Training Slows Brain Aging
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Counselling helps “perfectionist” women regain their fertility and become pregnant, US researchers say.
They found cognitive behaviour therapy alone was enough to help some women who had stopped having periods and ovulating to regain their fertility.
The therapy is usually used to treat people with depression.
A European fertility conference in Prague heard a build-up of stress can play a major role in preventing a woman from ovulating.
But sometimes the effect can build up gradually in a subtle way.
Cognitive behaviour therapy (CBT) can counter this by helping women to “make molehills out of mountains”, the researchers said.
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CBT should be provided by the state, as it’s cost-effective and much cheaper than funding fertility treatment Professor Sarah Berga
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Many of the women seen by the team were perfectionists - whether they had high-powered jobs or stayed at home - leading to high levels of stress.
Others felt overwhelmed and stressed by the demands they felt they had in their lives.
However, none had been diagnosed with anxiety or depression.
Individual therapy
The researchers, from Emory University in Atlanta, Georgia, have been investigating why these women, who are otherwise healthy, stop having periods or ovulating for over 20 years.
Five to 10% of women are not having periods at any one time, and a much larger population will be sub-fertile.
They had previously found a close relationship between levels of stress hormones and reproductive hormones.
Their preliminary study focused on 16 young women who had not had a period for six months, even though some already had children.
They had all been diagnosed with a condition called functional hypothalamic amennhorea (FHA), caused by a prolonged reduction in levels of a hormone which signals the release into the bloodstream of hormones that simulate ovulation.
The women had been shown to have increased levels of cortisol, a hormone linked to stress.
Half were given cognitive behavioural therapy, tailored to their own situations for 20 weeks.
This was designed to provide them with advice on how they could deal with their problems and keep them in perspective.
The rest of the women were simply observed.
Relaxation
Over the course of the study, six of the eight women given CBT regained full fertility, with one showing some signs of restored ovarian function.
Two later became pregnant within two months.
In the eight women who received no treatment, one recovered her fertility while another showed signs of ovarian function.
Women in the CBT group saw cortisol levels fall and a restoration of a key signal which prompts ovulation.
Lead researcher Professor Sarah Berga said medics should not simply return to the days where women were simply told ‘relax and you will get pregnant’.
“People do not relax just because you have told them to. You need to teach them how to relax.
“These are subtle effects we are seeing. What we need to do is help women to cope and help them not to make mole-hills out of mountains.”
She added: “CBT should be provided by the state, as it’s cost-effective and much cheaper than funding fertility treatment.”
The team now to study up to 4,000 nurses to monitor their menstrual cycles and see how stress and reproductive hormones change, so that they can evaluate the true extent of the problem.
Dr Mark Hamilton, chairman of the British Fertility Society, said: “About 20% of women who are infertile have problems with ovulation.
“Many of those are related to weight, but a number do have problems with ovulatory function.
“We know that lifestyle factors can influence the menstrual cycle, so it’s appropriate that medical practice takes account of that, and CBT is one approach that could be helpful.”
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“You would think because it’s a terminal illness it would have been on the NHS,” she said.
“There are many other illnesses which people suffer from who can claim free prescriptions, so why not cancer victims?”
We sent our reporter Jenny Matthews to investigate. If you have any other story ideas - send them to the BBC using the form at the bottom of the page.
“Bitter, I think, is how I feel.”
After several years fighting breast cancer Sharon Dobson, a busy 35-year-old mother of three young boys from Nunney in Somerset, is still reeling after being diagnosed with secondary bone cancer.
She was shocked to be told the condition, although controllable, is not curable.
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MRS DOBSON’S PRESCRIPTIONS
Hormone therapy injections (every four weeks)
Bone-strengthening tablets (every four weeks)
Painkilling patch (every 15 days)
Painkilling tablets (every six weeks)
Each prescription: 6.50
Discount vouchers (Prescription Pre-Payment Certificates), for anyone needing more then 14 prescriptions a year, cost 93.20 a year
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She then found out she would have to pay prescription charges for many of the medicines needed to control the illness.
“When they said you have to have this, this, this and this I thought there’s bound to be some help out there, I’ve got a terminal illness, I’ll get help. But there just doesn’t seem to be anything available.
“I think it’s cruel. It’s a terminal illness. I think there should be more out there for people like me.”
Mrs Dobson works part-time and her husband works full-time, so she does not qualify for free prescriptions on the basis of income.
She needs injections of hormone therapy to try to stop the disease spreading, bone tablets to help prevent fractures, a painkilling patch and other painkilling pills. Each prescription costs 6.50.
Although she could buy an annual prescription pre-payment certificate for 93.20, which would cover all her prescriptions, she is still furious about the whole principle of charging cancer patients for medicines.
Under current rules, dating back to 1968, people with some chronic illnesses such as diabetes and epilepsy do not have to pay for prescriptions - but people with others, including cancer and multiple sclerosis, do.
Review call
Mrs Dobson thinks it is time for a review of the system.
Her sons George, Charlie and James cheer her up
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“Secondary bone cancer is like diabetes - controllable but not curable. So why are they not the same?” she says.
The issue of prescription charges is a fairly hot topic at the moment.
Charity Breast Cancer Care recently launched a campaign urging free prescriptions for cancer patients and a review of the list of exempt conditions, saying no-one should have to pay prescription charges for what could be life-saving treatment.
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PRESCRIPTION EXEMPTIONS
Permanent fistulas (eg colostomy)
Forms of hypoadrenalism
Diabetes
Hypoparathyroidism
Myasthenia gravis
Myxoedema (underactive thyroid)
Epilepsy needing continuous anti-convulsive therapy
Permanent physical disabilities meaning person cannot leave house unaided
Exemptions drawn up in 1968; last reviewed 1998
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In Wales, politicians have reduced all prescription charges to 4 and plan to scrap them completely by 2007. The Scottish Parliament recently decided against scrapping prescription charges, but is looking again at the rules on exemptions.
The Department of Health said there were no plans at present for a review of prescription charges, but did note that the Health Select Committee was looking at the issue as part of a broader inquiry into NHS charges.
A spokeswoman said some people on low incomes, children, pregnant women and the over 60s all received free prescriptions.
“In England our policy is to use the finite resources of the NHS to give priority to helping people who may have difficulty in paying charges, rather than extending the exemption arrangements,” she said.
Getting on with it
In the meantime, Mrs Dobson is trying to come to terms with her illness.
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PRESCRIPTION CHARGES
England, Scotland, Northern Ireland: 6.50
Wales: 4 (to be scrapped by 2007)
Scottish Executive reviewing prescription charging system
Health Select Committee reviewing charges across the NHS
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“I do have my moments - right now I could probably cry - but I try not to cry in front of the children, and I don’t think I’ve cried for probably a week now.”
She says her sons - six-year-old twins George and James, and three-year-old Charlie - cheer her up greatly, while she has “very supportive” friends and family and a “brilliant” husband.
“I just feel that I need to keep on going, otherwise if I don’t I’ll just dwell on it and I don’t want to do that,” she says.
Do you have any pictures that could make a story? If so, you can send them to yourpics@bbc.co.uk or MMS them to 07725 100 100.
Click here for terms and conditions on sending photos and video
Your views
I, too, have a terminal illness and have to pay for my prescriptions; I buy an annual prescription prepayment certificate for 93.00 which works out very cost effectively and it covers every single drug prescription in that 12 month period. I have lived in the USA for part of my life and was astounded with the prescription charges there. The cost of an NHS prescription certificate is peanuts by comparison. Ask any American how they would feel about getting all the prescription drugs they need for a single payment of $160 and they would be desperate to make the deal!
Alexandra, Manchester, UK
Whilst I think it’s awful that this lady has to pay for her medication, there are many, many thousands of people in the same situation. I have medications for chronic asthma and for severe allergic reactions, all that cost me a fortune, but also keep me alive. I don’t believe you could ever reform the system as there would always be someone who felt it unfair that they don’t get free prescriptions. The NHS is so underfunded and free prescriptions would just cost the NHS millions that they haven’t got.
Lisa Morse, North Somerset
My wife died last year of cancer. She could afford to and paid the annual prescription charge which amounted to less than 2.00 per week. The value of her NHS treatment for the duration of the disease was well in excess of five figures. Surely if you can afford to pay the prescription charge it is a small token to pay. If you cannot afford to pay it there are plenty of exclusions.
Richard Simon, London
I think it’s terrible that this lady has to pay for her prescriptions. The current system is totally outdated. I have asthma which is a chronic condition although not seriously disabling, I have friends who have very serious asthma and frequently need hospital treatment. They don’t get free prescriptions either, but without their inhalers and steroids they would die! The NHS hasn’t reviewed this rule as they know that a lot of people out there would be exempt and it would cost millions of pounds putting more burden on our under funded health service.
Diane Graham, Wirral, UK
A friend of mine suffered three separate bouts of cancer and at the last bout a Macmillan nurse suggested she apply for Disability Living Allowance. She did, the nurse helped her with the forms and she was awarded the allowance - this may be worth looking at and may hopefully help towards this lady’s prescription costs. Hope this helps.
Irene, Newcastle upon Tyne
I too agree that people with ‘terminal’ illnesses should not have to pay for their treatment. My friend, who has an incurable cancer, has to inject herself with drugs every day and I find it absolutely appalling that she has to pay for them.
Wendy Reddall, North Shields
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Journalist Tony Macaulay takes a look at what is making the headlines in Friday’s morning papers.
When is a deadline not a deadline?
In Friday’s News Letter, the headline says the secretary of state was “left with egg on his face” as his 24 November deadline for political agreement came back to bite him.
It says “Peter Hain’s threats to close down the assembly and stop MLAs salaries now looks hollow”.
The News Letter says he “has downgraded his ambitions from devolved government being established by the 24 November to the DUP and Sinn Fein nominating first and deputy first ministers”.
And on Thursday, with the publication of legislation to move the St Andrews Agreement forward, the paper says “it became apparent there would be no nominations either”.
Poverty levels
Meanwhile, The Irish News claims that poverty levels are soaring in Northern Ireland.
The paper highlights a new report by the Joseph Rowntree Foundation warning that “rising rates and impending water charges will send countless families plunging into poverty”.
The report warns that “families relying on low wages will be driven into poverty when they are faced with additional household bills next year”.
The Belfast Telegraph tells the good news story of a Coleraine mother who has defied medical predictions.
Doctors told Stephanie Murphy that she could never have another child after being diagnosed with advanced breast cancer in 2002 and undergoing aggressive chemotherapy and radiotherapy.
But a beautiful picture on the front page shows Stephanie cuddling her daughter Nicole who recently celebrated her first birthday.
She says: “Cancer does not have to be a death sentence… I’m living proof of that and so is Nicole”.
The Independent front page is devoted to a special report from inside Zimbabwe.
Above a disturbing picture of freshly dug graves the headline is “Dead by 34 - this is the fate of women in Zimbabwe” where they now have the world’s lowest life expectancy after 26 years of Mugabe.
Life expectancy for women in the country was 65 just over a decade ago.
The paper says “Aids and starvation are condemning women to an early grave”.
It says the Robert Mugabe regime has succeeded in turning Zimbabwe “into a famished and demoralised land deserted by its men of working age, with its women left to die a silent death”.
The Daily Mail leads with a report that “parents are bullying GPs into prescribing anti-depressants for their children in record numbers”.
‘The Prozac Generation’
The paper says that middle-class parents are among the worst culprits, especially those with children under pressure to do well at school.
It says there is concern that children who are simply unhappy are being labelled as depressed and over a third of GPs feel under pressure from parents to provide a quick fix through drugs such as Prozac when counselling would be better.
The headline is: “The Prozac Generation”.
Finally, The Sun reports on a survey that reveals what it calls a “craze for wacky names” sweeping the country.
The paper says celebrity obsessed parents are giving their children names such as Gazza, Madonna, Superman, Tupac and Arsenal.
Apparently nearly 300 parents are doting over their little Beyonces and six parents can now be heard shouting “Gandalf - your dinner’s ready!”
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Mrs Bagot Stack promoted her philosophy of exercise structured and graded to the needs of all ages and abilities, and taught by trained physicians, through huge public displays. The first, in Hyde Park, drew 160,000 members whose activities were documented on the newsreels of the day, and form part of a new BBC television series.
Mrs Bagot Stack had long been interested in exercise when, in the 20s, she moved to Manchester, where she saw that women working in mills could benefit from systematic exercise to invigorate them after a hard day.
A trip to the Himalayas had also opened her eyes to the better posture of Indian women and yoga techniques which she incorporated into her system.
As her daughter Prunella recalls today, it was “very, very necessary. There was nothing like it at the time because there were private lessons if you could afford them, but there was nothing that was popular and cheap and that everybody could join”.
Prunella Stack, now 90, inherited her mother’s work aged 20
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“That was amazingly popular and cheap because it cost half a crown to join, 3/6 for an entrance badge and then sixpence a class. Well it just took off like a bomb. It was incredible.”
The craze gathered pace as Europe began to re-arm and the threat of war loomed large again. Finally, in 1937, the government harnessed the momentum built by the Women’s League and began a national health campaign. Prunella, who inherited the running of the league from her mother, was appointed to the campaign to stress physical exercise as “a matter of national importance”.
This 20-year leap by the British from weaklings to fitness fanatics owed a debt to other factors. The burgeoning Boy Scout and Girl Guide movement, which placed an emphasis on outdoor life, saw its membership shoot to a million in the 1920s. Healthy eating was also being pushed. Bermondsey Borough Council in London released a series of films to encourage its poverty-stricken residents to, among other things, brush their teeth
The cinema was a key propaganda tool, and women made up three-quarters of the audience in the 1920s. Pathe began Eve’s Film Review, which ran for about 10 minutes and focused on things it thought women would enjoy like fashion films, beauty or women’s sports.
Pathe cataloguer Jenny Hammerton says in the aftermath of World War I, women were partly motivated to get fit out of self-interest.
The Fitness League’s legacy
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“During the 20s there weren’t many men to go round because of the loss of male life during [the war],” says Ms Hammerton. “There was what was known as the two million superfluous women, I think a lot of the films focus on the body beautiful. They were really encouraging women to look their best in order to snare a man.”
In the 50s and 60s the attitude seemed to change. Len Almond, of the British Heart Foundation National Centre for Physical Activity & Health, says there was shift in schools to games such as netball and hockey, rather than dance and movement - something that put many women off exercising.
But with the aerobics craze of the 80s, the pendulum swung back again. Today the influence of the Women’s League - now called the Fitness League - can be seen in every gym workout room around the country.
Newly uncovered film footage of the Women’s League of Health and Beauty will feature in Nation on Film, to be broadcast on BBC Two on Tuesday 15 February at 1930 GMT.
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Doctors are set to lose the power to regulate themselves and senior medics will face regular MOT-style checks under a planned shake-up of regulation.
The overhaul, which will now be debated by parliament, has been announced by ministers following the Shipman murders and other medical scandals.
A stricter system of death certification is also to be introduced.
The General Medical Council is set to lose its power to adjudicate on fitness-to-practise cases.
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Patient safety is the overriding concern Andy Burnham
Health Minister
Reaction to proposed reforms
Q&A: Doctor regulation
Read the full proposals [282k]
Most computers will open this document automatically, but you may need Adobe Reader
Download the reader here
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The GMC will also have to change its membership to 50% doctors, 50% lay people in a move away from the much criticised profession-led regime.
Similar systems are being introduced for the other eight health professional regulatory bodies, covering the likes of dentists, pharmacists and nurses.
Rogue doctors
The proposals - the biggest overhaul of regulation in a generation - have been made by the government in a white paper and response to recent cases where patients have been harmed by doctors.
Dr Harold Shipman, from Hyde in Greater Manchester, murdered more than 200 people over a period of 23 years.
Dame Janet Smith, who chaired the inquiry into the case, accused the GMC regulatory body in her 2004 report of being more interested in looking after doctors than protecting patients.
She did not blame the GMC for failing to detect Shipman’s killing spree but said the culture in the medical profession was to focus on doctors’ interests.
The medical profession has also come under fire following other scandals, such as Clifford Ayling, a Sussex GP who sexually abused patients.
The proposals include:
Health minister Andy Burnham said he hoped the proposals would settle once and for all the controversies over doctor regulation.
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HAVE YOUR SAY
The proposals will provide lots of jobs for administrators and increase registration fees Dr B Green, Cheadle
Send us your comments
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“Patient safety is the overriding concern. It is crucial to ensure the systems we are imposing ensure the confidence of patients and the wider public and command professional confidence.”
Sir Liam said MOT-style checks would correct the situation where doctors can go their whole career without facing assessment whereas an airline pilot can expect 100 checks over the same period of time.
He said: “I am confident that the proposals will set out a framework through which patients, the public, professions and government secure a new settlement that assures the safety of patients.”
Doctors’ response
Mr James Johnson, chairman of the British Medical Association, said the profession had worked for several years to introduce revalidation checks.
However, he said the proposals for reform of the GMC cast doubt on the whole concept of professionally-led regulation.
“The protection of the public is absolutely the prime concern, but equally it is very important for the public that doctors feel that they are the patient’s doctor, and not the state’s doctor.”
Professor Ian Gilmore, president of the Royal College of Physicians, welcomed the proposals.
“Patients need to know that their doctor can treat them safely and to a high clinical standard - the new national framework will give both doctors and patients more confidence in the regulatory system.”
Sir Graeme Catto, president of the GMC, welcomed the plans, and said it was important that the public had confidence in the regulatory process.
However, he denied that the GMC had put doctors’ interests ahead of those of the public.
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The unusual document from the Vatican’s office for migrants and itinerant people also warned that automobiles can be “an occasion of sin” — particularly when used to make a dangerous passing maneuver or when used by prostitutes and their clients.
And it suggested prayer might come in handy — performing the sign of the cross before starting off and saying the rosary along the way. The rosary was particularly well-suited to recitation by all in the car, it said, since its “rhythm and gentle repetition does not distract the driver’s attention.”
Cardinal Renato Martino, who heads the office, told a news conference the Vatican felt it necessary to address the pastoral needs of motorists because driving has become such a big part of contemporary life.
He cited World Health Organization statistics that said an estimated 1.2 million people are killed in road crashes each year and as many as 50 million are injured.
“That’s a sad reality, and at the same time, a great challenge for society and the church,” he said.
He noted that the Bible was full of people on the move, including Mary and Joseph, the parents of Jesus — and that his office is tasked with dealing with all “itinerant” people on the roads — from refugees to prostitutes, truck drivers and the homeless.
The document, “Guidelines for the Pastoral Care of the Road,” extols the benefits of driving — family outings, getting the sick to the hospital, allowing people to get to work and seeing other cultures.
But it laments a host of ills associated with automobiles: Drivers use their cars to show off; driving “provides an easy opportunity to dominate others” by speeding; and drivers can kill themselves and others if they drink, use drugs or fall asleep at the wheel.
It warned about the effects of road rage, saying driving can bring out “primitive” behavior in motorists, including “impoliteness, rude gestures, cursing, blasphemy, loss of sense of responsibility or deliberate infringement of the highway code.”
It called for drivers to obey speed limits and to exercise a host of Christian virtues: charity to fellow drivers, prudence on the roads, hope of arriving safely and justice in the event of crashes.
Martino’s initiative was sure to make headlines in Italy, where car culture is deeply entrenched — this is the home of Ferrari and Fiat — and where weekend highway deaths make the evening news on a regular basis.
The Rev. Keith Pecklers, a Jesuit professor of liturgy at the Pontifical Gregorian University in Rome, said Martino was clearly responding to an underreported social concern: an increase in traffic deaths in places like Italy and Spain because of speeding, as well as an increase in road rage, aggressive driving and DUI in places like the United States.
“It may be surprising for people because we’re accustomed to the church speaking out about sexual matters, capital punishment, immigration,” he said. “The point Cardinal Martino is making is that driving is itself a moral issue. How we drive impacts on the lives of ourselves and others.”
Pecklers dismissed any suggestion that Martino’s “Ten Commandments” were at all sacrilegious, saying it was “creative pedagogy” that would certainly get people’s attention. He stressed that they could never be considered binding in the way the official Ten Commandments are.
The Rev. Thomas Williams, a Rome-based theologian, concurred.
“It might be a little flippant but it’s not sacrilegious,” he said.
But for some, the document was at least reason to poke fun at the Vatican.
“Overtaking is a sin? Well, then I’m a murderer, I’ll turn myself in immediately,” quipped movie director Dino Risi, whose classic film “The Easy Life” — “Il Sorpasso,” or “The Overtaking” — ends with a car crash.
“I think the Vatican has lost its marbles,” he added, according to the ANSA news agency.
There was no indication Pope Benedict XVI had approved of, or even read, the document. It was signed by Martino and his secretary — as is customary for lower-level documents that are routinely put out by the offices of the Vatican’s vast bureaucracy.
Martino is known as something of a loose cannon at the Vatican, and occasionally his pronouncements have gotten him into trouble.
In 2003, he was rebuked by Vatican officials for telling a press conference the United States treated Saddam Hussein “like a cow” after his capture. A senior Vatican official called in reporters several days later to stress that Martino was expressing his personal opinion and not the view of the pope.
Martino hasn’t shied away from controversial topics, either. Just last week he said Roman Catholics should stop donating money to Amnesty International because it had adopted a new policy calling for women to have access to abortion services in some circumstances.
The cardinal, who was the Vatican’s U.N. envoy for 16 years, has also expressed support for genetically modified foods and he has backed scientists who question the seriousness of climate change. More…
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