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  1. Diabetes link to shift-working

    Men who work on shifts face a massively increased risk of developing diabetes, researchers warn today.

    A new study links diabetes to shift-working - but finds men are most at risk.

    According to the Chinese researchers, shift-working men face a 37% increased risk of developing diabetes - compared with an overall increased risk of 9%.

    And workers of both sexes on rotating shifts face a 42% increased risk, according to the report in Occupational & Environmental Medicine.

    The researchers say the risk of diabetes may be because shift-workers tend to put on weight and suffer from an increased appetite.

    The findings come from an analysis of 12 international studies involving more than 226,500 people, of whom 14,600 had diabetes.

    Researcher Professor  Zuxun Lu, of Tongii Medical College, Huazhong University of Science and Technology, Wuhun, Hubei, China, says the findings do not prove that shift-working causes diabetes - but warns the findings are of "considerable public health importance."

    He adds: "Rotating shifts make it harder for people to adjust to a regular sleep-wake cycle, and some research has suggested that a lack of sleep, or poor quality sleep, may prompt or worsen insulin resistance."

    Shift work and diabetes mellitus: a meta-analysis of observational studies Occupational & Environmental Medicine 25 July 2014; doi 10.1136/oemed-2014-102150

  2. Fertility treatments bad for global warming - claim

    A crackdown on fertility treatment would help cut population size and tackle global warming, an expert claims today.

    Governments should only offer free fertility treatment to people who are medically infertile "through no fault of their own," according to bio-ethicist Professor Cristina Richie.

    They should not be offered to people making "lifestyle choices," she says.

    Professor Richie says fertility treatments are unusual among medical procedures as they produce a carbon footprint - but also leave a "carbon legacy" in the form of additional children.

    She says that assisted reproduction has created some five million new lives since the late 1970s.

    Writing in the Journal of Medical Ethics, she says: "It is therefore the obligation of environmental policymakers, the ethical and medical communities, and even society to carefully weigh the interests of our shared planet with a business that intentionally creates more humans when we must reduce our carbon impact."

    Professor Richie, of Boston College, Massachusetts, USA, includes same sex couples, single women and people who have voluntarily undergone sterilisation among those who might seek fertility treatment as a lifestyle choice.

    But one of the journal's associate editors warned the policy could lead to discrimination.

    Dr Dominic Wilkinson, a neonatologist at the University of Adelaide, Australia, said: "Climate change is important, but carbon caps should be applied equally and fairly. They should not be used to discriminate against those who are single or gay.”

    What would an environmentally sustainable reproductive technology industry look like? Journal of Medical Ethics 25 July 2014; doi:10.1136/medethics-2013-101716 [abstract]

  3. Antibiotic crisis fails to attract research funding

    A minuscule amount of scientific research funding in the UK is going to research into antibiotics, an expert warns today.

    The figures highlight the gap between official warnings about the crisis in antibiotics and the extent of activity aimed at tackling the problem.

    Recent announcements have tended to blame pharmaceutical companies for not giving priority to antibiotic research.

    But, according to Professor Laura Piddock, of Birmingham University, UK, just 1% of research funding awarded by public bodies and charities goes towards antibiotics research.

    Writing in The Lancet Infectious Diseases, Professor Piddock reports funding given by UK and EU funding bodies between 2008 and 2013.

    In the UK, some £13.8 billion was awarded for research but just £269 million went to the study of bacteria and, of this, just £95 million specifically to research antibiotics.

    Professor Piddock said today: "Our study clearly shows that the proportion of public and charitable funding for research into new antibiotics, understanding resistance mechanisms and ways of tackling resistance are inadequate for the size of the task.

    “Since 2011, most new EU funding has focused on public–private partnerships with industry. However, an increased understanding about antibiotic resistance is needed, not least to inform strategies to both minimise and prevent antibiotic-resistant bacteria arising when new treatments become available.”

    Writing in the journal Dr Michael Head, of the Farr Institute, University College London, UK, says: "Efforts to document the investments of other countries regarding antibiotic resistance research would be beneficial and would allow funders and policymakers to chart the optimum future direction of research money.

    "Metrics to establish the true burden of antibiotic resistance and methods also to assess the likely effect of other types of research are needed; for example, preventive research such as vaccine development will affect future burdens of bacterial infections and resistance.”

    UK and European Union public and charitable funding from 2008 to 2013 for bacteriology and antibiotic research in the UK: an observational study. Lancet Infect Dis 25 July 2014; doi: 10.1016/S1473-3099(14)70825-4 [abstract]

  4. Personal GPs might aid A&E

    Getting patients a more personal relationship with their GP in some of Britain's poorest areas could help cut pressure on accident & emergency departments, researchers say.

    Researchers in Bristol suggest that this single change to GP services could help reduce patient demand for emergency care.

    The Bristol University study suggests that some patients benefit from seeing the same doctor on every visit to a GP surgery.

    Researcher Dr Alyson Huntley set out the factors in primary care that can help reduce pressure on hospitals in a recent report in BMJ Open.

    Other factors include the distance that patients live from emergency departments and the ease of access to GP surgeries.

    Patients could also head for hospital when they were confused by their options for emergency care.

    Professor Huntley suggests that the NHS could establish projects to create GP continuity of care for the most high-risk patients.

    She said: "Our work has shown that providing continuity of care and making it easier for patients to get access to their GP can help achieve this reduction in unplanned admissions and emergency department attendance."

    The National Clinical Director for Urgent Care for NHS England, Professor Jonathan Benger, added: "There is a well-recognised need to improve urgent care in England. This report will help to inform both commissioners and providers of care regarding the relationship between general practice, accident and emergency department attendance and emergency hospital admission."

    Which features of primary care affect unscheduled secondary care use? A systematic review BMJ Open 2014;4:e004746; doi:10.1136/bmjopen-2013-004746 [abstract]


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