Category Archives: Diet & Fitness

Centenarian club: wealthiest investors expect to reach 100

More than half of the world’s wealthiest investors expect to live to the age of 100, according to a survey.

UBS wealth management polled 5,000 high-net worth individuals (HNWIs), defined as having at least $ 1m in investable assets, across 10 countries including Germany, the UK, US and Taiwan, and found that 53% were confident of becoming centenarians. This is considerably higher than the 80-year life expectancy in most developed countries.

The UBS report, entitled The Century Club, concluded: “The idea of living a century was once confined to science fiction. But no longer. For the world’s wealthy, living a 100-year life is not an outcome they consider a mere possibility. It’s one they expect.”

The richest 1% own half the world’s wealth, according to a report by Credit Suisse in November, which highlighted the growing gap between the super-rich and the remainder of the globe’s population.

Numerous studies have provided evidence that wealth inequality is linked to health inequality. Last year, data compiled by the Department of Health showed that in the UK the gap between rich and poor in relation to “healthy life expectancy” – defined as a life free of disease or disability – had widened to almost 20 years.

A University of Washington study in the US in 2017 came to a similar conclusion on a “life expectancy gap” between affluent and poorer areas of at least 20 years.

Longevity expectations


Longevity expectations Photograph: UBS

UBS found that the outlook for longevity varies by country and wealth. Three-quarters of Germany’s wealthy elite anticipate reaching 100 while less than a third of HNWIs in the US believe they will live that long. In Switzerland, Mexico and Italy the figure is more than two-thirds. In the UK, nearly a third (32%) expect to reach the age of 100.

However, even the wealthy worry about having enough money to pay for healthcare when they are older, according to UBS. There is more appetite to work longer and to spend less today to save for tomorrow, amid concerns about how to pay for end of life care.

What per cent of your wealth would you sacrifice to guarantee an extra 10 years of healthy life?
What per cent of your wealth would you sacrifice to guarantee an extra 10 years of healthy life? Photograph: UBS

Healthcare costs are the greatest concern among those surveyed by UBS, with 52% worried about rising medical bills. In addition, 35% worry about having less wealth to pass on to their children, and 33% fret about being forced to work longer to maintain their lifestyle.

At the same time, nearly eight in 10 believe that work is important for their wellbeing. This belief is particularly strong in Asia (93% in Hong Kong), and in Switzerland (87%), but far less so in the US and the UK, where the figures are 52% and 59% respectively.

Giving while living is increasingly popular


Giving while living is increasingly popular Photograph: UBS

Nine in 10 say their health is more important than increasing their wealth and a similar number believe their wealth enables them to live a healthier life.

Those with more than $ 10m spend four times more on health than their less wealthy peers. Ultra-high net-worth individuals with $ 50m-plus claim they would part with nearly half their riches in exchange for an extra 10 years of healthy life. UAE investors are the most likely to sacrifice more while US investors are the least likely.

The longer they live, the quicker the wealthy are going to give away their riches; and the more likely they are to skip a generation and give wealth to their grandchildren rather than their children.

Nearly two in three plan to give away more of their wealth while they are still alive to see heirs enjoy it, especially in Switzerland but less so in Mexico and the US, where people worry about outliving their assets.

Two-thirds of NHS healthcare assistants doing nurses’ duties, union finds

Almost two-thirds of healthcare assistants (HCAs) are performing roles usually undertaken by nurses, such as giving patients drugs and dressing their wounds, in the latest illustration of the NHS’s staffing crisis.

The apparently growing trend of assistants acting as “nurse substitutes” has sparked concern that patients may receive inferior or potentially unsafe care because they do not have the same skills.

Of the 376,000 assistants in the NHS in England, 74% are taking on extra tasks, according to findings by the union Unison.

In a survey of almost 2,000 mainly hospital-based HCAs across the UK, 63% said they were providing patient care with worryingly little help from doctors and nurses, and 39% said they were not confident the patients they look after were receiving safe care.

Q&A

Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors per capita. Greece, Austria and Norway have the most; the three countries with the fewest are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

“On my first day I was shown how to do tasks like taking pulses and blood pressures by another HCA,” said Nicole, an HCA in Greater Manchester and Unison member.

One healthcare worker who asked to remain anonymous said: “They said they’d never been trained properly how to do it and weren’t really sure if they were doing it properly. HCAs are doing electrocardiograms and taking bloods. That’s a lot of responsibility.”

In the survey, 51% of HCAs said they had not been properly trained to dress wounds, give out medication or change stoma bags.

“Healthcare assistants are being left to fill staffing gaps and do vital tasks without recognition or reward. It’s bad for them and bad for patients”, said Unison’s head of health, Sara Gorton. “It’s clear the pressures on them to act as nurse substitutes have increased over the winter.”

A majority of respondents (57%) said they had to perform extra tasks last winter as the NHS came under its most intense pressure ever, and 41% said they were asked to act beyond the usual limits of their roles, and without proper training more often than the previous winter.

The creeping expansion of HCAs’ roles, linked to the NHS in England’s shortfall of 40,000 nurses, risks leading to “nursing on the cheap”, the Royal College of Nursing said in response to the findings.

“As the shortage of nurses continues to bite, shifts are increasingly filled with more unregistered care staff,” said the RCN’s general secretary, Janet Davies. “Support workers play an extremely important role, but they should supplement the work of nurses, not replace them.

“It’s unfair on HCAs to expect them to deliver care they have not been trained for. It’s also unfair on patients,” she added. “Health outcomes improve with more registered nurses on duty. The government must not allow nursing on the cheap, and increasing the supply of registered nurses must be a priority.”

Jonathan Ashworth, the shadow health secretary, said: “The situation is getting worse year by year, putting patient safety at risk. It’s totally unacceptable to expect healthcare assistants to fill in, effectively acting up while denying them the training and support they deserve for taking on extra responsibilities.”

The policy director at the Nuffield Trust health thinktank, Candace Imison, said the findings were worrying. She said: “We know that across the NHS, staff – from healthcare assistants to clinicians – are being stretched beyond their capacity daily as the health service grapples with staff shortages and growing numbers of sick and frail patients.”

Alfie Evans’ father begs Pope Francis to ‘save our son’

The father of a 23-month-old boy at the centre of a life-support treatment battle has had a private audience with the pope during which he kissed the pontiff’s hand and asked him to “save our son”.

Evans, whose son Alfie has a rare degenerative brain disease, posted on Facebook that he had flown to the Vatican on Tuesday evening and met Pope Francis for 20 minutes.

The trip came as Evans, 21, and his partner, Kate James, 20, filed an application to the supreme court to appeal against a ruling that stated life support should be withdrawn from their son. The couple are fighting to take the child to Rome for further treatment.

The pair, from Liverpool, have lost cases in the high court, court of appeal, supreme court and European court of human rights after judges concluded that the child was in a semi-vegetative state and further treatment would be futile.

Alongside photos on Facebook of him kissing the pope’s hand, Evans wrote: “Alfie, we will do everything for you … We won’t allow your life to be taken. Your holiness, save our son.”

On Sunday, Francis used his Sunday blessing in St Peter’s Square to say prayers for the toddler. He said he hoped Alfie would “always be respected in dignity and cared for in a way suitable to [his] conditions, with the agreement of family members, doctors and health workers”.

Alfie Evans, who is receiving treatment at Alder Hey hospital in Liverpool


Alfie Evans. Photograph: Action 4 Alfie/AFP/Getty Images

In July, the pope intervened in the case of Charlie Gard, a British toddler who died of a rare genetic disease after his parents fought a court battle to take him abroad for treatment.

The basis of Evans and James’s latest legal appeal is that their son is being wrongly detained by Alder Hey hospital in Liverpool. They have made a habeas corpus application; the Habeas Corpus Act 1679 allows a person to have the legality of a detention examined.

On Monday, an appeal court panel of Lord Justice Davis, Lady Justice King and Lord Justice Moylan upheld a ruling by the high court judge Mr Justice Hayden, who endorsed a detailed plan put forward by doctors at Alder Hey for withdrawing life-support treatment.

A spokesman for Alder Hey hospital said: “The supreme court will consider the application for permission to appeal [against] the decision of the court of appeal. Our priority is to continue providing Alfie with the best care possible.”

Why I dread yet another cancer confessional | Mike Addelman

We live in the age of the confessional. In the not too distant past, private and intimate thoughts remained just that – and if we felt we needed to talk, a frank discussion with friends and loved ones often did the trick. But especially when it comes to cancer, this reticence now seems to be dissipating. Social media has turned the private into public and for many, that’s a very good thing. But for my family – and I suspect for others too – it can be difficult, upsetting and sometimes downright damaging.

My wife, and I don’t want to name her or talk very much about what she’s going through because that would defeat the object of this article, has terminal cancer. The physical symptoms are the least of her problems. It’s the associated anxiety and depression that makes coping with life so difficult. So imagine what it feels like when, out of the blue, the radio or the television reminds you that you are very poorly, and you and your family are going to suffer terribly.

Memorable and personal broadcasts about cancer seem to have proliferated in recent months. Steve Hewlett’s story, which ran on BBC Radio 4’s PM programme every week before his death, rightly received plaudits and awards. Tony Livesey, the Radio 5 Live presenter who lost his mother to cancer, recently ran a special series, Losing Mum. Clive Coleman, the BBC’s legal correspondent whose sister died of lung cancer, recounted his experience across the BBC network in February.

These broadcasts are often worthy and important. But they can inadvertently ride roughshod over the mental health of fragile and vulnerable people. It was Coleman’s story that lit the touchpaper in me after my wife inadvertently strayed upon the coverage. His story highlighted the urgent need for more funding for lung cancer research – a good thing – but its effect on my wife was devastating. I came home to find her in a state. She was crying, terribly anxious and scared, and I was left to pick up the pieces for a week.

It got me thinking about how we should talk about terminal illness, and the responsibilities of broadcasters to do this carefully. Does cancer somehow excuse journalists from the long-held belief that they shouldn’t be the story and that their job is to dispassionately report the news? Do famous people have special dispensation to bare their souls in public? Maybe even a more fundamental question should be asked too: what does this sort of coverage really achieve? It’s so hard to find the right answers. Anyone, famous people included, has the right and need to find solace and strength in the face of the terrible adversity that cancer forces upon us. These programmes certainly can raise awareness, help attract research funding, and educate the public so they might be able to spot the signs of cancer before its ravages take hold.

But broadcasters need to stay sensitive to those who are suffering now, and to honestly assess the impact of telling their own stories. They need to be more careful about an issue that affects a voiceless and vulnerable group who often are not in a position to make their feelings known.

I live in dread of one these stories coming on air. It’s not as simple as changing channels: by the time you have run to the radio to switch it off, it’s usually too late and too upsetting.

Mike Addelman is a former journalist and now works as a communications professional in higher education

Scale of vaginal mesh problem confirmed by NHS review

Hundreds of women are undergoing surgery each year to have vaginal mesh implants removed, an NHS review has found.

The investigation by NHS Digital came after the Guardian revealed last year that the number was far higher than official figures for complication rates suggested.

The latest report shows that in each year since 2008, surgeons have performed at least 500 removal operations in England for implants that have been used to treat common complications of childbirth and pregnancy.

Over the past decade, there were 5,374 mesh removal operations in women who had initially been treated for stress urinary incontinence. Over the same period, 101,538 patients had been implanted with mesh devices to treat this problem.

NHS Digital was tasked with collating figures on to help the health service create a “clearer” national picture of the rates of complications linked to the devices.

Q&A

What is a vaginal mesh implant?

The implants have been widely used as a simple, less invasive alternative to traditional surgical approaches for treating urinary incontinence and prolapse, conditions that can commonly occur after childbirth. For the majority of women the operation is successful.

However, concerns are mounting over the severe complications suffered by large numbers of patients, including chronic pain, mesh cutting through tissue into the vagina and being left unable to walk or have sex. Johnson & Johnson, whose subsidiary Ethicon produces one of the most widely used mesh products, is fighting a major class action in Australia. The Guardian revealed in August that thousands of women have undergone surgery to have vaginal mesh implants removed during the past decade, suggesting that about one in 15 women fitted with the most common type of mesh support later require surgery to have it extracted due to complications.

Carl Heneghan, a professor of evidence-based medicine at the University of Oxford who has called for a public inquiry into the use of mesh, said the report highlighted the urgent need for proper registries on medical devices that would establish complication rates and safety far more rapidly.

Most vaginal mesh implants used in the NHS were launched without clinical trials. “Twenty years after the first device was approved, we’re only just starting to get to grips with the evidence base,” Heneghan said. “That means there’s been experimentation for 20 years.”

Vaginal mesh implants have been widely used across Europe and in the US since the early 2000s, when they started to be favoured over traditional open-surgery procedures, which took longer to perform, involved a lengthier recovery for patients and were associated with their own range of complications.

The most common kind of procedure, called a TVT implant, typically takes 3o minutes and is performed using keyhole surgery. Patients often go home the same day and trials have found impressive success rates for resolving incontinence, but some women have been left with severe complications.

In response to growing concerns about the operation’s failure rate for prolapse, the health watchdog, Nice in December banned the use of vaginal mesh to treat prolapse. The latest figures show that in the most recent year, there were still more than 2,500 mesh operations for prolapse, suggesting that some surgeons have been slow to accept growing evidence of problems with the procedure.

Kath Sansom, the founder of the Sling The Mesh campaign group, said: “The government have selectively used figures in a bid to make mesh risk look low and have presented it in such a confusing way that to a non-experienced reader they will think mesh is not a problem.”

She added that the NHS Digital audit did not include private patients or women going to GPs for pain medication or antibiotics to treat urinary infections.

The health minister Lord O’Shaughnessy said: “These experimental statistics aim to provide the NHS with a clearer national picture on the use of meshes and tapes to treat urogynaecological prolapse or stress urinary incontinence.

“Given the importance of this issue, I have asked the chief medical officer, Prof Dame Sally Davies, to seek the views of relevant NHS bodies, surgical societies, and patient groups on the implications of the statistics, and report back to me within a month.”

Students on how they are getting a raw deal | Letters

I am an MA student on the journalism course at Birkbeck, University of London, fighting for compensation for lectures lost due to the staff strike. We paid £3,000 last term for services that were not provided. I wrote to the master of the university, David Latchman, about this and received no reply. I then wrote to the registrar and got this back: “Your tuition fees contribute towards your entire learning experience and are not directly linked to specific contact or teaching hours. Your tuition fees also cover infrastructure such as buildings, library and IT.” How can it possibly be stated that my entire learning experience is not diminished by a lack of lectures?

The university have taken my money and banked what they have not paid the lecturers, it seems. We have been told that the strike may affect lectures for the first two weeks of next term and could be ongoing. I have just been asked to pay my fees for the summer term. I don’t intend to throw more money at the university unless I get a promise of compensation if the strike is ongoing. I wonder if I’ll be thrown off the course?
Katrina Allen
London

As a student of English at the University of Southampton, I have been affected by the recent decision by the UCU that called for all of my lecturers to strike with the aim of retaining a favourable pension deal. At the end of my four-year course, I will have racked up debts in excess of £54,000, a sum that will increase at a rate of interest of approximately 6% (why didn’t I ask the banks for a loan instead?). I understand that lecturers are feeling frustrated about their pension cut, especially when the pay of the vice-chancellor of my university is £433,000. This is a perfectly legitimate concern. But without trying to mount a pedestal of moral authority, I would not be going on strike were I a lecturer. The work that goes into the six hours of lectures and seminars that I am entitled to each week is admirable. Oh, and the one hour per week during which I am able to arrange a 10-minute meeting with my tutor to discuss my progress.

If this was back in the days of free tuition, I might even have joined the staff on the picket lines. But unfortunately, I wasn’t born in the same decade as my baby-boomer parents, and I am paying £9,250 per annum for tuition alone. I hope that the lecturers don’t win this battle.

If vice-chancellors were to now bend and snap against their principles (however much I might disagree with whatever they are), it would set a dangerous precedent that students are legitimate pawns to take advantage of in industrial disputes. And we are not.
Ben Dolbear
Southampton

I am about to sit my GCSEs. I am surrounded by many bright young women every day, some who excel in examinations and others who do not. However, one thing we all have in common is our strong feelings towards standardised testing. Every year thousands of 15/16-year-olds are forced to sit GCSEs. What education ministers do not realise is the harm this pressure causes young people. It leads to high stress levels, a loss of interest in education and, in many cases, mental health problems: approximately one in 10 children have them.

I have seen the harmful effects of this robotic exam system which leaves no room for creativity. We need students to feel that there is more to life than exam grades. This can be achieved by encouraging universities to look at the whole person rather than just grades, and to value experiences and extracurriculars, like the US education system. The most successful people did not get straight A*s.

The exams should also lend themselves to all kinds of students, not simply those with the ability to memorise, testing true intelligence rather than artificial intelligence. We are growing up in an age of robots; surely we should be raising humans who can do what robots cannot do: be creative. The government should scrap GCSEs and focus on A-levels – maybe if the school system did not burn so many people out, then people would stay on. At least ministers should realise that, as Einstein (the cleverest of them all) said: “Everyone is a genius. But if you judge a fish on its ability to climb a tree, it will live its whole life believing it is stupid.”
Romy McCarthy
London

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Parents of Alfie Evans lose court fight over life support

The parents of a 23-month-old boy at the centre of a life-support treatment battle have lost their latest legal fight to allow the child to be moved to a foreign hospital for treatment.

Court of appeal judges ruled on Monday that Tom Evans, 21, and Kate James, 20, could not take their son Alfie Evans abroad to receive treatment for a rare degenerative brain disease.

Alfie Evans


Alfie Evans. Photograph: PA

The couple, from Liverpool, have already lost cases in the high court, court of appeal, supreme court and European court of human rights. Judges have heard that Alfie is in a “semi-vegetative state” and that further treatment would be futile.

The child’s parents want to move their son to a hospital in Rome where they believe he will receive better treatment. They say doctors at Alder Hey children’s hospital in Liverpool have refused to let them remove Alfie from the premises.

On Monday afternoon, appeal judges Lord Justice Davis, Lady Justice King and Lord Justice Moylan upheld a ruling by high court judge Mr Justice Hayden, who endorsed a detailed plan put forward by Alder Hey doctors for withdrawing life-support treatment.

Hayden said details of that plan could not be revealed because Alfie was entitled to privacy at the end of his life.

Barrister for the parents, Paul Diamond, said the couple might make a further appeal to the Supreme Court. Appeal court judges said doctors should continue treating Alfie pending a Supreme Court decision.

Last week, Alfie’s parents said their son had improved in recent weeks and they had asked Hayden to allow a new assessment, but he refused. The judge said the unanimous view of medical experts was that Alfie’s brain had been eroded by disease and further assessment was pointless. The child’s parents also suggested that Alfie was being unlawfully detained at Alder Hey, but the judge dismissed that suggestion.

The latest challenge came as Alder Hey children’s hospital employed extra security personnel because of demonstrations in support of the toddler’s parents. The hospital said noise from protesters outside the building on Sunday night had disturbed other young patients.

Some hospital visitors described the protest as “a circus” and said there was a bouncy castle, people drinking alcohol, and “children running everywhere” as 100 supporters gathered outside on Sunday night.

One patient’s relative, who did not want to be named, told BBC Radio Merseyside that visiting Alder Hey was “intimidating and scary” and that she heard chants of “burn it down” from protestors, which she said was “taking it too far”.

Alder Hey said in a statement: “We would ask that noise levels outside the hospital are kept to a minimum and for example car horns are not sounded.

“Loud and constant noise, such as from car horns, affects sleep and raises anxiety levels for our patients, especially when recovering from procedures, so please bear them in mind.”

Shortly after the statement, Evans posted a video on Facebook of Alfie’s hospital room, from which he said patients could only hear the noise outside if the window was opened. Car horns and cheering could be heard when Evans did so.

Alder Hey advised visitors that there would be more security inside the hospital “and a more controlled approach to access to certain areas”.

What depressed robots can teach us about mental health | Zachary Mainen

Depression seems a uniquely human way of suffering, but surprising new ways of thinking about it are coming from the field of artificial intelligence. Worldwide, over 350 million people have depression, and rates are climbing. The success of today’s generation of AI owes much to studies of the brain. Might AI return the favour and shed light on mental illness?

The central idea of computational neuroscience is that similar issues face any intelligent agent – human or artificial – and therefore call for similar sorts of solutions. Intelligence of any form is thought to depend on building a model of the world – a map of how things work that allows its owner to make predictions, plan and take actions to achieve its goals.

Setting the right degree of flexibility in learning is a critical problem for an intelligent system. A person’s model of the world is built up slowly over years of experience. Yet sometimes everything changes from one day to the next – if you move to a foreign country, for instance. This calls for much more flexibility than usual. In AI, a global parameter that controls how flexible a model is – how fast it changes – is called the “learning rate”.

Failure to adapt to adversity may be one of the main reasons why humans get depressed. For example, someone who becomes disabled due to a severe injury suddenly needs to learn to view themselves in a new way. A person who does so may thrive, while a person who fails to may become depressed.

The idea of a depressed AI seems odd, but machines could face similar problems. Imagine a robot with a hardware malfunction. Perhaps it needs to learn a new way of grasping information. If its learning rate is not high enough, it may lack the flexibility to change its algorithms. If severely damaged, it might even need to adopt new goals. If it fails to adapt it could give up and stop trying.

A “depressed” AI could be easily fixed by a supervisor boosting its learning rate. But imagine an AI sent light years away to another solar system. It would need to set its own learning rate, and this could go wrong.

One might think that the solution would be to keep flexibility high. But there is a cost to too much flexibility. If learning rate is too great, one is always forgetting what was previously learned and never accumulating knowledge. If goals are too flexible, an AI is rudderless, distracted by every new encounter.

The human brain’s equivalent of an AI’s key global variables is thought by computational psychiatrists to be several “neuromodulators”, including the dopamine and serotonin systems. There are only a handful of these highly privileged groups of cells and they broadcast their special chemical messages to almost the entire brain.

A line of studies from my laboratory and others suggest that the brain’s way of setting the learning rate involves the serotonin system. In the lab, if we teach a mouse a task with certain rules and then abruptly change them, serotonin neurons respond strongly. They seem to be broadcasting a signal of surprise: “Oops! Time to change the model.” Then, when serotonin is released in downstream brain areas, it can be seen in the laboratory to promote plasticity or rewiring, particularly to rework the circuitry of an outdated model.

Antidepressants are typically selective serotonin reuptake inhibitors (SSRIs), which boost the availability of serotonin in the brain. Antidepressants are naively depicted as “happiness pills”, but this research suggests that they actually work mainly by promoting brain plasticity. If true, getting out of depression starts with flexibility.

If these ideas are on the right track, susceptibility to depression is one of the costs of the ability to adapt to an ever-changing environment. Today’s AIs are learning machines, but highly specialised ones with no autonomy. As we take steps toward more flexible “general AI”, we can expect to learn more about how this can go wrong, with more lessons for understanding not only depression but also conditions such as schizophrenia.

For a human, to be depressed is not merely to have a problem with learning, but to experience profound suffering. That is why, above all else, it is a condition that deserves our attention. For a machine, what looks like depression may involve no suffering whatsoever. But that does not mean that we cannot learn from machines how human brains might go wrong.

Zachary Mainen is a neuroscientist whose research focuses on the brain mechanisms of decision-making

Alfie Evans’ parents return to court amid Alder Hey protests

The parents of a boy at the centre of a life-support treatment battle are to launch another legal challenge.

Tom Evans, 21, and Kate James, 20, will ask court of appeal judges on Monday to allow their 23-month-old son, Alfie Evans, to continue to receive treatment.

Alfie Evans


Alfie Evans. Photograph: PA

The couple, from Liverpool, have already lost cases in the high court, court of appeal, supreme court and European court of human rights.

The latest challenge came as the hospital where Alfie is being treated for a rare degenerative brain disease said it had employed extra security personnel because of demonstrations in support of the toddler’s parents.

Evans has said doctors at Alder Hey children’s hospital, in Liverpool, refused to let him remove Alfie from the premises. The parents want to move him to a hospital in Rome or Germany.

Alder Hey said noise from protesters outside the hospital on Sunday night had disturbed other young patients.

“We would ask that noise levels outside the hospital are kept to a minimum and for example car horns are not sounded,” it said in a statement. “Loud and constant noise, such as from car horns, affects sleep and raises anxiety levels for our patients, especially when recovering from procedures, so please bear them in mind.”

Shortly after the statement, Evans posted a video on Facebook of Alfie’s hospital room, from which he said patients could only hear the noise outside if the window was opened. Car horns and cheering could be heard when Evans did so.

Alder Hey advised visitors that there would be more security inside the hospital “and a more controlled approach to access to certain areas”.

Last week the high court judge Mr Justice Hayden endorsed a detailed plan put forward by Alder Hey doctors for withdrawing life-support treatment.

He said details of that plan could not be revealed because Alfie was entitled to privacy at the end of his life.

The Christian Legal Centre, a group that fights for Christians’ rights and is helping Alfie’s parents, said appeal court judges would be asked to overturn at least one decision made by Hayden last week.

Alfie’s parents last week said their son had improved in recent weeks and they had asked Hayden to allow a new assessment, but he refused. The judge said the unanimous view of medical experts was that Alfie’s brain had been eroded by disease and further assessment was pointless. They also suggested that Alfie was being unlawfully detained at Alder Hey, but the judge dismissed that suggestion.

Appeal court officials said an appeal court judge had decided that Alfie should continue to receive treatment pending the outcome of the hearing that begins on Monday.

Judges have heard that Alfie is in a “semi-vegetative state” and has a degenerative neurological condition that doctors had been unable to diagnose definitively.

Seven ways … to prevent bowel cancer

Be vigilant

Be aware of early warning signs (blood in stool, frequent/loose stools, abdominal pain/bloating after eating, or weight loss) and see your GP if you are concerned. But don’t panic. Colorectal (bowel) cancer is the third leading cause of deaths from cancer in the developed world, but only 5.4% of us will develop it. The good news is that colorectal cancer deaths have decreased by 30% in the past 20 years – partly because of screening, earlier detection and better treatment.

Especially if you’re over 60

Age is the greatest risk factor: 99% of cases occur in people over 40 and 85% in people over 60. Most people diagnosed are in their 70s. Unfortunately, it’s often older people who are most reluctant to report abnormal bowel symptoms.

Know your family history

It’s important to know your family’s medical history, with the proviso that most people who get bowel cancer don’t have any particular inherited tendency and their children won’t be at increased risk compared with the general population. But in 5-6% of cases there is a genetic predisposition and there are likely to have been other cases in the family. If you have a single first-degree relative with bowel cancer, your risk is two to three times higher than average (or higher if that relative was under 45 years old when they developed the cancer). If you have two affected first-degree relatives, your risk may be as high as four times the average. The most common inherited conditions that cause bowel cancer are familial adenomatous polyposis and Lynch syndrome.

Stay slim and active

Obesity increases the risk of developing and dying from bowel cancer by 1.5 times. The association is stronger for men than women. If you are obese, try to stay active; physical activity seems to offset some of the increased risk of being overweight. Most studies suggest that eating lots of fibre reduces the risk, but that may be partly because people who are a healthy weight tend to have a high-fibre diet.

Easy on the meat

Processed, smoked and cured meats can increase the risk of bowel cancer because they contain chemicals called nitrosamines. People who eat the most processed meat have about a 17% higher risk of developing bowel cancer, compared with those who eat the least. That means 56 out of 1,000 people may get bowel cancer among people who never eat processed meat, 61 out of 1,000 average meat eaters and 66 out of 1,000 among those who eat the most processed meat. The NHS advice is that red meat (pork, beef and lamb) is a good source of protein, but that eating more than 90g a day is associated with an increased risk of bowel cancer. One lamb chop is 70g, so if you have a couple of chops, you may want to give red meat a miss the following day.

An aspirin a day?

Taking a low dose (75mg) of aspirin a day for five years may reduce your risk of bowel cancer, but the risk of gastric bleeding is thought to outweigh the potential benefits. The jury is still out on this one. Likewise, there is no robust evidence yet that statins or hormone replacement therapy prevent bowel cancer.

Get screened

Anyone at greater than average risk of bowel cancer (positive family history, ulcerative colitis or Crohn’s disease) will be advised about whether and when to have screening with colonoscopy. For the rest of us, the national screening programme in England kicks in aged 55, with a one-off bowel scope screening test in some areas (this is the test Andrew Lansley – the former health secretary who now has bowel cancer – wants rolled out more widely, as it’s currently only available to 50% of eligible people). Those between 60 and 74 years old get sent a home-testing kit once every two years to detect blood in the stool with further investigation if positive. If you want to carry on doing the home test every two years over the age of 75, you can phone the bowel cancer screening helpline on 0800 707 60 60 to request a kit. In Scotland, the programme starts at 50 and broadcaster George Alagiah, who also has bowel cancer, is campaigning for the same service to be provided across the UK.