Inside Health

Dr Mark Porter unpicks the science behind the so called 'weekend effect'. Politicians have quoted research claiming that people are 20% more likely to die of a stroke at the weekend, while another much cited study finds 11,000 more deaths in people admitted at the weekend. But how valid are these figures and the research that generated them? Dr Margaret McCartney reviews the stroke data that has been criticised by experts as being out of date. While Mark Porter talks to Editor of the BMJ, Fiona Godlee, who published the 11,000 figure but is concerned about the political use of the findings. And discusses the study with lead author Nick Freemantle, plus Consultant Surgeon Sam Nashef who is sceptical about the results.

Inside Health listener and keep fit enthusiast, David Heathcote, wanted advice on how far he should safely push himself when he's training in the gym.In this special programme about the health benefits of keeping active, Dr Mark Porter helps David to find the answer to his question about the exercise "sweet spot". If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.Over the last decade there's been a growing interest in the relationship between activity and the risk of developing cancer. Studies have demonstrated that exercise appears to have a protective effect against at least four different cancers (breast cancer, colon cancer, endometrial cancer and some upper gastrointestinal cancers) and that being fit helps recovery from cancer too. Dr Denny Levett, a consultant in peri-operative medicine and critical care at University Hospital, Southampton who has a special interest in the relationship between exercise and health, says the reason for the apparent protective effect of fitness is still being researched but the evidence that the effect exists is now widely accepted. Professor of Clinical Cardiology, Sanjay Sharma from St George's University of London outlines the benefits to our hearts of keeping active and Park Run fan and regular Inside Health contributor, Dr Margaret McCartney, admits how running has become something of an obsession and promises that the evidence shows that when it comes to getting fitter, it's never too late to start.

Prescriptions for nerve drugs pregabalin and gabapentin have risen dramatically in recent years and at the same time, concerns about abuse. Former prisoner and addict "Patrick" tells Dr Mark Porter that "gabbies" or "pregabs" are drugs of choice in jail and Dr Iain Brew, a GP who works in prisons, says misuse is a growing problem and there are examples of doctors being pressurised into prescribing them. Dr Cathy Stannard, consultant in pain medicine at Southmead Hospital in Bristol, chaired an expert group that drew up new prescribing guidelines for pregabalin and gabapentin and she tells Mark that more attention needs to be paid to emerging evidence of misuse. Many women say that if they've had one caesarean section, they feel pressurised to have another one and Sara describes how her medical team planted "a seed of doubt" about the potential risks to her baby which she says for her meant another C-Section was inevitable. But new guidelines from the Royal College of Obstetricians and Gynaecologists spell out that vaginal birth after a previous caesarean is a clinically safe choice, with a 75% success rate, the same as for first-time mothers. Inside Health's Dr Margaret McCartney discusses the history of changing attitudes to natural birth after caesarean and says why the new guidelines should give future mothers the confidence to discuss, well in advance of their birth, the best option for them. How do you fill in health check forms that ask for family history if you don't know who your family was? Inside Health listener Jessica is adopted and her heart health check suggested a very low risk of a stroke or heart attack when she couldn't answer the family history question. Mark and Margaret discuss how common this is, and what difference family knowledge would make to Jessica's risk (not much).Adrenaline auto injectors were first used in the 1960s when they were developed for soldiers to use during nerve gas attacks allowing them to self administer the antidote. But is a device designed to be used by fit, trained soldiers just as suitable for use in children and adults of widely varying size and weight? These concerns were raised by a coroner conducting the inquest into the death of a 19 year old student who died of anaphylactic shock caused by a nut allergy, despite her using her auto injector. The Medicine and Healthcare Products Regulatory Authority and also the European Medicines Agency have been looking into issue and Dr Robert Boyle, allergy specialist at St Mary's Hospital, Paddington and Director of the Paediatric Research Unit at Imperial College, London provided expert advice. He talks to Mark about the limitations of auto injector design and urges everybody who might use the devices to ensure they are confident about exactly how to use them.

As cars were banned from central Paris this weekend and the health risks of pollution hit the headlines, Mark Porter examines the statistic that pollution kills 29,000 people a year in the UK.And he visits a pioneering clinic at Southampton General Hospital where falls in the elderly are seen as a risk factor for underlying health problems; 'Having a hip fracture is like having a heart attack or stroke' explains Dr Mark Baxter. 50% of people who have a hip fracture will have previously presented with a fall, but once they go on to break a hip, 1 in 10 elderly people may not be alive at the end of the month and up to 25% by the end of the year. Many elderly people are found to be on multiple treatments - blood pressure pills or bladder pills for example - that make people fall over. In recent years there has been much more attention paid to the cumulative burden of the side effects of medicines in the elderly - particularly the group of commonly used drugs known as Anticholinergics. And according to new research by a team at the University of East Anglia, taking Anticholinergics increases the risk of falls too - particularly in men.Following news of the Meningitis B vaccine in children, an Inside Health listener got in touch to ask why it wasn't being given to teenagers in light of data showing that there is a second peak in incidence in the disease among 15 - 19 year olds? Mark talks to Professor Andrew Pollard, Chair of the Joint Committee on Vaccination and Immunisation.And Inside Language: Dr Margaret McCartney and Professor Carl Heneghan demystify the terminology of medicine and research. This week, false positives and false negatives; when is something not what it seems, and when does it seem what it's not?

For five years the Cancer Drugs Fund has supplied seventy five thousand patients in England with cancer drugs, but its days are numbered. Spiralling costs have led to a reduction in the number of drugs the CDF will pay for, meaning newly-diagnosed patients may miss out. Dr Mark Porter talks to Vicky Rockingham about the anxiety that reform of the CDF is causing. Vicky is a mother of two, working full time, and receiving regorafenib paid for by the CDF for her rare type of gastrointestinal stromal tumour, or GIST. She tells Mark that the drugs from the CDF are giving her extra time with her family and enabling her to carry on working. And Jonathan Pearce, Chair of Cancer 52, an alliance of organisations that represent people with less common and rarer cancers like Vicky's, tells Mark why any new-model CDF must take into account individual patient needs. Regular Inside Health contributor, Dr Margaret McCartney, describes how patients access cancer drugs in Scotland, Wales and Northern Ireland and discusses with Mark the difficult decisions that access to expensive and innovative new cancer medicines present for the NHS.Last season's winter flu vaccine provided only limited protection to those who received it. An exceptional year where there was a mismatch between the flu virus that eventually circulated, and the vaccine that had been developed by international teams. The result was just 30% protection (down from its usual 70-80%). Dr Mark Porter asks the chair of the Joint Committee on Vaccination and Immunisation (JCVI), Professor Andrew Pollard, whether confidence in this year's vaccine could be dented.Babies, toddlers and pre-school children often seem to have bow legs and knock-knees and parents frequently turn up at their doctor's surgery asking for reassurance about the way their children walk. Manoj Ramachandran, consultant children's orthopaedic and trauma surgeon based at The Royal London and Bart's Hospital tells Mark that up to a quarter of the children referred to his clinics have normal, developmental lower limb variants. Children are naturally bow legged when they first walk and by the age of three, there's another natural re-alignment which tends to lead to knock knees. At both these ages his clinic receives a peak in referrals but by the age of seven, he says, most childrens' legs straighten up naturally.Inside Language: Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney continue to demystify the scientific language of medicine. This week, peer review.Producer: Fiona Hill.

Are league tables listing surgical outcomes the best way to assess your surgeon or are high risk patients being turned away as surgeons keep an eye on their figures? New data published this week list the clinical outcomes for heart surgery - cardiac surgeons are just one speciality from an ever expanding list of doctors whose performance is now published in league tables and subject to public scrutiny. But what impact has their introduction had on patient care? Sam Nashef, a consultant cardiac surgeon at Papworth Hopsital, discusses this issue with Mark Porter.Recent research in schools in Wales suggest that as many as one in 12 primary school children get them at this time of year - and that compares favourably with Australian research, which suggests the figure's much higher - closer to one in five. Resident sceptic Dr Margaret McCartney explains which treatments are supported by evidence.Lyn e-mailed Inside Health to understand why she often feels colder than other people. How, she asked, do we regulate our body temperature and are some people better at it than others? George Havenith is Professor of Environmental Physiology and Ergonomics at Loughborough University, and Mike Tipton, Professor of Human and Applied Physiology at the University of Portsmouth, provide answers.And in the next of our special series demystifying the language of research and statistics Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney unpack the concept of surrogate markers. These feature increasingly in medical research and can involve everything from blood test results, to the pattern on your heart trace or ECG.

Dr Mark Porter presents a programme devoted to questions from the listeners.Dr Mike Knapton from the British Heart Foundation answers a question about whether aspirin can protect against a second heart attack.A number of people asked about the treatment of vertigo. Vertigo is a symptom of a variety of conditions ranging from migraine and Meniere's, to strokes and tumours, but by far the most common is a condition called BPPV - benign paroxysmal positional vertigo. It is caused by debris floating around in the fluid in the balance sensors of the inner ear and typically affects people over 40. And there is a relatively simple way to treat it called the Epley movement, which is much underused. Dr Louisa Murdin, consultant in vestibular and balance disorders at Guy's and St Thomas's hospitals in London, explained how she uses the technique.Dr Margaret McCartney and Mark discuss why doctors sometimes use patronising language when talking to patients.Carpal tunnel syndrome - which normally eventually affects both hands - is caused by pressure on the median nerve as it passes under the flexor retinaculum ligament at the wrist - close to where the clasp or buckle on your watch would sit. The classic story is pins and needles affecting the thumb side of the hand and sparing the little finger, and often worse during the early hours of the morning.Dr Jeremy Bland, consultant in clinical neurophysiology at King's College Hospital London, and Kent and Canterbury Hospital, where he runs one of the few NHS clinics dedicated solely to carpal tunnel syndrome, explains why people wake up with symptoms and why wearing a splint can be helpful.Osteoporosis features regularly in our in-box - particularly concerns about bisphosphonates, the gold standard treatment for the bone thinning condition. Every year in the UK around 300,000 people break a bone - such as a hip or wrist - following a relatively trivial injury because their bones are weaker than they should be. Most are middle aged and elderly.Drugs like alendronate and etidronate are prescribed to make bones stronger after a fracture. Peter Selby, Professor of metabolic bone disease at the University of Manchester and a consultant at the Manchester Royal Infirmary, answers queries about how long these drugs should be taken.

From this week all UK babies will be vaccinated against that most feared disease, meningitis B, the first country in the world to take this step. But the decision to include Men B in the national immunisation programme has come too late for parents, Freya and Ross. A year ago their baby daughter, Harmonie, nearly died after contracting the infection. Her arms and legs as well as the tip of her nose had to be amputated because of the resulting sepsis. Sue Davie, Chief Executive of Meningitis Now tells Mark that the vaccine is great news and will save many lives. But she hopes in the future that it will be offered to older babies and young children, as well as another at risk group, adolescents. Mental health problems have long been linked to fluctuating hormone levels, at times of menstruation, childbirth and menopause. Dr Michael Craig who runs the Female Hormone Clinic at the Maudsley Hospital in London discusses the role of hormone replacement treatments.Statins are the most commonly prescribed medicines in the UK. They work to lower the level of cholesterol in your blood. There's been considerable debate about when doctors should start prescribing statins and NICE, the National Institute for Health and Care Excellence, had been keen for GPs to be paid to put more patients on the cholesterol-reducing drugs. Dr Margaret McCartney outlines the controversy and NICE Deputy Chief Executive, Professor Gillian Leng, tells Mark that the health advisory body has listened to concerns and why their new statins targets are now to be tested in the field.Young, healthy, sporty people don't get heart attacks. Except when they do. Dr Stuart Miller, Clinical Director of Sport and Exercise Medicine at the University of Bath admits that he was shocked when he had a heart attack, even though he cycles, swims and eats a healthy diet. Sanjay Sharma is professor of cardiology at St George's Hospital in London and he tells Mark how common unexpected heart attacks are. Producer: Fiona Hill.

Why more than 1 in 10 people having emergency abdominal surgery die within 30 days of their operation. Which thermometers parents should use and which they should not. Vitamins and dementia - a controversy dividing scientists. Could taking B vitamins lower the levels of the amino acid homocysteine and slow the onset of Alzheimer's disease? Absolute risk v relative risk.

The Off-Patent Drugs Bill aims to prevent people missing out on life-saving treatments, but doctors can already prescribe drugs off-licence so why do we need a new law? Pre-diabetes - a new label that could apply to as many as 1 in 3 British adults, but is it a useful to know this? The importance of diagnosing sepsis early and how to recognise the key signs. Plus Dr Margaret McCartney and Dr Carl Heneghan explain the meaning of the phrase 'all cause mortality'. Presented by Dr Mark Porter.