Lung disease patient

Over 1,000 doctors involved in the care of people with lung disease have expressed "grave concern" about the future of NHS care for their patients.

They have signed a letter to the head of the new NHS Commissioning Board in England, Sir David Nicholson.

It says staff are "disappointed and angry" that efforts to improve care for people with lung disease and asthma might "be left behind in the new NHS".

The Department of Health said it wanted "maximally effective" local services.

As part of the government's changes to the NHS in England, networks of doctors and nurses who organise care for the big killer diseases at a regional level are being restructured.

This is causing particular concern among professionals who look after patients with lung disease, because the 10 regional boards who had driven clinical improvements will no longer have support or funding after next April.

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We've very disappointed and angry that this apparatus is being dismantled. ”

Prof Mike MorganBritish Thoracic Society

The medical experts say treatment has been transformed in recent years, leading to better organisation of services such as oxygen delivery for patients who need it at home.

The letter says: "The respiratory improvement programme started by the Department of Health just two years ago is starting to make real progress in improving respiratory care, whilst also saving the NHS money.

"Yet the support and funding for all this work is being withdrawn from April 2013, just at the point when patients are about to really benefit.

"We are concerned that patients living with respiratory disease will be left behind in the new NHS."

Heartbreaking

The letter was put together during a conference organised by the British Thoracic Society in London this week.

One of the signatories, Prof Mike Morgan, who works in Leicester, said: "We've very disappointed that this apparatus is being dismantled.

"The government has identified respiratory disease as a priority, but appears to be removing the infrastructure that supports it.

"We've worked hard alongside patients to improve standards of care, and it's heartbreaking to see this work destroyed unnecessarily.

"This lack of supervision of the improvement of care won't work in future if it's left to its own devices."

The British Lung Foundation (BLF) says one in five people in the UK suffer from lung disease.

This includes three million people with Chronic Obstructive Pulmonary Disease (COPD) and four and a half million who have asthma.

'Unintelligible'

The BLF's chief executive, Dr Penny Woods, said: "At the moment, respiratory care in this country lags behind the rest of the developed world.

"Our patients are writing to MPs to express their concerns. We're worried that if these networks aren't continued, the variation in standards of care will get worse."

Neil Churchill, chief executive of Asthma UK, said: "The loss of networks and a coherent improvement programme will make it harder to reduce deaths and improve efficiency for respiratory diseases.

"Given their cost in lives and in pounds, this is simply unintelligible to doctors, nurses and patients. We have just three months to put this right."

A spokesman for the Commissioning Board said: "We fully recognise that respiratory disease is a high priority both for reducing premature mortality and improving long term quality of life.

"We look forward to working with the clinical community and leading respiratory charities on making local services maximally effective."

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French sperm count 'falls by a third

The sperm count of French men fell by a third between 1989 and 2005, a study suggests.

The semen of more than 26,600 French men was tested in the study, reported in the journal Human Reproduction.

The number of millions of spermatozoa per millilitre fell by 32.3%, a rate of about 1.9% a year. And the percentage of normally shaped sperm fell by 33.4%.

The average sperm count remained within the fertile range, but experts want to see more research into possible causes.

One of the paper's authors, Dr Joelle Le Moal, an environmental health epidemiologist, said: "To our knowledge, this is the first study concluding a severe and general decrease in sperm concentration and morphology at the scale of a whole country over a substantial period.

"This constitutes a serious public health warning."

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Something in our modern lifestyle, diet or environment like chemical exposure, is causing this.”

Prof Richard SharpeUniversity of Edinburgh

But Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: "The change in sperm concentration described, 73.6 to 49.9 million per millilitre [on average for a 35-year-old], is still well within the normal range and above the lower threshold of concern used by doctors which is suggestive of male infertility, 15 million per millilitre."

There has much been debate in the past 20 years over whether sperm quality has decreased, with research supporting both sides of the controversy. This latest research adds weight to the numerous European studies that suggest one in five young men has a sperm count low enough to impair fertility.

Prof Richard Sharpe, from the University of Edinburgh, said: "Something in our modern lifestyle, diet or environment like chemical exposure, is causing this.

"We still do not know which are the most important factors, but perhaps the most likely is a combination, a double whammy of changes, such as a high-fat diet combined with increased environmental chemical exposures."

The study analysed data from the French database Fivnat, which logs information from 126 assisted reproduction centres. Researchers examined semen samples provided by men aged between 18-70 whose partners were undergoing fertility treatment because of blocked or missing fallopian tubes.

'Jury out'

As the study took place over a period of years, it is important that methods remained the same for comparison- but critics have questioned this.

Dr Pacey said: "In the paper, the authors claim that the methods for measurement of sperm concentration and motility 'have not changed noticeably during the study period', yet to me this is an odd thing to say as in my experience they have changed remarkably everywhere else in the world.

"I would argue that the 'jury is still out' on this issue."

While the study took into account factors that can affect sperm quality, such as age, researchers were unable to control for socio-economic factors, smoking or weight, which have been shown to have a major impact.

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SARS-like virus cases found

LONDON: A new virus from the same family as SARS which sparked a global alert in September has now killed two people in Saudi Arabia, and total cases there and in Qatar have reached six, the World Health Organisation said.

The U.N. health agency issued an international alert in late September saying a virus previously unknown in humans had infected a Qatari man who had recently been in Saudi Arabia, where another man with the same virus had died.

On Friday it said in an outbreak update that it had registered four more cases and one of the new patients had died.

"The additional cases have been identified as part of the enhanced surveillance in Saudi Arabia (3 cases, including 1 death) and Qatar (1 case)," the WHO said.

The new virus is known as a coronavirus and shares some of the symptoms of SARS, or Severe Acute Respiratory Syndrome, which emerged in China in 2002 and killed around a 10th of the 8,000 people it infected worldwide.

Among the symptoms in the confirmed cases are fever, coughing and breathing difficulties.

Of the six laboratory-confirmed cases reported to WHO, four cases, including the two deaths, are from Saudi Arabia and two cases are from Qatar.

Britain's Health Protection Agency, which helped to identify the new virus in September, said the newly reported case from Qatar was initially treated in October in Qatar but then transferred to Germany, and has now been discharged.

Coronaviruses are typically spread like other respiratory infections, such as flu, travelling in airborne droplets when an infected person coughs or sneezes.

The WHO said investigations were being conducted into the likely source of the infection, the method of exposure, and the possibility of human-to-human transmission of the virus.

"Close contacts of the recently confirmed cases are being identified and followed-up," it said.

It added that so far, only the two most recently confirmed cases in Saudi Arabia were epidemiologically linked - they were from the same family, living in the same household.

"Preliminary investigations indicate that these two cases presented with similar symptoms of illness. One died and the other recovered," the WHO's statement said.

Two other members of the same family also suffered similar symptoms of illness, and one died and the other is recovering. But the WHO said laboratory test results on the fatality were still pending, and the person who is recovering had tested negative for the new coronavirus.

The virus has no formal name, but scientists at the British and Dutch laboratories where it was identified refer to it as "London1_novel CoV 2012".

The WHO urged all its member states to continue surveillance for severe acute respiratory infections.

"Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases," it said. (Reuters)

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Caffeine-diabetes

NEW YORK: Results of a large new U.S. study confirm that sugary drinks are linked to a heightened risk of developing Type 2 diabetes, but shed little light on whether caffeine helps or hinders the process.

Among more than 100,000 men and women followed for 22 years, those who drank sugar-sweetened drinks were as much as 23 percent more likely to develop diabetes than those who didn't, but the risk was about the same whether the drinks contained caffeine or not. And drinkers of both caffeinated coffee and decaf had slightly lowered diabetes risk.

"We found that caffeine doesn't make a difference at all," said the study's lead author Dr. Frank Hu of Harvard University. "Coffee can be beneficial and the caffeine doesn't appear to have a positive or negative effect on diabetes risk," Hu told Reuters Health.

Numerous past studies have linked regular consumption of soft drinks - both sugar- and artificially-sweetened - to an increased risk of diabetes. Research over the past decade has also suggested that caffeine temporarily prevents the body from processing sugar efficiently. Those who live with diabetes deal with this problem all the time.

That at least suggests that caffeine in conjunction with sweetened drinks might raise diabetes risk even further. However, other research has found a protective effect from coffee and tea, suggesting caffeine does the opposite.

Hu and his coauthors wanted to know if people who regularly drink sugary and caffeinated beverages might only be exaggerating their risk of developing a disease that affects nearly 26 million adults and children, or about eight percent of the U.S. population, according to the American Diabetes Association.

They examined the health habits of 75,000 women and 39,000 men involved in long-term health studies that began in the mid-1980s.

Compared to people who didn't consume sugary drinks, the likelihood of developing diabetes over the years for those who did was higher by 13 percent (caffeinated) or 11 percent (decaffeinated) among women, and by 16 percent (caffeinated) or 23 percent (decaffeinated) among men.

Caffeine-free artificially sweetened drinks were also linked to a slight (six percent) increase in risk among women.

However, coffee drinkers showed slightly lower risk compared to non-drinkers. The chances of developing diabetes were eight percent lower among women, whether they drank decaf or regular coffee, and for men, four percent lower with caffeinated coffee and seven percent lower with decaf.

Hu and his team have used this same dataset, which contains the health habits of mostly white health professionals, to suggest that regular coffee drinking in general is tied to lower diabetes risk.

But past studies, like the current one, have also found that the risk falls even lower if adults drink decaffeinated coffee.

"Our understanding of the body's tolerance to caffeine is not complete," said James Lane of Duke University. Lane has done short-term studies that linked caffeine to a disruption of the body's ability to process glucose, or "blood sugar."

This latest study suggests that people who currently drink sugary beverages could substitute unsweetened coffee or tea - though tea was associated with fewer benefits - instead.

Such advice could be important, since the number of Americans who develop diabetes has steadily increased, according to a study released earlier this month by the U.S. Centers for Disease Control and Prevention.

Diabetes can only be managed, not cured and its side effects range from high blood pressure to debilitating blindness.

"I'm disappointed that they are essentially repeating something they published several years ago. The bit about including sugar sweetened beverages and caffeine's possible interaction with sugar and diabetes does not add something of great value," Lane told Reuters Health.

Others agree more research is necessary to untangle caffeinated coffee's complicated relationship with diabetes risk.

At least one small, randomized two-month-long trial led last year by Rob Martinus van Dam of the National University of Singapore, also a co-author of the current study, found that caffeinated coffee did not seem to affect glucose levels in the blood.

Van Dam told Reuters Health that the next step toward establishing a direct link between caffeinated coffee and reduced diabetes risk would require a much larger study.

"We still don't advise people to start drinking coffee if they do not already," van Dam said.

People who want to lower their risk of developing diabetes could follow advice that has been better substantiated, such as eating large amounts of fruits and vegetables and exercising regularly. (Reuters)

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