Book your travel vaccination and immunisation advice session to protect yourself and to update your records. Prevention as we know it is better than cure and a lot more convenient all round. Go to the travel vaccination and immunisation service page to book http://www.rsphealthcare.com/adult.php
Ebola virus disease Clinical Updates West Africa and Democratic Republic of the Congo October 2014
The outbreak of Ebola virus disease (EVD) continues in an upward epidemic trend in Guinea, Liberia, and Sierra Leone . The high number of EVD infections in health-care workers continues to be a cause of great concern.
Nigeria and Senegal – status remains stable with no further cases reported .
United State - The recently reported case in the United States has died  and follow-up of contacts is ongoing .
Sierra Leone - The health care worker had treated an EVD case infected in Sierra Leone who had been medically evacuated by Spain to Madrid on 22 September 2014, where he died on 25 September .
This is the first documented transmission of Ebola infection in the European Union .
Spain - Spanish authorities notified WHO under the On 6 October 2014, the International Health Regulations (IHR) that an auxiliary nurse in Spain had been diagnosed with EVD.
Spanish authorities are conducting an intensive investigation of this case, to determine the mode of transmission and to trace those who have been in contact with the health care worker .
Congo - A separate outbreak of EVD in Democratic Republic of the Congo, which is not related to the outbreak in West Africa, appears to be under control .
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Adverse Out of hours provider loses contract following overdose case
10 November, 2009
The out-of-hours provider that hired German locum Dr Daniel Ubani - who accidentally killed a patient by administering a lethal overdose - is to have its NHS contract terminated.
NHS Cambridgeshire is cancelling its relationship with Take Care Now (TCN) after becoming “dissatisfied” with the company’s progress, a spokesman said.
The company hit the headlines after Dr Ubani accidentally gave 70-year-old David Gray ten times the recommended dose of a painkiller in February 2008.
A Care Quality Commission report into the company was announced after the death, the findings of which are expected early next year. An interim statement from the commission, published in October, called on all PCTs to scrutinise out-of-hours services more closely.
NHS Cambridgeshire officials said they had carried out 20 unannounced inspections and 13 spot checks since Mr Gray’s death. The primary care trust said spot checks had identified “further deficiencies” in cover provided by TCN leading to it being served a formal remedial notice in September.
Chris Banks, chief executive of NHS Cambridgeshire, said: “We recently became dissatisfied with the progress being made and concerned about TCN’s overall performance, such that on 18 September we served a formal remedial notice under the contract. The Care Quality Commission then published its interim statement on 2 October in which it referred to concern about unfilled shifts.
“The following weekend our healthcare governance team followed up with an unannounced spot check and, despite the Care Quality Commission’s findings the previous weekend, found further deficiencies in the shift cover provided by TCN,” he said.
“With this additional evidence of failure to provide the contracted services we decided to issue a termination notice ending our contract for these services with effect from 1 December,” Mr Banks added.
Take Care Now said in a statement that it had decided not to contest the decision to terminate its contract. Take Care Now medical director Dr Jim Kennedy said: “We couldn’t agree on a number of issues relating to the out of hours needs of patients in a rural community.”
CAMDOC - a consortium of local Cambridgeshire GPs, which currently provides out-of-hours services to Cambridge City and South Cambridgeshire - will provide OOH cover until a new contract begins in April.
Lack of health care worsens women's life quality: WHO
GENEVA (Reuters) - Despite living six to eight years longer than men, women lack essential health care throughout their lives, particularly as teenagers and elderly people, the World Health Organization said on Monday.
In a report, the WHO said that women around the world are "denied a chance to develop their full human potential" because many critical medical needs are ignored.
"Women generally live longer than men, but their lives are not necessarily healthy or happy," Margaret Chan, the head of the United Nations health agency, said at the WHO on Monday.
Though women tend to seek out medical services more often than men -- particularly before, during and after pregnancy -- they often fail to get adequate treatment to cope with violence, depression and problems related to old age, such as dementia.
"The obstacles that stand in the way of better health for women are not primarily technical or medical in nature. They are social and political," Chan said.
Childbirth assistance can be particularly hard to access for unmarried and marginalized women, teenagers and sex workers, WHO said in its first attempt to log differences between men's and women's health over their lifetimes.
"In many countries, sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of unmarried women and adolescents," the report said.
"Paradoxically, health systems are often unresponsive to the needs of women despite the fact that women themselves are major contributors to health, through their roles as primary care givers in the family and also health care providers," it said.
WHO also said some 99 percent of the estimated 500,000 women who die every year giving birth are in developing countries where medical supplies and skilled workers are in short supply.
But while emphasizing the many links between poverty and ill health, the report also stressed that many shortcomings affect women across income brackets and geographical regions.
Depression and anxiety affect far more women than men, and women are more likely to catch sexually transmitted diseases.
Women are also overwhelmingly more likely to be victims of sexual violence than men, and elderly women's health problems such as eyesight and hearing loss, arthritis, depression and dementia are often untreated.
Unequal access to education, employment and fair wages can also present obstacles to women's health, especially in markets where medical insurance is linked to work or where user fees are required to access basic services, the WHO report found.
The sections below provide health and travel advice and more information on what swine flu is and what the government is doing to help combat it.
The National Pandemic Flu Service has been launched in England.
If you are in England and feel like you may have swine flu, visit the new website by following the link below, or call 0800 1 513 100 0800 1 513 100 ( 0800 1 513 200 0800 1 513 200 for textphone).
People who have swine flu symptoms will be given a unique access number and told where their nearest antiviral collection point is. They should then ask a flu friend - a friend or relative who doesn't have swine flu - to go and pick up their antivirals. The flu friend must show their own ID as well as that of the patient.
Check your symptoms: Follow the link below or call 0800 1 513 100 0800 1 513 100 (textphone - 0800 1 513 200 0800 1 513 200 )·National Pandemic Flu Service Opens new windowContact your doctor directly rather than using the National Pandemic Flu Service if:
·you have a serious underlying illness
·you are pregnant
·you have a sick child under one year old
·your condition suddenly gets much worse
·your condition is still getting worse after 7 days (5 for a child)
The Health Protection Agency (HPA) estimates that there were 100,000 new cases of swine flu in the UK last week. The under-5s and 5-14 year olds are the age groups worst affected, with the over 65s continuing to show much lower rates of infection.
The majority of cases continue to be mild, although 840 people have been hospitalised and 26 people have died.
Evidence that you are sick
You do not need to provide a doctor’s sick note for the first seven days you are sick.
Your employer may ask you to fill in a self-certificate of their own design or form SC2 which you can get from your GP's surgery, or from the HM Revenue and Customs (HMRC) website.
If you are sick for more than seven days, you will need to ask your doctor for a sick note for your employer.
Although symptoms of swine flu have generally been mild, a small number of patients will develop more serious illness. Certain groups of people, and people with other health conditions, such as heart or lung disease, are at increased risk.
Find out more about the cause of swine flu and how it differs from ordinary flu.
Swine flu, like seasonal flu, is easily spread by the tiny droplets in a cough or sneeze. By taking a few simple steps you can help to reduce the risk of getting swine flu and to stop the virus spreading.
If you think you may have swine flu, find out what you should do.
While there have been cases of swine flu in the UK, travel to the UK is not restricted.
If you get swine flu while in the UK you will be able to access the same advice and treatment as UK residents. However, if you have symptoms of swine flu, you should delay travelling until you are well.
The H1N1 swine flu vaccination programme was announced for the UK on 15 October 2009. Pandemrix, made by GlaxoSmithKline, and Celvapan, made by Baxter, will be used over the coming weeks and months to vaccinate people in the UK against H1N1 swine flu.
Information about the vaccination programme can be found on the Department of Health’s website:
The Department of Health has identified priority groups who will be first in line for vaccination against swine flu. These groups will include pregnant women, frontline health and social care workers, and everyone in at risk groups aged over six months. The specific clinical priority groups for vaccination against swine flu have been identified as:
individuals aged over six months and under 65 years in the current seasonal flu vaccine clinical at risk groups
all pregnant women
household contacts of immune compromised individuals
people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups.
Product information (patient information leaflets and Summaries of Product Characteristics)
The product information (patient information leaflets (PILs) and Summaries of Product Characteristics (SPCs)) for both these vaccines is available below:
Preparation of Pandemrix vaccine (GSK) - added 5 November 2009
Further to feedback received on the mixing of the two Pandemrix vials, we would like to clarify that it is important that the entire contents of the vial of adjuvant emulsion are added to the vial of antigen suspension. The Department of Health training video and the UK Health Departments' publication 'Immunisation against infectious disease' (The Green Book)(external link) advise to:
"...Check both vials for any foreign particles. Shake both vials. Then draw up all of the adjuvant emulsion into the syringe. Inject this into the vial containing the antigen suspension".
This point will be clarified as part of the continuing review and variations of the Pandemrix Summary of Product Characteristics (SPC) and patient information leaflet (PIL).
Provision of patient information leaflets (PILs)
Because new data from clinical trials are constantly emerging, the dosing instructions and other aspects of the prescribing information is subject to change in the coming months. For this reason, printed PILs may quickly be out-of-date and may cause confusion. For the first few vaccine batches, we have asked both companies not to provide the printed PILs as these are now out-of-date. As an interim measure, we are advising patients and healthcare professionals to download PILs from this section of the MHRA website. The Department of Health is also actively communicating the recommended dosage instructions as advised by the Joint Committee on Vaccination and Immunisation (JCVI) (external link).
We are currently in the process of agreeing the best mechanism for the companies to print and provide hard copies of the most up-to-date PILs with future vaccine batches.
Vaccine safety and monitoring suspected side effects
Pandemrix and Celvapan have been licensed for use throughout Europe following a thorough review of their manufacturing quality, the immunity they induce and their safety. This was based on information from clinical trials of prototype H5N1 (‘bird flu’) strain vaccines which have been studied over several years, as well as trials using the current H1N1 swine flu strain.
As with any vaccine, the swine flu vaccines will cause side effects in some people, although not everybody will have a side effect. The most common side effects will be injection site reactions (pain, swelling, and/or redness), headaches, dizziness, muscle aches, mild fever and fatigue. These side effects are mainly mild and last only two to three days. Some of these symptoms may be similar to a mild flu-like illness, although it should be stressed that the vaccines cannot cause swine flu itself.
Because clinical trials are relatively limited in size, very rare side effects might not be identified until the vaccines have been used on a wide scale in large numbers of people. The swine flu vaccines are not unique in this regard and this applies to any new medicine or vaccine. This is why the MHRA has in place robust systems for post-licensing safety monitoring.
The Yellow Card Scheme underpins safety monitoring in the UK. Through this Scheme, healthcare professionals and members of the public voluntarily submit reports of suspected side effects to the MHRA. Drug companies also submit such reports as part of their legal requirements. Safety scientists at theMHRA carefully evaluate 'signals' of suspected safety issues; it is important to point out that just because a Yellow Card has been sent it does not necessarily mean that the vaccine caused the reaction - it may be coincidental or due to an underlying medical condition.
As well as analysing Yellow Card data, the MHRA will review safety data from all available sources including those from other countries. The MHRA will use advice from independent experts, including that of the Commission on Human Medicines (CHM), in assessing any identified risks. We will also work closely with our European and international counterparts in such evaluation.
On a weekly basis, we will produce an up-to-date summary of the safety experience, including reports of suspected side effects, which will be published in this section shortly.
Weekly ADR summaries
The MHRA produces a weekly summary of all suspected side effects reported in the UK for the H1N1 vaccines during the swine flu pandemic. The summary is updated each Thursday and includes all side effects to Celvapan and Pandemrix reported up to the end of the previous week.
How to report suspected side effects to swine flu medicines
A special online version of the Yellow Card Scheme has been set up to receive reports of suspected adverse reactions to the swine flu vaccines (as well as antiviral medicines): the ‘Swine Flu Adverse Reaction (ADR) Portal’. This is accessed via http://swineflu.mhra.gov.uk or by using the red button at the top of this page, and provides a simple and, most importantlu, a quick way of getting this information into the MHRA’s safety monitoring system. For those without internet access, postal Yellow Card reports can still be submitted.
This Swine Flu ADR Portal allows the MHRA safety scientists to access suspected side effect reports in real-time which will allow us to identify any new risks as soon as they emerge.
If you think that you or somebody you know has experienced a suspected adverse drug reaction to the GSK Pandemrix vaccine or the Baxter Celvapan vaccine, please report it to us using the Swine Flu ADR Portal at:
The number of swine flu cases in the UK now stands at 39 after four more cases were reported in Scotland and in a London school. People of all ages have caught the disease including an adult at Alleyn’s school in London.
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Cholesterol is a lipid (fat). It is manufactured by the liver from the fatty foods that we eat, and it is vital for the normal functioning of the body.
However, having an excessively high level of lipids in your blood - a condition known as hyperlipidaemia - can have a serious effect on your health, as it increases your risk of having a heart attack, or stroke. NHS Choices
Cholesterol is present in the membrane (outer layer) of every cell in the body. It insulates nerve fibres, and is an essential building block for hormones, such as the sex hormones and the hormones made and released by the adrenal glands.
Cholesterol also enables the body to produce bile salts.
Cholesterol is carried in the blood by molecules called lipoproteins. There are several different lipoproteins, but the three main types are:
Low density lipoprotein (LDL). This is often known as bad cholesterol and is thought to increase arterial disease (i.e. in the arteries). It carries cholesterol from the liver to the cells and can cause a harmful build-up if there is too much for the cells to use. Normally, the blood contains about 70% of LDL, but the level will vary from person to person.
High density lipoprotein (HDL). This is often referred to as 'good cholesterol', and is thought to prevent arterial disease. It takes cholesterol away from the cells and back to the liver, where it is either broken down or is passed from the body as a waste product.
Triglycerides are another type of fatty substance present in the blood. They're found in dairy products, meat and cooking oils. Triglycerides are also produced by the liver. People who are overweight, eat a diet high in fatty or sugary foods or drink a large amount of alcohol have an increased risk of a high triglyceride level.
The amount of cholesterol present in the blood can range from 3.6 to 7.8 mmol/litre. More than 6mmol/litre is considered high, and is a risk factor for arterial disease. Government advice recommends a target cholesterol level of less than 5. However, in the UK, two out of three adults have a total cholesterol level of 5 or above. Men in England, on average, have a level of 5.5, and women have a level of 5.6.
Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attacks and strokes. The risk of coronary heart disease also rises as the blood's cholesterol level increases. If other risk factors, such as high blood pressure and smoking, are present, the risk increases even more.
High cholesterol is not a disease in itself, but it is linked to serious conditions, such as cardiovascular conditions (disease of the heart and blood vessels), angina, stroke, and mini stroke, known as transient ischaemic attack (TIA). A high level of cholesterol in your blood, together with a high level of triglycerides, can increase your risk of developing coronary heart disease.
Coronary heart disease is caused by narrowing of the arteries that supply the heart with blood. This narrowing of the arteries is called atherosclerosis. Fatty deposits, such as cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This build up, known as plaque, usually affects small and medium sized arteries. The flow of blood through the arteries is restricted as the inside diameter is reduced. Blood clots, which often happen in the coronary arteries during a heart attack, are more likely to develop when arterial walls are roughened by the build up of fatty deposits.
A high cholesterol level may only be revealed if you have symptoms of atherosclerosis. These can include:
angina, caused by narrowed coronary arteries in the heart,
leg pain on exercising, due to narrowing of the arteries that supply the lower limbs,
blood clots and ruptured blood vessels, which can result in a stroke or mini-stroke (transient ischaemic attack (TIA)),
ruptured plaques, which can lead to a blood clot forming in one of the arteries delivering blood to the heart (coronary thrombosis), and may lead to heart failure if a significant amount of heart muscle is damaged, and
thick yellow patches (xanthomas) around the eyes or elsewhere on the skin. These are cholesterol deposits and can often be seen in people with inherited, or familial cholesterol (where your family members have a history of high chloresterol).
A number of different factors can contribute to high blood cholesterol.
Lifestyle risk factors
There are a number of preventable lifestyle-related risk factors that can increase your risk of developing high blood cholesterol. They include:
unhealthy diet - some foods contain cholesterol (known as dietary cholesterol) for example, liver, kidneys and eggs. However, dietary cholesterol has little effect on blood cholesterol. More important is the amount of saturated fat in your diet. Foods that are high in saturated fat include, red meat, meat pies and sausages, hard cheese, butter and lard, pastry, cakes and biscuits, and cream, such as soured cream and crème fraîche,
lack of exercise or physical activity - can increase your level of bad cholesterol (LDL), and decrease your level of good cholesterol (HDL),
obesity - if you are overweight you are likely to have an increased level of LDL and a decreased level of HDL, increasing your overall blood cholesterol level,
drinking excessive amounts of alcohol - the recommended amount is 3-4 units a day for men, and 2-3 units a day for women.
Treatable risk factors
There are a number of treatable conditions that can cause high blood cholesterol. They include:
hypertension (high blood pressure),
a high triglyceride blood level, and
medical conditions, such as kidney and liver diseases, and an under-active thyroid gland.
Fixed risk factors
There are a number of fixed risk factors that can cause high blood cholesterol. They include:
a family history of heart disease or stroke - you are more likely to have high cholesterol if you have a close male relative (father or brother) aged under 55, or a female relative (mother or sister) aged under 65, who has been affected by coronary heart disease or stroke,
a family history of a cholesterol related conditions for example, if a close relative, such as a parent, brother, or sister has familial hyperchloresterolaemia, or combined hyperlipidaemia,
being male men are more at risk of having high blood cholesterol than women,
age the older you are, the greater the likelihood of developing atherosclerosis,
early menopause in women, and
ethnic group people who are of Indian, Pakastani, Bangladeshi, or Sri Lankan descent have an increased risk of high blood cholesterol.
If you have a fixed risk factor (or a number of fixed risk factors) it is even more important to ensure that you take steps to address any lifestyle, or treatable risk factors that you may also have.
To measure cholesterol, a simple blood test is often carried out. Before the test is done, you may be asked not to eat for 12 hours (usually including night time when you are asleep). This ensures that all food is completely digested and will not affect the outcome of the test. Your GP, or practice nurse, can carry out the blood test, and will take a sample either using a needle and a syringe, or by pricking your finger.
The blood sample that is taken during the blood test will be used to determine the amount of LDL (bad cholesterol), HDL (good cholesterol), and triglycerides in your blood. Blood cholesterol is measured in units called millimoles per litre of blood (mmol/litre). In the UK, the current government recommendation is that you should have a total blood cholesterol level of less than 5mmol/litre, and an LDL cholesterol level of under 3mmol/litre.
Anyone can have their blood cholesterol level tested, but it is particularly important to have it checked if:
you are aged over 40,
you have a family history of cardiovascular disease for example, if your father or brother developed heart disease, or had a heart attack, or a stroke before the age of 55, or if your mother or sister had these conditions before the age of 65,
a close family member has a cholesterol related condition, such as familial hyper chloresterolaemia, or combined hyperlipidaemia,
you are overweight or obese,
you have high blood pressure (hypertension), or
you have a medical condition, such as a kidney condition, an under-active thyroid gland, or acute inflammation of the pancreas (acute pancreatitis). This is because these conditions can cause an increased level of cholesterol.
In assessing your risk of cardiovascular disease, heart attack, or stroke, your cholesterol ratio should not be taken on its own. A number of lifestyle factors should also be taken into consideration. For example:
BMI (body mass index - your weight in relation to your height),
treatable risk factors, such as high blood pressure (hypertension) and diabetes, and
fixed risk factors, such as your age, sex, and ethnicity.
If you have been diagnosed with high cholesterol, the first method of treatment will usually involve making some changes to your diet (adopting a low fat diet), and ensuring that you take plenty of regular exercise. After a few months, if your cholesterol level has not dropped, you will usually be advised to take cholesterol lowering medication.
Ensuring that you have a healthy diet by changing to one that is low in saturated fats, can reduce your level of LDL or bad cholesterol. If you are in a high risk category of getting cardiovascular disease, altering your diet will not lower your risk. However, eating a healthy, balanced diet has many other health-related benefits as well as reducing your cholesterol level.
A healthy diet includes foods from all of the different food groups carbohydrates (cereals, wholegrain bread, potato, rice, pasta), proteins (for example, from lean meat, such as chicken and oily fish, like mackerel or sardines), and fats (varieties that unsaturated, such as low fat mono- or poly-unsaturated spreads, and vegetable or sunflower oil). You should also eat at least five portions of a variety of different fruit and vegetables each day.
Cholesterol lowering medication
There are several different types of cholesterol lowering medication which work in different ways.
Your GP will be able to advise you about the type of treatment that is most suitable for you.
Commonly prescribed medication includes:
Statins (HMG-CoA reductase inhibitors). Statins, such as simvastatin and atorvastatin, work by blocking the enzyme (chemical) in your liver that is needed for making cholesterol. Statins are used to reduce your cholesterol to less than 4 mmol/l and your LDL cholesterol to less than 2 mmol/l. They are therefore useful in preventing and treating atherosclerosis which can cause chest pain, heart attacks, and strokes. Statins sometimes have mild side effects which can include constipation, diarrhoea, headaches, and abdominal pain.
Aspirin may be recommended, depending on your age and a number of other factors. A low daily dose of aspirin can prevent blood clots from forming. Children under 16 years of age should not take aspirin.
Niacin is a B vitamin that is found in foods and in multi-vitamin supplements. In high doses, available by prescription, niacin lowers LDL cholesterol and raises HDL cholesterol. Minor side effects include flushing or tingling skin, itching, and headaches.
Other medications, such as cholesterol absorption inhibitors (ezetimibe), and bile-acid sequestrants, are also sometimes used to treat high cholesterol. However, they may be less effective than other forms of treatment and have more side effects.
If you have high blood pressure (hypertension), your GP may also prescribe medication to lower it.
High cholesterol levels can be made worse by any other medical conditions you may have. Medical problems such as an under-active thyroid gland, an overactive pituitary gland, liver disease, or kidney failure, can all contribute to high cholesterol levels.
Some people have inherited disorders, such as familial hyper chloresterolaemia, or combined hyperlipidaemia, that prevent fats from being used properly and eliminated from the body. This allows the level of cholesterol to build up in the blood.
The major complications of raised blood cholesterol are heart attacks, strokes and arterial disease. The risks of all of these are increased if:
you are overweight,
have high blood pressure,
you have a strong family history of these conditions, or
you are diabetic.
You can help prevent high blood cholesterol by eating a healthy, balanced diet that is low in saturated fat.
Including a small amount of unsaturated fats in your diet can be a healthy choice, as this type of fat can actually reduce cholesterol levels. Current thinking is that the traditional Mediterranean diet, with its emphasis on raw olive oil in many foods, and low animal-fat content, is effective in ensuring cardiovascular health (the health of the heart and blood circulation).
Foods high in unsaturated fats include:
nuts and seeds,
sunflower, rapeseed and olive oil, and
If you are overweight, losing weight should also help reduce your cholesterol level.
Regular exercise can help weight loss.
If you have a family history of cholesterol problems, a blood test is advisable, as treatment may be necessary.
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