The number of heart transplants being carried out is falling
The number of adult heart transplant units in the UK should be cut because too few transplants are being performed, heart experts say.
Doctors at Newcastle’s Freeman Hospital said it was time to rethink the need for six centres after a 46% fall in transplants in the last decade.
They said having bigger and better resourced units may be preferable, the British Medical Journal reported.
The government has already indicated it is looking to carry out a review.
It is unclear why the number of heart transplants has fallen as the number of potential donors is at a record high.
A decade ago, 159 transplants were carried out each year, but by 2009-10 that had fallen to 86, the researchers said.
“Encouraging more people to join the organ donor register, or even better, changing our organ donation system so people must ‘opt out’ if they don’t want to donate would help increase the number of donor hearts available”
Professor Peter Weissberg British Heart Foundation
The analysis by four doctors, including two surgeons, suggested it could be down to a lack of intensive care beds or it could be because potential donors are found to have hearts which are unsuitable for transplant.
The fall in transplants has meant doctors are having to increasingly rely on the use of mechanical heart pumps instead.
But the experts said it was now important to review whether the right patients were being prioritised for transplants as well as looking whether the six units – in Birmingham, Glasgow, Newcastle, Manchester, Cambridge and London – were still viable.
One of the risks of having smaller centres is that surgeons do not do enough transplants to maintain their skills – although there are no suggestions care is suffering yet.
Professor Peter Weissberg, medical director at the British Heart Foundation, conceded fewer centres may be the solution.
But he added he would like to see more work to increase the number of suitable donors.
“Encouraging more people to join the organ donor register, or even better, changing our organ donation system so people must ‘opt out’ if they don’t want to donate would help increase the number of donor hearts available.”
NHS medical director Sir Bruce Keogh said an official review would be starting soon to ensure transplants were being “carried out in the most effective way”.
He added: “The department is committed to strengthening the heart transplant programme, increasing the number of organ donors and hearts donated for transplant and giving more people the opportunity to benefit from a heart transplant.”
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
Coffee linked to one in 10 burst blood vessels in the brain
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Coffee, sex and blowing your nose could increase the risk of a type of stroke, say researchers in the Netherlands.
The study on 250 patients identified eight risk factors linked to bleeding on the brain.
They all increase blood pressure which could result in blood vessels bursting, according to research published in the journal Stroke.
The Stroke Association said more research was needed to see if the triggers caused the rupture.
More than 150,000 people in the UK have a stroke each year with nearly 29,000 due to bleeding on the brain.
Bleeding can happen when a weakened blood vessel, known as a brain aneurysm, bursts. This can result in brain damage or death.
The researchers at the University Medical Center in Utrecht looked at 250 patients for three years to identify what triggers ruptures.
They found that coffee was responsible for more than one in 10 burst brain aneurysms.
Percentage of bursts due to:Coffee 10.6%Vigorous exercise 7.9%Nose blowing 5.4%Sex 4.3%Straining to defecate 3.6%Drinking cola 3.5%Being startled 2.7%Being angry 1.3%
While people drinking coffee had only a 1.7 times greater risk, it is more common than other risk factors.
Being startled increased the risk by more than 23 times, but was responsible for just 2.7% of cases.
Dr Monique Vlak, a neurologist and the study’s lead author, said: “All of the triggers induce a sudden and short increase in blood pressure, which seems a possible common cause for aneurysmal rupture.”
The authors said one in 50 people has a brain aneurysm, but only a few rupture.
Dr Vlak advised that: “Reducing caffeine consumption or treating constipated patients with unruptured intracranial (brain) aneurysms with laxatives may lower the risk of subarachnoid haemorrhage.”
The study only looked at the triggers for the burst. High blood pressure weakens blood vessels in the first place and can be caused by being overweight, smoking and a lack of exercise.
Dr Sharlin Ahmed, Research Liaison Officer at The Stroke Association said: “A sudden surge in high blood pressure can increase the likelihood of an aneurysm rupturing. However, it’s very difficult to determine whether the triggers identified in this study are definitely related to the onset of a stroke as they could simply be put down to coincidence.
“A lot more research needs to be carried out to assess whether each of the identified triggers could directly cause an aneurysm to rupture.”
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
A dramatic change in circumstances can lead to debt issues
With a 10-day-old baby and separated from her husband, financial difficulties built up for Kathryn Bevan at a time of high emotion.
The 42-year-old from Liverpool was facing a complicated web of debt. She had moved house five times in as many years and had lost sight of outstanding bills at different addresses.
“I did not know where to turn,” she says.
“I felt like I was going to have a lifetime of debt and just move through life trying to dodge people.”
But after approaching the advice group Christians Against Poverty, she declared bankruptcy a year ago and has recently become entirely debt-free.
She is not alone. Official figures published on Friday are due to reveal how thousands of people have been dragged into insolvency since Christmas.
Becoming bankrupt is not an easy decision to make. Kathryn describes the phone call with the charity worker to outline all her debts as “the worst of my life”.
Forms of insolvencyBankruptcy: The traditional way of escaping overwhelming debt. Ends after one year, but you are likely to lose all your assets including your house to pay something to the creditorsIndividual voluntary arrangement (IVA): A deal between you and your creditors, overseen by an insolvency practitioner. Less stigma, less chance of losing your home, but involves paying some of your debts in one go or over a number of yearsDebt Relief Orders: Introduced in April 2009, these allow consumers with debts of less than £15,000 and minimal assets or surplus income to write off debts without a full-blown bankruptcy
What to expect if you go bankruptThe size of her debt, her small income, but her willingness to live to a budget meant bankruptcy was advised as the best path to take.
“I felt ashamed. Who was I to have all my debts written off when there are other people who work hard to pay them off?” she said.
Kathryn says that she received such good support from the charity that she is volunteering herself to help others in the same situation.
Debt advisers are clear that others can avoid being pulled into the financial and emotional whirlpool of insolvency if they seek expert advice when debt problems begin.
And in general, they say, men are less likely to follow Kathryn’s example.
Advice charities, like the Consumer Credit Counselling Service (CCCS), say men are less likely to seek help for spiralling debts than women – even though men face a greater risk of bankruptcy.
There is no easy explanation as to why men are more at risk of bankruptcy than women
There is no easy theory that explains why this is the case, especially because there is such a wide range of circumstances that could lead to debt problems.
But Una Farrell, of the CCCS, says the charity’s helpline receives a number of calls from men who ring during their lunch hour to discuss serious debt problems.
“They often just hope things will get better. They do not want people, including their family, to know but they are worried about it,” she says.
The greater likelihood of men going into bankruptcy is a complex result of various social and economic issues, says economic psychologist Stephen Lea, of the University of Exeter.
One significant factor, he says, is that the greater proportion of small business are run by men. When they fail, as some inevitably will, then bankruptcy is often the clearest route to take.
The average age of someone filing for bankruptcy in the UK is falling. In 2005 it was 41, but it is now estimated to be 38.
“It is sad and depressing that some never been out of debt since they were a teenager at home”
Stephen Lea Economic psychologist
Attitudes of shame and guilt connected to bankruptcy are less extreme in younger people than the older generations, says Professor Lea.
This means younger people have a greater willingness to take on bankruptcy, he says.
He adds that young people up to the age of 25 are increasingly unaware of the long-term consequences of taking on debt.
This can lead to serious problems when a relationship breaks down, jobs are hard to find, or redundancy hits.
“It is sad and depressing that some never been out of debt since they were a teenager at home,” he says.
However, he agrees with advice charities that the sooner those with debt problems seek advice, the better.
A spokeswoman for Christians Against Poverty, which has 150 church-based debt counselling centres in the UK, says that the vast majority of people who are able to pay off their debts do so, given the correct support.
“A change in circumstances, rather than overspending, is what puts people in debt and their desire is to put things right rather than wanting an easy way out,” she says.
This is echoed by the CCCS, which – despite the absence of mass redundancies – has seen a shift since the economic downturn began and credit became less available.
“Generally, people owe less, but they are finding it more difficult to pay,” says Ms Farrell.
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
