By Pallab Ghosh
Science correspondent, BBC News Scientists hope to better understand how Parkinson’s develops

The UK's first major investigation of a disease using stem cells that does not involve the need to create and destroy embryos is being launched.

A Oxford University team will use induced pluripotent stem (IPS) cells, adult stem cells which have the ability to become any cell in the human body, to examine Parkinson's disease.

These cells will be used to grow the brain neurons which die in those with the disorder, a conference will hear.

IPS cells were developed in 2007.

At the time, scientists said it had the potential to offer many of the advantages of embryonic stem cells without any of the ethical downsides.

Three years on, it seems to be living up to that claim.

Compare and contrast

The team at Oxford University is among the first in the world to use IPS to carry out a large scale clinical investigation of a major disease.

Parkinson's is currently poorly understood.

Researchers will be taking skin cells from a 1,000 patients with early stage Parkinson's and turning them in to nerve cells carrying the disease to learn more about the brain disorder, the UK National Stem Cell Network annual science meeting will hear.

The technique is useful because it is difficult to obtain samples of diseased nerve tissue from patient biopsies.

IPS enables the researchers to create limitless quantities of nerve cells to use in experiments and to test new drugs.

"Parkinson's disease is the second most common neurodegenerative disease in the UK and is set to become increasingly common as we live longer," said Dr Richard Wade-Martins, head of the Oxford Parkinson's Disease Centre.

"Once we have neurons from patients we can compare the functioning of cells taken from patients with the disease and those without to better understand why dopamine neurons die in patients with Parkinson's."

The research is being funded by Parkinson's UK.

The charity's director of research, Kieran Breen, described it as "vital research that will help us better understand the causes of this devastating condition and how it develops and progresses.

"We hope the work will pave the way for new and better treatments for people with Parkinson's in the future."

There are about 120,000 people in the UK with Parkinson's.

By Nick Triggle
Health reporter, BBC News All hospitals have been told to go for foundation trust status

NHS hospitals will be looking to exploit a host of "exciting" opportunities to move into private health markets, bosses say.

Self-governing hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.

The Foundation Trust Network believes the move will spark a burst of innovation in the sector.

But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday's White Paper. Health Secretary Andrew Lansley said he wanted to create a "vibrant" industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

"It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate."

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

"In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system."

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

Joint ventures with the private sector may also prove popular, she added, covering both services and the development of drugs.

Overstretch concerns

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services its uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: "These initiatives bring in money which can then be reinvested in NHS services."

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

"Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.

"It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

"They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service."

A spokeswoman for the Department of Health said trusts were not being privatised.

"This isn't about turning foundation trusts into profit-driven bodies. The legislation will make clear that they are social enterprises and give them more control over their own futures."

Charlize’s choice could be altering women’s brain activity

Seeing a celebrity endorse a pair of shoes alters a woman's brain activity – even if she does not drop everything to get her feet into the latest Jimmy Choos, a study suggests.

A Dutch team scanned the brains of 24 women as they looked at pictures of celebrities and attractive, non-famous contemporaries sporting certain shoes.

Celebrity endorsement has become increasingly prevalent in recent years.

And the research concluded advertisers are onto something.

The women were presented with 40 colour photographs of famous and non-famous women deemed to be similarly attractive, and wearing the same footwear.

Encoding memories

When confronted with a celebrity, the team documented heightened activity in a certain part of the brain – the medial oribitofrontal cortex. The same was not observed when pictures of an attractive non-celebrity were presented.

Writing in the Journal of Economic Psychology, they suggested that this activity links the celebrity with the product in a part of the brain associated with feeling affection.

Moreover this link could be rapidly recalled.

"The enhanced memory performance for items that were encoded in the context of a famous individual can neither be explained by increased attractiveness of the celebrity nor by a higher level of perceived expertise, but only by the persuasiveness of fame itself," wrote lead author Mirre Stallen of Erasmus University.

However, contrary to expectations, the number of women saying they would go out and purchase these shoes did not differ significantly between celebrity and non-celebrity photographs.

But the researchers stressed there could be a longer term impact, even if it did not manifest itself as an immediate desire to buy.

A future study will investigate whether men are equally swayed by celebrities' footwear.

Better cancer drugs are one reason for the survival improvements

Survival rates for some cancers have doubled over the past four decades, a charity has said.

People with breast, bowel and ovarian cancers, and non-Hodgkin's lymphoma, are now twice as likely to survive for at least 10 years than in the 1970s.

Cancer Research UK's figures show leukaemia survival is now four times as high, although the charity warned there was still much work to do.

The Department of Health said it was "delighted" by the findings.

Launching a television campaign, the charity said investment in research was key to further boosting survival.

The figures go back to the early 1970s and include estimated survival rates for the latest diagnoses made in 2007.

In breast cancer, 10-year survival has jumped from less than 40% to a predicted 77% currently.

And half of people diagnosed with bowel cancer are now expected to survive at least 10 years compared with 23% in the 1970s.

For ovarian cancer and non-Hodgkin's lymphoma, survival has increased from 18 to 35% and from 22 to 51% respectively.

In cancers such as oesophageal cancer and myeloma, although survival rates are still very poor at below 20%, rates have improved almost threefold over the past few decades, Cancer Research UK said.

However, some other cancers have shown little improvement, most notably lung and pancreatic cancer, the figures show.

‘Real progress’

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "There are many reasons for our continuing success in the fight against cancer, including faster diagnosis, better surgery, more effective radiotherapy and many new drugs, all developed using the knowledge that our laboratory research has given us."

He said with further investment in research, he expected the trend to continue.

Professor Michel Coleman, an expert in statistics at the London School of Hygiene and Tropical Medicine, who calculated the figures, said the survival data reflected "real progress" in cancer diagnosis and treatment.

"Ten-year survival figures for patients diagnosed in 2007 are of course predictions, but they are derived from the latest national data on cancer patient survival – and for most cancers, the true 10-year survival for these patients will turn out to be higher than we report."

The figures prompted Professor Mike Richards, the Department of Health's national cancer director, to say: "We are delighted to note these improvements in cancer survival.

"Improving health outcomes is a key priority for the coalition government and will be a major focus of the forthcoming review of the Cancer Reform Strategy."

Harpal Kumar, Cancer Research UK's chief executive, said the improvements being seen in cancer care were "encouraging, but we have to do better".

"We need to develop even more effective treatments that can prolong life further and we need to ensure that each individual patient has optimal treatment."

> colspan="3"
class = "left"
>

TEN YEAR SURVIVAL RATES FOR ADULTS

> class = "left"
>
CANCER TYPE class = "right"
>
1971/2 class = "right"
>
2007 (predicted) colspan="3"
class = "left"
>

Source: Cancer Research UK.

Data is for adults in England and Wales aged 15-99

class = "left"
>

Bladder

class = "right"
>

34.6%

class = "right"
>

48.9%

> class = "left"
>

Bowel – Colon

class = "right"
>

22.6%

class = "right"
>

50.4%

class = "left"
>

Bowel – Rectum

class = "right"
>

23.9%

class = "right"
>

49.3%

> class = "left"
>

Brain

class = "right"
>

5.7%

class = "right"
>

9.4%

class = "left"
>

Breast (women)

class = "right"
>

38.9%

class = "right"
>

77.0%

> class = "left"
>

Cervix

class = "right"
>

48.4%

class = "right"
>

63.0%

class = "left"
>

Hodgkin's lymphoma

class = "right"
>

49.0%

class = "right"
>

77.9%

> class = "left"
>

Kidney

class = "right"
>

22.2%

class = "right"
>

43.5%

class = "left"
>

Larynx (men)

class = "right"
>

50.5%

class = "right"
>

59.6%

> class = "left"
>

Leukaemia

class = "right"
>

8.1%

class = "right"
>

33.2%

class = "left"
>

Lung

class = "right"
>

3.2%

class = "right"
>

5.3%

> class = "left"
>

Melanoma

class = "right"
>

49.3%

class = "right"
>

83.2%

class = "left"
>

Myeloma

class = "right"
>

5.3%

class = "right"
>

17.1%

> class = "left"
>

Non-Hodgkin's lymphoma

class = "right"
>

21.8%

class = "right"
>

50.8%

class = "left"
>

Oesophagus

class = "right"
>

3.6%

class = "right"
>

10.0%

> class = "left"
>

Ovary

class = "right"
>

18.0%

class = "right"
>

35.4%

class = "left"
>

Pancreas

class = "right"
>

1.9%

class = "right"
>

2.8%

> class = "left"
>

Prostate

class = "right"
>

20.4%

class = "right"
>

68.5%

class = "left"
>

Stomach

class = "right"
>

4.6%

class = "right"
>

13.5%

> class = "left"
>

Testis

class = "right"
>

67.4%

class = "right"
>

96.5%

class = "left"
>

Uterus

class = "right"
>

55.2%

class = "right"
>

74.5%

> class = "left"
>

Other cancers

class = "right"
>

34.0%

class = "right"
>

36.3%

class = "left"
>

ALL CANCERS

class = "right"
>

23.7%

class = "right"
>

45.2%

Chronic migraines can dramatically impair quality of life

Botox has been approved as a preventive treatment for chronic migraine by UK drug regulators.

It comes after a trial of more than 1,300 patients showed success in reducing the frequency of headaches.

But only patients who suffer headaches for at least 15 days a month, half of which come with migraine symptoms, are eligible, the Medicines and Healthcare Products Regulatory Agency said.

It is thought around 700,000 people in the UK get chronic migraines.

Migraine charities said many of those would not have been properly diagnosed and that some patients can really struggle to find a treatment that works.

Injections of botox, or botulinum toxin, are more commonly associated with smoothing out wrinkles.

It is not exactly clear why it may work in chronic migraines but it is thought that, as well as being a muscle relaxant, it may work to block pain signals.

In clinical trials, patients were given up to five courses of injections of botox into specific head and neck muscles every 12 weeks.

After 24 weeks, those treated with Botox had fewer days with a migraine than those who received a placebo injection.

By one year, nearly 70% of those treated with Botox had a 50% reduction in the number of migraines compared with before the trial.

The final results were published in Headache in May this year.

Prevention not cure

Lee Tomkins, director of Migraine Action, stressed it was not a "cure" but offered hope for those who suffer the most frequent migraines.

"We have been following these studies really closely and the evidence is really pretty solid.

"These people spend half their lives in pain.

"Even if they get half the attacks, it can really improve their quality of life."

She advised people to speak to their GP to find out if the treatment might be suitable for them and whether they should be referred to a neurologist who could carry out the injections.

And she recommended keeping a diary of symptoms to help doctors diagnose the problem.

Wendy Thomas, chief executive of The Migraine Trust, added: "We know that treatment with acute pain medication does not always work for these patients so we welcome new therapies, especially preventative medication, for this potentially disabling condition."

Stem cell therapy is a less invasive treatment than joint replacement

A stem cell therapy for osteoarthritis is to be tested on patients in the UK for the first time.

A year-long trial, funded by Arthritis Research UK, will mix stem cells with cartilage cells in the lab and inject them back into damaged knee joints.

The new treatment could be an alternative to joint replacement surgery, experts hope.

Scientists from Keele University will study up to 70 people from the end of this year.

The trial will be run at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire as part of a five-year research programme.

Three treatments are being tested in a randomised trial of patients with osteoarthritis of the knee.

Cell therapy

Using keyhole surgery, a patient's cartilage cells – also known as chondrocytes – and bone marrow stem cells will be removed and grown in a laboratory for three weeks.

They will then be re-implanted separately in some patients, and mixed together in other patients, into the area of damaged or worn cartilage.

Scientists will then test the effectiveness of all three types of cell therapy, based on the quality of the new cartilage formed over a period of 12 months.

Chondrocytes – cartilage cells – have been grown in a lab and re-injected into patients' damaged knees for the last 15 years.

But scientists now want to find out if combining cartilage cells and stem cells in the same process could work better, and specifically if one type of cell stimulates the other.

Less invasive

Osteoarthritis affects an estimated 8m people in the UK.

The condition is caused by wear and tear to the surface of joints, leading to stiffness and pain.

At present there is little effective treatment for osteoarthritis patients, apart from pain-relieving drugs and joint replacement.

The trial will focus on knee joints, but the results could have implications for other joints, say the scientists.

The advantage of stem cell treatment is that it's much less invasive than major joint replacement surgery.

Sally Roberts, professor of orthopaedic research at Keele University and lead scientist on the trial, says it's also a more "biological approach".

"We are using the body's own cells to repair damaged joints. The hope is that it will be permanent and long-term repair," she said.

But, even if successful, the treatment won't be used on everyone with osteoarthritis.

"Surgeons don't want to put implants into young patients in their 30s, so we are targeting these people for the use of this cell therapy if we can produce robust new cartilage cells.

"Stem cells certainly have huge potential – we just need to learn how to harness it properly," she added.

Jane Tadman, spokesperson for Arthritis Research UK, said: "This is just the start of developing this technique, and it could be a few years before such treatment will be in routine use."

Richard Rudd's mother, father and two daughters all agreed it was time to let him go.

On October 23 2009, Richard was riding a motorcycle when he hit a car at speed.

He was found six metres away from his bike.

Diagnosed as paraplegic at the scene, after spending a month undergoing various tests and scans it was confirmed that the paralysis of both arms and legs was to be permanent.

Richard's father – also called Richard – said at the time: "To keep somebody alive whilst they're suffering and they're not going to get better, it's playing God, if you like, because it's going against nature.

"If nature had been left to take its course, Richard would have been gone a few weeks back."

The family was clear that Richard would not want his treatment to be continued. They remembered when discussing a friend who had become paraplegic following a car accident, he said: "If ever this happens to me, I don't wanna go on. I don't wanna be like him."

Initially it was believed that Richard had fallen into a coma from which he was unlikely ever to emerge.

His ventilator was the only thing keeping him alive.

Richard was unable to respond to his family – or even to doctors treating him – but then a startling discovery was made.

Defining death

The attending consultant, Professor David Menon, discovered that Richard was able to move his eyes in response to simple commands and questions.

This meant that, in theory at least, Richard could make the decision to live or die himself.

Professor Menon is a world-leading expert in the treatment of brain injuries and 13 years ago he established the Neuro Critical Care Unit (NCCU) in Addenbrooke's Hospital in Cambridge.

It is now the largest unit of its kind in Europe with provision for 21 patients at any one time.

In this unit, the rules governing death are directly challenged.

"It's really important to think about death not as an event but as a process," said Professor Menon.

"That process can be strung out quite considerably and slowed down. It can also be interrupted."

In the UK today the legal definition of death is brain death, not whether the heart is beating as many believe.

And Professor Menon thinks that it is not just survival that is important but the quality of that survival.

"Between survival and death there is a slightly grey area," he said.

"The successes of modern medicine are often rightly publicised, but we rarely discuss what happens when medicine fails.

"For example, death is commonly viewed as an event which involves cessation of the heartbeat.

"In actual fact, it is irreversible damage to the brain that decides whether a person survives or not, and the heart needs to have stopped for several minutes before such damage results.

"Indeed, it is common, as with head injury, for the brain to be irreversibly damaged, while the function of the heart and lungs is maintained by intensive care."

Around 40% of patients admitted to the unit make a meaningful recovery.

Two months after Richard's accident, a speech therapist was asking him the same 20 simple questions – about his interests and family – each day.

Before the accident, Richard (r) was a keen motor cyclist and F1 fan

He answered by moving his eyes left or right to signal yes or no responses.

If Richard consistently answered correctly it would demonstrate that he had the capacity to finally be asked the question about what he wants: to continue treatment or stop it – effectively ending his life.

Richard had been in the NCCU for six months before Dr Menon asked him the question he had wanted to ask him ever since he saw his eyes move for the first time.

"He remembered he had had an accident," said Professor Menon.

"He was aware that he was being treated on an artificial ventilator and being fed through a tube going into his stomach and this was likely to be going on for some time. I didn't specify how long.

"Finally I then asked him if we were happy for us to go on treating him and he said 'yes'. I asked him again and on three occasions he made it clear, just with yes/no answers, that this was a consistent response."

Making progress

Richard is now able to make facial expressions and his long-term memory is intact.

He has been moved to a different unit nearer his home in Worcester and, after seeing slow but steady improvements, Richard Rudd Snr has changed his view.

"We all sit round and talk in the pub or at work and say 'if this happened to me, turn the machine off'," he said.

"It's all hypothetical and you don't know until it happens to yourself. As a family and friends, if that person can't decide for themselves, sometimes you feel that you can decide for them.

"Because, in theory, you think you can never live in that situation, you sometimes put that judgement onto somebody else.

"At the end of the day, you probably have no right to do that.

"But now Richard's in the situation where that's actually happened. It's real life – it's not pretend. He is in that situation.

"The will to live takes over."

Between Life and Death is on BBC One at 2235 BST on Tuesday 13 July, on BBC HD at 0000 BST on Wednesday 14 July and afterwards on iPlayer.

Sunlight on the skin helps generate vitamin D

Having low vitamin D levels may increase a person's risk of developing Parkinson's disease later in life, say Finnish researchers.

Their study of 3,000 people, published in Archives of Neurology, found people with the lowest levels of the sunshine vitamin had a three-fold higher risk.

Vitamin D could be helping to protect the nerve cells gradually lost by people with the disease, experts say.

The charity Parkinson's UK said further research was required.

Parkinson's disease affects several parts of the brain, leading to symptoms like tremor and slow movements.

30-year study

The researchers from Finland's National Institute for Health and Welfare measured vitamin D levels from the study group between 1978 and 1980, using blood samples.

They then followed these people over 30 years to see whether they developed Parkinson's disease.

They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson's, compared with the group with the highest levels of vitamin D.

Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from foods like oily fish, milk or cereals.

As people age, however, their skin becomes less able to produce vitamin D.

Doctors have known for many years that vitamin D helps calcium uptake and bone formation.

But research is now showing that it also plays a role in regulating the immune system, as well as in the development of the nervous system.

Vitamin target

Writing in an editorial in the US journal Archives of Neurology, Marian Evatt, assistant professor of neurology at Emory University School of Medicine, says that health authorities should consider raising the target vitamin D level.

"At this point, 30 nanograms per millilitre of blood or more appears optimal for bone health in humans.

"However, researchers don't yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination."

Dr Kieran Breen, director of research at Parkinson's UK, said: "The study provides further clues about the potential environmental factors that may influence or protect against the progression of Parkinson's.

"A balanced healthy diet should provide the recommended levels of vitamin D.

"Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson's, and at what stage these would be most beneficial."

Most of brain growth occurs in the earliest years of life

Having a big head may help protect against the worst ravages of dementia, say researchers.

They found that people with Alzheimer's with the largest craniums had better memory and thinking skills than patients with smaller skulls.

The Munich University team believe a larger head means there are greater brain reserves to buffer against dementia-related brain cell death.

Their findings, based on 270 patients, are published in the journal Neurology.

The patients were recruited through research registries or specialist memory clinics in the US, Canada, Germany and Greece.

They were given memory and cognitive skill tests and a brain scan to gauge the extent of their disease. They also had their head size measured.

A larger head was linked to better performance in the tests, even when patients had the same amount of Alzheimer's-related brain cell loss.

Specifically, for every 1% of brain cell death, an additional centimetre of head size was associated with a 6% greater score on the memory tests.

Although brain size is largely determined by genetics, the researchers say lifestyle can have an impact.

Poor nutrition or disease in early life can compromise growth, for example.

‘Complex disease’

The researchers say the first few years of development are critical. By the age of six, the brain will have reached 93% of its final size.

"Improving prenatal and early life conditions could significantly increase brain reserve, which could have an impact on the risk of developing Alzheimer's disease or the severity of symptoms of the disease," lead researcher Dr Robert Perneczky said.

Dr Simon Ridley, head of research for the Alzheimer's Research Trust, said: "Alzheimer's is a very complex disease, so we should be careful not to focus too much on a single risk factor, particularly as there is little we can do about the size of our heads.

"The researchers have also posed the idea that nutrition, injury or infection in early life can have an impact on brain reserve, suggesting that we should look after our brain from day one.

"Research is the only answer to dementia. We must invest in research now to deliver the treatments needed to avert the coming dementia crisis."

By Michelle Roberts
Health reporter, BBC News Being in a group helps people lose weight, says one nutritionist

A leading nutritionist says GPs should send obese patients to weight-loss schemes rather than offer NHS help because they will see better results.

Dr Susan Jebb of the Medical Research Council found in a study that people in a WeightWatchers programme lost twice as much weight as those with GP care.

WeightWatchers part-funded the study, but Dr Jebb stressed similar schemes would be as effective.

The National Obesity Forum said buying in services could benefit NHS patients.

The NHS is currently running pilot schemes with WeightWatchers.

GPs can buy one patient a 12-week course for about £45.

It was one of these schemes in Northampton that Dr Susan Jebb and colleagues studied, as well as two similar projects running in Australia and Germany.

Over the course of a year, the Northampton GPs referred half of 772 overweight patients to weekly WeightWatchers meetings, paid for by the doctor's surgery.

The other half received GP-led care. This typically involved things like providing leaflets about healthy eating and scheduled appointments with a nurse for weigh-ins and advice.

The patients had their weight recorded at regular intervals throughout the year to see the results.

At each measurement appointment, WeightWatchers came out best.

By 12 months, that group had lost twice as much – nearly 7kg (15lbs) on average per patient, compared to around 3kg (6lbs) in the GP-led group.

Although this amount of weight loss may seem small, the researchers say it can make a big difference in terms of health, say the researchers.

Cost-effective

Dr Jebb said: "Losing four to five kilograms can halve a person's diabetes risk if they are overweight, so even a little can be beneficial.

"We know a lot of people are overweight and need to lose weight. The challenge is how you do it.

"In the NHS we do not have the resources for a massive weight management programme. But this would be cost effective."

But Dr Jebb said that WeightWatchers was not unique, and that any similar programme involving regular weight checks, goal-setting and peer support could achieve the same.

"It's having a weekly weigh-in and the accountability it brings with it, as well as the support of the group, that seems to work.

"People are more likely to stick at it."

Fewer patients in the WeightWatchers group dropped out of the trial than in the GP-led group, although compliance was a problem generally, with just over half of the patients completing the trial overall.

Dr Jebb stressed weight-loss schemes would not be suitable for everyone, and GPs should bear this in mind.

"Men may not feel it's the right group for them, nor some ethnic groups. It's certainly not some panacea for the nation's weight problems.

"But GPs can now be confident that here is a way they can really help some of their patients that's based on evidence."

Determination

The health advisory body National Institute for Health and Clinical Excellence (NICE) already recommends in guidelines that GPs should consider referring overweight patients to a commercial provider.

Dr Brian Karet of the Royal College of GPs said it was important that patients had the motivation to shed excess pounds.

"Many GPs will try and find out how determined people are to lose weight, using techniques such as motivational interviewing, but it helps enormously to have a locally available group-based programme to then point people towards.

"Primary care trusts and commissioning groups should certainly consider setting up locality-based groups like this, or buying in to one of the commercial providers of weight loss support such as WeightWatchers."

Tam Fry of the National Obesity Forum said: "GPs are generalists by definition whereas WeightWatchers are the 'consultants' in their field.

"It's therefore not surprising that the latter achieve the better results.

"Referral to any organisation with a proven weight-loss system which can be replicated anywhere has to be the best option for the patient, the GP and the NHS.

"It may upset some PCTs to use commercial suppliers – but they do produce value for money."

The trial will be presented at the International Conference on Obesity in Stockholm this week.

By Nick Triggle
Health reporter, BBC News

GPs should have responsibility for much of England's NHS budget, proposals being put forward on Monday will suggest.

Ministers want doctors to club together in consortia to take charge of billions of pounds of funds for mental health, hospital and community services.

It would represent a major change but they believe GPs are better placed than managers to respond to patient need.

But some experts question whether GPs have the skills to take it on.

‘Empower’ doctors

The NHS budget stands at £105bn. About 80% of this is given to local health managers working for 152 primary care trusts which in turn commission services for their areas.

But the White Paper, which will be published later, is expected to call for much of this to be handed to GPs working together in formal partnerships in what would be a major shake-up of the NHS structure.

The White Paper is also expected to make reference to the creation of an independent NHS board to oversee health services.

Prof Chris Ham, chief executive of the King's Fund health think tank, said the proposals were part of the "biggest organisational upheaval in the health service, probably, since its inception".

He said giving GPs additional responsibilities was a "good idea", although there were possible pitfalls.

Prof Ham said: "GPs know their patients and their needs very well. They are, therefore, well positioned to take decisions on the use of resources and improve patient care and patient outcomes.

"The risk is that not all GPs have the motivation to do so – many don't have the skills either – and to implement this across the whole of England, without some degree of testing and piloting, could be a risky thing for the government to do."

The GP move has long been championed by Health Secretary Andrew Lansley – and in recent months the British Medical Association has indicated it is open to working with the government on the idea.

Speaking to the BBC on Sunday, Mr Lansley said the proposals would "empower" doctors and tackle the "frustrating" bureaucracy which plagued the health service.

"We have got to design services better and save money. GPs are best placed to do this."

But some experts have expressed concerns about the idea.

A report by the Civitas think tank said there was little evidence that GPs would be better than the current system and even warned the restructuring could set the NHS back by three years.

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By Jane Elliott
Health reporter, BBC News Newborn baby girl Sinnah survived – others are not so lucky

Alice Waterman says she has never seen so much blood in her life.

The 55-year-old independent midwife from East Anglia has gone to Sierra Leone with VSO in the hope that training local midwives will save lives in a country where one woman in eight dies in childbirth.

The images she describes are harrowing.

Blood covered the floor as a mother who had recently given birth to twins struggled to survive.

She needed a transfusion, but there is no blood bank in this West African state. Staff instead had to find out whether any relatives could help.

"The situation is very dire. To see it in reality is shocking in the 21st Century," she said.

"The death of young women appears to be accepted as part of normal life in Sierra Leone."

Difficult journey

And if the risks for mothers are great, their children do not fare much better. One out of every five babies will not live to see the age of two.

The mother survived the birth, said Alice, but sadly one of her babies did not, and Alice says this has left a lasting impression.

"I wondered about the twins – the first, a girl, had lived and was wrapped in a cloth and left at the side of the delivery room – which was also the office, and the place where staff got changed, put their bags and washed their hands in a bucket. There is no running water in the Makeni Government Hospital.

"The second twin, a boy, born by breech, died during birth.

Twins are more prevalent, but not always seen as a joy in the way they are in the developed world, she says.

"Sometimes a weaker twin does not survive beyond a few weeks, if that long. Many twins die at birth or one does not survive the birth."

Ante-natal care is poor, with basic equipment lacking, and iron tablets are not available in a country where most women are anaemic, even before they get pregnant.

"Hospitals often run without running water – only available from a well and a generator only turned on when an operation like a C-section [Caesarean section] is carried out. Equipment is often old, broken, run down. Wards are dirty and the smell of a postnatal ward without any ventilation is nasty. "

In demand

The government has now introduced free health care for pregnant women, lactating women and under fives – which means more women are coming to the hospitals.

Kaeiatu Dumbuya has her blood pressure taken by midwife Mariatu Koroma. Pic Jenny Hardy

And although this is better, Alice says it puts increased pressure on the country's 95 midwives who are dealing with a population of more than six million.

"I don't think that the government anticipated the demand for the free service," she said.

Theresa Bagrey, VSO's programme manager for health and a Sierra Leonian midwife said the situation was critical.

"Generally, we have the worst maternal and child mortality statistics in the world. Our mothers are dying."

By Emma Wilkinson
Health reporter, BBC News In 2008, more than 40,000 under-18s conceived

Pregnant teenagers are more likely to give birth prematurely and have a small baby than women in their 20s, says an Irish research team.

Fourteen to 17-year-olds were also more likely to give birth early if they were having a second child, a study of more than 50,000 women in England found.

The findings, reported in BMC Pregnancy and Childbirth, highlighted the importance of routine medical checks.

The team said more studies were needed to find out why the young were at risk.

The study included all women aged between 14 and 29 who had given birth in north-west England over a two-year period.

In all, 3,600 of those were aged between 14 and 17, the researchers said.

More than a third of them came from the most socially deprived areas.

The study also found teenage mothers were also more likely to be underweight.

Those aged under 17 were 21% more likely to have a premature baby with their first pregnancy and 93% more likely to have their second baby early.

There was also a link with younger mothers and having a baby with a low birth weight.

Researcher Dr Ali Khashan, from University College Cork, in the Republic of Ireland, said it might be that the risk of premature birth in the young teenagers was related to "biological immaturity".

"It is also possible that the increased risk of poor pregnancy outcome in the second teenage pregnancy is related to numerous complicating factors such as greater social deprivation and less prenatal care," he added.

The team said teenagers needed to be given proper medical checks during pregnancy and also said more needed to be done to promote contraception after a teenager had their first baby.

Second child

Professor Louise Kenny, consultant obstetrician and gynaecologist at Cork University Maternity Hospital and study leader, said more research was needed to find out the exact cause of premature babies in teenage girls.

She said one issue was that teenage mothers tended to turn up to health services later in their pregnancy than older mothers and were more likely to miss check-ups.

"It's not clear why the risk is greatest for teenagers having their second child," she said.

"It might be that pre-existing risk factors are increased by the physical and psychosocial demand of another pregnancy during teenage years – but again more research is needed."

She added: "We are particularly keen to emphasis the importance of post-natal follow-up, support and adequate counselling regarding contraception for teenagers."

Professor Steve Thornton, spokesman for the Royal College of Obstetricians and Gynaecologists, said he suspected there were a host of complex social and behavioural reasons behind the findings.

"The nice clear message here is that it is even more important for pregnant teenagers to have their antenatal checks to identify if there are any problems."