Measles: Greater Manchester Reports Recent Spike in Confirmed Cases

Doctors have urged people in Greater Manchester to make sure they and their children are vaccinated against measles after a sharp recent increase in cases.

Public Health England said there had been 32 confirmed cases across Greater Manchester so far this year.

At the end of January there had only been five confirmed cases.

"The majority of the cases are in unvaccinated children," said Dr Kristina Poole, from Public Health England North West.

Experts have warned in recent years that a rise in the number of measles cases may be linked to the controversy surrounding the MMR vaccine used to immunise people against it.

In 2018 there were 144 cases in Greater Manchester, up from 127 in 2017.

The government's chief medical advisor Prof Dame Sally Davies has insisted the MMR vaccine is safe.

She said uptake was "not good enough" and urged parents to ignore "social media fake news".

Dr Poole said the MMR vaccine both protected individuals against the measles virus and also limited its spread throughout the community.

"MMR is a highly effective and safe vaccine," she said.

According to data from the World Health Organization (WHO), the number of measles cases in Europe tripled between 2017 and 2018 to 82,596.

Measles is a highly contagious disease that in severe cases can lead to complications including blindness, pneumonia and infection and swelling of the brain.

The UK, which was declared free of the disease for the first time by the WHO in 2017, experienced small outbreaks last year.

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Satisfaction With NHS 'Hits 11-Year Low'

Public satisfaction with the NHS has fallen to its lowest level for over a decade, a long-running survey suggests.

The British Social Attitudes poll of nearly 3,000 people found 53% of in England, Scotland and Wales were satisfied with services last year.

That is a three percentage point drop since 2017 and the lowest level since 2007. A peak of 70% was seen in 2010.

Experts said waiting times and a lack of staff were major concerns as ratings for GPs dropped to an all-time low.

The findings of the survey have been released by the Nuffield Trust and King's Fund think tanks, which helped to provide analysis around the figures.

Ruth Robertson, from the King's Fund, said the issues identified by the public were "long-standing" problems that the government had not yet managed to deal with.

She pointed out the findings were even more interesting considering the public had been polled in the summer after the 70th anniversary of the creation of the NHS and at a time when the government had announced extra funding for the health service.

"There was no birthday bounce," she added.

Of those who were not satisfied last year, 30% said they were actively dissatisfied, with virtually all the rest being neither satisfied or dissatisfied. Less than 1% said they could not answer.

Being free at the point of use, the quality of care and the range of services and treatments available were the main reasons people expressed satisfaction.

Despite the drop in satisfaction, the rating was still well above the all-time low of 34%, which was recorded in 1997. The survey started in 1983.

• How individual services compare
• The poll also provided breakdowns for individual services.

It showed satisfaction with GPs was at it lowest level ever, at 63%, but that was still higher than dentistry and accident and emergency.

Prof Helen Stokes-Lampard, of the Royal College of GPs, said GPs always wanted to provide the best care they could, so it was "disappointing" to see the drop.

"We know that general practice is currently facing intense resource and workforce pressures and while GPs are working incredibly hard to combat these, we understand that many patients are still waiting too long to see their doctor - something we find just as frustrating," she added.

There were some encouraging signs, however, that when people did get to access hospital care, they were happy - as satisfaction ratings for outpatient services hit their highest levels ever, at 70%.

Meanwhile, satisfaction levels with social care, which is run by councils not the health service, were down, at 26%.

Although researchers said significant numbers - about one in 10 - did not express an opinion, suggesting people did not use these services or did not know what they were.

Niall Dickson, chief executive of the NHS Confederation, which represents health services, said: "These findings show the inevitable consequence of starving the NHS of funding for the best part of a decade.

"We should be under no illusions about the scale of the task we face to restore public confidence in the health service."

A spokeswoman for England's Department of Health and Social Care said the recently announced long-term plan coupled with the extra money would "safeguard" the future of the NHS.

Meanwhile, a Welsh government spokesman said other polling there showed satisfaction in Wales was higher- but, he added, there was "always more to be done".

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Being a Couch Potato is 'Bad for the Memory of Over-50s'

Watching television for more than three-and-a-half hours a day could leave adults with a deteriorating memory, a study suggests.

Tests on 3,500 adults over 50 found that verbal memory decline was twice as bad in couch potatoes, compared to lesser TV watchers, over six years.

Our memory naturally gets worse as part of the ageing process.

But this happened faster the more TV was watched, University College London research found.

The researchers cannot be sure that TV was the cause of more rapid memory decline, but they say it could be that watching it for long periods stopped people from doing other more stimulating activities such as reading, and exercising.

The study, in Scientific Reports, found that those who watched television for more than three-and-a-half hours a day experienced, on average, an 8% to 10% decrease in verbal memory.

For those watching less than that per day, it was around 4% to 5%.

There was no evidence of TV having an impact on language fluency.

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Dr Daisy Fancourt, from the UCL Institute of Epidemiology and Health Care, said that while watching television may have educational and relaxation benefits, "overall this suggests that adults over the age of 50 should try and ensure television viewing is balanced with other contrasting activities".

Study participants, from England, were tested on how well they could remember a list of 10 common words and asked to list as many words in a particular category in one minute.

They were asked how much TV they watched each day and monitored from 2008-09 to 2014-15.

The research took into account other potential explanations for memory decline including lifestyle factors, and other behaviours, such as time spent sitting, and exercising.

Although the study did not ask people what they were watching on TV, some types of television could have a greater effect on cognitive decline, it said.

"Older people tend to like watching more soap operas, which can be stressful because they identify closely with the characters," says Prof Andrew Steptoe, from UCL.

"This may create cognitive stress which could contribute to memory decline."

Don't Panic

Prof Dame Til Wykes, professor of clinical psychology and rehabilitation from King's College London, said being a passive TV observer may be a potential explanation for the study findings.

"There is still a lot we don't know, such as whether memory reductions are affected by what we watch, whether we watch alone or whether you interact with the TV like those on Gogglebox. We also don't know whether changing behaviour would improve memory.

"Although this result will cause us to think carefully about screen time, a lot more research is needed before we panic and closely measure TV time like a step counter."

Dr Bob Patton, lecturer in clinical psychology, University of Surrey, said older adults (and their carers) should be mindful of too much time spent watching TV.

"While TV may not rot the brain as traditional wisdom may suggest, even moderate watching is associated with some very real changes among viewers aged over 50."

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Adolescent Health: Teens 'More Depressed And Sleeping Less'

Adolescents are more likely to feel depressed and self-harm, and are less likely to get a full night's sleep, than 10 years ago, a study suggests.

Yet smoking, alcohol and anti-social behaviour - often linked to mental health problems - were less common for 14-year-olds in 2015 than in 2005.

Factors behind mental health problems may be changing, the University College London researchers said.

The rise in depressive symptoms was "deeply worrying", a charity said.

Researchers from London and Liverpool analysed data from two large cohorts of 14-year-olds - the first group from around Bristol, born in 1991-92, and the second from across the UK, born in 2000-01.

There were 5,600 young people surveyed in the first group and 11,000 in the second.

In 10 years, based on a standard questionnaire on mood and feelings, levels of depression in this age group rose from 9% to 15%.

Adolescents who said they had hurt themselves on purpose rose from 12% to 14%. The rate of increase was similar for boys and girls, although girls are more likely to self-harm.

How the health and behaviour of teenagers has changed over 10 years, 2005-15

Study based on two surveys of 14-year-olds

While obesity and poor body image also rose, fewer 14-year-olds in 2015 had tried alcohol, binge drinking, smoking and having sex - compared with those surveyed a decade before.

They were also less likely to have tried cannabis or other drugs - 4.3%, down from 5%.

When it came to sleeping, the 2015 cohort were more likely to go to bed later and wake up earlier, meaning that more of them slept less than the recommended eight hours for teenagers.

Dr Praveetha Patalay, associate professor at UCL and co-author of the study in the International Journal of Epidemiology, said the research gave a bigger picture of adolescent health, not only mental health in isolation.

"It's a holistic view, with some things getting worse and some improving.

"We have to remember that lots of things are changing for young people - in different directions."

She said that although the study could not pinpoint causes of mental health difficulties, it could be valuable in identifying what the risk factors are for mental health problems.

In her early teenage years Lauren Nicole Coppin Campbell, now 21, began to suffer with body image and low self-esteem.

For her, the images of people she was seeing on social media and in popular culture had a negative impact.

"I didn't feel like the people I was seeing on my feed we're representative of me.

"You rarely saw curvy, chubby, black women or girls who were being portrayed as beautiful or intelligent.

"On social media or other media you often see stereotypes - the bigger woman is the comedian, the funny person you laugh at or who you feel sorry for."

Before she was 16, she began forcing herself to be sick in a bid to obtain what she calls a "twisted image of perfection."

At times it felt like there was no escape.

"It isn't just online," she added.

"You can go to school or see friends on the weekend and they might start talking about Kylie Jenner or whoever else who may make you feel you're lesser than."

Lauren is now working as a plus size model and is an ambassador for The Be Real Campaign.

Emma Thomas, chief executive of charity YoungMinds, said the rise in 14-year-olds self-harming or experiencing depressive symptoms was "deeply worrying".

"The factors behind mental health problems are often complex, but we know that stress at school, bullying, concerns about body image, and the pressures associated with social media can all have a big impact," she said.

"To make matters worse, it's often far too difficult for young people to get mental health support, which means that their problems can escalate unnecessarily."

Dr Bernadka Dubicka, chair of the child and adolescent faculty at the Royal College of Psychiatrists, said: "This study provides further confirmation that young people today are struggling with mental health problems more than their 90s counterparts.

"The sharp rise in levels of depression and the increase in self-harm are worrying, as are the concerns our young people have around their body image."

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'Tiniest Baby Boy' Ever Sent Home Leaves Tokyo Hospital

A baby boy who weighed just 268g (9.45oz) at birth has been released from hospital in Japan, and is believed to be the smallest boy in the world to have been successfully treated.

The baby was born by emergency C-section in August, and was so small he could fit into a pair of cupped hands.

The infant was nurtured in intensive care until he was released last week, two months after his due date.

He had grown to a weight of 3.2kg, and is now feeding normally.

Born at 24 weeks, the tiny boy spent five months in hospital.

"I can only say I'm happy that he has grown this big because honestly, I wasn't sure he could survive," the boy's mother said, according to Tokyo's Keio University Hospital.

Doctor Takeshi Arimitsu, who treated the extraordinary baby, told the BBC he was the smallest infant born (on record) to be discharged from a hospital, according to a database of the world's littlest babies held by the University of Iowa.

He said he wanted to show that "there is a possibility that babies will be able to leave the hospital in good health, even though they are born small".

The previous record-holder was a boy born in Germany, weighing 274g. The smallest surviving baby girl in that same database was also born in Germany, in 2015, and reportedly weighed 252g.

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Keio University Hospital said the survival rate of babies born weighing less than a kilogram is about 90% in Japan. But for those born under 300g, that falls to around 50%.

Among the very smallest babies, the survival rate is much lower for boys than girls. Medical experts are unsure why, though some believe it could be linked to the slower development of male babies' lungs.

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Pesticides, Other Environmental Pollutants Advance Progression of ALS

While exact causes of amyotrophic lateral sclerosis (ALS) remain unknown, new research shows pesticides and other environmental pollutants advance the progression of the neurodegenerative disease.

The latest study from the University of Michigan ALS Center of Excellence, recently published in the Journal of Neurology, Neurosurgery Psychiatry (a BMJ journal), supports the group's 2016 research that found increased levels of numerous pesticides in blood tests of people with ALS, says senior author Eva Feldman, M.D., Ph.D., director of U-M's ALS Center of Excellence.

"Our latest publication shows that other toxins like polychlorinated biphenyls, known as PCBs, are also elevated in ALS patients and correlate with poor survival," says Feldman, a Michigan Medicine neurologist. "Our research shows that environmental pollution is a public health risk that we believe must be addressed." ALS, also known as Lou Gehrig's disease, is a rapidly progressive disease that causes people to lose their ability to move their limbs and body.

For the study, each of the 167 U-M patients had blood drawn shortly after being diagnosed with ALS. They were then divided into quartiles based on the concentration of pollutants in their bloodstream. The quartile with the highest amount of pollutants had a median survival time of 1 year and 11 months from the initial date of ALS diagnosis. Meanwhile, the quartile with the lowest concentration of pollutants had a months-longer median survival time at 2 years, 6 months.

"Our concern is that not only are these factors influencing a person's likelihood to get ALS, but also speeding up disease once they have it," says Michigan Medicine neurologist Stephen Goutman, M.D., M.S., the study's primary author and the director of U-M's ALS clinic.

High Rate of Disease in Michigan

Michigan Medicine researchers are uniquely poised to study the origins of ALS in the search for more effective treatments and, eventually, a cure. Feldman says Michigan has one of the highest rates of ALS in the country, according to the Centers for Disease Control and Prevention.

"'Why us? Why Michigan?' We believe the answer may lie in the fact that Michigan is both an industrial and agricultural state," says Feldman, who founded Michigan Medicine's ALS Center of Excellence in 1998.

Throughout Michigan's farming history, a variety of persistent environmental chemicals have been used in pesticides. These chemicals are absorbed into the ground and can potentially reach water supplies. While harmful pesticides have been identified and banned, such as DDT in 1972, their consequences persist, taking decades to degrade in some cases. These chemicals can accumulate in the sediments of rivers and the Great Lakes, as well as in the fish that populate them.

Michigan's industrial activities have placed the state among the top five generators of hazardous waste in the U.S., with 69 designated Superfund sites. PCBs, which are non-flammable, man-made chemicals used in electrical and hydraulic equipment, were in use until 1979. Similar to pesticides, these industrial chemicals degrade slowly, can leech into the ground and may affect the environment for decades to come.

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"If these chemicals are getting into the water bodies, such as lakes and rivers, in Michigan, this could be a source of exposure for everybody," Goutman says. "These persistent environmental chemicals take a long time to break down, sometimes decades. Once you're exposed they may accumulate in your body. They get into the fat and can be released into the blood. We're particularly concerned about ALS patients who have been exposed to higher amounts of these chemicals."

"As pollution changes the environment, we are being exposed to more and more toxins. We don't yet know how this is going to contribute to human disease over time. As we look at more toxins, we want to identify those that are of greater significance in terms of disease onset or progression," Goutman adds.

"If we can determine what these chemicals are doing to our organs, brains and motor neurons, then we can develop drugs to counteract those effects."

Improve Quality of Life, Advance the Research

ALS has no cure, but two FDA-approved medications, riluzole (also known as Rilutek) and edaravone (also known as Radicava), are shown to have modest effects in slowing disease. Goutman says using non-invasive ventilation - a ventilator that's connected to a mask that covers the nose, nose and mouth, or entire face - is an extremely effective therapy for ALS. It's reported to increase survival by 13 months on average. Also, it is important to not overlook other related symptoms in ALS and treat these to improve quality of life and to address mobility and safety, which Goutman discussed in a recent Facebook Live presentation.

Feldman says future research will continue to address the question her patients most frequently ask: "Why did I get this disease?" A clear understanding of the development of ALS will help researchers work toward a cure.

Next, the team plans to study a new cohort of patients in U-M's clinic. Repeating similar results would further validate their findings, they say, establishing the framework for a national study. The scientific team has also received funding from the Center for Disease Control to understand the metabolism and interactions of pesticides and pollutants in ALS patients, and how specific metabolites correlate with disease onset, progression and survival. Feldman says understanding the metabolism of pesticides will lead to drug discovery.

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Prenatal Vitamins May Reduce the Risk of Autism in High-Risk Families

Researchers at the University of California have found that mothers of children with autism spectrum disorder (ASD) may be able to reduce the risk of autism in further offspring by taking prenatal vitamins during their first month of pregnancy.

Study author Rebecca Schmidt and colleagues believe this is the first study to suggest that maternal use of prenatal vitamins may reduce ASD recurrence in siblings of children with ASD in high-risk families.

According to the Public Health Agency of Canada, about one in every 66 Canadian children and adolescents aged 5 to 17 years has ASD.

Previous studies have shown that younger siblings of children with ASD are up to 13 times more likely to be diagnosed with the condition than the general population.

For the current research, Schmidt and team recruited participants from the Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) cohort study and evaluated 241 children whose older siblings had ASD.

As reported in the journal JAMA Psychiatry, the prevalence of ASD among children of mothers who took prenatal vitamins during the first month of pregnancy was 14.1%, compared with a prevalence of 32.7% among children whose mothers did not take the vitamins during that time.

Schmidt says scientist still need to find out how prenatal vitamins may be reducing the risk of ASD, but that it is already known that vitamins such as folic acid are essential for brain development and many of the pathways that may influence autism risk.

"It's recommended already that moms take prenatal vitamins, or folic acid supplements, starting before pregnancy to catch this early developmental window," she says.

Pediatrics professor Lonnie Zwaigenbaum from the University of Alberta called the findings "remarkable."

For the growing number of families who have a child with autism and are looking ahead to future pregnancies, they're really demonstrating that the potential reduction in absolute risk is really quite significant." - Lonnie Zwaigenbaum.

Schmidt and colleagues say that additional research is now needed to confirm and investigate the findings in order to inform public health recommendations for ASD prevention in affected families.

Schmidt, R., J., et al. 2019. Association of Maternal Prenatal Vitamin Use With Risk for Autism Spectrum Disorder Recurrence in Young Siblings. Jama Psychiatry.

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