WHO wants HIV patients treated sooner to save lives, halt spread

By Kate Kelland

LONDON (Reuters) - Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organisation sOrganizationaid on Sunday.

While better access to cheap generic AIDS drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed.

But in new guidelines aimed at controlling and eventually reducing the global AIDS epidemic, the U.N. health agency said some 26 million HIV-positive people - or around 80 percent of all those with the virus - should be getting drug treatment.

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else.

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/AIDS department director.

"And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV."

Some 34 million people worldwide have the HIV virus that causes AIDS and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region.

But the epidemic - which has killed 25 million people in the 30 years since HIV was first discovered - is showing some signs of being turned around. The United Nations AIDS program UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving AIDS drugs in 2012, up from just 300,000 people a decade earlier, according to latest WHO data also published on Sunday.

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drugmakers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline.

"IRREVERSIBLE DECLINE"?

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease.

"With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she said in a statement.

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimeter or less.

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

The guidelines also say all pregnant or breastfeeding women and all children under five with HIV should start treatment immediately, whatever their CD4 count, and that all HIV patients should be regularly monitored to assess their "viral load".

This allows health workers to check whether the medicines are reducing the amount of virus in the blood. It also encourages patients to keep taking their medicine because they can see it having positive results.

"There's no greater motivating factor for people to stick to their HIV treatment than knowing the virus is 'undetectable' in their blood," said Gilles van Cutsem, the medical coordinator in South Africa for the international medical humanitarian organisation Médecins Sans Frontières (MSF).

MSF welcomed the new guidelines but cautioned that the money and the political will to implement them was also needed.

"Now is not the time to be daunted but to push forward," MSF president Unni Karunakara said in a statement. "So it's critical to mobilize international support... including funding for HIV treatment programs from donor governments."

The WHO's Hirnschall said getting AIDS drugs to the extra patients brought in by the new guidelines would require another 10 percent on top of the $22-$24 billion a year currently needed to fund the global fight against HIV and AIDS.

(Editing by Gareth Jones)

Source : http://news.yahoo.com/wants-hiv-patients-treated-sooner-save-lives-halt-042525713.html

U.S. sets birth control rule for employers with religious ties

By David Morgan

WASHINGTON (Reuters) - The Obama administration on Friday made it final that employees of religiously affiliated, nonprofit institutions would receive insurance coverage for birth control amid mounting legal challenges to a rule in the recent healthcare law.

The White House proposed in early 2012 an arrangement that allows universities, hospitals and other employers with a religious affiliation to avoid paying directly for contraceptives. Instead, insurance companies provide coverage and foot the bill under the law.

The rule requires an institution's health insurer or third-party insurance administrator to notify employees about birth control benefits and provide beneficiaries with direct payments that cover the cost of contraceptive services.

The announcement was made by the U.S. Department of Health and Human Services. It puts into effect a requirement that has been beset by more than a year of talks between administration officials and religious employers.

The U.S. Roman Catholic bishops and other denominations oppose contraception on religious grounds and have protested against the requirement as have conservatives.

"Today's announcement reinforces our commitment to respect the concerns of houses of worship and other non-profit religious organizations that object to contraceptive coverage, while helping to ensure that women get the care they need, regardless of where they work," HHS Secretary Kathleen Sebelius said in a statement.

The rule formally takes effect on August 1. Thanks But the administration gave nonprofit employers an additional five months to adjust to the new regulations by having it apply to plan years beginning on or after January 1. Other employers have been required to make contraceptives coverage available to their workers since last August.

Women's advocates applauded the regulations as a milestone that could have profound impact on the education and economic opportunities of women including college students.

"Birth control is basic healthcare for women, and this policy treats it like any other kind of preventive care," Planned Parenthood President Cecile Roberts said in a statement.

The U.S. Conference of Catholic Bishops, which has spearheaded opposition to the policy, responded to the ruling.

"We have received and started to review the 110-page final rule," New York Cardinal Timothy Dolan said in a statement. "It will require more careful analysis. We will provide a fuller statement when that analysis is complete."

LEGAL FIGHT EXPANDS

Opponents say the policy, part of President Barack Obama's Patient Protection and Affordable Care Act, violates religious tenets of nonprofit and for-profit employers alike, particularly coverage for the morning-after pill to stop pregnancy and other types of contraceptives, which they view as tantamount to abortion.

Employers have had legal successes, raising speculation that the lawfulness of the rule may eventually be tested by the U.S. Supreme Court.

More than 60 lawsuits have been filed by religious organizations and businesses against the requirement, and courts have granted some 20 for-profit businesses temporary relief from the law while their cases proceed in court.

Earlier this month, a federal judge in Pennsylvania granted the same relief to a religiously affiliated nonprofit for the first time in the case of Geneva College, which was established by the Reform Presbyterian Church.

Friday's regulations came a day after a federal appeals court in Denver ruled that Hobby Lobby, family-owned arts and crafts chain may be exempt from offering contraceptive benefits to its 13,000 full-time employees.

Hobby Lobby's lawyer, Kyle Duncan of the Becket Fund, said his organization filed an emergency request late Thursday asking the district court to take immediate action on the company's request for an exemption from the mandate. On Friday, the retailer was excused by a federal judge from paying up to $1.3 million a day in fines for not providing coverage.

(Additional reporting by Terry Baynes in New York; Editing by Michele Gershberg, Vicki Allen and Kenneth Barry)

Source : http://news.yahoo.com/obama-administration-sets-final-contraceptives-rule-faith-affiliated-153243124.html

With Mandela, end-of-life care dilemmas magnified

CHICAGO (AP) — The emotional pain and practical demands facing Nelson Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Some choose to let go with little medical interference; others seek aggressive treatment. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say.

Mandela "is not only revered he is loved and profoundly admired by people all over the world and the sense of letting go must be difficult for everyone involved," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

In much of Africa, people are considered fortunate to live past age 60. For those who reach old age, death is still seen as sad, but friends and family typically celebrate with big parties to honor a life well-lived. Taking extraordinary measures to keep that person alive would be considered dishonorable, said Dr. Sola Olopade, the Nigerian-born clinical director for the University of Chicago's Center for Global Health.

If such measures are being used for Mandela, many could consider it "quite painful," Olopade said, "because those are not the last memories you want to have for someone with such an exemplary life."

U.S. doctors said Mandela's lung infection is most likely pneumonia, a very common cause of illness and death in the elderly.

The infection is usually caused by bacteria and causes lungs to fill with fluid or pus, making breathing difficult and often causing fever and weakness. Treatment includes antibiotics and extra oxygen, often from a mechanical ventilator.

In the United States, an elderly person critically ill with pneumonia would typically be hospitalized in an intensive care unit and put on a mechanical ventilator, or breathing machine, said Dr. J.P. Kress. He is director of the University of Chicago's medical intensive care unit's section on lung and critical care. Ventilators often require a breathing tube down the throat, and patients need to be sedated because of the discomfort.

These patients typically are hooked up to feeding tubes, intravenous fluids and all kinds of monitoring machines to check heart rate, blood pressure and other functions. For long stays, lying prone in a hospital bed, they have to be periodically moved into different positions to prevent bed sores; their arms and legs have to be exercised to fight muscle wasting.

Mandela has been hospitalized several times since December for a recurring lung infection, and he has had tuberculosis.

In a hospitalization in March and April, doctors drained fluid from around his lungs, making it easier for him to breathe. He got care at home until he returned to the hospital on June 8.

For elderly patients hospitalized repeatedly with lung problems, the chances for recovery are often grim, Kress said.

"It's possible he's sitting in a chair asking, 'When am I going to get out of the hospital?' but that's very unlikely," he said.

Patients so critically ill may have ups and downs, and small changes like needing a little less help from a ventilator may be seen as a sign of improvement even when the outlook remains poor, Kress said.

Shaffner, the Vanderbilt doctor, said, "There are always little glimmers of hope. It's not a straight line down ... when you're so gravely ill."

Ada Levine faced end-of-life decisions with her mother, Maria Robles of Chicago. And it was difficult even though her mother had made her wishes known. Robles died two weeks ago at age 75 after 12 years of heart failure and other problems that had her in and out of the hospital.

"It was not going to get better," Levine said. "You're hopeful. You believe in miracles and 'maybe.' At some point you realize there is no miracle and you have to be strong and do the right thing."

Her mother did not want life support, but following that directive is easier said than done, Levine said.

"It's brutal, very difficult, hard, to watch this person decline and think now you're responsible for making their decisions."

Schaffner went through the same experience with his mother. She died 10 years ago at age 84 after several strokes and then pneumonia.

When she was still lucid, the family discussed end-of-life care. She did not want to be kept alive on a ventilator. So when she developed pneumonia and was hospitalized, she got comfort care — fluids, antibiotics and sedatives to calm her anxiety over struggling to breathe — but no intensive treatments with fancy machines.

After several days, when it became clear "there was zero chance she was going to turn around," the family brought her home, with hospice care, and she died less than two weeks after falling ill, Schaffner said.

Loretta Downs, former president of the Chicago End-of-Life Care Coalition, said decisions about life support should turn around the patient's wishes.

"Very often it's not the person who's dying's choice," but the family's, she said. "Now that we can prolong dying there's this whole question of are we prolonging dying versus prolonging living? It's not comfortable to be on life support."

___

AP Chief Medical Writer Marilynn Marchione contributed from Milwaukee and Andrew Meldrum contributed from Johannesburg.

___

Online:

End-of-life care: http://1.usa.gov/bPeFiT

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Source : http://news.yahoo.com/mandela-end-life-care-dilemmas-magnified-184035743.html

Judge: Hobby Lobby won't have to pay fines

OKLAHOMA CITY (AP) — A federal judge says Hobby Lobby and a sister company will not be subject to daily fines for refusing certain birth-control for workers.

U.S. District Judge Joe Heaton on Friday set a hearing for July 19 on claims by Hobby Lobby and the Mardel Christian bookstore chain that they should not have to provide some types of birth control, as required under the federal health care overhaul.

The companies faced fines totaling $1.3 million daily beginning Monday. But Heaton ordered the federal government to not impose a penalty.

An appeals court said Thursday the companies could fight the new law on religious grounds but Heaton first had to reconsider an injunction request. Heaton said Hobby Lobby showed it would suffer consequences and that an injunction was in the public interest

Source : http://news.yahoo.com/judge-hobby-lobby-wont-pay-fines-205227917.html

Surgeon allowed to work despite inquiry into 10 deaths

Mr Jones' family only learnt that the hospital had concerns about Mr Sarker after an original inquest into his death was dramatically halted midway through when the coroner was informed of the trust's investigation.

Mr Jones' son, Simon Middup-Jones, 52, said: "You put your trust in these people, you presume they are very qualified and very capable. You put your trust in them but unfortunately I don't think we should have."

Mr Sarker's colleagues first raised concerns in June last year.

The trust allowed him to continue to operate under supervision. At the same time, it commission the RCS report.

It is understood that the RCS examined the cases of 75 of Mr Sarker's patients and compared them to the cases of two other doctors working in similar fields.

The RCS found that Mr Sarker had an eight per cent mortality rate, with six patients dying within 28 days of surgery. The two sample doctors had three deaths between them in the same period.

The investigation also found that Mr Sarker's patient readmission rate was more than three times that of the other two doctors.

In addition, the RCS recommended that further checks be carried out on Mr Sarker's online CV, which allegedly included a claim that he won a "distinction in surgery" prize which does not exist.

The findings of the RCS report remained concealed for nearly a year until details were leaked by a whistleblower.

The trust admitted it allowed Mr Sarker to operate on patients without telling them of its concerns and investigations.

It only disclosed the existence of the report this month and refuses to publish it on legal advice.

Jennifer Emerson, a solicitor at law firm Irwin Mitchell, representing a number of families who have lost loved ones, said: "It is appalling that despite a recommendation by the Royal College of Surgeons the ongoing investigation has not being made public."

One of Mr Sarker's patients, Mrs Thomas, a widow, died in September.

She had been diagnosed with colon cancer in May and underwent an operation at the Alexandra Hospital, performed by Mr Sarker.

However it is believed the surgery failed to take out all the cancer and Mrs Thomas needed follow-up surgery two weeks later.

She was readmitted to hospital three more times before dying of suspected multiple organ failure.

Marten Coates, a crown court judge and close friend of Mrs Thomas who is managing her estate, has instructed lawyers Irwin Mitchell to investigate the trust.

He has also reported Mr Sarker to the General Medical Council, the medical watchdog, which has confirmed it is investigating the surgeon.

It placed restrictions on his licence to practise in February.

Judge Coates said: "The trust we now know notified the Royal College of Surgeons of its concerns about Sudip Sarker's practice in July 2012.

"Jean Thomas was an inpatient on their wards after that date. No one told Jean or those close to her."

He added: "Sudip Sarker led Jean to believe that it would be a quick operation, a straightforward keyhole procedure and the cancer would be removed. She would be discharged and that would be the end of her case.

"But in fact my understanding is that the procedure chosen and performed by Sudip Sarker was wholly inappropriate."

A second patient, Mr Jones, died at the hospital in June last year after an operation to remove a part of his intestine.

Mr Middup-Jones said his father, who ran a joinery firm in Bewdley in Worcestershire, was "fit and strong" for his age when he started to feel unwell in February last year.

He visited his GP and was later referred to Mr Sarker, who confirmed that he had early stages of rectal cancer and would need surgery. He underwent a colostomy at Alexandra Hospital on May 30.

After the operation Mr Jones was taken to intensive care to recover.

Mr Jones said his father seemed to be "rallying" and was looking forward to being moved onto a ward but on June 5 his condition deteriorated and he died the next day. The post-mortem noted cause of death as septic shock from a wound infection.

Mr Jones left his wife, Jane, four children and seven grandchildren.

His family said that initially, although they were shocked by his death, they accepted that any surgery carried risks.

It was only during the inquest into Mr Jones' death earlier this year that they discovered the surgeon who carried out the operation was under investigation.

Mr Middup-Jones said the coroner was questioning Mr Sarker when a court official interrupted the hearing to say there was a phone call.

Mr Middup-Jones said: "When the coroner returned, she turned to Mr Sarker and said 'am I correct in understanding you are under investigation for your methodology and practices?'

"It was a complete bombshell, you could have heard a pin drop.

"It was the first we knew anything about it."

Mr Jones' family has also instructed Irwin Mitchell Solicitors to examine if they have a claim for medical negligence.

Lindsay Tomlinson, associate solicitor specialising in medical law at Irwin Mitchell, said: "We have serious concerns about the death rates and surgery complication figures we have seen in the news but are equally concerned by the fact that it seems that colleagues were so concerned about Mr Sarker that they reported him to the RCS yet he was allowed to continue working for the Trust for a further three months."

Worcester Acute Services Hospital Trust said it had taken advice about telling Dr Sarker's patients of the investigation into him.

A Trust spokesman said: "In this specific case the Trust considered this matter with NCAS (National Clinical Assessment Service) to determine what measures were required to maintain patient safety. In those areas where the surgeon's practice had been questioned the critical responsibility was transferred to a supervising surgeon."

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/2dfa8029/l/0L0Stelegraph0O0Chealth0Chealthnews0C10A150A6960CSurgeon0Eallowed0Eto0Ework0Edespite0Einquiry0Einto0E10A0Edeaths0Bhtml/story01.htm

Crackdown on NHS 'health tourists'

Jeremy Hunt, the Health Secretary, will call a halt to foreign patients wrongly getting free care, after putting the cost of the problem at up to £200 million a year.

Under the plans, doctors will be able to track a patient's immigration status from the NHS number. Ministers will also consider ways to make non-resident foreigners pay for GP care, either with their own money or by claiming back the money from other governments.

However, the plan has come under fire from some doctors who are opposed to being "border guards". The British Medical Association has warned that it could appear discriminatory to check the immigration status of people who "happen to look foreign and talk funny".

However, the Coalition is pushing ahead with the reforms, after David Cameron promised earlier this year to put a stop to foreigners "abusing" the NHS.

"No one expects health workers to become immigration guards and we want to work alongside doctors to bring about improvements, but I'm clear we must all work together to protect the NHS from costly abuse," he said.

"We want a system that is fair for the British taxpayer by ensuring that foreign nationals pay for their NHS treatment.

"By looking at the scale of the problem and at where and how improvements can be made we will help ensure the NHS remains sustainable for many years to come."

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/2dfffe96/l/0L0Stelegraph0O0Chealth0C10A1512820CCrackdown0Eon0ENHS0Ehealth0Etourists0Bhtml/story01.htm

Farewell Dame Edna, the global gigastar from Moonee Ponds

By putting a non-porous barrier between himself and Edna, Humphries has not only fed the idea of his character as someone else entirely, but also avoided having to do any talking on her behalf. So we're largely left with Edna's own explanation of what she means to us: "In the early days," she says, "I was mousy, timid, extremely reticent and, above all, vulnerable… then I grew in confidence and authority. I felt I had something to tell the audience, though I didn't know what it was. So I told them about themselves. I described my own home and people listened and they said, 'We know that house, we know that lava lamp, we know that picture on the wall, the Chinese girl with the tinted green face.' And slowly they began to feel that where they lived was not such a boring place, after all, because I had enshrined it in a work of art."

In other words, she represented a kind of universal dread; one that lurked in minds in places the young Humphries didn't even know existed: the fear of being left behind.

But where did the actual meat and bones of Edna come from? While Humphries is enduringly evasive on the subject, others have detected echoes of a troubled relationship with his mother. In his autobiography, My Life as Me, Louisa Humphries, wife of a Melbourne engineer, comes across as strident, fussy, narrow-minded and suspicious of anything that smacks of enlightenment. A particularly poignant passage recounts how young Barry, a voracious reader, returned home one day to discover that his mother had given all his books away.

"But why?" he sobbed. "They were my books."

"Don't be silly, Barry," sighed Mrs H. "You've read them."

While he doesn't pretend it was a particularly happy childhood, Humphries plays down the suggestion that he modelled Edna directly on Louisa – citing instead the family's talkative daily help, a local woman called Shores. "My poor mother has been press-ganged into the role of Edna's prototype," he has written, "by the speculations of critics. Naturally, the character has borrowed more than a little of my mother's astringency of phrase, but Edna's garrulity derives from Shores…"

Barry was never going to find his future in the Melbourne suburbs. From an early age he displayed a talent for repartee, putting together songs and sketches and displaying a fascination for surrealism and the Dadaist movement that drove much of his later work. While studying philosophy and fine arts at university, he penned a sketch about a woman offering accommodation to foreign athletes visiting Australia for the 1956 Olympics, "as long as they're white and speak English".

He hadn't intended to perform it himself, but when the female student due to play the part fell ill, Barry draped himself in a frock and took to the stage. In the decades that followed, he has been a restless perfectionist, moving between his homes in England, Australia, Switzerland and New York.

Despite 60 years as a performer, artist and writer, he remains an enigma behind those diamante-encrusted glasses. Even the women he has been married to have struggled to understand him. Brenda Wright, his second wife (of four), once said: "He puts a smokescreen around his personal life and presents himself in a certain way, which isn't reality. I was perturbed by the perceptions he had of people, some of which were very cruel."

It is better, and certainly Humphries's preference, to let Edna speak for herself. The threadbare dress and hairy legs have given way to resplendence, the company of notables, the homage of nations and the wisdom of age, but at heart the dame is still the gladdie-waving La Stupenda of Moonee Ponds.

"I always have to go back to Australia to reconnect with my roots," she explains. "Sitting under an anthill communicating with my spirit ancestors. That's how I get the strength I need to perform my mission, for that is what it is, possums: a glorious opportunity to pass on to ordinary people the gifts Dame Nature gave me."

Next year she will pass into retirement. And since we know that she's only human, we can't really complain.

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/2dfc1aae/l/0L0Stelegraph0O0Cculture0Ccomedy0C10A1498780CFarewell0EDame0EEdna0Ethe0Eglobal0Egigastar0Efrom0EMoonee0EPonds0Bhtml/story01.htm

Why having big families is good for you (and cheaper)

So, with the help of Swedish researcher Therese Wallin, I set about pulling together data that put a different cost/benefit complexion on the "shall we have another?" conversation.

Some of the most startling literature comes from medical research. It has long been known that siblings – by sharing germs at a young age and mutually priming immune systems – provide some protection against atopic conditions such as hay fever and eczema. But the latest breakthroughs suggest growing up with a brother or sister can also guard against food allergies, multiple sclerosis and some cancers. For reasons that have yet to be fully fathomed, these benefits do not apply to children simply by dint of spending time sharing bugs with other youngsters – as they would, for instance, in day care.

The other "epidemics" of modern childhood, obesity and depression, are also potentially reduced by exposure to siblings. A clutch of major studies from all over the world shows that the more siblings a child has, the thinner they will be. Put simply, siblings help children burn off fat. One American study honed its analysis down to an amazingly precise deduction: with each extra brother or sister, a child will be, on average, 14 per cent less obese. Reductio ad absurdum? We can scoff at such a definitive conclusion, until we realise that no one in medical academia has suggested that having a sibling ever made anyone fatter.

None of this is rocket science. When we compare like with like, regardless of family background, children with siblings tend to enjoy better mental health. Obviously, again, this is to generalise massively. The world is full of jolly singletons. But dig into some of the big data sets out there and unignorable patterns emerge. On experiences on which nation states hold a big corpus of statistics, events such as divorce and death, for example, strong correlations exist.

Cause is not always correlation, but it stands to reason that when parents split up or die, a child will benefit from having a sibling to turn to.That solidarity runs throughout the lifespan. After all, a sibling is for life, not just for childhood.

Indeed, policymakers with an eye to areas beyond elderly care may need to wake up to the shifting sands of family composition. In the late 20th century, the received wisdom among sociologists was that it mattered not a jot to society at large whether more people were sticking to one child. Now that assumption is being questioned. Is the valuable role played by siblings in elderly care factored into the welfare debate? Will an economy with fewer creative middle children be as competitive? How easy will the state find waging war when more parents are reluctant to see their only child march to the front?

More broadly, the last decade has seen a major evolution in academic thinking about siblings. They have ousted parents as being the key driver behind personality development. And where, 30 years ago, academics such as Toni Falbo argued that to be born an only child was to have won the lottery of life, now research is running in the opposite direction.

A slew of reports by serious scholars, such as Prof Judy Dunn of King's College London, have chipped away at the idea that family size is the product of a consequence-free decision. Researchers have shown that "siblinged" children will have stronger soft skills and keener emotional intelligence than single children. They will be better at gratification deferment (because they have learnt to wait their turn) and hit motor milestones such as walking and talking more rapidly than those without sibling stimulation.

Some of the most recent evidence even suggests that a child with a brother and/or sister will have more evolved language skills and do better at exams. This information is truly revolutionary. For decades, the assumption of academic ideas such as the Dilution Theory has been that less is more.

Have too many children and, as a parent, you will not be able to leverage your resources on to a solitary stellar-achieving child. Indeed, for parents who cannot stop themselves hovering above and over-scheduling their hurried offspring, a sibling for their one-and-only can be the antidote to pushy parenting.

"There is a danger of suffocating a child with too much pressure," Amy Chua told me in an interview. She is the best-selling author of The Battle Hymn of the Tiger Mother, a parent so determined to wring the last drop of performance out of her children that she would arrange marathon daily violin lessons, even on holiday. Having more than one, said Chua, had blunted her laser-like focus.

Chua's views on parenting have been heeded by millions. But I also wanted to listen to those anonymous child-care professionals who will, often sotto voce, argue that British children are changing, and not for the better. The kindergarten nanny, for instance, who told me of the game she plays spotting which of her new intake has a brother or sister (she claimed a 90 per cent success rate).

To some only-children and their parents, that will sound the ancient hollow note of animus towards those deemed somehow selfish in not – where possible – having another. In truth, that bigotry has fewer adherents nowadays. People understand that being a one-off parent is a natal no-brainer, a logical response to the economic challenges of parenthood. What, hitherto, they have failed to see, is that modern social science is rewriting the way we see siblings and, yes, it may be worth paying in the short term to benefit in the long term. Either way, the Cost of the Sibling is nothing like as high as some would have you believe.

And what of my own children? How do they feel, providing the material for a sibling laboratory? The eldest, just 14, has already announced that, should she have children, their numbers will be limited.

My wife and I started out similarly sceptical about fecundity. But, having struggled to have a second child, it was hard to shake the mindset that a pregnancy was anything other than a blessing. As our family expanded, necessitating bigger cars and fewer holidays, we took to heart the views attributed to Elizabeth Longford, the historian and Roman Catholic mother-of-eight. Asked why so many, she said that since her children were so different, curiosity drove her to find the limits of genetic diversity.

We find that a big family has unleashed the inner anthropologist in us, too. Some friends flinch at the managed chaos of our home, but my wife and I love the abundance of human interaction. We are the directors of our own daily soap opera.

Colin Brazier is a presenter for Sky News. His book, 'Sticking up for Siblings', will be published by Civitas on August 22. To order, contact Civitas on 020 7799 6677

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/2dfc1aaf/l/0L0Stelegraph0O0Cwomen0Cmother0Etongue0Cfamilyadvice0C10A149910A0CWhy0Ehaving0Ebig0Efamilies0Eis0Egood0Efor0Eyou0Eand0Echeaper0Bhtml/story01.htm

Hundreds of thousands out for London's gay pride

1 of 7. People take part in the first Gay Pride march (Marche des Fiertes) since a French law permitting gay and lesbian marriage was passed, in Paris June 29, 2013.

Credit: Reuters/Gonzalo Fuentes

Source : http://feeds.reuters.com/~r/reuters/lifestyle/~3/Kaqh0ajZmMI/story01.htm

U.S. sets birth control rule for employers with religious ties

WASHINGTON | Fri Jun 28, 2013 11:32am EDT

WASHINGTON (Reuters) - The Obama administration on Friday issued its final rule requiring health insurance coverage of contraceptives for the employees of faith-affiliated universities, hospitals and other institutions.

Officials said the rule does not differ substantially from a proposed version released earlier this year that sought to insulate employers that oppose birth control on religious grounds by providing the benefits to their workers without out-of-pocket costs through outside plans funded by insurers.

Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/ejdz2BaUZf0/story01.htm

Patients facing eight-hour waits in ambulances outside A&E departments

"Patients can't get into A&E because there isn't an empty cubicle, let alone the staff, so they end up trapped in ambulances. Meanwhile A&E is full of patients who can't be moved onto wards, because they are full of elderly people who can't be discharged because there isn't help at home," he said.

In twelve months, the numbers waiting at least four hours before "handover" to A&E staff tripled, with 96 such cases in 2012/13, the figures show.

The longest delays were at Royal Cornwall Hospital in Truro.

On one day in March, one patient waited more than eight hours before handover, while two others waited more than seven hours.

Letters seen by this newspaper disclose that a month later, Ken Weyman, the chief executive of South Western Ambulance Service, warned the hospital's chief executive that the equivalent of 14 crews were being lost each day because they were stuck at casualty units.

The situation had left the 999 service, which covers Cornwall, Devon, Dorset, Gloucestershire, Somerset, Wiltshire and Avon, with no ambulances to send to life-threatening calls, he said.

Earlier correspondence from Norma Lane, executive director of delivery at the ambulance service cites incidents in which six ambulances at a time were stuck parked outside the hospital.

The letter, seen by The Sunday Telegraph, says: "This is unacceptable from the views of patients waiting, as well as presenting serious risks to those patients."

It continues: "The impact on our resources significantly compromises our ability to respond to life-threatening calls and extends serious risk to the public."

At Stepping Hill Hospital in Stockport, a patient waited almost six hours last December, while at Tameside Greater Hospital, in Lancashire, there was a wait of more than five hours, according to disclosures under the Freedom of Information Act.

The vast majority of the longest delays were in the South, with 67 patients who called South Central Ambulance Service waiting four hours outside A&E, compared with 24 such cases the previous year.

In total, 18 patients waited more than four hours for handover Queen Alexandra Hospital, Portsmouth, with 13 such waits outside Royal Hampshire County Hospital and 12 outside Wexham Park Hospital in Slough.

In documents seen by this newspaper, Will Hancock, the head of South Central Ambulance trust, said queues at A&E meant one ambulance crew had been left caring for 10 hospital patients at once – putting them in danger.

His log discloses a knock-on effect on others calling 999, describing delays of 30 minutes for paramedics to see a patient with chest pains – which can signal a heart attack – and of more than 20 minutes in response to a person choking, and a young woman coughing up blood.

A second letter sent to Ursula Ward, chief executive of Portsmouth Hospitals NHS trust, last November, said the problems had caused delays sending ambulances to four further incidents categorised as "life-threatening".

Patients also waited at least four hours at Broomfield Hospital in Chelmsford; Norfolk and Norwich Hospital; Southend Hospital;, Milton Keynes Hospital; Southampton General Hospital: Royal Berkshire Hospital in Reading; John Radcliffe Hospital in Oxford; Basingstoke and North Hampshire Hospital; Stoke Mandeville Hospital; Warrington General Hospital; Southport District General Hospital; Solihull Hospital, Royal Shrewsbury Hospital; Sandwell General Hospital; City Hospital in Birmingham and University Hospital of Coventry and Warwickshire.

South Central Ambulance Service said the delays were a "major concern" and work was underway to redesign A&E systems to tackle the problem.

Royal Cornwall Hospitals trust declined to comment.

Portsmouth Hospitals trust said the waiting times were related to a number of factors including public demand and availability of community care.

Simon Holmes, medical director, said that for some periods the trust had adopted a policy of keeping a single ambulance crew as a handover team so other crews could get back on the road more rapidly.

NHS England said that Professor Sir Bruce Keogh, national medical director, is leading an urgent and emergency care review to address problems currently faced in urgent care, including ambulance services, which began public consultation earlier this month

Last year this newspaper revealed that Monitor, the regulator of NHS foundation trusts, had warned hospitals not to keep patients in ambulances in order to comply with the government target of treating all patients admitted to A&E within four hours.

Monitor said that hospitals who used the technique – known as "stacking" – risked "serious implications" for their patients and tied down ambulances needed to respond to emergencies.

Although the practice began under Labour, the extent of this has risen sharply under the Coalition. Local newspapers have found instances of as many as 14 ambulances queuing up outside a hospital A&E department.

In a letter to trusts last year, Monitor specifically warned hospitals against "gaming to meet health care targets". "We would encourage all trusts to ensure that such practices are not taking place at your hospitals," the regulator's letter read. "Evidence of foundation trusts carrying out these practices would be taken very seriously by Monitor."

The watchdog has the power to sack health trust boards or issue fines.

Ever since the Coalition was formed three years ago, ministers have pledged to protect the NHS from the spending cuts being felt across Whitehall departments and local government.

However, in his spending review last week George Osborne, the Chancellor, announced that councils would gain access billions of the health service's budget used to pay for care for the elderly. Experts claims this will lead to a major squeeze on the NHS's front-line services.

Under the new plans the NHS will pay £2 billion a year to local authorities to support those who need social care – up from an annual contribution of £1 billion. The government has said this will ease pressure on A&E departments by moving elderly people away from hospitals.

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/2dfa802a/l/0L0Stelegraph0O0Chealth0Chealthnews0C10A150A6350CPatients0Efacing0Eeight0Ehour0Ewaits0Ein0Eambulances0Eoutside0EAandE0Edepartments0Bhtml/story01.htm

Why having big families is good for you (and cheaper)

So, with the help of Swedish researcher Therese Wallin, I set about pulling together data that put a different cost/benefit complexion on the "shall we have another?" conversation.

Some of the most startling literature comes from medical research. It has long been known that siblings – by sharing germs at a young age and mutually priming immune systems – provide some protection against atopic conditions such as hay fever and eczema. But the latest breakthroughs suggest growing up with a brother or sister can also guard against food allergies, multiple sclerosis and some cancers. For reasons that have yet to be fully fathomed, these benefits do not apply to children simply by dint of spending time sharing bugs with other youngsters – as they would, for instance, in day care.

The other "epidemics" of modern childhood, obesity and depression, are also potentially reduced by exposure to siblings. A clutch of major studies from all over the world shows that the more siblings a child has, the thinner they will be. Put simply, siblings help children burn off fat. One American study honed its analysis down to an amazingly precise deduction: with each extra brother or sister, a child will be, on average, 14 per cent less obese. Reductio ad absurdum? We can scoff at such a definitive conclusion, until we realise that no one in medical academia has suggested that having a sibling ever made anyone fatter.

None of this is rocket science. When we compare like with like, regardless of family background, children with siblings tend to enjoy better mental health. Obviously, again, this is to generalise massively. The world is full of jolly singletons. But dig into some of the big data sets out there and unignorable patterns emerge. On experiences on which nation states hold a big corpus of statistics, events such as divorce and death, for example, strong correlations exist.

Cause is not always correlation, but it stands to reason that when parents split up or die, a child will benefit from having a sibling to turn to.That solidarity runs throughout the lifespan. After all, a sibling is for life, not just for childhood.

Indeed, policymakers with an eye to areas beyond elderly care may need to wake up to the shifting sands of family composition. In the late 20th century, the received wisdom among sociologists was that it mattered not a jot to society at large whether more people were sticking to one child. Now that assumption is being questioned. Is the valuable role played by siblings in elderly care factored into the welfare debate? Will an economy with fewer creative middle children be as competitive? How easy will the state find waging war when more parents are reluctant to see their only child march to the front?

More broadly, the last decade has seen a major evolution in academic thinking about siblings. They have ousted parents as being the key driver behind personality development. And where, 30 years ago, academics such as Toni Falbo argued that to be born an only child was to have won the lottery of life, now research is running in the opposite direction.

A slew of reports by serious scholars, such as Prof Judy Dunn of King's College London, have chipped away at the idea that family size is the product of a consequence-free decision. Researchers have shown that "siblinged" children will have stronger soft skills and keener emotional intelligence than single children. They will be better at gratification deferment (because they have learnt to wait their turn) and hit motor milestones such as walking and talking more rapidly than those without sibling stimulation.

Some of the most recent evidence even suggests that a child with a brother and/or sister will have more evolved language skills and do better at exams. This information is truly revolutionary. For decades, the assumption of academic ideas such as the Dilution Theory has been that less is more.

Have too many children and, as a parent, you will not be able to leverage your resources on to a solitary stellar-achieving child. Indeed, for parents who cannot stop themselves hovering above and over-scheduling their hurried offspring, a sibling for their one-and-only can be the antidote to pushy parenting.

"There is a danger of suffocating a child with too much pressure," Amy Chua told me in an interview. She is the best-selling author of The Battle Hymn of the Tiger Mother, a parent so determined to wring the last drop of performance out of her children that she would arrange marathon daily violin lessons, even on holiday. Having more than one, said Chua, had blunted her laser-like focus.

Chua's views on parenting have been heeded by millions. But I also wanted to listen to those anonymous child-care professionals who will, often sotto voce, argue that British children are changing, and not for the better. The kindergarten nanny, for instance, who told me of the game she plays spotting which of her new intake has a brother or sister (she claimed a 90 per cent success rate).

To some only-children and their parents, that will sound the ancient hollow note of animus towards those deemed somehow selfish in not – where possible – having another. In truth, that bigotry has fewer adherents nowadays. People understand that being a one-off parent is a natal no-brainer, a logical response to the economic challenges of parenthood. What, hitherto, they have failed to see, is that modern social science is rewriting the way we see siblings and, yes, it may be worth paying in the short term to benefit in the long term. Either way, the Cost of the Sibling is nothing like as high as some would have you believe.

And what of my own children? How do they feel, providing the material for a sibling laboratory? The eldest, just 14, has already announced that, should she have children, their numbers will be limited.

My wife and I started out similarly sceptical about fecundity. But, having struggled to have a second child, it was hard to shake the mindset that a pregnancy was anything other than a blessing. As our family expanded, necessitating bigger cars and fewer holidays, we took to heart the views attributed to Elizabeth Longford, the historian and Roman Catholic mother-of-eight. Asked why so many, she said that since her children were so different, curiosity drove her to find the limits of genetic diversity.

We find that a big family has unleashed the inner anthropologist in us, too. Some friends flinch at the managed chaos of our home, but my wife and I love the abundance of human interaction. We are the directors of our own daily soap opera.

Colin Brazier is a presenter for Sky News. His book, 'Sticking up for Siblings', will be published by Civitas on August 22. To order, contact Civitas on 020 7799 6677

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/2dfc1aaf/l/0L0Stelegraph0O0Cwomen0Cmother0Etongue0Cfamilyadvice0C10A149910A0CWhy0Ehaving0Ebig0Efamilies0Eis0Egood0Efor0Eyou0Eand0Echeaper0Bhtml/story01.htm

Farewell Dame Edna, the global gigastar from Moonee Ponds

By putting a non-porous barrier between himself and Edna, Humphries has not only fed the idea of his character as someone else entirely, but also avoided having to do any talking on her behalf. So we're largely left with Edna's own explanation of what she means to us: "In the early days," she says, "I was mousy, timid, extremely reticent and, above all, vulnerable… then I grew in confidence and authority. I felt I had something to tell the audience, though I didn't know what it was. So I told them about themselves. I described my own home and people listened and they said, 'We know that house, we know that lava lamp, we know that picture on the wall, the Chinese girl with the tinted green face.' And slowly they began to feel that where they lived was not such a boring place, after all, because I had enshrined it in a work of art."

In other words, she represented a kind of universal dread; one that lurked in minds in places the young Humphries didn't even know existed: the fear of being left behind.

But where did the actual meat and bones of Edna come from? While Humphries is enduringly evasive on the subject, others have detected echoes of a troubled relationship with his mother. In his autobiography, My Life as Me, Louisa Humphries, wife of a Melbourne engineer, comes across as strident, fussy, narrow-minded and suspicious of anything that smacks of enlightenment. A particularly poignant passage recounts how young Barry, a voracious reader, returned home one day to discover that his mother had given all his books away.

"But why?" he sobbed. "They were my books."

"Don't be silly, Barry," sighed Mrs H. "You've read them."

While he doesn't pretend it was a particularly happy childhood, Humphries plays down the suggestion that he modelled Edna directly on Louisa – citing instead the family's talkative daily help, a local woman called Shores. "My poor mother has been press-ganged into the role of Edna's prototype," he has written, "by the speculations of critics. Naturally, the character has borrowed more than a little of my mother's astringency of phrase, but Edna's garrulity derives from Shores…"

Barry was never going to find his future in the Melbourne suburbs. From an early age he displayed a talent for repartee, putting together songs and sketches and displaying a fascination for surrealism and the Dadaist movement that drove much of his later work. While studying philosophy and fine arts at university, he penned a sketch about a woman offering accommodation to foreign athletes visiting Australia for the 1956 Olympics, "as long as they're white and speak English".

He hadn't intended to perform it himself, but when the female student due to play the part fell ill, Barry draped himself in a frock and took to the stage. In the decades that followed, he has been a restless perfectionist, moving between his homes in England, Australia, Switzerland and New York.

Despite 60 years as a performer, artist and writer, he remains an enigma behind those diamante-encrusted glasses. Even the women he has been married to have struggled to understand him. Brenda Wright, his second wife (of four), once said: "He puts a smokescreen around his personal life and presents himself in a certain way, which isn't reality. I was perturbed by the perceptions he had of people, some of which were very cruel."

It is better, and certainly Humphries's preference, to let Edna speak for herself. The threadbare dress and hairy legs have given way to resplendence, the company of notables, the homage of nations and the wisdom of age, but at heart the dame is still the gladdie-waving La Stupenda of Moonee Ponds.

"I always have to go back to Australia to reconnect with my roots," she explains. "Sitting under an anthill communicating with my spirit ancestors. That's how I get the strength I need to perform my mission, for that is what it is, possums: a glorious opportunity to pass on to ordinary people the gifts Dame Nature gave me."

Next year she will pass into retirement. And since we know that she's only human, we can't really complain.

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/2dfc1aae/l/0L0Stelegraph0O0Cculture0Ccomedy0C10A1498780CFarewell0EDame0EEdna0Ethe0Eglobal0Egigastar0Efrom0EMoonee0EPonds0Bhtml/story01.htm

The untold story of gun violence - life-altering injuries

1 of 12. Miles Turner is helped up the stairs to his home by his mother Angela and his father Miles in Chicago, Illinois, June 9, 2013.

Credit: Reuters/Jim Young (UNITED STATES - Tags: CIVIL UNREST CRIME LAW)

By Mary Wisniewski

CHICAGO | Sat Jun 29, 2013 4:33pm EDT

CHICAGO (Reuters) - Miles Turner V, 18, was shot at least five times on a Chicago sidewalk last October. Doctors believed he might die, but he survived.

The high school football player, who had never been in any trouble, is now undergoing physical therapy, in hopes of being able to walk again.

"His life has changed dramatically from what it was," said his father, Miles Turner IV. "It's not easy."

Young Miles represents a largely untold side of the gun violence story. It's about the survivors who must live with costly and often permanently debilitating injuries.

The Healthcare Cost and Utilization Project, a group of national hospital databases, in 2009 showed 76,100 emergency room visits for gunshot wounds, about half of which involved assault. That same year, the U.S. Centers for Disease Control logged 11,493 firearm homicides - less than a third of the number of assault injuries.

One notable example of a gunshot survivor whose life was permanently changed is former Arizona Congresswoman Gabrielle Giffords, who was shot in the head during a public appearance in 2011. She retired from Congress to focus on a lengthy recovery.

"Just looking at the number of deaths misses the enormity of the problem of street shootings," said David Hemenway, director of the Harvard Injury Control Research Center, who would like to see more research done on non-fatal gunshot injuries. "Until you can quantify the enormity of the problem, you can't figure out what interventions work and don't work."

MILES TURNER'S RECOVERY

Miles Turner V was around the corner from his home on Chicago's South Side, talking with a girl on her porch, when his cousin came by. Unlike Miles, who took no interest in street life, Modell McCambry, 17, was a gang "wannabe," according to Miles' father.

A gunman stepped out of the gangway and shot Modell. As Miles bent over to embrace his mortally wounded cousin, he was shot in the back, his parents said. The assailant has not been caught.

Miles was so gravely wounded that after one surgery, doctors told his father the youth's intestines fell through their hands when they picked them up. He remained in a medically induced coma for weeks.

Around Christmas, Miles was moved to a specialty wound center, and then to the Rehabilitation Institute of Chicago before going home in May. Teachers from Leo Catholic High School tutored him so he could keep up with his education, and he graduated June 2.

Adjustment to the physical changes in his life has been difficult for Miles. The former athlete has a catheter and needs a wheelchair to move around. His parents rise early to help him wash and get dressed, before they go to work.

Normally sociable and with a good sense of humor, during his treatments Miles was sometimes withdrawn, said his mother, Angela Turner.

She recalled sitting at his bedside and telling him: "It's unfortunate that this happened to you but He spared your life, so it's not the end. It's just something we have to deal with right now."

COSTLY INJURIES

A shooting - fatal or not - is a nest of different costs, including the price of criminal justice and the destruction of a community by fear, Hemenway said.

"The medical care costs can be very hard - the victim's quality of life goes way down, and the costs to society can be enormous," he said.

It is difficult to say if advances in medical care have decreased deaths or improved injury outcomes, said Hemenway, since firearms, like medicine, have become more potent.

Injuries from firearms cost close to $21 billion in 2010, according to a study published in 2012 by the Pacific Institute for Research and Evaluation, a non-profit independent research group. Factored into the costs are lost work time, medical care, emergency transport services and police work, the study said.

In Cook County, which includes Chicago, every gunshot victim that enters the public hospital system costs taxpayers an average of $52,000. There were 846 reported victims in 2012, putting the costs at about $44 million.

"The terrible truth is the people who die cost us less than the people who live," said County Board President Toni Preckwinkle, speaking on the issue last fall.

This is a plague that affects mostly young males. Assault-related gunshot injuries are nine times higher among men, and three times more likely for victims aged 18-29 than any other age group, according to the healthcare project.

Nationally, 44 percent of injuries related to assault in 2009 involved victims without insurance, while 25 percent were billed to Medicaid, the project found.

Miles Turner's medical bills have been covered largely by insurance from his parents' jobs.

But incidental costs have hit hard. Parking, for example, cost $24, twice a day, at one facility. The shootings drove away tenants from the buildings the Turners own, which has forced them to dig into retirement savings to pay bills.

CONSEQUENCES OF SURVIVAL

Sometimes a non-fatal shooting can be a turning point that brings someone out of a dangerous lifestyle, according to Dr. Marie Crandall, a surgeon at Chicago's Northwestern Memorial Hospital.

Northwestern refers injured people to CeaseFire Illinois, an anti-violence group that works to stem gang shootings and offers resources such as job skill training.

"People have definitely told me, in post-op follow ups, that this injury has set them straight," Crandall said. "It's sad, and it's an opportunity."

But she sometimes sees the same people in the trauma center more than once.

Even for those whose lives are not ruled by violence, a gunshot wound can change priorities. Chicago native Andrew Holmes was shot in the leg during an attempted robbery when he was in his 20s. It took him six painful months to learn to walk again.

Now 53, he said care shown by medical staff inspired him to become a community activist against violence. "A person's life is turned all the way around," Holmes said.

Miles Turner V hopes to attend the University of Miami, and learn how to make video games. His parents say he will likely enroll at a community college first. And Illinois Governor Pat Quinn, upon learning that Miles was good with computers, has offered him a job.

Miles Turner IV said he never asked God why this happened to his youngest child. "The only thing I asked the Lord was to let my son live."

But he does get angry at the young people on the streets who seem to care little about the damage bullets can do.

"It destroys everything," said Turner.

(Reporting by Mary Wisniewski; Editing by Arlene Getz, Greg McCune and Gunna Dickson)

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Hundreds of thousands out for London's gay pride

1 of 7. People take part in the first Gay Pride march (Marche des Fiertes) since a French law permitting gay and lesbian marriage was passed, in Paris June 29, 2013.

Credit: Reuters/Gonzalo Fuentes

Source : http://feeds.reuters.com/~r/reuters/lifestyle/~3/Kaqh0ajZmMI/story01.htm

The untold story of gun violence - life-altering injuries

1 of 12. Miles Turner is helped up the stairs to his home by his mother Angela and his father Miles in Chicago, Illinois, June 9, 2013.

Credit: Reuters/Jim Young (UNITED STATES - Tags: CIVIL UNREST CRIME LAW)

By Mary Wisniewski

CHICAGO | Sat Jun 29, 2013 4:33pm EDT

CHICAGO (Reuters) - Miles Turner V, 18, was shot at least five times on a Chicago sidewalk last October. Doctors believed he might die, but he survived.

The high school football player, who had never been in any trouble, is now undergoing physical therapy, in hopes of being able to walk again.

"His life has changed dramatically from what it was," said his father, Miles Turner IV. "It's not easy."

Young Miles represents a largely untold side of the gun violence story. It's about the survivors who must live with costly and often permanently debilitating injuries.

The Healthcare Cost and Utilization Project, a group of national hospital databases, in 2009 showed 76,100 emergency room visits for gunshot wounds, about half of which involved assault. That same year, the U.S. Centers for Disease Control logged 11,493 firearm homicides - less than a third of the number of assault injuries.

One notable example of a gunshot survivor whose life was permanently changed is former Arizona Congresswoman Gabrielle Giffords, who was shot in the head during a public appearance in 2011. She retired from Congress to focus on a lengthy recovery.

"Just looking at the number of deaths misses the enormity of the problem of street shootings," said David Hemenway, director of the Harvard Injury Control Research Center, who would like to see more research done on non-fatal gunshot injuries. "Until you can quantify the enormity of the problem, you can't figure out what interventions work and don't work."

MILES TURNER'S RECOVERY

Miles Turner V was around the corner from his home on Chicago's South Side, talking with a girl on her porch, when his cousin came by. Unlike Miles, who took no interest in street life, Modell McCambry, 17, was a gang "wannabe," according to Miles' father.

A gunman stepped out of the gangway and shot Modell. As Miles bent over to embrace his mortally wounded cousin, he was shot in the back, his parents said. The assailant has not been caught.

Miles was so gravely wounded that after one surgery, doctors told his father the youth's intestines fell through their hands when they picked them up. He remained in a medically induced coma for weeks.

Around Christmas, Miles was moved to a specialty wound center, and then to the Rehabilitation Institute of Chicago before going home in May. Teachers from Leo Catholic High School tutored him so he could keep up with his education, and he graduated June 2.

Adjustment to the physical changes in his life has been difficult for Miles. The former athlete has a catheter and needs a wheelchair to move around. His parents rise early to help him wash and get dressed, before they go to work.

Normally sociable and with a good sense of humor, during his treatments Miles was sometimes withdrawn, said his mother, Angela Turner.

She recalled sitting at his bedside and telling him: "It's unfortunate that this happened to you but He spared your life, so it's not the end. It's just something we have to deal with right now."

COSTLY INJURIES

A shooting - fatal or not - is a nest of different costs, including the price of criminal justice and the destruction of a community by fear, Hemenway said.

"The medical care costs can be very hard - the victim's quality of life goes way down, and the costs to society can be enormous," he said.

It is difficult to say if advances in medical care have decreased deaths or improved injury outcomes, said Hemenway, since firearms, like medicine, have become more potent.

Injuries from firearms cost close to $21 billion in 2010, according to a study published in 2012 by the Pacific Institute for Research and Evaluation, a non-profit independent research group. Factored into the costs are lost work time, medical care, emergency transport services and police work, the study said.

In Cook County, which includes Chicago, every gunshot victim that enters the public hospital system costs taxpayers an average of $52,000. There were 846 reported victims in 2012, putting the costs at about $44 million.

"The terrible truth is the people who die cost us less than the people who live," said County Board President Toni Preckwinkle, speaking on the issue last fall.

This is a plague that affects mostly young males. Assault-related gunshot injuries are nine times higher among men, and three times more likely for victims aged 18-29 than any other age group, according to the healthcare project.

Nationally, 44 percent of injuries related to assault in 2009 involved victims without insurance, while 25 percent were billed to Medicaid, the project found.

Miles Turner's medical bills have been covered largely by insurance from his parents' jobs.

But incidental costs have hit hard. Parking, for example, cost $24, twice a day, at one facility. The shootings drove away tenants from the buildings the Turners own, which has forced them to dig into retirement savings to pay bills.

CONSEQUENCES OF SURVIVAL

Sometimes a non-fatal shooting can be a turning point that brings someone out of a dangerous lifestyle, according to Dr. Marie Crandall, a surgeon at Chicago's Northwestern Memorial Hospital.

Northwestern refers injured people to CeaseFire Illinois, an anti-violence group that works to stem gang shootings and offers resources such as job skill training.

"People have definitely told me, in post-op follow ups, that this injury has set them straight," Crandall said. "It's sad, and it's an opportunity."

But she sometimes sees the same people in the trauma center more than once.

Even for those whose lives are not ruled by violence, a gunshot wound can change priorities. Chicago native Andrew Holmes was shot in the leg during an attempted robbery when he was in his 20s. It took him six painful months to learn to walk again.

Now 53, he said care shown by medical staff inspired him to become a community activist against violence. "A person's life is turned all the way around," Holmes said.

Miles Turner V hopes to attend the University of Miami, and learn how to make video games. His parents say he will likely enroll at a community college first. And Illinois Governor Pat Quinn, upon learning that Miles was good with computers, has offered him a job.

Miles Turner IV said he never asked God why this happened to his youngest child. "The only thing I asked the Lord was to let my son live."

But he does get angry at the young people on the streets who seem to care little about the damage bullets can do.

"It destroys everything," said Turner.

(Reporting by Mary Wisniewski; Editing by Arlene Getz, Greg McCune and Gunna Dickson)

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WHO wants HIV patients treated sooner to save lives, halt spread

An HIV-infected patient displays medicine at a hospital in Payao province, about 600 km (373 miles) north of Bangkok November 28, 2007.

Credit: Reuters/Sukree Sukplang

By Kate Kelland

LONDON | Sun Jun 30, 2013 12:49am EDT

LONDON (Reuters) - Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organization said on Sunday.

While better access to cheap generic AIDS drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed.

But in new guidelines aimed at controlling and eventually reducing the global AIDS epidemic, the U.N. health agency said some 26 million HIV-positive people - or around 80 percent of all those with the virus - should be getting drug treatment.

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else.

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/AIDS department director.

"And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV."

Some 34 million people worldwide have the HIV virus that causes AIDS and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region.

But the epidemic - which has killed 25 million people in the 30 years since HIV was first discovered - is showing some signs of being turned around. The United Nations AIDS program UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving AIDS drugs in 2012, up from just 300,000 people a decade earlier, according to latest WHO data also published on Sunday.

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drugmakers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline.

"IRREVERSIBLE DECLINE"?

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease.

"With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she said in a statement.

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimeter or less.

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

The guidelines also say all pregnant or breastfeeding women and all children under five with HIV should start treatment immediately, whatever their CD4 count, and that all HIV patients should be regularly monitored to assess their "viral load".

This allows health workers to check whether the medicines are reducing the amount of virus in the blood. It also encourages patients to keep taking their medicine because they can see it having positive results.

"There's no greater motivating factor for people to stick to their HIV treatment than knowing the virus is ‘undetectable' in their blood," said Gilles van Cutsem, the medical coordinator in South Africa for the international medical humanitarian organisation Médecins Sans Frontières (MSF).

MSF welcomed the new guidelines but cautioned that the money and the political will to implement them was also needed.

"Now is not the time to be daunted but to push forward," MSF president Unni Karunakara said in a statement. "So it's critical to mobilize international support... including funding for HIV treatment programs from donor governments."

The WHO's Hirnschall said getting AIDS drugs to the extra patients brought in by the new guidelines would require another 10 percent on top of the $22-$24 billion a year currently needed to fund the global fight against HIV and AIDS.

(Editing by Gareth Jones)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/S0tmcLU9vVA/story01.htm

U.S. sets birth control rule for employers with religious ties

WASHINGTON | Fri Jun 28, 2013 11:32am EDT

WASHINGTON (Reuters) - The Obama administration on Friday issued its final rule requiring health insurance coverage of contraceptives for the employees of faith-affiliated universities, hospitals and other institutions.

Officials said the rule does not differ substantially from a proposed version released earlier this year that sought to insulate employers that oppose birth control on religious grounds by providing the benefits to their workers without out-of-pocket costs through outside plans funded by insurers.

Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/ejdz2BaUZf0/story01.htm

WHO wants HIV patients treated sooner to save lives, halt spread

An HIV-infected patient displays medicine at a hospital in Payao province, about 600 km (373 miles) north of Bangkok November 28, 2007.

Credit: Reuters/Sukree Sukplang

By Kate Kelland

LONDON | Sun Jun 30, 2013 12:49am EDT

LONDON (Reuters) - Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organization said on Sunday.

While better access to cheap generic AIDS drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed.

But in new guidelines aimed at controlling and eventually reducing the global AIDS epidemic, the U.N. health agency said some 26 million HIV-positive people - or around 80 percent of all those with the virus - should be getting drug treatment.

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else.

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/AIDS department director.

"And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV."

Some 34 million people worldwide have the HIV virus that causes AIDS and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region.

But the epidemic - which has killed 25 million people in the 30 years since HIV was first discovered - is showing some signs of being turned around. The United Nations AIDS program UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving AIDS drugs in 2012, up from just 300,000 people a decade earlier, according to latest WHO data also published on Sunday.

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drugmakers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline.

"IRREVERSIBLE DECLINE"?

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease.

"With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she said in a statement.

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimeter or less.

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

The guidelines also say all pregnant or breastfeeding women and all children under five with HIV should start treatment immediately, whatever their CD4 count, and that all HIV patients should be regularly monitored to assess their "viral load".

This allows health workers to check whether the medicines are reducing the amount of virus in the blood. It also encourages patients to keep taking their medicine because they can see it having positive results.

"There's no greater motivating factor for people to stick to their HIV treatment than knowing the virus is ‘undetectable' in their blood," said Gilles van Cutsem, the medical coordinator in South Africa for the international medical humanitarian organisation Médecins Sans Frontières (MSF).

MSF welcomed the new guidelines but cautioned that the money and the political will to implement them was also needed.

"Now is not the time to be daunted but to push forward," MSF president Unni Karunakara said in a statement. "So it's critical to mobilize international support... including funding for HIV treatment programs from donor governments."

The WHO's Hirnschall said getting AIDS drugs to the extra patients brought in by the new guidelines would require another 10 percent on top of the $22-$24 billion a year currently needed to fund the global fight against HIV and AIDS.

(Editing by Gareth Jones)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/S0tmcLU9vVA/story01.htm

Surgeon allowed to work despite inquiry into 10 deaths

Mr Jones' family only learnt that the hospital had concerns about Mr Sarker after an original inquest into his death was dramatically halted midway through when the coroner was informed of the trust's investigation.

Mr Jones' son, Simon Middup-Jones, 52, said: "You put your trust in these people, you presume they are very qualified and very capable. You put your trust in them but unfortunately I don't think we should have."

Mr Sarker's colleagues first raised concerns in June last year.

The trust allowed him to continue to operate under supervision. At the same time, it commission the RCS report.

It is understood that the RCS examined the cases of 75 of Mr Sarker's patients and compared them to the cases of two other doctors working in similar fields.

The RCS found that Mr Sarker had an eight per cent mortality rate, with six patients dying within 28 days of surgery. The two sample doctors had three deaths between them in the same period.

The investigation also found that Mr Sarker's patient readmission rate was more than three times that of the other two doctors.

In addition, the RCS recommended that further checks be carried out on Mr Sarker's online CV, which allegedly included a claim that he won a "distinction in surgery" prize which does not exist.

The findings of the RCS report remained concealed for nearly a year until details were leaked by a whistleblower.

The trust admitted it allowed Mr Sarker to operate on patients without telling them of its concerns and investigations.

It only disclosed the existence of the report this month and refuses to publish it on legal advice.

Jennifer Emerson, a solicitor at law firm Irwin Mitchell, representing a number of families who have lost loved ones, said: "It is appalling that despite a recommendation by the Royal College of Surgeons the ongoing investigation has not being made public."

One of Mr Sarker's patients, Mrs Thomas, a widow, died in September.

She had been diagnosed with colon cancer in May and underwent an operation at the Alexandra Hospital, performed by Mr Sarker.

However it is believed the surgery failed to take out all the cancer and Mrs Thomas needed follow-up surgery two weeks later.

She was readmitted to hospital three more times before dying of suspected multiple organ failure.

Marten Coates, a crown court judge and close friend of Mrs Thomas who is managing her estate, has instructed lawyers Irwin Mitchell to investigate the trust.

He has also reported Mr Sarker to the General Medical Council, the medical watchdog, which has confirmed it is investigating the surgeon.

It placed restrictions on his licence to practise in February.

Judge Coates said: "The trust we now know notified the Royal College of Surgeons of its concerns about Sudip Sarker's practice in July 2012.

"Jean Thomas was an inpatient on their wards after that date. No one told Jean or those close to her."

He added: "Sudip Sarker led Jean to believe that it would be a quick operation, a straightforward keyhole procedure and the cancer would be removed. She would be discharged and that would be the end of her case.

"But in fact my understanding is that the procedure chosen and performed by Sudip Sarker was wholly inappropriate."

A second patient, Mr Jones, died at the hospital in June last year after an operation to remove a part of his intestine.

Mr Middup-Jones said his father, who ran a joinery firm in Bewdley in Worcestershire, was "fit and strong" for his age when he started to feel unwell in February last year.

He visited his GP and was later referred to Mr Sarker, who confirmed that he had early stages of rectal cancer and would need surgery. He underwent a colostomy at Alexandra Hospital on May 30.

After the operation Mr Jones was taken to intensive care to recover.

Mr Jones said his father seemed to be "rallying" and was looking forward to being moved onto a ward but on June 5 his condition deteriorated and he died the next day. The post-mortem noted cause of death as septic shock from a wound infection.

Mr Jones left his wife, Jane, four children and seven grandchildren.

His family said that initially, although they were shocked by his death, they accepted that any surgery carried risks.

It was only during the inquest into Mr Jones' death earlier this year that they discovered the surgeon who carried out the operation was under investigation.

Mr Middup-Jones said the coroner was questioning Mr Sarker when a court official interrupted the hearing to say there was a phone call.

Mr Middup-Jones said: "When the coroner returned, she turned to Mr Sarker and said 'am I correct in understanding you are under investigation for your methodology and practices?'

"It was a complete bombshell, you could have heard a pin drop.

"It was the first we knew anything about it."

Mr Jones' family has also instructed Irwin Mitchell Solicitors to examine if they have a claim for medical negligence.

Lindsay Tomlinson, associate solicitor specialising in medical law at Irwin Mitchell, said: "We have serious concerns about the death rates and surgery complication figures we have seen in the news but are equally concerned by the fact that it seems that colleagues were so concerned about Mr Sarker that they reported him to the RCS yet he was allowed to continue working for the Trust for a further three months."

Worcester Acute Services Hospital Trust said it had taken advice about telling Dr Sarker's patients of the investigation into him.

A Trust spokesman said: "In this specific case the Trust considered this matter with NCAS (National Clinical Assessment Service) to determine what measures were required to maintain patient safety. In those areas where the surgeon's practice had been questioned the critical responsibility was transferred to a supervising surgeon."

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/2dfa8029/l/0L0Stelegraph0O0Chealth0Chealthnews0C10A150A6960CSurgeon0Eallowed0Eto0Ework0Edespite0Einquiry0Einto0E10A0Edeaths0Bhtml/story01.htm