Public health advice issued to islanders ahead of hot weather
Director of Public Health, Professor Peter Bradley, said: "While the warm weather is enjoyed by most, extreme heat can cause harm to health including heat exhaustion, heatstroke and dehydration, particularly to the most vulnerable in the community. "I encourage all islanders to take precautions and stay safe in the hot weather."
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Telegraph
41 minutes ago
- Telegraph
Lucy Letby ‘raised alarm over poor care of babies in her hospital'
Lucy Letby raised the alarm over the poor care of babies at the hospital in which she worked, new documents show. The former neo-natal nurse, 35, was convicted of the murder of seven children and the attempted murder of seven more at the Countess of Chester Hospital in a prosecution that has come under intense scrutiny. Letby has since appointed a new legal team who have submitted an application on her behalf to the Criminal Cases Review Commission, claiming that she is the victim of a miscarriage of justice. Mark McDonald, Letby's barrister, said that she was a 'hard working nurse who loved her job' and would never harm a child. He added: '[That] is why she would not let any fault pass. This was a neonatal unit in crisis and she consistently formally reported issues. 'She was a whistleblower – but instead of listening to her they went for her instead.' Mr McDonald said Letby was targeted for raising concerns, and an expert international panel recently concluded that no murders were committed and instead that the babies collapsed or died because of either poor care or natural causes. Lawyers for the families of Letby's victims previously rubbished the panel's findings as 'full of analytical holes' and 'a rehash' of the defence case heard at trial. The documents that reveal Letby's complaints were first reported by The Mail on Sunday. The records – known as Datix Admin and Management Forms – cover a number of medical emergencies in the unit in 2015 and 2016. The group that investigated Letby's complaints included Dr Stephen Brearey, who was one of two doctors who would later raise questions about whether she was 'purposely harming babies'. Lack of resources On June 30 2016, Letby used the system to report an incident a week earlier when a baby had suffered a 'sudden acute collapse requiring resuscitation', only for staff dealing with the emergency to find that the sodium bicarbonate infusion required to deal with the crisis was not available. Dr Brearey's investigating group recommended new measures to 'ensure adequate stock levels in future'. Letby filed a second report about another baby on the ward who had collapsed three hours after the first incident, saying that 'resources were not available on unit' to deal with the emergency. According to the Mail on Sunday, Dr Brearey later amended the incident form to state that the medical resources mentioned were not necessary to deal with the incident and in any case were not 'routinely kept on the unit' – but then conceded that because of 'a recent increase in usage' delivery would be arranged. Another report by Letby in June 2016 identified failures by doctors over the administration of intravenous medication. Dr Brearey's group concluded that nurses should check the equipment 'on an hourly basis' and that Dr Brearey would 'update new doctors at induction'. At Dr Brearey's request, Letby was removed from clinical duties the following month. Other reports by Letby included the 'unexpected death' of a baby in August 2015. However, it was concluded that 'neonatal care was appropriate... it is unlikely any changes in management would have prevented this sad outcome'. She also recorded the deterioration of an infant after ventilation records were not recorded for a 12-hour period and a 'chest drain complication' resulting from a lack of needles on the ward. Letby's case is now being considered by the Criminal Cases Review Commission, which is expected to report back before Christmas.
The Guardian
an hour ago
- The Guardian
Why antibiotics are like fossil fuels
In 1954, just a few years after the widespread introduction of antibiotics, doctors were already aware of the problem of resistance. Natural selection meant that using these new medicines gave an advantage to the microbes that could survive the assault – and a treatment that worked today could become ineffective tomorrow. A British doctor put the challenge in military terms: 'We may run clean out of effective ammunition. Then how the bacteria and moulds will lord it.' More than 70 years later, that concern looks prescient. The UN has called antibiotic resistance 'one of the most urgent global health threats'. Researchers estimate that resistance already kills more than a million people a year, with that number forecast to grow. And new antibiotics are not being discovered fast enough; many that are essential today were discovered more than 60 years ago. The thing to remember is that antibiotics are quite unlike other medicines. Most drugs work by manipulating human biology: paracetamol relieves your headache by dampening the chemical signals of pain; caffeine blocks adenosine receptors and as a result prevents drowsiness taking hold. Antibiotics, meanwhile, target bacteria. And, because bacteria spread between people, the challenge of resistance is social: it's as if every time you took a painkiller for your headache, you increased the chance that somebody else might have to undergo an operation without anaesthetic. That makes resistance more than simply a technological problem. But like that British doctor in 1954, we still often talk as if it is: we need to invent new 'weapons' to better defend ourselves. What this framing overlooks is that the extraordinary power of antibiotics is not due to human ingenuity. In fact, the majority of them derive from substances originally made by bacteria and fungi, evolved millions of years ago in a process of microbial competition. This is where I can't help thinking about another natural resource that helped create the modern world but has also been dangerously overused: fossil fuels. Just as Earth's geological forces turned dead plants from the Carboniferous era into layers of coal and oil that we could burn for energy, so evolution created molecules that scientists in the 20th century were able to recruit to keep us alive. Both have offered an illusory promise of cheap, miraculous and never-ending power over nature – a promise that is now coming to an end. If we thought of antibiotics as the 'fossil fuels' of modern medicine, might that change how we use them? And could it help us think of ways to make the fight against life-threatening infections more sustainable? The antibiotic era is less than a century old. Alexander Fleming first noticed the activity of a strange mould against bacteria in 1928, but it wasn't until the late 1930s that the active ingredient – penicillin – was isolated. A daily dose was just 60mg, about the same as a pinch of salt. For several years it was so scarce it was worth more than gold. But after production was scaled up during the second world war, it ended up costing less than the bottle it came in. This abundance did more than tackle infectious diseases. Just as the energy from fossil fuels transformed society, antibiotics allowed the entire edifice of modern medicine to be built. Consider surgery: cutting people open and breaking the protective barrier of the skin gives bacteria the chance to swarm into the body's internal tissues. Before antibiotics, even the simplest procedures frequently resulted in fatal blood poisoning. After them, so much more became possible: heart surgery, intestinal surgery, transplantation. Then there's cancer: chemotherapy suppresses the immune system, making bacterial infections one of the most widespread complications of treatment. The effects of antibiotics have rippled out even further: they made factory farming possible, both by reducing disease among animals kept in close quarters, and by increasing their weight through complex effects on metabolism. They're one of the reasons for the huge increase in meat consumption since the 1950s, with all its concomitant welfare and environmental effects. Despite the crisis of resistance, antibiotics remain cheap compared with other medicines. Partly – as with fossil fuels – this is because the negative consequences of their use (so-called externalities) are not priced in. And like coal, oil and gas, antibiotics lead to pollution. One recent study estimated that 31% of the 40 most used antibiotics worldwide enter rivers. Once they're out there, they increase levels of resistance in environmental bacteria: one study of soil from the Netherlands showed that the incidence of some antibiotic-resistant genes had increased by more than 15 times since the 1970s. Another source of pollution is manufacturing, particularly in countries such as India. In Hyderabad, where factories produce huge amounts of antibiotics for the global market, scientists have found that the wastewater contains levels of some antibiotics that are a million times higher than elsewhere. Like the climate crisis, antibiotic resistance has laid global inequalities bare. Some high-income countries have taken steps to decrease antibiotic use, but only after benefiting from their abundance in the past. That makes it hard for them to take a moral stand against their use in other places, a dilemma that mirrors the situation faced by post-industrial nations urging developing nations to forgo the economic benefits of cheap energy. This may be where the similarities end. While we look forward to the day when fossil fuels are phased out completely, that's clearly not the case with antibiotics, which are always going to be part of medicine's 'energy mix'. After all, most deaths from bacterial disease worldwide are due to lack of access to antibiotics, not resistance. What we are going to need to do is make our approach to development and use much more sustainable. Currently, many pharmaceutical companies have abandoned the search for new antibiotics: it's hard to imagine a more perfect anti-capitalist commodity than a product whose value depletes every time you use it. That means we need alternative models. One proposal is for governments to fund an international institute that develops publicly owned antibiotics, rather than relying on the private sector; another is to incentivise development with generously funded prizes for antibiotic discovery. And to address the issue of overuse, economists have suggested that health authorities could run 'subscription' models that remove the incentive to sell lots of antibiotics. In one pilot scheme in England, two companies are being paid a set amount per year by the NHS, regardless of how much of their product is actually used. Finally, we have to remember that antibiotics aren't the only game in town. Supporting other, 'renewable' approaches means we get to use the ones we do have for longer. Vaccines are vital to disease prevention – with every meningitis, diphtheria or whooping cough vaccine meaning a potential course of antibiotics forgone. And the 20th century's largest reductions in infectious disease occurred not because of antibiotics, but thanks to better sanitation and public health. (Even in the 2000s, the threat of MRSA was addressed with tried-and-tested methods such as handwashing and cleaning protocols – not new antibiotics.) Given that antibiotics themselves emerged unexpectedly, we should also be investing more in blue-skies research. Just as we no longer burn coal without a thought for the consequences, the era of carefree antibiotic use is now firmly in the past. In both cases, the idea that there wouldn't be a reckoning was always an illusion. But as with our slow waking up to the reality of the climate crisis, coming to appreciate the limits of our love affair with antibiotics may ultimately be no bad thing. Liam Shaw is a biologist at the University of Oxford, and author of Dangerous Miracle (Bodley Head). Being Mortal: Medicine and What Matters in the End by Atul Gawande (Profile, £11.99) Infectious: Pathogens and How We Fight Them by John S Tregoning (Oneworld, £10.99) Deadly Companions: How Microbes Shaped our History by Dorothy H Crawford (Oxford, £12.49)
Daily Mail
an hour ago
- Daily Mail
Study finds medication lowers risk of dangerous behaviors in people with ADHD
ADHD affects around five per cent of children and 2.5 per cent of adults globally and is linked increased risks of suicidal behaviors, substance abuse, transport accidents, and criminality if people do not seek treatment. An international team of researchers wanted to fin out if taking medication would mitigate these risks. Researchers from the University Of Southampton, UK and the Karolinska Institute in Sweden found that during two years of treatment with ADHD medication, people who took the drugs were less likely to experience these harmful incidents than those weren't medicated. Around 22 million Americans are estimated to have ADHD and just over half of these are prescribed medication to manage their symptoms. Medications are classified into two main categories: stimulants and non-stimulants. Stimulants, the most common type, include methylphenidate and amphetamine-based medications that improve the transmission of the brain chemical dopamine which affects mood, motivation and movement. Non-stimulant options like atomoxetine, clonidine, and guanfacine can also be used, if stimulants are not effective or well tolerated. These help improve the transmission of norepinephrine, a hormone that helps with alertness and focus. Exactly why the condition occurs is not completely understood, but ADHD tends to run in families, suggesting genes may play a part. In the new study, researchers examined multiple population and health records in Sweden. The team used a novel study design called a 'trial emulation' to simulate a trial using existing real-world data from 148,581 people with ADHD. Comparing those who had started any type of ADHD medication within three months of diagnosis with those who hadn't, they looked at the records over the following two years. They found any form of medication reduced the first occurrence of four of the five incidents (with accidental injury being the exception) and all five outcomes when considering recurring incidents. Those taking stimulant medication were associated with the lowest incident rates, compared to non-stimulant medications. Methylphenidate was the most commonly prescribed drug, the researchers found. The likelihood was most reduced amongst people exhibiting a recurring pattern of behavior, such as multiple suicide attempts, numerous drug relapses or repeat offending. Medication didn't reduce the risk of a first-time accidental injury, but did reduce the risk of recurring ones. The study is the first of its kind to show the beneficial effect of ADHD medication on these broader clinical outcomes using a novel statistical method and data representative of all patients in routine clinical care from a whole country. Dr Zheng Chang, senior author of the study from the Karolinska Institute said: 'This finding is consistent with most guidelines that generally recommend stimulants as the first-line treatment, followed by non-stimulants. 'There is an ongoing discussion regarding whether methylphenidate should be included in the World Health Organization model list of essential medications, and we hope this research will help to inform this debate.' Co-senior author on the paper Samuele Cortese, a National Institute For Health And Care Research (NIHR) Research Professor at the University of Southampton added: 'The failure form clinical services to provide timely treatments that reduce these important outcomes represents a major ethical issue that needs to be addressed with urgency, with the crucial input of people with lived experience.'
