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Thursday, December 1, 2011

Cash crisis hits disease battle

 Projects to protect people against diseases including malaria are under threat Efforts to tackle diseases which kill millions each year could be badly affected by a severe shortfall in donations to a worldwide funding body.

The Global Fund to Fight Aids, TB and Malaria will make no new grants until 2014, and there is a threat to some existing projects.

It asked international donors for $20bn, but received just $11.5bn.

This misses even the fund's "minimum" $13bn target, which it says is needed to maintain programmes until 2014.

HIV charities said they were "extremely alarmed" by the decision.

This is the first time in its 10 year history that the fund has been forced to cancel its three-yearly funding round.

It blames the problem on a combination of "substantial budget challenges" in some of the countries who would normally contribute, and low interest rates cutting returns on its investments.

'Worst possible time'

However, in recent years it has faced accusations of failing to make sure money reached those in need, commissioning a review in March after reports of "grave misuse of funds" in four recipient countries.

This led to some donors, including Germany and Sweden, holding back their funding temporarily.

The HIV/Aids Alliance, whose member organisations rely heavily on the fund for projects across the world, said that it was the worst possible time for money to be withdrawn.

It said that planned projects to tackle high rates of HIV in areas of China and South Sudan might be affected by the funding cut.

Alvaro Bermejo, its director, said: "These should be exciting times - the latest scientific developments are showing us that HIV treatment can have a powerful HIV prevention effect.

"Never again must we reach a position where life-saving programmes are cancelled or delayed."

Another medical charity, Médecins Sans Frontières, described the financial situation as "dire".

He said that some countries with low HIV treatment coverage, such as Kenya, Lesotho and South Africa, had already been refused funding for larger scale programmes.

Dr Tido von Schoen-Angerer, one of its executive directors, said: "Donors are really pulling the rug out from under people living with HIV/Aids at precisely the time when we need to move full steam ahead and get life-saving treatment to more people."

He called for other governments to help make up some of the shortfall in donations.

The fund, which is based in Geneva, said that only "essential" programmes in low or middle-income countries would receive more funding to keep them going until 2014.

It says it intends to bring in new management to improve administration.

Do miracle memories exist in UK?

  Can some people remember minute details of almost every day of their lives? A psychologist from Hull University is looking for people in the UK who have a rare condition that allows them to recall an apparently incredible amount of detail about their own lives.

So far it has been found in just a handful of people, all of them in the US.

And if the condition really does exist it challenges the current models of how memory works.

But that is the question - does it really exist?

The condition was first described in a paper in the journal Neurocase in 2006 by three academics from the University of California which reported the case of a woman who could tell researchers exactly what she was doing on a particular date.

The paper describes how the woman, known as AJ, "spends an excessive amount of time recalling her personal past with considerable accuracy and reliability".

Since then a number of other people identified themselves as having similar powers but all of them have been from the US.

There is even a US TV show on CBS channel in which an implausibly attractive female detective has amazing powers of autobiographical recall.

The title? Unforgettable, of course.

'Clear and vivid'

Now Prof Giuliana Mazzoni of Hull University is keen to track down anyone in the UK who has similar powers of recall.

"The characteristics of this type of memory are a very clear and vivid memory for almost every day in a person's life.

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We might be able to actually have all this detailed information stored in our memory”

End Quote Prof Giuliana Mazzoni University of Hull "People are given dates - like 14th April 1981 - and they're able to tell what they were doing, where they were, what they were wearing, with whom they were speaking, what happened to them in life."

And unlike those who can perform amazing feats of memory - like recalling sequences of cards and numbers - these people seem to be able to recall details with very little effort and without using memory training techniques.

And if genuine, Prof Mazzoni says the condition poses a challenge to existing ideas on how memory works - and our own potential for developing greater powers of recall.

"For a few years now we have been thinking that in order to remember we have to abstract information.

"It is scattered information from this episode or that episode. We just maintain the gist of the information but we lose all the details.

"But apparently these people are able to remember visual details, auditory details, what they said and what they heard.

"If it is true it means that we might be able to actually have all this detailed information stored in our memory and then maybe we can all do that."

But is it real?

Prof Mazzoni was initially sceptical over reports of people seem to have an almost total recall of their autobiographical memory.

But the more she read about the condition, the more she was convinced it could be feasible.

"The evidence that I have seen up until now has overcome my initial scepticism.

"At the beginning I really thought that it was a made-up situation.

"But after having read the main scientific article and having read what these people report about their lives and having seen that their memory is accurate, I think it is a real condition that deserves to be studied."

"I'd really love to find them. I'd really love to know everything about them.

"I think the number will be relatively limited but we are setting up a study in which we will study their memory and can compare their memory to the memory of people like me who has a very normal autobiographical memory."

Dreaming 'eases painful memories’

 Dreams seemed to help ease the painful memories, the study suggested Scientists have used scans to shed more light on how the brain deals with the memory of unpleasant or traumatic events during sleep.

The University of California, Berkeley team showed emotional images to volunteers, then scanned them several hours later as they saw them again.

Those allowed to sleep in between showed less activity in the areas of the brain linked to emotion.

Instead, the part of the brain linked to rational thought was more active.

The study, published in the journal Current Biology, said it showed the links between dreams and memory.

Most people have to deal with traumatic events at some point in their lives, and, for some, these can produce post-traumatic stress disorder (PTSD), leaving them emotionally disturbed long after the event itself.

Mapping blood flow

There is significant evidence that the 20% of sleep in which we dream, also called REM sleep, plays a role in the processing of recent memories, and researchers believe that better understanding of this could eventually help PTSD patients.

The researchers recruited 35 volunteers, splitting them into two groups.

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In cases of more severe trauma, it may be just too difficult for the patient to process it during sleep, especially if the event has had a significant impact on that person's day to day life”

End Quote Dr Roderick Orner Consultant clinical psychologist After showing them 150 images designed to provoke an emotional reaction, half were allowed a good night's sleep.

While inside an MRI scanner to map blood flow in the brain - a good way to work out which regions are most active - the volunteers were shown the images a second time.

Those who had slept properly had less activity in the amygdala, a part of the brain associated with heightened emotions, and more activity in the prefrontal cortex, a brain region linked to more rational thinking.

The non-sleepers reported a far more emotional response to seeing the pictures again.

The scientists believe that chemical changes in the brain during REM sleep may help explain how the body makes this change.

Dr Matthew Walker, who led the study, said: "We know that during REM sleep there is a sharp decrease in norepinephrine, a brain chemical associated with stress.

"By reprocessing previous emotional experiences in this neurochemically safe environment of low norepinephrine during REM sleep, we wake up the next day, and those experiences have been softened in their emotional strength.

"We feel better about them, we feel we can cope."

Consultant clinical psychologist Dr Roderick Orner said that although sleep was believed by many to play a crucial role in the processing of traumatic memories, there were likely to be many other factors at work in PTSD patients.

He said: "In cases of more severe trauma, it may be just too difficult for the patient to process it during sleep, especially if the event has had a significant impact on that person's day to day life."

First baby at home 'higher risk'

A home birth carries a higher risk for the babies of first-time mothers, according to a landmark study published in the British Medical Journal.

However, the chance of harm to the baby is still under 1%, the study of almost 65,000 births in England found.

For a second birth there was no difference in the risk to babies between home, a midwife-led unit or a doctor-led hospital unit.

Midwife-led care was in general much more likely to lead to a natural birth.

The Birthplace study is the largest carried out into the safety of different maternity settings - comparing births at home, in midwife-led units attached to hospitals, those that are stand-alone and doctor-led hospital units.

All the women followed had healthy pregnancies and began labour with no known risk factors.

It found that, overall, birth is very safe wherever it happens.

The rates of complications, including stillbirth or other problems affecting the baby, was 5.3 per 1,000 births in hospital compared with 9.3 per 1,000 home births.

Prof Peter Brocklehurst, who led the research, said there were clear differences between women having their first baby and those having subsequent children.

He said: "The risk of an adverse outcome for a baby are higher for a woman planning her first baby at home than in all of the other settings, but there was no difference between the midwife and hospital obstetric units."

About 45% of women planning to have their first baby at home were transferred during labour, although this was mainly because of delays in giving birth and the need for an epidural pain-relief injection, rather than because the baby was in distress.

The transfer itself was not thought to be responsible for the difference because there was no raised risk for women moved from stand-alone midwife units to hospital during labour.

There was no difference in risk when women were having their second baby, whether that was at home, in a midwife unit or a traditional hospital setting.

The rate of transfer from home to hospital was much lower too, at just 12%.

Currently, about 90% of babies are born in medically-led hospital obstetric units. And in many areas women have a limited choice of where to have their baby.

Continue reading the main story

This Oxford University research raises fundamental questions about maternity care in the UK. Nine out of 10 babies are born in medically-led obstetric units. There has been a trend to centralise this into fewer and larger centres to guarantee consultant cover. Many of the decisions have taken place without definitive evidence about the safety for babies and the experience for mothers. This study provides that.

It reveals an unexplained difference in the rate of normal birth between units run by midwives and those run by doctors. The disparity on emergency Caesarean sections is particularly striking. It suggests a different culture in the way midwives and doctors see birth, with doctors concerned about risks and midwives focused on normality.

Although all politicians promise women choice about where to give birth, it is hard to see how that is meaningful. Only half of trusts in England have a midwife led unit and this research suggests it is an attractive option for the 350,000 low risk women giving birth each year.

Mary Newburn, from the National Childbirth Trust (NCT), said this research should drive an an expansion in midwife-led care, either at birth centres or at home for the half of women expected to have a low-risk birth.

"It's so disappointing that, at the moment, in 50% of NHS trusts there are no midwife-led units. And only 3% of births are home births.

"We think those figures show women don't really have access to out-of-hospital options."

The research also confirms that midwife-led care is much more likely to lead to a normal birth - without any interventions, including forceps or ventouse.

That was true whether the baby was born at home or in a midwife-led unit.

The emergency Caesarean rate for the low-risk women in the study was 11% in doctor-led units compared with only 2.8% at home, and 4.4% in a midwife led unit on a hospital site.

Louise Silverton, from the Royal College of Midwives, said: "Where a woman needs an emergency Caesarean section for their first birth, they will not be regarded as low risk for the next birth, and won't have the choice of going outside a medically-led unit."

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported the expansion of midwife-led units located on hospital sites, as there can be rapid transfer if complications occur.

Although researchers say they could not find an explanation for the higher level of interventions in units run by doctors, RCOG president, Dr Tony Falconer, said: "Within an obstetric unit, care is provided in a multidisciplinary, multi-professional manner, involving midwives and specialist doctors.

"Midwifery and obstetric units both work to standard clinical guidelines and medical help is provided only when indicated."

GP surgeries to 'widen services'

Yorkshire-based GP Dr Ian Rutter is taking part in the review A major review of the health service in NI is likely to recommend that GPs' surgeries should provide more services.

That could mean patients who currently have to go to hospital for a treatment would instead get it from a specialist at their local health centre.

A large part of the review is expected to focus on how services can be moved from hospitals into the community.

Some health centres already provide a range of services and that model is expected to be extended.

One of the experts undertaking the review is Dr Ian Rutter, a GP based in Yorkshire.

He is a former clinical advisor to the UK's Department of Health.

Dr Rutter said a greater focus is needed on what matters to patients, encouraging GPs to develop specialisms and doing as much as possible to treat people in the community.

BBC NI travelled to Dr Rutter's practice based in Shipley, outside Bradford.

From the outside, the practice is similar to many local GP surgeries, but inside, patients can be seen by dermatology, cardiovascular even geriatric specialists.

"We are able to offer patients care nearer to their home which they prefer," he said.

"We offer care for all sorts of problems that don't require hospital care but do need hospital expertise."

'No reason'

"By bringing specialists into the practice we are now able to offer a very extensive range of services beyond which a normal practice normally offers."

He sees no reason why his model cannot be applied to Northern Ireland.

"It would take 2-3 years to gain the necessary expertise for some GPs to be doing this work, but you could easily start to move specialists into community settings," Dr Rutter said.

"You have some fantastic buildings in Northern Ireland - some that would be ideal for this sort of work.

"I don't think GPs will have to work any longer hours, I do think they're going to enjoy working in an environment like this because you are not endlessly dealing with people who keep coming back because the system is failing them.

"Instead you are in a situation of solving the problem the first time and that is immensely rewarding."

Dr Rutter said he was aware that funding may not be available to make the changes, but he said resources could be used in a different way.

Up for change

"Throwing more money at this won't solve the problem - it's how you use the system to best maximise health care."

The BMA met those carrying out the health review.

According to Dr Tom Black, chairman NI General Practitioners Committee, doctors are up for change.

When asked if they would be looking for extra money he said: "I don't think there are extra funds within the health service.

"The GPs recognise the work has to be done. Services can't be run the way they have been and we are going to have to work more efficiently, in a different way integrating with hospital services."

Already steps have been taken locally in the direction Dr Rutter would like. At Holywood Arches in east Belfast, speciality services have begun creeping in.

Dr Alan Stout runs the ENT clinic.

"The ENT clinic started three months ago. We look at all the hospital referrals from east Belfast and deal with the ones we can in the primary care clinic," he said.

"Figures are positive. We can deal with around 50% of the overall number, the rest will be sent to hospital. Waiting lists are certainly shorter."

The Health Review, led by John Compton, is due to be handed to the health minister at the end of this month.

Edwin Poots is expected to address the assembly before the Christmas recess.

Home care 'breaches human rights'

 Ministers have already promised they will be revamping social care Basic care for the elderly in their own homes in England is so bad it breaches human rights at times, an inquiry says.

The home care review by the Equality and Human Rights Commission highlighted cases of physical abuse, theft, neglect and disregard for privacy and dignity.

It said on many occasions support for tasks such as washing and dressing was "dehumanising" and left people "stripped of self-worth".

The findings have added weight to calls for a complete overhaul of the system.

Campaigners described the situation as "shameful", while councils, which are in charge of providing such services, said without urgent reform services would just get worse.

There are currently nearly 500,000 people who are getting council-funded support in their own homes.

The home care review said about half of people who had given evidence reported real satisfaction with care, but a number of common complaints were made by others. These included:

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The physical abuse reported was most often in the form of rough handling or unnecessary physical force.

A 78-year-old woman who lives alone told the commission about her treatment.

She said: "Most of the girls [from the agency] were nasty. They were rough. Rather than say 'Sit in the chair', they'd push me back into the chair, that sort of thing, and I didn't like that.

"I couldn't do anything about it. I can't even walk and I think they know this, you see. They know you're vulnerable."

Older people not being given enough support to eat and drink, with some staff arguing health and safety restrictions prevented them preparing hot mealsNeglect because care workers stick rigidly to their tasks, such as a case when a woman was left stuck on the toilet because staff were too busyFinancial abuse, including money being systematically stolen over a period of timeChronic disregard for privacy and dignity, such as leaving people unwashed and putting them to bed in the afternoonPatronising behaviour, with cases highlighted including staff talking on mobile phones while they tended to clientsPhysical abuse involving pushing and rough handlingThe commission said such problems could be said to be in breach of various parts of the European Convention on Human Rights.

Ann Reid says one of her husband's carers refused to help him go to the toilet, because he was reading the newspaper

In particular, it highlighted article eight, which guarantees respect for dignity and personal autonomy, article three, which covers the prohibition of inhuman and degrading treatment, and article two, governing the right to life.

To rectify the situation, the Equality and Human Rights Commission (EHRC) said the law needed extending to clear up a potential loophole.

Councils are already covered by the Human Rights Act, but as they buy most home care services from the voluntary and private sector, it remains unclear how well protected the elderly are.

Continue reading the main story

A number of people complained that services were inflexible with staff keeping rigidly to set tasks. Taken to the extreme, this can result in serious situations being ignored.

A council officer recounted a case where one woman's pleas for help were ignored by her carer.

"I had a lady who was on the toilet when the carer came. She shouted 'I'm stuck, I need some help'. The carer shouted up: 'Can't do that, but I've made you a butty and I'm going now.'"

The commission also called on councils to ensure they balanced quality of service with price when tendering for services.

But it made clear that part of the problem was a basic lack of compassion and common sense among staff, pointing out simple measures such as staff covering someone with a towel while washing them could make all the difference.

Age discrimination was also highlighted as a significant barrier as older people were getting less money towards their care than younger people with similar problems.

But the commission suggested the prospects for the future looked bleak as one in three councils had already cut back on home care spending while a further one in five were planning to.

'Simply unacceptable'

EHRC commissioner Baroness Sally Greengross, who led the report, said it was time home care provided by councils was encompassed by the Human Rights Act.

She told BBC Radio 4's Today programme: "Two messages came out loud and clear. This poor care mustn't continue.

"And one of the ways to stop it continuing is to close the loophole, which means that any care that's commissioned by a local authority or another public body should come under the Human Rights Act so people are protected from abuse."

Linda Stephens, whose mother suffered from dementia and had home care, and who also worked as a carer herself, told the BBC there had been a lack of understanding of people and their needs.

She said: "Although I gave them quite an in-depth idea of what care was needed for mum - a lot of it would have been prompting and support - but unfortunately because of time restraints on them they were task orientated."

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One of the common complaints was a lack of help the elderly were given eating and drinking.

The report highlighted cases where people unable to feed themselves were given no help or where uneaten meals were left for days.

In one incident a carer watched as a 76-year-old cancer patient struggled from her lounge to her kitchen to microwave her meal because the worker argued they could not help because of health and safety.

The woman's daughter said: "It is hard to think of a reason or excuse big enough adequately to cover such a fundamental lack of care from one adult to another."

Michelle Mitchell, charity director at Age UK, described the findings as "shameful".

"It is simply unacceptable that care in people's own homes, where they can be at their most vulnerable, is often inadequate, disrespectful and lacking in dignity."

Ministers have already promised the whole social care system - including care homes as well as help at home - will be looked at, with initial plans expected to be published in the spring.

This comes after a recent government-commissioned review recommended costs - the system is means-tested - be capped, while the regulator has promised to toughen its inspections of home care providers.

But councils pointed out such promises have been being made for over a decade.

Councillor John Merry, of the Local Government Association, said: "These results are symptomatic of a social care system that is under-funded and in need of urgent reform. The longer ministers procrastinate, the more our population ages and the worse things will become."

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