Category Archives: Depressions

World Rugby criticises call for scrum and tackle ban in school sport

World Rugby has criticised the claims in a study calling for tackling and scrums to be banned in school sport.

Allyson Pollock and Graham Kirkwood from the Institute of Health at Newcastle University argued in the British Medical Journal that most injuries in youth rugby occur due to the collision elements of the game.

The pair called for “harmful contact” to be prohibited on school playing fields. Removing collision from school rugby is likely to “reduce and mitigate the risk of injury” in pupils, they said.

However, in a statement, the sport’s governing body questioned the data on which the claims were based.

“World Rugby and its member unions take player safety very seriously and proactively pursue an evidence-based approach to reduce the risk of injury at all levels,” the statement said.

“These claims are not based on like-for-like injury statistics and the conclusions are not supported by the available data.

“It is well documented that, for most sports, injury rates increase with age, but the quoted research mixes 9-12 with 18-20 age groups.

“Indeed, within the published studies where injury has been properly defined and monitored, suggest the risk for pre-teens is not unacceptably high compared to other popular sports.”

Pollock and Kirkwood called on the UK chief medical officers to advise the British government to remove harmful contact from the game.

In 2016, the nation’s most senior medics rejected a call for a ban on tackling in youth rugby.

But Pollock, who has been researching injuries and rugby injuries for more than 10 years, and senior research associate Kirkwood said that under United Nations conventions, governments have a “duty to protect children from risks of injury”.

“We call on the chief medical officers to act on the evidence and advise the UK government to put the interests of the child before those of corporate professional rugby unions and remove harmful contact from the school game,” they wrote.

“Most injures in youth rugby are because of the collision elements of the game, mainly the tackle.

“In March 2016, scientists and doctors from the Sport Collision Injury Collective called for the tackle and other forms of harmful contact to be removed from school rugby. The data in support of the call is compelling.”

That call was rejected by a range of former players and officials working within the game as well as World Rugby, however.

Nigel Owens MBE (@Nigelrefowens)

They will want to ban walking to school next. And only rubber pens and pencils to be used in class. What is the world coming too. https://t.co/CYMmk6WSgt

September 26, 2017

Dr Willie Stewart, a consultant neuropathologist who has been working in the field of brain injury for more than 15 years and sits on World Rugby’s Concussion Advisory Body, tweeted: “The health crisis facing Britain’s children is not #concussion but obesity and lack of exercise.”

Peter Robinson, the father of Ben Robinson, who died at 14 from second impact syndrome following a school game, and who worked with Stewart in helping to inspire a change in concussion guidelines, added on Twitter: “Banning tackling at schools not the answer. Mismanagement of Concussion is the greatest risk in the game.”

Citing previous research into sports injuries in youngsters, Pollock and Kirkwood had argued in the article that rugby, along with ice hockey and American football, have the highest concussion rates.

They said that rule changes in collision sports can make a difference, highlighting the Canadian ban on “body checking” – where a player deliberately makes contact with an opposing player – in ice hockey for under 13 year olds.

Meanwhile, in the UK “teacher training in the skills of rugby are lacking, as is concussion awareness training,” the pair wrote.

The researchers called on the UK chief medical officers to advise the British government to remove harmful contact from the game. They pointed to a history of concussion being associated with the “lowering of a person’s life chances” across a number of measures including low educational achievement and premature death. Meanwhile, a head injury is linked to an increased risk of dementia.

Commenting on the article, Prof Tara Spires-Jones, UK Dementia Research Institute programme lead and deputy director of the Centre for Discovery Brain Sciences at the University of Edinburgh, said: “Very strong, reproducible evidence supports a greater risk of dementia in people who have head injuries in their lifetimes, which urges caution in games where there is a significant risk of head injury.

“However, the data on specifically whether playing rugby or other contact sports in school increases your risk of dementia are not as robust yet due to a lack of large prospective studies. It is also very clear that there are many health risks of leading a sedentary lifestyle.”

Sixth mass extinction of wildlife also threatens global food supplies

The sixth mass extinction of global wildlife already under way is seriously threatening the world’s food supplies, according to experts.

“Huge proportions of the plant and animal species that form the foundation of our food supply are just as endangered [as wildlife] and are getting almost no attention,” said Ann Tutwiler, director general of Bioversity International, a research group that published a new report on Tuesday.

“If there is one thing we cannot allow to become extinct, it is the species that provide the food that sustains each and every one of the seven billion people on our planet,” she said in an article for the Guardian. “This ‘agrobiodiversity’ is a precious resource that we are losing, and yet it can also help solve or mitigate many challenges the world is facing. It has a critical yet overlooked role in helping us improve global nutrition, reduce our impact on the environment and adapt to climate change.”

Three-quarters of the world’s food today comes from just 12 crops and five animal species and this leaves supplies very vulnerable to disease and pests that can sweep through large areas of monocultures, as happened in the Irish potato famine when a million people starved to death. Reliance on only a few strains also means the world’s fast changing climate will cut yields just as the demand from a growing global population is rising.

There are tens of thousands of wild or rarely cultivated species that could provide a richly varied range of nutritious foods, resistant to disease and tolerant of the changing environment. But the destruction of wild areas, pollution and overhunting has started a mass extinction of species on Earth. The focus to date has been on wild animals – half of which have been lost in the last 40 years – but the new report reveals that the same pressures are endangering humanity’s food supply, with at least 1,000 cultivated species already endangered.

Tutwiler said saving the world’s agrobiodiversity is also vital in tackling the number one cause of human death and disability in the world – poor diet, which includes both too much and too little food. “We are not winning the battle against obesity and undernutrition,” she said. “Poor diets are in large part because we have very unified diets based on a narrow set of commodities and we are not consuming enough diversity.”

The new report sets out how both governments and companies can protect, enhance and use the huge variety of little-known food crops. It highlights examples including the gac, a fiery red fruit from Vietnam, and the orange-fleshed Asupina banana. Both have extremely high levels of beta-carotene that the body converts to vitamin A and could help the many millions of people suffering deficiency of that vitamin.

Quinoa has become popular in some rich nations but only a few of the thousands of varieties native to South America are cultivated. The report shows how support has enabled farmers in Peru to grow a tough, nutritious variety that will protect them from future diseases or extreme weather.

Mainstream crops can also benefit from diversity and earlier in 2017 in Ethiopia researchers found two varieties of durum wheat that produce excellent yields even in dry areas. Fish diversity is also very valuable, with a local Bangladeshi species now shown to be extremely nutritious.

Earth already in midst of sixth mass extinction, scientists say – video report

“Food biodiversity is full of superfoods but perhaps even more important is the fact these foods are also readily available and adapted to local farming conditions,” said Tutwiler.

Bioversity International is working with both companies and governments to ramp up investment in agrobiodiversity. The supermarket Sainsbury’s is one, and its head of agriculture, Beth Hart, said: “The world is changing – global warming, extreme weather and volatile prices are making it harder for farmers and growers to produce the foods our customers love. Which is why we are committed to working with our suppliers, farmers and growers around the world to optimise the health benefits, address the impact and biodiversity of these products and secure a sustainable supply.”

Pierfrancesco Sacco, Italy’s permanent representative to the UN’s Food and Agriculture Organisation, said: “The latest OECD report rates Italy third lowest in the world for levels of obesity after Japan and Korea. Is it a coincidence that all three countries have long traditions of healthy diets based on local food biodiversity, short food supply chains and celebration of local varieties and dishes?”

He said finding and cultivating a wider range of food is the key: “Unlike conserving pandas or rhinos, the more you use agrobiodiversity and the more you eat it, the better you conserve it.”

Why I needed to let my little brother die | Cathy Rentzenbrink

My little brother Matty was knocked over by a car on his way home from a snooker hall near Snaith in Yorkshire in 1990. He was 16 and we desperately wanted him to survive.

If Matty’s accident had happened a few years earlier he would have died in the road – but he was intubated, resuscitated, and had some holes drilled in his skull to relieve the pressure on his brain. So he remained in a critical condition for a few days, and then opened his eyes at the rate of a few millimetres a day, and that was really all he ever did. He couldn’t go to rehabilitation because there was nothing to rehabilitate. So we brought him home and built a bungalow extension on to the pub where we lived, and carried on hoping and dreaming that if we loved him enough we could reverse his brain damage.

It was when I saw Tony Bland, who was left in a persistent vegetative state (PVS) after the Hillsborough disaster, on the news that I realised there was a legal way out. Bland died after his treatment was withdrawn in 1993. But it wasn’t until 1998, when Matty was 24, that we went to court and a judge agreed that Matty’s feeding tube should be withdrawn so that he could die.

Everyone involved was compassionate, and I have always felt grateful that they tried not to make it horrible for us. But it was horrible. That’s why I welcomed last week’s ruling by Mr Justice Peter Jackson that in future, where doctors and families are in agreement they should not have to go to court to seek permission for treatment to be withdrawn from patients in a persistent vegetative or minimally conscious state.

I know lots of people will jump up and down and say we’re all going to start murdering our relatives, but this is a modest, compassionate step. Obviously vulnerable people need to be protected, but when something so terrible happens to a member of your family, anything that eases the burden is a good thing.

The reason court proceedings are so hard for families is that not only do you have to agree that you want the person to die, you have to administer it – make statements and swear affadavits – so you feel implicated. It took a year for the case that led to last week’s judgment to go through court, and it’s incredibly hard to be with someone, to care for them, when you know they’re going to die. You still don’t want them to get bed sores. You still want them to have physiotherapy so their limbs don’t get more twisted.

The surgeon Henry Marsh in his book Do No Harm says it’s very easy to save someone’s life with brain surgery – you drill some holes, let out some blood. But what we don’t know is what to do then, with those people who make no progression beyond having a beating heart.

If you haven’t been with someone with severe brain damage you might think that such people should be kept alive just in case of some kind of sleeping beauty scenario. But with new developments in medicine, death is no longer the worst outcome. It took me about four years to realise that Matty wouldn’t have wanted to live like that.

Of course there are connections with the wider debate about assisted dying, but I think these cases are right out there on their own. Often people who object to assisted dying do so for religious reasons, but Matty wasn’t alive because of the will of god. He was alive because of a human intervention that probably shouldn’t have been made. The right to life argument can’t be applied in the same way across the board.


Unless you’ve stared into the blank eyes of someone in a vegetative state, I just don’t care about your arguments

People are worried about creating precedents, but when someone wants to talk to me about all this, and has views they want to discuss, I’m always interested in whether they’ve spent time with someone in a PVS; if they have, then I’m quite interested, but if they haven’t then I’m not. Until you’ve spent time with someone, and stared into their blank eyes and seen that they are no longer there because their brain has been mashed out, I just don’t care about your legal or academic arguments.

I’m glad the book I wrote about what happened to Matty is on a syllabus for law students. But what they should also do is go and spend a day with people who are never getting better. Artificial nutrition and hydration is wonderful, but it was invented to keep people alive for a few days so doctors could make a life-saving intervention. No one would have said when they developed tube feeding, “and we’ll be able to keep people alive for decades while their limbs twist up and their families disintegrate around them”. It is a travesty.

There are no good outcomes in these situations; it’s about damage limitation. It’s profoundly psychologically and morally confusing to realise that you want the person you love most in the world to die. Having to go to court is by no means the worst thing that happened to my family as a result of Matty being hit by a car, but it is one thing that can be changed. The judge is right. It should be, so others are spared that ordeal.

Cathy Rentzenbrink is the author of The Last Act of Love

Mental health data shows stark difference between girls and boys

A snapshot view of NHS and other data on child and adolescent mental health reveals a stark difference along gender lines.

As reported earlier this week, the results of a study by University College London and the University of Liverpool show a discrepancy between the emotional problems perceived by parents and the feelings expressed by their children. Researchers asked parents to report signs of emotional problems in their children at various ages; they also presented the children at age 14 with a series of questions to detect symptoms of depression.

Graph showing that there is a discrepancy between self-expressed emotional problems in teens and problems reported by their parents


The study reveals that almost a quarter of teenage girls exhibit depressive symptoms. Data from NHS Digital, which examines the proportion of antidepressants prescribed to teenagers between 13 and 17 years old, shows that three-quarters of all antidepressants for this age group are prescribed to girls.

More than two-thirds of antidepressants prescribed to teenagers are for girls


Eating disorders are one of the most common manifestations of mental health problems, and are in some cases closely related to depression. A year-by-year breakdown of hospital admissions for eating disorders indicates that, while eating disorders in both boys and girls are on the rise, more than 90% of teens admitted to the hospital for treatment are girls.

Graph showing the difference between girls and boys admitted to hospital for eating disorders

Records also show hospital admissions dating back to 2005 for individuals under 18 years old who committed self-harm. While the numbers for boys have seen a smaller amount of variation with a general upward trend, the figure for girls has climbed sharply during the last decade, with the most significant jump occurring between 2012/13 and 2013/14.

Hospital admissions for self-harm are up by two-thirds among girls


Two of the most common methods of self-harm are poisoning and cutting. Self-poisoning victims are about five times as likely to be girls, and the number of girls hospitalised for cutting themselves has quadrupled over the course of a decade.

Most self-harm admissions involve cases of self-poisoning, which has risen drastically among girls
Self-harm hospitalisations involving girls cutting themselves have quadrupled since 2005


Although self-harm, depression, and other mental health problems are more commonly reported and identified in girls, suicide rates are far higher among boys. This data is consistent with research on differences found between men and women in methods used to commit suicide, the influence of alcohol, and other social or cultural factors.

Teenage boys are more than twice as likely to kill themselves as girls
  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Farmer wants a revolution: ‘How is this not genocide?’

The kurrajong tree has scars in its wrinkled trunk, the healed wounds run long and vertical under its ancient bark. Standing in front of the homestead, it nestles in a dip on high tableland from which there is a clear view across miles and miles of rolling plains to the coastal range of south-east Australia.

Charles Massy grew up here, on the sweeping Monaro plateau that runs off the eastern flank of Mount Kosciuszko, an only child enveloped by the natural world, running barefoot, accompanied by dogs and orphaned lambs. Fifth generation, he has spent his adult life farming this tough, lean, tussock country; he is of this place and it of him. But when his friend and Aboriginal Ngarigo elder Rod Mason came to visit he discovered that a lifetime of intimately knowing the birds, trees and animals of this land wasn’t significant at all.

The tree is probably a lot older than 400 years. Rod told him that when the old women walked their favourite songline tracks they carried seeds of their favourite food and resource plants, and sowed them at spirituality significant camping places. His front garden was one such ceremony place – there would have been a grove planted, and the women had stripped the bark from the tree to make bags and material. This old tree represented a connection to country “deeper than we can imagine, and linking us indivisibly with the natural world”, he writes in his book Call of the Reed Warbler: A New Agriculture – A New Earth.

Part lyrical nature writing, part storytelling, part solid scientific evidence, part scholarly research, part memoir, the book is an elegant manifesto, an urgent call to stop trashing the Earth and start healing it. More than that, it underlines a direct link between soil health and human health, and that the chemicals used in industrial agriculture are among the causes of modern illness.


It makes a world war look like a little storm in a teacup. And we are in denial

“Most of our cereal crops, the soybeans, the corn, are all predicated now on the world’s most widely used chemical which is glyphosate [Roundup],” Massy says. “There is mounting evidence that it is one of the most destructive chemicals ever to get into the system. Its main effect is on the human gut and our entire immune system.

“When you look at the As – autism, ADHD, all the other auto-immune diseases – their take off is a 95% correlation to these chemicals being introduced. The evidence is that it affects the gut and the immune system, though it is not the sole factor, and it is a complex thing. But it is that gut that drives our whole immune system, it is our second brain.”

Roundup in a supermarket


‘There is mounting evidence that it is one of the most destructive chemicals ever to get into the system,’ Charles Massy says of Roundup. Photograph: Rene van den Berg/Alamy

He says that when you spray insects with insecticides you kill off the predators so you have got to have more powerful chemicals next time because the pests come back stronger. “Roundup is now on its sixth or seventh phase.”

Massy is among scientists who believe we have entered a new geological epoch, the life-threatening Anthropocene, where human impact has permanently altered the Earth’s geology and sustaining systems, causing ecological destruction and extinction of species. “It is the greatest crisis the planet and humanity has ever faced,” he says, sitting at his kitchen table in country New South Wales. “It makes a world war look like a little storm in a teacup. And we are in denial.”

Tall, lean, fit, with white hair crowning a face that has spent a life outdoors, Massy looks more like the establishment grazier he is rather than a powerful advocate for revolutionising everything about the way we farm, eat and think about food. We are at a tipping point, he says, and if we it ignore we are “history”.

Massy spent eight years going to his office in an outbuilding behind the house in the early hours of morning to write before a day of working on the farm; the 569-page book is his life’s work; the big picture, the long view both historical and into the future that pulls together the latest international scientific research and thinking on climate change, regenerative farming, industrial agriculture and the corporations driving it.

He writes: “While consuming more resources than the Earth’s systems can replenish, we are hurtling towards multiple calamities. We are degrading the air we breathe, denaturing the food we eat and water we drink and lacing them with a witch’s brew of deadly poisons.”

We have lost touch with the land, we manipulate the Earth to our own ends, we dominate it and are ultimately destroying it. Aboriginal people, he says, saw it differently, as something to be nurtured and nourished, a living entity. He calls their custodianship “one of the greatest ever sustainable partnerships between humankind and the ecosystems they occupied”.

Farmer and author Charles Massy


The farmer, scientist and author at home on his property, Severn Park. Photograph: Mike Bowers for the Guardian

Then white Australians brought what he calls the mechanical mind and the European mind. “It is a totally different continent to anywhere else in the world. It works totally differently to that young landscape of Europe with humidity and rich soils. Until we throw off the European mechanical mind we are going to continue to stuff the joint. It is not something inanimate that you can belt. It is almost like being with a lover, you have got to nurture it and care for it.”

Now 65 and “a fossil” Massy is, by his own admission, a “biophilia”, filled with the wonder and delight of nature. “I believe one cannot gain true ecological literacy without a great empathy with, and understanding of, nature and how it functions. Thus one’s heart also needs to be involved.”

But his own journey and awakening was slow and stumbling. He was at university when, at the age of 22, his father had a heart attack and he came home to manage the merino and cattle property. Well-intentioned and diligent he read the books, he sought advice, he learned. “I thought I was running a pretty good show.” His wool was being bought for fabric by “the top guys in Italy. We were the first group to breed animal welfare-friendly sheep.” But he now realises he was “blind” and “oblivious”, he saw the landscape “as if through a glass darkly”.

He writes: “I completely overlooked the most important of all factors, the keystone of the whole operation: that our farm was a complex and dynamic series of ecological systems, and that our landscape actually functioned in specific but sensitive ways.” He made mistakes; he assiduously ploughed a paddock just before a huge storm came and washed the topsoil away, “I had cost the landscape perhaps a thousand years of topsoil.” Like many other regenerative farmers he reached the conclusion he had to make a big shift when something “cracked” his mind open.


If people ate truly nutrient-rich food out of healthy soil, you would slash the national health bill straight away

For Massy it was the years of drought, 1979 to 1983, that plunged him into depression and major debt. He finally understood that he needed a completely different mindset and management approach if he was going to come to terms with the reality of drought. “The land, soils, micro-organisms and other creatures and vegetation are adapted to this,” he writes. And so he began his journey towards enlightenment. After 35 years he went back to university and completed a PhD in human ecology, consulting everyone from scientists to Aboriginal elders.

We are driving in his ute across the plateau, cloud shadows dancing across the big-sky landscape, kangaroos and wallabies bouncing along, kelpies on the back to muster the healthy sheep. The paddocks are strewn with great monolithic rocks, 400m years old. There are birds and wildlife that have returned since he became a holistic farmer. Deep in the soil the bugs, microbes and fungi are sourcing nitrogen and nutrients. Change has to literally be grassroots, food health comes from the ground up, the health of people is entwined with the health of landscapes and soil. “The minute you fertilise and spray all that biology is gone. The vital thing about regenerative or organic farming is this healthy living dynamic soil. Landscapes with diverse arrays of plants are nutrition centres and pharmacies with vast arrays of primary and secondary compounds.”

As the dogs bound away to herd the sheep, he says, “One of the big ideas I discovered going back to uni was this concept which I came to, that our natural complex systems will self-organise themselves back to health. I think it is one of the biggest ideas. I think it is as big as evolution. It has only just emerged with physics and chemistry and computers and stuff. The Earth itself it is a self-organising regulating system.”

The human element is the problem, the learning how to live tuned to its rhythms, to get out of its way, to listen to the land. “I say confidently that not many farmers can read the landscape. For them to change they have got to admit they have been wrong for most of their lives. The thing that is challenging about it is that you have got to be totally flexible to adjustment and really get your mind into how nature works and be able to change tactics.”

He tells the story of the grasshoppers. Before he began holistic grazing the property was regularly hit by plagues of wingless grasshoppers. “They turned an OK season into instant drought. They thrive under degrading management, bare ground provides them with egg beds. But once we began our biodiverse plantings plus holistic grazing we have not had a grasshopper attack since.

The entrance to Charles Massy’s property


The entrance to Severn Park: ‘Now we have got 10 invaluable native grass species I never thought I would see on our property,’ Massy says. Photograph: Mike Bowers for the Guardian

“Ecological grazing yields total ground cover, higher cover, deeper roots, more moisture absorption plus more biologically alive soils; it means nematodes and other creatures eat the grasshopper eggs. You get excited when you see a new plant species suddenly emerge again. Now we have got 10 invaluable native grass species I never thought I would see on our property.”

The winter nights are cold on the plateau and, with a glass of red wine and before an open fire, Massy is unrepentant about criticising the big-end-of-town companies that promote chemicals in industrial farming, and the governments that don’t act. In the book he says unhealthy food “is not just poisoning us but is also, confoundingly, making us obese as well”. Now he says “when you are eating that McDonald’s crap even though you are bloated your body is still hungry because your organs are not getting nutrients.

“If people ate truly nutrient-rich food out of healthy soil, you would slash the national health bill straight away. The big chemical companies and big food companies know exactly what they are doing. It is now causing millions of deaths – tell me why that is not genocide?”

But just as nature find its own solutions, culling, reorganising, so too is Massy offering answers, a “toolkit” of how to change.

“This combines the best of Old Organic – namely its respect, empathy and reverence for Mother Nature – with the best of modern, ecologically simpatico science and Earth-empathic thought.” The kind of people who make the change, he found, were those with strong belief in community and healthy food that does not come from contaminated soil.

Call of the Reed Warbler cover

What lies beneath “is a burgeoning mass of life and activity that is 10-fold that above the ground; fungi bacteria, and other organisms have begun to create and sustain an entirely different, living absorbent soil structure; the very heart and essence of healthy farming and landscape function. The secret is to simply restore healthy landscape function and allow nature to do the rest.”

Massy agrees that he is “not naive enough to think it would be a nice seamless shift. I think we are going to see some pretty frightening stuff.”

But for him, a defining moment came when, while sitting against an old snow gum, he heard the “beautiful, piercing song of a reed warbler” returning after a long absence from this area. It was, he says, a “metaphor for us humans to once more become the enablers, the nurturers, the lovers of Earth”.

Call of the Reed Warbler: A New Agriculture – A New Earth is published by University of Queensland Press ($ 39.95)

Get up, stand up: including exercise in everyday life healthier than gym, says study

Incorporating physical activity into our everyday lives, from taking the stairs to holding “walkaround” meetings in the office, is more likely to protect us from heart disease and an early death than buying a gym membership, according to the author of a major new global study.

The study, published in the Lancet medical journal, found that one in 20 cases of heart disease and one in 12 premature deaths around the globe could be prevented if people were more physically active. It compared 130,000 people in 17 countries, from affluent countries like Canada and Sweden to some of the least affluent, including Bangladesh and Zimbabwe.

While 30 minutes of exercise per day for five days a week, which most guidelines recommend, reduces heart disease and deaths, one to two hours a day is the optimal amount of physical activity, said lead author Professor Scott Lear, of Simon Fraser University’s faculty of health sciences in Vancouver, Canada.

Most people will think they cannot incorporate that much physical activity into their life, he said. “They will think ‘I’m stressed out and have to make dinner – and then do exercise for two hours!’” he said.

But the study showed that those people who have the highest activity levels are those for whom it is part of their everyday working lives. In developing countries, more people still have physically taxing jobs but as they become more economically prosperous, their activity levels fall.

“They are going from sweeping the floor to buying a vacuum,” said Lear.

He does not advocate selling the vacuum cleaner, but we could all incorporate more activity into our lives rather than relying on occasional forays to the gym or swimming pool. “It becomes routine as opposed to an endeavour,” he said. “Sitting for hours is not good for hearts or the physical body. Getting up every 20 to 30 minutes for a walk around is beneficial. I have a cooking timer.

“We spend a lot of time in meetings. If it is just two or three people, why not have a walkaround meeting?”

He also suggests playing with children in the park rather than sitting watching them, increasing the walk to work by getting off the tube or bus early and taking the stairs rather than the lift.

The authors found that the more physically active people were, the lower their risk of heart disease or an early death.

“Participating at even low physical activity confers benefit and the benefit continues to increase up to high total physical activity,” says the study. People who did more than 750 minutes of brisk walking or equivalent activity per week reduced their risk of death by 36%.

But the study notes that “the affordability of other CVD [cardiovascular disease] interventions such as consuming fruits and vegetables and generic CVD drugs is beyond the reach of many people in low-income and middle-income countries; however, physical activity represents a low-cost approach to CVD prevention.”

While the amount of physical work people do in low income countries reduces heart disease, their chances of surviving if they do have a heart attack or stroke are lower because their health services are not as advanced.

The World Health Organisation recommends that adults aged 18-64 years old do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, as well as muscle strengthening exercises at least two days a week. But it is thought that almost a quarter (23%) of the world’s population are not meeting physical activity guidelines.

The study is the first to compare physical activity and heart disease levels in countries of varying affluence.

“The clear-cut results reinforce the message that exercise truly is the best medicine at our disposal for reducing the odds of an early death,” said Dr James Rudd, a senior lecturer in cardiovascular medicine at the University of Cambridge.If a drug company came up with a medicine as effective as exercise, they would have a billion-dollar blockbuster on their hands and a Nobel prize in the post.”

“There is a trend for more heart disease in lower income groups both within and between populations,” said John Martin, professor of cardiovascular medicine at University College London. “In the UK it has been shown that lower social class is associated with more heart disease. Walking is easy and cheap. This study should encourage governments to rebalance health budgets away from high tech treatment of heart disease to promoting simple strategies of prevention like walking.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation said: “In an age where we’re living increasingly busy but often sedentary lives in the west, weaving physical activity into our daily routines has never been more important, not only to improve our physical health but also overall well-being. Increased physical activity could have an even greater beneficial impact in lower income countries, due to its low its cost and the high incidence of heart disease in those countries.”

No, a standing desk isn’t as unhealthy as smoking

A headline in the Independent today has proclaimed that standing at work is “as unhealthy as a cigarette a day”, citing a new study published in the American Journal of Epidemiology. Illustrated with a picture of a woman bent over her standing desk clutching at her back, we’re instructed to “sit back down”.

But a closer look at the research in question reveals very little to do with standing desks. In fact, the study did not look at standing desks at all. The research was conducted on a sample of 7,320 residents of Ontario, Canada, followed up for over a decade. And its findings are striking – people whose job requires them to stand for long periods of time were twice as likely to contract heart disease compared to those who do jobs that predominantly involve being seated.

So should we all lower our standing desks and recover our office chairs from wherever we’ve stashed them? I am not going to rush to do so (at this point I should fess up and say I have used a standing desk for the past three years and I love it).

Firstly, did the researchers ask people whether they stood or sat at work? No, they did not. People were categorised by the job they did. This immediately means that if you’re an office worker with a standing desk, you’ll be categorised as a sitter, because that’s predominantly what office workers do. The supplementary table of the paper lists a number of common jobs and how they were categorised for the study. Seated jobs included truck drivers, administrative officers, secretaries, professional occupations in business services and accounting clerks. Standing jobs on the other hand included retail salespersons, cooks, food and beverage servers and machine or tool operators.

Now here we get on to the classic problem with observational epidemiology. People who work different types of jobs are going to be different in loads of ways other than their jobs, all of which might also impact on risk of heart disease. This is called confounding. The authors of the study take a number of these in to account, for example pre-existing health conditions, whether the person smokes, whether they were obese, and various others. But it’s very hard to be sure that you’ve taken all of the potential confounding factors like these in to account. There could very easily be other differences rather than just whether a person is more likely to be standing or sitting. For example how much they exercise could have a big impact. Perhaps, as one person on Twitter suggested to me, after a day on your feet you’re less inclined to go for a run of an evening.

Also, as can be seen from the list of jobs they’ve included in each group, there might be socio-economic differences between people who do jobs that require standing at work and those who are more likely to sit – and these might be related to how good your diet is, how much disposable income you have, all things that sadly are associated with ill health. Even if you attempt to take these factors in to account in a statistical model, if you’re relying on self-reported or large scale data it’s almost impossible to be sure you’ve really accounted for all the variability.

So while this study is really interesting, and might indicate that jobs where you’re more likely to stand are linked to an increased risk of heart disease, personally I think there’s a little more going on than simply that we should all sit down at work if we want to protect our hearts. Not to mention that this study has absolutely nothing to do with standing desks, and didn’t actually ask the individuals included whether they did stand or sit at work, but inferred it from the type of job they did. I’m not lowering my standing desk just yet.

One in seven GP practices in England failing on safety

About 7 million people are being treated at GP surgeries in England that have severe safety problems, according to the first performance review of its kind by the Care Quality Commission (CQC).

One in seven GP practices are failing on safety, even after CQC inspectors have told them to improve, the report found, with smaller practices more likely to be rated “inadequate” or “requiring improvement”.

The review also uncovered significant regional disparities in GP surgery performance, with London having the highest rate of practices (17%) rated as inadequate or requiring improvement.

This contrasted with the north-east, where 98% of practices were rated good or outstanding, closely followed by Yorkshire and the Humber, and the south-west of England.

The CQC rated the performance of 7,365 GP surgeries between 2014 and earlier this year, with practices scored against a series of indicators, including whether they were effective, caring, safe and well-led. It rated 90% of them as good or outstanding. But 8% required improvement and 2% were inadequate overall.

Problems found by the review included managing and dispensing medicines and vaccines, managing serious incidents, and having appropriate equipment and medicines for emergency use.

Disparities in performance between small and large practices were also uncovered by the report, with “super surgeries” faring better.

The report said: “Findings from our interviews suggest that in a larger practice it is easier to have staff with defined roles, and there is a greater likelihood that there will be well-functioning nursing teams where nurses focus on particular areas, such as diabetes or chronic obstructive pulmonary disease (COPD), and junior nurses take on task-oriented roles.

“Our qualitative analysis indicated that the factors that inhibited a higher rating for a smaller practice could be related to financial pressures and professional or clinical isolation.

“Although patients value single-handed GPs, it can be harder to deliver high-quality, innovative services as a team of one. Where there are more people working in a practice, and a larger patient list, it is easier to deliver a wider range of high-quality services and be innovative.”

The review found super practices can have large numbers of doctors, with 60 or more in some cases, with many smaller surgeries now coordinating to share resources.

GP surgery inspections were carried out in more than one phase. On first review, 27% of GP practices in England were rated as “requiring improvement” and 6% were rated as “inadequate” for safety.

When failing practices were reinspected six months later, some had got better but 13% of practices overall still required improvement and 2% were inadequate for safety. Only 1% of practices were rated as outstanding for safety as of May this year.

Prof Steve Field, chief inspector of general practice at the CQC, said the “clear majority” of practices were safe and of a high quality.

“Where we identified concerns, most practices have taken action and improved,” he said. “GPs, practice managers and other primary care staff should be commended for their efforts.

“The challenge is for this focus on quality to be maintained and for general practice to be supported in continuing to give patients this same high standard of care in future while embracing and driving the changes elsewhere in the system.

“The pressures on GPs are very real but we have found many practices are already delivering care in new and innovative ways to benefit their patients and the wider community.”

Mental health trust pays damages over man’s death in tower block fire

A mental health trust has paid out damages over the case of a man with bipolar disorder and a history of lighting fires who was trapped in a blaze at his cluttered tower block flat.

Bob Crane, 61, a well-known character in the Stokes Croft area of Bristol, had been cooking on open fires at his seventh-floor council flat for more than a year because his electricity had been cut off.

Concerns were repeatedly raised that Crane was putting himself and his neighbours at risk, but he died of smoke inhalation and carbon monoxide poisoning after his cooking fire got out of control.

Crane’s son, Alex, told the Guardian his father was treated as an antisocial nuisance rather than a vulnerable man with a serious untreated mental illness, and criticised agencies involved for failing to work in a joined-up way to keep him and other residents safe.

He said: “No one was prepared to take the lead. There was no coordinated effort. It was all very haphazard though it should have been obvious there was a serious danger to life. Too many heads were buried in the sand. It was all but inevitable that my dad would die in a fire, and it is a miracle that no one else was killed.”

Alex, an English teacher now living in Vietnam, said he had tried to look after his father. He said: “My dad and I were very close. I looked after him for my whole adult life until the strain became too much and I placed my trust in the Avon and Wiltshire mental health partnership (AWP) and Bristol city council to keep him safe.”

Crane was diagnosed with bipolar disorder in 1985 and was detained under the Mental Health Act on a number of occasions. In 2012 Crane stopped taking medication and, because he refused to acknowledge he was ill and rejected help, was discharged from mental health services.

In May 2013 the electricity supply to Crane’s flat was cut off and he began to light fires to cook and heat water. Firefighters were called four times to reports of smoke and flames at the flat.

Crane was served with an injunction prohibiting him from lighting fires in or near his tower block, Carolina House, in June 2014. He did not stop and the following month a nurse who had visited wrote that his flat was a “major fire hazard” and if there was a blaze there was a “high risk” he and his neighbours would not be able to escape.

A mural that appeared in Stokes Croft that was dedicated to Bob Crane.
A mural dedicated to Bob Crane that appeared in Stokes Croft. Photograph: Steve Morris for the Guardian

Crane died following a fire in September 2014. A report from the fire and rescue service concluded: “The most probable cause was the deliberate ignition of flammable materials such as paper or wood for the purpose of cooking or heating water.”

An inquest ruled that Crane’s death was accidental and a serious case review that investigated how agencies including AWP and the city council handled the case raised concerns about joint working practices. It said there had been a failure to understand that Crane’s antisocial behaviour was a symptom of the deterioration of his mental health.

Alex Crane brought a claim for damages against AWP and the city council, arguing they had violated his father’s right to life under the European convention on human rights. While not accepting that it was liable or negligent, AWP settled and the claim against the council has been discontinued.

Alex Crane said his father was an eccentric but well-liked character in Stokes Croft, a neighbourhood famed across the globe for its street art. Three murals appeared in the neighbourhood dedicated to Crane following the fatal fire.

He said: “My dad was a very interesting character, outgoing and sociable. He made everyone laugh and he had lots of friends. He also had an anti-authoritarian streak, which sometimes ended in confrontation with people he perceived to be the establishment.”

Alex Crane said he did not believe professionals understood his father’s illness. “He always presented as articulate even when he was completely out of touch with reality.”

He also expressed concern at the funding available for mental health services. “There is a shameful lack of resources. I’ve been involved in this [his father’s case] since I was 13 and I’ve seen mental health services get considerably worse. The availability of beds, of time with professionals has gone down and down.

“Ultimately, my dad’s case illustrates the dangers of expecting under-funded, under-trained and under-staffed public services to care for mentally ill people in the community.”

Alex Crane’s lawyer, Gus Silverman, of solicitors Irwin Mitchell, said more should have been done to help Crane. He said: “It is extremely concerning that Bob was allowed to continue living on the seventh floor of a high-rise block when the authorities knew that he was regularly lighting fires, living without electricity and suffering from a serious untreated mental illness.”

A spokesperson for AWP said: “Although the trust was not liable or negligent we made a financial settlement. This was a complex issue involving multiple agencies and after taking legal advice and considering a range of factors we determined that a payment with no admission of liability would be the best outcome for the taxpayer.

“We would like to reiterate our condolences to the family and friends of Mr Crane for their loss.”

A Bristol city council spokesperson said: “We were extremely saddened and concerned about Mr Crane’s death. This tragic incident resulted in a review of our practices and we worked closely with the Bristol safeguarding adults board to help develop a new policy around self-neglect, which all partners now follow.”

Mental health trust pays damages over man’s death in tower block fire

A mental health trust has paid out damages over the case of a man with bipolar disorder and a history of lighting fires who was trapped in a blaze at his cluttered tower block flat.

Bob Crane, 61, a well-known character in the Stokes Croft area of Bristol, had been cooking on open fires at his seventh-floor council flat for more than a year because his electricity had been cut off.

Concerns were repeatedly raised that Crane was putting himself and his neighbours at risk, but he died of smoke inhalation and carbon monoxide poisoning after his cooking fire got out of control.

Crane’s son, Alex, told the Guardian his father was treated as an antisocial nuisance rather than a vulnerable man with a serious untreated mental illness, and criticised agencies involved for failing to work in a joined-up way to keep him and other residents safe.

He said: “No one was prepared to take the lead. There was no coordinated effort. It was all very haphazard though it should have been obvious there was a serious danger to life. Too many heads were buried in the sand. It was all but inevitable that my dad would die in a fire, and it is a miracle that no one else was killed.”

Alex, an English teacher now living in Vietnam, said he had tried to look after his father. He said: “My dad and I were very close. I looked after him for my whole adult life until the strain became too much and I placed my trust in the Avon and Wiltshire mental health partnership (AWP) and Bristol city council to keep him safe.”

Crane was diagnosed with bipolar disorder in 1985 and was detained under the Mental Health Act on a number of occasions. In 2012 Crane stopped taking medication and, because he refused to acknowledge he was ill and rejected help, was discharged from mental health services.

In May 2013 the electricity supply to Crane’s flat was cut off and he began to light fires to cook and heat water. Firefighters were called four times to reports of smoke and flames at the flat.

Crane was served with an injunction prohibiting him from lighting fires in or near his tower block, Carolina House, in June 2014. He did not stop and the following month a nurse who had visited wrote that his flat was a “major fire hazard” and if there was a blaze there was a “high risk” he and his neighbours would not be able to escape.

A mural that appeared in Stokes Croft that was dedicated to Bob Crane.
A mural dedicated to Bob Crane that appeared in Stokes Croft. Photograph: Steve Morris for the Guardian

Crane died following a fire in September 2014. A report from the fire and rescue service concluded: “The most probable cause was the deliberate ignition of flammable materials such as paper or wood for the purpose of cooking or heating water.”

An inquest ruled that Crane’s death was accidental and a serious case review that investigated how agencies including AWP and the city council handled the case raised concerns about joint working practices. It said there had been a failure to understand that Crane’s antisocial behaviour was a symptom of the deterioration of his mental health.

Alex Crane brought a claim for damages against AWP and the city council, arguing they had violated his father’s right to life under the European convention on human rights. While not accepting that it was liable or negligent, AWP settled and the claim against the council has been discontinued.

Alex Crane said his father was an eccentric but well-liked character in Stokes Croft, a neighbourhood famed across the globe for its street art. Three murals appeared in the neighbourhood dedicated to Crane following the fatal fire.

He said: “My dad was a very interesting character, outgoing and sociable. He made everyone laugh and he had lots of friends. He also had an anti-authoritarian streak, which sometimes ended in confrontation with people he perceived to be the establishment.”

Alex Crane said he did not believe professionals understood his father’s illness. “He always presented as articulate even when he was completely out of touch with reality.”

He also expressed concern at the funding available for mental health services. “There is a shameful lack of resources. I’ve been involved in this [his father’s case] since I was 13 and I’ve seen mental health services get considerably worse. The availability of beds, of time with professionals has gone down and down.

“Ultimately, my dad’s case illustrates the dangers of expecting under-funded, under-trained and under-staffed public services to care for mentally ill people in the community.”

Alex Crane’s lawyer, Gus Silverman, of solicitors Irwin Mitchell, said more should have been done to help Crane. He said: “It is extremely concerning that Bob was allowed to continue living on the seventh floor of a high-rise block when the authorities knew that he was regularly lighting fires, living without electricity and suffering from a serious untreated mental illness.”

A spokesperson for AWP said: “Although the trust was not liable or negligent we made a financial settlement. This was a complex issue involving multiple agencies and after taking legal advice and considering a range of factors we determined that a payment with no admission of liability would be the best outcome for the taxpayer.

“We would like to reiterate our condolences to the family and friends of Mr Crane for their loss.”

A Bristol city council spokesperson said: “We were extremely saddened and concerned about Mr Crane’s death. This tragic incident resulted in a review of our practices and we worked closely with the Bristol safeguarding adults board to help develop a new policy around self-neglect, which all partners now follow.”