Early menopause genes unravelled

17 October 2010 Last updated at 19:10 ET

Research into the genetics of early menopause may lead to a simple test for women, says a UK scientist.

One in 20 women starts their menopause before the age of 46 - which can affect their chances of conceiving even a decade earlier.

The study, published in Human Molecular Genetics, found that four genes working in combination appeared to raise the risk significantly.

This could eventually help identify women at greatest risk.

Menopause is normally triggered when the number of remaining eggs in the ovary falls below about 1,000.

However, the biological controls which determine how quickly this ovarian egg reserve is used up are less well understood.

The researchers, from the University of Exeter and the Institute of Cancer Research, looked at four genes already thought to have some link to the menopause.

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A woman's ability to conceive decreases on average 10 years before she starts the menopause."

End Quote Dr Anna Murray University of Exeter

They took 2,000 women who had experienced early menopause, and a similar number of women who had entered the menopause at the normal age.

They found that the presence of each of the four genes appeared to have some influence on the age of menopause.

Egg depletion

When more than one was found in a woman's genetic makeup, the impact was even greater.

Dr Anna Murray, from the University of Exeter, said that the ability to predict menopause was not just important at the time, but could be crucial to decisions made many years earlier.

In particular, the quicker-than-expected depletion of the egg reserve could make a difference to a woman's ability to conceive.

She said: "It is estimated that a woman's ability to conceive decreases on average 10 years before she starts the menopause.

"Therefore, those who are destined to have an early menopause and delay childbearing until their 30s are more likely to have problems conceiving."

She added: "These findings are the first stage in developing an easy and relatively inexpensive genetic test which could help the one in 20 women who may be affected."

Professor Anthony Swerdlow, from the Institute of Cancer Research, described the findings as a "valuable step" towards helping women work out if they are at risk.

"This may in turn allow them to make informed decisions about their future fertility," he said.

This is not the first attempt to find a way to identify those women who are at greatest risk of an early menopause.

Other methods include using ultrasound to assess the number of eggs left in the ovary, to try to work out how quickly that number is falling.

The latest study is part of a major effort - the Breakthrough Generations Study - following the fortunes of 100,000 women in an effort to reveal the causes of diseases such as breast cancer.

Iranian scientists also say that measuring levels of a hormone called AMH on a three-yearly basis may also be able to predict the problem years in advance.

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Sterilisation 'bribe' for addicts

17 October 2010 Last updated at 17:00 ET <!-- Embedding the video player --> <!-- This is the embedded player component --> <!-- end of the embedded player component --> <!-- Player embedded -->

Drug addicts across the UK are being offered money to be sterilised by an American charity.

Project Prevention is offering to pay �200 to any drug user in London, Glasgow, Bristol, Leicester and parts of Wales who agrees to be operated on.

The first person in the UK to accept the cash is drug addict "John" from Leicester who says he "should never be a father".

The move has been criticised by some drug charities who work with addicts.

'Bribery'

Project Prevention founder Barbara Harris admitted her methods amounted to "bribery" but said it was the only way to stop babies being physically and mentally damaged by drugs during pregnancy.

Drug treatment charity Addaction estimates one million children in the UK are living with parents who abuse drugs.

Pregnant addicts can pass on dependency to the unborn child, leading to organ and brain damage.

Mrs Harris set up her charity in North Carolina after adopting the children of a crack addict.

Damage to children

Speaking to the BBC's Inside Out programme, she said: "The birth mother of my children obviously dabbled in all drugs and alcohol - she literally had a baby every year for eight years.

"I get very angry about the damage that drugs do to these children."

After paying 3,500 addicts across the United States not to have children, she is now visiting parts of the UK blighted by drugs to encourage users to undergo "long-term birth control" for cash.

John, a 38-year-old addict from Leicester, is the first person in the UK to accept money to have a vasectomy, after being involved in drugs since he was 12.

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It might work in America but Great Britain is a very different country"

End Quote Maria Cripps Dovetail Centre

He said: "It was something that I'd been thinking about for a long time.

"I won't be able to support a kid; I can just about manage to support myself."

Simon Antrobus, chief executive of Addaction, said while no-one wanted to see children brought up in a drug-using environment, there was no place for Project Prevention in the UK.

"It exploits very vulnerable people who are addicted to drugs and alcohol at probably the lowest point in their lives," he said.

The Reverend Robert Black, of Victory Outreach, which works with former addicts in east London, said he thought Project Prevention's aims were "very devious".

Reversible contraception

Maria Cripps, project manager at the Hackney Dovetail Centre which works with drug users and their carers, said: "I think Barbara uses some very extreme examples to get her point across. It might work in America but Great Britain is a very different country."

But Reverend Martin Blakebrough, director of Camden's Kaleidoscope Project in north London, said sterilisation was "worth considering" if it was right for the individual.

A spokesperson at the British Medical Association said: "The BMA's ethics committee does not have a view on the charity Project Prevention.

"As with all requests for treatment, doctors need to be confident that the individual has the capacity to make the specific decision at the time the decision is required.

"The BMA's ethics committee also believes that doctors should inform patients of the benefits of reversible contraception so that the patients have more reproductive choices in the future."

Sterilising The Addicts is on Inside Out London, East Midlands, West, and Wales on 18 October on BBC One at 1930 BST and in Scotland as BBC Scotland Investigates: Addicts - No Children Allowed. Those living in the rest of the UK can watch via the BBC iPlayer following transmission.

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Warning over parent alcohol abuse

17 October 2010 Last updated at 19:03 ET

Millions of children are at risk of neglect because of a parent's drinking, and yet the problem is being ignored, say charities.

Alcohol Concern and the Children's Society want social workers to have more compulsory training on how to deal with alcohol abuse within families.

Their report estimates 2.6m children live with a parent whose drinking could lead to neglect.

A body representing social workers said alcohol posed more problems than drugs.

Unsurprisingly, a poll carried out by Alcohol Concern in July found an overwhelming majority thought that heavy drinking by parents had a negative impact on children - many thought it was as harmful as drug abuse.

However, the two charities say that the scale of the problem is not fully recognised.

The parents of the 2.6 million children are defined as "hazardous" drinkers - either because of the sheer amount or frequency of their drinking, or because their drinking, even at a lesser level, leads to other problems, such as not being able to get up in the morning, or fulfil "expected duties".

Of those 2.6m children, 700,000 are being raised by a parent defined as an alcoholic.

No training

Despite alcohol or substance misuse being suggested as a factor in more than half of social worker cases which progress to the "serious review" stage, there is relatively little emphasis placed on the problem within social worker training.

Recent research suggested that one third of social workers had received no training on alcohol or drugs, and, of the remainder, half had been given three hours or less.

Bob Reitemeier, the chief executive of The Children's Society, said: "I cannot stress strongly enough the harmful impact that substance abuse can have on both children and whole families - it is imperative that everyone understands these risks and we believe that education is the key.

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Millions of children are left to do their best in incredibly difficult circumstances"

End Quote Don Shenker Alcohol Concern

"We are calling on the government to make sure that everyone who needs either training or education to deal with parental substance abuse is given the appropriate assistance."

Mandatory substance abuse training for social workers was recommended in a 2003 report from the government's own drug advisory group.

Alcohol Concern suggested that the system currently "sweeps the problem under the carpet".

Chief executive Don Shenker said: "Millions of children are left to do their best in incredibly difficult circumstances.

"A government inquiry must look into all aspects of parental alcohol misuse so that we can improve outcomes for these children."

Groups representing social workers agreed with the report's recommendations.

Dr Sarah Galvani, who chairs the British Association of Social Workers Special Interest Group in Alcohol and Other Drugs, said training for both newly-qualified and existing social workers was "lacking".

"Problematic alcohol abuse by parents is highlighted by social workers as far more prevalent than drug use.

"Alongside the overlapping experiences of domestic violence and mental ill health, parental alcohol and other drug use are the three factors that repeatedly put children at risk of serious harm.

"We must support social workers to work as best as they can in what are often very complex and challenging situations."

Public health minister Anne Milton said health service reforms would help local communities put in place services tailored to tackle problems such as this.

She said: "This report highlights the harm that millions of children face because their parents drink too much alcohol.

"It paints a shocking picture, which is why we must make sure that we identify early on, children and families that need support."

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SNP to scrap prescription charges

16 October 2010 Last updated at 01:26 ET

The Scottish government is to confirm it will abolish prescription charges next April, despite huge funding pressures ahead.

Health Secretary Nicola Sturgeon will tell the SNP conference in Perth that the sick should not have to pay for "Labour's economic mess".

Prescription charges in Scotland have been gradually cut from the previous level of almost �7.

Ms Sturgeon will also commit to protecting Scottish NHS spending.

Her move comes ahead of the UK government's Spending Review on Wednesday, which is expected to signal tough cuts to Holyrood's budget next year.

Ms Sturgeon's decision to stick to the SNP's original plan on doing away with prescription charges has come at a time when some are questioning whether such universal benefits can really be paid for.

Proposals to give free prescriptions to people in England with long-term conditions were put on hold earlier this year due to financial pressures on the NHS.

All charges have been scrapped in Wales, and were abolished in Northern Ireland in April.

But Ms Sturgeon will tell the conference that the move will benefit 600,000 people on low incomes and thousands with long-term health problems.

"Some have argued that, in this financial climate, we should not go ahead with our plans to abolish prescription charges," she will tell delegates.

"Times are tight and I believe, and this government believes, the last people who should be paying the price of Labour's economic mess are the sick."

Ms Sturgeon will also accuse Scottish Labour of "ducking and diving" on matching the SNP's commitment on protecting health spending, adding: "At a time when our revenue budget is facing significant cash cuts, there will be no revenue cash cuts in the budget for our NHS."

With next May's Holyrood elections on the horizon, the deputy SNP leader will also issue a rallying call to the party faithful, saying the Nationalists had a "proud record" of their first term in government.

She will say: "We have strong leadership and a wealth of experience.

"Most importantly of all, we have a clear alternative.

"We offer the only alternative to a Labour party that wrecked our economy and a Tory-Liberal coalition whose policies will wreck our society."

As well as Ms Sturgeon's speech, BBC Scotland political editor Brian Taylor will be quizzing Finance Secretary John Swinney in a live webcast from 1100 to 1130.

The webcast, to be shown on the BBC Scotland news website, will feature questions submitted by BBC viewers, readers and listeners.

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Chest compressions &#39;vital&#39; in CPR

14 October 2010 Last updated at 20:11 ET

Concentrating on chest compressions rather than mouth-to-mouth when giving emergency resuscitation can produce better results, says research published in The Lancet.

A study of 3,000 patients found that chest compressions alone increased chances of survival by more than 22%.

But training in how to give both chest compressions and mouth-to-mouth breaths is the best option, experts say.

The UK Resuscitation Council is due to produce new CPR guidelines next week.

Cardiopulmonary resuscitation (CPR) is a combination of chest compressions and mouth-to-mouth breaths, given in a life-threatening emergency like a cardiac arrest or heart attack.

The study, compiled by doctors from the Medical University of Vienna in Austria, looked at the survival rates of people treated by untrained members of the public taking instructions from the emergency services over the phone.

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If you're unwilling or unable to do full CPR then chest compressions are better than nothing."

End Quote Dr Meng Aw-Yong St John Ambulance

Dr Peter Nagele, from the department of anaesthesiology, critical care and pain therapy at the Medical University of Vienna, said that if untrained bystanders avoided mouth-to-mouth breaths during CPR, they were more likely to perform uninterrupted chest compressions.

That then increased the probability of CPR being successful.

Different techniques

The research in The Lancet involved two analyses.

The first used data from three randomised trials involving more than 3,000 patients.

It showed that chest-compression-only CPR was associated with a slightly improved chance of survival compared with standard CPR (14% v 12%).

In the second analysis of seven observational studies, researchers found no difference between the two CPR techniques.

The study authors maintain that continuous, uninterrupted chest compressions are vital for successful CPR.

Dr Jas Soar, chair of the Resuscitation Council from Southmead Hospital in Bristol, said: "Any CPR is better than no CPR. If you witness a cardiac arrest, dial 999 immediately. Those trained in CPR should follow existing guidance of 30 chest compressions followed by two rescue breaths.

"Those not trained should start compressions and follow instructions until an expert arrives," Dr Soar said.

Dr Meng Aw-Yong, medical adviser at St John Ambulance, acknowledged that rescue breaths could be off-putting.

"The current advice is that if you're unwilling or unable to do full CPR then chest compressions are better than nothing.

"The best solution, however, is for people to get trained in how to carry out chest compressions and rescue breaths so they can be the difference between a life lost and a life saved," he said.

The British Heart Foundation says that being able to do CPR more than doubles the chances of survival.

Claire O'Neill, community resuscitation programme lead at the BHF, said: "For someone who is untrained in cardiopulmonary resuscitation, doing both chest compressions and rescue breaths really can be difficult.

"We also know that uninterrupted chest compressions are very important for increasing the chance of survival. So being directed to focus solely on chest compressions could make people more willing to attempt resuscitation, which could ultimately save lives," she said.

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Call to axe paediatric heart unit

15 October 2010 Last updated at 01:01 ET By Jane Hughes Health correspondent, BBC News

The children's heart surgery unit at Oxford's John Radcliffe Hospital should close, a national review of paediatric heart centres in England has said.

Surgery was suspended there in March after four children operated on by the same surgeon died in three months.

The review will recommend that three or four other paediatric heart units out of 11 in England also stop surgery.

The aim is to improve the safety of heart operations by having fewer, more specialised centres.

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Pooling surgical expertise into fewer, larger centres is in the best interests of children"

End Quote Leslie Hamilton Review team member

Children's heart surgery at the John Radcliffe has been under the spotlight since it emerged that four children died there between last December and February of this year.

'Serious shortcomings'

An inquiry found that the deaths were not due to errors of judgement, but that the surgeon had not been given appropriate supervision.

It criticised the hospital trust for "serious shortcomings", in the way it had taken on more cases to try to avoid closure of the paediatric unit.

Paediatric cardiac surgery at the hospital remains suspended.

An expert group has been reviewing the work of the 11 centres across England which conduct this type of specialist surgery.

The review was launched in response to the 1990s Bristol heart babies scandal, when children having heart surgery died unnecessarily.

Its full recommendations are due early next year, but it is likely to say that the four or five smallest centres should stop carrying out operations.

This number would include the John Radcliffe cardiac centre, which it has already ruled is too small, and lacks the expertise to offer a good service to patients.

It will recommend that the Oxford children's cardiac unit stops doing surgery, but continues to offer diagnosis and pre- and post-operation care.

Leslie Hamilton, former president of the Society for Cardiothoracic Surgery and a review member, said the decision was aimed at improving the safety of heart operations.

"The NHS needs to ensure the very best outcomes for children," he said. "Children's heart surgery is complex and must be performed by highly skilled specialist surgical teams.

"Pooling surgical expertise into fewer, larger centres is in the best interests of children and their families."

The recommendation to close the Oxford surgical unit will be the subject of a public consultation. However, it is highly unlikely that children's operations there will now resume.

The John Radcliffe hospital described the news as disappointing for patients, their families and staff. But Director of Planning, Andrew Stephens, said it was not entirely surprising. "Oxford is one of the smallest centres," he said, "and the main thrust of the review is that there should be fewer, larger paediatric cardiac centres in the future."

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