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Two microbiota subtypes identified in irritable bowel syndrome with distinct responses to the low FODMAP diet | Gut


IBSP (pathogenic-like) and IBSH (health-like) subtypes. IBSP microbiomes were enriched in Firmicutes and genes for amino acid and carbohydrate metabolism, but depleted in Bacteroidetes species. IBSH microbiomes were similar to controls.

The clinical response to the low FODMAP diet was greater in IBSP subjects compared with IBSH (p=0.02).


  • It can be helpful to test IBS patients’ Gut Biome before recommending a FODMAP diet.
  • The FODMAP diet can be expected to be most helpful to patients with HIGH fermicutes and LOW bacteroides species.

HIV Transmission Rates After Exposure

BMJ Paper looking at management of potential BBV after a needlestick injury

“The estimated risk for HIV transmission after injury through a needle contaminated with HIV infected blood and after mucous membrane exposure is 0.3% and 0.09% respectively.8,9”


8. Bell DM. Occupational risk of HIV virus infection in heath care workers: an overview. Am J Med1997;102(5B):9–15.PubMedGoogle Scholar

9. Ippolito G, Puro V, De Carli G. The Italian study group on occupational risk of HIV infection. The risk of occupational HIV infection in health care workers. Arch Intern Med1993;153:1451.CrossRefPubMedWeb of ScienceGoogle Scholar

Other infections

The risk associated with a single parenteral exposure to blood from a source patient who has HBV infection ranges from 6% in HBV “e” antigen negative patients to as high as 40% in “e” antigen positive.12 The average incidence of seroconversion to HCV after needlestick injury from an HCV positive source is 1.8% (range 0%–7%).13

Fasting & Blood Pressure, Gut Biome Link

From the Original Article

One of the most widely used animal models of hypertension are spontaneously hypertensive stroke-prone (SHRSP) rats, a line of rats that develop hypertension at six weeks of age, much earlier than control animals. Like hypertensive humans, these rats show gut dysbiosis.

To investigate whether gut dysbiosis contributes to the development of hypertension, the researchers transferred gut microbiota from SHRSP rats to rats with normal blood pressure. The previously healthy rats to develop high blood pressure, pointing towards a causal relationship between gut dysbiosis and hypertension.

Could changing the feeding pattern through fasting reduce the blood pressure of the SHRSP rats?

To test this, the researchers split the SHRSP rats into two groups: one group had unlimited access to food, while the other group was fed only every other day. After nine weeks, the rats that had unlimited access to food had developed high blood pressure, as is expected for the SHRSP model. In contrast, rats that were fed only every other day did not develop high blood pressure.

Faecal Transplant Experiments further demonstrate the causal nature of the Gut Biome

The researchers observed that germ-free rats that had received microbiota from the fasting SHRSP rats had lower blood pressure than germ-free rats that had received microbiota from normal-fed SHRSP rats. With this, the researchers discovered that modulating the gut microbiota

Further Questions
  • Exactly what is the gut dysbiosis, which species?
  • Is there a similar difference between normotensive and hypertensive humans?
  • Does alternate day fasting affect human BP the same for hypertensives?
  • Does the same dysbiosis affect normotensive humans? Could it be an identifiable risk factor/ predictor?
  • Hypertension is strongly age related in humans ==> therefore ==> Is dysbiosis age related?

Ottawa ankle rules | Radiology Reference Article | Radiopaedia.org


Radiology is indicated if there is;

1. inability to weight bear (four steps) immediately after the injury and in emergency department


2. point tenderness at;

  • posterior edge (of distal 6 cm) or tip lateral malleolus
  • posterior edge (of distal 6 cm) or tip medial malleolus
  • the base of the fifth metatarsal
  • the navicular


Fast Foods & Phthalates

Original Academic Article

Phthalate and novel plasticizer concentrations in food items from U.S. fast food chains: a preliminary analysis | Journal of Exposure Science & Environmental Epidemiology


Summary: by USA Today

From their website:

MARINA PITOFSKY | USA TODAY | 6:30 pm EDT October 27, 2021

A new study shows that chemicals known as phthalates, which have been linked to health problems, have been detected in food from popular chains like McDonald’s, Chipotle and more.  

The peer-reviewed analysis was published this week in the Journal of Exposure Science & Environmental Epidemiology by researchers from George Washington University, the Southwest Research Institute (San Antonio, Texas), Boston University and Harvard University.

The research includes items from McDonald’s, Burger King, Pizza Hut, Domino’s, Taco Bell and Chipotle locations in San Antonio, Texas. Researchers obtained 64 food samples of hamburgers, fries, chicken nuggets, chicken burritos and cheese pizza from the chains.

They found that over 80% of the foods contained a phthalate called DnBP. And 70% contained the phthalate DEHP. Both of the chemicals have been linked to reproductive health problems.  

Food containing meat, such as chicken burritos and cheeseburgers, had higher levels of the chemicals studied, while cheese pizza had the lowest levels.   

Phthalates … have been linked to reproductive problems, learning and attention problems in children and more

Fatty acid found in palm oil linked to spread of cancer


palmitic acid promoted metastasis in mouth and skin cancers.

Covid: Pfizer and AstraZeneca jabs effective against Indian variant – study – BBC News


The BBC report that:

  • The Pfizer and AstraZeneca coronavirus vaccines are highly effective against the variant identified in India after two doses.
  • Two jabs of either vaccine give a similar level of protection against symptomatic disease from the Indian variant as they do for the Kent one.
  • However, both vaccines were only 33% effective against the Indian variant three weeks after the first dose. This compared with 50% effectiveness against the Kent variant.
  • The Pfizer vaccine was found to be 88% effective at stopping symptomatic disease from the Indian variant two weeks after the second dose, compared with 93% effectiveness against the Kent variant.
  • The AstraZeneca jab was 60% effective against the Indian variant, compared with 66% against the Kent variant.

Maternal and infant microbiomes affect offspring’s disease risk 

Researchers have conducted a review of studies analyzing how disruptions to maternal and infant microbiomes may increase the risk of certain illnesses later in life.

The microbiome refers to the tens of trillions of microorganisms that live in our intestine, respiratory tract and on our skin.

There is increasing evidence that disruptions to a person’s microbiota in early life may influence the likelihood of developing certain illnesses later in life. Earlier this year, for example, a study reported by Medical News Today found that an increase in richness of gut bacteria at 3 months of age was associated with reduced risk for food allergies at 1 year of age.

“Disturbed microbiota could potentially contribute to a wide range of childhood diseases including allergies, asthma, obesity and autism-like neurodevelopmental conditions,” notes Dr. Meropol.

However, she points to a number of recent studies that suggest a number of factors that may aid a child’s microbiome development, including breastfeeding, vaginal birth and skin-to-skin contact straight after birth.

Growing evidence that microbiota development begins before birth 
Popular notion holds that the development of microbiota begins at birth and that the womb is a sterile environment. However, recent studies have challenged this idea, suggesting that gut microbiota development begins before birth. Dr. Meropol and colleagues discuss this theory, pointing to a review that assesses the growing evidence that a child’s microbiota development starts in the womb.

In a review titled “Microbial Programming of health and disease starts during fetal life,” Petya T. Koleva, of the University of Alberta in Canada, and colleagues cite research that found the offspring of mothers with allergies have greater abundance of Enterobacteriaceae bacteria in their earliest stools, which may raise their risk of later-life respiratory problems.

“This means that not only do we have to consider the microbiome of the child but also that of the mother,” notes Dr. Meropol, “and the irony is that some of our modern medical practices, through their effect on these early microbiota, could have unintended consequences, interfering with normal development of children’s immune, metabolic, and neurologic systems.”

Source: Maternal and infant microbiomes affect offspring’s later-life disease risk – Medical News Today

Gene editing improves muscle function in mice with Duchenne muscular dystrophy 

A new gene-editing technique called CRISPR/Cas9 improved muscle function in live mice with Duchenne muscular dystrophy, establishing its potential as a therapy for humans.

Source: Gene editing improves muscle function in mice with Duchenne muscular dystrophy – Medical News Today

Study links high sugar intake to increased risk of breast cancer – suggesting a causal effect not just an association

When it comes to the rising rates of obesity, sugar is deemed a key culprit. But high sugar intake may not only lead to weight gain; a new study claims it can increase the risk of breast cancer and hasten spread of the disease to the lungs … According to the team, previous research has identified a link between dietary sugar intake and risk of breast cancer, with some studies suggesting inflammation may play an important role.

the team set out to assess how sugar intake influenced breast cancer development in mice that were randomized to various diets, including a sucrose-enriched diet, a fructose-enriched diet and a starch-control diet.

Mice fed a diet enriched with sucrose or fructose were more likely to develop breast cancer and have the disease spread to the lungs, according to the results of a new study.

Source: Study links high sugar intake to increased risk of breast cancer – Medical News Today

corecharity.org.uk leaflet for Irritable Bowel Syndrome

Source: corecharity.org.uk/wp-content/uploads/2015/10/CORE-PATIENT-INFORMATION-IRRITABLE-BOWEL-SYNDROME.pdf

Rome Foundation // Rome III Diagnostic Criteria for IBS and other Functional Gut Diseases

At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort** associated with 2 or more of the following:
  • Improvement with defecation; and/or.
  • Onset associated with a change in frequency of stool; and/or.
  • Onset associated with a change in form (appearance) of stool.



Source: Rome Foundation // Rome III Diagnostic Criteria

IBS Diagnosis

Presenting Symptoms of IBS

Person reporting any of the following symptoms for at least 6 months in the absence of any red flag symptoms:

  • Abdominal pain or discomfort
  • Bloating
  • Change in bowel habit

(Note: on this post the grey text denotes material taken from the NICE website as downloaded on 04/01/15)

The Rome III Criteria for the diagnosis of IBS are more precisely defined and given as; At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort associated with 2 or more of the following:

  • Improvement with defecation; and/or.
  • Onset associated with a change in frequency of stool; and/or.
  • Onset associated with a change in form (appearance) of st


Red Flags in IBS

Ask all people with possible irritable bowel syndrome symptoms if they have any of the following ‘red flag’ indicators and refer them to secondary care for further investigation if they have.
  • Unintentional and unexplained weight loss.
  • Rectal bleeding.
  • A family history of bowel or ovarian cancer.
  • In people aged over 60, a change in bowel habit lasting more than 6 weekswith looser and/or more frequent stools.
Assess and clinically examine all people with possible irritable bowel syndrome symptoms and refer to secondary care if any of the following ‘red flags’ are found:
  • anaemia
  • abdominal masses
  • rectal masses
  • inflammatory markers for inflammatory bowel disease.
Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer in line with NICE’s pathway on ovarian cancer.
See the NICE pathway on suspected cancer recognition and referral for detailed referral criteria where cancer is suspected.
NICE has also produced a pathway on colorectal cancer.


Assessing the Impact of IBS

Several tools have been proposed, used and validated for use in assessing the impact or quality of life of IBS on patients.

A thorough comparison of the various tools is available on the website of one of the authors – Dr Drossman and a downloaded version (04/01/15) is mirrored here IBS-QOL published. The preferred tool that Cloud Health uses is the IBS-QOL which consists of 34 questions on a 0-5 Liekhert scale that considers 8 Dimensions (Dysphoria, Interference with activity, Body image, Health worry, Food avoidance, Social reaction, Sexual & Relationship).

The IBS-QOL is a proprietary questionnaire that is available from the University of Washington and was described for academic purposes in the American Journal of Gastroenterology on the website of the journal Nature and a downloaded version (04/01/15) of that is mirrored here. American Journal of Gastroenterology



Confirming a diagnosis of IBS in people who meet the diagnostic criteria

Faecal calprotectin testing

The following recommendations are from NICE diagnostics guidance on faecal calprotectin diagnostic tests for inflammatory diseases of the bowel.
Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) in adults with recent onset lower gastrointestinal symptoms for whom specialist assessment is being considered, if:
  • cancer is not suspected, having considered the risk factors (for example, age) described in the NICE pathway on suspected cancer recognition and referral, and
  • appropriate quality assurance processes and locally agreed care pathways are in place for the testing.
Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of IBD or non-IBD (including IBS) in children with suspected IBD who have been referred for specialist assessment, if:
  • appropriate quality assurance processes and locally agreed care pathways are in place for the testing.

Other tests

Also, carry out the following tests to exclude other diagnoses:
But do not do the following tests to confirm diagnosis of irritable bowel syndrome:
  • ultrasound
  • rigid/flexible sigmoidoscopy
  • colonoscopy; barium enema
  • thyroid function test
  • faecal ova and parasite test
  • faecal occult blood
  • hydrogen breath test (for lactose intolerance and bacterial overgrowth).


The following implementation tool is relevant to this part of the pathway.


The NICE guidance that was used to create this part of the pathway.
Irritable bowel syndrome in adults (2008 updated 2015) NICE guideline CG61




Parts of London have higher TB rates than Iraq or Rwanda

Parts of London have higher TB rates than Iraq or Rwanda – http://www.bbc.co.uk/news/uk-england-london-34637968


Study suggests that excess fat around the waist is an increased health risk even at a normal weight and BMI


From their own website;

Normal weight women with extra belly fat had nearly a 50 percent increased risk of death during the study period versus a normal weight woman whose weight was more equally distributed throughout her body. Compared to obese women (measured by BMI only), the normal weight women with belly fat had a 32 percent higher risk of early death, the researchers found.

Dr. David Katz, director of the Yale University Prevention Research Center, in New Haven, Conn., and president of the American College of Lifestyle Medicine, said the study findings raise the question: who would have more belly fat and still be at a normal weight according to their BMI?

Some people are more prone to depositing excess fat around the middle, he said. This can lead to fat accumulation in vital organs, especially the liver, he explained.

Another group may be those who have excess body fat and illness, perhaps in early stages, causing loss of lean body mass, Katz said. Although it’s not clear from this study how many people might fall into this category, he added.

Regardless of why someone has gained weight around the middle, Katz said, “We have long known that all varieties of overweight are not created equal with regard to health risk, and that central obesity is the most concerning variety.”

In his editorial, Poirier wrote, “These new data provide evidence that clinicians should look beyond BMI. Although assessing for total fat mass with BMI to identify patients at greater cardiovascular risk is a good start, it is not sufficient.”

The 116 things that can give you cancer – the full list … International Agency for Research on Cancer via the Guardian

The 116 things that can give you cancer – the full list


From their website

The 116 things that can give you cancer – the full list
Rocked by the news that processed meat could be terribly bad for you? Well, chimney sweeping, salted fish and fracking also appear on the list compiled by the International Agency for Research on Cancer
Aisha Gani and Benedict Nicholson
Published: 07:00 GMT+00:00 Wed 28 October 2015
Follow Aisha Gani
The World Health Organisation said processed meats are among the most carcinogenic substances along with cigarettes, alcohol, sunbeds and arsenic.
The World Health Organisation said processed meats are among the most carcinogenic substances along with cigarettes, alcohol, sunbeds and arsenic. Composite: Rex, Alamy
After Monday’s bombshell news from the World Health Organisation that bacon, ham and sausages are carcinogenic, you can be forgiven for wondering just what exactly is safe for you to come into contact with – let alone eat.

Handily, the International Agency for Research on Cancer – a body that collects and publishes cancer figures worldwide – has a list of the 116 substances and activities (for some of them are more verb than noun) that are now considered to cause cancer.

Processed meats rank alongside smoking as cancer causes – WHO

Red meat isn’t on the list – that only probably causes cancer. This is the IARC’s group 1 list – the stuff it says definitely is carcinogenic. The IARC splits the list into three categories, which it calls “exposure circumstances”, “mixtures” and “agents”.

Carcinogenic exposure circumstances

1 Tobacco smoking: The most common exposure to the stimulant, prepared from the leaves of the tobacco plant, is through burning it and smoking it from a cigarette or hookah pipe into the mouth and then releasing it. Smoking’s history dates back to as early as 5000–3000BC when the agricultural product began to be cultivated in South America.

2 Sunlamps and sunbeds: A tanning bed, a device that emits ultraviolet radiation for a cosmetic tan, can give humans overexposure to UV radiation, which can cause skin cancer, cataracts, and premature skin ageing.

3 Aluminium production: Increased lung and bladder cancer risks have been reported in workers in aluminium reduction plants. The fumes of chemicals the workers may inhale, and exposure to coal-tar pitch volatiles for long periods during the process, can cause cancer.

4 Arsenic in drinking water: The highly toxic chemical which is used to make certain alloys used in the manufacturing industry, can get into the drinking water supply, particularly in ground water. Arsenic is known to cause skin cancer, and linked to causing liver, lung, kidney, and bladder cancer.

5 Auramine production: Auramine can be used as an antiseptic agent as well as to make dyes. A study found there to be an excess of bladder tumours among men engaged in the manufacture of auramine, through inhaling harmful agents, such as formaldehyde and sulphur, during the manufacturing process.

6 Boot and shoe manufacture and repair: Linked to increased risk of nasal cancer and leukaemia, due to exposure to suspected carcinogens such as leather dust, benzene and other solvents, yet the risk of cancer in shoe manufacturing may vary depending on the duration and level of exposure.

Play Video. Duration: 00:16
7 Chimney sweeping: Cleaning chimneys of soot and dust, historically done by small boys who could climb the chimney but now done mechanically, could cause a very specific form of cancer – termed “chimney sweep” cancer. It could be caused by inhalation and accidental ingestion of coal and burnt wood fumes and residue.

8 Coal gasification: Studies of the cancer levels of workers who had occupational exposure to coal gasification – when coal is reacted with oxygen, steam and carbon dioxide to form a gas – showed there to be an excess of lung cancer.

9 Coal tar distillation: Derived from coal, coal-tar pitch is a thick black liquid that remains after the distillation of coal tar. It is used as a base for coatings and paint, in roofing and paving, and as a binder in asphalt products. Both coal tar and coal-tar pitch contain many chemical compounds, including carcinogens such as benzene. Human exposure to coal tars can be through inhalation, ingestion, and absorption through the skin. The general population can be exposed to coal tars in environmental contaminants.

10 Coke (fuel) production: Workers at coking plants and coal-tar production plants – where coal is refined to be used as a solid fuel – may be exposed to coke oven emissions, and have an excess risk of dying from lung cancer and kidney cancer.

A furniture-maker’s workshop
A furniture-maker’s workshop. Photograph: Sam Frost
11 Furniture and cabinet making: Furniture makers are shown to have a statistical increase in nasal cancer risk, with excessive exposure to wood dust, according to studies.

12 Haematite mining (underground) with exposure to radon: Mining hematite, an underground source of iron, workers are simultaneously exposed to radon – a radioactive carcinogen, which can cause a large increase in the risk of lung cancer.

How bad is meat for me? Frankly, the experts don’t know

13 Secondhand smoke: Otherwise known as passive smoking, a non-smoker’s risk of getting lung cancer can increase by a quarter by breathing in other people’s smoke. It may also increase the risk of cancers of the larynx (voice box) and pharynx (upper throat). It’s estimated that every year, secondhand smoke kills over 12,000 people in the UK from lung cancer, heart disease, stroke and the lung condition chronic obstructive pulmonary disease.

14 Iron and steel founding: Studies of iron and steel founding workers in various parts of the world showed them to have a significantly increased risk for lung cancer. Exposures in the iron and steel founding industry are complex and include a wide variety of known genotoxic and carcinogenic substances including metals and formaldehyde.

15 Isopropanol manufacture (strong-acid process): People in the isopropanol manufacturing industry may face an increased risk of developing cancer due to exposure to suspected carcinogens, such as diisopropyl sulphate, isopropyl oils and sulphuric acid. The colourless, flammable chemical compound with a strong odour has a wide variety of industrial, household and pharmaceutical uses. Isopropyl alcohol solution is found in rubbing alcohol, hand sanitiser, and disinfecting pads.

I’m not giving up my ham and mustard sandwich | Ann Robinson

16 Magenta dye manufacturing: The production of magenta dyes – purplish-red in colour and among the first synthetic dyes to be produced in the 1850s – has chemicals linked to bladder cancer. Yet some carcinogenic chemicals were banned from hair dyes in the 1970s.

17 Occupational exposure as a painter: Studies have found a link between work as a painter and risk of cancer. Deaths such as bladder cancer and leukaemia in such cases could have been from an exposure to benzene – a chemical at high levels that can cause cancer and found in paint production – mixed with other organic solvents. Cases of lung cancer may be from exposure to particles containing lead chromate and to asbestos in the paint trade.

18 Paving and roofing with coal-tar pitch: Paving with coal tar and coal-tar pitch may contain many chemical compounds, including carcinogens such as benzene.

A worker taps a rubber tree in Songon, Ivory Coast
A worker taps a rubber tree in Songon, Ivory Coast. Photograph: Thierry Gouegnon/Reuters
19 Rubber industry: Harvested mainly in the form of the latex from certain trees, the manufacturing process of stretchy material can cause the risk of developing cancer, caused by chemicals. Studies examining countries with workers in the rubber industry showed they were more likely to have cancers such as bladder cancer, lung cancer, and leukaemia.

20 Occupational exposure of strong inorganic acid mists containing sulphuric acid: The liquid aerosols formed by condensation of sulphuric acid vapour, which is highly corrosive, can cause a higher risk of getting lung cancer.

Carcinogenic mixtures

21 Naturally occurring mixtures of aflatoxins: Such toxins produced by certain species of fungi, are among the most carcinogenic substances known, and linked to increased risk of liver cancer.

Cans of beer on display in an off-licence
Cans of beer on display in an off-licence. Photograph: Christopher Furlong/Getty Images
22 Alcoholic beverages: Alcoholic beverage consumption is a cause of breast, colorectal, larynx, liver, oesophagus, oral cavity and pharynx cancers, and as a probable cause of pancreatic cancer, as classified by the IARC.

23 Areca nut: Areca nut is a mild stimulant, akin to coffee, that is chewed with betel leaf. It is known to cause increased risk of mouth and oesophageal cancer.

24 Betel quid without tobacco: A leaf indigenous to Asia, is chewed with areca nut as a stimulant and can increase the risk of oral cancer.

25 Betel quid with tobacco: Betel can increase the risk of oral cancer.

26 Coal-tar pitches: This thick black liquid contains many chemical compounds, including carcinogens such as benzene.

27 Coal tars: Coal tar, a bi-product of coke production, contains many chemical compounds, including benzene.

Hazelwood coal mines in Morwell, Australia
Hazelwood coal mines in Morwell, Australia. Photograph: Meredith O’Shea for the Guardian
28 Indoor emissions from household combustion of coal: Coal is one of the most well-known carcinogens in the public consciousness, due to the prevalence of cancer in miners. It is a risk if coal dust produced from old-fashioned coal-burning fires is inhaled.

29 Diesel exhaust: There is a cancer risk from inhaling exhaust fumes produced by a diesel internal combustion engine. Over 30 components of diesel oil are listed at various levels of carcinogenic by the IARC.

30 Mineral oils, untreated and mildly treated: The World Health Organisation classifies untreated or mildly treated mineral oils as group-1 carcinogens to humans. Highly refined oils are classified as group-3, meaning they are not suspected to be carcinogenic, yet due to insufficient findings, cannot be classified as harmless.

Ground to dust: fracking, silicosis and the politics of public health

31 Phenacetin, analgesic mixtures containing: Studies on this pain- and fever-reducing drug, now banned in some countries link it with renal, pelvic and other urothelial tumours in patients.

32 Plants containing aristolochic acid: Used in Chinese herbal medicine for centuries, this plant extract is found to cause kidney disease and urothelial cancer.

33 Polychlorinated biphenyls (PCBs): This synthetic compound, widely used in electrical equipment in the past, was banned at the end of the 1970s in many countries because of environmental concerns. Studies of PCBs in humans have found increased rates of melanomas, liver cancer, gall bladder cancer, biliary tract cancer, gastrointestinal tract cancer, and brain cancer, and may be linked to breast cancer. PCBs are known to cause a variety of cancers in animals.

34 Chinese-style salted fish: Diets that are very high in salt-cured meats and fish, or pickled foods – which are more common in parts of Asia and northern Africa – can increase the risk of nasopharyngeal cancer, related to the upper part of the throat behind the nose. These foods can be very high in nitrates and nitrites, which react with protein to form nitrosamines. These chemicals can damage DNA.

The hydraulic fracturing test site operated by Cuadrilla in Balcombe, England
A police officer stands guard on the perimeter of the hydraulic fracturing test site operated by Cuadrilla in Balcombe, England. Photograph: Leon Neal/AFP/Getty Images
35 Shale oils: The development of shale gas, including fracking, may release toxic chemicals into air, water and soil during the process. Chemicals used in fracking are known to be of concern and have been linked to an increased risk of cancer. Benzene, acrylamide, and formaldehyde are all listed by the IARC as human carcinogens.

36 Soots: Coal dust, principally from the burning of coal, had contributed to a specific chimney sweep cancer that was prevalent in the 19th century.

37 Smokeless tobacco products: Tobacco chewed as a stimulant, sometimes with other leaves such as betel, is specifically linked to cancers of the larynx and the mouth.

38 Wood dust: Awareness of wood dust as a carcinogen and cause of nasal cancer is on the rise. In 2011 a cabinet maker’s widow successfully sued for £375,000 after her husband’s death.

Something is going to kill you. Life is about what happens before that | JC Johnson

39 Processed meat: Meat that is cured or treated in some way, either for preservation or taste. Examples include ham, bacon and sausages. It was ranked as dangerous as tobacco in October 2015 by the World Health Organisation (WHO), with specific links to bowel cancer.

Carcinogenic agents and groups of agents

40 Acetaldehyde

41 4-Aminobiphenyl

42 Aristolochic acids and plants containing them

43 Arsenic and arsenic compounds

44 Asbestos

45 Azathioprine

46 Benzene

47 Benzidine

48 Benzo[a]pyrene

‘It’s scaremongering’: the world’s meatiest places react to WHO report

49 Beryllium and beryllium compounds

50 Chlornapazine (N,N-Bis(2-chloroethyl)-2-naphthylamine)

51 Bis(chloromethyl)ether

52 Chloromethyl methyl ether

53 1,3-Butadiene

54 1,4-Butanediol dimethanesulfonate (Busulphan, Myleran)

55 Cadmium and cadmium compounds

56 Chlorambucil

57 Methyl-CCNU (1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea; Semustine)

58 Chromium(VI) compounds

59 Ciclosporin

60 Contraceptives, hormonal, combined forms (those containing both oestrogen and a progestogen)

Contraceptive pills
Contraceptive pills. Photograph: Yay Media AS/Alamy
61 Contraceptives, oral, sequential forms of hormonal contraception (a period of oestrogen-only followed by a period of both oestrogen and a progestogen)

62 Cyclophosphamide

63 Diethylstilboestrol

64 Dyes metabolized to benzidine

65 Epstein-Barr virus

66 Oestrogens, nonsteroidal

67 Oestrogens, steroidal

68 Oestrogen therapy, postmenopausal

69 Ethanol in alcoholic beverages

70 Erionite

71 Ethylene oxide

72 Etoposide alone and in combination with cisplatin and bleomycin

The Kingdom by Damien Hirst
A tiger shark in formaldehyde (The Kingdom by Damien Hirst). Photograph: Sotheby’s/PA
73 Formaldehyde

74 Gallium arsenide

75 Helicobacter pylori (infection with)

76 Hepatitis B virus (chronic infection with)

77 Hepatitis C virus (chronic infection with)

78 Herbal remedies containing plant species of the genus Aristolochia

Food industry greets cancer links with a shrug – it’s been here before

79 Human immunodeficiency virus type 1 (infection with)

80 Human papillomavirus type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66

81 Human T-cell lymphotropic virus type-I

82 Melphalan

83 Methoxsalen (8-Methoxypsoralen) plus ultraviolet A-radiation

84 4,4’-methylene-bis(2-chloroaniline) (MOCA)

85 MOPP and other combined chemotherapy including alkylating agents

86 Mustard gas (sulphur mustard)

87 2-Naphthylamine

88 Neutron radiation

89 Nickel compounds

90 4-(N-Nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK)

91 N-Nitrosonornicotine (NNN)

92 Opisthorchis viverrini (infection with)

A woman wears a mask in front of Harbin railway station in China
A woman wears a mask in front of Harbin railway station in China as thick smog envelops the city. Photograph: Tao Zhang/Demotix/Corbis
93 Outdoor air pollution

94 Particulate matter in outdoor air pollution

95 Phosphorus-32, as phosphate

Addictive and probably carcinogenic: scientist reveals dangers of Daily Mail | Dean Burnett

96 Plutonium-239 and its decay products (may contain plutonium-240 and other isotopes), as aerosols

97 Radioiodines, short-lived isotopes, including iodine-131, from atomic reactor accidents and nuclear weapons detonation (exposure during childhood)

98 Radionuclides, α-particle-emitting, internally deposited

99 Radionuclides, β-particle-emitting, internally deposited

100 Radium-224 and its decay products

101 Radium-226 and its decay products

102 Radium-228 and its decay products

103 Radon-222 and its decay products

104 Schistosoma haematobium (infection with)

105 Silica, crystalline (inhaled in the form of quartz or cristobalite from occupational sources)

The sun
The sun, source of solar radiation. Photograph: Nasa/Soho/EPA
106 Solar radiation

107 Talc containing asbestiform fibres

108 Tamoxifen

Health threat of sugar is vastly underestimated, study claims

109 2,3,7,8-tetrachlorodibenzo-para-dioxin

110 Thiotepa (1,1’,1”-phosphinothioylidynetrisaziridine)

111 Thorium-232 and its decay products, administered intravenously as a colloidal dispersion of thorium-232 dioxide

112 Treosulfan

113 Ortho-toluidine

114 Vinyl chloride

115 Ultraviolet radiation

116 X-radiation and gamma radiation

Future gazing. People Can Live To Be 135 Years Old … But Only If They Believe They Can : LIFE : Tech Times


From their website.

Humans can grow as old as 135 years if they change the way they think about aging, one author and expert on geriatrics claims.

Rudi Westendorp says people’s mindset is the only reason that prevents them from coping with increased life expectancy. He is the author of “Growing Older Without Feeling Old: On Vitality and Ageing.”

Susannah Mushatt Jones is the oldest person alive at 116 years old. Westendorp thinks that this record is about to be broken because, he believes, the first person to reach the age of 135 has already been born. He claims that humans are gaining six hours in life expectancy every day, and he expects this to continue.

Westendorp, a geriatric medicine professor at the University of Copenhagen, says that over the past 100 years, our life expectancy has doubled from 40 years to 80. People, however, do not know how to adapt to the changes.

Most of us believe that our bodies will eventually deteriorate, he says, urging us to change our lifestyle by the time we reach 50. For Westendorp, people fail to grasp the notion that we can live longer. As a result, we limit and refrain from enjoying life to the fullest.

“They believe that when the maximum number of bends or heartbeats has been reached, it’s over, the organ is broken, the body is sick and the person dies,” says Westendorp.

Older people pass on their own habits, beliefs and expectations to their children, and these can greatly influence how the younger generations live their lives.

Beliefs about what the body can and cannot do at a certain age and their views about retirement and pensions are outdated, the author notes. Such notions emerged when lifespans were significantly shorter.

“It’s wrong to think we can take the life stories of our parents and grandparents as a blueprint for the way our own lives should unfold,” he points out.

“Who brings their children up in the realistic expectation that they will reach the age of 100?”

Westendorp encourages people to continually enjoy living healthy social lives. He said lonely, elderly people are most likely to die earlier than smokers. We should alter the way we think about aging: after all, aging is all in the mind, he says.

An example of “Nudge” – Leaving food on kitchen worktop can make you nearly 2 stone heavier | Daily Mail Online


From their website;

Women who kept breakfast cereal on work surfaces weighed 20lbs more
Those with a fruit bowl on display weighed 13lbs less than clear surfaces
Normal weight women more likely to have a designated snack cupboard
If you want to stay trim, make sure you keep your kitchen tidy.

Leaving food on the worktop can lead to over-eating, a study suggests.

If your spouse gains weight ‘your risk of obesity DOUBLES’  | Daily Mail Online


From their website;

Countless past pieces of research have linked marriage and weight gain
Study found when one spouse becomes obese their partner’s risk doubles
Men whose wives became obese were 78% more likely to follow suit
Having a husband who was obese linked to 89% chance a woman would be
Experts say similar changes in diet and physical activity are to blame

From Heart Attacks To Suicide, How Being A Perfectionist Can Impact Your Health


From their website;

According to Professor Gordon Flett, of the Department of Psychology at York University in Canada, about two in five people are perfectionists, and they typically fit into three main categories: The self-oriented perfectionist is the type who sets their own high personal standards of perfection, while the other-oriented perfectionist exacts high standards on others. Then, there is the socially prescribed perfectionist, who was forced into the mold by the other-oriented perfectionist holding them to higher standards. They all have one thing in common: every area of life is held to the exact same, impossible standard…
… it signals to your amygdala, the fear center in your brain, and the fight-or-flight center kicks in,” she said. “Perfectionists likely have an overactive fear center. In your brain, too much energy going to your fight-or-flight center means not enough energy going to everyday operations.”

As a result, we become exhausted, and this leaves us vulnerable to a whole list of things …

…You’ll Run Yourself Down

Perfectionism has long been linked to exhaustion and subsequent susceptibility to disease, better known as burnout. In a recent study, British researchers examined 43 studies conducted over the past two decades pertaining to perfectionistic-linked burnout. They found burnout was more rampant within the work environment, where inner levels of perfectionism were also supported by external pressures and a lack of validation.

But becoming run down physically and emotionally often sets you up for even greater physical health issues. “By thinking that you have to be perfect, you may be putting yourself at a level of stress that means you’re not going to be protected from health problems and, in fact, exposed to increased risk.”

A 2006 study conducted by Danielle Molnar of Brock University in Canada found that perfectionism and eventual burnout leads to more sick days. After evaluating participants for their levels of perfectionism, they found that those who experienced socially prescribed perfectionism had poorer overall physical health. This translated into more visits to the doctor, taking more days off from work, and experiencing a wide variety of health problems that compelled them to rate their own personal health as low.

But perfectionism-related stress not only leaves you more vulnerable to health issues, it can also slow your recovery. In Flett’s own research, he and his colleagues looked at 100 heart attack patients, and found the perfectionists were slower to recover and more susceptible to future cardiac issues. Slower recovery was also observed in perfectionists with Crohn’s disease and ulcerative colitis.

“Our studies show that when someone has a serious illness, like heart disease, that perfectionism… is a magnifier of difficulties and stressors. And if you don’t give up on the perfectionism, it’s going to hinder your recovery,” he said.

More alarmingly, a 2009 study found that earlier mortality was also more common among perfectionists. Prem Fry, a psychology professor at Trinity Western University in Canada, examined 450 adults aged 65 and older for 6.5 years. The participants were initially given a questionnaire to assess their levels of perfectionism, and then researchers observed their health for the follow-up years. Ultimately, they found that those with high perfectionist tendencies were 51 percent more likely to die earlier than those with lower perfectionist scores. They reasoned that this was likely due to the high levels of stress and anxiety they found in these people.

Blood test could detect Alzheimer’s years before a patient starts showing symptoms | Daily Mail Online


From their website;

Autoantibodies in blood could show if person will develop dementia
The biomarkers show risk of suffering Alzheimer’s and the stage it is at
It could lead to earlier treatment to slow progression of devastating illness
Scientists say patients could change lifestyle factors linked to the disease
Scientists are a step closer to developing a blood test that can detect Alzheimer’s disease

Big Brain Doesn’t Mean Big Smarts


From their website;

Having a big brain doesn’t guarantee you’ll have an outsized IQ, a new analysis indicates.

Researchers who examined 148 studies that included more than 8,000 people found only a weak association between brain size and IQ.

Supplements Don’t Benefit Prostate Cancer Patients


From their website;

A new study finds no evidence that men’s health supplements help prostate cancer patients.

Although popular, such supplements do not appear to lower the risk for experiencing radiation treatment side effects; the risk that localized cancer will spread; or the risk that prostate cancer patients will die from their disease, researchers found.

The study focused on supplement use among more than 2,200 men newly diagnosed with localized prostate cancer.

“We suspected that these pills were junk. Our study confirmed our suspicion,” said study lead author Dr. Nicholas Zaorsky, resident physician in radiation oncology at the Fox Chase Cancer Center in Philadelphia.

Electronic Nose Sniffs Out Ovarian Cancer in Exhaled Breath


From their website

Electronic Nose Sniffs Out Ovarian Cancer in Exhaled Breath

We know that exhaled breath contains biomarkers that point to presence of existing disease, including cancer, but their detection is challenging without bulky and expensive equipment. Building specialized devices that detect volatile organic compounds linked to disease requires large sensor arrays, a limitation that has made them currently impractical. Now researchers at Technion−Israel Institute of Technology and Carmel Medical Center in Haifa, Israel have developed tiny flexible sensors that are each able to replicate the work of many. In a study testing the breath of 43 volunteers that included 17 ovarian cancer patients, their sensors achieved an 82% accuracy of detection.

The sensors are flexible and are made of gold nanoparticles that have molecules onto which volatile organic compounds (VOCs) attach to. When captured, the different VOCs bend the sensors at different angles depending on their nature and provide more information than simply whether they’re there or not.

The researchers believe this technology can be applied to other cancers and different diseases, leading to cheap and easy to use diagnostic devices that require only a patient breath to work.

Study in NANO Letters: Dynamic Nanoparticle-Based Flexible Sensors: Diagnosis of Ovarian Carcinoma from Exhaled Breath…

Via: American Chemical Society…

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At Medgadget, we report on the latest medical technology news, interview leaders in the field, and file dispatches from medical events around the world.

Sertraline, an Anti-Depressant, May Change Brain Structures Differently in Depressed and Non-Depressed Individuals

Very interesting animal study.

From their own website;

Antidepressants are usually prescribed for individuals suffering from depression, which work by changing one or more of the neurotransmitters in the brain. Selective Serotonin Reuptake Inhibitors (SSRIs) are one such anti-depressant medication and inhibit the reabsorption of serotonin, thereby increasing the levels of this neurotransmitter. The shift in serotonin levels enables the brain cells to transmit messages better, and as a consequence, improve mood… Since Sertraline is prescribed for both depression and non-mood disorders, such as anorexia, bulimia, hot flashes, and post-traumatic stress disorder (PTSD), the current study was conducted to throw light on the effect of Sertraline on the brains of depressed, as well as non-depressed subjects… The results show:
In depressed monkeys, Sertraline increased the volume of the anterior cingulate cortex in the brain (the anterior cingulate cortex is involved in memory, cognition, learning, modulation of emotional behavior, spatial navigation, etc.).
Sertraline decreased the volume of the anterior cingulate cortex, as well as the hippocampus in non-depressed subjects (The hippocampal region is associated with memory and learning).


Unforgiveness, depression, and health in later life: the protective factor of forgivingness

Recent study performed by the Department of Human Development & Family Studies, University of Missouri, USA

From the publisher’s website;

Conclusion: Forgiving others and the self may be protective of well-being when women feel unforgiven by others. These findings have implications for forgiveness intervention programs and contribute to literature pertaining to forgiveness and health in later life.


Digital Health Intelligence Limited

From their website;

People are keen to use digital health services, but have little knowledge of those already on offer and are keener for them to support than replace traditional services


The article goes on to detail that there is a low awareness about digi-health sevices that are already available, for example only 4% know that they can access their own GP records online.

Procalcitonin Blood Tests

Procalcitonin is an infrequently used blood test in primary care. In hospital medicine it has been shown to have good sensitivity in determining whether a patient is suffering from a bacterial infection. If it were to be used within a GP appointment then the test has the potential to assist the decision of whether or not antibiotics are needed for common complaints such as cough, sore throat or earache.



Gene associated with sudden cardiac death identified by ICD monitoring — ScienceDaily


Very early finding shows that amongst patients who have an implanted cardiac defibrillator there are two genes are more common in those who go on to have a potentially fatal ventricular arrhythmia. This genetic distribution appears to be seen in the general population too and this raisers the prospect of identifying some high/ higher risk individuals.

Handling Acute Stress – an HBR primer

A Simple Yet Powerful Way to Handle a Stress Episode https://hbr.org/2015/08/a-simple-yet-powerful-way-to-handle-a-stress-episode

This short essay starts with a familiar scenario and reminds us of a useful pair of definitions before an acronym to aside mindfulness.

(1) Acute vs Chronic Stress.
(2) Threat  vs Challenge.
(3) RAIN
Recognition: Consciously take notice of what is occurring in your body and mind. For example, “My mouth feels dry and there is a pit in my stomach. I feel like an idiot.”

Acceptance: Acknowledge that the stress response is present and allow it to be here. This doesn’t mean that you’re happy about it, but giving up the effort to resist it is, paradoxically, the quickest way to help it subside.

Investigation: Ask yourself calmly what thoughts and emotions are present, what stories you are telling yourself. Following this technique, the candidate might have answered, “I can’t believe I sound so lame. I’m afraid that I will lose this opportunity, that I will not be admitted to business school, that I will feel like a failure in front of my family and friends, and that I won’t have a successful career.”

Non-identification: Having recognized, accepted, and explored the implications of your stress symptoms, the final step is to realize that although you are experiencing them, they do not define you. “I am having the thought that I may feel like a failure” is very different from and much more manageable than “I am a failure.”

Predictor of child vocabulary in early speech:

Infants’ ability to relate words to objects at 12 months linked to language skills at 18 months — ScienceDaily


Cognitive development is broadly defined as the process by which babies and young children learn about the world around them, and includes the acquisition of problem solving, memory, perception and, of course, language.

At 12 months old, your infant’s ability to group objects according to the names associated with them — as opposed to their appearance alone — offers a glimpse into how his or her vocabulary will develop by the time they are 18 months, Northwestern University researchers have found.

Psychologist shows why talking to kids really matters — ScienceDaily


significant differences in both vocabulary and real-time language processing efficiency were already evident at age 18 months

By age 24 months, there was a six-month gap … in processing skills critical to language development.

Infants who heard more child-directed speech developed greater efficiency in language processing and learned new words more quickly. The results indicate that exposure to child-directed speech — as opposed to overheard speech — sharpens infants’ language processing skills, with cascading benefits for vocabulary learning.

Gene leads to nearsightedness when kids read — ScienceDaily


The genetic association that has been discovered is for a tendency to develop shortsightedness in the teenage years if the individual spends significant amounts of time reading.

Young black women have a higher frequency of BRCA mutations than previously reported — ScienceDaily

From Science Daily

Young black women are more likely to have aggressive types of breast cancer compared to non-Hispanic white women, … Women who have inherited mutations in the BRCA1 or BRCA2 genes are more likely to develop breast cancer or ovarian cancer, especially at a younger age. Approximately 5 percent of women with breast cancer in the United States have mutations in BRCA1 or BRCA2 based on estimates in non-Hispanic white women. Moffitt Cancer Center researchers  … discovered that 12.4 percent of the participants (young black women diagnosed with breast cancer at or below age 50) had mutations in either BRCA1 or BRCA2.



IgG Food Intolerance Tests: What does the science say? « Science-Based Medicine

The Science Based Medicine website has in depth and detailed reviews on a wide range of subjects.

From their website;

Food allergies can be as real as drug allergies, and are arguably much harder to prevent. We can usually control when we get penicillin. But what about peanuts, eggs, or milk, all of which can also cause life-threatening anaphylaxis?  Food allergies seems to be growing: not only anaphylaxis, butmore people believe they have some sort of allergy to food.  Allergy is sometimes confused with the term “intolerance”, which seems more common, possibly as the availability of “food intolerance testing” grows. Food intolerance testing and screening is particularly popular among alternative practitioners. Testing can take different forms, but generally the consumer is screened against hundreds of food products and food additives. They are then provided with a list of foods they are “intolerant” to. … Children may be tested, too, and parents may be given a long list of foods they are told their child is intolerant of. I’ve seen the effects in the community, too. Think going “peanut free” is tough? A public school in my area sent home a list of forbidden food products: dairy, eggs, bananas, tree nuts, peanuts, soy, sesame, flax seed, kiwi, chicken, and bacon. Were these all true allergies? It’s not disclosed. Anaphylactic or not, the parents had informed the school, and the school had banned the food product.


At present, there are no reliable and validated clinical tests for the diagnosis of food intolerance. While intolerances are non-immune by definition, IgG testing is actively promoted for diagnosis, and to guide management. These tests lack both a sound scientific rationale and evidence of effectiveness. The lack of correlation between results and actual symptoms, and the risks resulting from unnecessary food avoidance, escalate the potential for harm from this test. Further, there is no published clinical evidence to support the use of IgG tests to determine the need for vitamins or supplements. In light of the lack of clinical relevance, and the potential for harm resulting from their use, allergy and immunology organizations worldwide advise against the use of IgG testing for food intolerance.



there’s a big gap between what many perceive as an allergy and what is clinically considered a true allergy




Bright Futures

This is a widely used programme for monitoring childhood development in American.





Source: Bright Futures


Source: www.zerotothree.org/public-policy/state-community-policy/nitcci/multidisciplinary-consultant-module-2.pdf


This American manual gives a list of assessment tools in the final appendix (p65) which includes the Ounce scale and ITFI which were not included/ reported on in the UCL paper.

Whole body CT scan MOTs a health risk. – Telegraph 2008

Health MOTs using whole body CT scans are putting patients at risk of cancer and may be banned under Government plans

The scans which cost between £300 and £2,000 are advertised widely by private healthcare companies as offering early detection of problems such as heart disease and cancer.

Government health advisors say any company offering whole body computerised tomography (CT) scans or lung scans to patients without any symptoms should stop immediately.

There are thought to be around 12,000 whole body or lung scans carried out every year in the UK and this is expected to grow.


Source: Whole body CT scan MOTs a health risk. – Telegraph

A perfect 10: Why Sweden comes out on top in early child development programming

Source: A perfect 10: Why Sweden comes out on top in early child development programming

SAMJ: South African Medical Journal – Diagnosis of bacterial infection

This article gives a helpful reminder of current practice – it details the classic medical process of …  history –> clinical examination –> beside tests –> laboratory tests. Of relevance to General Practice it explores the use of CRP and Procalcitonin tests. Thereafter it highlights upcoming technologies that show potential to be helpful in the future.

From their website;

New technologies

New technologies that are likely to emerge as important diagnostic tools in future include nanoparticle probe technology and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOFMS). Nanosphere’s Verigene Gram-positive (BC-GP) blood culture assay is performed directly on positive blood cultures using nucleic acid extraction and PCR amplification. Target DNA is then hybridised to oligonucleotides on a microarray with automated qualitative analysis. The test was approved by the US Food and Drug Administration in 2014 and currently has the ability to identify 10 Gram-positive and 8 Gram-negative organisms along with multiple resistance genes. Currently, two MALDI-TOFMS platforms are available in the USA, MALDI Biotyper (Bruker Corporation, Billerica, Mass.) and VitekMS System (bio-Merieux, Durham, NC). MALDI-TOF performs MS on target molecules following ionisation and disintegration; these patterns are compared with known organism fingerprints. It is capable of analysing thousands of samples from specimens per day, including blood, sputum and urine. Another promising infection testing platform that uses PCR followed by electrospray ionisation MS (PCR/ESI-MS) technology is able to rapidly detect >800 bacteria, including unculturable organisms and three classes of antibiotic resistance markers, directly from clinical specimens. In a recent study of 331 blood samples it was able to detect twice as many organisms as culture.[21]



UCL Comparison of 13 Different tools for Assessing Child Development


1. Measures completed by parents

Ages and Stages Questionnaires (ASQ-3)
Parents’ Evaluation of Developmental Status (PEDS)
Parents’ Evaluation of Developmental Status – Developmental Milestones

2. Measures completed by professionals with involvement of parents

Child Development Inventory (CDI)
Child Development Review (CDR)
Bayley Scales of Infant and Toddler development


3. Measures completed by Health professionals

Mullen Scales of Early Learning (MSEL)
Battelle Developmental Inventory (BDI-2)
BDI-2 Screening Test
Brigance Early Childhood Screens
Denver II
Griffiths Mental Development Scales
Schedule of Growing Skills (SGS-II)

Source: https://www.ucl.ac.uk/cpru/documents/review_of_measures_of_child_development

A second language gives toddlers an edge — ScienceDaily


“We found the cognitive benefits of bilingualism come much earlier than reported in previous studies.”

Antibiotic Use Linked to Type 2 Diabetes Diagnosis | Endocrine Society

From their website;

“In our research, we found people who have Type 2 diabetes used significantly more antibiotics up to 15 years prior to diagnosis compared to healthy controls,” said one of the study’s authors, Kristian Hallundbæk Mikkelsen, MD, of Gentofte Hospital in Hellerup, Denmark. “Although we cannot infer causality from this study, the findings raise the possibility that antibiotics could raise the risk of Type 2 diabetes. Another equally compelling explanation may be that people develop Type 2 diabetes over the course of years and face a greater risk of infection during that time.”


Sinusitis Prediction Algorithm

Sinusitis Prediction Rule

This page gives 3 different tools to allow the clinical decision of whether antibiotics can be expected to be helpful in sinusitis or not. [1] Williams Prediction Rules, [2] Berg Prediction Rules and [3] the Task Force on Rhinosinusitis Rules from 1999, 92 and 97 respectively.

Early research findings suggest screening for lung cancer might be helpful for some categories

PLOS Medicine: Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts

Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts

Currently the recommendation is that never-smokers should not be screened.

Smokers aged ≥65–80 y are a high-risk group who may benefit from screening –


It should be remembered that this study compared screening by CT scan VS screening by CXR.

Widely accepted opinion is that the statistical risk of lung cancer has returned to normal in ex-smokers who quit more than 15 years ago however this study suggests – but does not prove – that the lung cancer risk continues beyond that.

ADHD Self-Administered Questionairre

Adult Self-Report Scale (ASRS v1.1) for ADHD – MDCalc

Adult Self-Report Scale (ASRS v1.1) for ADHD Screens for presence of adult ADHD.



The ASRS is presented in an abbreviated form above and this short set of 6/18 questions can be considered as a quick screening tool.


The full ASRS consists of 18 questions is and is accepted under the DSM (Diagnostic and Statistical Manual) as being a valid tool. a positive result on the full ASRS is not diagnostic of ADHD but indicates that an appointment with a Doctor is needed.


Prescan ® | Official website of Prescan ® Full Body Scan

Prescan – Full Body Scan – has been an active market leader in the field of Preventive Medical Examination and research both nationally and internationally.

Source: Prescan ® | Official website of Prescan ® Full Body Scan


MRI Scans

Centor Criteria – Classic



The original Centor Criteria use 4 simple questions to assess the chances that a sore throat is caused by a bacterial infection.

Centor Criteria – Modified

Centor Score (Modified) for Strep Pharyngitis – MDCalc

Centor Score (Modified) for Strep Pharyngitis

Is your purse a hotbed of bacterial infection? – Health News – NHS Choices

Many of the bacteria found in the study can cause serious infections

This is a report about an interesting study but ultimately it may not have a strong relevance or applicability in most situations. The research was conducted in Mauritius and they swabbed the outside of 145 womens’ handbags and mens’ wallets. The primary finding was that 95% carried bacteria. However as they point out themselves;

From their website;

In about three-quarters (73%) this was scanty growth; 13% showed moderate growth and 14% showed heavy growth. … and … In fact, all of the things we use in the environment around us, like mobile phones, computers, keyboards and other equipment are all likely to carry some bacteria.

Otherwise there were interesting if unsurprising secondary findings;

From their website;

  • 11% often placed them on kitchen tables

  • 18% placed them on dining tables

  • 18% allowed their children to handle them

  • 82% never emptied them

  • Most women kept purses in handbags, most men in trouser pockets



In conclusion it might be fair to say that in day-to-day life this study does not have a notable impact. However in settings where individuals are particularly susceptible to infections then this study does back up and re-inforce the current practice of making every effort to reduce their exposure to risk.

Pregnancy Calculator


Cancer Screening

Epidemiology & Commonest Cancers

Cancer Risk Factors – Family History

Cancer Risk Factors – Modifiable / Lifestyle

Cancer Risk Factors – Past Medical History / Non-Modifiable

National Screening Programmes

Advanced Cancer Screening or Early Detection

Symptom Triage Tools

Women should be able to get antibiotics for urinary tract infection without a prescription | The BMJ

From their website;

Uncomplicated cystitis is common and easily treated with drugs such as nitrofurantoin. Kyle Knox asks why women cannot treat themselves, without using up precious appointments in general practice

Acute uncomplicated urinary tract infections (AUUTIs) are common, especially in premenopausal, sexually active women, of whom about 30% will have been affected by age 26.1 AUUTIs usually resolve without sequelae and rarely progress to pyelonephritis, but they result in considerable morbidity, and the goal of treatment is to ameliorate the severity and duration of symptoms.

Source: Women should be able to get antibiotics for urinary tract infection without a prescription | The BMJ


In one of the online BMJ responses;

(The article) argues that: a) the clinical recognition of an uncomplicated cystitis does not require the assessment of a health professional, b) there is good evidence of the efficacy and safety of a 3 day-course of Nitrofurantoin, and c) the threat of a growing resistance to Nitrofurantoin do not outweigh the benefits of easy access to this antibiotic. Thus, why cannot women with an uncomplicated cystitis treat themselves, without using up precious appointments in general practice?

RCGP response to BMJ article on treating cystitis with antibiotics

Dr Maureen Baker, Chair of the Royal College of GPs, said: “Cystitis can cause a huge amount of discomfort for patients, and whilst antibiotics can help in some cases, they are not always the most appropriate treatment as the cause is not always bacterial.

“Aside from the patient safety risks associated with deregulating access to some of these powerful drugs, we are currently amidst an international drive to reduce antibiotic use, in order to curb growing global resistance to them.

“Although the strain of antibiotics referenced in the article has actually seen very little resistance built up against it so far, making it more widely available would inevitably increase resistance to it and remove one of the few antibiotics with low resistance rates from the formulary, therefore adding to this global problem.

“GPs already face enormous pressure to prescribe antibiotics, and it often takes a lot of effort to persuade patients that they are not always the answer to treating illness – making them available without a prescription would simply undermine this. There is also the risk that bypassing the GP for patients with cystitis might lead to recurrent strains of the infection being treated inappropriately, and more serious conditions going undetected.

“Instead of increasing the availability of antibiotics for patients suffering from cystitis, we should concentrate our efforts on making alternative treatments to cystitis more widely available – and identifying new non-antibiotic strategies – to reduce the need for and resistance to the drugs, so that they will still be effective when our patients really need them.”

Source: RCGP response to BMJ article on treating cystitis with antibiotics

Alcohol “FAST” Screening Tool


Alcohol “AUDIT” Screening Tool


Calculate Alcohol Intake


NHS England Alcohol Intake


Calculate Your BMI – Metric BMI Calculator


Kidzmet :: Discover The Way Your Kids and Students Learn Best


21 Ways to Connect with Your Kids


JvR Psychometrics Assessment Catalogue Murphy-Meisgeier Type Indicator for Children® (MMTIC®)


Office Blood Testing Equipment

QuikRead go wrCRP – www.oriondiagnostica.com.

Top 9 OOH/ WIC Presentations (Monitor, UK – 2014)

  1. coughs, colds and flu-like symptoms;
  2. skin conditions or skin infections;
  3. stomach upset or pain;
  4. breathing problems (such as asthma);
  5. back pain;
  6. urinary tract infections;
  7. ear, eye and throat infections;
  8. cuts, strains and sprains; and
  9. insect and animal bites.



Top 10 Presentations to Australian GP (2013)

RACGP – Common general practice presentations and publication frequency.

  1. hypertension,
  2. immunisation,
  3. upper respiratory tract infection,
  4. depression,
  5. diabetes,
  6. lipid disorder,
  7. general check-up,
  8. osteoarthritis,
  9. back complaint, and
  10. prescription request

Ottawa rules for x-ray of knee, ankle and foot

Ottawa rules for x-ray of knee, ankle and foot.

Alvarado Score for acute appendicitis – PubMed – NCBI

umb/rif :: n/v :: anor :: tender rif (2pt) :: rebound :: pyr :: leuco (2pt)



The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. – PubMed – NCBI.


Lose It! – The Book