Liver test to aid paracetamol overdose treatment

Paracetamol

People who overdose on paracetamol could be helped by a blood test that shows immediately if they are going to suffer liver damage.

Researchers in Edinburgh and Liverpool said the test would help doctors identify which patients arriving in hospital need more intensive treatment.

The blood test detects levels of specific molecules in blood associated with liver damage.

The three different molecules are called miR-122, HMGB1 and FL-K18.

Previous studies have shown that levels of these markers are elevated in patients with liver damage long before current tests can detect a problem.

Free up beds

A team led by the Universities of Edinburgh and Liverpool measured levels of the three markers in more than 1,000 patients across the UK who needed hospital treatment for paracetamol overdose.

They found the test could accurately predict which patients are going to develop liver problems, and who may need to be treated for longer before they are discharged.

The test could also help identify patients who could be safely discharged after treatment, freeing up hospital beds.

About 50,000 people are admitted to hospital each year in the UK due to paracetamol overdose.

Many people unknowingly consume too much by taking paracetamol at the same time as cold and flu medications that also contain the drug.

Liver injuries are a common complication of drug overdoses. In some cases the damage can be so severe the patient needs a transplant and, in rare instances, can be fatal.

Patients with a life-threatening level of paracetamol in their blood can be treated with an antidote called acetylcysteine, given by intravenous drip.

The treatment is associated with side effects so doctors do not treat patients longer than necessary.

Large workload

The researchers said the test could help to pinpoint patients who are unlikely to benefit from treatment.

The study, published in the Lancet Gastroenterology and Hepatology, was funded by the Edinburgh and Lothians Health Foundation and the Medical Research Council.

Dr James Dear, of the University of Edinburgh, said: “Paracetamol overdose is very common and presents a large workload for already over-stretched emergency departments.

“These new blood tests can identify who will develop liver injury as soon as they first arrive at hospital. This could transform the care of this large, neglected, patient group.”

FDA approves ‘trackable’ pill

man with a pill on his tongue

US regulators have approved the first pill that can be digitally tracked through the body.

The Abilify MyCite aripiprazole tablets – for treating schizophrenia and manic episodes – have an ingestible sensor embedded inside them that records that the medication has been taken.

A patch worn by the patient transmits this information to their smartphone.

The information can also be sent to the prescribing doctor, if the patient consents to this.

Experts hope it could improve medication compliance, although the company that makes the tablets says this has not been proved for their product.

The prescribing notes also stress that Abilify MyCite should not be used to track drug ingestion in “real-time” or during an emergency, because detection may be delayed or may not occur.

Stomach fluid

The pills are not licensed to be used in elderly patients with dementia-related psychosis.

About the size of a grain of sand, the sensor activates when it comes into contact with stomach fluid.

It can take 30 minutes to two hours to detect ingestion of the tablet.

Mitchell Mathis, from the Food and Drug Administration, said: “Being able to track ingestion of medications prescribed for mental illness may be useful for some patients.

“The FDA supports the development and use of new technology in prescription drugs and is committed to working with companies to understand how technology might benefit patients and prescribers.”

Indulgent grandparents ‘bad for children’s health’

Grandmother and grandchildren

Indulgent grandparents may be having an adverse impact on their grandchildren’s health, say researchers.

The University of Glasgow study, published in PLOS One journal, suggests grandparents are often inclined to treat and overfeed children.

The study also found some were smoking in front of their grandchildren and not giving them sufficient exercise.

But Maureen Lipman, a grandmother of two, said: “The grandparents’ job is always definitely to indulge.”

  • Children with obesity ‘need NHS help’
  • Parents ‘may be overfeeding infants’

The researchers looked at 56 studies with data from 18 countries, including the UK, US, China and Japan.

The report focused on the potential influence of grandparents who were significant – but not primary – caregivers in a child’s early years.

The review considered three key areas of influence:

  • diet and weight
  • physical activity
  • smoking
Image copyright Getty Images

In terms of both diet and weight, the report concluded that grandparents’ behaviour had an adverse effect.

Grandparents were characterised by parents as “indulgent” and “misinformed”, and accused of using food as an emotional tool.

Many studies found they were inclined to feed grandchildren high-sugar or high-fat foods – often in the guise of a treat.

Parents felt unable to interfere because they were reliant on grandparents helping them out.

The study also found that grandchildren were perceived to be getting too little exercise while under the care of their grandparents.

Physical activity levels appeared to be related to whether grandparents were active themselves, or whether there was appropriate space where children could be active.

Image copyright Getty Images
Image caption Maureen Lipman likes giving her grandchildren ice cream and jelly

But actress Maureen Lipman said there was a big difference between grandparents who looked after their grandchildren everyday compared to those who see them at the weekends.

“If you’re seeing them once a week you’re going to overindulge but if you work with them every day, you’re going to treat them as your own children,” she said.

She keeps turkey dinosaurs in the freezer for her grandchildren Ava and Sacha and likes giving them ice cream with jelly.

“I try with the vegetables and fail,” she said. “You can’t train other people’s children.”

“The grandparents’ job is kind of to be in cahoots with the grandchildren against the parents.”

She said being a mother could be “quite challenging”, but being a grandmother was “just pure pleasure”.

Ms Lipman said: “It’s a walking miracle that you’ve brought something into the world that’s brought something into the world.”

She’s also conscious of an “unspoken rivalry”.

“There are two sets of grandparents – and you don’t want to be the one that isn’t giving them the nice piece of cake.”

‘Unintentional’

In the study, smoking around the children, even when they had been asked not to, became an area of conflict between grandparents and parents.

Conversely, in certain cases, the birth of a grandchild became a catalyst to a grandparent giving up smoking – or changing their habits.

Lead researcher Dr Stephanie Chambers said: “From the studies we looked at, it appears that parents often find it difficult to discuss the issues of passive smoking and over-treating grandchildren.

“While the results of this review are clear that behaviour such as exposure to smoking and regularly treating children increases cancer risks as children grow into adulthood, it is also clear from the evidence that these risks are unintentional.

“Given that many parents now rely on grandparents for care, the mixed messages about health that children might be getting is perhaps an important discussion that needs to be had.”

‘Healthy habits’

According to Grandparents Plus, grandparents are “the largest provider of informal childcare” in the UK and they need to be “better recognised and supported”.

The charity’s chief executive, Lucy Peake, said: “Grandparents want the best for their grandchildren, and the more they’re informed and enabled to play a positive role in their grandchildren’s lives the better things will be.

“We know that children benefit enormously from having close relationships with their grandparents right through childhood into adolescence.

“What this study shows is that the role they’re playing in children’s lives needs to be better recognised and supported.

“We’d like to see more focus on ensuring that information available to parents about children’s health reaches grandparents too.”

Prof Linda Bauld, from Cancer Research UK, which part-funded the study, said: “With both smoking and obesity being the two biggest preventable causes of cancer in the UK, it’s important for the whole family to work together.

“If healthy habits begin early in life, it’s much easier to continue them as an adult.”

Giving birth on due date ‘less risky’ for older mums

young boy touching his mum's pregnant belly

Stillbirth and newborn death risk could be reduced by offering more pregnant women the chance to give birth on their due date, experts believe.

Currently, women who are overdue but well are often given a couple of extra weeks to see if labour will happen spontaneously before doctors intervene.

New research suggests bringing forward induction to 40 weeks’ gestation may be a safer option for mothers and babies.

The study, in PLOS Medicine, included first-time mothers aged 35 and over.

This is a group that generally has a higher risk of birth complications – although the absolute risk for an individual woman and her baby is still small, say experts.

It is also a group that is growing in number, with 14% of first-time mothers in the UK now aged 35 and over. In 2015 in England and Wales, almost 40,000 women aged 35 or over gave birth to their first baby, according to the Office for National Statistics.

Bringing on labour

Inductions are offered to avoid the risks of prolonged pregnancy, which can include stillbirth.

In the UK, about one in three labours starts in this way.

Guidelines recommend inductions are offered to pregnant women between 41 and 42 weeks of gestation – one to two weeks after the due date.

But according to the new research, one baby death might be avoided for every 526 inductions of labour if women over 35 were helped to give birth on their due date rather than a week or two after it.

In the study of nearly 80,000 women in England, the rate of stillbirth or death of a baby within seven days of birth was eight per 10,000 pregnancies when induction was carried out earlier, compared with 26 per 10,000 when induction was postponed (known as “expectant management”) to allow more time for labour to happen naturally.

By their calculations, the London School of Hygiene and Tropical Medicine researchers say a change in policy to inductions at 40 weeks could potentially save about 50 babies’ lives a year in the UK.


Why a woman might be induced:

  • if she’s overdue
  • if her waters have broken
  • if she or her baby has a health problem

It’s a woman’s choice whether to have her labour induced or not.

Most women go into labour naturally by 42 weeks of pregnancy.


But lead researcher Hannah Knight said it was too soon to recommend changing the current guidelines – more studies were needed first – although the findings could help pregnant women make informed choices about the timing of their labour.

“There appears to be evidence that bringing forward the offer of induction to 40 weeks would be beneficial. It should be something that women and doctors discuss together.

“This study represents the strongest evidence yet that moving the offer of induction forward to 40 weeks might reduce the risk of stillbirth in this specific age group, which we know face a greater risk of stillbirth and neonatal death.”

Prof Lesley Regan, from the Royal College of Obstetricians and Gynaecologists, said the implications of a policy change would be enormous for both the health service and women themselves.

“Further research to determine the impact of such a change in practice is needed.

“While induction is safe and studies have shown no short-term adverse impact on mother or baby, induction of labour represents an intervention, is associated with costs to the service, and can be a more prolonged process than spontaneous labour.”

A recent study in the New England Journal of Medicine found earlier induction had no effect on the chance of needing a caesarean delivery.

Health tourism charges come into force in England

Hospital patient

Providers of NHS treatment are required from Monday to make sure patients in England are eligible for free care – and to charge them up front if not.

The measures apply to planned, non-urgent care – A&E, general practice and infectious disease treatment remain free to all.

The government hopes it will contribute to £22bn of savings needed in the NHS.

But the British Medical Association said the changes may prevent vulnerable people getting treatment they need.

Under the new measures, patients will be asked where they have lived in the last six months.

If they have lived abroad, they will be asked to show documentation that they are entitled to free NHS care, such as a non-UK European Health Insurance Card.

Hospitals and other parts of the NHS are also required to flag when a patient should be charged so that providers elsewhere within the health service can more easily recoup costs.

  • Reality Check: How much could NHS recover from foreign patients?

Health Minister Lord O’Shaughnessy said: “We have no problem with overseas visitors using our NHS as long as they make a fair financial contribution, just as the British taxpayer does.

“The new regulations simply require NHS bodies to make enquiries about, and then charge, those who aren’t entitled to free NHS care.”

But Dr Chaand Nagpaul, of the British Medical Association, which represents doctors, said the current proposals “lack clarity” and “run the risk of causing confusion”.

“It is vital that patients do not face bureaucratic or financial obstacles that prevent acutely sick and vulnerable individuals from seeking necessary treatment,” he said.

“This would be morally unacceptable and could end up costing the NHS more money due to lack of timely treatment.”

The government has previously estimated that up to £500m could be recovered from overseas visitors’ and migrants’ use of the NHS every year.

The BMA, at the time however, called that figure “exaggerated” and “unreliable”.

Typhoid vaccine set to have ‘huge impact’

Child in dirty water

A new vaccine that could prevent up to nine-in-10 cases of typhoid fever has been recommended by the World Health Organization.

Experts say it could have a “huge impact” on the 22 million cases, and 220,000 deaths, from typhoid each year.

Crucially it works in children, who are at high-risk of the infection, unlike other typhoid vaccines.

It is hoped the vaccine could eventually help countries eliminate typhoid.

Typhoid fever is caused by Salmonella Typhi bacteria and patients have:

  • prolonged fever
  • headache
  • nausea
  • loss of appetite
  • constipation
  • in one-in-100 cases it causes fatal complications

The bacteria are highly contagious and spread through contaminated food or water.

The infection is most common in countries with poor sanitation and a lack of clean water, particularly in south Asia and sub-Saharan Africa.

Two typhoid vaccines already approved to help reduce the number of cases, but none are licensed for children under the age of two.

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The decision to recommend the new conjugate typhoid vaccine was made by the WHO’s Strategic Advisory Group of Experts on Immunization (Sage).

Prof Alejandro Cravioto, the chairman of Sage, said: “For the first time I think we do have a very effective vaccine.”

Sage recommended the vaccine should be given to children aged six-months old and said catch-up campaigns focusing on children up to 15 years old should also take place.

Prof Cravioto said the vaccine was vital as the world was “reaching the limit” of current treatments due to the “crazy amount” of antibiotic resistance the typhoid bacterium had acquired.

‘A valuable weapon’

Data from a clinical trial of the vaccine, carried out by the University of Oxford, was published just last month in the Lancet medical journal.

The “challenge study” gave the vaccine to 112 people and then deliberately infected (challenged) them with typhoid-causing bacteria.

Such an approach gives a clear picture of a vaccine’s effectiveness without having to immunise thousands of people. It showed the vaccine was up to 87% effective.

Prof Andrew Pollard, who ran those trials, told the BBC News website: “It could have a huge impact.

“If it can be rolled out in all communities, it must be possible to prevent the majority of cases and if it also interrupts transmission, which hasn’t been shown yet, then it could be eliminated from those regions.”

Gavi, the global body that pays for vaccines in 68 low and middle-income countries, is now considering whether to add the typhoid vaccine.

Dr Seth Berkley, the chief executive of Gavi, said: “Not only could this vaccine save lives, it could also prove to be a valuable weapon in the fight against antimicrobial resistance.”

Before antibiotics, typhoid killed one-in-five people infected. Now there is growing levels of typhoid that is resistant to drugs.

‘Incredible’ editing of life’s building blocks

Editing DNA

Scientists have demonstrated an “incredibly powerful” ability to manipulate the building blocks of life in two separate studies.

One altered the order of atoms in DNA to rewrite the human genetic code and the instructions for life.

The other edited RNA, which is a chemical cousin of DNA and unlocks the information in the genetic code.

The studies – which could eventually treat diseases – have been described as clever, important and exciting.

Cystic fibrosis, inherited blindness and other diseases caused by a single typo in the genetic code could ultimately be prevented or treated with such approaches.

Both studies were performed at the Broad Institute of MIT and Harvard.

Base editing

The first, published in the journal Nature, developed tools called base editors.

DNA is built out of the four bases: adenine (A), cytosine (C), guanine (G) and thymine (T). If a single one of them is in the wrong place, it can cause disease.

Base editors alter the molecular structure of one base to convert it into another. Researchers can now manipulate the four bases.

And the team used base editing to correct an inherited disease that leads to dangerously high levels of iron in the blood.

Prof David Liu of the Broad Institute said: “We are hard at work trying to translate base editing technology into human therapeutics.”

However, he admits there are still issues around safety and implementation:

“Having a machine that can make the change you want to make is only the start. You still need to do all this other work, but having the machine really helps.”

RNA

The second study, published in the journal Science, focused on RNA, another of the molecules essential for life.

DNA is the master copy of the genetic code, but in order for a cell to use the genetic instructions, it must first create an RNA copy.

It is like going to a library where you cannot read any of the books, but can only use photocopies.

The researchers used their RNA approach to correct an inherited form of anaemia in human cells.

Feng Zhang – also of the Broad Institute – said: “The ability to correct disease-causing mutations is one of the primary goals of genome editing.

“This new ability to edit RNA opens up more potential opportunities to… treat many diseases, in almost any kind of cell.”

All of the experiments were on human cells growing in the laboratory.

Dr Helen O’Neill, from UCL, said: “This is an exciting week for genetic research.

“These papers highlight the fast pace of the field and the continuous improvements being made in genome editing, bringing it closer and closer to the clinic.”

Scientific advances in genetic engineering are taking place at an incredible pace.

And the same technologies work on plants, animals and micro-organisms too, posing questions for areas like agriculture.

Dr Sarah Chan, a bioethicist at the University of Edinburgh, said we can no longer pretend the technology is too dangerous to contemplate.

She told the BBC: “We can’t hide any more.

“The science is moving fast in the sense it is becoming less risky, more certain, more precise and more effective.

“It is absolutely past time for us to engage more widely with publics on the issue of gene editing.”

10 things to know about sleep as the clocks go back

woman lying in bed

People across the UK will wake up having gained an hour’s sleep on Sunday morning, as the clocks go back heralding darker evenings and shorter days. But how much do we know about sleep and its impact on our lives, from our health and mood, to how long we’ll live?

1. We’re told to get our eight hours

We often hear that we should all be getting eight hours’ sleep a night. Organisations from the NHS to the US National Sleep Foundation recommend it. But where does this advice come from?

Studies carried out around the world, looking at how often diseases occur in different groups of people across a population, have come to the same conclusion: both short sleepers and long sleepers are more likely to have a range of diseases, and to live shorter lives.

But it’s hard to tell whether it is short sleep that is causing disease or whether it is a symptom of a less healthy lifestyle.

Short sleepers are generally defined as those who regularly get less than six hours’ sleep and long sleepers generally more than nine or 10 hours’ a night.

How many hours should you sleep? - hours slept vs likelihood of developing disease makes a J shaped curve

Pre-puberty, children are recommended to get as much as 11 hours’ sleep a night, however, and up to 18 hours a day for newborn babies. Teenagers should sleep for up to 10 hours a night.

Shane O’Mara, professor of experimental brain research at Trinity College Dublin, says that, while it’s difficult to tell whether poor sleep is a cause or a symptom of poor health, these relationships feed off each other.

For example, people who are less fit exercise less, which leads people to sleep badly, become exhausted and less likely to exercise, and so on.

We do know that chronic sleep deprivation – that is, under-sleeping by an hour or two a night over a period of time – has been linked time and again by scientists to poor health outcomes: you don’t have to go for days without sleep to suffer these negative effects.

2. What happens in your body when you don’t sleep enough?

Poor sleep has been linked to a whole range of disorders.

A review of 153 studies with a total of more than five million participants found short sleep was significantly associated with diabetes, high blood pressure, cardiovascular disease, coronary heart disease and obesity.

how lack of sleep can affect your body: links with diabetes, heart disease, dementia, low mood and cognitive functioning, vaccinations less effective, lower immune response linked to coughs and colds, greater risk of obesity

Studies have shown that depriving people of enough sleep for only a few nights in a row can be enough to put healthy adults into a pre-diabetic state. These moderate levels of sleep deprivation damaged their bodies’ ability to control blood glucose levels.

Vaccines are less effective when we are sleep deprived, and sleep deprivation suppresses our immune system making us more prone to infection.

One study found participants who had fewer than seven hours of sleep were almost three times more likely to develop a cold than those who slept for seven hours or more.

People who don’t sleep enough also appear to produce too much of the hormone ghrelin, associated with feeling hungry, and not enough of the hormone leptin, associated with feeling full, which may contribute to their risk of obesity.

There are also links to brain function and even in the long term to dementia.

Prof O’Mara explains that toxic debris builds up in your brain during the course of the day and waste is drained from the body during sleep. If you don’t sleep enough, you end up in a mildly concussed state, he says.

The impact of sleeping too much is less understood, but we do know it is linked to poorer health including a higher risk of cognitive decline in older adults.

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3. We need different types of sleep to repair ourselves

After we fall asleep we go through cycles of “sleep stages”, each cycle lasting between 60 and 100 minutes. Each stage plays a different role in the many processes that happen in our body during sleep.

sleep cycle through the night from awake to drowsy to light sleep, deep sleep, REM sleep and back

The first stage in each cycle is a drowsy, relaxed state between being awake and sleeping – breathing slows, muscles relax, the heart rate drops.

The second stage is a slightly deeper sleep – you may feel awake and this means that, on many nights, you may be asleep and not know it.

Stage three is deep sleep. It is very hard to wake up during this period because it is when there is the lowest amount of activity in your body.

Stages two and three together are known as slow wave sleep which is usually dreamless.

After deep sleep we go back to stage two for a few minutes, and then enter dream sleep, also called REM (rapid eye movement). As the name suggests, this is when dreaming happens.

In a full sleep cycle a person goes through all the stages of sleep from one to three, then back down to two briefly, before entering REM sleep.

Later cycles have longer periods of REM, so cutting sleep short has a disproportionately large effect on REM.

4. Shift workers who have disturbed sleep get sick more often

Shift work has been associated with a host of health problems. Researchers have found shift workers who get too little sleep at the wrong time of day may be increasing their risk of diabetes and obesity.

Shift workers are significantly more likely to report “fair or bad” general health according to a 2013 NHS study, which also found people in this group were a lot more likely to have a “limiting longstanding illness” than those who don’t work shifts.

shift workers are off sick more than regular hour workers and the pattern is more pronounced among non-manual workers

People who work shifts are significantly more likely to take time off sick, according to figures from the Office for National Statistics.

There is a far bigger gap for non-manual workers than manual workers – lack of sleep seems to have a bigger impact on those doing more sedentary jobs.

5. And many of us are feeling more sleep deprived than ever

To judge from media reports, you’d think we were in the grip of a sleeplessness epidemic. But are we really all more sleep deprived than before?

A big piece of research looking at data from 15 countries found a very mixed picture. Six showed decreased sleep duration, seven increased sleep duration and two countries had mixed results.

Lots of a evidence suggests the amount we sleep hasn’t changed that much in recent generations.

But if you ask people how sleep deprived they think they are, a different picture emerges.

So why do so many people report feeling tired?

It may be that this problem is concentrated in certain groups, making the trend harder to pick up on a population-wide level.

Sleep problems vary considerably by age and gender, according to one study of 2,000 British adults. It found women at almost every age have more difficulty getting enough sleep than men.

The sexes are more or less level at adolescence but women begin to feel significantly more sleep deprived than men during the years where they may have young children, while work may become more demanding. The gap then shrinks again later in life.

who is struggling to sleep - women struggle more than men and people in the middle of their lives are more sleep deprived

Caffeine and alcohol both affect sleep duration and quality.

And later nights and more social activities mean some of us are getting less rest, despite having the same number of hours of sleep, according to Prof Derk-Jan Dijk, of the University of Surrey’s sleep research centre.

Some people may also sleep too little during the week and catch up at the weekend, bringing the average up but leaving those people feeling sleep deprived.

For example, adolescents are particularly at risk of becoming sleep deprived, according to Prof Dijk.

6. But we didn’t necessarily always sleep this way

Aside from a few outliers – Margaret Thatcher could apparently get by on only four hours a night – people tend to go to bed in the late evening for around seven or eight hours.

But this wasn’t necessarily always the norm according to Roger Ekirch, a history professor at Virginia Tech in the USA. He published a paper in 2001 drawn from 16 years of research.

in 2017 biphasal sleep is virtually unheard of. 1900 people slept in one block until dawn. 1825 typically awoke at 2-3 am from first sleep. 1800 typically woke at 1am from first sleep

His subsequent book, At Day’s Close, contained a wealth of historical evidence suggesting that hundreds of years ago, humans in many parts of the world slept in two distinct chunks.

Dr Ekirch uncovered more than 2,000 pieces of evidence in diaries, court records and literature which suggest people used to have a first sleep beginning shortly after dusk, followed by a waking period of a couple of hours, then a second sleep.

  • The myth of the eight-hour sleep

He thinks this means the body has a natural preference for segmented sleep.

Not all scientists agree. Other researchers have found hunter-gatherer communities in the modern world who sleep in one block despite not having electric lighting. This suggests sleeping in two blocks is not necessarily our default.

According to Dr Ekirch the shift from biphasal to monophasal sleep happened in the 19th Century because domestic lighting pushed bedtimes later with no corresponding change in rising time, improved lighting changed the human body clock, and the industrial revolution put a greater emphasis on productivity and efficiency.

7. Phones are keeping teenagers awake

Sleep experts say teenagers need up to 10 hours sleep a night, but almost half don’t get this much according to the NHS.

Bedrooms are supposed to be a place of rest but are increasingly filled with distractions like laptops and mobile phones, making it harder for young people to nod off.

We have more different types of entertainment on offer than ever, making the temptation to stay awake greater. The blue light emitted by electronic devices makes us feel less sleepy. And the activity itself – be it talking to friends or watching TV – stimulates our brain when it should be winding down.

68% of young people think using phones at night affects school work. 45% check their phone after going to bed. 10% check their phone more than 10 times a night.

Digital Awareness UK and the Headmasters and Headmistresses Conference recommend a nightly “digital detox”, putting mobile devices away for 90 minutes before lights out.

Last year the two organisations commissioned a poll which found a high proportion of young people check their phones after going to bed.

8. Testing for sleep disorders is on the up

More people are turning up at their doctors complaining of problems sleeping.

Analysing data collected by NHS England, the BBC found in June that the number of sleeping disorder tests had increased every year over the past decade.

There are a number of factors, but the biggest is probably the rise in obesity, according to Dr Guy Leschziner, a consultant neurologist at Guy’s and St Thomas’ Hospital’s Sleep Disorders Centre.

the NHS has been carrying out a growing number of sleep diagnostic tests over the last decade

The most common and fastest-growing complaint he sees is obstructive sleep apnoea – where the airway collapses and people stop breathing in their sleep – and this is strongly related to weight.

The media has also played a role because people are more likely to go to their GPs having read an article or searched for their symptoms online, he says.

The recommended treatment for insomnia is cognitive behavioural therapy, and doctors are increasingly aware that they shouldn’t be prescribing sleeping pills. But many still do because it’s difficult to access non-drug based treatments, particularly outside big cities.

  • Body Clock: What makes you tick?

9. Are other countries doing it differently?

One study looked at sleep habits in 20 industrialised countries.

It found variations of up to an hour in the time people went to bed and woke up, but overall sleep duration was fairly constant across countries. Generally, if a population on average went to bed later, they woke up later too, although not in every case.

how much sleep do people in different countries get? Australia gets the most, Brazil the least
White line

Researchers have concluded that social influences – hours worked, timing of school, leisure habits – play a far bigger role than the natural cycle of light and dark.

In Norway, where the period of lightness each day varies through the year from zero to 24 hours, sleep duration throughout the year only varies on average by about half an hour.

Both in countries like the UK, where dusk and dawn times vary considerably across the seasons, and in countries closer to the Equator where dusk and dawn times vary minimally, sleep duration remains constant through the year.

But what about the impact of artificial light?

A study of three communities who had no access to electricity, in Tanzania, Namibia and Bolivia, found the average sleep duration was 7.7 hours – in step with industrialised countries.

So sleep duration seems remarkably consistent throughout the world – it’s the time we all go to bed and wake up that varies slightly.

These pre-industrialised communities did not fall asleep as soon as it got dark, but around three hours after sunset and generally woke before sunrise.

Most studies in this area suggest that artificial light delays sleep time but does not necessarily decrease overall sleep duration.

10. Morning larks, night owls?

There have always been morning people and evening people. We even have genetic evidence that backs this up.

But the introduction of artificial light appears to have exacerbated this effect, particularly for people who prefer to stay up late.

If you are already inclined towards being a night owl, artificial light will make you stay up even later.

About 30% of us tend towards being morning people and 30% towards being evening people, with the other 40% of us somewhere in the middle – although marginally more people prefer early rising to late nights.

are we morning or evening people? slightly more of us are extreme morning than evening but most people are in the middle

We do have some control over our body clocks, however. Those who are naturally late to bed and late to rise can try reducing their exposure to light in the evenings and making sure they get more light exposure in the daytime.

A team of researchers took a group of volunteers camping in Colorado, where they had no access to artificial light. Only 48 hours was enough to shift the campers’ body clocks forward by almost two hours.

Levels of melatonin, the hormone that tells our body to prepare for sleep, began rising earlier in the volunteers – their bodies were preparing for sleep much closer to sunset.

Heart surgery survival chances ‘better in the afternoon’

Surgery

Open heart surgery appears to be safer in the afternoon because of the body’s internal clock, scientists have said.

The body clock – or circadian rhythm – is the reason we want to sleep at night, but it also drives huge changes in the way our bodies work.

The research, published in the Lancet, suggests the heart is stronger and better able to withstand surgery in the afternoon than the morning.

And it says the difference is not down to surgeons being tired in the morning.

Doctors need to stop the heart to perform operations including heart valve replacements. This puts the organ under stress as the flow of oxygen to the heart tissue is reduced.

The doctors and researchers looked for complications including heart attacks, heart failure or death after surgery. They found:

  • 54 out of 298 morning patients had adverse events
  • 28 out of 298 afternoon patients had adverse events
  • Afternoon patients had around half the risk of complications
  • One major event would be avoided for every 11 patients operated on in the afternoon

One of those involved in the research, Prof Bart Staels, from the Institut Pasteur de Lille, told the BBC News website: “We don’t want to frighten people from having surgery – it’s life saving.”

He also said it would be impossible for hospitals to conduct surgery only after lunch.

But Prof Staels added: “If we can identify patients at highest risk, they will definitely benefit from being pushed into the afternoon and that would be reasonable.”

Obesity and type 2 diabetes have been shown to increase the risk of complications after surgery.

Heart health is already known to fluctuate over the course of a day.

The risk of a heart attack or stroke is highest first thing in the morning, while the heart and lungs work at their peak in the afternoon.

Body Clock

Dr John O’Neill, from the UK Medical Research Council’s Laboratory of Molecular Biology, said: “Scientifically it is not hugely surprising, because just like every other cell in the body, heart cells have circadian rhythms that orchestrate their activity.

“Our cardiovascular system has the greatest output around mid/late-afternoon, which explains why professional athletes usually record their best performances around this time.”

Other possible explanations for the findings included surgeons being tired in the morning or their own body clock affecting their surgical skill, particularly if they are not “morning people”.

But Prof Staels said the researchers had gone to great lengths to show that the difference in survival rates was not down to the surgeons.

The French team also experimented on cardiac tissue samples from patients and showed they beat more readily in the afternoon.

And an analysis of the DNA in the samples found 287 genes whose activity showed a circadian rhythm – waxing and waning during the day.

They then moved into mice and used experimental drugs to alter the activity of one of those genes and seemed to be able to reduce the risk of death.

Prof Staels said: “We believe we have identified a potential way to circumvent the disturbing observation that operations in the morning lead to more complications.”

However, that will require more research to confirm.

The researchers are also investigating whether circadian rhythms have an impact on survival in other types of surgery.

Dr Mike Knapton, from the British Heart Foundation, said: “Thousands of people now have open heart surgery in the UK. If this finding can be replicated in other hospitals this could be helpful to surgeons planning their operating list, for non-urgent heart surgery.

Superbug ‘sleuthing’ finds secret outbreaks

Bacteria growing on a plate

A feat of “genomic sleuthing” has uncovered 173 secret outbreaks of the superbug MRSA, a study shows.

They were found in the east of England over the course of just one year, according to the details published in Science Translational Medicine.

The researchers say their approach could transform the way we tackle MRSA and other superbugs.

Detecting outbreaks that are happening under our noses should cut the number of people infected.

  • MRSA – or methicillin-resistant Staphylococcus aureus – is a bacterial infection that is resistant to a number of widely-used antibiotics
  • It can cause life-threatening infections if the bug breaches the skin, such as through a surgical wound

Detective work

Hospitals in the UK have become very good at catching outbreaks of MRSA, especially when they happen in the same place at the same time – such as in one hospital ward.

But MRSA also spreads outside of hospitals, in people’s homes, in care homes; and patients and staff also move around from place to place.

Doctors will see the individual cases, but cannot always spot the bigger picture and catch the outbreak.

Prof Sharon Peacock, one of the researchers, told the BBC: “Patients move around wards very quickly and you don’t always spot the links Sherlock Holmes might detect, but the genomics does it for you.”

The team at the Wellcome Trust Sanger Institute sequenced the genetic code of every single MRSA sample that came through three hospitals and 75 GP surgeries.

They then pieced together the clues in a feat of genetic genealogy.

By looking at the genetic code, the researchers could work out which samples were closely related and therefore part of the same outbreak.

Surprise

They found 173, ranging from outbreaks affecting two patients up to 44.

“I was surprised by how many we detected,” Prof Peacock said.

She added: “This could reverse the way we do infection control to be much more targeted, efficient and effective.”

This strategy cannot prevent an outbreak from occurring, but it can nip it in the bud.

It is possible to get rid of MRSA, which mostly lives up the nose or on skin, using creams and antiseptic baths.

A smaller scale version of this study managed to track down the carrier of MRSAand bring an outbreak in a baby unit to an end.

Huge advances in DNA sequencing mean the whole genome of a bacterium can be worked out in a day for around £120.

The researchers are about to start a trial investigating the cost-effectiveness of introducing genomic detective-work into the NHS.

Dr Jonathan Pearce, the head of infections and immunity at the UK’s Medical Research Council, said: “This study sheds light on MRSA transmission within and between hospitals and the community, which could help strengthen infection prevention and control measures.”