A new clinical trial researching treatment for patients with sight loss as a result of diabetes has shown a type of laser treatment to be both cost effective and non-invasive, offering the best option for patients and healthcare providers.
There are currently several treatment options offered to people with Diabetic Macular Oedema (DMO), including two types of laser treatment and eye injections. DMO is the most common sight-threatening complication of diabetes, affecting over 27 million adults. This new research provides much-needed evidence to enable patients and healthcare professionals to be better informed on treatment options.
DMO happens when blood vessels in the retina at the back of the eye leak, causing fluid build-up at the macula, which provides central vision. The leakage occurs when high blood sugar levels damage blood vessels.
The severity of DMO is most often determined by measuring the thickness of the macula, which in-turn will determine the treatment offered. Patients with more severe DMO (with thickness of 400 microns or more) are treated with injections into the eye of drugs, known as anti-VEGFs.
Patients with mild DMO (with thickness of less than 400 microns) can be treated with macular lase, which can be standard threshold laser or subthreshold micropulse laser. The former produces a burn or scar on the retina. The latter, which is a more recent technology, works without leaving a burn or scar or any type of visible change or mark on the retina.
The research, published in Ophthalmology, found that subthreshold micropulse laser, which does not create a burn on the retina, was effective in maintaining a patient’s vision. This also requires much less frequent visits to the clinic and is much more cost effective than treatment via eye injections, with eye injections costing almost ten times more than laser treatments.
Professor Noemi Lois, Clinical Professor of Ophthalmology at Queens University and Honorary Consultant Vitreoretinal Surgeon at the Belfast Health and Social Care Trust and lead author on the study, explains: “The absence of a scar or burn following subthreshold micropulse laser led to some healthcare professionals to doubt its effectiveness compared to the standard threshold laser.
“However, our research addressed this by demonstrating that subthreshold micropulse laser is as good as standard threshold laser for helping people’s vision, reducing macula thickness, allowing people to meet driving standards, and maintaining their quality of life, both in general terms and for vision in particular.”
The research team set out to compare both types of available laser treatment through a large randomised clinical trial, known as DIAMONDS (DIAbetic Macular Oedema aNd Diode Subthreshold micropulse laser SML). They recruited 266 patients across 16 NHS hospitals around the UK, with half receiving standard threshold laser and the other half receiving subthreshold micropulse laser. Unique to this trial, patients were involved in selecting the outcomes, including how driving standards would be met following treatment. At the end of the two-year trial, DIAMONDS found both laser treatments to offer equivalent benefits.
The total cost of the care of patients enrolled in the trial (including the laser treatment and any other treatments required as well as the costs of the follow-up visits) over two years was similar for both patient’s groups. Over the two-year period, the cost per patient was just under £900 (£897.83) for patients in the subthreshold micropulse laser arm of the trial compared to £1125.66 for those in the standard laser arm.
Professor Lois adds: “Some ophthalmologists advise patients with milder forms of DMO to have injections of anti-VEGFs, rather than laser, despite laser being less invasive and requiring less visits to the clinic.
“Laser treatment costs significantly less than eye-injections of anti-VEGFs. With an average of ten injections required over two years, the total cost of eye injections per patient amounts to approximately £8,500 for the drug alone. This is almost ten times the cost of subthreshold micopulse laser without taking into account additional costings such as staff time.
“Until we published these findings, there was no robust evidence comparing these types of laser treatments. A lack of information led some healthcare professionals to favour standard laser over subthreshold micropulse laser. We now have robust evidence to show that both laser treatments are not only effective in clearing the fluid from the retina and maintaining vision for at least two years, but both are also cost-effective.”
“Armed with this knowledge, it’s likely that patients will opt for micropulse subthreshold laser, which doesn’t burn the retina and is comparable to standard laser. Whilst we didn’t directly compare laser treatments to treatment via eye injections of anti-VEGFs, hopefully we have shown that laser is an effective treatment, while remaining much less invasive to the patient and much less costly to the NHS.”
The research was funded by the Health Technology Assessment (HTA) of the National Institute for Health and Care Research (NIHR).
Dr Pat Carragher has been named as a winner in the prestigious national 2022 WellChild Awards, in association with GSK, having been nominated by his colleague Emma Craig.
Pat will be off to collect his award in London on September 8th.
The Awards are run by WellChild, the national charity for seriously ill children, and will be attended by the charity’s Patron, Prince Harry, The Duke of Sussex and his wife Meghan, The Duchess of Sussex. The Duke will deliver remarks.
Dr Carragher, who is Medical Director at Children’s Hospices Across Scotland, was picked from hundreds of nominations from across the UK to win the Legacy category in these Awards which celebrate the resilience of children living with serious illnesses or complex conditions and honour the dedication of those individuals who go the extra mile to help these children and their families.
In summer of 2022, Dr Pat Carragher will be retiring as Medical Director at CHAS after nearly 39 years of working as a doctor. He has encountered periods of great change in his years as a medic including in Primary Care when he was a GP in Kinross before becoming Rachel House’s first hospice doctor and formally beginning work in Children’s Palliative Care in March 1996.
Dr Carragher has led the changes to CHAS’s medical service provisions through the Covid-19 pandemic. Despite the challenges the pandemic brought, alongside the team, he was determined to find ways to continue to reach the thousands of children with life-shortening conditions that rely on CHAS.
He helped establish new and innovative ways of working using technology to provide help to families across Scotland and proved himself to be a strong and resilient leader through immense change. He has reshaped CHAS’s medical services, helping families during what continues to be an isolating and unpredictable time.
Within three to four weeks from the start of the Coid-19 Pandemic, CHAS completely adapted its service offering to survive and to maintain the very best standards of care for children with palliative care needs, and to support their families.
Dr Carragher also led on virtual work through the “Near me” consultations via the NHS and by the use of Microsoft Teams, to interact with and assess children at home, and to work with their parents.
CHAS’s pioneering virtual children’s hospice was also launched at the beginning of the pandemic and has rapidly developed since proving to be extremely successful.
Dr Carragher has also helped lead the CHAS hospital teams in Glasgow, Aberdeen and Edinburgh through this period of transformation, providing clinical leadership and support in the planning and delivery of palliative care whilst working closely with the NHS and local authorities.
He was key in launching the first hospital-based Supportive and Palliative Care team in Scotland at the Royal Hospital for Children in Glasgow and has continued to provide specialist advice through the pandemic.
Rami Okasha, the Chief Executive Officer of Children’s Hospices Across Scotland, who nominated Dr Carragher for the WellChild Award, said: “Dr Pat’s leadership and strength of character has enabled the team to adapt in ways which they never imagined. He’s shown resilience and an unwavering drive for reaching all of those who require CHAS’s help, and he’s inspired not only the medical team but all teams.”
“Dr Pat was continuously able to inspire and encourage teams to ‘keep going’ during the pandemic and to embrace the new and innovate ways to deliver care. He has provided solid leadership throughout this period of immense change.
“Dr Carragher ends many presentations with the following which he feels is vital for us all to understand: ‘The death of a child has serious and lasting effects on parents and other family members, effectively for the rest of their lives. Any attempt to reduce symptoms and improve quality of life in the final days or weeks, must not only be good for a child but, in the fullness of time, be helpful to those left behind‘.”
WellChild Chief Executive, Matt James said: “There are more children and young people than ever before in the UK living with long-term, serious health needs.
“The WellChild Awards 2022, in association with GSK, will be a unique opportunity to recognise and highlight the immense challenges they have faced and to celebrate the remarkable positivity, resilience and spirit they have demonstrated.
“It will also help us to shine a light on the dedication of those around them, from siblings, professionals and volunteers who have gone above and beyond to help them through such challenging times.”
Remarkable Evelyn from Edinburgh is rewarded for exceptional work for seriously ill children with national WellChild Award
Nurse Evelyn Rodger from Edinburgh has been named as a winner in the prestigious national 2022 WellChild Awards, in association with GSK, having been nominated by colleague and charity CEO, Rami Okasha, and will be off to collect her award in London on September 8th.
The Awards are run by WellChild, the national charity for seriously ill children, and will be attended by the charity’s Patron, Prince Harry, The Duke of Sussex and his wife Meghan, The Duchess of Sussex. The Duke will deliver remarks.
Evelyn, who is a Diana Children’s Nurse with Children’s Hospices Across Scotland was picked from hundreds of nominations from across the UK to win the Nurse category in these Awards which celebrate the resilience of children living with serious illnesses or complex conditions and honour the dedication of those individuals who go the extra mile to help these children and their families.
Evelyn has been a Diana Children’s Nurse (DCN) with Children’s Hospices Across Scotland for the past eight years, having joined the charity in 2014.
In her role Evelyn is based in the neonatal Unit in Simpsons in Edinburgh Royal Infirmary but she also covers five neonatal units across Southeast of Scotland and Tayside.
In addition to her nursing Evelyn supports and delivers training for NHS Lothian and CHAS staff, developing an environment of close working not only with the hospital and community teams, but with the CHAS hospice, at home and family support teams. Evelyn’s dedication and her collaborative approach creates a seamless service to families.
Evelyn was instrumental in a pioneering memory making project called ‘Joes Toes’ which has raised over £15,000 since 2018 to allow CHAS and neonatal units to purchase the materials required to make 3D baby hand and foot-casts, respectfully done in baby Joe’s name.
Joe was one of twins who was sadly stillborn as a result of twin to twin transfusion syndrome. Part of Evelyn’s role as Diana Nurse is to provide bereavement support and to help parents find ways to create precious lasting memories with their babies, a role which she feels very passionate about.
Joe’s mother Marie said: “Evelyn is a compassionate, kind, gentle woman who is incredibly knowledgeable in bereavement care and we feel privileged that she was there to support us in making cherished memories with Joe and with saying goodbye with no regrets.
“As part of the memory making process, we asked if she would be able to help us take 3D casts of Joe’s feet. Evelyn was more than willing to help us in any way she could. Joe’s cast is now one of our most cherished possessions and to be able to physically touch, hold, see, something that was exactly his is so very precious.
“Our little Joe has given us, and now other families, so much without even being here. He never drew breath but he has changed us forever.”
CHAS CEO Rami Okasha, who nominated Evelyn for the WellChild Award, said: “Evelyn is retiring from CHAS in September this year so to receive a WellChild Award in her retiral year is an incredible honour.
“Evelyn has supported hundreds of families, making sure they have time to spend together and are able to make the choices about end-of-life care for their child and understand the really difficult things that are going on around them.
“More than that Evelyn is an inspiration to her colleagues who work so well with the team across CHAS and across the NHS to support newborn children and parents when the time they have together is going to be incredibly short.
“Evelyn goes above and beyond to build deep connections with families and says in touch with them even long after her care ends. I have heard myself from parents the difference that Evelyn has made to them. It is humbling to hear and I want Evelyn to know there are people across Scotland whose lives she has changed forever and they are incredibly grateful to the skill and dedication and kindness she has shown every single day at her work.”
WellChild Chief Executive, Matt James said: “There are more children and young people than ever before in the UK living with long-term, serious health needs.
“The WellChild Awards 2022, in association with GSK, will be a unique opportunity to recognise and highlight the immense challenges they have faced and to celebrate the remarkable positivity, resilience and spirit they have demonstrated.
“It will also help us to shine a light on the dedication of those around them, from siblings, professionals and volunteers who have gone above and beyond to help them through such challenging times.”
Elderly residents at Glencairn Care Home in Edinburgh have been out enjoying the wonders of the capital this summer, with a programme of fun activities including rickshaw rides, theatre visits and musical performances.
The care home residents, located at Marchmont, have a busy calendar of socialising and events to see them through the summer months as part of the home’s ongoing commitment to being a ‘people-first’ home that centres decisions around the needs of its residents.
Exploring the streets of Edinburgh on pedal-powered rickshaw vehicles, the group have been experiencing the capital city at a much more leisurely pace while taking in the sites of the Meadows, Bruntsfield and Morningside.
To ensure that the residents feel part of Edinburgh’s Fringe celebrations, the activities coordinators also arranged visits to shows throughout the month, while visits from a historian and a cello player have also been scheduled into the calendar of events.
At Glencairn, as part of its people-first approach, residents are regularly consulted on the activities programme, asked for input and asked for reviews to determine what to plan and book next.
The activity schedule has recently been awarded plaudits as part of the Care Inspectorate’s ongoing review programme. The home was awarded a rating of 5 which is considered ‘Very Good,’ scoring highly across areas including; care and wellbeing, leadership and meaningful contact.
Debra Husband, Activities Coordinator, Glencairn Care Home, said:“We’ve had packed calendar of activities this summer which has been fantastic for the residents here at Glencairn.
“The sun has been shining and it’s been fantastic to get out and about to enjoy the city. We’re so lucky to be located in the heart of Edinburgh and the rickshaw rides in particular have meant that we can take the residents out to enjoy and explore our surroundings on a regular basis.”
Jozi Stables, Manager, Glencairn Care Home said: “Providing the residents of Glencairn with a full and enjoyable social calendar provides so much more than just a break from the daily routine of the home but it helps our residents to retain a sense of their identity, adventure and provides a rich and enjoyable life.
“We pride ourselves on bringing unique experiences to the home and also creating fun and adventurous excursion for our residents. The activities feed into the overall care ethos we have here at Glencairn which is ensuring the needs of our residents come first and we work closely with them to design plans that suit their recreation, care and wellbeing needs.”
The home, managed by Renaissance Care Homes, is one of sixteen homes located across Scotland and currently provides care provision for 26 residents.
The care group which runs 16 homes across Scotland is known for its fun and inventive campaigns that engage residents and focus on bettering their health and wellbeing, as well as encouraging fun and physical activity, some of which includes hosting the Renaissance Care Olympic Games and an upcoming Foodies Festival.
A list of the most frequently asked questions has been prepared to help give families in East Lothian more information around E-coli following a cluster of cases linked to local nurseries.
If, after reading this list, you still have questions or concerns about your own family circumstances, please get in touch.
A general information line on 0800 22 44 88 has been created through NHS24 to help families answer many of the questions they may be facing.
Background:
A cluster of cases of E-coli has been linked to nurseries in East Lothian. Four nurseries remain closed.
Cases of E-coli have been identified in Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery. Families have been informed of the actions they need to take.
Two other nurseries – West Road Pear Tree and Musselburgh Bridge Street Private Nursery – remain closed as a precaution after symptoms of a sickness bug were reported. Families have been informed and asked to provide samples if their child has had any symptoms to rule out the presence of E-coli.
There are currently in excess of 34 confirmed cases.
All children and staff from both Pear Tree Nursery at Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery have been formally excluded under the Public Health Act and need to go through the clearance process.
Children and staff attending the Pear Tree Nursery at West Road and Musselburgh Bridge Street Private Nursery have been advised to hand in samples if they have had Gastrointestinal symptoms.
Information last updated 22nd August 2022
General Questions
Q. What are the main symptoms of E.coli?
A. E.coli can cause:
Nausea
Vomiting
Stomach pains
Diarrhoea
Bloody diarrhoea
Fever
Q. Why is E.coli so serious?
A. Infection with this bug can have a range of effects from mild diarrhoea, to bloody diarrhoea and in a small proportion of cases it can cause serious complications such as kidney failure. Complications are more common in children aged under five or the elderly.
Q. Where does E.coli infection come from?
A.This bug is carried by a proportion of healthy animals such as cattle. It can be picked up from contact with animal faeces in the environment.
People can also become infected through eating contaminated food for example meat which has not been adequately cooked, or contaminated fruit or vegetables which have not been adequately washed. Unpasturised milk or contaminated water can also cause infection.
E.coli can also be passed on from someone who is infected with the bacteria.
Q. How is E.coli spread?
A. The infection can be spread person to person in families, nurseries or other institutions when contaminated faeces from an infected person are somehow ingested by another person (faecal-oral route). It can also be spread through contaminated food, water or from environmental contamination, including animal parks and gardens.
Q. How can E.coli be prevented?
A. Firstly, thorough hand washing with soap in running water after going to the toilet, before preparing food and after contact with animals or farm environments. Handwashing after nappy changing is very important as is environmental cleaning. Secondly, good food hygiene is essential, for example cooking all meat products thoroughly, washing all salads, fruits and vegetables before consumption and keeping raw and cooked food separate with separate utensils.
Q. My child does not attend any of the above named nurseries, but has diarrhoea, do they have E.coli and what should I do?
A. There are many causes of diarrhoea particularly in children and in most cases it is due to a virus such as norovirus or rotavirus. We would recommend that you take your child to the GP for assessment if their symptoms do not settle down after 24 hours or you are concerned about your child. All children with symptoms of diarrhea should remain off school or nursery until at least 48 hours after their last symptoms. This also means that children should not attend any other settings or clubs where there are children under the age of 10. They should also not be allowed to play with their friends until they have fully recovered.
Q. My child has no contact with any of the above named nurseries, but had diarrhoea 2 weeks ago and is better, what should I do?
A. If your child had a bout of diarrhoea or vomiting which has resolved and they have had no contact with the named nurseries it is highly unlikely that they have an E-coli infection. If you are concerned about your child or their symptoms return please speak to your GP.
Q. My child has no contact with the above named nurseries but has bloody diarrhoea, what should I do?
A. If your child develops bloody diarrhoea, you should contact your GP for an immediate medical assessment taking a stool sample from your child to your GP. Your child may have an E.coli infection that is not linked to the nurseries.
Q. Should I take any special cleaning precautions at home as I have young children?
A. The main preventative action to prevent the spread of diarrhoeal illness is good hand washing with soap under running water, after using the toilet, nappy changing and before eating.
Wipes can be used to remove faecal matter from your hands after changing a nappy but may not act as an anti- bacterial and hand washing is also needed. Alcohol gels should only be used if soap and running water is not available and are only effective on hands that are already visibly clean.
Surfaces should be cleaned using warm water and detergent for surfaces followed by drying with a paper towel. Bleach, or other household disinfectants may be used on appropriate surfaces depending on manufacturer’s recommendations.
Q. My child does not attend the above nurseries and has symptoms – none of which are listed at Q1, but I’m worried about E.coli .
A. It is unlikely that your child has E coli infection. Seek advice from your GP or Health Visitor in the usual way if you are concerned about their health and follow the precautions mentioned above.
Q. Can an E.coli infection be treated with antibiotics?
A. Antibiotics are not routinely recommended for E.coli infection, and in some cases may make the illness more severe. Anti-motility drugs, such as Imodium are also not recommended for diarrhoea caused by E.coli.
Children who are diagnosed with an E.coli infection in their poo will be seen by the pediatricians at the Royal Hospital for Children and Young People. They will give advice to parents on what treatment the child will receive while they have E.coli infection.
Q. My child was at a party/other group where a child from the above nurseries attended, what should I do?
A. There is a very low risk of spread of infection if the other child from the nursery had no symptoms at the time. E.coli is more likely to be passed on when a child has active diarrheal symptoms. If your child does develop symptoms of E.coli you should take them to your GP.
Q. My child started P1 last week and was in a class with a pupil who has since been excluded from Meadowpark Pear Tree Nursery, should I be worried?
A. There is no need for concern. The IMT acts in line with Public Health Scotland guidance which states that people should be excluded from work or school once there is a confirmed presence of E-coli.
In this case, there were only reports of general sickness symptoms. As a precaution, the nursery was closed on August 12, children and staff asked to stay home and report any sickness symptoms over coming days which included the start of the new school term on August 17.
E-coli went on to be detected in a small number of cases on August 19. None of the children who were starting P1 had symptoms of any infection and therefore the risk to others was extremely low.
They have only now been excluded as a precautionary measure to rule out infection as possible contacts within the nurseries with confirmed E.coli and can return to school when negative samples have been received.
Q. My child has been playing with a child who attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, should they continue to do this?
A No, at this time children who are excluded from nursery should not play or socialise with anyone outwith those who normally live within their household until they have been contacted directly by the Health Protection Team and advised that they can do so.
Q. My child has been playing with a child who attends the Pear Tree Nursery in West Road or the Musselburgh Bridge Street Private Nursery, should they continue to do this?
A As long as the child from either of these nurseries has been asymptomatic or symptom free from at least 48 they can continue to play and socialise. This is because there are currently no confirmed cases of E.coli in these nurseries.
Q. When can we expect to get further updates on the situation
A. The situation is changing regularly, and as new information comes to light the Health Protection Team will update parents. Information will be sent to the nursery management team to distribute to parents.
The Health Protection Team are working with Environmental Health, the Care Inspectorate and the Nursery management to ensure that the nurseries open as soon as possible and it is safe to do so.
Q. When will the Nurseries re-open?
A We are unable to answer that at present. This will depend partly upon when individual staff and children have been notified that they are able to return to pre-school establishments, and the nurseries meeting required standards for safety and care and standards for the control of infections.
The investigation into the outbreak is ongoing and as new cases emerge it is difficult to predict when each nursery will reopen. The nurseries may reopen at different times and we will communicate this to parents as more information becomes available.
We understand that this is a very difficult time for parents and once the Health Protection Team, Environmental Health Team and the Care Inspectorate are satisfied that the nurseries are safe, your children will be allowed to return.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark.
A If the child from Pear Tree Nursery at Church Street or Pear Tree at Meadowpark is symptomatic or confirmed to have E.coli infection, and their sibling is aged 10 years or under, the Health Protection Team will risk assess and likely exclude the child as a contact.
This means that the sibling cannot attend nursery or school until they have been contacted directly by the Health Protection Team and are advised they can do so.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery.
A As long as the nursery sibling has no symptoms, this is fine. If the nursery child develops symptoms medical advice should be sought for that child and the situation would be reviewed. All schools and nurseries should enforce the rule that children with diarrhoea or vomiting should remain off until 48 hours after their last symptoms.
Q. I am a nursery manager in another nursery, how will I know when a child who also attends one of the affected nurseries can return to my establishment?
A For children attending the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark, all parents of these children will receive a letter from the Health Protection Team indicating that their child’s results are negative and that they can return to preschool groups.
They cannot return to any preschool group until they are notified directly by the Health Protection Team. If the Health Protection Team have been made aware that a child attends another nursery, that nursery will receive a formal exclusion letter for the child and will also receive a clearance letter from the Health Protection Team once the child is cleared to return.
For children attending the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery, the children can continue to attend as long as they have not had symptoms or have been symptom free for at least 48 hours.
Questions for those Families or Staff with links to Pear Tree Nurseries in Meadowpark or Church Street
Q. My child is due to start Primary School but attended the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street
A. All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child needs to submit 2 stool samples at least 24 hours apart to their GP. The Health Protection Team will check that those samples are clear for E.coli infection.
Once the laboratories have reported the negative results, the Health Protection Team will contact you directly and lift the Public Health exclusion allowing your child to return to school.
Q. Why are two samples needed for clearance?
A Two samples are needed in line national guidance. The stool samples should be taken a minimum of 24 hours apart to ensure the results are robust.
Q. Where do I take the samples?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory.
Please ensure that samples are collected at least 24 hours apart and that the label is completed with all the relevant information. Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends.
Until you have been notified directly by the Health Protection Team about the results of the samples, your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. When will the screening test results be available?
A We expect results to be available within 2 weeks. The majority of samples have to be processed at the E coli reference lab in Edinburgh. At this time, our labs are using extra capacity but the samples have to be carefully processed.
You will be notified by telephone of the results. Please do not call the Health Protection Team for results. The Health Protection Team will contact you as soon as both results are available. The Laboratories are processing in excess of 500 tests so there may be delays in getting results to staff and parents.
Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the infection could be spread any further.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street as well as another nursery or playgroup, can they attend the other nursery?
A Your child should not attend any pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can they go to a birthday party, children’s sports, swimming or soft play area?
A All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child has been formally excluded they should not mix with other children until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street but has had no diarrhoea can they go to another nursery?
A No. All children must not attend any other pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are advised by the Health Protection Team that they can do so. This is because occasionally people can carry the infection without having symptoms and it is essential that we minimise any chance of further spread.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has diarrhoea, what should I do?
A You should attend your GP for assessment and submit a stool sample.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has bloody diarrhoea, what should I do?
A You should seek immediate medical attention via your GP and submit a stool sample.
Q. I am a staff member from the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can I work at another nursery?
A No, you must not work in any pre-school establishment, caring for children, or handling food until you have been notified directly by the Health Protection Team that you are clear to do so.
This is to ensure that any chance of further spread is minimised as occasionally people can carry the infection without having symptoms.
You may be eligible for compensation for loss of earnings, from the Health Protection Team if you have been formally excluded under the Public Health Act. A compensation form will be attached to your exclusion letter.
Q. I visited one of the Pear Tree Nursery branches: Church Street, Meadowpark or West Road since 15th July 2022, do I need to be checked for infection?
or
I visited the Musselburgh Bridge Street Private Nursery since 09th August 2022, do I need to be checked for infection?
A If this was a short visit where you did not eat food or use the toilet facilities within the nursery, the risk of infection is low, however, please be vigilant for any signs of infection such as those listed at the beginning of this document and contact your GP if symptoms do present.
Q. I have worked in the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark since 15th July or my child has attended one of these nurseries since 15th July and have not received any letters from public health, should I have?
A Yes, the Health Protection Team have sent inform and advise information out to all the staff and parents via the Nursery Management Team’ The Health Protection Team have sent out or are in the process of sending out formal exclusion letters to all staff and children who’s details have been supplied by the Nursery Management Team.
Questions for those Families or Staff with links to Pear Tree Nurseries in West Road
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli. If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Pear Tree Nursery in Westroad, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. I have worked in the Pear Tree Nursery at West Road since 15th July or my child has attended this nursery since 15th July and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Questions for those Families or Staff with links to Musselburgh Bridge Street Private Nursery
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Musselburgh Bridge Street Private Nursery, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. I have worked in the Musselburgh Bridge Street Private Nursery since 9th August 2022 or my child has attended this nursery since 9th August 2022 and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
For cases who have confirmed E coli infection
Q. My child has confirmed E coli infection, will they get better and when?
A. Before your child can go back to a nursery or a pre-school establishment they need to be completely free of infection. In some cases, this can be several weeks after the initial illness, and repeat stool samples are needed. It is extremely important that your child does not attend any pre-school establishments until they are notified directly by the Health Protection Team that they are free of infection.
Family members may also need tests and may be excluded from some types of work such as food handling or health care professions.
In a small percentage of cases, complications arise including Haemolytic Uraemic Syndrome which can cause renal failure. These children will be monitored extremely carefully in hospital.
Q. What is Haemolytic Uraemic Syndrome?
A This develops in a small percentage of people with E.coli infection. It affects blood cells and can cause kidney failure, therefore it is a serious complication.
Q.My child has confirmed E.coli and I have been excluded from my own work, when can I go back?
A You have been formally excluded from your work because you are a contact of a case of E.coli and work in a risk group, you will need two negative specimens taken at least 24-hours apart before you can return to work. The Health Protection Team will advise you further on this.
It is extremely important that you do not go back to work until you receive direct communication from the Health Protection Team indicating that you can do so. This is to reduce the risk of any further spread. You may be eligible for compensation for loss of earnings, a compensation form should be included with your exclusion letter.
Q.My child has confirmed E.coli infection but is well and we are due to go on holiday, what should we do?
A It is not recommended that you go on holiday until all required tests have returned negative, and this has been directly communicated to you by the Health Protection Team. This is to avoid the possibility of further infections occurring or members of other families needing to be excluded from work or school.
Q. My child has been invited to a party, should they attend?
A. No, Your child must not attend any parties, pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
Q. Can my child socialise with with any other people or families?
A. No, Your child should not be socialising with other children or families outwith those who normally live in your household until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
What does Exclusion Under the Public Health etc (Scotland) Act 2008 mean?
Q. Why is a person excluded?
A Exclusion or restriction from work, school or nursery under the Public Health etc (Scotland) Act 2008 is applied when an individual(s) has an infectious disease or has been in close contact with someone with an infectious disease and when there is considered to be a risk that this disease could be passed on to other people.
Exclusion under the Public Health Act is used to reduce the risk of spread of infectious diseases from person to person via the ‘faecal oral route’: when you put something in your mouth, which has been contaminated by the stools/faeces of someone with the bug.
Q. Who can be excluded?
A. Children under the age of 10 are excluded under the Public Health Act when they have been diagnosed with an infectious disease that could be spread to others. If a child under the age of 10 is in close contact (e.g. a sibling) of someone who has an infectious disease, they may also be excluded.
Q. Where/what is a person excluded from?
A. Children who are excluded under the Public Health Act should not attend nursery, school or childcare facilities for the duration of the exclusion. Your child’s nursery/school/childminder will receive a letter to inform them of the exclusion; this will not include specific details of your child’s diagnosis.
In addition to exclusion for nursery/school, there are other activities that may be linked to possible spread of infection to vulnerable groups of people and should therefore be avoided.
Examples of activities and places to avoid during exclusion are:
Swimming
Soft play facilities
Children’s parties /crèches / playgroups / toddler groups / nurseries / after school clubs
Sports clubs
Other gatherings of children
Contact with children under the age of 10 years who are not part of your household
Q. What happens next?
A. You may have initially been told about your child’s infectious disease by your GP, an Environmental Health Officer or a doctor at the hospital. Exclusion under the Public Health Act is the responsibility of a Consultant in Public Health. Should you need further advice or information please contact the Health Protection Team.
Your child’s exclusion can be lifted when they have been formally cleared of infection. Clearance requires testing of stool samples, which you give to your GP surgery. Your child’s first sample can be submitted 48 hours after their last episode of symptoms. Samples should be collected at least 24 hours apart, 2 consecutive negative samples are required to show that your child is free from infection.
Once the Health Protection Team has received the results of samples and confirmed that your child’s exclusion can be lifted, we will inform you by telephone and in writing. Your child’s nursery/school will also be informed.
Non-existent awareness of leukaemia symptoms “extremely worrying” – as new figures show people in Scotland don’t know bleeding, bruising, fatigue and infections are a sign of the blood cancer
Leading UK leukaemia charities launch memorable new campaign to get people “parroting on” about the symptoms for Blood Cancer Awareness Month in September
People in the Scotland are being urged to take notice of the symptoms of leukaemia, as new research published today shows that only 1% of those surveyed in the region were able to identify ALL four of most widely reported symptoms – fatigue, bruising, unusual bleeding and repeated infections.
Leukaemia is a form of blood cancer affects people of all ages and 28 people receive a leukaemia diagnosis every day in the UK – that’s over 10,000 every year. Overall survival for leukaemia stands at just over 50% – making it one of the most deadly forms of cancer.
Early diagnosis could saves lives yet the recent public survey by leukaemia charities Leukaemia UK and Leukaemia Care, found that over that nearly half (48%) of respondents from Scotland could not recognise ANY amongst the four most widely reported symptoms of the disease, which kills 5,000 people a year in the UK, and which is often diagnosed too late.
The two charities are collaborating on an important campaign, #SpotLeukaemia, to raise awareness of the symptoms ahead of Blood Cancer Awareness Month in September. Blood cancer is the fifth most common cancer and third deadliest.
In a new film released today Leukaemia Care and Leukaemia UK have called on the expertise of ‘Henry’, a talented Macaw parrot, to try to make the symptoms of leukaemia memorable.
The ad sees Henry using a range of objects to create a catchy and repetitive ‘Spot Leukaemia rap’ featuring the symptoms of leukaemia.
People who are concerned about any of these symptoms– fatigue, bruising, unusual bleeding and repeated infections – are being strongly urged by the charities to contact their GP and request a blood test. More information is available on the Spot Leukaemia website at www.spotleukaemia.org.uk.
The ad focuses on the top four symptoms. Other symptoms of leukaemia include fever or night sweats, bone or joint pain and swollen lymph nodes.
The charities are now calling on people to start “parroting on” about leukaemia and its symptoms, share the video (https://youtu.be/UMRTMKVvYhQ) with friends and family, and visit the Spot Leukaemia website for more help and advice.
Awareness of the symptoms of leukaemia is low in Scotland
Only 9% of respondents across Scotland recognised that repeated infections – one of the most common symptoms of leukaemia – are a symptom, only 31% said unusual bruising is a symptom and only 17% said unusual bleeding is a symptom. Only 39% of respondents were not able to recognise fatigue as a symptom – which is often the most likely symptom to be identified by those later diagnosed with leukaemia.
Case study:
Melissa McNaughton, 33, from Bridgeton, Glasgow, felt tired, something she attributed to working too hard. So, it came as a shock to Melissa when she was diagnosed with chronic myeloid leukaemia. Here, she talks about her diagnosis and her life since.
“I was diagnosed 12th June 2018 and I am not yet in remission. I am now on my fourth chemotherapy drug. Looking back to just before my diagnosis, I felt tired, but other than that, nothing.
“I have had quite bad health most of my adult life, so I am in and out of the doctors a few times per year. I just put the tiredness down to working too much as I run my own business.
“I popped into the doctors for my blood test (every few months) to check my iron levels. My GP told me to go to hospital the following day – I knew what hospital and what ward I was heading to. My GP is absolutely amazing and has been very supportive throughout the journey.
“So, I arrived at the hospital, headed to the second floor and walked through the doors. I was surrounded by posters that were all about cancer and effects of chemo, support groups, giving blood, wig makers, etc. I felt ill with fear, and I had no clue what I was going into.
“I sat down and one of the nurses came up to me and said, “Are you here for chemo today?” I said, “I have no idea why I’m here.” And ran away into the toilet and had a panic attack. I was meant to see a consultant first. I then went in and they said there was a 99 per cent chance I had chronic myeloid leukaemia (CML).
“Sitting in the consultant’s room with my mum, dad and husband, I was in my own little world. I heard a few words and could see the consultant’s mouth moving but nothing coming out. I just heard the words “cancer” and “leukaemia”. A million questions were going through my head: what’s going to happen to me? What will my life be like? Am I going to die? How long will I live? Can I have children?
“It’s so strange all these things go through your head that you have never thought of before. I was looking around at my mum and dad and they were asking questions; my husband was just in a daze. It wasn’t nice to see the fear in their eyes. I’m such a happy, bubbly, positive person and I snapped myself out of the daze and said, “What’s next?” completely interrupting the consultant.
“He said the next step was to do a bone marrow biopsy and he could get me in next week. I asked if I could just have it done today. I was then taken into another room and had my back injected to make it numb to do the biopsy. Then it began; it was a horrible pressure pain and I was crying.
“But the song from The Greatest Showman ‘This Is Me’ was playing in the background and I focussed on that – I feel it’s now became my theme song! I was back in the hospital on Friday. I was told the results were back and I had CML. Everything was going to change.
“Again, I tried not to let all the thoughts come into my head and I asked to start the treatment straight away; I was not waiting around. Off to the pharmacy I went and collected all my pills. I then went back to work the following week – this was not stopping me.
“The first generation of the TKIs were awful, I couldn’t get through a full day, I could only get up for about an hour or two at a time. I was sick, weak, bone pain, muscle pain. It was horrible! I’ve never cried so much. I lost so much weight, I was so weak I could hardly use a knife and fork. I tried to keep going with work, but it was all too much. I had to cut my hours right down.
“I have never felt like this in my life, it got me really down for a while. But my inner warrior was not going to let that happen for long. I tried to power through. I was then taken off these tablets and moved onto another generation. I am still on them now, but I was covered from head to toe in a rash, and my bones in my legs were so sore and weak they felt like they were going to snap.
“Fast forward to today. I have had my “cancerversary” of four years living with cancer. Every day is still a struggle and some days are worse than others. I’m getting there.
“Cancer will just have to get used to living with me because I am in no way going to let it beat me. I’m still smiling and not stopping. My blood levels are steadily going down which is great. I have not hit my target yet, but everything is moving in the right direction.
“I try to keep doing everything I would normally do weekly but just a bit slower and sometimes it’s quite difficult. I try to carry on as normal as possible, but this is my new normal! I try to pop make-up on and look a bit more like myself. I am a hair extension master and I had to close down my salon of 10 years due to the pandemic so I have started a new business from scratch, IvyHQ where I for hair extensions and I have developed my own line of hair and training.
“When I had my own salon we did a charity karaoke night to raise funds for Leukemia Care. In my spare time, myself and husband love travelling around Scotland with our new puppy, Hope.
“I have heard a few times that if you’re going to have cancer, this is the best one to have. Really? Did you actually just say that to me? Nobody will know how it feels unless they are going through it. Some other cancers you have to go through the horrible process of being injected with chemo, losing your hair and being weak, but when you come out the other side of it that can be you “fixed”. Whereas with me I will have to be on tablets for life. It’s very different.
I’ve also had, “Is that you cured now?”, because I’ve done my hair and make-up and managed to get out in high heels for an hour. Just because I look ok doesn’t mean I feel it. I try not to talk about it too much, so when someone asks me how I am I always say I’m good!
“I’m not going to go into detail with them by saying, “Oh, today’s been a bit hard, it took me two hours to get out of bed and I needed help getting out of the shower today as my legs went into a cramp.” But these are things I have daily and I just carry on with a smile on my face as I’m so lucky to be able to have this treatment.
“And hopefully, in time, these will all ease off. I have kept working as much as I can all the way through, as having my own business, if I don’t work, I don’t get paid. I have also made up my own hashtag #mycmljourneydiary online as I felt it’s good to keep a wee diary to look back on.
“Also, if someone is going through the same thing as me and if I can help in any way at all, that will make me feel good that I can help. It’s got the good, the bad and the ugly. All “keeping it real” posts. Spot Leukaemia is so important to raise awareness as I had no idea what leukaemia really was until I had it. It is so important to me as getting the word out there will hopefully make someone go along for a blood test!”
Melissa’s only symptom of leukaemia was fatigue, but there are other signs which include:
Bruising
Bone Pain
Repeated infections
Are you currently experiencing similar symptoms to Melissa? Request a blood test from your GP. For more information on our Spot Leukaemia campaign, our goal and how to get involved, head over to our official Spot Leukaemia website at www.spotleukaemia.org. Early diagnosis saves lives. #SpotLeukaemia
Nationally, those who are over 55 also underestimate their risk, thinking that leukaemia is a childhood disease. Only 11% of over 55s thought that they had the greatest risk of leukaemia, whereas in reality cases rise sharply after the age of 55 and 38% of all new cases occur in the over 75s.
Fiona Hazell, Chief Executive of Leukaemia UK said, “It’s extremely worrying that less than 1% of Brits are able to identify the most common symptoms of leukaemia, when 28 people are diagnosed each day in the UK.
“People underestimate their risk by thinking that leukaemia is a childhood disease. In reality, both incidence and mortality rates rise sharply after the age of 55. Raising awareness in this age group is critical in order to treat it early and effectively; and ultimately to improve survival rates overall.”
A lack of awareness of which age groups are most at risk from leukaemia is also concerning, with 43% of respondents thinking that leukaemia is most common in the under 24s.
Whilst it is true that leukaemia is the most common type of childhood cancer, leukaemia incidence rates rise sharply after the age of 55 and 38% of all new diagnoses occur in those over 75. The survey found that only 2% of Brits think that leukaemia is most common in those over 75. The Spot Leukaemia campaign particularly wants to increase awareness among those who are over 65, as this age group is the most likely to be diagnosed with leukaemia.
Zack Pemberton-Whiteley, Chief Executive of Leukaemia Care said, “To hear that less than 1% of the UK public are able to identify the four most common symptoms of leukaemia is extremely worrying.
“Early diagnosis of leukaemia can improve survival. With over 10,000 people being diagnosed every year with a leukaemia, this shows just how important it is to continue to raise awareness of the signs and symptoms and how much work needs to be done.
“We know that our new Spot Leukaemia video may ruffle some feathers but in order to raise awareness we needed to create something that will fly. It’s crucial that if you think you have fatigue, bruising or bleeding or repeated infections that you contact your GP and ask for a blood test. It’s as simple as that and we will continue to parrot-on about it.”
trials in 11 areas across England to help people’s mental and physical health
GPs will issue social prescriptions such as walking, wheeling and cycling, backed by £12.7 million
schemes will include cycling and walking groups, cycle training and free bike loans
Social prescriptions, including walking, wheeling and cycling, will be offered by GPs as part of a new trial to improve mental and physical health and reduce disparities across England, the government has announced today (22 August 2022).
The government has awarded £12.7 million in multi-year funding to 11 local authority areas in England. The funding will go towards several pilot projects in each location, including:
adult cycle training
free bike loans
walking groups
Other schemes include all-ability cycling taster days where people who may not have cycled before can try to in a friendly environment, or walking and cycling mental health groups where people can connect with their communities as they get active.
The pilots must be delivered alongside improved infrastructure so people feel safe to cycle and walk.
The 11 local authority areas that will trial social prescriptions are:
Bath and North East Somerset
Bradford
Cornwall
Cumbria
Doncaster
Gateshead
Leeds
Nottingham
Plymouth
Suffolk
Staffordshire
The pilots, a commitment in the government’s Gear Change plan published in 2020, aim to evaluate the impact of cycling and walking on an individual’s health, such as reduced GP appointments and reliance on medication due to more physical activity. For the first time, transport, active travel and health officials will work together towards a whole systems approach to health improvement and tackling health disparities.
Walking and Cycling Minister, Trudy Harrison, said: ”Walking and cycling has so many benefits – from improving air quality in our communities to reducing congestion on our busiest streets.
“It also has an enormous positive impact on physical and mental health, which is why we have funded these projects which will get people across the country moving and ease the burden on our NHS.”
National Active Travel Commissioner, Chris Boardman, said: “As a nation we need healthier, cheaper and more pleasant ways to get around for everyday trips. Active Travel England’s mission is to ensure millions of people nationwide can do just that – so it’s easier to leave the car at home and to enjoy the benefits that come with it.
“Moving more will lead to a healthier nation, a reduced burden on the NHS, less cancer, heart disease and diabetes, as well as huge cost savings. This trial aims to build on existing evidence to show how bringing transport, active travel and health together can make a positive impact on communities across England.”
The pilots will be delivered between 2022 and 2025 with on-going monitoring and evaluation to support continued learning.
The project is bringing together a range of government departments and agencies including:
Heart Research UK Healthy Heart Tip, written by the Health Promotion and Education Team at Heart Research UK
Healthy Heart Tip: Sandwich Month
August is officially sandwich month! The first sandwich became popular in the 18th and 19th centuries and has been a staple part of our diets ever since.
Whether you’re grabbing an egg sandwich for breakfast or a turkey BLT at lunch, sandwiches are convenient, quick, and easy. Here we share some ideas to make your sandwiches healthier.
Choose nutritious wholegrains
Your basic sandwich is generally made with bread, on a roll or in a wrap. If you’re going to choose one of these items, boost the nutrition of your sandwich by choosing whole grains. Whole grains are a more nutrient-dense, less processed, and healthier option compared to refined grains (like white bread).
Healthy filling
Add a healthy sandwich meat or other lean protein. Freshly-cooked lean meats such as roasted turkey or chicken breast, canned salmon or tuna, or for vegetarian options; eggs, nut butter, tofu, smashed cooked beans and reduced-fat cheese are good healthy options. Additionally try using low-fat butter or a vegetable spread if you normally use full-fat butter.
Add in some colour
An easy way to make any sandwich or wrap a bit healthier is by adding vegetables as they can add a whole host of benefits to your meal. Veggies add nutrients, freshness, and flavour. Any mix of roasted veggies, fresh tomatoes, fresh greens (the darker, the better), sliced red onion, sliced cucumbers, and sliced peppers are all good choices.
Give these healthy sandwich tips a try and get creative!
Serve with a piece of fruit and a high-protein snack as a side, and you’ll score a lot of nutrition and satisfaction all at once.
For more tips on how to stay healthy, sign up for our weekly healthy tips at
Thousands of victims of the infected blood scandal will each receive an interim compensation payment of £100,000, the Government has announced today (17 August).
The UK Government intends to make payments to those who have been infected and bereaved partners in England by the end of October. The same payments will be made in Scotland, Wales and Northern Ireland.
The commitment to pay interim compensation meets, in full, the recommendations set out by inquiry chairman Sir Brian Langstaff in his interim report last month. That report built on the study by Sir Robert Francis QC in his detailed consideration of the issues. Details were announced by Chancellor of the Duchy of Lancaster Kit Malthouse today.
The intention is that payments will be tax-free and will not affect any financial benefits support an individual is receiving. Infected individuals and bereaved partners who are registered with any of the four UK infected blood support schemes will receive payment. Advice to those people on how exactly the interim payment will be made will be outlined to them shortly.
Prime Minister Boris Johnson said:“While nothing can make up for the pain and suffering endured by those affected by this tragic injustice, we are taking action to do right by victims and those who have tragically lost their partners by making sure they receive these interim payments as quickly as possible.
“We will continue to stand by all those impacted by this horrific tragedy, and I want to personally pay tribute to all those who have so determinedly fought for justice.”
Chancellor of the Duchy of Lancaster Kit Malthouse said:“Those affected by the infected blood scandal have suffered terribly over many years and that heart-breaking and unimaginable pain has been compounded by the financial uncertainty many have faced.
“These interim payments will start the process of securing that certainty. My priority is to get the money to those people as quickly as possible.
“I am grateful to Sir Brian Langstaff for the work he has done to date on the inquiry, and Sir Robert Francis, for his work on compensation. Of course, no amount of money will compensate for the turmoil victims and their loved ones have faced, but I hope these payments help to show that we are on their side and will do everything in our power to support them.”
Health and Social Care Secretary, Steve Barclay, said: “The infected blood scandal should never have happened. In accepting Sir Brian Langstaff’s recommendations, today we are taking an important step in righting this historic wrong for the thousands of people infected and bereaved partners left behind.
“Building on the ongoing support we are providing through the England Infected Blood Scheme, these new interim payments of £100,000 will ensure those impacted across the whole country by this injustice can access the compensation they need, right now.
“I’m grateful to those who have campaigned extensively in support of these changes – we have listened and work is underway to ensure those impacted by this tragedy receive the support they rightly deserve.”
The Government has updated Sir Brian Langstaff that his recommendations have been accepted.
A sister’s quick thinking saved the life of a student who had fallen ill with meningitis, when she took her straight to A&E on their way home from university.
Ashleigh Denton was 18 and in her first year at the University of the West of England in Bristol when she became ill with a headache and flu-like symptoms on a night out. The following day her sister Sophie drove from Oxfordshire to collect her but, halfway home, went straight to Swindon A&E as Ashleigh’s condition suddenly worsened.
Doctors say her fast response that day saved Ashleigh’s life.
“If my sister had tried to take me to Oxford rather than Swindon – less than an hour down the road – doctors said I would have died,”Ashleigh said. “It would have been too late.”
Now Ashleigh, 29, is telling her story to raise awareness of meningitis and the importance of looking out for your friends and taking quick action if the disease is suspected, as she spearheads charity Meningitis Now’s ‘Look out for your mates’ student campaign, which launches today.
The campaign is timed to coincide with the announcement of A-level results as thousands of young people contemplate their future. Meningitis Now is concerned that the combination of new-found social freedoms, the desire of young people to mix in large groups and a move to campus-based accommodation for students, will present the ideal opportunity for infectious diseases to spread, putting young people at a higher risk of meningitis.
“If you’re at university and you or one of your friends is unwell or acting out of character and you’re not sure if it’s something small or serious, get things checked out,”Ashleigh added. “Don’t be afraid to go to hospital – meningitis can develop so quickly, from just having a headache to being at death’s door.”
“It is so important to have your symptoms checked as soon as possible if you are concerned.”
Ashleigh, from Bicester in Oxfordshire, initially thought she was getting a cold. “I started to get a headache, but I wasn’t worried, so I went out with my friends as planned.
“Within a couple of hours my behaviour had changed – I was agitated and emotional – and this is one of the biggest things I tell people. It’s not the physical symptoms that I remember the most, but my behaviour.”
Ashleigh left the club and two girls who were going to the same place as her shared a taxi home. “They noticed I was unwell and even offered for me to stay at theirs, but I declined as I just wanted my bed,” she said.
“The next day I woke up, still with a headache, and assumed I was just hungover. As the day went on I really didn’t feel right. I phoned my mum to tell her and that I was going to sleep for a bit, but I was crying and she knew something wasn’t right.
“She spoke to my sister, who phoned me and asked if I wanted her to pick me up and take me home. I initially said ‘no’ but eventually agreed and she came from Oxford to Bristol to get me.
“In the car home my symptoms got worse very quickly. My head was so sore, I couldn’t open my eyes, my neck stiffened, I was retching, and I just knew something was seriously wrong.
“Just at the right time my sister saw a sign for the hospital in Swindon and took me straight there.
“In A&E I remember struggling to breathe, so I just stopped as it felt like the easier option. My sister shook me and I came to and started breathing again, but it wasn’t long before I stopped. My sister pressed the panic button and within seconds a team rushed in and carried me to resus.
“I am told I became aggressive, so I was sedated and admitted to ITU.
“During this time I was given a CT scan and a lumbar puncture, which confirmed I had Group B meningococcal meningitis and septicaemia.
“I had developed a rash but not until I got to hospital. What most people don’t realise is that the rash is not an early symptom and if you have one, you are in the advanced stages of meningitis.”
Ashleigh’s family was told there was a one in three chance that she would wake up blind, deaf or brain damaged.
“But fortunately I woke up two days after arriving at hospital and the first thing I said was ‘I want my breakfast’.Somehow, before I was even told, I knew I had meningitis.
“I was in hospital for a week and unable to walk or get out of bed by myself for the first few days. What I didn’t realise at the time was that my brain was muddled as a result of the infection and would be for a few months. I just had no awareness of this until a family member asked my mum if I was making any sense a few weeks after I’d got home.”
Fortunately, despite not being her usual self for three months and struggling with fatigue, Ashleigh went on to make a good recovery, even returning to university for her exams in August, five months after she first became ill.
“I am forever thankful for my family, and the doctors and nurses at Great Western Hospital in Swindon, for saving my life.”
Ryan Bresnahan wasn’t so lucky, His mum, Michelle, who set up the Bristol-based charity, a Life for a Cure, following Ryan’s death from meningitis in 2010, has been campaigning tirelessly to raise awareness of the symptoms of the disease and funds for research.
Ryan was a fit and healthy 16-year-old when he was tragically struck down by Meningitis B within an hour of first feeling ill.
Michelle said: “I know only too well how devastating this disease can be and have seen the worst it can do, destroying young lives and tearing apart those who remain.
“No-one should be left counting the cost of making the wrong assumption – meningitis can affect anyone at any time but we need to highlight that teenagers and young people are the second most at risk group of contracting the disease, after babies and toddlers.”
Meningitis Now chief executive, Dr Tom Nutt, said:“Research has shown that up to a quarter of 15 to 24-year-olds carry the bacteria that cause meningococcal meningitis and septicaemia in the back of their throats compared to one in 10 of the general population.
“Whilst many young people will have been vaccinated against MenACWY, which protects against four strains of meningococcal meningitis, at school, we estimate that up to half a million under-25s may have missed this important vaccination. If that’s you – contact your GP and see if you can get up to date with your vaccinations.
“And very few young people will have been vaccinated against MenB, which is the strain Ashleigh and Ryan had and that causes the most cases of bacterial meningitis in the UK.
“Common complaints such as a hangover and Freshers’ Flu are often given as reasons for a person not feeling too well – but we are asking young people not to simply assume this is the case. A headache and fever are also common signs of meningitis, which is why it is so important that young people should learn the signs and symptoms of the disease, look out for themselves and their mates and seek medical help straight away if they feel unwell.”
The early signs and symptoms of meningitis and septicaemia can be similar to ‘flu, tummy bug or a hangover and include fever, headache, nausea, vomiting, diarrhoea, muscle pain, stomach cramps and fever with cold hands and feet.
More specific signs and symptoms include fever with cold hands and feet, drowsiness, confusion, pale blotchy skin, stiff neck, dislike of bright lights and a rash which doesn’t fade under pressure.
Meningitis Now has free information for parents and students, including leaflets, signs and symptoms cards and fridge magnets – all of which contain lifesaving information.
