Publisher Health

Childhood body mass index is unlikely to have a big impact on children’s mood or behavioural disorders, according to a study published today in eLife.
The results suggest that some previous studies, which have shown a strong link between childhood obesity and mental health, may not have fully accounted for family genetics and environmental factors.
Children with obesity are more likely to be diagnosed with depression, anxiety, or attention-deficit hyperactivity disorder (ADHD). But the nature of the relationship between obesity and these mental health conditions is not clear. Obesity might contribute to mental health symptoms, or vice versa. Alternatively, a child’s environment might contribute to both obesity and mood and behavioural disorders.
“We need to better understand the relationship between childhood obesity and mental health,” says lead author Amanda Hughes, Senior Research Associate in Epidemiology at Bristol Medical School, University of Bristol, UK. “This requires teasing apart the contributions of child and parent genetics and the environmental factors affecting the whole family.”
Hughes and colleagues examined genetic and mental health data from 41,000 eight-year-old children and their parents from the Norwegian Mother, Father, and Child Cohort Study and Medical Birth Registry of Norway. They assessed the relationship between children’s body mass index (BMI) — a ratio of weight and height — and symptoms of depression, anxiety and ADHD. To help separate the effects of the children’s genetics from the influence of other factors that affect the whole family, they also accounted for parental genetics and BMI.
The analysis found a minimal effect of a child’s own BMI on their anxiety symptoms. There was also conflicting evidence about whether a child’s BMI influenced their depressive or ADHD symptoms. This suggests that policies aiming to reduce childhood obesity are unlikely to have a big impact on the prevalence of these conditions. “At least for this age group, the impact of a child’s own BMI appears small. For older children and adolescents, it could be more important,” says Neil Davies, Professor at University College London, UK.
When they looked at the effect of the parents’ BMI on the children’s mental health, the team found little evidence that the parents’ BMI affected children’s ADHD or anxiety symptoms. The data suggested that having a mother with a higher BMI might be linked with depressive symptoms in children, but there was little evidence of any link between the child’s mental health and the father’s BMI.
“Overall, the influence of a parent’s BMI on a child’s mental health seems to be limited. As a result, interventions to reduce parents’ BMIs are unlikely to have widespread benefits to children’s mental health,” says Alexandra Havdahl, Research Professor at the Norwegian Institute of Public Health, Norway. Havdahl is a co-senior author of the study alongside Neil Davies and Laura Howe, Professor of Epidemiology and Medical Statistics at Bristol Medical School.
“Our results suggest that interventions designed to reduce child obesity are unlikely to make big improvements in child mental health. On the other hand, policies which target social and environmental factors linked to higher body weights, and which target poor child mental health directly, may be more beneficial,” Hughes concludes.
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Long-term consumption of Allura Red food dye can be a potential trigger of inflammatory bowel diseases (IBDs), Crohn’s disease and ulcerative colitis, says McMaster University’s Waliul Khan. Researchers using experimental animal models of IBD found that continual exposure to Allura Red AC harms gut health and promotes inflammation.
The dye directly disrupts gut barrier function and increases the production of serotonin, a hormone/neurotransmitter found in the gut, which subsequently alters gut microbiota composition leading to increased susceptibility to colitis.
Khan said Allura Red (also called FD&C Red 40 and Food Red 17), is a common ingredient in candies, soft drinks, dairy products and some cereals. The dye is used to add colour and texture to foodstuffs, often to attract children.
The use of synthetic food dyes such as Allura Red has increased significantly over the last several decades, but there has been little earlier study of these dyes’ effects on gut health. Khan and his team published their findings in Nature Communications. Yun Han (Eric) Kwon, who recently completed PhD in Khan’s laboratory, is first author.
“This study demonstrates significant harmful effects of Allura Red on gut health and identifies gut serotonin as a critical factor mediating these effects. These findings have important implication in the prevention and management of gut inflammation,” said Khan, the study’s senior author, a professor of the Department of Pathology and Molecular Medicine and a principal investigator of Farncombe Family Digestive Health Research Institute.
“What we have found is striking and alarming, as this common synthetic food dye is a possible dietary trigger for IBDs. This research is a significant advance in alerting the public on the potential harms of food dyes that we consume daily,” he said.
“The literature suggests that the consumption of Allura Red also affects certain allergies, immune disorders and behavioural problems in children, such as attention deficit hyperactivity disorder.”
Khan said that IBDs are serious chronic inflammatory conditions of the human bowel that affect millions of people worldwide. While their exact causes are still not fully understood, studies have shown that dysregulated immune responses, genetic factors, gut microbiota imbalances, and environmental factors can trigger these conditions.
In recent years there has been significant progress in identifying susceptibility genes and understanding the role of the immune system and host microbiota in the pathogenesis of IBDs. However, similar advances in defining environmental risk factors have lagged, he said.
Khan said that environmental triggers for IBDs include the typical Western diet, which includes processed fats, red and processed meats, sugar and a lack of fibre. He added that the Western diet and processed food also includes large amounts of various additives and dyes.
He added that the study suggests a link between a commonly used food dye and IBDs and warrants further exploration between food dyes and IBDs at experimental, epidemiological and clinical levels.
The study was funded by the Canadian Institutes of Health Research.
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New research findings have revealed an underlying genetic cause for why some children who have had COVID-19 infection develop Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but potentially life-threatening disease.
The findings are the first potential genetic cause identified for MIS-C, a disease that typically occurs about four weeks after COVID-19 infection and has broad symptoms such as fever, vomiting and inflammation of the heart muscle that can lead to hospitalization. States have reported about 9,000 MIS-C cases, with 71 deaths, according to most recent Centers for Disease Control and Prevention numbers.
The results, published in Science, are rooted in more than 40 years of research from Robert Silverman, Ph.D., of Cleveland Clinic Lerner Research Institute’s Department of Cancer Biology. The study, led by Rockefeller University, found genetic mutations to the proteins OAS and RNase L increased the inflammatory response in some immune cell types. That change can cause inflammation in multiple organs, including the heart, lungs, kidneys and gastrointestinal tract. In the study, mutations were identified in a small subset of children with MIS-C.
OAS proteins are induced by interferons, as a first line of defense against viruses. After sensing viral double-stranded RNA, OAS proteins activate RNase L to prevent the virus from multiplying and spreading.
“RNase L acts like scissors to cut up messenger RNA that gets translated into proteins, including proteins known as cytokines that cause inflammation,” Dr. Silverman said. “The autosomal recessive mutations in MIS-C either prevent the scissors from operating (OAS mutations) or prevent the scissors from being made at all (RNase L mutations). These findings offer important insights about how OAS-RNase L can protect against this severe unexplained complication of COVID-19.”
Dr. Silverman’s lab, which studies the role of interferons in immune responses with a focus on the OAS-RNase L pathway, collaborated with a team at Rockefeller University led by Jean-Laurent Casanova, M.D., Ph.D. Dr. Casanova’s team found the mutations in part through analyzing DNA sequence data from MIS-C patients in comparison to other children who were infected with COVID-19 but did not contract MIS-C.
“Our findings improve the understanding of MIS-C by clarifying the molecular, cellular and immunological basis of the disease,” said Dr. Casanova. “We identified the mutations through analyzing DNA sequence data from MIS-C patients in comparison to other children who were infected with COVID-19 but did not contract MIS-C. One of the key research questions was whether increased virus multiplication or an exaggerated inflammatory response led to MIS-C in the cases with the mutations. Our results support the latter explanation.”
As part of an international collaboration, Dr. Silverman’s team determined what the specific effects of the mutations were on the pathway. That included screening dozens of mutant genes, identifying the effects on RNA and then correlating the results with the disease.
“Our team took what I had learned over the years about these enzymes to get the functional data that the study needed,” said Dr. Silverman. “Essentially, this validated the effects these mutations had on function.”
Dr. Silverman’s lab also contributed reagents not commercially available, synthesizing a small molecule that switches on RNase L and makes it cleave RNA. The study determined that these mutations led to an exacerbated inflammatory response at a molecular level, according to the paper.
Knowledge about these mutations and how it affects immune mechanisms could provide more information on other diseases that cause chronic inflammation, like Kawasaki disease, which presents similarly to MIS-C.
Funding to Cleveland Clinic: National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health under award R01AI104887.
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Modern humans evolutionarily split from our chimpanzee ancestors nearly 7 million years ago, yet we are continuing to evolve. 155 new genes have been identified within the human lineage that spontaneously arose from tiny sections of our DNA. Some of these new genes date back to the ancient origin of mammals, with a few of these “microgenes” predicted to be associated with human-specific diseases. This work is publishing on December 20th in the journal Cell Reports.
“This project started back in 2017 because I was interested in novel gene evolution and figuring out how these genes originate,” says first author Nikolaos Vakirlis, a scientist at the Biomedical Sciences Research Center “Alexander Fleming” in Vari, Greece. “It was put on ice for a few years, until another study got published that had some very interesting data, allowing us to get started on this work.”
Taking the previously published dataset of functionally relevant new genes, the researchers created an ancestral tree comparing humans to other vertebrate species. They tracked the relationship of these genes across evolution and found 155 that popped up from regions of unique DNA. New genes can arise from duplication events that already exist in the genome; however, these genes arose from scratch.
“It was quite exciting to be working in something so new,” says senior author Aoife McLysaght, a scientist at Trinity College Dublin. “When you start getting into these small sizes of DNA, they’re really on the edge of what is interpretable from a genome sequence, and they’re in that zone where it’s hard to know if it is biologically meaningful.”
Of these 155 new genes, 44 of them are associated with growth defects in cell cultures, demonstrating the importance of these genes in maintaining a healthy, living system. Since these genes are human specific, it makes direct testing difficult. Researchers must seek another way to explore what effects these new genes may have on the body. Vakirlis and his team examined patterns found within the DNA that can hint at if these genes play a role in specific diseases.
Three of these 155 new genes have disease-associated DNA markers that point to connections with ailments such as muscular dystrophy, retinitis pigmentosa, and Alazami syndrome. Apart from disease, the researchers also found a new gene that is associated with human heart tissue. This gene emerged in human and chimp right after the split from gorilla and shows just how fast a gene can evolve to become essential for the body.
“It will be very interesting in future studies to understand what these microgenes might do and whether they might be directly involved in any kind of disease,” says Vakirlis.
“These genes are convenient to ignore because they’re so difficult to study, but I think it’ll be increasingly recognized that they need to be looked at and considered,” says McLysaght. “If we’re right in what we think we have here, there’s a lot more functionally relevant stuff hidden in the human genome.”
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Investigators from the Smidt Heart Institute at Cedars-Sinai have identified how biological pacemaker cells — cells that control your heartbeat — can “fight back” against therapies to biologically correct abnormal heartbeat rates. The research also uncovered a new way to boost the effectiveness of RNA therapies by controlling this “fighting back” activity.
This novel concept, published today in the peer-reviewed journal Cell Reports Medicine, is an important step in the evolution and creation of biological pacemakers — which aim to one day replace traditional, electronic pacemakers.
“We are all born with a specialized group of heart cells that set the pace for our heartbeats,” said Eugenio Cingolani, MD, senior author of the study and director of the Cardiogenetics Program in the Smidt Heart Institute at Cedars-Sinai. “But in some people, this natural heartbeat is too slow, leading to the need for an electronic pacemaker.”
While electronic pacemakers have saved many lives since they were invented in the 1950s, there are limitations and side effects, including battery life, device-related infections and system failure. They also come with risks, including infection, swelling, bleeding, blood clots, damage to neighboring blood vessels, and in some cases, a collapsed lung.
“But the biggest problem is that the machines do not cure the problem,” Cingolani said. “They only allow you to find a way around it. Our intention is to create a biological solution, cells that we can reprogram within the heart to naturally stabilize the heartbeat.”
In the latest research study, Cingolani and team harnessed the same modified messenger RNA (mRNA) technology used in creating the Pfizer and Moderna COVID-19 vaccines. MRNA carries information from genes to make proteins, the building blocks of life.
An mRNA vaccine is essentially a code that, when it enters a cell, tells it to make a specific protein.
In their latest research study, investigators injected laboratory mice with mRNA that was chemically modified to express a protein called TBX18. In doing so, they found that heart cells “fought back”: They inhibited TBX18 protein expression by producing microRNAs, nature’s own regulatory molecules that specifically fine-tune gene expression. As a result, the amount of TBX18 protein produced was insufficient to support the heartbeat.
The team looked for a way to bypass the suppressive effect of the microRNAs. After identifying the precise microRNAs involved, the investigators used chemical antagonists to specifically suppress those microRNAs, increasing TBX18 protein expression, and stabilizing the heartbeat.
“This concept that cells ‘fight back’ against modified RNA is of practical importance, as it suggests how one might improve the effectiveness of RNA therapy,” said study author Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor. “We now have a clearer picture of how to inhibit microRNAs, release the brake, and ultimately get better gene expression.”
Of equal significance, researchers found a similar reaction — the cells’ ability to fight back — is at play in limiting the expression of VEGF-A, an alternative type of chemically modified messenger RNA that has been used to grow new blood vessels.
As a next step, Cingolani, Marbán and team are planning additional studies to assess the long-term efficacy and safety, with a view to eventually apply the insights to improve the efficacy of mRNA therapy in clinical trials.

Nurses in Northern Ireland, Wales and England have taken to the picket line to protest pay and working conditions for the second day this month.The Royal College of Nursing wants a 19% pay rise and says below-inflation increases are compromising care by making it hard to attract and retain nurses.But Rishi Sunak insists he will not back down against striking workers, including nurses, urging them to consider whether strikes are “really necessary”.

A government minister has advised the public not to take risks when paramedics are on strike on Wednesday.Speaking on BBC Breakfast, Will Quince said the Armed Forces – who will provide support during the industrial action – were not allowed to “break the law by driving through red lights”.

Published1 hour agoShareclose panelShare pageCopy linkAbout sharingImage source, Family photoBy Nelli BirdBBC NewsA mother whose four-year-old son nearly died after swallowing 52 magnets from a toy has urged parents to be aware of the dangers.Doctors had to remove Jude’s appendix and cut his bowel in five places where the magnets got trapped.His mother Lyndsey Foley said she feared she was going to lose him.Public Health Wales (PHW) urged people to think before buying products containing mini magnets and button batteries for children.My toddler died after swallowing a button batteryBeware ‘lethal’ button batteries in Christmas toys’Be honest’: How to talk to kids about a budget ChristmasMs Foley, 34, from Merthyr Tydfil, said she became concerned after her son, now five, had recurring bouts of sickness over an eight week period this summer. After concern grew, in August she took Jude to Prince Charles Hospital when he was in severe pain.Blood tests and physical examinations appeared normal until something appeared on an X-ray. “The doctor thought that he was lying on a necklace at first but upon looking at it, I knew straight away that it was these beads,” she said.”Then within five minutes the doctors were arranging for an ambulance to take us down to the Children’s Hospital in Cardiff. “We got blue lighted down. I started to panic. It was only then that I realised how serious it was.”Ms Foley said she had bought the magnetic beads toy for her eight-year-old daughter Poppy.The toys are popular with children, with a variety of videos on YouTube showing how you can make shapes, objects and houses with with the tiny magnetic balls. Lyndsey however had no idea her son had been swallowing “one or two, here or there” over the space of a couple of months.”The surgeon said if I hadn’t brought him in when I did, it could have been fatal,” she said.”Due to the nature of the bowel and the force of the beads, it was tearing holes in his bowel which was causing his bowel to leak so an infection was spreading through his body. He was getting poisoned.”Surgeons were operating on Jude for seven hours due to the complexity of the operation.Jude could not eat anything and was bed-bound for seven days during his two-week hospital stay.Image source, Supplied photo / BBCHis mother said: “He was in pain. It was traumatic for him. It was horrible for me because I couldn’t give him a cwtch because he was hooked up to so many pipes. “I am very lucky Jude has no long-term health affects, but the surgeon did warn us that he may have had a colostomy bag for life or he could have been on monthly vitamin injections because of the shortness of the bowel.”Battery lodged in baby’s throat for four monthsChild’s button battery death sparks warningMs Foley now wants to warn other parents of the dangers from small toys. “If you’ve got these beads at home, remove them. They are so dangerous. “I still have that guilt, thinking what I put my child though or what could have been… How his life could have changed through me purchasing a toy that you think is safe. I never would have thought the damage it would have caused.”Jude is having regular check-ups and is doing well, but a five-inch scar on his tummy will be a reminder of what happened. “Jude has learnt his lesson now – don’t put anything in your mouth,” said Ms Foley. “And me, as a parent, I am more aware of what I am buying.” Sarah Jones, consultant in environmental public health at Public Health Wales, said: “We are asking parents to think carefully before buying products containing magnets and button batteries for children. “Mini magnet toys don’t make good stocking fillers. They should always be stored out of the reach of small children. “Similar dangers come from children swallowing button batteries too. “Parents should make sure the button battery compartment is properly closed and secure on all toys before giving them to children.”More on this storyMy toddler died after swallowing a button battery11 FebruaryChild’s button battery death sparks warning21 June 2021Beware ‘lethal’ button batteries in Christmas toys24 December 2019’Be honest’: How to talk to kids about a budget Christmas8 December

Published32 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Matthew HillBBC West Health CorrespondentA heart surgeon says he “probably saved the life” of a baby by carrying out a “world-first” operation using stem cells from placentas.Professor Massimo Caputo from the Bristol Heart Institute used pioneering stem cell “scaffolding” to correct baby Finley’s heart defect.He hopes to develop the technology so children born with congenital cardiac disease won’t need as many operations. Finley, now two, is “now a happy growing little boy”.But he was born with the main arteries in his heart the wrong way round and at just four days old had his first open-heart surgery at Bristol Royal Hospital for Children. Unfortunately the surgery didn’t solve the problem and his heart function deteriorated significantly, with the left side of the heart suffering from a severe lack of blood flow. His mother, Melissa, from Corsham, in Wiltshire, said: “We were prepared from the start that the odds of him surviving were not good. “After 12 hours, Finley finally came out of surgery but he needed a heart and lung bypass machine to keep alive, and his heart function had deteriorated significantly.”After weeks in intensive care it looked like there was no conventional way to treat Finley’s condition and he was reliant on drugs to keep his heart going.But a new procedure was tried, involving stem cells from a placenta bank.Prof Caputo injected the cells directly into Finley’s heart in the hope they would help damaged blood vessels grow.The so-called “allogenic” cells were grown by scientists at the Royal Free Hospital in London, and millions of them were injected into Finley’s heart muscle. Allogenic cells have the ability to grow into tissue that is not rejected and in Finley’s case, have regenerated damaged heart muscle.”We weaned him from all the drugs he was on, we weaned him from ventilation,” said Prof Caputo.”He was discharged from ITU and is now a happy growing little boy.” Using a bio-printer, a stem cell scaffold is made to repair abnormalities to valves in blood vessels, and to mend holes between the two main pumping chambers of the heart.Artificial tissue is normally used used on babies for cardiac repairs, but it can fail and it doesn’t grow with the heart, so as the children grow, they require more operations. Prof Caputo hopes a clinical trial on the patches will happen in the next two years, after successful laboratory work.The trial of the stem cell plasters offers hope for patients like Louie from Wales, who has a number of congenital heart defects.The 13-year-old from Cardiff had his first open heart surgery with Prof Caputo at just two weeks’ old and then again aged four to replace the material fixing his heart. But because the materials aren’t completely biological, they are unable to grow with him and he needs repeat operations.Like Louie, every day in the UK, around 13 babies are diagnosed with a congenital heart defect – a heart condition that develops before the baby is born, according to the British Heart Foundation.Because the materials used to fix the heart can be rejected by the patient’s immune system, they can cause scarring in the heart that can lead to other complications, and can gradually break down and fail in just a few months or years. A child might therefore have to go through the same heart operation multiple times throughout its childhood- around 200 repeat operations for congenital heart defects are carried out every year in the UK.Louie hopes the breakthrough means the number of operations he faces will be significantly reduced thanks to the stem cell technology and tissues able to grow with his body.”I don’t like having the procedures,” he said.”It’s not good in the long term, knowing every couple of years I need an operation so that would make me a lot more relaxed.”Prof Caputo and his team say the stem cell technology could save the NHS an estimated £30,000 for every operation no longer needed, saving millions of pounds each year.Dr Stephen Minger, an expert in stem cell biology and director of SLM Blue Skies Innovations Ltd, applauded the research.He said: “Most studies that I am aware of in adults with heart dysfunction or failure show only minimal therapeutic benefit with stem cell infusion. “I’m happy that the clinical team will go on to do a standard clinical trial which should tell us if this was a ‘one-off’ success and also give us some better understanding of mechanisms behind this.”Follow BBC West on Facebook, Twitter and Instagram. Send your story ideas to: bristol@bbc.co.uk More on this storySynthetic mouse embryo develops beating heart25 August’His scar is something he needs to be proud of’15 May’Pumping heart patch’ ready for human use4 June 2019

Published22 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Michelle RobertsDigital health editorAbout 10,000 NHS nurses in England, Wales and Northern Ireland are to strike for the second time in less than a week in protest over their pay. Wednesday will see ambulance staff in England and Wales walk out too, unless a meeting later with the health secretary can avert it. Steve Barclay has invited three unions representing paramedics to talks.It follows warnings of extensive disruption to services at a very challenging time of year for the NHS.The joint letter was sent out by health chiefs to NHS trusts and integrated care boards in England, urging hospitals to free-up beds by safely discharging patients ahead of industrial action by ambulance crews.Measures should also be put in place to make sure ambulance patient handovers are kept to no more than 15 minutes, it advises.Nurses staged their biggest ever strike in the history of the NHS last week.Nearly 10,000 staff were absent on Thursday and 16,000 appointments and surgeries had to be rescheduled in England alone.Tuesday’s action could cause similar disruption, although services such as urgent cancer care, will continue. The strike involves nurses in about a quarter of hospitals and community teams in England, all health boards in Northern Ireland and all but one health board in Wales. Nurses are not striking in Scotland.Protected services include chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care, along with some areas of mental health and learning disability and autism services.Make firm promise on ambulance pay, says union bossAre nurses striking in your area?What will nurses’ strike mean for patients?Why are the strikes happening?The walkout is mostly about pay. In England and Wales, most NHS staff have already received a pay rise of roughly £1,400 this year – worth about 4%, on average, for nurses.The Royal College of Nursing (RCN) union wants a 19% pay rise- 5% above the RPI inflation rate which currently stands at 14% – saying its members have received years of below-inflation pay increases.Prime Minister Rishi Sunak has said the pay offer to nurses is appropriate and fair, despite pressure from health leaders and some former Conservative ministers to rethink.But RCN general secretary Pat Cullen said he should ask himself why nurses were taking “unprecedented” strike action sacrificing a day’s pay, and highlighted worries over patient safety and the future of the NHS.Calling for talks with Mr Sunak, Ms Cullen said: “Let’s get this wrapped up by Christmas. “I will negotiate with him at any point to stop nursing staff and patients going into the New Year facing such uncertainty.”But if this government isn’t prepared to do the right thing, we’ll have no choice but to continue in January and that will be deeply regrettable,” she warned.The government maintains the nurses’ demands are unaffordable and the recommendation of an independent pay review body in setting wages have been followed.Health Secretary Steve Barclay said it was “disappointing” union members were striking despite the impact on patients.”The RCN’s demands are unaffordable during these challenging times and would take money away from frontline services while they are still recovering from the impact of the pandemic,” he said.He added that he was “open to engaging with the unions on how to make the NHS a better place to work”.The RCN has threatened to escalate strike action if ministers do not join talks within 48 hours of Tuesday’s walkout.This video can not be playedTo play this video you need to enable JavaScript in your browser.The action by nurses will be followed on Wednesday by a strike by ambulance staff, when Unison, GMB and Unite members take action. GMB union members will go on strike again on 28 December.Around 1,200 members of the military are being drafted in to cover the striking ambulance workers in a move unions call a “desperate measure”. It is expected they will be handling less serious calls.All of the most life-threatening calls, like cardiac arrest, will be responded too, but people who suffer trips, falls and other non-life threatening injuries may not be sent an ambulance.North East Ambulance Service said it would not be able to respond to all calls of a serious nature and some patients would have to make their own way to hospital.Stephen Segasby, from the service, said: “Ambulances will still be able to respond during the strike, but this will only be where there is an immediate risk to life.”This means that less serious calls will not receive a response and some patients might be asked to make their own way to hospital, where it is safe for them to do so.”London Ambulance Service also warned that patients with conditions that were not life-threatening were unlikely to get an ambulance on strike days. Record number of nurses quitting the NHSNurses’ leader Pat Cullen: ProfileThe strikes in the health service are part of widespread industrial action across a number of public sectors.The main union representing Border Force staff is set to walk out for eight days between 23 and 31 December.Postal strikes will take place on 23 and 24 December – some of the busiest days for pre-Christmas deliveries. The RMT rail workers’ union is also set to stage strike action between Christmas Eve and 27 December.How will patients be affected?People who are seriously ill or injured, and whose life is at risk, should call 999 as usual, or call 111 for non-urgent careOther services, such as some cancer treatments, mental health services or urgent testing, may be partially staffedRoutine care is likely to be badly affected, including planned operations such as knee and hip replacements, community nursing services and health visitsOfficial advice is that those with an appointment which hasn’t already been rearranged should turn up at their allotted timeGPs, community pharmacies and dentists will not be affectedWatch Make Sense of Strikes on iPlayer and find out more about why people are striking and whether industrial action works.More on this storyWhy are nurses and ambulance staff striking?9 hours agoMother of ill child grills health secretary on NHS. Video, 00:01:20Mother of ill child grills health secretary on NHS15 hours ago1:20Around the BBCAre nurses striking in your area?