What the papers say – weekly digest (19/01/24)

Your weekly digest of the top healthcare stories, covering news published from 15/01/2024 – 19/01/2024.

The Guardian

Older people are being urged to get fully vaccinated against Covid as a world-first study shows thousands of hospital admissions and deaths in the UK could have been avoided if everyone had received all their doses. The rollout began strongly in the UK, with 90% of the population over the age of 12 vaccinated with at least one dose by January 2022. However, rates of subsequent doses fell sharply, a study shows, with less than half the population fully jabbed by June 2022. COVID-19 continues to infect people of all ages across the UK, while the last date for those eligible to get their seasonal jab – which includes all adults aged 65 or over – is 31 January. In the first study to involve the entire UK population of 67 million people, researchers found that by June 2022, just 44% of the population had been given their recommended number of jabs and boosters. More than 7,000 hospital admissions and deaths in the UK could have been avoided that summer alone if people had had all their Covid jabs, the study suggested. The research, led by Health Data Research UK (HDR UK) and the University of Edinburgh, was published in the Lancet. The study looked at everyone in the UK aged five and over, with under-vaccination defined as not having had all the doses for which an individual was eligible. As of 1 June 2022, 45.7% of people in England were under-vaccinated, as were 49.8% of people in Northern Ireland, 34.2% in Scotland and 32.8% in Wales, the study found. Researchers used mathematical modelling to find that 7,180 hospitalisations and deaths out of 40,393 Covid hospital admissions and deaths from 1 June to 30 September 2022 were avoidable had the UK population been fully vaccinated. Of the 40,393 hospitalisations and deaths, 14,156 were in people who were under-vaccinated. While all age groups were affected, the majority were older people, researchers said. Under-vaccinated people aged over 75 were more than twice as likely to suffer a severe Covid-19 outcome than those fully protected, the study found. Those eligible for a seasonal Covid vaccine include all those aged 65 or over, those aged between six months and 64 who are at increased risk, and those living in a care home for older adults. Frontline health and social care workers, carers aged 16 to 64, and people aged 12 to 64 who live with someone with a weakened immune system are also eligible. Researchers said the study was a landmark advance for science. It included virtually everyone in the UK and united NHS data which was stored and gathered differently depending on the country. Experts now aim to extend this type of study to many other areas of medicine, such as cancer, diabetes, heart disease and respiratory diseases.

Ministers are facing calls to tackle the NHS’s chronic lack of staff as figures reveal that the bill for hiring temporary frontline workers has soared to more than £10bn a year. Hospitals and surgeries across the UK are paying a record £4.6bn for agency personnel and another £5.8bn for staff doctors and nurses to do extra ‘’bank’’ shifts to plug gaps in rotas. The Royal College of Nursing said the levels of agency spending  were ‘’staggering’’. It would be cheaper to employ more nurses as staff instead of having tens of thousands of vacancies, its general secretary, Pat Cullen, said. The NHS in ENgland has 42,306 vacant nursing posts. A clampdown by the NHS in England in 2015-16 on the use of agency staff led to trusts reducing their spending on them from £3.63bn that year to £2.38bn in 2019-20. But it has since crept back up and was £2.99bn in 2021-22, hitting £3.46bn in 2022-23, the firm found. NHS England said trusts were now spending less on agency staff than before and also less as a proportion of the service’s overall spending this year. But it did not provide figures to substantiate either claim.

More than 100 MPs from across the political spectrum have demanded that Rishi Sunak speeds up compensation for patients given contaminated blood. The MPs urged ministers to show the same ‘’determination’’ evident in recent efforts to tackle the Post Office scandal. In what is widely recognised as the worst treatment disaster in the history of the NHS, thousands of people died after being given blood products contaminated with HIV and hepatitis C in the 1970s and 1980s. The government has said it is not ready to make a final decision on compensation despite calls by the official inquiry to speed up payments. Many of those affected by the contaminated blood scandal have become frustrated, not only by the delays, but also the speed with which ministers acted on the recent Horizon scandal. In an open letter to Sunak, MPs including Damian Green, a former deputy prime minister, and Sir Robert Buckland, the former justice secretary, said ministers needed to show the same resolve in tackling what they said was arguably a worse scandal than Horizon. The government last December opposed implementing recommendations on setting up an independent commission to oversee quick compensation,’’ they wrote. ‘’We trust the change in direction towards those affected by gross national injustices will be reflected positively towards those infected and affected by what is commonly regarded as the worst treatment disaster in the history of the NHS.’’

Viagra taken with chest pain medication can prove to be fatal, a study has warned. Phosphodiesterase type 5 inhibitors (PDE5i) – erectile dysfunction drugs sold as Viagra, Levitra and Cialis – and nitrates in chest pain medications can cause drops in blood pressure. Swedish researchers studied 61,400 men on nitrates with 5,700 of those also using erectile dysfunction pills. Men taking both had an overall risk of death plus heart attack, heart failure and other cardio issues. Few events occurred within 28 days of men receiving an erectile dysfunction drug, indicating that there is low immediate risk. Associate Professor Daniel Peter Andersson, of Karolinska Institutet in Stockholm, said there is a ‘’need for careful patient-centred consideration’’ before prescribing both drugs. The results are in the Journal of the American College of Cardiology.

The parents of a 23-year-old man who died after eating a takeaway pizza have called for a meeting with the bosses of the UK’s big three delivery apps to discuss how to prevent further allergy-related deaths. James Atkinson, who had a known peanut allergy, died in July 2020 after eating less than a slice of pizza ordered from a Newcastle restaurant using the Deliveroo app. Unknown to him, the ingredients included a powder that was 99% peanuts. A coroner ruled yesterday that Atkinson died from a severe allergic reaction to the peanuts. She said she would not be making any direct recommendations to Just Eat, Deliveroo and Uber Eats, which have no legal requirement to provide allergen information. Atkinson’s parents, Stuart and Jill, said they wanted to meet the apps’ bosses ‘’to carry out a collaborative review of what further steps can be taken to better protect consumers’’.

The Telegraph

Energy drinks hugely popular with children and young people may increase the likelihood of developing mental health issues, a study claims. Youngsters who drink high levels of them have an increased risk of anxiety, stress, depression and suicidal thoughts, says researchers. Large consumption is also linked to risky behaviours – such as substance use, violence and unsafe sex – as well as poor academic performance, sleep problems, and diet issues. There are now calls for the Government to ‘’step up and deliver’’ on its 2019 commitment to impose a blanket ban on their sale to under-16s. Lead author Amelia Lake, from the Centre of Translational Research in Public Health at Teesside University, said: ‘’Energy drinks are marketed as a way to improve performance but our findings suggest that they are actually doing more harm than good. ‘’We have raised concerns about the health impacts of these drinks for the best part of a decade after finding they were being sold to children as young as 10 for 25p.’’ Many shops and supermarkets already stop under-16s from buying drinks that can be high in caffeine, sugar and other stimulants. A 500ml can of Monster Energy has as much caffeine as four espressos and the equivalent of 13 teaspoons of sugar – while a can of Red Bull, at just 250ml, has the same amount of caffeine as two espressos and the equivalent of seven teaspoons of sugar. The Teesside University and Newcastle University study, which looked at 57 studies of 1.2 million children and young people from 16 countries.

Health chiefs are warning that there is a risk that measles will return across the country after low vaccine rates led to a large outbreak in the Midlands. Seven years after measles was briefly eliminated as an endemic disease in Britain, hospitals in and around Birmingham said they have been dealing with their biggest outbreak in years. Leading immunologists have warned that unless more children are vaccinated more hospital admissions and even deaths could be expected. With health teams unable to contain the outbreak and track contacts fast enough, there is now a fear of full community transmission. The UK has had a measles vaccine since 1968, in which time it has stopped an estimated 20 million cases and 4,500 deaths, mainly among children. Globally this century the vaccine is estimated to have prevented 56 million deaths. Measles is highly contagious and requires 95 per cent vaccine coverage to achieve herd immunity. In the late 1990s and early 2000s there was a fall in uptake due to false claims that the vaccine was linked to autism. By the early 2010s vaccination had bounced back to a level that led to the UK being declared measles-free in 2016. Although cases were still imported, endemic transmission had stopped. But, three years later, amid falling vaccination rates, measles returned. Nationally, uptake of both doses of the MMR vaccine is now at about 85 per cent but in some pockets, especially in ethnic minority areas, that figure is far lower. Health authorities believe the poor uptake is linked to vaccine hesitancy and disruption since the pandemic began.

A private hormone clinic for transgender young people has become the UK’s first to receive approval from England’s health watchdog. The Gender Plus Hormone Clinic has been approved by the Care Quality Commission (CQC) to prescribe hormones for over-16s. This comes weeks before the only NHS gender service for children in England and Wales, the Tavistock clinic, is shut down. Its replacement service, which has been delayed, is due to open this spring. The clinic is part of private service Gender Plus, which offers young people questioning their gender identity psychological support for a fee. On its website, the CQC says services are checked to ensure they are ‘’safe, effective, caring, responsive, and well led’’. Gender Plus will be able to prescribe hormones to over-16s who have been assessed by clinical psychologists across a minimum of six sessions. Not all patients will be suitable for hormones, clinicians say, and the clinic won’t prescribe puberty-blocking treatment. Last year it emerged that seven Gender Plus staff members worked or previously worked at the Tavistock clinic in London. Dr Hilary Cass produced a review of the Tavistock clinic in 2022 which found it was ‘’not a safe… long-term option’’ and should close. The clinic was accused of rushing teenagers into hormone-blocking drugs and was rated ‘’inadequate’’ by the CQC.

Reaction times improve after exercise giving hope for the treatment of Parkinson’s disease, research said. The findings could lead to exercise-based treatments to improve cognitive health for conditions including Parkinson’s, schizophrenia, ADHD, addiction and depression, according to scientists at the University of Portsmouth. The researchers found the reaction time of cyclists improved as dopamine levels increased during exercise. Dr Joe Costello, from the university’s school of sport, health and exercise science, said: ‘’These findings support growing evidence that exercise prescription is a viable therapy.’’

Companies are giving employees the day off if they are too sad to work on ‘’Blue Monday’’ – the most depressing day of the year. The third Monday of January is said to be so miserable because of the cold weather and extended gap between paydays in December and January. Blue Monday was a term first coined by psychologist  Cliff Arnall in 2004 after the holiday company Sky Travel reportedly asked him for a ‘’scientific formula’’ for the January blues. The aim of the ad campaign was to boost holiday bookings, and lift winter spirits. Though Sky Travel went bust in 2015, Blue Monday has entered into the cultural lexicon – and remains a common tool for ad campaigns aiming to encourage spending at a time when wallets are still recovering from Christmas. Several start-ups have used it as an opportunity to offer workers the day off, though some insist the day is spent on ‘’wellness activities’’ such as hiking or volunteering. It is the latest in a wider trend towards wellness perks and extra days off. Data from jobsite Adzuna found that 6,800 vacancies advertised by companies such as WH Smith and EE offered their birthday off. A handful advertised mental health days and ‘’pawternity leave’’ – time off for employees to bond with a new pet. Several companies have given employees Blue Monday off in recent years. Heather Suttie, of Glasgow-based podcasting business Violet, said: ‘’A day off like this works wonders for morale and wellbeing.’’ Maj Hussain, the chief executive of Magic, a PR firm, said of his employees: ‘’Monday can feel less blue if they have the day off to look after themselves and spend time with family.’’ And James Thurlow-Craig, director of Hampshire-based website design agency Create Designs, said: ‘’People do look forward to having the day off, particularly as January feels like the longest month to get paid. That final week is a challenge for a lot of people.’’

The Times

Shortages of medicines including diabetes drugs, cancer treatments and hormone replacement therapy are putting patient safety at risk, experts have warned. Pharmacists are facing aggression and abuse from customers as they deal with the ‘’worst ever’’ shortages, sector leaders said, describing the system as ‘’unviable and broken’’. The problems include manufacturing difficulties, missing key ingredients and global demand putting pressure on supplies, the Royal Pharmaceutical Society said. Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said the situation was ‘’the worst we have ever seen’’. She added: ‘’Our supply system is consistently unable to cope as soon as the demand for a medicine goes up – for example, scabies medicines, ADHD medicines, diabetes medication, some cancer medicines, HRT – the list continues. Every week we get a message informing us that a particularly popular medicine is going to be out of stock for a period of time.’’ The association has 4,500 members, which make up 52 per cent of independent community pharmacies. Hannbeck said rising prices were leaving pharmacy operators out of pocket. ‘’It is an unviable and broken system. Many pharmacies are closing their doors for good because of funding challenges,’’ she said. Hannbeck added she had highlighted the problems to government officials but no action had been taken. ‘’Patients are without their medicines and in some cases at risk of harm, pharmacists are out of pocket, exhausted, and yet it seems the officials refuse to see the seriousness of this situation,’’ she said.

The government is preparing for another pandemic within the decade, warning that artificial intelligence could create dangerous pathogens. A growing number of biological hazards, from antimicrobial resistance to deliberate attacks, must be taken as seriously as a nuclear threat, said Oliver Dowden, the deputy prime minister, as he launched a partnership with the US. The ‘’strategic dialogue’’ between the countries would result in an unprecedented co-operation, Dowden said.  It builds on the ‘’Atlantic declaration’’ signed last June that set out plans for an economic alliance designed to develop new technologies in the West. He claimed that biological threats were ‘’increasing all the time’’, warning that the UK needed to ‘’make sure we up our game’’. New pathogens might come from climate change, driving humans closer to animals, ‘’but also, there’s hostile state threats and other unregulated spaces’’. Dowden was speaking at St Thomas’ Hospital in London, where a unit has been using genetic sequencing to detect within hours, rather than days, what is causing illnesses. The respiratory metagenomics technology will be rolled out to ten NHS sites using £3million in funding. It provides data to health officials on which viruses, bacteria and fungi are circulating. He suggested the UK would always look to co-operate with China as fresh threats emerged, adding: ‘’It’s ultimately for the World Health Organisation and others working with them to nail down the origin of the Covid outbreak.’’

Thousands of NHS patients will have their physiotherapy sessions moved out of hospitals and into local gyms and leisure centres. The scheme reduces missed appointments by about a third, a trial has suggested, improving quality of life for those with health problems such as lower back pain and arthritis. They reported that missed appointments ranged from 17 to 23 per cent before the trial. With the trial, rates were 12 to 16 per cent. The pilot, run with ukactive, the trade body for the physical activity sector, will run for 19 months, during which about 25,000 patients are expected to benefit from lower transport costs. Approximately half of referrals to the trust’s physiotherapy team are for those suffering from lower back pain, for which exercise is key to recovery. Other patients who have conditions such as arthritis and fibromyalgia have been referred to the service to improve their fitness and muscle strength. Once their treatment finishes, patients will be able to access discounted gym memberships.

An artificial-intelligence chatbot can reduce depression in pregnant women and new mothers, a trial has shown. Highly engaged users of the AI mental health app Wysa had a 13per cent improvement in scores on a scale of depression severity. The difference was enough to move them from the ‘’moderate to severe depression’’ category to that of ‘’moderate’’ depression. Wysa is already used in parts of the NHS, and the new study, led by a Cambridge University researcher, suggests it ‘’can support mental health wellbeing across a range of maternal events and experiences’’. The paper is published in the journal Frontiers in Global Women’s Health. It found that users interacted with the chatbot to talk about their emotions and what was causing them stress, and not typically to seek maternal health support specifically. Between 10 and 20 per cent of women in the UK experience mental health problems during pregnancy or within a year after giving birth. Conditions might include postnatal depression and anxiety, psychosis, post-traumatic stress disorder and obsessive-compulsive disorder. NHS figures, obtained by Labour under the Freedom of Information Act suggest almost 20,000 mothers in England who seek help with mental health are denied care each year. In some areas, those who did receive help had to wait up to 19 months to start treatment. In the UK, perinatal depression, anxiety and psychosis are estimated to have long-term costs of about £8.1 billion for the total number of babies born in a year, much of which relates to adverse impacts on the child rather than the mother.

Scientists who looked at data from more than 18,000 teenagers in China and the United States, have found that the more siblings an adolescent has, the more likely they are to be depressed, anxious and have low self-esteem. There is already good data to show that children in large families have mixed blessings. As a positive, children with more siblings seem to have better social skills and are less likely to go on to divorce. ‘’It may be that siblings provide ‘practice partners’ for negotiating complex relationships, and (developing and maintaining) long-term relationships in general,’’ said Professor Douglas Downey, of Ohio State University, in the Journal of Family Issues. Since better relationships are linked to better mental health, this suggests that having more siblings might be beneficial for teenagers. There is another theory, however, called the ‘’resource dilution’’ hypothesis. It is familiar to any harassed parent who has declared ‘’there’s only one of me’’.  ‘’Parental resources are finite,’’ Downey said. ‘’As the number of children in the family increases, the parental resources accrued by any one child necessarily decline, much like a pie being cut into smaller pieces.’’ As evidence for this, it appears that children with more siblings leave education earlier. The research cannot definitively prove that it is the siblings that are causing the effect – large families differ from small ones in other ways. However, the decline in mental health was stronger if, for instance, the siblings were closer in age – adding weight to the argument that they were competing for the same resources. It is possible that the effect is age-specific. It may be that better adjusted adults are a result of sibling arguments in adolescence.

Playing video games can put people at risk of going deaf or developing tinnitus, researchers have warned. Scientists from the World Health Organisation reviewed global studies involving more than 50,000 people, finding that sound often exceeds safe levels, particularly for children. Experts warned that gamers often wear headphones for hours at a time and that loud ‘’impulse noises’’ such as shooting can damage their ears. They said that given the popularity of gaming among children and teenagers, more needs to be done to raise awareness of the risks. Youngsters should be encouraged to turn the volume down and take regular breaks to avoid long-term harm including tinnitus, a persistent ringing or buzzing in the ears. The study published in the journal BMJ Public Health, concluded that ‘’gamers who are listening at high intensity sound levels and for long periods may be at risk of permanent sound-induced hearing loss and/or tinnitus’’. The team, including experts from the University of South Carolina and the WHO, pointed to guidelines on the ‘’permissible’’ time a person can be exposed to loud noises – such as gaming or playing music through headphones. There is a ‘’trade off’’ which means people can play for longer without damaging their hearing, as long as it is at a lower volume. For example, it is safe to listen to noise at 75 decibels for 40 hours a week but they should not spend more than 45 minutes a week listening to noise at 92 decibels. However, gaming often exceeds these levels. Franki Oliver, of the hearing loss charity RNID, said: ‘’There are two factors that increase the risk of noise-induced hearing loss and tinnitus: how loud the sound is, and how long you are exposed to it for. ‘Younger people may not realise how loud the volume is so it’s a good idea for parents and carers to encourage regular breaks and turn the volume down if it’s too loud. Noise induced hearing damage can be permanent, but it is preventable.’’

Giving your children a glass of orange juice with their breakfast may seem like a healthy option. But research shows that daily fruit juice in childhood can cause weight gain and should be avoided to tackle the obesity crisis. A team at the University of Toronto looked at data from 46,000 children, finding that the more often they drank fruit juice, the fatter they tended to be. They warned that juice is ‘’liquid calories’’ and parents should limit their child’s intake to prevent them growing up obese or developing an unhealthy sweet tooth that lasts a lifetime. The study pooled data from previous clinical trials involving all popular types of juice, including apple, orange and grape. Each daily glass of fruit juice was linked with a small increase in body mass index (BMI), particularly in younger children. ‘’The youngest age group of children, 8 years or younger, had the greatest BMI gains, followed by children aged 9 to 13 years, and children 14 years and older,’’ the study found, because ‘’a typical glass would contribute to a larger proportion of daily energy in younger children than it would in older children’’. There have long been concerns about the high sugar in juice contributing to tooth decay but the study is the biggest yet to also conclusively demonstrate a link with weigh gain. NHS figures show more than one in five children are obese aged 10 and 11. Guidelines say that babies and children under five should not be given fruit juice or smoothies, owing to the risk of tooth decay. Older children and adults should limit fruit juice to one 150ml glass a day, with a meal to reduce the effect on teeth. The study also looked at data from 268,000 adults. However, it found that there was no ‘’significant’’ link between weight and juice consumption in adults and said further trials were needed.