Fat, pregnant or both?

"I'm not fat, I'm pregnant!" Actually, some women may be both but there are currently no UK guidelines to help midwives and women define how much is too much when it comes to weight gain during pregnancy.

    In this week's Scrubbing Up, Bridget Benelam from the British Nutrition Foundation says there needs to be clear advice on weight control for pregnant women.

Nearly half of women of childbearing age are overweight or obese in the UK and this means there are increasing numbers of obese pregnant women. But spotting those mothers whose bumps are due to fat as well as baby is difficult, not least because there are no UK guidelines on how much weight women should gain during pregnancy.
Pregnancy weight gain varies and depends on many things - including the weight of the baby, the amount of amniotic fluid and the mother's increased blood volume - as well as body fat. Some additional fat is stored during pregnancy to provide a reserve for breast feeding when the baby is born.
But excessive weight gain during pregnancy carries health risks for the mother and child. It also makes the delivery of the baby more difficult, with caesarean sections and forceps deliveries more common. All this puts a strain on an already stretched maternity service.
Despite the common idea that women need to "eat for two" when pregnant, there is actually only a small number of extra calories needed in pregnancy.
No extra calories are needed during the first 28 weeks of pregnancy and only an extra 200kcal per day are required during the last 12 weeks, the equivalent of two small slices of bread.
In a survey of over 6,000 women carried out by the Royal College of Midwives and NetMums last year, 61% said their midwife did not have enough time to discuss their concerns about weight management and nutrition, meaning many women may embark on pregnancy without having discussed how to manage their weight at this important time.

And whilst there is a clear need for readily available advice, guidance is lacking.

Current recommendations in England from NICE (National Institute for health and Clinical Excellence ) do not address the issue of how much weight gain is healthy in pregnancy. Indeed, they flag up the need for UK-specific guidance.
These guidelines, issued in 2010, do say that women who are overweight or obese should be encouraged to lose weight before trying for a baby.
However, they say once a woman is pregnant, she should not be encouraged to diet to lose weight as this may harm the health of the growing baby and so women should follow a healthy diet and be physically active.
But what does this mean in practice?
In the US, guidelines go further.
The Institute of Medicine sets out what is a healthy weight gain - 25 to 35 pounds (11.5 to 16kg) during pregnancy for women at a normal weight for their height.
And it says overweight and obese women should gain less weight during pregnancy than lean women. For example, no more than 20 pounds (9kg) for the most obese.
Pregnancy is a window of opportunity where women are particularly interested in looking after their health and that of their growing baby.
Getting the right help and advice about weight control to pregnant women (and those planning a pregnancy) could help to reduce the risks to both mums and their babies, and also help mitigate the strain that obesity in pregnancy puts on the health service.
But midwives need support in delivering this advice on weight control, something they may never have been trained to provide. Arming them with clear guidance would be a good place to start.

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Chocolate may protect the brain and heart

Eating high levels of chocolate could reduce the risk of coronary heart disease and stroke, according to a review of previous research.

    Data from 114,009 patients suggested risk was cut by about a third, according to a study 
But the researchers warned that excessive consumption would result in other illnesses.
The British Heart Foundation said there were better ways to protect the heart.
The analysis, conducted by scientists at the University of Cambridge, compared the risk to the brain and heart in groups of people who reported eating low levels of chocolate, fewer than two bars per week, with those eating high levels - more than two bars per week.
Chocolate shield It showed that the "highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with the lowest levels".

Victoria Taylor British Heart Foundation

One of the researchers, Dr Oscar Franco, said chocolate was known to decrease blood pressure.

He told the BBC the findings were "promising", but needed further research to confirm any protective effect.
The study also warns that chocolate can lead to weight gain and Type 2 diabetes. It suggested that chocolate could one day be used to protect from heart problems and stroke - if the sugar and fat content of chocolate bars was reduced.
Dr Franco added: "The advice if you don't eat chocolate is not to start eating chocolate."
For those who did eat chocolate, he recommended that they should "avoid binge-eating" and eat "small amounts [of chocolate] on a regular basis".
Victoria Taylor, senior heart health dietician at the British Heart Foundation, said: "Evidence does suggest chocolate might have some heart health benefits but we need to find out why that might be.
"We can't start advising people to eat lots of chocolate based on this research.
"It didn't explore what it is about chocolate that could help and if one particular type of chocolate is better than another.
"If you want to reduce your heart disease risk, there are much better places to start than at the bottom of a box of chocolates."

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Future heart health 'shaped by diet'

Growing up starved of calories may give you a higher risk of heart disease 50 years on, research suggests.

     Researchers in The Netherlands tracked the heart health of Dutch women who lived through the famine at the end of World War II.
Those living on rations of 400-800 calories a day had a 27% higher risk of heart disease in later life.
It's the first direct evidence early nutrition shapes future health,
The Dutch famine of 1944-45 gave researchers in Holland a unique opportunity to study the long-term effects of severe malnutrition in childhood and adolescence.
A combination of factors - including failed crops, a harsh winter and the war - caused thousands of deaths among people living in the west of The Netherlands.
The women, who were aged between 10 and 17 at the time, were followed up in 2007.
The team, from the University Medical Center Utrecht and the University of Amsterdam, found those who were severely affected by the famine had a 27% greater risk of developing heart disease than those who had had enough to eat.
Diet impact
Lead author Annet van Abeelen told the BBC: "The most important message is that it is good to realise that disturbing the development of children through acute malnutrition can have implications for later adult health.
"It's not only the short-term direct consequences that matter. Even 50 years later, there is still a higher risk of adult coronary heart disease."
Victoria Taylor, senior heart health dietitian for the British Heart Foundation, said: "This study showed a link between children and young adults experiencing famine and the likelihood of them developing heart disease later on in life.
"Although it wasn't clear exactly what changes occurred in the body to increase the risk, this highlights how our environment can have a long-term impact upon our heart health.
"Fortunately, the problems of famine seen in other countries have not been an issue in the UK in recent times. But that doesn't make this study irrelevant for us.
"It adds to the importance of providing a healthy diet for children and young people because of the way it can shape their future heart health."

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Cholera pandemic has a single global source

                      How cholera has spread from the Bay of Bengal

A major cholera pandemic has spread in at least three waves from a single global source: the Bay of Bengal.

   A study in Nature  reveals cholera's spread over the last 60 years into Asia, Africa, Europe and the Americas, continent-hopping on long-haul flights.
The research by a team from Cambridge's Sanger Institute showed the infection is evolving, with the newest waves showing antibiotic resistance.
A UK expert said it was "a scandal" cholera was still affecting people.
Cholera is a bacterial infection of the intestine that causes diarrhoea. It affects 3-5m people annually in 56 countries, killing between100,000 and 150,000.
If untreated, it can kill within hours through dehydration. It is easily treated by drinking clean water, but without this, severe cases have a 30-50% mortality rate.
'Only explanation' In this study, the researchers sequenced the genome of 154 samples collected from patients around the world. Genome sequencing technologies have been getting better, faster and cheaper. Until recently, sequencing would be carried out on just four or five bacteria samples.
Similarities between cholera genomes showed how the various strains are related, while subtle differences showed how it is evolving.
By investigating these bacteria at the genetic level, the authors were able to piece together the story of the latest, and ongoing, global cholera pandemic.
"We were surprised to see that the pattern we see is very clear. All of the samples were related. There is a single global source of cholera in the Bay of Bengal," said co-author Dr Nick Thomson of the Sanger Institute.
It is not yet clear why the Bay of Bengal is at the centre of the pandemic, though cholera bacteria exist naturally within some marine ecosystems.
The local ecology, climate, and the presence of large river deltas are likely to be key factors in its presence there.
The results show several cases of cholera suddenly jumping between continents, suggesting that it was spread by passengers on long-haul flights.
"I think that's the only possible explanation. Our data show that this has happened, for example from Angola to South America.
"Many people can have cholera with no symptoms, so they transmit it without realising," added Dr Thomson.
'One fell swoop' The most recent outbreak is in Haiti where it took hold shortly after the 2010 earthquake after being absent for more than a century.
So far it has killed nearly 6,000 people and hospitalised 200,000.

Dr Valerie Curtis London School of Hygiene & Tropical Medicine

A recent report by the US Centre for Disease Control and Prevention linked this outbreak to the arrival of UN troops from Nepal, a finding supported by this study. In November 2010, the UN issued an appeal for $160m to fight the spread of the cholera in Haiti.

Another worrying pattern emerged from the genome analysis. Three waves of cholera have come out of the Bay of Bengal since the 1950s, and from the second wave onwards, all of the strains were antibiotic resistant.
That means that the resistance was acquired within 15 years of the first clinical use of antibiotics tetracycline and furazolidone for cholera treatment.
Dr Thompson said: "I'm not surprised it happened so fast. We think that antibiotic resistance moves between strains, and in one fell swoop a strain can become multi-resistant."
"Antibiotics are clearly one of the major driving forces in cholera evolution. However, in general antibiotics just reduce the length of infection in people."
Dr Valerie Curtis of the London School of Hygiene & Tropical Medicine said: "It's an appalling scandal that in the 21st century people are still suffering from this ancient disease.
"Cholera is symptomatic of countries where something has gone badly wrong, where the infrastructure of sanitation and clean water has broken down. This is really about poverty.
"What this study shows is that it's easy for pockets of poverty in Africa to affect pockets of poverty in the Americas, for example. It's almost impossible to stop the spread of such diseases but what we must do is invest in the public health of poor countries."

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US scientists 'knew Guatemala syphilis tests unethical'

US government scientists who infected Guatemalans with syphilis and gonorrhoea as part of a study knew they were violating ethical rules, a US presidential panel has said.

The researchers infected hundreds of prisoners, psychiatric patients and sex workers during the 1940s to study the effects of penicillin.
None of the Guatemalans was informed.
But many of the same scientists had sought consent from participants in an earlier study in the US.
Dr Amy Gutmann, head of the Presidential Commission for the Study of Bioethical Issues, called the research a "shameful piece of medical history".
"It is important that we accurately document this clearly unethical historical injustice. We do this to honour the victims," she said in a statement.
Morally wrong Guatemala's Vice President Rafael Espada told the BBC that his government would make a formal apology to the Guatemalan people as local doctors had also been involved in the US-funded programme.
"We want to share this tragedy with the whole world," he said.

Dr Amy Gutmann Chair of the Commission

The Commission said some 5,500 Guatemalans were involved in all the research that took place between 1946 and 1948.

Of these, some 1,300 were deliberately infected with syphilis, gonorrhoea or another sexually transmitted disease, chancroid.
And of that group only about 700 received some sort of treatment.
According to documents the commission had studied, at least 83 of the 5,500 subjects had died by the end of 1953.
The commission was unable to say whether any of those deaths were caused directly or indirectly by the deliberate infections.
But Dr Gutmann lambasted those responsible for the research.
"Those involved in the study failed to show a minimal respect for human rights and morality in the conduct of research," she said in her concluding remarks to the panel.
She said many of the actions were "grievously wrong" and those individuals behind the study were "morally culpable to various degrees".
"Civilisations can be judged by the way they treat their most vulnerable... we failed to keep that covenant," she said.
Lessons from history In the 1940s, sexually transmitted diseases were a major health threat.
Many of the same researchers had carried out studies on prisoners in Terre Haute in the US state of Indiana.
But in that case, the panel said, the researchers fully informed patients of what would be happening and gave them informed consent forms to sign.
In Guatemala, patients were told "little to nothing" and there were no consent forms.
US President Barack Obama set up the commission when the research first came to light last year.
He also apologised to his Guatemalan counterpart, Alvaro Colom, saying the acts ran contrary to American values.
The commission is due to publish its first report next month outlining the historical facts.
Its final report, due to be completed in December, will examine the ethical issues involved and will aim to make sure such incidents never happen again.
Earlier this year, a group of Guatemalans who were involved in the study announced they were suing the US government over the affair.

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New body 'liquefaction' unit unveiled in Florida funeral home

             Resomation founder Sandy Sullivan explains how the machine works

A Glasgow-based company has installed its first commercial "alkaline hydrolysis" unit at a Florida funeral home.

    The unit by Resomation Ltd is billed as a green alternative to cremation and works by dissolving the body in heated alkaline water.
The facility has been installed at the Anderson-McQueen funeral home in St Petersburg, and will be used for the first time in the coming weeks. It is hoped other units will follow in the US, Canada and Europe.
The makers claim the process produces a third less greenhouse gas than cremation, uses a seventh of the energy, and allows for the complete separation of dental amalgam for safe disposal.
Mercury from amalgam vaporised in crematoria is blamed for up to 16% of UK airborne mercury emissions, and many UK crematoria are currently fitting mercury filtration systems to meet reduced emission targets.
"Resomation was developed in response to the public's increasing environmental concerns," company founder Sandy Sullivan told BBC News. "It gives them that working third choice, which allows them to express those concerns in a very positive and I think personal way."
The installation was only made possible after the state legislature in Florida approved the use of the technology, one of seven US states in which the process has now been legalised.
The system works by submerging the body in a solution of water and potassium hydroxide which is pressurised to 10 atmospheres and heated to 180C for between two-and-a-half and three hours.
Body tissue is dissolved and the liquid poured into the municipal water system. Mr Sullivan, a biochemist by training, says tests have proven the effluent is sterile and contains no DNA, and poses no environmental risk.
The bones are then removed from the unit and processed in a "cremulator", the same machine that is used to crush bone fragments following cremation into ash. Metals including mercury and artificial joints and implants are safely recovered.
The machine is patented in Europe with patents pending in other countries.
Legislative hurdle Alkaline hydrolysis has been used in the past to dispose of medical cadavers and farm animals.
Last year, Aquamation Industries of Australia disposed of several bodies in Queensland using a rival alkaline hydrolysis machine. The same design was also used in Ohio earlier this year to dispose of 19 bodies until a state court shut it down, ruling that the process was not compliant with state law.
Mr Sullivan, whose company is now majority owned by Co-operative Funeralcare, claims his machine will provide a more efficient and quicker process. He also believes the equipment can rival cremation for cost, particularly given the expense of fitting mercury abatement systems.
He is now pressing for legislative changes in the UK to make alkaline hydrolysis a reality in Britain.
"The installations in the US will assist in that process because many of the leaders in the funeral industry are coming to see this unit functioning in the next couple of months once it's running," said Mr Sullivan.
"Once they see the unit running, see the process and how dignified, respectful, quiet and quick it is, they will help to push through legislative change in the UK."
Freeze drying Another "green" alternative to cremation is in the pipeline. Susanne Wiigh-Masak, a Swedish biologist, has for a decade proposed a technology she calls Promession.
The process involves a fully automated and patented machine. Coffins are fed in one end, and the body removed from the coffin within the unit and then treated with liquid nitrogen.
The body is then vibrated until the body fragments, after which the remains are dried and refined further, and then passed through filters to remove metals, including dental amalgam. The remains are then poured into a square biodegradable coffin, again automatically, for shallow burial.

Swedish biologist Susanne Wiigh-Masak explains how "promession" works, and how the idea evolved

For Ms Wiigh-Masak, it is all about preparing the body for this shallow burial, a process which says is akin to composting. It was in her garden on the island of Lyr on Sweden's west coast, that the idea came to her.
"It only takes two to three weeks before the kitchen and garden waste is soil so this is what inspired me to really see if not only the kitchen and garden waste but also everything organic, including us, could be treated this way to really become soil," she told BBC News.
So far, the technology has only been tested on pigs, with one pig even being fitted with a hip replacement prior to death, to test the efficacy with which the metal joint could be removed during the process.
Ms Wiigh-Masak is now confident commercial operations will begin soon, after the Swedish government promised to introduce new legislation that would allow individuals to use a "burial tax" paid by all Swedes not just for cremation and burial, but also for Promession.
Designs are complete, manufacturers appointed, and four potential sites in Sweden have been earmarked for facilities.
She says 60 countries around the world have expressed an interest in the technology, including councils in England such as Crewe and Nantwich Council and Cambridge City Council (who have also held discussions with Resomation Ltd).
Many individuals have already signed up for the process. The bodies of about a dozen people - including Ms Wiigh-Masak's late parents - are being held in cold storage because, prior to their deaths, they signalled their desire to undergo the process.

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Bad sleep ups blood pressure risk

Elderly men who spend little time in deep sleep could be at risk of developing high blood pressure, according to US scientists.

   A study on 784 patients, in the journal Hypertension, showed those getting the least deep sleep were at 83% greater risk than those getting the most.
Researchers say they would expect a similar effect in women.
The British Heart Foundation said it was important for everyone to prioritise sleep.
High blood pressure - also known as hypertension - increases the risk of heart attack, stroke and other health problems.
Researchers measured the "sleep quality" of 784 men over the age of 65 between 2007 and 2009. At the start none had hypertension, while 243 had the condition by the end of the study.
The patients were split into groups based on the percentage of time asleep spent in deep, or slow wave, sleep. Those in the lowest group - 4% deep sleep - had a 1.83-fold increased risk of hypertension compared with those in the highest group, who spent 17% of the night in deep sleep.

Natasha Stewart British Heart Foundation

One of the report's authors, Professor Susan Redline from Harvard Medical School, said: "Our study shows for the first time that poor quality sleep, reflected by reduced slow wave sleep, puts individuals at significantly increased risk of developing high blood pressure.

"Although women were not included in this study, it's quite likely that those who have lower levels of slow wave sleep for any number of reasons may also have an increased risk of developing high blood pressure."
The report said further studies were needed to determine if improving sleep could reduce the risk.
Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: "Whilst this study does suggest a link between lack of sleep and the development of high blood pressure, it only looked at men aged over 65.
"We would need to see more research in other age groups and involving women to confirm this particular association.
"However, we do know more generally that sleep is essential for staying healthy. It's important we all try to make sleep a priority and get our six to eight hours of shut-eye a night."

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Opticians 'should offer blood sugar checks'

Opticians should offer blood sugar checks alongside eye tests to help spot patients with undiagnosed diabetes, experts propose.

A simple finger prick blood test in this setting could identify hundreds of thousands of people with type 2 diabetes, according to researchers.
A pilot study in northern England found the targeted screening picked up one case for every 100 people tested.
This would capture people who do not routinely visit their GP, experts say.
The Department of Health said people in England aged 40 to 72 were offered a check for diabetes alongside other vascular diseases as part of the NHS Health Check programme.
Under-diagnosed In the UK, 850,000 people are thought to have type 2 diabetes without knowing it, while another 2.5 million people are diagnosed.

Lead researcher Dr Jenny Howse

While universal screening is not currently recommended, Durham University researchers say there is a case for targeted screening.

In their study, published in the British Journal of General Practice, they asked five optometry practices to start offering finger prick tests to any customers attending for an eye check who had one or more risk factors of diabetes, such as increased body mass index or being aged over 40.
Out of nearly 2,000 customers, two-thirds were offered the blood test, and about half consented and had the check.
Of the 1,000 tested, a third were found to have abnormally high sugar levels in their blood suggestive of diabetes and were advised to visit their doctor for further tests.
162 people took the advice and went to see their GP, and of these 138 said they were sent for more investigations.
And this led to nine people being diagnosed with pre-diabetes and seven with diabetes.
Dr Jenny Howse, who led the research along with colleagues at The James Cook University Hospital in Middlesbrough, said: "The screening test is less invasive and time consuming than fasting blood glucose and oral glucose tolerance tests.
"Already pharmacists and chiropodists have shown it is feasible to offer screening in their practices, here in the UK as well as in Australia and Switzerland.
"In the US, 60% of adults visit dentists at least once a year for standard check-ups and those practices could be suitable locations to screen for diabetes.
"In the UK, our initial results show screening for diabetes in opticians is a feasible option but we now need to look at the practicalities of delivering it, including liaison between opticians and GPs and the time costs for opticians."
'Can be misleading' But the charity Diabetes UK does not recommend finger prick tests for risk assessment.
A spokesman said: "Finger prick tests on their own can be misleading.
"Blood glucose levels can vary in all individuals during any given day, and these tests also do not factor in other risk factors for developing Type 2 diabetes, such as having a large waist or a family history of the condition.
"People with one of more risk factors may be falsely reassured if they have a normal glucose reading.
"Also, a positive diagnosis can cause anxiety if someone does not have access to information and advice provided by a trained healthcare professional at hand."
But he said a commitment to finding new ways of diagnosing diabetes early was "always positive".

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Coral could hold key to sunscreen pill

Scientists hope to harness coral's natural defence against the sun's harmful ultraviolet rays to make a sunscreen pill for humans.

    The King's College London team visited Australia's Great Barrier Reef to uncover the genetic and biochemical processes behind coral's innate gift.
By studying a few samples of the endangered Acropora coral they believe they can synthetically replicate in the lab the key compounds responsible.
Tests on human skin could begin soon.
Before creating a tablet version, the team, led by Dr Paul Long, plan to test a lotion containing the same compounds as those found in coral.
To do this, they will copy the genetic code the coral uses to make the compounds and put it into bacteria in the lab that can rapidly replicate to produce large quantities of it.

Lead researcher Dr Paul Long

Dr Long said: "We couldn't and wouldn't want to use the coral itself as it is an endangered species."

He said scientists had known for some time that coral and some algae could protect themselves from the harsh UV rays in tropical climates by producing their own sunscreens but, until now, they didn't know how.
"What we have found is that the algae living within the coral makes a compound that we think is transported to the coral, which then modifies it into a sunscreen for the benefit of both the coral and the algae.

"Not only does this protect them both from UV damage, but we have seen that fish that feed on the coral also benefit from this sunscreen protection, so it is clearly passed up the food chain."
This could ultimately mean that people might be able to get inbuilt sun protection for their skin and eyes by taking a tablet containing the compounds. But for now, Dr Long's team are focusing their efforts on a lotion.
"Once we recreate the compounds we can put them into a lotion and test them on skin discarded after cosmetic surgery tummy tucks.
"We will not know how much protection against the sun it might give until we begin testing.
"But there is a need for better sunscreens."
Another long-term goal of the Biotechnology and Biological Sciences Research Council-funded study is to look at whether the processes could also be used for developing sustainable agriculture in the Third World.
The natural sunscreen compounds found in coral could be used to produce UV-tolerant crop plants capable of withstanding harsh tropical UV light.

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UK stem cell stroke trial passes first safety test

The world's first clinical trial of brain stem cells to treat strokes is set to move to its next phase.

     An independent assessment of the first three patients to have had stem cells injected into their brain at Glasgow's Southern General Hospital has concluded it has had no adverse effect.
The assessment paves the way for the therapy to be tested on more patients to find a new treatment for stroke.
The hope is that the stem cells will help to repair damaged brain tissue.
The trial is being led by Prof Keith Muir of Glasgow University. He told BBC News that he was pleased with the results so far.
"We need to be assured of safety before we can progress to trying to test the effects of this therapy. Because this is the first time this type of cell therapy has been used in humans, it's vitally important that we determine that it's safe to proceed - so at the present time we have the clearance to proceed to the next higher dose of cells."
An elderly man was the first person in the world to receive this treatment last year. Since then it has been tried out on two more patients.
Global trials
The patients have received very low doses of stem cells in trials designed to test the safety of the procedure.

Michael Hunt Reneuron Group

Over the next year, up to nine more patients will be given progressively higher doses - again primarily to assess safety - but doctors will also be using this clinical trial to assess the best ways of measuring the effectiveness of the treatment in subsequent larger trials, which would not begin for at least 18 months.

Critics object as brain cells from a foetus were originally used to create the cell treatment. Michael Hunt, Chief Executive Officer of the company that produced the stem cells, Renuron, said that the technology used to grow the cells is such that no further foetal tissue will be required.
There are a growing number of well-regulated clinical trials of stem cell treatments now under way in various parts of the world, including one which also began last year by the US firm Geron to develop a treatment for paralysis.
The development of stem cell treatments is still at an early stage and it is likely to be many years before these treatments become widely available. According to Mr Hunt:
"The earliest a treatment could be widely available if everything goes very well is five years. It is very much a case of so far, so good. It is still at a very early stage but we draw great comfort from these results."
Strokes kill about 67,000 people in the UK every year, according to the Stroke Association.
The charity says it is the third most common cause of death in England and Wales after heart disease and cancer.

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Health Focus: Acne agony

Dr Susannah Hoey, Consultant Dermatologist at the Royal Victoria Hospital, gives advice on acne treatments.

Most of us, at some stage of our lives, will get the odd spot. But for others it can be more problematic.
In fact, for those who suffer from acne it can mean years of feeling self-conscious or inferior.
This week on Health Focus, our Health Correspondent Marie-Louise Connolly talks to Dr Susannah Hoey, a Consultant Dermatologist at the Royal Victoria Hospital in Belfast who gives advice on dealing with skin problems.
We also find out how young people cope with acne.
The most common cause of acne is hormonal changes. From puberty, the body starts to produce sexual hormones, known as androgen.
These changes cause most adolescents, both male and female, to experience some form of acne, ranging from very mild to moderate.
However, in some cases the acne can be quite severe, resulting in permanent scaring of the skin.
Acne problems disappear for most people when they reach adulthood and hormone levels begin to regulate again.
For others, they have acne into adulthood but for a small minority, it never goes away.

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Teenager on acne treatment dies

A 14-year-old boy has died after taking for the first time a medical treatment for acne prescribed by his doctor.

Shaun Jones, of Rhydyfelin, Pontypridd, died after suffering a suspected allergic reaction to the tablets.
The promising rugby player developed breathing difficulties and collapsed after taking the pills.
His family said his death had left a "great hole" in the lives and have declined to name the acne treatment until medical tests are completed.
Acne medication does warn of the dangers of potential allergic respiratory tract and skin reactions, but deaths are described as very rare.
An inquest has been adjourned to await further investigations into his death, which happened on 21 October.
His father Graeme Jones said: "It is unbelievable. He was a strong, fit lad and was loved by everyone.
"He was popular with the girls and had a couple of spots, so the doctor gave him some antibiotic acne tablets. A lot of his friends are taking them.
"It was the first time he'd taken them and he developed breathing difficulties.
"We called 999 and he went to hospital - but it was too late. The doctors couldn't save him.
"The doctor that gave him the tablets is really upset, but we don't blame him. It was just one of those terrible things.
"We're still coming to terms with losing him. One minute he was here and now he's gone.
"Shaun's little sister is devastated. She can't bear to leave our sides because she thinks something will happen to us too."
Shaun played for his village rugby team, Rhydyfelin RFC, and the Pontypridd schools team and won the most improved player in the latest club awards.
'Dedicated and talented'
"He was one of those boys that didn't stop," said his father. "He'd come back from rugby training then race out again to be with his mates. He had so much energy.
Rhydyfelin coach Dai Watkins said: "He was an awesome player whose name was first on the teamsheet.
"The fact that he was so so fit and strong makes it all the harder to take. He was so dedicated and talented."
Shaun's funeral will be held on Thursday, where friends and team-mates have been asked to wear colourful rugby or sports shirts to celebrate his life.
Classmates at Hawthorn High School in Pontypridd, where Shaun was a pupil, have been offered counselling.
A spokesman for Rhondda Cynon Taff Local Health Board said: "We cannot comment on individual cases."

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Grieving father's call for change

                                    Shaun Jones' parents outside the inquest in Cardiff

The father of a 14-year-old boy who died after taking treatment for acne says young people are under too much pressure to look good.

     Shaun Jones, who had spots on his back and shoulders, had an "idiosyncratic reaction" to an acne medication, the coroner recorded at the inquest.
He died as a result of complications after medical treatment.
His father Graeme said young people were under pressure to look perfect "like a model in a magazine".
A narrative verdict was recorded, saying the cause of death was an idiosyncratic reaction to a single capsule.
"We need to change the way society is, if that's done through the schools, education, news, radio, whatever it takes," said Mr Jones, speaking before the inquest.
"If you do have one or two spots, it's not the end of the world and you will grow out of them - don't be influenced by peer pressure or the magazines, the glossy magazines, the pin-up people you see, the pop stars," he urged.
Mr Jones said his son, a pupil at Hawthorn High School in Pontypridd, had talked about his spots to his family.
"He was picture perfect, he just wanted the small blemishes tidied up," he said.
"That's the way young kids are. He just wanted to eradicate whatever blemishes he had left."
After the inquest, Sefton Kwasnik, solicitor for the Jones family, said there were many unanswered questions about the case, including the dispensing of the alternative medication.
Mr Kwasnik said there was a possibility of Mr and Mrs Jones taking civil action in the future once they had assessed the inquest and its verdict.
"From the moment they went to the doctors' surgery to today has opened a whole range of issue for others that they don't want to have visited upon them either.
"At every turn the family have been faced with obstruction and difficulty."
He added: "The family will continue their pursuit of justice for their son."


Shaun played for his village rugby team, Rhydyfelin RFC, and the Pontypridd schools team, winning the most improved player in the club awards.
"His biggest ambition was to play for Wales, that's all he wanted to do," said Mr Jones.
Terrible shock
He said his son was a strong, fit boy and it was a terrible shock to see him fighting for his life in hospital.
"My life stopped there and then and I think it flashed before me to see my son in such a poor condition," he said.
"Someone who was big, athletic, fit - one of the fittest lads I had ever, ever known.
"It was about 1040 on that Tuesday morning and we were called back to his bedside where they were performing CPR for the last time and that's where we lost him.
"They said sorry and there's nothing more we can do and then they switched the machine off and that was it."
Mr Jones said he wanted to prevent other families from suffering a similar tragedy.
"I don't want this happening to any other family or any other children in the world not just in Britain, the world, it's got to be stopped," he said.

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Boy died of acne tablet reaction

A coroner is to raise issues of how drugs are dispensed after the death of a 14-year-old boy from a reaction to taking a single acne pill.

Cardiff coroner Mary Hassell said she would be writing to the Lord Chancellor about the case of Shaun Jones, whose death was "beyond" one in a million.
She found Shaun, from Pontypridd, died "of complications" 12 hours after taking the drug Sebomin.
But this was a different drug to the one his doctor had prescribed.
Afterwards, the family said it was considering civil action against the medical authorities.
Recording her narrative verdict, Ms Hassell said Shaun died "as a result of complications of medical treatment".
She said she had researched the case and found no other recorded idiosyncratic deaths involving the tablet anywhere in the world.
"On that basis, this wasn't a one in a million occurrence, it was beyond that," said Ms Hassell.
"Shaun's reaction to it seems to be random and pretty much unique," she said.
Ms Hassell said she would be writing a report to the Lord Chancellor's office underlining the importance of doctors prescribing drugs and the correct information being supplied with medication.
"I have heard that when Shaun went to the pharmacy, he was given a different drug to the one which the doctor prescribed," she said.
"He was given a drug for the first time without the product information leaflet.
"It would be easy to dismiss it as the error of an individual but that would be too easy.
"I know that no system is foolproof and will catch everything but it may be strengthened to catch a little more."
Six foot (1.83m) Shaun, who "excelled at rugby", had previously used a lotion to treat his spots but went to the doctor after hearing his friends had been given medication for acne, the inquest heard.
After being given a prescription, he went to his local pharmacy with his mother Clare, where they were told that drug was out of stock.
Instead pharmacist Lee Coombs gave him Sebomin, which has the same active ingredient.
Mr Coombs said he had not checked with a doctor before changing Shaun's prescription, but said the two drugs were "pharmaceutical equivalents".
He also admitted that, confronted with the same situation again, he would not have dispensed drugs without a leaflet.
The situation arose because only one leaflet is issued per batch of 56 drugs - and as Shaun was prescribed 28, the box was split.
The inquest heard the prescription was only amended by Dr Catherine Taylor, Dr Jones's colleague, on the afternoon of October 21, after Shaun had died.
She said she could not remember if she had been told of the death at the time.
Dr Taylor said she had no concerns "signing off" the changed prescription, as the two drugs were identical.
Mrs Jones noticed there was no safety leaflet included in the box, but thought nothing of that at the time, the inquest heard.
Shaun took the medication with a glass of water just before going to bed at 2230 GMT on October 20 last year at his home in the Rhydyfelin area.
Little more than an hour later, he complained to his parents of shortness of breath and tightness in his chest.
Mrs Jones initially contacted an out of hours GP service but was told no doctor was available, the hearing was told.
When Shaun's condition deteriorated, he was taken to the Royal Glamorgan Hospital, Llantrisant, by ambulance early the next morning.
Despite treatment there, and at the University Hospital of Wales, Cardiff, where he was transferred, Shaun died at 1040 GMT.
In a statement read to the court, his mother Clare Jones said: "My son was fit and healthy. He was 6ft tall and physically very fit.
"He excelled at rugby and trained and played very hard. I'm mystified by his death as is my entire family."
She said she had since conducted her own research into the medication Shaun took.
Mrs Jones said: "Had there been instructions in the box and having read all the information on this drug since, I would have called 999 straightaway and certainly wouldn't have given him the tablet before going to bed."
The whole episode was "extremely painful" for her, Shaun's father Graeme and his younger sister, she said.
Pathologist Dr Edgar Lazka said he could not give a medical cause of death.
His findings were consistent with the theory that Shaun died from an acute reaction to minocycline hydrochloride, the active ingredient in both Sebomin and Minocin, he added.
He said Shaun's face and larynx were swollen, but told the inquest that could have been caused by intensive care treatment.
Dr Lazka said Shaun had the early signs of pneumonia, but it was not severe enough to kill such a "strapping young lad".
Dr Stephen Jolles, consultant immunologist at the University Hospital of Wales, told the inquest that it was possible either the colourings or the active ingredient in the Sebomin tablets Shaun took caused the reaction.
He said it was possible for only "tiny amounts" of a substance to cause a reaction if someone was allergic.

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Acne drug not found to increase suicide risk

People being treated for severe acne should have their mental health closely monitored, a study reports.

     But a popular acne drug was not found to increase the risk of suicide, despite previous findings.
The study of 5,700 people, in the British Medical Journal, was carried out at the Karolinska Institute, Sweden between 1980 and 2001.
Acne can have serious psychological effects, say experts.
Severe acne sufferers are commonly prescribed a drug called isotretinoin, also known as Roaccutane, Accutane, Amnesteem, Claravis, Clarus or Decutan.
It has been used since the 1980s to treat severe acne if a course of antibiotics does not prove effective.
But there have been reports linking isotretinoin to depression and suicidal behaviour.
So Dr Anders Sundstrom and his research team from SwedenDr Sarah Bailey University of Bath

They found that 128 of the 5,700 patients investigated who were taking the drug were admitted to hospital for attempted suicide.

The risk of suicide was highest within six months of ending treatment - but the researchers say this is most likely to be because patients whose acne improved following treatment were distraught if there was no improvement in their social life, rather than anything to do with the treatment itself.
They stress that attempted suicide was a rare event - the figures suggest just one person out of every 2,300 individuals taking isotretinoin will make a first suicide attempt.
Monitor patients Dr Sundstrom said of his findings: "The underlying condition of acne is a more important factor for suicide attempts. We are not certain the drug adds anything."
Writing in an editorial in the BMJ, Australian acne experts John Sullivan and Parker Magin say that the Swedish research is important given the complexity of the issue.
"It is difficult to tease out the relation between mental health and isotretinoin because acne itself is associated with psychiatric morbidity, including depression."
They also say that the study shows GPs must closely monitor acne patients on isotretinoin.
"During and after treatment with isotretinoin (perhaps, especially, unsuccessful treatment), patients should be carefully monitored for depression and suicidal thoughts."
Dr Sarah Bailey, lecturer in the Department of Pharmacy and Pharmacology at the University of Bath, said: "This is an important paper that strengthens the view that acne itself can have significant psychological effects and that there is a low risk of suicide for some acne patients.
"However, the controversial issue of increased suicide risk with isotretinoin use is not resolved by this paper, which the authors themselves acknowledge.
"Perhaps their most interesting and novel finding is that the risk of suicide is increased AFTER treatment has stopped and therefore it is essential to continue to monitor patients carefully."

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Why spotting the best acne treatment is a pain

Acne is a very common skin condition which it is tempting to characterise as purely a teenage affliction.

  However, it can last into the late twenties or even thirties and become a serious and embarrassing problem affecting relationships, confidence and the mental health of sufferers.
Yet a recent review of research into treatments for acne found lots of gaps in information, particularly when comparing how well different products work.
Online acne support groups are full of people feeling depressed, lonely and enduring sleepless nights before they find the right treatment and get rid of the terrible spots that characterise this chronic skin condition.
Professor Hywel Williams, from the centre of evidence-based dermatology at Nottingham University, says there is no wonder when there are now 40 or 50 different acne products available.
"As a patient you see all these products on the shelves of the chemist, but which one is the best? There is very little comparative information."

Dr Susannah Baron consultant dermatologist

He believes more independent research is needed, not just research led by the pharmaceutical industry.

"There are lots of unanswered questions... like when should you start treating acne? And what should you start the treatment with?" Prof Williams says.
This is complicated by the fact that experts still do not know exactly what triggers acne and how treatment affects the course of the disease.
Nick Geddie had acne from the age of 12. Now a primary school teacher in West Sussex, his acne has still not disappeared, but it is something he has found ways of dealing with.
"I can keep it under control with the drug I am using now and I don't tend to get as many spots as I did, but I still don't like going to the beach and stripping off.
"When I was a teenager I got it severely on my back, chest and neck and it had a massive impact on my self-esteem.

"It felt like the end of the world not looking like everyone else in the changing rooms at an all boys' school.

"After I went to see the GP and started taking tablets I felt my confidence start to return."
Dr Susannah Baron, consultant dermatologist with East Kent NHS Trust and a spokesman for the British Skin Foundation, says the psychological impact of acne on teenagers is huge.
"Being a teenager is really hard anyway and then you get acne. Girls often try to do something about it earlier than boys, who may get worse acne because of the surge in testosterone.
"Many people spend a lot of money on products which may not work. Some of the over-the-counter washes and gels may help but the best thing is to go and see your GP who can give you prescription treatment to put on your skin which may be a roll-on anti-bacterial liquid, cream or gel."
A typical acne journey can start with a cream or gel treatment, progressing to others if the first one doesn't work, then perhaps a course of oral antibiotics and then a referral to a skin specialist if there is no improvement.
Treatment with isotretinoin (also known as accutane or roaccutane), is usually for people with moderate to severe acne or for anyone with acne scarring, because of the side effects associated with the medication. However it does work extremely well and after one course of treatment 80% of people never get acne again.
In fact there are huge variations in the reactions to different treatments.
While Dr Baron is sceptical that alternative therapies make any difference to acne because of the lack of evidence, some people beg to differ.
Elaine Mummery is a nutritionist who runs an acne clinic in Glasgow. She has also written a book called Spotless - The Essential Guide to Getting Rid of Spots and Acne.
She says acne is the body giving us a sign.
"When I look at someone's face I know by the type of spots what the problem is and how to fix it.
"For some people it means cutting out cow's milk from their diet, for others they need to cut down on sugar - but there's always a reason and you can fix it. The clue is in the spot."
She works with her patients for four weeks, assesses them individually and then encourages them to change one or more elements of their diet.
"In the past, I've got them to drink vegetable juices, increase their fruit intake maybe or cut out carbohydrates to try to turn the body more alkaline and improve their acne."
It doesn't work for everyone but as long as something does then acne sufferers will undoubtedly be happy.

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US stroke rates 'rising in young'

More children and young adults in the US are having strokes - with unhealthy lifestyles being a likely cause, scientists have said.

        Researchers at the US Centers for Disease Control and Prevention analysed hospital data on up to eight million patients a year between 1995 and 2008.
Tthey say stroke rates in five to 44-year-olds rose by about a third in under 10 years. Higher blood pressure, diabetes and obesity were common in stroke patients.
The researchers looked at figures for ischemic stroke, due to blood clots, and haemorrhagic stroke, which is caused by bleeding on the brain.
The rate of ischemic stroke increased by 31% in five to 14-year-olds, from 3.2 strokes per 10,000 hospital cases to 4.2 per 10,000.
There were increases of 30% for people aged 15 to 34 and 37% in patients between the ages of 35 and 44.
In all age groups the increase was greater in men than in women.
Figures for haemorrhagic stroke showed decreases in age groups except the five to 14-year-olds, but the researchers said: "The increase in ischemic stroke far outweighs the decreases."
 
''Health initiatives''
    The report said the prevalence of hypertension, obesity and tobacco use had increased in stroke patients.

More than half of 35 to 44-year-olds who had an ischemic stroke also had hypertension.

"Urgent public health initiatives are needed to reverse trends in modifiable risk factors associated with stroke in adolescents and young adults," the report concludes.
Dr Lorna Layward, from the Stroke Association in the UK, said: "People usually associate strokes with older people, but a quarter of all strokes happen to people of working age, and around 400 children have a stroke every year in the UK.
"We know that high blood pressure is the biggest risk factor for stroke, along with other factors such as obesity, diabetes, poor diet and smoking.
"This research emphasises the need for people to be aware that stroke can affect younger people, and for all of us, regardless of our age, to check our blood pressure and adopt a healthy lifestyle."

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'Anti-cancer virus' shows promise

An engineered virus, injected into the blood, can selectively target cancer cells throughout the body in what researchers have labelled a medical first.

    The virus attacked only tumours, leaving the healthy tissue alone, in a small trial on 23 patients, according to the journal Nature.
Researchers said the findings could one day "truly transform" therapies.
Cancer specialists said using viruses showed "real promise".
Using viruses to attack cancers is not a new concept, but they have needed to be injected directly into tumours in order to evade the immune system.
Smallpox to cancer Scientists modified the vaccinia virus, which is more famous for being used to develop a smallpox vaccine.
The virus, named JX-594, is dependent upon a chemical pathway, common in some cancers, in order to replicate.
It was injected at different doses into the blood of 23 patients with cancers which had spread to multiple organs in the body.

Prof John Bell University of Ottawa

In the eight patients receiving the highest dose, seven had the virus replicating in their tumours, but not in healthy tissue.

Prof John Bell, lead researcher and from the University of Ottawa, said: "We are very excited because this is the first time in medical history that a viral therapy has been shown to consistently and selectively replicate in cancer tissue after intravenous infusion in humans.
"Intravenous delivery is crucial for cancer treatment because it allows us to target tumours throughout the body as opposed to just those that we can directly inject."
Infection prevented further tumour growth in six patients for a time. However, the virus did not cure cancer. Patients were given only one dose of the virus as the trial was designed to test the safety of the virus.
It is thought that the virus could be used to deliver treatments directly to cancerous cells in high concentrations.
Prof Bell acknowledges that the research is still in the very early stages, but he said: "I believe that some day, viruses and other biological therapies could truly transform our approach for treating cancer."
Cancer Research UK's Prof Nick Lemoine, also director of Barts Cancer Institute, said: "Viruses that multiply in just tumour cells - avoiding healthy cells - are showing real promise as a new biological approach to target hard-to-treat cancers.
"This new study is important because it shows that a virus previously used safely to vaccinate against smallpox in millions of people can now be modified to reach cancers through the bloodstream - even after cancer has spread widely through the patient's body.
"It is particularly encouraging that responses were seen even in tumours like mesothelioma, a cancer which can be particularly hard to treat."

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Global governments 'must get tough on obesity'

Tougher action - including taxing junk food - is needed by all governments if the obesity crisis is going to be tackled, experts say.

   The international group of researchers, who have published a series of articles in The Lancet, said no country had yet got to grips with the problem.
They said changes in society meant it was getting harder for people to live healthy lives.
And they warned without state action, health systems could become swamped.
Obesity-related problems, such as diabetes, were now accounting for between 2% and 6% of health care costs in most countries.
Rising spending But as one of the articles showed, this is likely to get worse if current trends continue.
Researchers made projections for the US and the UK - two of the developed countries with the worst rates of obesity.
They predicted obesity rates would rise from a quarter in the UK to about 40% by 2030.
Such a scenario would cost the NHS an extra £2bn a year - the equivalent of 2% of health spending.
The rise in costs would be even greater in the US, where obesity rates would rise from one in three to about one in two.
The researchers accepted that the whole of society - from the individual to industry - had a role to play in tackling the problem.
But they said governments needed to take a lead by using legislation and direct intervention to create a better environment.
They said many measures - including taxes on unhealthy food, restrictions on junk food advertising, traffic light labelling and school-based education programmes - would save money as well as benefit health.

OBESITY MEASURES
Category	Saves money	Minor cost	Higher cost
SOURCE: The Lancet
FOOD	Tax junk food Limit junk food ads Traffic light labelling	Cost benefit category
LIFESTYLE	Discourage kids from TV Exercise and healthy eating at school Work with obese children	Help families with overweight children	School walking trains
TREATMENT		Surgery for obese teenagers and adults	Weight loss drugs

Others, such as providing obesity surgery and health programmes aimed at families with overweight children, would come with a minor cost although should still be looked at.

Oxford University expert Professor Klim McPherson, who was one of the lead researchers, said: "It is about changing the environment in which people live so they can make healthier choices."
But he said too many countries shied away from taking the right action and urged a forthcoming UN summit on health in September to "show leadership" by putting pressure on governments to act.
In particular, he criticised the government in England, which has been focusing on voluntary agreements with industry rather than legislation.
He said ministers were "enfeebled by their ideology" and too worried about accusations of the nanny state.
"They have this idea that government action in this sphere would not be a good idea," he added.
Professor Boyd Swinburn, who is based in Australia and works for the World Health Organization, agreed governments had been too slow to act on the "obesity crisis".
"There is more willingness to invest in drugs and surgery than dealing with the underlying causes."
He also compared the tactics of the food industry - in terms of getting people addicted to their products and in blocking attempts to discourage consumption - to those of tobacco firms in previous decades.

Dr Frank Atherton, president of the Association of Directors of Public Health, also said he was in favour of the interventions being suggested: "Of course we have to work with industry, but there is a feeling that the emphasis of this government has turned too far away from legislation."

However, Terry Jones, of the Food and Drink Federation, said the industry had been taking positive steps.
"The Lancet fails to recognise the lengths to which the UK food and drink industry has gone to help improve the health of the nation, particularly in relation to rising obesity levels," said Mr Jones.
Public health minister Anne Milton said the government believed the best way to achieve results was through a "collective voluntary effort".
She said this was achieving results, citing the pledge by industry to put calorie information on menus.
"We have no current plans to impose a 'fat tax', but we are working with food companies to reduce fat, sugar and salt and ensure healthier options are available.
"We also want to see businesses use more consistent and informative front-of-pack nutrition labelling than has been achieved in the past," she added.
"We recognise the significant threat that obesity poses to society and have taken a proactive part in improving health."

 

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Vitamin A pills 'could save thousands of children'

Giving vitamin A supplements to children under the age of five in developing countries could save 600,000 lives a year, researchers claim.

      Writing in the British Medical Journal, UK and Pakistani experts assessed 43 studies involving 200,000 children, and found deaths were cut by 24% if children were given the vitamin.
And they say taking it would also cut rates of measles and diarrhoea.
The body needs vitamin A for the visual and immune systems to work properly.
It is found in foods including cheese, eggs, liver and oily fish.
The World Health Organization (WHO) estimates that, around the world, 190 million children under the age of five may have a vitamin A deficiency.
But despite widespread efforts, supplementation programmes do not reach all the children who could benefit.
Capsules are now distributed twice a year in at least 60 countries, with average annual coverage rates nearing 80%.
However, University of Oxford and Aga Khan University researchers who carried out this work say the effectiveness of vitamin A is so well-established that policy-makers should provide supplements to all children at risk.
'Effective and cheap' They evaluated studies that involved children aged six months to five years, and compared rates of illness and death among those who were given vitamin A and those who were not.

They found vitamin A supplements reduced child mortality by 24% in low- and middle-income countries.

They calculate that, considering the estimated 190m children who are vitamin A deficient, reducing deaths by 24% would save more than 600,000 lives each year.
Dr Evan Mayo-Wilson from the University of Oxford, who worked on the study, said: "Until other sources are available, supplements should be given to all children who are at risk of vitamin A deficiency.
"After just one year, children who had taken supplements were less likely to have died than children who received a placebo [dummy version].
Vitamin A supplements are highly effective and cheap to produce and administer."
He said there had been recent criticism of vitamin A programmes - with some saying there were risks that respiratory infection rates could increase, particularly in children who were not vitamin A deficient - but he added there was "little doubt" that vitamin A prevented young children from dying.
In an editorial for BMJ Online, Professor Wafaie Fawzi, from the department of nutrition, epidemiology, and global health at Harvard School of Public Health, added: "Effort should now focus on finding ways to sustain this important child survival initiative and fine tune it to maximise the number of lives saved."

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