception that it’s safe,” said Dr. A. Eden Evins, director of the Center for Addiction Medicine at Massachusetts General Hospital in Boston. “Before we unleash the powers of the marketplace to woo people to use this addictive substance, we need to better understand who is at risk. Once moneyed interests are involved, this trend will be difficult to reverse,” she added.

The most disturbing new studies about early teenage use of marijuana showed that young adults who started smoking pot regularly before they were 16 performed significantly worse on cognitive tests of brain function than those who had started smoking later in adolescence. They performed particularly poorly on tests assessing executive function, which is responsible for planning and abstract thinking, as well as understanding rules and inhibiting inappropriate responses.

Imaging scans also found detectable differences in how their brains worked, said Staci Gruber, the lead author of these studies and director of the cognitive and clinical neuroimaging core at the imaging center at McLean Hospital in Boston. Imaging scans found alterations in the frontal cortex white matter tracts of the brain in the early-starters, she said, that are associated with impulsiveness. “The frontal cortex is the last part of the brain to come online, and the most important,” Dr. Gruber said. “Early exposure perhaps changes the trajectory of brain development, such that ability to perform complex executive function tasks is compromised.”

A recent study showing a drop in IQ scores among teenagers who are regular pot smokers is especially troubling, Dr. Evins said. A more recent study found that people who started smoking marijuana as teenagers and used it heavily for decades lost IQ points over time, while those who started smoking as adults did not, though some critics have said these differences may not be meaningful. Older survey studies had indicated that regular pot smokers were less likely to graduate from high school or pursue higher education, but it was never clear which came first, difficulty in school or the drug use. “If parents who are spending thousands of dollars on SAT prep courses knew about the cognitive effects marijuana has on their kids’ brains, they would be up in arms,” Dr. Evins said. Other health concerns about marijuana are less well documented but may turn out to be significant. States that legalized marijuana prohibit driving under its influence, and studies have found marijuana smoking increases weaving between lanes and slows reaction times. And although marijuana is not as damaging to the lungs as tobacco, in part because people do not smoke a pack of joints a day, a regular habit can eventually take a toll on the lungs.

At the very least, the new studies suggest parents who recall their own pot parties may want to suggest greater moderation to their children. And teenagers who insist on trying marijuana are better off waiting until they’re older. “It’s the same message as with alcohol,” Dr. Gruber said. “Just hold on, it’s worth it to wait.”

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STAND UP AT THE OFFICE TO LOSE WEIGHT

Exercise expert recommends Ernest Hemingway's style of writing standing up

Office workers trapped behind their desks all day should push away their chairs and work standing up, recommends an exercise scientist.

Standing up for three hours extra a day would burn off 8lb (3.6kg) of fat each year, says John Buckley, from the University of Chester. Leading by example, Dr Buckley is using a standing desk which is believed to date from the 1940s. "There is no need to sit down so much," says Dr Buckley. Anyone feeling Christmas-pudding shaped after the holidays should consider standing rather than sitting at work, says Dr Buckley.

There are custom-made computer desks for anyone wanting to stand as they answer their emails - or else old desks can be set at a height for standing.

Upright language

This upright stance was championed by Ernest Hemingway, whose vigorous prose was matched by this more physical approach to writing. John Buckley demonstrates working on his laptop standing up. "Writing and travel broaden your ass if not your mind and I like to write standing up," wrote Hemingway in a letter in 1950. Vladimir Nabokov was another writer who preferred to stand.

Dr Buckley, from the department of clinical sciences and nutrition, says that switching from chairs to working standing up will reduce obesity and improve circulation. Standing up for three hours will consume 144 calories, he says. "People are sitting down at work, then sitting in the car and then sitting down in front of the television," says Dr Buckley. "Your metabolic rate crashes to an absolute minimum. "It isn't natural. Humans are designed to stand up and keep moving."

Dr Buckley is part of an advisory group, working with England's chief medical officer on responses to obesity.

There have been several recent reports warning about the sedentary nature of work and recreation.

A study in the autumn made a strong connection between too much sitting down and an increased risk of diabetes.

A previous study warned that a sedentary lifestyle could be causing as many deaths as smoking.

Dr Buckley says that regular changes in the workplace can make a long-term improvements. "It's little changes in behaviour... such as standing at your desk that can add up to make quite a big difference to your health," he says.

By Sean CoughlanBBC News education correspondenT
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