Scientists hope to learn more about how flu is transmitted

It is the time of year when coughs, colds and flu seem to spread like wildfire.

One person in the office gets sick and it is not long before half the workforce has taken to their bed.

And all those Christmas parties probably aggravate the situation as we mix with more people than we usually would.

But how much do we actually know about how colds and flu spread - for example how many others does one cold sufferer infect?

Researchers are hoping a big-brother style experiment will provide some answers, at least where influenza is concerned.

Next year, Professor John Oxford, an expert in virology from Queen Mary's School of Medicine and Dentistry, in London, will lock volunteers in a hotel for a week, deliberately infect some with the flu virus, and wait to see what happens.

"To start with, we'll take 15 volunteers, with no immunity to the particular flu virus and infect five of them," he said.

"Using CCTV, we'll keep an eye on them and look for patterns of transmission."

It will be the first study looking at the spread of flu by directly infecting volunteers and sitting back to see what happens.

Pandemic planning

Knowing how easily flu can spread will help officials planning for pandemics, said Professor Oxford who is applying for government funding for the research.

"The second phase will be seeing if we can break the chain of transmission with things like hand-washing or wearing a hygiene mask."

The problem is the common cold is not thought to be serious enough to investigate properly Dr Douglas Fleming Royal College of General Practitioners

He hopes the experiment, being done with Professor Jonathan Van Tam from Nottingham University, will get underway next year.

It is certainly true that "coughs and sneezes spread diseases".

And it would also seem to make sense to stay away from work or school to avoid sharing the bugs around.

Knowledge gaps

But there are a fair few gaps in our knowledge when it comes to the common cold, says Dr Douglas Fleming, director of the Royal College of GPs Research Unit in Birmingham.

COLDS AND FLU Colds and flu are both common respiratory illnesses caused by viruses Whereas there are hundreds of different types of cold viruses, flu is caused by the influenza virus of which there are three major types, A, B and C The influenza virus constantly changes its structure which is why a new vaccine has to be developed every year A cold lasts only two to four days and causes a stuffy or runny nose, sneezing, sore throat, cough, mild fever and tiredness Flu is more severe, can last a week or more and is associated with a high fever, chills, headache, intense muscle pains, exhaustion, loss of appetite, cough and sometimes a blocked nose and sore throat

"The problem is the common cold is not thought to be serious enough to investigate properly," he said.

"Nearly everyone gets better so there isn't the attention given to it, but I think we should be trying to get to know much more about common respiratory infections."

For example, he said people might complain that colds seem to last longer than they used to but is that a sign of age or a sign of the changing nature of the cold virus.

"We don't have the facts - I can say I've never had a cough like that before but is it because you shake things off better in your youth.

"Whether people are having colds that last longer than they did years ago we simply don't know."

Surveillance

He said much of the lack of understanding around colds could be solved by more investment in surveillance.

It's not even entirely clear why we get more colds in winter.

If you have got really horrible flu, the only thing to do is stay away from people - Professor Steve Field Royal College of General Practitioners

Over, the past decade there has been much research into the structure of the cold virus with rhinovirus - one of the most common cold viruses - being the most understood.

This includes how it attaches to the lining of the nose to cause infection.

However, even with this information it is unlikely there will ever be a "cure" for the common cold for several reasons.

A cold is caused by many different viruses, by the time you know you have a cold it is probably too late to treat it, and as colds are fairly minor and self-limiting any side effects from medication, however minor, would probably not be worth the hassle.

Also there would be dangers of viruses becoming resistant to effective medications, rendering them useless, just as we are seeing with antibiotics.

So what do we know about colds?

Well according to the Common Cold Centre at Cardiff University, it has been estimated that adults suffer two to five colds per year, and school children may suffer seven to 10 colds per year.

Children to blame

Young children are mainly responsible for spreading common cold viruses and infection usually occurs at home or in the nursery or school.

The incubation period for a common cold is usually around two days before the symptoms begin and a person is most infectious when they are in the early stages of sneezing, runny nose and cough.

Professor Steve Field, chair of the Royal College of GPs said there is certainly a lot of cold and flu circulating this Christmas and it's hard to avoid catching one.

"We really need to try and encourage children and adults to use handkerchiefs and afterwards wash their hands, so if you're shaking people's hands and if you're in close contact you prevent passing it on.

"But if you have got really horrible flu, the only thing to do is stay away from people," he said.

Doctors are seeing younger people with alcohol-related conditions

Jane (not her real name) was faced with the shock discovery that her young son was drinking heavily when somebody knocked on her door to tell her he had collapsed in the street.

At the age of 12, Alan, (not his real name) had drunk himself unconscious and was being revived by paramedics after attending a friend's birthday party.

He had drunk a bottle of vodka, along with half a bottle of Martini.

But he had already been consuming huge amounts of alcohol for a year before that watershed incident brought his problem to the attention of his shocked parents.

"I work full-time and I would send him to a child minders," said the distraught mother from Bournemouth.

"Unbeknown to me, Alan had stopped going after school and had started hanging around with much older children - the wrong crowd basically."

Further signs that all was not well with him began surfacing in primary school and continued into his secondary schooling, where he was constantly "getting into trouble".

I think a lot of it was probably my fault, I did not keep a closer eye on him Jane

However, his parents bore the full brunt of the side effects symptomatic of excessive drinking.

"He has quite violent rages when he is drunk," added Jane.

"He would head-butt the wall or punch the door - every single door in our house had to be replaced."

Over the years, Alan has also destroyed most of the family furniture.

Neither he nor Jane have been able cope with his drinking, which spiralled out of control - both have been prescribed anti-depressants.

Alan was eventually diagnosed as an alcoholic at 15, by which time he was consuming about 10 to 15 cans of lager a day.

It was then doctors warned him if he continued along this destructive path he would be dead at 25.

However, Alan, now 20, did try two years ago to start afresh by completing an apprenticeship to become a painter and decorator.

But he crashed his car while drunk and lost his job as a result.

He is now on police bail awaiting trial for alcohol-related violence, according to Jane.

"I think a lot of it was probably my fault, I did not keep a closer eye on him," she said.

Anti-social behaviour

Research shows Alan's story is not only far from unique but one that is familiar to a growing number of families across Britain.

Portsmouth is one city which has obtained government funding to combat under-age drinking.

The Paulsgrove area has the highest percentage of 11-16 year olds in the city, and is currently the area with the highest rate of under-age drinkers according to Hampshire police.

A new "Weekend Project", funded with £24,000 from the Home Office, is aimed at educating young people and their parents about the dangers of under-age drinking and offering support.

Figures showed children aged 11 to 13 are drinking more alcohol

Police figures showed 659 alcohol-related anti-social behaviour offences were recorded in Paulsgrove from 1 March to 31 August this year.

In particular, Cheltenham Road and Allaway Avenue featured on the force's top 10 worst streets for anti-social behaviour offences and collectively accounted for more than 20% of this type of offence in the city, a police spokeswoman said.

Insp Eddie Charlton, of Hampshire police, said: "The alcohol tends to give them a bit more bravado and makes them do more stupid things - criminal damage, being abusive to residents and generally making their neighbours and their community's lives much more miserable."

Last year, Alcohol Concern called for parents who give alcohol to children aged under 15 to be prosecuted in its report on the government's Alcohol Harm Reduction Strategy.

The study's figures showed on average boys aged 11 to 13 were drinking 50% more alcohol in 2006 than in 2000.

The alcohol consumption figure for girls almost doubled in the same period.

Dr Nick Sheron, a liver specialist at Southampton University Hospitals Trust, believes the "easy accessibility of cheap alcohol" is one of the major factors fuelling under-age drinking.

"The government should increase tax on alcohol in line with income gradually in order to redress the balance," he said.

"There has been a tenfold increase in liver deaths since the 1970s.

"I think we have got the balance wrong and it's the young people who are paying the price for that."

The Amish population is best known for avoiding modern technology

A gene mutation which protects the heart against a high-fat diet has been found in the Amish population.

Researchers found 5% of the US Amish population in Lancaster, Pennsylvania have a mutation in a protein which breaks down fatty particles.

Those with the mutation had higher levels of "good" HDL-cholesterol and lower levels of "bad" LDL-cholesterol, the journal Science reported.

It is hoped the finding will lead to new therapies to reduce cholesterol.

The researchers used blood samples from 800 volunteers in the Old Order Amish community to look for DNA markers that might be associated with levels of fat particles called triglycerides in the blood stream.

The discovery of this mutation may eventually help us to develop new therapies to lower triglycerides and prevent cardiovascular disease Dr Toni Pollin

High blood levels of triglycerides, one of the most common types of fat in food, have been linked to heart disease.

They found a mutation in the APOC3 gene, which encodes a protein - apoC-III - that inhibits the breakdown of triglycerides.

As part of the study, participants drank a high-fat milkshake and were monitored for the next six hours.

Individuals with the mutation produced half the normal amount of apoC-III and had the lowest blood triglyceride levels - seemingly because they could break down more fat.

They also had relatively low levels of artery-hardening - a sign of cardiovascular disease.

Protection

Study leader Dr Toni Pollin, assistant professor of medicine at the University of Maryland School of Medicine, said: "Our findings suggest that having a lifelong deficiency of apoC-III helps to protect people from developing cardiovascular disease.

"The discovery of this mutation may eventually help us to develop new therapies to lower triglycerides and prevent cardiovascular disease," she added.

The researchers believe the mutation was first introduced into the Amish community in Lancaster County by a person who was born in the mid-1700s.

It appears to be rare or absent in the general population.

Cathy Ross, cardiac nurse at the British Heart Foundation said the benefits of high HDL cholesterol and low LDL cholesterol are already being achieved by drugs such as statins.

"If new drugs can be developed that mimic the effect of this mutation, it may afford more ways in which individuals could be protected from developing cardiovascular disease.

"There are also lots of other simple ways people can reduce your risk of cardiovascular disease such as eating a diet low in saturated fat, having five portions of fruit and vegetables a day and taking regular physical activity."

Around 2% of pregnant women have premature rupture of membranes

Researchers have identified a test which can predict whether a woman is likely to give birth if her waters break early in pregnancy.

High levels of lactate in vaginal fluid is strongly associated with onset of labour within 48 hours, according to Swedish researchers.

UK experts said the test would help to plan care and reassure women whose membranes rupture prematurely.

The study appears in Obstetrics and Gynaecology journal, BJOG.

Known as the "Lac-test", the tool was assessed in 86 women with singleton pregnancies of 20 to 36 weeks gestation.

When membranes rupture unexpectedly there's a big dilemma - do you deliver the baby or not, will this woman go into labour or not? Professor Andrew Shennan

Among 23 women with high lactate concentrations, 87% had spontaneous onset of labour within 48 hours.

In 58 women with low lactate concentrations - in effect a negative Lac-test - only 5% went into labour within 48 hours.

The median time between examination and onset of labour was 13.6 hours for those with a high lactate concentration and 48 days for those with a low lactate value.

Prediction

The researchers said previous studies had found an association between high lactate concentration in vaginal fluids and rupture of membranes in pregnancies of more than 34 weeks gestation, but this is the first time the link has been seen under 34 weeks.

Being able to predict labour is even more valuable in these premature babies, as steroids can be given to promote lung development and women can be referred to specialist hospitals.

Preterm prelabour rupture of membranes (PPROM) - waters breaking in pregnant women before 37 weeks - occurs in 2% of pregnancies and accounts for one-third of all preterm births.

Study leader, Dr Eva Wiberg-Itzel, from the Department of Clinical Science and Education at the Karolinska Institute, said: "The diagnosis of ruptured membranes is easy when there is an obvious leakage of amniotic fluid, but more difficult when the leak is scanty or intermittent.

"We believe that the Lac-test adds important information in clinical practice."

Professor Philip Steer, editor-in-chief of BJOG, said it seemed a promising tool to predict the onset of labour.

"A more reliable diagnosis of PPROM could help doctors determine when to keep women in hospital, and improve the timing of antenatal steroid therapy."

Professor Andrew Shennan, an obstetrician at St Thomas' Hospital in London, said the test could solve a potentially important problem.

"When membranes rupture unexpectedly there's a big dilemma - do you deliver the baby or not, will this woman go into labour or not?

"We would probably give steroids anyway as it's a high risk situation, but the main thing is being able to tell the women what's likely to happen.

"We can also get them to a specialist unit if needed."

Lung development can be a problem for premature babies

British researchers have identified a potential target for encouraging lung growth in babies in the womb.

A study in mice showed that a well-known molecule called the calcium receptor has a key role in the development of lungs in the foetus.

Drugs targeting the receptor are already available, the Cardiff University researchers said.

The results, which could lead to better outcomes for premature babies, are published in the Journal of Physiology.

If we can show that one of these drugs can modulate the action of the calcium receptor in the lung, it could be used to mature the lungs of a very premature baby as it grows Professor Paul Kemp, University of Cardiff

The final stages of lung development happen late in pregnancy so babies born prematurely can struggle to get enough oxygen and can develop chronic lung disease.

The latest research found that the calcium receptor "switches on" the growth of the lungs in the foetus.

In the study, the researchers were able to manipulate lung development by interrupting receptor function.

The next step is to carry out studies in individuals who have mutations in the calcium receptor which causes it to be permanently switched on or switched off, the researchers said.

"If that showed correlation between the mutation and post-natal lung health then we could move into clinical trials," said study author Professor Paul Kemp.

"The really exciting thing about the calcium receptor is that there are already drugs available that can alter its function.

"If we can show that one of these drugs can modulate the action of the calcium receptor in the lung, it could be used to mature the lungs of a very premature baby as it grows.

"An existing drug could potentially be approved much more quickly than a new one" he added.

He said the therapy could be something that is done in parallel with steroid treatment which is already given in babies at risk of being born early.

Annette Briley, research midwife for Tommy's, the baby charity said chronic lung disease is one of the major health problems facing premature babies, often presenting problems well into adulthood.

"Whilst this could be a promising breakthrough, it must be stressed that further rigorous randomised control tests must be carried out to assess the effectiveness of these drugs in premature babies."

Warning over internet painkillers

Celecoxib was one of the drugs found to be available online

UK experts have warned of the dangers of purchasing drugs online in response to a study showing wide availability of strong painkillers over the internet.

A team at Edinburgh University found 35 websites selling prescription-only pain drugs to UK customers without requiring a prescription.

Government regulators warned that buying medicines online may have "deadly" consequences.

The results appear in the British Journal of Clinical Pharmacology.

By trawling for online pharmacy sites through Google and Yahoo search engines, the researchers found almost 100 selling medicines to UK consumers.

Almost half of those sold prescription-only painkillers but 76% did not require the customer to provide a valid prescription.

Six asked for a prescription but accepted a fax or email copy which the researchers said could be forged or modified.

Side-effects

The drugs available included opioids such as tramadol and non-steroidal anti-inflammatories, such as naproxen and celecoxib, commonly prescribed for conditions such as arthritis.

They can have severe side-effects and some should not be taken in conjunction with other medicines or in people with certain conditions, the researchers said.

At best you will be wasting your money and at worst they could be deadly Spokeswoman, MHRA

Co-proxamol - a drug which has been removed from the market in the UK due to concerns over the risk of overdose - was available from three websites.

The researchers did not take the final step of actually buying the medicines as they felt it would not be ethical.

Study author Professor David Webb, an expert in clinical pharmacology at the University of Edinburgh, said these were drugs that people should not be taking without advice from a doctor, but they were available with a couple of clicks of the mouse.

"We were surprised at how many sites you could go to and find, in some cases, quite potent painkillers that have addictive potential and that you could get them without prescription."

He added: "The regulators are very aware of this problem and it is not one they can easily manage.

"But there certainly needs to be some sort of international agreement."

Illegal sales

A spokeswoman for the Medicines and Healthcare Products Regulatory Agency, said although the sale of prescription only medicines without a proper patient consultation was illegal it was not illegal to buy medicines online.

"But we strongly advise people that buying drugs or slimming products from the internet is not a good idea, unless buying from a website that has a Royal Pharmaceutical Society of Great Britain (RPSGB) internet pharmacy logo.

"At best you will be wasting your money and at worst they could be deadly.

"You don't know what these products contain and you don't know in what conditions they have been made."

The RPSGB launched their logo scheme for bone fide pharmacy websites at the beginning of 2008.

Priya Sejpal, RPSGB head of professional ethics, said: "Internet pharmacy undoubtedly offers patients easy access and choice, but it also brings increased risk.

"There are a growing number of unregulated suppliers operating online with no professional qualifications or healthcare expertise.

"In many cases, medicines purchased from such suppliers are counterfeit, substandard or unapproved new drugs."

Thousands of patients head abroad for cosmetic operations

The NHS is having to pick up the tab for cosmetic surgery performed abroad that has gone wrong, doctors say.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons said many patients were turning to the health service for follow-up care.

A poll of 203 NHS surgeons found that more than a third knew of cases where complications followed surgery abroad.

The government warned people that the NHS was only there to deal with emergency complications in such cases.

And it urged those thinking about going abroad for operations to be careful.

It is estimated that up to 100,000 people a year are heading abroad for cheap cosmetic surgery such as breast enlargements, tummy tucks and face-lifts.

What may seem like a bargain could cost them their health Vivienne Nathanson, of the British Medical Association

BAPRAS said the growing demand was being fuelled by the availability of cheap flights, but warned that the trend was leading to problems.

It said its members had seen a range of complications including blood poisoning, wound infections and blood clots, as well as patients who were not happy with the results of the surgery.

And the association warned that the extra work being caused by having to see these patients could end up delaying other NHS work.

It said patients should be made to pay for rectifying treatment except where there was a life life-threatening situation or if the patient was suffering from acute pain.

Complications following UK-based cosmetic surgery is the responsibility of the private clinic.

Anthony Armstrong, a leading member of BAPRAS, said: "Cosmetic operations involve major surgery.

"Anyone considering cosmetic surgery abroad must make sure they are fully aware of the potential complications that can occur and consider how these will be dealt with.

"They should not assume that the NHS will pick up the pieces and they may find themselves having to pay privately for follow-up surgery here."

Risks

But the British Medical Association said it was against patients being barred from NHS care.

Dr Vivienne Nathanson, head of ethics at the BMA, added: "It is essential that patients are warned about the potential risks of any surgery, and the specific risks of managing complications after having surgery overseas.

"What may seem like a bargain could cost them their health."

Katherine Murphy, of the Patients Association, agreed it would be wrong to withhold treatment.

She said patients needed better information about treatment available abroad.

A spokesman for the Department of Health said it had already made clear that the NHS was only there to deal with emergencies in such cases.

The spokesman added: "People are free to have cosmetic or other private surgery abroad if they wish to.

"However, we strongly advise people to do their research and make sure that they are clear about prices, procedures, recovery times, aftercare and what happens in the event that the treatment goes wrong."