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Published13 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Annabel RackhamBBC NewsThe National Institute for Health and Care Excellence (NICE) has recommended eight online therapies for anxiety and depression.NICE says the therapies have the potential to help more than 40,000 people in the UK.Each therapy must come with a formal assessment from an NHS therapist in order for it to be recommended.According to NHS Digital, there is a six-week waiting list for patients who need mental health support in England.There are hopes that introducing online digital therapies could ease pressure on the NHS. The treatments can help those with depression, anxiety, PTSD and body dysmorphia and are centred on the use of cognitive behavioural therapy (CBT) – a talking therapy which can help a patient manage their problems by suggesting alterations to their thought process and behaviour. The therapies have been conditionally recommended by NICE – meaning early assessments have taken place to identify promising medical technology but more evidence needs to be gathered.Some online treatments for PTSD have already been trialled by the NHS in Scotland and Wales. England mental health referrals at 4.3 million highQuarter of 17-19-year-olds may have mental disorderSarah, who was diagnosed with PTSD by a GP, trialled online therapy as part of a Cardiff University study. “I’ve been completely match-fit since I’ve done the programme,” she told the BBC.She added: “It’s given me techniques that are so useful in everyday life. In work, if I’ve got an important meeting and I feel a bit anxious, it’s taught me techniques for breathing and mindfulness.”Using a series of modules on topics related to depression, online programmes such as Beating the Blues and Deprexis offer worksheets and exercises to help people better understand their mental health problems, alongside techniques for changing their behaviour or thinking patterns.Others, such as SilverCloud, provide mindfulness tools and resources which are designed to be completed by the patient, but overseen by a mental health practitioner.Shows promiseMark Chapman, interim director of medical technology and digital evaluation at NICE, said: “Our rapid assessment of these eight technologies has shown they have promise.”Developed using tried-and-tested CBT methods, each one has demonstrated it has the potential to provide effective treatment to the many thousands of people who live with these conditions.”Using a series of trials, NICE intends to gather further information about how effective the programmes are, as well as whether they “represent good value for the NHS”, Mr Chapman added.Professor Dame Til Wykes, of the School of Mental Health and Psychological Sciences at London’s King’s College, cautioned “we don’t know enough” about the effectiveness of online therapies and whether the therapies will offer sufficient support for mental health patients.Her view was echoed by mental health charity Mind, with content manager Jessica D’Cruz asserting “the majority” of people needing support “will struggle to benefit from this”.She added: “It’s also important to remember the ongoing under-funding of NHS mental health services, and the issues many services are experiencing in the wake of pressures from the pandemic and cost of living crisis.”More on this storyOnline therapy for PTSD ‘as good as’ face-to-face16 June 2022England mental health referrals at 4.3 million high15 March 2022Quarter of 17-19-year-olds may have mental disorder29 November 2022

Published12 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Max MatzaBBC NewsFBI Director Christopher Wray has said that the bureau believes Covid-19 “most likely” originated in a “Chinese government-controlled lab”.”The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident,” he told Fox News.It is the first public confirmation of the FBI’s classified judgement of how the pandemic virus emerged.China has denied a lab leak in Wuhan, calling the allegation defamatory. His interview comes a day after the US ambassador to China called for the country to “be more honest” about Covid’s origins.In his interview on Tuesday, Mr Wray said China “has been doing its best to try to thwart and obfuscate” efforts to identify the source of the global pandemic. “And that’s unfortunate for everybody,” he said.Other US intelligence agencies have drawn differing conclusions to the FBI’s, with varying degrees of confidence in their findings.Some studies suggest the virus made the leap from animals to humans in Wuhan, China, possibly at the city’s seafood and wildlife market.The market is a 40-minute drive from a world-leading virus laboratory, the Wuhan Institute of Virology, which was conducting research into coronaviruses.Covid-19 first emerged three years ago and has since led to the deaths of nearly seven million people. More on this storyChina should be honest on Covid origin, says US envoy15 hours agoWhy the lab-leak theory is being taken seriously27 May 2021

Published32 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Philippa RoxbyHealth reporterYou don’t have to be a runner or play sport to feel the benefits of exercise – fitting a brisk walk into your day is good enough, UK analysis suggests. It found if everyone did as little as 11 minutes of daily activity, one in 10 premature deaths could be prevented.Most people don’t manage to do the minimum recommended 150 minutes of exercise a week, however.But doing some exercise is better than doing nothing, the researchers from the University of Cambridge say. The NHS recommends everyone does 150-300 minutes of physical activity that raises the heart rate every week or 75-150 minutes of vigorous activity per week, which makes you breathe hard.The research team looked at hundreds of previous studies on the benefits of physical activity and concluded that even doing half the recommended amount could prevent one in 20 cases of cardiovascular disease and nearly one in 30 cases of cancer.That equates to 75 minutes per week – or 11 minutes per day – riding a bike, walking fast, hiking, dancing or playing tennis.”You should feel yourself moving, your heart will beat faster but you won’t necessarily feel out of breath,” says Dr Soren Brage, who led the research.Doing that amount is enough to reduce the risk of developing heart disease and stroke by 17% and cancer by 7%, the findings suggest.Regular exercise reduces body fat and blood pressure while also improving fitness, sleep and heart health in the long run.Pumping weights could help you live longerFriends could be key to finding fitness motivationBest time to exercise may differ for men and womenThe benefits of exercise were even greater for some specific cancers, such as head and neck, gastric, leukaemia and blood cancers, but lower for lung, liver, endometrial, colon and breast cancers.Not everyone finds it easy to do the exercise recommended by the NHS – two out of three people say they do less than 150 mins (2.5 hours) of moderate exercise and fewer than one in 10 manage more than 300 mins (five hours) per week. “If you are someone who finds the idea of 150 minutes of moderate-intensity physical activity a week a bit daunting, then our findings should be good news,” says Dr Brage.”If you find that 75 minutes a week is manageable, then you could try stepping it up gradually to the full recommended amount.”Image source, Getty ImagesThe analysis, in the British Journal of Sports Medicine, looked at previous published research on the benefits of exercise in nearly 100 large studies and nearly 200 peer-reviewed articles to get an overview of the evidence.They calculated that if everyone in the studies had done at least 150 minutes of exercise a week – the full amount – then around one in six early deaths would be prevented.The researchers say replacing some habits is all that is needed.For example, they advise trying to walk or cycle to work or to the shops instead of using a car, or being active when playing with your children or grandchildren.Getting enjoyable activities into your weekly routine is the best way to increase the amount of physical activity you do, they say.The NHS recommends adults also do activities that strengthen muscles twice a week.Yoga, pilates, lifting weights, heavy gardening and carrying heavy shopping bags all count.More on this storyPumping weights could help you live longer28 September 2022Best time to exercise may differ for men and women31 May 2022Weekend burst of exercise can be enough to stay fit5 July 2022Doctors warned about ‘dry scooping’ fitness fad8 October 2021Related Internet LinksPhysical activity guidelines for adults aged 19 to 64 – NHSBenefits of exercise – NHSThe BBC is not responsible for the content of external sites.

BBC Correspondent Sean Dilley told the story of his last walk with his guide dog Sammy in September 2022. Sammy retired after more than eight years of service.Following the coverage, the charity Guide Dogs has had a record number of applications to volunteer, with more than 4,500 people coming forward.Before the pandemic there were around 5,000 guide dog partnerships – now there are 3,695. More than one in five people who had a guide dog before then now do not.Since then, the BBC has followed the stories of puppy raisers, fosterers and guide dog users to understand what needs to be done to fix Britain’s guide dog shortage. Watch the full documentary here.Video by Gem O’Reilly and Sean Dilley

A study from the University of Illinois Chicago links precarious work with increases in body mass index. The study adds to a growing body of evidence that precarious work may contribute to poor health outcomes.?
The UIC scientists who wrote the paper defined precarious work as an accumulation of “unfavorable facets of employment,” such as low wages, insecure employment contracts, irregular hours and lack of union representation.
“Over the last few decades, there has been an increase in the number of Americans engaging in precarious work — we see this with the rise of the ‘gig’ economy or the number of people working for ride-share companies, for example. With millions of Americans now engaging in precarious work, we need to pay closer attention to the health impacts of type of employment, ” said study author Vanessa Oddo, assistant professor of kinesiology and nutrition at the UIC College of Applied Health Sciences.
To understand the impact of precarious work on BMI, the researchers analyzed 20 years of data from the National Longitudinal Survey of Youth adult cohort (1996-2016). The average age of the participants was 44.
They looked at seven precarious employment dimensions — material rewards, working time arrangements, employment stability and collective organization, for example — and identified 13 self-reported survey indicators of precarious employment. Computational and statistical models were used to compare these indicators with BMI, a rough indicator of obesity.
Indicators of precarious employment were highest among Latino and Black women with lower education. A 1-point increase in precarious employment was associated with a 2.18-point increase in BMI.
The findings are reported in Obesity.
The researchers say that “these modest changes in BMI may have important implications at the population level, given that small changes in weight affect chronic disease risk.
“Policies and workplace interventions to improve employment quality warrant consideration to protect American workers and mitigate the growing burden of obesity-related chronic diseases in the United States,” the authors write.
The study was primarily supported by a grant from the National Institute on Minority Health and Health Disparities (R00MD012807). Additional support was provided by the National Institute on Aging (R01AG060011) and National Institute on Minority Health and Health Disparities (F31MD013357).

TOPPENISH, Wash. — Three days before Christmas, the only hospital in this remote city on the Yakama Indian Reservation abruptly closed its maternity unit without consulting the community, the doctors who delivered babies there or even its own board.At least 35 women were planning to give birth at Astria Toppenish Hospital in January alone, and the sudden closure — which violated the hospital’s commitment to the state to maintain critical services in this rural area — threw their plans into disarray.Victoria Barajas, 34, expecting her first child, scrambled to find a new doctor before her due date, Jan. 7. Jazzmin Maldonado, a 29-year-old schoolteacher due to give birth soon, wondered how she could make it to a distant hospital in time.After an earlier miscarriage, doctors had placed a stitch in her cervix to prevent a second one, and the stitch would have to come out fast once labor began.Astria Toppenish Hospital is one of a string of providers across the nation that have stopped providing labor and delivery care in an effort to control costs — even as maternal deaths increase at alarming rates in the United States, and as more women develop complications that can be life-threatening.The closure in Toppenish mirrors national trends as financially strained hospitals come to a harsh conclusion: Childbirth doesn’t pay, at least not in low-income communities.From 2015 to 2019, there were at least 89 obstetric unit closures in rural hospitals across the country. By 2020, about half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association.In the past year, the closures appear to have accelerated, as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined.A study of hospital administrators carried out before the pandemic found that 20 percent of them said they did not expect to be providing labor and delivery services in five years’ time.Women in rural areas face a higher risk of pregnancy-related complications, according to a study by the Commonwealth Fund. Those living in so-called maternity care deserts are three times as likely to die during pregnancy and the critical year afterward as those who are closer to care, according to a study of mothers in Louisiana.Ambulances aren’t reliable in many rural areas like the Yakama reservation, which spreads over a million acres. There aren’t many emergency vehicles, and the vast distances make for long waits. In the fall and winter, dense fog often blankets the roads, making driving treacherous.Astria Toppenish Hospital in Washington is one of several providers across the United States that have stopped providing labor and delivery care to control costs, even as maternal deaths increase at alarming rates.Ruth Fremson/The New York TimesAdriana Guel, 35, a mother of three, survived a rare life-threatening complication called an amniotic embolism during one of her deliveries and credited the hospital with saving her life.Ruth Fremson/The New York TimesIn Toppenish, the frustration and fear erupted at a recent city council meeting, which drew such a large crowd that it spilled into the hallway outside the chambers. Astria, a health care system based in Washington State, had committed to keeping certain services, including labor and delivery, available for at least a decade after acquiring the hospital, residents noted.Now the hospital said it could not afford to do so, and the state has taken no action. “There will be lives lost — people need to know that,” Leslie Swan, a Native American doula, said.At the meeting and in interviews, many women said the doctors and labor and delivery nurses at Astria Toppenish Hospital had saved their lives. Adriana Guel, 35, a mother of three, survived a rare life-threatening complication called an amniotic embolism during one of her deliveries and credited the hospital with saving her life.The mayor, Elpidia Saavedra, 47, had an obstetric emergency 10 years ago when an ectopic pregnancy ruptured. Semone Dittentholer, 39, said she almost died as a teenager, when she miscarried and lost massive amounts of blood.“It’s a lifeline that we’ve had, and now that part of that lifeline is getting cut down,” said Ms. Dittentholer, who works on the reservation at the Ttawaxt Birth Justice Center, which offers support to pregnant women and to new mothers and has been providing space for a local obstetrician to see women once a week in order to ease access to care.“It’s just another reminder of how scary it can be out here.”A Downward SpiralThe United States is already the most dangerous developed country in the world for women to give birth, with a maternal mortality rate of 23.8 per 100,000 live births — or more than one death for every 5,000 live deliveries.Recent figures show that the problems are particularly acute in minority communities and especially among Native American women, whose risk of dying of pregnancy-related complications is three times as high as that of white women. Their babies are almost twice as likely to die during the first year of life as white babies.Women of color are more likely to live in maternity care deserts or in communities with limited access to care. According to the March of Dimes, the maternal health nonprofit, seven million women of childbearing age reside in counties where there is no hospital-based obstetric care, no birthing center, no obstetrician-gynecologist and no certified nurse midwife, or where access to those services is limited.Fewer than half of women in rural areas can find perinatal care within 30 miles, according to the Centers for Medicare and Medicaid Services.The closure of an obstetrics unit often begins a downward health spiral in remote communities. Without ready access to obstetricians, prenatal care and critical postpartum checkups, risky complications become more likely.But running a labor and delivery unit is expensive, said Katy Kozhimannil, director of the University of Minnesota Rural Health Research Center. The facility must be staffed 24 hours a day, seven days a week, with a team of specialized nurses and backup services, including pediatrics and anesthesia.Elpidia Saavedra, the mayor of Toppenish, had an obstetric emergency 10 years ago when an ectopic pregnancy ruptured. Ruth Fremson/The New York TimesHills outside of Toppenish. Ambulances aren’t reliable in many rural areas like the Yakama reservation, which spreads over a million acres. In the fall and winter, dense fog often blankets the roads, making driving treacherous.Ruth Fremson/The New York Times“You have to be ready to have a baby any time,” Dr. Kozhimannil said.Staffing shortages have driven costs up, and hospitals have been forced to bring in contract nurses, who can cost more than three times as much as a staff nurse. Labor and delivery nurses are in high demand, and pay for them can be even higher.A vast majority of pregnant patients at Astria Toppenish had insurance coverage, but mostly Medicaid, which pays hospitals far less than private insurance plans do. Half of pregnant women in the United States are on Medicaid, and it pays poorly in all states.In Washington State, Medicaid would pay $6,344 for a childbirth, about one-third of the $18,193 paid by private plans, according to an analysis by the Health Care Cost Institute that compared traditional fee-for-service rates paid by Medicaid with those paid by private plans.In wealthier communities, private insurance helps offset low Medicaid payments to hospitals. But in rural areas where poverty is more entrenched, there are too few privately insured patients.“Toppenish is the canary in the coal mine,” said Cassie Sauer, president and chief executive of the Washington State Hospital Association, noting that many hospitals serving low-income communities in the state are in similar financial straits.The administrator of Astria Toppenish, Cathy Bambrick, said the hospital had no cash reserves and the labor and delivery unit lost $3.2 million last year after a temporary Washington State initiative that paid enhanced Medicaid rates came to an end.The cost of nursing spiked as the hospital turned to contract nurses, she said.There was no money in the budget to replace an infant security system last year when it failed, she said. Recently, the ultrasound machine stopped working, and because the hospital could not afford a new one, Ms. Bambrick paid $50,000 for a refurbished machine.Although Astria Toppenish serves a low-income population, Ms. Bambrick said, it does not qualify for any of the myriad government programs that help fund rural health services and hospitals in the state.“We fall through the cracks,” Ms. Bambrick said.Cultural AwarenessAstria Toppenish’s patients are a particularly vulnerable population that includes a large community of farm workers who toil in the Yakima Valley vineyards, orchards and hops fields.So many children come from low-income homes that local schools provide free lunch. Patients often struggle to come up with gas money to go to doctor’s appointments. Chronic diseases that complicate pregnancy — like diabetes, heart disease and substance abuse — are common.The Yakima Valley Farm Workers Clinic in Toppenish.Ruth Fremson/The New York TimesDr. Jordann Loehr, an obstetrician who works at the Yakima Valley Farm Workers Clinic. “They are poor in spite of working hard,” she said of its patients. Ruth Fremson/The New York Times“They are poor in spite of working hard,” said Dr. Jordann Loehr, an obstetrician who works at the Yakima Valley Farm Workers Clinic.Many women opted to give birth at Astria Toppenish because of its reputation for respecting patients’ wishes and for cultural sensitivity — including a labor room for Native American women that faces east, an ancestral practice, and permission for as many family friends and “aunties” in the delivery room as the mother wanted.The nurses did not rush women in labor, and the unit had a cesarean section rate of 17 percent (way below the national average of 32 percent). They taught first-time mothers about infant care and breastfeeding — but also about how to use a papoose board safely, and why mothers shouldn’t overbundle a newborn, a common practice.Nurses at the hospital introduced new mothers to ideas that contravened long-held beliefs.“Our population generally has the cultural understanding that you don’t hold newborns — it makes them needy,” said Angi Scott, a labor and delivery nurse. “We tell them, ‘No, you can’t spoil a newborn. Babies who are held more in the first year of life grow up to be more self-assured. It’s important to hold your baby.’”Many residents fear the obstetrics closure is a prelude to the hospital closing its doors altogether in a repeat of what happened in 2019, when the Astria Health system declared bankruptcy and later closed the largest of its three hospitals, a 150-bed facility in Yakima. Astria had purchased the hospital just two years earlier.For now, the four obstetricians in town — all women — are digging in. Dr. Loehr has led a community drive to reestablish a maternity unit by creating a public hospital district, a special entity that would be governed and funded locally with taxes or levies.Dr. Anita Showalter, another obstetrician, recently delivered Ms. Barajas’s baby, but at an Astria hospital farther away. She already had suffered one miscarriage, and Dr. Showalter stayed with her through 37 hours of labor. Baby Dylan was born on Jan. 15 at 1:52 a.m. “My heart is full,” Ms. Barajas said in a text.Shayla Owen, 35, who lives in Goldendale, went into labor on the day before Valentine’s Day, and her husband drove her 70 miles over a desolate mountain pass to a hospital in Yakima. They were almost out of gas by the time they got there.Baby Isaiah weighed 8 pounds 3 ounces, after 10 hours of labor. Ms. Owen said she had made the right call when she decided against trying a home birth.“I hemorrhaged after the delivery,” she said. “So I was glad I was at a hospital.”Shayla Owen with her son Israel. She went into labor the day before Valentine’s Day and nearly ran out of gas being driven the 70 miles to a hospital to give birth to Israel’s brother, Isaiah.Ruth Fremson/The New York Times