Category Archives: Depressions

One in eight people set to have type 2 diabetes by 2045, says study

One in eight people in the world will have type 2 diabetes by 2045 if obesity continues to climb at the present rate, according to a new study.

Last year, 14% of the global population was obese and 9% had type 2 diabetes. By 2045, 22% will be obese and 14% will be suffering from type 2 diabetes, estimates presented at the European Congress on Obesity in Vienna suggest.

The implications of the expanding numbers are severe for health systems in every country. Diabetes UK estimates that the NHS spends £14bn a year on the disease already, which is about 10% of its budget. People with diabetes need monitoring, treatment and care for the serious potential complications which can include amputations and blindness.

The study was carried out by scientists funded by the pharmaceutical company Novo Nordisk, which makes diabetes treatments, together with the Steno Diabetes Centre in Gentofte, Denmark, and University College London. They say that to prevent type 2 diabetes rates rising above 10%, obesity levels must come down by a quarter.

The institutions collaborated to launch the Cities Changing Diabetes programme in 2014 to accelerate the global fight against urban diabetes. The program began with eight cities: Copenhagen, Rome, Houston, Johannesburg, Vancouver, Mexico City, Tianjin and Shanghai. These have since been joined by a further seven cities: Beijing, Buenos Aires, Hangzhou, Koriyama, Leicester, Mérida and Xiamen.

“These numbers underline the staggering challenge the world will face in the future in terms of numbers of people who are obese, or have type 2 diabetes, or both. As well as the medical challenges these people will face, the costs to countries’ health systems will be enormous,” said Dr Alan Moses of Novo Nordisk Research and Development in Søborg, Denmark.

“The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified. Developing effective global programs to reduce obesity offer the best opportunity to slow or stabilise the unsustainable prevalence of diabetes. The first step must be the recognition of the challenge that obesity presents and the mobilisation of social service and disease prevention resources to slow the progression of these two conditions.”

The researchers have calculated the likely rise in obesity for individual countries. If current trends in the US continue, obesity will increase from 39% in 2017 to 55% in 2045, and diabetes rates from 14% to 18%. To keep diabetes rates in the US stable between 2017 and 2045, obesity must fall from 38% today to 28%.

In the UK, they say, current trends predict that obesity will rise from 32% today to 48% in 2045, while diabetes levels will rise from 10.2% to 12.6%, a 28% rise. To stabilise UK diabetes rates at 10%, obesity prevalence must fall from 32% to 24%.

“Each country is different based on unique genetic, social and environmental conditions which is why there is no ‘one size fits all’ approach that will work. Individual countries must work on the best strategy for them,” said Moses.

The tide could be turned, he said, “but it will take aggressive and coordinated action to reduce obesity and individual cities should play a key role in confronting the issues around obesity.”

One in eight people set to have type 2 diabetes by 2045, says study

One in eight people in the world will have type 2 diabetes by 2045 if obesity continues to climb at the present rate, according to a new study.

Last year, 14% of the global population was obese and 9% had type 2 diabetes. By 2045, 22% will be obese and 14% will be suffering from type 2 diabetes, estimates presented at the European Congress on Obesity in Vienna suggest.

The implications of the expanding numbers are severe for health systems in every country. Diabetes UK estimates that the NHS spends £14bn a year on the disease already, which is about 10% of its budget. People with diabetes need monitoring, treatment and care for the serious potential complications which can include amputations and blindness.

The study was carried out by scientists funded by the pharmaceutical company Novo Nordisk, which makes diabetes treatments, together with the Steno Diabetes Centre in Gentofte, Denmark, and University College London. They say that to prevent type 2 diabetes rates rising above 10%, obesity levels must come down by a quarter.

The institutions collaborated to launch the Cities Changing Diabetes programme in 2014 to accelerate the global fight against urban diabetes. The program began with eight cities: Copenhagen, Rome, Houston, Johannesburg, Vancouver, Mexico City, Tianjin and Shanghai. These have since been joined by a further seven cities: Beijing, Buenos Aires, Hangzhou, Koriyama, Leicester, Mérida and Xiamen.

“These numbers underline the staggering challenge the world will face in the future in terms of numbers of people who are obese, or have type 2 diabetes, or both. As well as the medical challenges these people will face, the costs to countries’ health systems will be enormous,” said Dr Alan Moses of Novo Nordisk Research and Development in Søborg, Denmark.

“The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified. Developing effective global programs to reduce obesity offer the best opportunity to slow or stabilise the unsustainable prevalence of diabetes. The first step must be the recognition of the challenge that obesity presents and the mobilisation of social service and disease prevention resources to slow the progression of these two conditions.”

The researchers have calculated the likely rise in obesity for individual countries. If current trends in the US continue, obesity will increase from 39% in 2017 to 55% in 2045, and diabetes rates from 14% to 18%. To keep diabetes rates in the US stable between 2017 and 2045, obesity must fall from 38% today to 28%.

In the UK, they say, current trends predict that obesity will rise from 32% today to 48% in 2045, while diabetes levels will rise from 10.2% to 12.6%, a 28% rise. To stabilise UK diabetes rates at 10%, obesity prevalence must fall from 32% to 24%.

“Each country is different based on unique genetic, social and environmental conditions which is why there is no ‘one size fits all’ approach that will work. Individual countries must work on the best strategy for them,” said Moses.

The tide could be turned, he said, “but it will take aggressive and coordinated action to reduce obesity and individual cities should play a key role in confronting the issues around obesity.”

UK’s new air pollution strategy ‘hugely disappointing’, says Labour

A new clean air strategy published by the UK government has been criticised as “hugely disappointing” by the Labour party. Other groups said it did little to tackle the dirty diesel vehicles that are the main source of toxic air in urban areas.

The new strategy, announced on Tuesday by environment secretary, Michael Gove, aims to crack down on a wide range of pollutants. These include particulates from wet wood and coal burning in homes, ammonia emissions from farms and dust from vehicle tyres and brakes.

Ministers also want to give provide personalised pollution alerts to people and give local authorities new powers to cut pollution, all subject to public consultation.

The government said the new action would reduce the costs of air pollution to society by an estimated £1bn every year by 2020. The health costs of toxic air are currently estimated at £20bn a year, by the Royal College of Physicians and the Royal College of Paediatrics and Child Health.

The new clean air strategy is a response to an EU directive on cutting harmful emissions. An air quality plan, published in July 2017, is related to a separate EU directive on cleaner air. The latter plan was condemned as “woefully inadequate” by city leaders and “inexcusable” by doctors, and was ruled illegally poor in February, the third such high court defeat for ministers.

On Thursday, the government suffered another legal blow, with the UK referred to Europe’s highest court over its failure to tackle nitrogen dioxide pollution, which mostly comes from diesel vehicles.

Gove said: “Air quality has improved significantly since 2010 but 60 years on from the historic Clean Air Act a clear truth remains – air pollution is making people ill, shortening lives and damaging our economy and environment.

“This is why we are launching this clean air strategy, backed up with new primary legislation,” he said. “It sets out the comprehensive action required across all parts of government to improve air quality.”

The health secretary, Jeremy Hunt, said: “Air pollution is contributing to a national health crisis. We have a responsibility to stop this issue at source. Today’s [strategy] does just that, taking a giant step towards cleaning up our air for good.”

However, Sue Hayman, the shadow environment secretary, said: “It’s hugely disappointing that despite being dragged through the courts time and again on its inadequate air quality plans, the government is dragging its feet by announcing yet another consultation.” She said Gove had issued more than 25 consultations since the 2017 general election, but none had yet produced new laws.

James Thornton, the CEO of the environmental lawyers ClientEarth who have defeated ministers three times in court, said: “Road transport is still the main source of illegal air pollution in our towns and cities. We need a national network of clean air zones (CAZs) to take the most polluting vehicles out of the most polluted areas.”

The government’s own research shows CAZs, in which cars are deterred from city centres by pollution charges, are by far the most effective solution to air pollution. But ministers refused to make them compulsory, instead making them a voluntary and last-resort option for local authorities.

Greenpeace and the British Lung Foundation both backed the call for CAZs. Paul Morozzo, at Greenpeace, also said proposed new powers for local government looked like ministers passing the buck: “It looks like local authorities are being handed responsibility without the clarity on where the resources will come from.”

Details of the government’s new proposals were not available. But on domestic wood and coal burning it said it would legislate to ensure “only the cleanest domestic fuels” will be on sale. This may include wood bearing the “Ready to Burn” logo which indicates low moisture content. Wood and coal burning in homes contributes almost 40% of emissions of small particulate pollution, PM2.5, which is especially damaging to health.

Ammonia from manure and fertilisers on fields blows into cities and is a significant contributor to particle pollution. Ministers want to require farmers to invest in better slurry control and fertiliser application, perhaps supported by grants from a revised farm subsidy scheme.

Particulate pollution is below EU limits in most parts of the UK, but it is above the stricter World Health Organization limits for 90% of the population. The government has now set a goal to halve the number of people living in such areas by 2025. Another action to help achieve this is “working with international partners to research and develop new standards” for tyres and brakes that shed fewer particles.

Most common childhood cancer ‘partly caused by lack of infection’

Clean modern homes, antiseptic wipes and the understandable desire to protect small babies against any infection are all part of the cause of the most common form of childhood cancer, a leading expert has concluded after more than 30 years of research.

Childhood acute leukaemia, says the highly respected Prof Mel Greaves, is nothing to do with power lines or nuclear fuel reprocessing stations. Nor is it to do with hot dogs and hamburgers or the Vatican radio mast, as have also been suggested. After the best part of a century of speculation, some of it with little basis in science, Greaves – who recently won the Royal Society’s prestigious Royal Medal – says the cancer is caused by a combination of genetic mutations and a lack of childhood infection.

The best news, says Greaves, is that the cancer is likely to be preventable. And part of the answer could be to ensure children under the age of one have social contact with others, possibly at daycare centres.

Greaves, from the Institute of Cancer Research in London, has compiled evidence from decades of work on acute lymphoblastic leukaemia (ALL), which affects one in 2,000 children. In the 1950s and 1960s, it was lethal. Today, 90% of children are cured, although the treatment is lengthy and toxic and can have long-term consequences.

Greaves describes a “triple whammy” that he believes is the cause of ALL. One in 20 children, he says, are born with a genetic mutation that puts them potentially at risk. But they will be fine if their immune system is properly set up. For that to happen, they must encounter benign bacteria or viruses in their first year of life.

Those whose immune systems are not fully functioning because they have not had an early challenge to deal with – and who then later encounter an infection such as a cold or flu – may develop a second genetic mutation that will make them susceptible to the cancer.

ALL, he says, is increasing globally at the rate of about 1% a year. Unlike most diseases, it is increasing in more affluent populations. Something about our modern lifestyles has to be involved, Greaves reasoned. “Infectious disease tracks with poverty,” he said. “The problem is not infection. The problem is lack of infection.”

There is a similar story at work in type 1 diabetes, Hodgkin’s lymphoma, multiple sclerosis and allergies, he says.

ALL rates are low or non-existent in the poorest countries, where families have lots of children and cross-infection is common. One exception is Costa Rica, which has invested heavily in medical schools and its health system, and brought down family sizes from 7.2 children on average to 2.3. They now have significant levels of Hodgkin’s lymphoma, type 1 diabetes and ALL.

In a paper in the journal Nature Reviews Cancer, Greaves has assembled the evidence from his own work and that of colleagues around the world into the genetics, cell biology, immunology, epidemiology and animal modelling of childhood leukaemia.

That includes experiments in mice that have been modified to have the first gene mutation. Those that were kept in clean and sterile conditions and then later transferred into a dirty environment developed the cancer.

Greaves and other scientists are anxious that no parents should feel in any way responsible for their child’s cancer, pointing out that keeping babies away from any source of infection is very normal behaviour – and that there is still an element of chance in developing the two genetic mutations.

The factors that may decrease a baby’s risk, says the paper, are going to a day care centre as a small baby, having older siblings who are likely to bring infections into the home, breastfeeding and probably being born via a vaginal delivery rather than a more sterile caesarean.

Greaves says he hopes the work may lead to some sort of vaccine or drug to prevent childhood leukaemia.

Chris Bunce, professor of translational cancer biology at the University of Birmingham, called Greaves one of the superstars amongst modern cancer biologists” who had demonstrated that the early mutation putting a child at risk occurred in a cell before birth and now presented “a compelling model” of the way the cancer arises.

Prof Charles Swanton, Cancer Research UK’s chief clinician, said: “This research sheds light on how a form of childhood blood cancer might develop, implicating a complex combination of genetics and early exposure to germs, dirt, and illness.”

But he added: “We want to assure any parents of a child who has or has had leukaemia that there’s nothing that we know of that could have been done to prevent their illness.”

Italy’s far right use Irish vote to boost anti-abortion campaign

Activists and far-right politicians have seized on Italy’s low birth rate and the attention on Ireland’s referendum on abortion to boost their pro-life campaign.

As the 40th anniversary of Italy’s legalisation of abortion approaches, the renewed effort also comes as the far-right League, which contains many anti-abortion militants, stands on the brink of forming a government with the anti-establishment Five Star Movement following inconclusive general elections in March.

Ahead of the 22 May anniversary, ProVita, the Italian pro-life association, has published a booklet repeating debunked claims that women who have an abortion could be more prone to breast cancer and suicide or become alcoholics or drug addicts.

Quick guide

The Irish abortion referendum

The Irish abortion referendum

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Photograph: Clodagh Kilcoyne/X03756

The move came after authorities in Rome covered up a huge poster featuring an 11-week-old foetus in the womb on a wall in the Vatican area in April. A message alongside the image said: “You are here because your mother has not aborted you.”

“The plan was to intensify the campaign ahead of the anniversary,” said Alessandro Fiore, a spokesman for ProVita. “But we increased it even more after the poster was censored; we were contacted by many people from across Italy who wanted to do something similar in their towns. The Irish referendum, by chance, also helps to strengthen our message.”

Toni Brandi, the president of ProVita, joined counterparts in Ireland on a recent visit, as the country prepares for a landmark referendum on liberalising strict abortion laws on 25 May.

Italians voted to legalise abortion in a similar plebiscite in 1978. But 70.4% of gynaecologists still refuse to terminate pregnancies for moral reasons, which means it is almost impossible for women to access a safe procedure. That number is around 90% in southern regions, while in the central Molise region only one doctor carries out terminations. Last year a woman in Padua, a city in the northern Veneto region, had to visit 23 hospitals before finding one that would end her pregnancy. Doctors in Rome who do not object to the procedure are banned from going for jobs at hospitals managed by the Vatican.

Politicians from the League and smaller far-right party Brothers of Italy are helping to galvanise the pro-life campaign. Massimiliano Romeo, a senator with the League, said: “Six million children have been killed in the womb [since 1978], then they say we have to import migrants to boost the population.”

If the League succeeds in entering government, the party has pledged to make it a priority to better inform women of what they say are the physical and psychological consequences of abortion.

But claims that abortion leads to depression and suicide, causes cancer and affects future fertility have long been dismissed by medical organisations.

Emma Bonino, a politician who had an illegal abortion at a young age, was at the forefront of bringing about the enactment of the so-called Law 94. Until 1978, illegal abortions were the third-biggest cause of death for women in Italy.

“The campaigning by this group is nothing new,” Bonino, a former foreign minister, said. “They have been there for the last 40 years, as a minority movement – they have the right to exist and express their opinion but we have always managed to fight them. Our duty now is to fight organised conscientious objection – which actually has nothing to do with conscientiously objecting but career.”

Many medics fear being pushed out of the system or not being hired if they perform abortions. And those that do are often shamed. In the late 1990s a doctor killed himself after being exposed for terminating pregnancies in secret.

Ministry of Health data shows that the number of abortions performed each year fell from 233,976 in 1983 to 84,926 in 2016, while the number of moral objectors has risen. Unwanted pregnancies also significantly decreased after Law 94 was introduced, as people could avail themselves of information about contraception which until then had been forbidden thanks to a ban stemming from the Benito Mussolini-era.

There is no data available on the real demand for abortion or on the numbers carried out illegally. In recent years a significant demand is said to come from migrant women who have been forced into prostitution.

Silvana Agatone, a gynaecologist in Rome who does not object, said one of the reasons the health ministry is able to register a decline is because medics who once performed abortions, and who were required to report each procedure, have retired.

“They no longer get as many report cards each month but it doesn’t mean to say women are no longer having abortions,” she said. “It means that illegal abortions are increasing.”

There are fears that access to safe abortion will become even more difficult in future, as fewer medical students are receiving training.

“The Catholic-right has conquered the hospitals – there are so many militants,” said Elisabetta Canitano, a gynaecologist and president of the feminist association Vita di Donna.

“Even if the foetus is incompatible with life – they say ‘God sent it, so God will take it when he decides’. They insist that the woman must go ahead with the pregnancy, even if the child is then sent to a hospice to die.”

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

Give me your tired, your poor, your huddled masses …

You can learn a lot about a society from what is happening at its margins. That’s because no sustainable solution to a problem can exclude those who are vulnerable, such as the mentally ill, refugees, people with learning disabilities and the LGBT+ community.

This week we found inspiring stories of inclusion at the margins, from Europe to the Middle East and North America.

For 700 years, residents in a small Belgian town have been housing strangers with severe mental health problems and learning disabilities. Jennifer Rankin visited the residents of Geel, whose “radical kindness” is stirring interest from academics and policymakers.

Throughout the Middle East, gay and transgender people face state-sponsored repression, intimidation and violence. In comparison with other countries in the region, there is a relatively thriving community in Lebanon, although there is still a daily threat of harassment. In Beirut, Saeed Kamali Dehghan visited Helem – meaning “dream” in Arabic – the first community centre for LGBTQI+ people in the Arab world where “everyone is welcome”.

Joseph Aoun, Genwa Samhat and Wael Hussein work at Helem, described as an ‘important and necessary LGBTQ oasis in the Middle East and North Africa region’.


Joseph Aoun, Genwa Samhat and Wael Hussein work at Helem, described as an ‘important and necessary LGBTQ oasis in the Middle East and North Africa region’. Photograph: Adib Chowdhury

When Abu Bakr al-Rabeeah, 17, and his Syrian family arrived in the Canadian city of Edmonton, he was determined to challenge those who saw them as helpless refugees, defined by the conflict they had escaped. As he learned English he began to recount his story to a trusted teacher, who soon realised his astonishing tale needed to be heard by a bigger audience, as Ashifa Kassam discovered.

Abu Bakr al-Rabeeah with teacher Winnie Yeung, who helped him write his book.


Abu Bakr al-Rabeeah with teacher Winnie Yeung, who helped him write his book. Photograph: Freehand Books

What we liked:

This piece in Pacific Standard looks at the success of “recovery high schools” for students with addiction problems. And the Philadelphia Citizen profiles the work of the excellently named Center for Good Food Purchasing, which encourages large institutions to be smarter about how and where they buy their food.

What we heard:

Parked cars are the problem no one can see. I live in a small British city and I’m in a car club. I wish there was more incentive to join these kinds of schemes as there is always a car/van available when I need one and they really work. If they were cheaper I think more people would use them as they realise that they are an economical and reliable alternative to owning a car.

Commenter cakeycakey writing below the line of our Dutch parking spaces story

Where was the upside?

In the Netherlands, where a project in The Hague encouraging residents to transform their parking spaces into something greener has sparked a debate about whether we need cars at all.

Eline Keus, an active member of de natuurlijke stad (‘the natural city’) in The Hague, sits at her flower-filled parking spot.


Eline Keus, an active member of de natuurlijke stad (‘the natural city’) in The Hague, sits at her flower-filled parking spot. Photograph: Judith Jockel for the Guardian
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If there is a story, innovation or trailblazer you think we should report on, write to us at theupside@theguardian.com.

Suffer hay fever? Don’t blow your nose | Brief letters

It’s not just trees (We can’t chop down all these trees and not harm ourselves, 15 May). The railway ecosystem includes many other types of plant. On my trips from Winchester to Waterloo in the 1960s, I saw everlasting peas (Lathyrus latifolius) in full flower, cascading down the banks. There are still pockets of plant diversity on the route between Cambridge and King’s Cross, thanks to Margaret Fuller, wife of the crossing keeper at Shepreth, as recorded in The Illustrated Virago Book of Women Gardeners (ed Deborah Kellaway; 1995).
Margaret Waddy
Cambridge

David Cox offers some good advice (Seven ways to deal with hay fever, G2, 14 May) but misses out the real game-changer. Hay fever sufferers must not blow their noses. Everyone seems to know not to rub an irritated eye, but not that blowing has much the same effect on the nasal passages – congestion, irritation, and more discharge.
Dr Stuart Handysides
(Retired GP), Ware, Hertfordshire

Woody Guthrie’s words of long ago apply: Some rob you with a six-gun and some with a fountain pen (Carillion fall blamed on hubris and greed, 16 May). Why no prosecutions?
Huw Kyffin
Canterbury

Is it my imagination or is the royal romance, and lead-up to the wedding, beginning to sound a little like the plot of Notting Hill Part II (Markle’s father ‘may miss her wedding after surgery’, 16 May)?
Tony Hart
Formby, Merseyside

Who is giving Prince Harry away?
Marion McNaughton
Warburton, Cheshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Failure to act against ‘dangerous’ midwives resulted in deaths – report

Babies and mothers died after a health regulator failed to act against midwives suspected of providing dangerously poor care, despite the police raising concerns about their conduct, a damning report has concluded.

The Nursing and Midwifery Council (NMC) did nothing for two years about information supplied by Cumbria police on maternity staff at Furness general hospital, an inquiry found.

The NMC’s failure to instigate disciplinary proceedings against midwives at the hospital allowed them to carry on practising when they represented a danger to pregnant women and their offspring, according to the Professional Standards Authority (PSA).

Up to 19 babies and mothers died at the hospital between 2004 and 2012 as a result of mistakes by staff of its maternity unit, in one of the biggest patient care scandals involving an NHS trust in England.

A previous inquiry into the deaths concluded that 13 of the infants and women would have lived if they had received better care. The scandal involved six neonatal deaths, 10 stillbirths and three deaths of mothers at the hospital, which is one of five run by Morecambe Bay hospitals NHS foundation trust.

The PSA’s review of the NMC’s handling of the scandal was commissioned by the health secretary, Jeremy Hunt. Cumbria police told the review: “We were really concerned that reports of the same midwives [of whom] we had the cases sitting in front of us were still practising at the hospital.”

The PSA, which supervises medical regulators, found that the NMC was not prompted to do anything by the police reports, despite their seriousness.

“In our view there was scope for the NMC to investigate the wider fitness to practise of the midwives concerned and the police expected them to do so at the time the information was sent,” the 80-page report says. “We saw no evidence that the NMC considered doing so. This was an opportunity missed, given that some of the midwives identified by the police were subsequently involved in adverse events at [Furness general hospital].”

The NMC has admitted that its handling of cases involving midwives from the trust was unacceptable and has said it is “truly sorry”. Jackie Smith, the regulator’s chief executive since 2012, announced her resignation on Monday.

Bill Kirkup, who led the inquiry into the scandal that reported in 2015, has criticised the NMC’s “lamentable failure” over its decision to clear two midwives of misconduct relating to the death in 2008 of Joshua Titcombe. He died nine days after his birth after midwives failed to spot he had a serious infection.

In a scathing joint statement, Joshua’s father, James Titcombe, and two other bereaved parents, Liza Brady and Carl Hendrickson, said the report exposed “the truly shocking scale of the NMC’s failure to respond properly to the serious concerns and detailed information provided to them”.

They said: “We were particularly horrified that even when Cumbria police directly raised significant issues, the NMC effectively ignored the information for almost two years. Whilst this was going on, serious incidents involving registrants [midwives] under investigation continued, meaning lives were undoubtedly put at risk. Avoidable tragedies continued to happen that could well have been prevented.”

They also slated the NMC for being “defensive, legalistic and in some cases grossly misleading in their responses to families and others” and for its “culture of denial and reputational management”.

The PSA’s report also reveals that the NMC mishandled its dealings with bereaved families, had very poor record-keeping and did not pass on to the PSA material that the latter’s inquiry team then found elsewhere.

Smith, the outgoing chief executive, said: “Since 2014 we’ve made significant changes to improve the way we work and as the report recognises, we’re now a very different organisation. The changes we’ve made put vulnerable witnesses and families affected by failings in care at the heart of our work. But we know that there is much more to do.”

Nurses falling ill after inhaling spice fumes in prisons, says union

Nurses treating prisoners who have fallen ill after smoking the psychoactive drug spice are suffering adverse effects to their own health after inhaling fumes, the nursing union has said.

The Royal College of Nursing (RCN) says that under current guidance its members are expected to enter cells before smoke has cleared. As a result they are reporting to the union that they are suffering the effects of inhaling the substance for hours following exposure, with some unable to drive home after their shift, it says.

In at least one case, a nurse was taken to A&E by ambulance after being knocked unconscious by the psychoactive fumes.

One nurse, speaking on condition of anonymity, said: “Recently we’ve had to give medical care to over 50 people [who have been smoking spice] in one week. Walking back after attending to a patient, I’ve suddenly felt dizzy, nauseous – it’s almost like the world has zoomed out.

“It’s really bizarre. I’ve sat in my car in the carpark for 50 minutes after work so I feel confident enough to drive. We’re all worried about driving in case it’s not safe or we get stopped and it shows in our system.”

Use of psychoactive substances is widespread in UK jails and the Prison Officers Association has previously warned about the impact on its members. Last month, Tees, Esk & Wear Valleys NHS foundation trust withdrew nursing staff from Holme House prison in County Durham due to the risk posed by spice.

The RCN has written to the head of the prison service (HMPPS) demanding more is done to protect nurses from the effects of the drug.

Janet Davies, the RCN chief executive and general secretary, said: “As dedicated health professionals, prison nursing staff are expected to offer high quality care, but they should not be expected to put their own wellbeing on the line to deliver it.”

The union argues that HMPPS guidance fails to distinguish between the longer-term issue of secondhand tobacco smoke and the “serious and acute issue” of exposure to spice.

The guidance also outlines a duty “to intervene to protect a prisoner(s) or member of staff in danger of immediate harm in a cell where smoke or fumes has not yet cleared”.

The RCN says such a requirement is unacceptable for healthcare staff, given that emergency responders are advised, under Resuscitation Council guidelines, to ensure their own safety before treating casualties.