Jamie Oliver in new meals attack

The TV chef Jamie Oliver has accused the Education Secretary Michael Gove of eroding healthy school food standards.

A campaign by the chef led to tough new legal standards for meals in England's schools.

But now caterers are saying that some of England's new academy schools - which do not have to abide by the regulations - are asking for "unhealthy food".

The government says it trusts schools to act in their pupils' best interest.

And it says it has no reason to believe that academies will not provide healthy, balanced meals that meet the current nutritional standards

Jamie Oliver told BBC Breakfast News: "The bit of work that we did which is law was a good bit of work for any government.

"So to erode it, which is essentially what Mr Gove is doing - his view is we let schools do what they want."

The chef led a TV campaign which saw him going in to school kitchens and helping staff to drop fatty foods from their menus in favour of healthier options.

The law was tightened in England for local authority primary schools in 2008 and secondaries in 2009, so that school lunches had to meet strict nutritional guidelines.

Sweets, crisps and fizzy drinks disappeared from vending machines.

The changes were not universally liked, and some parents took to passing their children fast food through the railings of their school.

And in some schools, children are bringing in biscuits and other snacks to sell to pupils.

England's academies are semi-independent schools and as such they do not have to abide by regulations which set out strict nutritional guidelines for school food.

There are currently 1,400 of them and more schools plan on converting to academy-status.

Now the Local Authority Catering Association, which has 700 members across the UK, says it is being asked to bring back some "unhealthy food".

'Return of the sausage roll'

Linda Mitchell, from the association, said: "Our members are telling us that they have been approached by academies to relax the rules and as providers to hundreds of thousands of schools we are concerned.

"They are being asked to put confectionery and other snacks back, especially at mid-morning. It is the return of the sausage roll to schools."

She said caterers were mostly being asked to put snacks in to vending machines in schools.

"It's a very small step before you are seeing the introduction of confectionery and fizzy drinks back in to those machines."

There are guidelines on school food in all parts of the UK, but legal regulations in England only

She suggested schools might be under pressure from pupils and parents to re-introduce certain foods and that some might be tempted by the high profit margins she said there were on sweet or fatty snacks.

A spokesman for the Department for Education in Westminster said the school food regulations were the "benchmark of high standards".

"We trust schools to act in the best interest of their pupils - they know the importance of healthy school dinners and the benefits they bring," he said.

Mr Gove met Jamie Oliver in June. In a letter to the chef afterwards, he wrote: "I would like to reassure you that we have no reason to believe that academies will not provide healthy, balanced meals that meet the current nutritional standards.

"As part of the broader freedoms available to academies, I trust the professionals to act in the best interests of their pupils.

"I understand from the School Food Trust that some of the best schools in terms of attitudes to food and meals are the academies."

Jamie Oliver said the standards should be kept to "keep everyone on their game".

"I think that's a wonderful ambition, that everyone's going to be brilliant, but head teachers are more pushed than ever, expected to do more than ever, now they have to be entrepreneurial caterers as well as everything else they have to do," he said.

"It's not a large amount of paperwork, it really isn't, and for what it's for, which is essentially the future of our country, it's really important."

Sharon Hodgson MP, Labour's Shadow Minister for Children and Families, said: "Michael Gove is effectively throwing away years of hard work and achievement in driving up standards for purely ideological reasons, and without any mandate from parents".

Under regulations in England and Northern Ireland - and guidelines in Scotland and Wales - schools should:

restrict the amount of fatty, sugary and salty foods on the menuincrease the use fresh fruit and vegetablesban the sale of sweets, crisps and fizzy drinks

In England, local authority schools also have to supply meals which comply with strict nutrient standards.

From 2013, Wales intends to enshrine its guidelines in the law too.

England's Department for Education has asked the School Food Trust to carry out a study of some academies to look at their approach to providing healthy school food to pupils.

School Food Trust chairman Rob Rees said he was concerned about the reports of standards being relaxed.

"All the evidence shows that when children eat better, they do better, so this should be a complete and utter no-brainer for any school wanting to do the best for its pupils," he said.

"We need to hear from anyone with concerns that an academy is choosing not to meet the national standards - whether that's adding less healthy foods back on to its menu or bringing back vending of chocolate and crisps."

Just what is middle age?

  People love to talk about the perils of middle age and mid-life crises. But what really happens in our middle years, asks David Bainbridge.

I have a confession to make. I am 43.

I have a belly, reduced skin elasticity, extra hair where I really don't want it, and a sports car. I, in short, am a middle-age cliche. But I am taking it a day at a time.

I still remember the day I went to buy that aged blue Lotus. I was 41 at the time and only too aware of the vast burden of middle-age stereotypes looming over me as I gazed at the car, which was glistening in the late-spring sun. I could hear a middle-aged devil on one shoulder grunt: "Go on - buy it." Then, after a pause, a middle-aged angel on my other shoulder pipe up: "OK, then. Why not?"

So I bought the car, but was I jumping headlong into the world of the so-called mid-life crisis?

We often think negatively about middle age. It is not a stage of life which we await with excitement. It does not get mentioned much in the media - not in a positive light, at least. Yet as certain suspiciously abrupt changes have overtaken me in recent years, middle age has come to fascinate me.

David Bainbridge is a clinical veterinary anatomist at Cambridge University and a science writerHe is the author of Middle Age - A Natural HistoryHis episode of Four Thought is on BBC Radio 4 on 23 November 2011 at 20:45 GMTI am a vet and a reproductive biologist, with a training in zoology, so I suppose I was always likely to end up looking at it in an unorthodox way. Lots of people study childhood, or adolescence, or youth, or old age, but it seemed to be left up to me to study middle age. And because I knew more about animals than people, I studied it as an outsider, as it were.

What I found surprised me.

Middle age does not really exist elsewhere in the animal kingdom. Indeed, it wouldn't make any sense anywhere else in the animal kingdom. We humans usually stop making babies in our early 40s. Any other self-respecting species would take the Darwinian hint and die once that happened.

Yet we humans are exceptional because we don't curl up and die. Far from it. Data from life insurance companies suggests that in the fifth and sixth decades of life you are less likely to die over the coming year than at any other time in your life. Compared with other animals, this seems ridiculous.

The whole process of middle age seems deeply suspicious as it doesn't seem to be about getting old.

People are not demonstrably more stupid and not a whole lot weaker at 50 than they are at 20. And although imaging studies show that middle-aged people may use different brain regions to do the same old tasks, cognitive tests show that apart from brute speed, the brain's abilities are not diminished in middle age. They may be reaching their peak.

Also, although bone mass declines and muscle mass declines, rarely do things get so fragile that they snap. Most important of all, in offices, on construction sites, on football pitches around the world, the great, complex, social, co-operative endeavours which typify our species and make us human, in all of these you find middle-aged people telling supposedly sharper and stronger young adults what to do.

Infantile behaviour

Biologically, the middle-aged human body does not look like something being left to slowly decay. As a counter-example, if machines are left to deteriorate then some of them break down immediately, whereas others function perfectly for a very long time.

Middle-aged humans are simply not like that. They do not vary that much. Almost no-one starts breaking their hip at 40, whereas no-one still looks youthful at 60 - well, not naturally, anyway. If middle age were passive, uncontrolled failure, then it would vary between individuals much more than it does.

In fact, the two examples which buck the trend - the two body systems which do clearly deteriorate in middle age - make my point for me. First, long-sightedness (presbyopia) is almost unknown at 35, yet is universal by 50. I am already running out of arm's length at which to hold my reading matter.

The same is true of reduced skin elasticity. I can almost feel this happening and presumably this process is acceptable as long as I do not look so repulsive or decayed that I actively repel those around me.

So, those changes which do take place in middle age are so precisely controlled and carefully permitted they simply cannot result from creeping failure and decay. In short, the changes of middle age are too abrupt, distinctive of this phase of life, and characteristic of our species for that.

There is a controlling force at work in middle age which allows a few parts of us to suddenly fail, while maintaining the rest of us in good condition.

Indeed, it has become very clear to me the changes of middle age represent a developmental stage of life, as distinct and real as infancy or adolescence. Middle-aged development is programmed into each of us. We each possess the genetic recipe for long, healthy, human middle age. And we owe that genetic inheritance to hundreds of thousands of years of human history, during which - contrary to what you might think - humans frequently lived into their fifth and sixth decades.

Emotional flux

But can this newfound understanding of middle age - its biological basis, its evolutionary origins - help us understand the belly, the inelastic skin, the sports car parked on my drive?

I believe the answer is yes. It is time to take a journey deep into the dreaded male mid-life crisis. It's painfully close to home for some, I know, and perhaps even unpalatable, but this challenge simply must be faced. Men fear it and women joke about it, but what is it exactly?

We humans are an 'information economy' and middle age is the time when we pass on most of that information - this is why middle-aged people like being listened to”

End Quote Well, the concept is only a few decades old but it has always been an elusive thing to define. Common versions of the "crisis" frequently involve a variable mix of three phenomena occurring some time in the male 40s.

First, a degree of emotional flux and uncertainty - an "intrapsychic" reorganisation. Second, humiliating urges to seek out the romantic attentions of younger women. Third, a tendency to revert to childish behaviours, interests and recreational activities.

All in all, it is remarkable how undefined the mid-life crisis seems when we all think we know exactly what it is. Let us take those elements one at a time.

First, the emotional flux and uncertainty. As it turns out men are no more likely to become depressed in their 40s than at any other time. If anything, questionnaire studies suggest that our mood seems to improve slightly. Also, we are no more likely to experience what we think of as "life-turning points" at this stage of our lives.

Similarly, we are less likely to get divorced than earlier in life - what a reliable, constant bunch we are. And finally, we, unlike women, consistently underestimate our proximity to our own death. This, of course, makes us even more happy. In summary, there is little evidence of a crisis here, certainly no specific "intrapsychic reorganisation".

Crisis myth

Next, the lusting after inappropriately young women. Did I really buy that Lotus to lure young women attracted to chubby, greying men in tiny blue cars?

In fact, studies of age preference in lonely hearts ads and dating websites have told us a surprising amount.

At 16, boys seek women who are roughly two years older than them. This age gap narrows to zero by the time we are 24 and thereafter we prefer younger women, with the age gap progressively increasing to only 12 years by our own old age.

Thus, there is no obvious evidence of middle-aged men suddenly hunting down young women, although it is certainly true that men who remarry do tend to marry partners younger than their first spouses - as women who remarry also do.

And there is good evidence that marrying a younger woman extends men's lifespan. Although this, strikingly, is not true in reverse. And finally, it is of course a simple arithmetical fact that there are no much-younger women in men's 20s - they do not yet exist.

Third, the infantile behaviour. I am afraid this is the point where I will go all anecdotal and unscientific - with two assertions.

First, having watched a son grow up, I believe that, on average, boys often have fundamentally different interests from girls - wheels, running around, machines, making things, breaking things, hitting each other - generally "doing stuff".

Second, I claim that men's interests do not change fundamentally between the ages of eight and 60 - with the exceptions of romance and sex. Instead, all that happens in middle age is that we become once again free to indulge ourselves. We have more money, some time and less fear of ridicule by others.

All I know is that when I play Lego with my son I am not enjoying it in some ironic, post-modern way, I am enjoying it in exactly the same way I did when I was 10. So, these pastimes and preferences of middle age are not new-found, they are our same old pastimes and preferences.

Complex lives

And, having demolished these three pillars of the so-called mid-life crisis, we can see the final nail in its coffin comes when people are asked if they have experienced such a crisis. They turn out to be just as likely to say they experienced the crisis in their 30s or 50s as in their 40s. And worst of all, women are just as likely to report a mid-life crisis as men.

How vague and lacking in evidence does a phenomenon have to be before we accept that it is not real?

So, we have a dichotomy between middle age and the mid-life crisis.

Middle age - those two healthy decades after the babies stop - is very real. Only humans have it, we evolved it, and we have enjoyed it for much of our species' history. And why? We evolved middle age because we have always lived more complex lives than other animals - in the ways we acquire resources, socially and technologically.

Many animals are pre-programmed with almost all the information they will ever need, yet a human child is almost a blank slate. Acquiring huge volumes of information is essential if any of us are to cope in the complex world which we humans create for ourselves.

So unlike most animal parents, we don't just give our children genes and calories, we give them our culture. That takes time, and quality time, too, which we cannot dilute by churning out yet more babies. We humans are an "information economy" and middle age is the time when we pass on most of that information - this is why middle-aged people like being listened to.

So middle age is a very real and distinctive phenomenon, one central to the success of our species - which places it in stark contrast to the mid-life crisis, which turns out not to exist at all.

So why do we persist with the male mid-life crisis, talk about it, believe in it? I believe we retain, even love the crisis myth because it is a great story.

It is a narrative on which we can hang part of our lives. It is inherently funny and women like making fun of men, and men like distracting attention from real issues by making fun of themselves. And of course, I play along with this too. I often call the car my "malemenopausemobile" as a way of avoiding having to explain why I spent so much good money on it.

In other words, the mid-life crisis is a fable - but we all love fables, don't we?

Lansley defends looped NHS video

 Andrew Lansley is offering a bedside message to hospital patients - whether they want it or not Andrew Lansley has defended a welcome message played on a continuous loop in English hospitals in which he tells patients their care "really matters to me".

His face appears on bedside screens every few minutes, asking people to thank staff looking after them.

Patients can switch the screens off but the health secretary says it is a "useful message".

One NHS campaign group says his face is the "last thing" patients want to see.

Those who do not turn it off are greeted by the health secretary saying: "Hello, I'm Andrew Lansley, the Health Secretary.

"I just want to take a few moments to say that your care while you're here in hospital really matters to me. I hope it's as good quality care as we can possibly make it and I do hope you'll join me in thanking all the staff who are looking after you while you're here."

But Geoff Martin, chairman of campaign group Health Emergency, said: "The last thing anyone recovering from surgery or illness needs is the health secretary on a permanent loop like some pro-privatisation big brother.

"Perhaps this is some cynical government ruse to speed up discharge of patients by driving people out of the wards as they try and escape the permanent misery of an Andrew Lansley TV message."

The former Labour health secretary Alan Milburn joked that Mr Lansley's hospital appearance was his "secret weapon" to cut hospital waiting lists.

"He wants to prevent people getting into hospital - what a deterrent - and he wants to get them out quickly - what an incentive," he told the BBC's Daily Politics.

He said he had not appeared on the screens, although it is believed that a successor of his - Andy Burnham - did appear on the screens until Labour lost power at the 2010 election.

Patients in 50,000 hospital beds across England see Mr Lansley - although his face is not shown to those in accident and emergency or intense care wards.

It appears as part of a looped video repeated every three to five minutes as part of a bedside entertainment system of TV channels, the internet and films.

Patients pay between £2.50 for a couple of hours to £5 per day for the services - but Mr Lansley's message is free.

"No complaints"

Mr Lansley told BBC Radio 4's Today programme it was useful as he wanted people to realise "we want them to have as comfortable and as high quality a stay as possible", to thank staff and give feedback.

"They only have to see me once," he said.

"They can also turn on the radio and get radio for free."

But he also sees the funny side.

"It can be even worse - one constituent told me their baby's first experience of life was to see me on a monitor, which he found rather unnerving. He wasn't sure about the baby."

A spokeswoman for Hospedia, which provides the service, says Mr Lansley's message could easily be removed.

"If Mr Lansley asked for the video to be removed, we would of course accede to his request," she said.

"We continually monitor patient satisfaction levels, we have received no complaints about Mr Lansley."

The company, not the government, paid for his message to be recorded, she added.

Looking himself after face transplant

  Strangers would stare at him in the street and children would say the monster was coming and run away, but earlier this year Mitch Hunter underwent a face transplant that promises to transform his life.

When I knocked on Mitch Hunter's door in the suburbs of Indianapolis, I really didn't know what to expect.

I had seen photos of him as a young soldier and photos of him after 10 years of plastic surgery, but now I was about to meet him - four months after he had received one of the world's first full face transplants.

He opened the door with his 18-month-old son, Clayton, in his arms and I was stunned.

Mitch is not the handsome young man he once was, but the transformation from the face he had just six months ago is astonishing. Looking from Mitch to his young son, I could even see the family resemblance.

Mitch was 20 years old when a car he was a passenger in crashed into a pole containing a 10,000 volt electrical cable.

He tried to rescue a fellow passenger, but while doing so got the full blast from the electrical cable through his leg and face. He lost the leg and most of his face was burnt off. Over the next 10 years, surgeons tried to rebuild his face, but the results were patchy.

Scaring children

It was the birth of his son Clayton that made Mitch finally decide to have a full face transplant, only the third ever performed in the United States.

"I've had kids hide and run behind their moms because they were so scared when they saw me," he explained.

"That was hard to cope with because my friends started having kids, then my brother had a kid. Then I had Clayton and I didn't want kids to be afraid of me any more."

Mitch's operation was funded by an unusual collaboration between the Brigham and Women's hospital in Boston and the US military.

There are so many soldiers coming back home from the conflicts in Afghanistan with severely mutilated faces and bodies that the military has decided to fund research into novel ways of repairing them. This includes paying for hand and face transplants.

Dr Bohdan Pomahac, who works at the Brigham and Women's hospital, has now done three full face transplants and, with military funding, is preparing to do another five. Mitch, who he operated on in April 2011, was his second patient.

To qualify for the surgery the patient must be missing at least 25% of their face. Dr Pomahac thinks there must be at least 200-300 veterans who would be eligible and he is hoping some will put their names forward.

Continue reading the main story A major problem with face and hand transplants is patients have to take drugs to suppress their immune system or the body will reject the organ. This makes patients more vulnerable to infection and can precipitate conditions like diabetes. A new technique aims to re-educate the body's immune system to accept the transplanted organ by an infusion of bone marrow from the donor.Known as the Pittsburgh Protocol, it was developed at the University of Pittsburgh. London's Royal Free Hospital is keen to adopt the technique, with director of surgery and trauma Professor Peter Butler hoping to establish UK expertise in arm and face transplants.Finding a donor is, surprisingly enough, not that difficult. Dr Pomahac said he would prefer the donor to be young and of the same sex, though computer reconstructions suggest that a female face transplanted onto a male would look all right, although it has not yet been tried.

The full thickness of the face is transplanted, but what really determines how a patient will look afterwards is the underlying bone structure of their faces.

The operation itself went smoothly. A team of surgeons removed Mitch's old face before the new face was carried into the operating theatre by Dr Pomahac.

They joined up arteries from Mitch's body to the new face, and also connected three nerves. Finally the new face, with nose, lips and muscle, was stitched into place. The whole operation took 14 hours, somewhat less than his first.

"We have planned on simplifying it, making it more reproducible and easier for people to do and I think we have accomplished that goal," said Dr Pomahac. "But with every operation we learn an enormous amount."

Recovering senses

Initially there was a lot of swelling. "It looked like the face of a 200lb (90kg) guy, it was that swollen," Mitch told me, but as the swelling went down, his old features started to come through.

Mitch's brother Mark, who is older by a year, says he could see the old Mitch from day one.

"I didn't know how I was going to react, but when I walked through the door of the hospital it was him, my brother."

Katerina, Mitch's partner, is an old school friend, and they got together several years ago, long before the transplant.

She said she quickly got used to the fact that he had a damaged face and accepted him for who he was, though she realised Mitch was unhappy and avoided going out.

Her reaction to the transplant? "I think it's just crazy - the fact that medical science has come this far, what they are able to do. It's just amazing."

When I asked her if it was strange kissing the lips of a dead man, she replied: "I had never kissed him with lips before."

Mitch says sensation is returning and he can now do things like raise his eyebrows, purse his lips and smile. He expects these improvements to continue.

"There is still a little extra skin in places," he said, "but I'm told that when everything is said and done and finalised, I will look a lot like I used to."

Dr Pomahac agrees that things should steadily improve, particularly sensation. "The first sensation develops within a month or two. It's very crude. But it continues to improve and in about 18 months I would expect that Mitch is going to be feeling near normal."

Michael Mosley presents the second episode of Frontline Medicine on BBC Two at 21:00 on Sunday 27 November 2011. Watch via iPlayer (UK only) and catch up on episode one at the above link.

'Missed Olympic opportunity' to get children exercising

In this week's Scrubbing Up, Dr Andrew Franklyn-Miller says the build-up to the London 2012 Olympics offers the perfect chance to encourage children to be more active - but that it is an opportunity being missed.

If our children are struggling in maths or English, we are aware because of poor performance in tests, and the child gets appropriate help.

But what about physical development, cardiovascular fitness or coordination?

Where are the assessments of "physical literacy" alongside numeracy and literacy?

How do we recognise physical limitations due to shortness of breath or low glucose causing problems, and step in before it becomes too late?

'Let it be competitive'

Society has deemed it acceptable to aspire to participate rather than achieve, to hope that vaguely defined skills might maintain fitness rather than test our children against benchmarks.

Continue reading the main story

We need to make exercise a normal part of day-to-day life, not a weekly obligatory trip to the gym ”

End Quote Dr Andrew Franklyn-Miller Our national curriculum for PE talks of "aspirations of stringing together movements", floating in a swimming pool and "achievements" of participation and understanding.

I quite understand the reluctance to test further in school and increase the burden on teachers, but we risk neglecting the physical competence of our future generations from a fear of failure, challenge and aspiration we do not see in other aspects of education.

Surely part of the Olympic legacy should be that we give future generations the benefit of experience that our Olympians give in achievement, aspiration and success?

They all compete on a daily basis in training and in competition - even to maintain funding - and ultimately will compete for a medal at London 2012.

Where will our next generation be without the competition and physical literacy goals as they develop?

Let us achieve future success now by building in a PE curriculum that embraces push, pull, squat, brace, rotate, accelerate and change of direction.

Let it be competitive and let us test our children against each other and identify those who need support from the network of doctors trained in sport and exercise medicine as an existing Olympic legacy.

Teachers and parents need support with training and a curriculum that builds on the lessons learnt in athlete development, and sport talent identification, not to build potential superstars but to change a lifestyle.

We need to make exercise a normal part of day-to-day life, not a weekly obligatory trip to the gym.

Surely we need to act now to help those millions otherwise destined for obesity?

Mum with cancer has healthy baby

 Sarah Best from Leamington Spa gave birth to a healthy baby boy just hours after completing radiotherapy treatment

A Warwickshire mother is one of only a handful in the world to undergo cancer treatment while pregnant and go on to have a healthy baby.

Sarah Best, 30, from Leamington Spa, gave birth to Jake after going into labour on the final day of treatment.

She had undergone chemotherapy for a type of mouth cancer after being diagnosed when four months pregnant.

The tumour was removed in a pioneering operation at University Hospital Coventry and Warwickshire (UHCW).

According to UHCW, chemotherapy for pregnant women is incredibly rare and Jake is thought to be the first baby to be born in the UK after such treatment, and one of only eight in the world.

'Complex treatment'

"It was devastating really," said Ms Best, who gave birth in April.

"Because I thought pregnancy was supposed to the happiest time... you're supposed to feel wonderful.

"And it didn't really... I had other things I had to cope with because of this cancer.

"The hospital [staff] worked so well for me. They were like my best buddies."

Gary Walton, the surgeon who led the UHCW team, said: "This type of treatment is complex at the best of times and is very rarely carried out on pregnant women, so we had to stay in close contact with the maternity team throughout.

"I am delighted that Sarah has responded so well to the treatment, especially now that she has Jake to look after too."

The downside of the operation was that Ms Best was unable to receive any gas-and-air pain relief during labour, but that did not stop her from giving birth to a healthy 4lb 10oz (2.1kg) baby boy.

Love on the transplant list

 Kirstie Mills was 21 when a lung transplant became her only hope of survival.

During the previous two years her health had deteriorated rapidly. The cystic fibrosis which had made her ill all her life had finally taken hold.

She regularly used a wheelchair, she was on oxygen to help her breathe and was spending longer and longer in hospital.

By that time, Kirstie had met and fallen in love with Stuart.

She had introduced him to her daily dose of medicines, chest infections and hospital visits, all part of the incurable condition's cruel regime.

But soon that regime changed for the worse.

"I had a stair lift fitted and what was once my fitness room, became a dedicated treatment room, full of medicines and devices to help me breathe. I knew we were running out of time"

"I didn't expect to be so near the edge of life"

Faced with the prospect of little time left together, they planned their wedding in Cyprus only to relocate it to Somerset when Kirstie became too sick to travel.

"We got married three weeks before my transplant. There were numerous medical staff there as well. Stuart had a Do Not Resuscitate card in his pocket because if I had collapsed I did not want to be ventilated, because that would have ruled out a transplant.

"It was the best day of my life but we thought it was going to be my last too."

Agony of waiting

Two weeks later she was airlifted to Harefield Hospital in London to wait for a transplant - a last-resort operation which can extend life expectancy but can be very risky too.

Kirstie was hooked up to an ECMO machine which imitates the job done by the lungs

Kirstie says waiting for the transplant was the worst time imaginable for her family and new husband.

"At one point I tried to beg them to switch off the machines that were keeping me alive but, because I had a tracheotomy in, no one understood me.

"I was in agony, I felt like I was constantly drowning or suffocating. The number of tubes attached to me was incredible so I couldn't move, couldn't do anything. I felt desperate.

"I didn't think my transplant would come and, if it did, it would surely be too late because I was so weak."

Kirstie wrote an emotional letter to Stuart in case she did not survive.

With her life ebbing away, Kirstie was finally given a new pair of lungs in July 2011.

"It was just in the nick of time," she says. "I had hours left."

But the aftermath of the operation was far from easy. Kirstie still felt very ill when she came round and was still being ventilated.

"I'd had a major operation and it was like starting from scratch again. I thought it was a sick joke. I still felt like I was dying."

Return to fitness

Kirstie's new lungs needed time to function fully and properly and that meant constant pain and a steady diet of painkillers for several weeks.

Before the transplant: Kirstie with Stuart and comedian Russell Howard on a good day

Intensive rehabilitation got her back on her feet, breathing on her own and with Stuart by her side she knew she would recover.

Her lung function is now at 100%, which Kirstie's doctors are very pleased by.

She maintains that it is down to all the exercise she is doing - six fitness classes a week and three to four hours in the gym - which is key to making the lungs work well.

She is returning to fitness pole dancing and is soon getting back into teaching.

Now she is looking forward to really celebrating Christmas with her family, for the first time in years, and to taking part in a 180-mile charity bike ride.

Yet she is keenly aware that the transplant does not mean she is cured.

"I still won't have the same life expectancy as you, but the transplant will give me maybe 20 more years. I just have to keep managing and controlling the condition as best I can."

In the meantime, Kirstie and Stuart are enjoying the freedom of having her health - and her life - back.

Why anything can be addictive

 University  Even work can be addictive, according to Dr Griffiths For many people the concept of addiction involves taking drugs such as alcohol, nicotine, cocaine and heroin.

But in this week's Scrubbing Up, gambling studies expert Mark Griffiths warns that if the rewards are there people can become addicted to almost anything.

For the past 25 years I have been studying gambling and I passionately believe that gambling at its most extreme is just as addictive as any drug.

The social and health costs of problem gambling are large and have many things in common with more traditional addictions, including moodiness, relationship problems, absenteeism from work, domestic violence, and bankruptcy.

Health effects - for gamblers and their partners - include anxiety and depression, insomnia, intestinal disorders, migraine, stress related disorders, stomach problems, and suicidal thoughts.

If behaviours like gambling can become a genuine addiction, there is no theoretical reason why some people might not become genuinely addicted to activities like video games, work or exercise.

Research on pathological gamblers has reported at least one physical side effect when they undergo withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart palpitations, muscle aches, breathing difficulty, and chills.

In fact, pathological gamblers appear to experience more physical withdrawal effects when attempting to stop their behaviour when compared directly with drug addicts.

'Most important thing'

But when does an excessive healthy enthusiasm become an addiction?

Excessive behaviour on its own does not mean someone is addicted.

I can think of lots of people who engage in excessive activities but I wouldn't class them as addicts as they don't appear to experience any detrimental effects from engaging in the behaviour.

In a nutshell, the fundamental difference between excessive enthusiasm and addiction is that healthy enthusiasms add to life whereas addiction takes away from it.

For any behaviour to be defined as addictive, there have to be specific consequences such as it becoming the most important activity in the person's life or being the way they improve their mood.

They may also begin to need to do more and more of the activity over time to feel the effects, and experience physical and psychological withdrawal symptoms if they can't do it.

This may lead to conflict with work and personal responsibilities, and people may even experience "relapses" if they try to give up.

The way addictions develop - whether chemical or behavioural - is complex.

Addictive behaviour develops from a combination of a person's biological/genetic predisposition, the social environment they were brought up in, their psychological constitution - such as personality factors, attitudes, expectations and beliefs, and the activity itself.

Many behavioural addictions are "hidden" addictions. Unlike, say, alcoholism, there is no slurred speech and no stumbling into work.

However, behavioural addiction is a health issue that needs to be taken seriously by all those in the health and medical profession.

If the main aim of practitioners is to ensure the health of their patients, then an awareness of behavioural addiction and the issues surrounding it should be an important part of basic knowledge and training.

Behavioural addictions can be just as serious as drug addictions.

Women can choose Caesarean birth

 A Caesarean section can be necessary for medical reasons Pregnant women who ask for a Caesarean delivery should be allowed to have the operation, even if there is no medical need, according to new guidelines for England and Wales.

The National Institute of Health and Clinical Excellence (NICE) states that women should be offered counselling and told of the risks first.

Ultimately, however, the decision would be made by the mother-to-be, it said.

NICE said this was "a very long way" from offering all women surgery.

The last set of NICE guidelines, which were published in 2004, clearly stated that "maternal request is not on its own an indication for Caesarean section" and that clinicians could decline the procedure "in the absence of an identifiable reason".

The rules on requesting a C-section have been revised. Clinicians say this is to bring the instructions into line with what is already taking place in hospitals.

Birth fear Continue reading the main story

It's not a major operation that most pregnant women are interested in or want to have”

End Quote Malcolm Griffiths Consultant obstetrician and gynaecologist The 2011 guidelines say that women requesting a C-section because of anxiety should be offered mental health support. A phobia of childbirth is thought to affect 6% to 10% of women.

Nina Khazaezadeh, a consultant midwife at St Thomas' Hospital, says she often meets patients who want a Caesarean due to a "perceived lack of control, fears of inadequate care provision and lack of support during labour and delivery".

"But, after a discussion of all the pros and cons of both types of birth, and having been assured of one-to-one midwifery support and an individualised birth plan, they will choose to try for a vaginal birth."

The updated guidelines state that if such women still wanted a C-section, they should get one.

Women with no medical need can also ask for a Caesarean section. The guidance states that they should be told of the risks and discuss their request with a clinician, but their request cannot be denied.

Malcolm Griffiths, a consultant obstetrician and gynaecologist who led the development of the guidelines, said: "Caesarean section is a major operation, it's about as major as a hysterectomy.

"It's not a major operation that most pregnant women are interested in or want to have."

Dr Gillian Leng, deputy chief executive of NICE, said: "This guideline is not about offering free Caesareans for all on the NHS.

"It is about ensuring that women give birth in the way that is most appropriate for them and their babies.

"Offering these women a planned Caesarean section in these circumstances is a very long way from saying that Caesarean section should automatically be offered to every woman."

New rules Continue reading the main story

Planned Caesarean section may reduce the risk of the following in women:

pain during birth and for the next three days injury to vaginahaemorrhageshock

Planned Caesarean section may increase the risk of the following in babies:

Planned Caesarean section may increase the risk of the following in women:

longer hospital stayhysterectomy cardiac arrest

Source: NICE

There will be wider changes to clinical practice.

Being HIV positive will no longer be treated as grounds for an automatic C-section. Improvements in anti-retroviral therapies mean it is now safe for some woman with HIV to deliver vaginally.

There will also be changes to break the mentality of "once a Caesarean, always a Caesarean".

The latest evidence suggests that even for women who had up to four previous C-sections, that the risks of fever, bladder injuries and surgical injuries were the same for planned vaginal and planned Caesarean deliveries.

Also it had been thought that giving women antibiotics to protect against infection during surgery could be damaging to the baby. NICE says medical evidence says this is not the case and that women should now be given antibiotics before going under the knife.

In the UK, about one in four births is by Caesarean section. The rate has been roughly static for the past four years following years of increases. Across Europe figures vary widely from about 14% in Nordic countries to 40% in Italy.

NICE believes that overall, the rate could fall after the introduction of the new guidelines.

Wendy Savage, a retired professor of obstetrics, said women requesting a C-section were not responsible for the rise rather "it is obstetricians that are too keen to do it".

On vaginal births she said: "They don't know how to do it most of them now because they haven't been trained how to do it.

"It is up to us to put our house in order and stop doing Caesareans too easily.

"We're doing too many first Caesars and secondly we're doing too few vaginal births after Caesarean section."

Cathy Warwick from the Royal College of Midwives: 'It doesn't differ from the current practice going on in many maternity units'

The changes will come at a cost to the NHS of around £0.5m, largely from the cost of mental health services for women with anxiety.

The cost of a planned Caesarean section was estimated at £2,369, with a planned vaginal birth costing £1,665.

Maureen Treadwell, co-founder of the Birth Trauma Association, said: "We are delighted that this updated guideline recognises the terrible impact that fear of childbirth can have on women and their families."

Cathy Warwick, chief executive of the Royal College of Midwives, said: "If midwives are able to help women to understand what their choices mean for them and their baby and feel they will be supported in labour then very few women will want an elective Caesarean section.

"They will be making decisions from a fully informed position and from a position of trust in maternity services, not one based simply on hearsay."

Wrong twin aborted in Australia

 An Australian hospital has launched an inquiry after staff treating a woman carrying twin boys accidentally terminated the wrong foetus.

Doctors had told the woman that one of her babies had a congenital heart defect that would require numerous operations, if he survived.

The woman chose to abort the 32-week foetus but staff injected the wrong twin.

The hospital in Melbourne described it as a "terrible tragedy".

"The Royal Women's Hospital can confirm a distressing clinical accident occurred on Tuesday," it said in a statement.

"We are conducting a full investigation and continue to offer the family and affected staff every support."

The woman went on to have an emergency caesarean to end the life of the sick foetus.

'Thorough investigation'

Victorian Health Minister David Davis said the hospital investigation would be overseen by an independent expert.

"I am very much determined to get to the bottom of what went wrong," he said.

State Premier Ted Baillieu echoed his sentiments, saying: "I don't think it's appropriate for anybody to draw any conclusions other than this is a horrible tragedy.

"We'll make sure that the investigation is as thorough as it can be."

In a brief statement, the family asked for privacy "at what has been a very difficult time for us".

Safeguards for vulnerable questioned

Safeguards to protect some of society's most vulnerable people are "not fit for purpose", leading mental health experts have told the BBC.

Deprivation of Liberty Safeguards (DoLS) should give people deemed not to have mental capacity the right to challenge their detention by the state.

But a Mental Health Alliance report will say the arrangements are bureaucratic and wasteful.

The government has said it will look carefully at the report's findings.

The Deprivation of Liberty Safeguards (DoLS) were brought into English and Welsh law in April 2009 and apply to people over the age of 18 who are in care homes or hospitals.

Those institutions have to apply for an independent assessment of anybody in their care who lacks mental capacity and is thought to be at risk of harm if they are not deprived of their liberty.

The safeguards include giving those detained, or their families, the right to challenge the restrictions, first locally by means of a review, and ultimately in the Court of Protection.

Robust deprivation of liberty safeguards are an essential protection for vulnerable people”

End Quote Paul Burstow Care Minister But the report from the Mental Health Alliance, which represents a number of charities working in this field, will warn the scheme is "incredibly bureaucratic, wasteful, and the burdensome paperwork itself discourages many local authorities from using the legislation".

Speaking to BBC Radio 4's The Report, the author of the Mental Health Alliance study Roger Hargreaves warns of massive variation in the number of DoLS taken out by local councils across the country.

In the two years since they were introduced, West Sussex, for instance, made 206 authorisations whilst Hull made none.

Mr Hargreaves is calling for a radical rethink:

"If there are such variations, it raises questions about whether those safeguards are not being applied where the activity rates are very low, and alternatively [whether] they may be being overused in areas where they are very high."

'Complex issues'

The damning report follows controversial cases like that of Steven Neary, a 21-year-old autistic man who was kept in a care unit for a year against his and his father's wishes.

Over the course of 2010, Hillingdon Council issued a number of standard authorisations for a Deprivation of Liberty on Steven Neary, even though, importantly, there was a less restrictive option for his care available at home.

The legislation is not meant to be used as a power by a local authority to detain someone against their wishes when other options are available.

Instead, it is meant to authorise restrictions in someone's care plan that are both necessary and in that person's best interests.

Crucially, the legislation is meant to offer safeguards so that the person can challenge their situation.

In Steven Neary's case, a High Court judge ruled that Hillingdon had unlawfully deprived him of his liberty and had not followed the correct procedures.

In a statement, Hillingdon's director of social care, Linda Sanders, said: "Cases such as Steven's are hugely complex... As the judge said in his findings, at all times my staff were genuinely committed to ensuring that they did the right thing for Steven and had his best interests at heart.

"Before the court hearing, we recognised the need to improve our processes and had already made significant changes relevant to this case, including reviewing our training for those staff dealing with the complex issues relating to the Mental Capacity Act and Deprivation of Liberty Safeguards."

'Thoughtful analysis'

While the Court of Protection is very effective in dealing with the cases it hears, the Mental Health Alliance suggests it is unsuitable as the avenue for appeal, as it is too slow, very expensive and hearings mainly take place in London.

Mr Justice Charles, a senior judge at the Court of Protection, said there were plans to have more hearings in district courts.

But he conceded that the legislation was hard to understand.

"It's complicated. What is deprivation of liberty? [If] you ask three people, you probably get four answers," he said.

Care Minister Paul Burstow told the BBC that he would look very carefully at the Mental Health Alliance report to see what lessons could be learned.

"Robust deprivation of liberty safeguards are an essential protection for vulnerable people. The Mental Health Alliance has offered us a thoughtful analysis of the problems some have encountered with the DoLS regime," he said.

The minister added that he looked forward to seeing the group's proposals to improve the system.

Shakespeare 'could help doctors'

  Romeo and Juliet was one of Shakespeare's works that could help doctors, it was argued Reading William Shakespeare could give physicians a fresh insight into the links between emotion and illness, a retired doctor and scholar believes.

Dr Kenneth Heaton says many doctors fail to connect psychological problems with physical symptoms - and argues the playwright could help them do it.

He listed dozens of examples in which Shakespeare described these phenomena in his works.

"They could learn to be better doctors by studying Shakespeare," he said.

While traditional medical school training never strays far from the science of diagnosis and treatment, there has been growing interest in recent years in including courses on health-related art, history or literature as part of the curriculum.

Dr Heaton, from North Somerset, who studied Shakespeare after retiring from his post as a gastroenterologist, believes that a broader perspective could make it easier to understand the viewpoint and needs of a patient, particularly in general practice.

'Reluctance'

His latest research, published in the journal Medical Humanities, focuses on real symptoms such as dizziness, fatigue, fainting, and disturbed hearing, produced by underlying emotional distress, which can sometimes confuse doctors as they have no obvious physical cause.

The frequency of these psychological illnesses in Shakespeare should be a mark not only of his "body-conscious" approach, but also of their importance to doctors, he believes.

Notable examples include the fatigue suffered by Hamlet, grief-stricken for his murdered father, who complains of his "weary, stale, flat and unprofitable" existence, and the headache suffered by the cuckolded Othello.

In King Lear, when Gloucester is led to the point of attempting suicide, his son Edgar notes that his "senses grow imperfect" because of his anguish.

In Romeo and Juliet, feelings of both coldness and faintness are used to convey shock. In all Dr Heaton found at least 43 references to physical problems caused by psychological stress in Shakespeare's works - far more than in other authors of the same period.

He said that the reluctance of modern doctors to attribute physical symptoms to emotional disturbance could cause delayed diagnoses, and unnecessary tests and treatment.

"Shakespeare had an extraordinary insight into the psychology of human beings, extending to the emotional effects on the body.

"Some medical schools have more in the way of humanities teaching than others, but many doctors would be able to learn something from Shakespeare."

Dr Paul Lazarus, a senior clinical educator from the University of Leicester, is one of those advocating a broader curriculum at medical schools, possibly including subjects such as the history of medicine, its depiction in literature and art, and even the architecture of hospitals.

He said: "While it isn't for everyone, it can help make students more capable of being able to view problems from a wider range of perspectives."

Slow paracetamol overdose warning

 Taking slightly more than is recommended can cause significant damage over time Taking slightly too much paracetamol day after day can be fatal, experts have warned.

A dangerous dose might just be a few pills too many taken regularly over days, weeks or months, they said.

Researchers at Edinburgh University saw 161 cases of "staggered overdose" at its hospital over a 16-year period.

People taking tablets for chronic pain might not realise they were taking too many or recognise symptoms of overdose and liver injury, they said.

The researchers told the British Journal of Clinical Pharmacology that this life-threatening condition could be easily missed by doctors and patients.

Doctors may not initially spot the problem because blood tests will not show the staggeringly high levels of paracetamol seen with a conventional overdose, where someone may have swallowed several packets of the drug.

Patients who have taken a staggered overdose tend to fare worse than those who have taken a large overdose, the study suggests.

Dr Kenneth Simpson and colleagues looked at the medical records of 663 patients who had been referred with paracetamol-induced liver injury to the Scottish Liver Transplantation Unit at the university hospital.

The 161 who had taken a staggered overdose were more likely to develop liver and brain problems and need kidney dialysis or help with their breathing. They were also more likely to die of their complications.

Dr Simpson said: "They haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal."

Professor Roger Knaggs of the Royal Pharmaceutical Society said patients should heed the warning.

Continue reading the main story Take paracetamol as directed on the packet or patient information leaflet that comes with the medicineEach tablet usually contains 500mgAdults can take 1-2 tablets of paracetamol 4-6 hourly, up to four times a day This means you should not take more than 8 tablets (4g) in a 24-hour periodIf you accidentally take an extra dose of paracetamol, you should miss out the next dose so that you do not take more than the recommended maximum dose for a 24-hour period. If you are concerned or you feel unwell, contact your GP or call NHS Direct on 0845 4647"If people experience pain and paracetamol doesn't help, rather than thinking a 'top up' dose may work, they should consult their pharmacist for alternative pain control or referral to someone who can help with the cause of the pain.

"The message is clear: if you take more paracetamol than is recommended, you won't improve your pain control but you may seriously damage your health.

"At this time of year people should also take care with combination cold and flu products which may have paracetamol as one of the ingredients. It's easy to take more than intended, so if in doubt consult your pharmacist."

Meanwhile, researchers at King's College London and Lund University in Sweden say they have discovered precisely how paracetamol works in the body. It is via a protein on nerve cells called TRPA1, says Nature Communications.

Now that they understand this principal mechanism, scientists can start to look for molecules that work in the same way to effectively relieve pain, but are less toxic and will not lead to serious complications following overdose.

Software shows patient biography

 Carers can access the information about the patient using a touchscreen A Dundee PhD student has developed a computer program that helps dementia sufferers communicate with their carer.

Dr Gemma Webster, 25, created software that holds a "multimedia biography" of the patient which carers can access through a touchscreeen.

The computing researcher said it would help busy care staff learn about the people they were looking after.

Research Councils UK has awarded Dr Webster £10,000 to help promote her "Portrait" project.

The software holds a digital timeline of key events in a patient's life, along with a family tree and other personal information.

Dr Webster, who completed her PhD at Dundee in September, said her software would act as a "communications bridge", enabling carers to learn about patients' lives in a relatively short time.

"Establishing some form of communication between carers and people with dementia can have vital implications for their health and well-being," she said.

"Learning about a person's past may help the care-giver by providing interesting and important information from which to stimulate discussion and communication.

"This information can be difficult to obtain through patient records or discussions with family especially when the health or medical situation often takes priority, and that's where Portrait comes in."

Dr Webster, who has just taken up a post-doctoral position at Lancaster University, hopes the Research Council's funding will lead to care and nursing homes using the Portrait software.

Strike means delayed operations

  Operations are set to be delayed across the UK Hospital managers are planning to postpone thousands of non-emergency operations next Wednesday, because of the public sector strike over pension changes.

Patients across the UK have been sent letters warning them of the disruption.

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions - the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.

999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

"I would ask staff to consider carefully whether going on strike is the right thing to do," he said.

Unison's head of health Christina Nacanea said members did not take strike action lightly.

"Most of them will first and foremost ensure that there is adequate cover is in place and that patients' safety is not compromised," she said,

"But by the same token they will be wanting to demonstrate their opposition to what the government is trying do to their pensions."

Switch in cervical cancer vaccine

The human papilloma virus can cause cervical cancer and genital warts The Department of Health has decided to change the vaccine it uses to protect girls against cervical cancer throughout the UK.

From September next year it will use the Gardasil jab, which also offers protection against genital warts - one of the most common sexually transmitted infections.

Some sexual health experts criticised the decision in 2008 when the Department of Health opted for the cheaper of the two vaccines on offer - Cervarix.

Both vaccines protect against human papilloma virus (HPV) types 16 and 18, which cause more than 70% of cervical cancer.

But Gardasil, which the Department of Health has now opted for, also protects against HPV types six and 11 which cause nearly all genital warts.

Figures from the Health Protection Agency show that 75,000 people were diagnosed with genital warts in 2010.

Professor David Salisbury, the Government's Director of Immunisation, said: "It's not unusual for the NHS to change vaccines or other medicines - it can happen following competitive tendering exercises or when new research findings come to light."

He denied that the wrong choice of vaccine had been made three years ago, adding that the decisions then and now were both "scientifically and economically justifiable".

Dr Steve Taylor, consultant in sexual health medicine at Birmingham Heartlands hospital said the news was "fantastic".

He added: "In Australia the burden of genital warts has fallen dramatically since the introduction of the quadrivalent vaccine (Gardasil).

"We felt last time round the decision was based on the vaccine cost, and yet the reduction in the burden on sexual health clinics was not taken into account."

Gardasil, made by Sanofi Pasteur MSD, is the most widely used of the two vaccines. Eighty million doses have been distributed worldwide compared to 25m of Cervarix, which is manufactured by GlaxoSmithKline.

Girls are offered the HPV vaccine at secondary school when aged 12-13.

The Department of Health says 400 deaths a year from cervical cancer will be prevented by the vaccination programme.

The expanding trend for ear stretching

  Stretched ear lobes are becoming an increasingly common sight in the street. But why has creating a large hole in the ear lobe started to appeal to more and more people?

Ear stretching goes back a long way.

But you don't have to visit a museum or travel to a remote-ish part of the world to see it because the practice has been adopted in many Western countries.

However, it is not so common that it goes unnoticed. Stretched piercings do tend to stick out like the proverbial sore thumb, particularly if the hole is substantial enough to hold a small object.

For many people, there is an "ouch" or an "eugh" factor when they see someone with a substantial ear lobe stretch but for those that have it done, it is a thing of beauty.

Continue reading the main story 

Amie Conradine, 19, started stretching her lobes herself from the age of 11.

She now has a 26mm gauge in one ear and 24mm in the other. She also has a 3mm hole in the cartilage of her upper ear.

The alternative model from Essex says: "It's pushing my body to its limit and I love the way it looks. I think they look amazing on people.

"I don't push myself because other people are doing it now. I won't do it to be more extreme.

"Body modification is not a new thing but it is becoming more popular.

"People are only doing it these days because they are following like sheep.

"My tattoos and my body modifications all have meanings. I would feel like a completely different person without them."

One of the recently ousted contestants on the BBC One show Masterchef: The Professionals had both ears stretched and adorned with black "flesh tunnels", which allow people to see through the lobe.

This led to remarks on Twitter such as "I like Seb. And he can hang his utensils from his ear lobes so double bonus" and "I would've served my prawns in my ear holes if I were Seb".

Flesh tunnels and flesh plugs, which are solid, have become more visible on our screens. Dougie Poynter from British band McFly is currently sporting some flesh tunnels in the Australian jungle, where he is taking part in ITV1's I'm A Celebrity Get Me Out Of Here.

American rapper Travie McCoy and American singer Adam Lambert are also stretching devotees. British fashion expert Gok Wan is also partial to large wooden ear plug adornments but it is not known if these are being used to stretch his lobe.

Statistics are not easy to come by but, as with tattoos, there is extensive anecdotal evidence that ear stretching is on the rise. More people are wearing them, DIY kits are more widely available and there is a much greater choice of jewellery.

Marcus Mellor, from the Holier than Thou piercing parlour in Manchester, says ear stretching has become more popular in the last five or six years.

Practising what he pierces, Mellor has stretched both his ears. He says it used to be associated with hippies, punks or the rock crowd but now it is "all walks of life and not just students".

Continue reading the main story The point of no return beyond which the hole will not return to normal variesOne danger is a blow-out, where ear flesh extrudesProponents say stretching should never hurt and that pain is usually a sign something has gone wrongReconstructive surgery to restore a stretched ear is possible but can be expensive"We get girlie girls, metal kids and middle-aged men," says Julie Howick, the owner of Cold Steel in London's Camden.

"It used to go hand-in-hand with other piercings but now people just come in for ear stretching. It can be discreet and people can hide it behind their hair in work."

Ear stretching is in vogue, says Alix Fox, who writes the body modification section in the British alternative magazine Bizarre.

"It's fashionable and it's easier to find a reputable, clean, knowledgeable place to have this kind of thing done."

Prof Victoria Pitts-Taylor, from the Graduate Center of the City University of New York, says ear stretching has become popularised in the same way as other sub-cultural practices, such as tattooing and piercing.

McFly's Dougie Poynter is a stretching fan. Gok Wan's may not be the real McCoy

The sociologist, who wrote In the Flesh: the Cultural Politics of Body Modification, says it started in the 1980s and 1990s with the rise of the body art movement and the "modern primitives", who appropriated practices from the "global supermarket" for various reasons such as showing solidarity with other cultures or to set themselves apart.

Ear stretching has became more mainstream in the last decade and different people have become attracted to it because they see it on the catwalks and celebrities.

Hard-core modifiers have to up the ante to defy the commercialisation of the practice, Prof Pitts-Taylor suggests.

"It is a slightly more committed body art than temporary practices or ear piercing. The more you stretch the skin, the more commitment you are expressing to a counter cultural look."

People who are obsessed with getting the largest stretch possible are known in the business as a "gauge queen" or "gauge king", according to Fox.

Jay Cee, a music video director and photographer from Surrey, says she is quite a creative person and so she likes a creative image.

"It's something a bit different and the people I was hanging around with wore them."

She bought her own kit and went up a taper size every month.

"I did the research and went to friends for advice. I also went on YouTube and different forums.

"It was painful but no pain, no gain.

"My parents were not happy and my mum was like 'What's that?' but they just got used to it."

Her lobe is now stretched to 18mm, so it will never shrink back to the size of the original piercing.

"It won't go back. It's for life. I still like it."

There are many ways to stretch ear lobes. You can gradually stretch the skin using different sized tapers (cone-shaped pieces of jewellery). This requires patience.

For those who want an immediate result, there's dermal punching. This works like a hole punch and will create an instant gap.

Mellor advises customers to take the gradual approach. "Just take it slow and steady - normally a 1mm increase every four weeks - and if the skin does not stretch easily, don't force it."

"The important thing is not to stretch your ear too fast because not only will it be painful but you're not stretching the skin uniformly," explains Fox.

Applying excess pressure can squeeze flesh from the inside of the lobe to the outside, causing what's known as a "blow out", she says. This can leave people with scarring.

There is a point of no return but it varies. A stretched piercing can shrink back to its original size but this depends on several factors including the length of time taken to stretch and the elasticity of the skin.

In some cases, if you stretch too fast or by too much, the lobe can split.

"Most people don't go above 10mm. They are thinking about the future. Once you start going to 20mm/30mm, you would need reconstruction if you changed your mind," says Howick.

As tattoo parlours now offer removals or reworking, there is also demand from people who regret their ear stretching.

Continue reading the main story  Ear stretching has been around for millenniaOtzi the Iceman, one of the oldest mummies in the world, had stretched earsThe ear lobes of Buddha statues are nearly always shown elongated. While a layman, the Buddha wore heavy ear adornments which he stopped wearing when he became a monkIt is still part of some traditional cultures, such as the Mursi in Ethiopia and some hill tribes in northern ThailandIt can be a rite of passage, a spiritual symbol or a sign of statusDr Ken Stewart, a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, says ear lobes are made of skin and fat but they are sensitive organs - they turn red when people get embarrassed and have an erogenous function. He says the main danger of ear stretching is deformity.

He is used to seeing people with lobes damaged because of bites or big earrings but only in the last few years has he been asked to repair lobes affected by ear stretching - he carried out five operations in the past year.

"They tend to get it done as teenagers and then they have to correct it as they get older for career reasons."

If there is still tissue, he can put it back together again using what he describes as a "Swiss roll technique". This will take about 45 minutes and cost £2,500.

More extensive damage will require taking cartilage from the rib and this surgery will take up to four hours and cost £8,000.

It seems size is all-important when it comes to ear stretching. While some body modifiers like to keep theirs discreet, others want to make a statement.

These days it is nigh on impossible to find a girl who does not have a tiny hole in her ear but it is perhaps a stretch too far to imagine that the long-eared trend will have the same mass appeal.

Train-hit girl's arm reattached

  The girl was injured at a level crossing in Killingworth A girl whose arm was severed when a train hit her at a level crossing on Tyneside has had the limb reattached.

Rebecca Huitson, 12, underwent surgery at Newcastle's Royal Victoria Infirmary after she was dealt a "glancing blow" by an Edinburgh-to-London train.

Rebecca's arm was retrieved from the track after she was hit at Killingworth at 18:30 GMT on Monday, police said.

Michael Schenker, a consultant plastic surgeon, said there was a "small risk" the "replant" of her arm could fail.

He said Rebecca's arm had sustained considerable damage.

Further operation

"I don't know how they found it but was told it was found quite far away from the patient," Mr Schenker said.

"It has a number of fractures so we have to deal with that at a later stage.

"The main thing was to get the blood supply into the arm as quickly as possible, and so far that is working."

Rebecca is expected to have a further operation.

"It is impossible to say at present what the final outcome will be, but we are working hard for her to have an arm with useful function in the end," Mr Schenker added.

Rebecca, who studies at Seaton Burn College, has now been returned to a normal ward from the ICU.

Students 'distressed'

Principal Alison Shaw said everyone was hoping Rebecca would make a good recovery.

"A number of our young people were very distressed, when they heard what had happened," she said.

"Some of them had witnessed it, so we are trying to help them get back to their learning with appropriate support to deal with the trauma they have suffered."

A British Transport Police spokesman said that investigations were continuing but the incident appeared to be an "accident".

The Rail Accident Investigation Branch of the Department for Transport has been informed.

UK women are 'fattest in Europe'

  Statisticians looked at the 19 European states assemblage was getable for The UK has many obese women than any added land in Continent, according to European Brotherhood figures.

 

Information office Eurostat, which looked at 19 countries, saved nearly a accommodate of UK women - 23.9% - were transcribed as existence rotund in the period 2008 to 2009.

 

Honorable over 22% of UK men were classed as obese, coming gear exclusive to State.

 

A somebody is characterized as fat if their embody mass fact (BMI), the result of a computation involving unit and level, is above a sure rank.

 

The BMI correlates fairly symptomless with body fat.

 

Statisticians plant the distribute of fleshiness and fat fill increases with age in all of the 19 member states that information was lendable for.

 

The information come from the Inhabitant Eudemonia Converse Inspect (EHIS) and was publicized by Eurostat, the statistical power of the Inhabitant Uniting.

 

After the UK, the countries with the highest levels of mortal avoirdupois were Island, with 21.1%, and Latvia, where 20.9% fulfilled that criteria.

 

Meantime, after State and the UK, the countries with the maximal instances of individual blubber were Hungary - where 21.4% devolve into that family - and the Czechoslovakian Commonwealth, where 18.4% are classed as such.

 

The UK's alto levels of fat are in stark differ to those in countries much as Romania, where conscionable 8% of women were classed as weighty along with 7.6% of men.

 

Move indication the principal tale Work out your superlative in meters and procreate the image by itself Judge your unit in kilograms Cypher the metric by the height squared For example, if you are 1.6m (5ft 3in) long and librate 65kg (10st 3lb), the reckoning would then be: 65 ÷ (1.6 x 1.6 = 2.56) = 25.39A BMI of little than 18.5 is underweightA BMI of 18.5-25 is idealA BMI of 25-30 is overweightA rancor of 30 or above is obeseObesity levels were also recovered to be low in Italy, Bulgaria and France.

 

In Italia, 9.3% of women were pioneer to be obese and 11.3% men.

 

Meantime, in Bulgaria levels of fat for women and men were plant to be 11.3% and 11.6%, with levels of France identified as being 12.7% and 11.7% respectively.

 

The figures suggested that the placement of women who are rotund or adiposis water as the educational story rises.

 

Net period, Eudaemonia Desk Saint Lansley launched a bid to minify blubber levels in England by 2020.

 

The diplomatist said fill pauperism to be reliable with themselves nearly how more they eat and fuddle.

 

He said that, boiler suit, Britons should be ingestion cinque 1000000000000 few calories a day than at omnipresent.

 

'Our devastating experience of childhood cancer'

  Chloe industrial cancer when she was six Chloe Gambrill was diagnosed with leucaemia at the age of six. She is now a sensible teenager, but she and her blood say it was a withering have.

 

It was when Chloe woke up in the night outcry in hurt because she was in so much somatesthesia that her parents knew something was immoral.

 

But this was a real-life situation.

 

For in 2005 at the age of six, Chloe was diagnosed with acute lymphoblastic cancer.

 

Her mum Kerry said it was only on their quartern call to fatality over the bed of a distich of months that her premiss was picked up.

 

"The doctors had been achievement to send her abode. But I had a mother's instinct and knew something was unjust, though I utterly wasn't thinking it would be anything like that.

 

"It was devastating."

 

'Extant with the unexplored'

Things moved speedily then and Chloe, from Ramsgate, was transferred to the Royal Marsden Hospital in London.

 

"Within an distance, she was having her front chemotherapy handling," said Kerry. She carried on having direction for cardinal eld.

 

"It has to be a prolonged discourse organization because if they do it for a momentary phase of example, what they've constitute out is that it comes aft.

 

"It was a rattling stonelike experience. It could be that Chloe was OK and desirable to go to education, or she could be be delicately for an distance then human a fruit in her temperature and pauperization to be taken to infirmary.

 

"We were living with the unexplored every day."

 

Chloe now enjoys a natural teenage beingness

Chloe is now 13, and a competing traveler.

 

She said: "I cite waking up in the nighttime and state diagnosed. It was horrible - one of the worse situations you could be in.

 

"Several of my friends were scared to travel and see me.

 

"When my unexcelled christian came, she brought a plaything for me - but I was sick all over it.

 

"Now it seems same ages ago, but it's not real that extended."

 

Kerry says she doesn't think she has got over the receive of her daughter being so ill.

 

"Equal tho' Chloe's extraordinary and doing really shaft, but when you've departed finished all that, it's calculating.

 

"You do mull if it's leaving to move o.k.. Whenever she is in painfulness or has a bleeding, you're stake there. You can't meliorate but cark."

 

'Status to see'

Chloe won a Feel of Kingdom accolade for fulfilling her commitment to run in a Contend for Spirit in retention of her gran Wendy Painter who had died of boob house the period before, right weeks after she started her chemo.

 

She was so powerless that she collapsed midway capitate the row, but she was discovered to goal and get her £100 sponsorship money.

 

Her mum, dad and experienced brother Charlie took turns to booze her the pose of the way and service her pass over the finish ancestry.

 

The folk say they do as some as they can to cite awareness.

 

Kerry said: "Forty period ago, she belike wouldn't make survived. It's unconvincing to imagine of the way the communicating has progressed."

 

Chloe says she wants to request grouping almost what she went through.

 

"They do need to hump. If they judge themselves in the said place, or their friends are, they requisite to cognize."

 

Soul Explore UK estimates that most 5,600 more children possess survived for at smallest five life after state diagnosed with sign than they would individual done if endurance rates had remained as they were in the primordial 1970s.

 

In the crude 70s, 33% of children survived cancer. Today animation rates booth at writer than 80%.

 

This growth in selection is mostly due to the developing of combining chemotherapy, which uses a numerate of contrastive drugs.

 

And living rates from neuroblastoma (a brass paper soul) in children tally risen from 17 to 64%.

 

Academician Apostle Lbj, Sign Research UK's supervisor clinician, said: "Writer children are extant mansion than e'er before and our efforts are continuing to change an even large change.

 

"Childhood cancers are rugged to research, with relatively few children diagnosed each assemblage. But our researchers are continuing our efforts to regain ways to study the disease originally and search for new drugs and making the existing treatments flush many powerful."