Tag Archives: than

Achoo! Why letting out an explosive sneeze is safer than stifling it

Following the case of a man who ruptured this throat, medics say holding in a sneeze can cause ear damage or a brain aneurysm

Although it is rare, the report’s authors say blocking the nostrils and mouth when sneezing is dangerous.


Although it is rare, the report’s authors say blocking the nostrils and mouth when sneezing is dangerous. Photograph: Peter Jordan/PA

In a season where colds are rife, holding your nose and closing your mouth might seem like a considerate alternative to an explosive “Achoo!”. But doctors have warned of the dangers of such a move after a man was found to have ruptured the back of his throat when attempting to stifle a sneeze.

Medics say the incident, which they detail in the British Medical Journal Case Reports, came to light when a 34-year old man arrived in A&E with a change to his voice, a swollen neck, pain when swallowing and a popping sensation in his neck after he pinched his nose to contain an expulsion.

The team took scans of the man’s neck to investigate and discovered bubbles of air in the tissues at the back of the throat, and in the neck from the base of the skull to halfway down the man’s back.

That, they say, suggested a tear had occurred at the back of the throat as a result of increased pressure from the stifled sneeze, leading to air collecting in his soft tissues.

“For reasons of propriety and etiquette, one sometimes stops a sneeze. However on unfortunate rare occasions it might lead to potentially serious complications,” said Dr Sudip Das, co-author of the report from the University Hospitals of Leicester NHS Trust.

The authors warn that blocking the nostrils and mouth when sneezing is dangerous, noting that while tearing of the throat tissue is rare, it could result in a ruptured eardrum or even a brain aneurysm.

“Spontaneous perforation of the throat with leakage of air under the skin is very rare,” said Das, although he noted that there had been cases before.

Mr Shahz Ahmed, an ENT consultant and skull base surgeon at University Hospital Birmingham who was not involved in the case, added that such complications from sneezing were so uncommon that there was no evidence in general that individuals should not hold one in.

Das and colleagues add that similar complications canoccur if the lower portion of the oesophagus tears, a serious and potentially fatal situation that can be triggered, among other causes, by retching and vomiting. “Any cause of increase in pressure in a closed throat, viz severe coughing or vomiting, can cause the symptoms,” said Vas. “A known weakness in the wall of the voice box, throat, gullet or the lung may predispose the patient to such complications.” But, he added, “even then the condition is rare.”

The patient was admitted to hospital and given intravenous antibiotics to prevent infection and was tube-fed to aid healing, with scans a week later showing no signs of air bubbles. “The patient was subsequently discharged with advice to avoid obstructing both nostrils while sneezing,” they write.

Do you work more than 39 hours a week? Your job could be killing you

Long hours, stress and physical inactivity are bad for our wellbeing – yet we’re working harder than ever. Isn’t it time we fought back?

Health at work illo 1


Illustration: Leon Edler

When a new group of interns recently arrived at Barclays in New York, they discovered a memo in their inboxes. It was from their supervisor at the bank, and headed: “Welcome to the jungle.” The message continued: “I recommend bringing a pillow to the office. It makes sleeping under your desk a lot more comfortable … The internship really is a nine-week commitment at the desk … An intern asked our staffer for a weekend off for a family reunion – he was told he could go. He was also asked to hand in his BlackBerry and pack up his desk.”

Although the (unauthorised) memo was meant as a joke, no one laughed when it was leaked to the media. Memories were still fresh of Moritz Erhardt, the 21-year-old London intern who died after working 72 hours in a row at Bank of America. It looked as if Barclays was also taking the “work ethic” to morbid extremes.

Following 30 years of neoliberal deregulation, the nine-to-five feels like a relic of a bygone era. Jobs are endlessly stressed and increasingly precarious. Overwork has become the norm in many companies – something expected and even admired. Everything we do outside the office – no matter how rewarding – is quietly denigrated. Relaxation, hobbies, raising children or reading a book are dismissed as laziness. That’s how powerful the mythology of work is.

Technology was supposed to liberate us from much of the daily slog, but has often made things worse: in 2002, fewer than 10% of employees checked their work email outside of office hours. Today, with the help of tablets and smartphones, it is 50%, often before we get out of bed.

Health at work illo 2


Illustration: Leon Edler

Some observers have suggested that workers today are never “turned off”. Like our mobile phones, we only go on standby at the end of the day, as we crawl into bed exhausted. This unrelenting joylessness is especially evident where holidays are concerned. In the US, one of the richest economies in the world, employees are lucky to get two weeks off a year.

You might almost think this frenetic activity was directly linked to our biological preservation and that we would all starve without it. As if writing stupid emails all day in a cramped office was akin to hunting-and-gathering of a previous age … Thankfully, a sea change is taking place. The costs of overwork can no longer be ignored. Long-term stress, anxiety and prolonged inactivity have been exposed as potential killers.

Researchers at Columbia University Medical Center recently used activity trackers to monitor 8,000 workers over the age of 45. The findings were striking. The average period of inactivity during each waking day was 12.3 hours. Employees who were sedentary for more than 13 hours a day were twice as likely to die prematurely as those who were inactive for 11.5 hours. The authors concluded that sitting in an office for long periods has a similar effect to smoking and ought to come with a health warning.

When researchers at University College London looked at 85,000 workers, mainly middle-aged men and women, they found a correlation between overwork and cardiovascular problems, especially an irregular heart beat or atrial fibrillation, which increases the chances of a stroke five-fold.

Labour unions are increasingly raising concerns about excessive work, too, especially its impact on relationships and physical and mental health. Take the case of the IG Metall union in Germany. Last week, 15,000 workers (who manufacture car parts for firms such as Porsche) called a strike, demanding a 28-hour work week with unchanged pay and conditions. It’s not about indolence, they say, but self-protection: they don’t want to die before their time. Science is on their side: research from the Australian National University recently found that working anything over 39 hours a week is a risk to wellbeing.

Is there a healthy and acceptable level of work? According to US researcher Alex Soojung-Kim Pang, most modern employees are productive for about four hours a day: the rest is padding and huge amounts of worry. Pang argues that the workday could easily be scaled back without undermining standards of living or prosperity.

Health at work illo 3


Illustration: Leon Edler

Other studies back up this observation. The Swedish government, for example, funded an experiment where retirement home nurses worked six-hour days and still received an eight-hour salary. The result? Less sick leave, less stress, and a jump in productivity.

All this is encouraging as far as it goes. But almost all of these studies focus on the problem from a numerical point of view – the amount of time spent working each day, year-in and year-out. We need to go further and begin to look at the conditions of paid employment. If a job is wretched and overly stressful, even a few hours of it can be an existential nightmare. Someone who relishes working on their car at the weekend, for example, might find the same thing intolerable in a large factory, even for a short period. All the freedom, creativity and craft are sucked out of the activity. It becomes an externally imposed chore rather than a moment of release.

Why is this important?

Because there is a danger that merely reducing working hours will not change much, when it comes to health, if jobs are intrinsically disenfranchising. In order to make jobs more conducive to our mental and physiological welfare, much less work is definitely essential. So too are jobs of a better kind, where hierarchies are less authoritarian and tasks are more varied and meaningful.

Capitalism doesn’t have a great track record for creating jobs such as these, unfortunately. More than a third of British workers think their jobs are meaningless, according to a survey by YouGov. And if morale is that low, it doesn’t matter how many gym vouchers, mindfulness programmes and baskets of organic fruit employers throw at them. Even the most committed employee will feel that something is fundamentally missing. A life.

Peter Fleming’s new book, The Death of Homo Economicus: Work, Debt and the Myth of Endless Accumulation, is published by Pluto Press (£14.99rrp). To order a copy for £12.74 with free UK p&p, go to guardianbookshop.com

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Patients in Africa twice as likely to die after an operation than global average, report shows

Patients undergoing surgery in Africa are more than twice as likely to die following an operation than the global average, despite generally being younger, healthier and the surgery they are undergoing being more minor, research has revealed.

The study, which covered 25 countries, revealed that just over 18% of in-patients developed complications following surgery, while 1% of elective in-patients died in hospital within 30 days of their operation – twice the global average.

Prof Bruce Biccard, a co-author of the latest study from the University of Cape Town, said that one of the major problems is likely to be an insufficient number of medical staff, resulting in difficulties in spotting or tackling complications following operations. “[The reason] that people do so terribly in Africa from a surgical point of view is that there are just no human resources,” he said.

The research, Biccard added, offers a crucial snapshot of issues around surgery in low and middle income countries. “Data from Africa is almost non existent,” he said.

Writing in journal the Lancet, the international team of researchers describe how they collected data from 11,422 adult patients at 247 hospitals spread over 25 countries – including Ethiopia, Egypt, Nigeria and Zambia – to assess patient outcomes following surgical procedures which required an overnight stay. Each hospital collected data during one week of their choosing between February and May 2016, although data on complications and death were not available for every patient.

The results reveal that 2.1% of those who underwent any surgery, and 1% of those who had elective surgery, died in hospital within 30 days of their operation. Only a minority of deaths occurred on the day of the operation itself.

Just over 18% of all patients developed complications, ranging from stroke to pneumonia, almost one in 10 of whom died. “It is likely that many of these deaths were preventable,” the authors note.

However the study also revealed that the number of operations across the continent was very low and fewer than 43% of surgeries in Africa were elective, with the majority of patients instead undergoing urgent or emergency operations. Meanwhile, caesarean deliveries accounted for 33% of surgeries across Africa – a remarkably high proportion.

Together, says Biccard, that highlights another problem: that many individuals who need surgery might not have access to it. “The real sad thing is that there is a lot of surgery obviously that is not happening,” he said. “That is probably a huge killer in Africa,” he added.

The authors suggest that the findings are probably a reflection of a scanty workforce, limited numbers of hospital beds, and poor systems to check up on patients follow surgery, noting that there are only about 0.7 specialist surgeons, obstetricians and anaesthesiologists per 100,000 population. The recommended figure to decrease the risk of death following surgery is 20–40 such specialists per 100,000 population. “There is no way we are going to be able to train enough physicians to fill this deficit in human resources,” said Biccard, suggesting that either systems for focusing care on high-risk patients need to be developed, or non-physicians would need to be helped to identify patients who might be at risk.

The authors also note that 14 African countries did not take part in the study, but that with some of those politically unstable, in conflict, or having few doctors, surgical outcomes could be even worse.

Dr David Walker, a consultant in anaesthesia and critical care medicine at University College London Hospitals, who was not involved in the study, said that issues of care of patients around the time of surgery was a global issue.

“It seems to be, no matter where in the world you have surgery, complications for many are an inevitable consequence of hospitalisation,” he said. “Importantly, when complications occur there may be considerable disparity in patient outcomes after those complications: so it [often] isn’t the complication that kills you, it is the failure to rescue – how [the patient is looked after following the complication].”

The latest study, he adds, suggests that poor access to timely surgery is a “forgotten epidemic” in Africa. “It reminds us also about the importance of the surgical journey – looking after patients from the minute they present in hospital, through surgery and, really importantly, the ability to care for patients in the post-operative period,” he said.

Patients in Africa twice as likely to die after an operation than global average, report shows

Patients undergoing surgery in Africa are more than twice as likely to die following an operation than the global average, despite generally being younger, healthier and the surgery they are undergoing being more minor, research has revealed.

The study, which covered 25 countries, revealed that just over 18% of in-patients developed complications following surgery, while 1% of elective in-patients died in hospital within 30 days of their operation – twice the global average.

Prof Bruce Biccard, a co-author of the latest study from the University of Cape Town, said that one of the major problems is likely to be an insufficient number of medical staff, resulting in difficulties in spotting or tackling complications following operations. “[The reason] that people do so terribly in Africa from a surgical point of view is that there are just no human resources,” he said.

The research, Biccard added, offers a crucial snapshot of issues around surgery in low and middle income countries. “Data from Africa is almost non existent,” he said.

Writing in journal the Lancet, the international team of researchers describe how they collected data from 11,422 adult patients at 247 hospitals spread over 25 countries – including Ethiopia, Egypt, Nigeria and Zambia – to assess patient outcomes following surgical procedures which required an overnight stay. Each hospital collected data during one week of their choosing between February and May 2016, although data on complications and death were not available for every patient.

The results reveal that 2.1% of those who underwent any surgery, and 1% of those who had elective surgery, died in hospital within 30 days of their operation. Only a minority of deaths occurred on the day of the operation itself.

Just over 18% of all patients developed complications, ranging from stroke to pneumonia, almost one in 10 of whom died. “It is likely that many of these deaths were preventable,” the authors note.

However the study also revealed that the number of operations across the continent was very low and fewer than 43% of surgeries in Africa were elective, with the majority of patients instead undergoing urgent or emergency operations. Meanwhile, caesarean deliveries accounted for 33% of surgeries across Africa – a remarkably high proportion.

Together, says Biccard, that highlights another problem: that many individuals who need surgery might not have access to it. “The real sad thing is that there is a lot of surgery obviously that is not happening,” he said. “That is probably a huge killer in Africa,” he added.

The authors suggest that the findings are probably a reflection of a scanty workforce, limited numbers of hospital beds, and poor systems to check up on patients follow surgery, noting that there are only about 0.7 specialist surgeons, obstetricians and anaesthesiologists per 100,000 population. The recommended figure to decrease the risk of death following surgery is 20–40 such specialists per 100,000 population. “There is no way we are going to be able to train enough physicians to fill this deficit in human resources,” said Biccard, suggesting that either systems for focusing care on high-risk patients need to be developed, or non-physicians would need to be helped to identify patients who might be at risk.

The authors also note that 14 African countries did not take part in the study, but that with some of those politically unstable, in conflict, or having few doctors, surgical outcomes could be even worse.

Dr David Walker, a consultant in anaesthesia and critical care medicine at University College London Hospitals, who was not involved in the study, said that issues of care of patients around the time of surgery was a global issue.

“It seems to be, no matter where in the world you have surgery, complications for many are an inevitable consequence of hospitalisation,” he said. “Importantly, when complications occur there may be considerable disparity in patient outcomes after those complications: so it [often] isn’t the complication that kills you, it is the failure to rescue – how [the patient is looked after following the complication].”

The latest study, he adds, suggests that poor access to timely surgery is a “forgotten epidemic” in Africa. “It reminds us also about the importance of the surgical journey – looking after patients from the minute they present in hospital, through surgery and, really importantly, the ability to care for patients in the post-operative period,” he said.

Size does matter: wine glasses are seven times larger than they used to be

Our Georgian and Victorian ancestors may have enjoyed a Christmas tipple but judging by the size of the glasses they used they probably drank less wine than we do today.

Scientists at the University of Cambridge have found that the capacity of wine glasses has ballooned nearly seven-fold over the past 300 years, rising most sharply in the last two decades in line with a surge in wine consumption.

Wine glasses have swelled in size from an average capacity of 66ml in the early 1700s to 449ml today, the study reveals – a change that may have encouraged us to drink far more than is healthy. Indeed, a typical wine glass 300 years ago would only have held about a half of today’s smallest “official” measure of 125ml.

In the first UK analysis of its kind, the university’s behaviour and health research unit quizzed antique experts and examined 18th-century glasses held at the Ashmolean museum in Oxford, glassware used at Buckingham Palace, and more recent glasses in John Lewis catalogues. The evidence was clear: the newer glasses were bigger.

wine glass sizes

The study, published on Wednesday in the BMJ, measured wine glass capacity from 1700 to the present day to help understand whether any changes in their size might have contributed to the rise in wine consumption.

“Wine will no doubt be a feature of some merry Christmas nights, but when it comes to how much we drink, wine glass size probably does matter,” said Prof Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, who led the research.

In 2016, Marteau and her colleagues carried out an experiment at the Pint Shop in Cambridge, altering the size of wine glasses while keeping the serving sizes the same. They found this led to an almost 10% increase in sales.

For the new study, the researchers obtained measurements of 411 glasses from 1700 to the modern day. They found wine glass capacity increased from 66ml in the 1700s to 417ml in the 2000s, with the mean wine glass size in 2016-17 even higher at 449ml.

Wine glasses graphic

“Wine glasses became a common receptacle from which wine was drunk around 1700,” says first author Dr Zorana Zupan. “This followed the development of lead crystal glassware by George Ravenscroft in the late 17th century, which led to the manufacture of less fragile and larger glasses than was previously possible.”

The paper points out that alcohol is the fifth largest risk factor for premature mortality and disability in high income countries. In England, the type of alcohol and volume consumed has fluctuated over the last 300 years, in response to economic, legislative and social factors. Significantly, wine consumption increased almost fourfold between 1960 and 1980, and almost doubled again between 1980 and 2004, a trend attributed to better marketing and licensing liberalisation which allowed supermarkets to compete in the lucrative drinks retail business.

“Our findings suggest that the capacity of wine glasses in England increased significantly over the past 300 years,” added Zupan. “Since the 1990s, the size has increased rapidly. Whether this led to the rise in wine consumption in England, we can’t say for certain, but a wine glass 300 years ago would only have held about a half of today’s small measure.”

The strength of wine sold in the UK has also increased since the 1990s, adding to the amount of pure alcohol being consumed by wine drinkers.

Q&A

Large wine glasses: fashion or marketing ploy?

It’s the pubs’ and bars’ equivalent of supermarkets putting sweets by the checkout. The fashion for larger glasses – whether they are filled to the top or not – simply encourages people to drink (and spend) more than they need. Larger, stylish wine glasses can also increase the pleasure from drinking wine, which may also increase the desire to drink more.

In England, the type of alcohol and volume consumed has fluctuated over the last 300 years, largely in response to economic, legislative and social factors. Until the second half of the 20th century, beer and spirits (often watered down) were the most common forms of alcohol consumed, with wine generally the tipple of the upper classes.

In the 1930s and 1940s fortified wines were popular but wine took off when package holidays introduced Britons to exotic European tastes and law changes allowed UK supermarkets to compete in the sector.

Alcohol strength has also gone up significantly due to the public’s taste for riper, softer wines that are ready to drink. Wines like Bordeaux and Rioja that used to be about 12.5%-13% abv are often now 14% or more.

In England, wine is increasingly served in pubs and bars in 250ml servings, with smaller measures of 125ml often absent from wine lists or menus despite a regulatory requirement that licensees make customers aware of them.

The Wine and Spirits Trade Association said sociological trends were probably part of the reason for the growing wine glasses.

“The size of a wine glass reflects the trend and fashions of the time and is often larger for practical reasons” said the WSTA chief executive Miles Beale. “Red wine, for example, is served in a larger glass to allow it to breathe, something which perhaps wasn’t a priority 300 years ago.”