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Latest News: Study offers insight into genetics of schizophrenia

Tuesday July 22 2014

Schizophrenia affects around 1 in 100 people

Schizophrenia can cause psychosis and hallucinations

"More than 100 schizophrenia genes have been pinpointed," reports the Daily Mail. In one of the largest studies of its kind, researchers have gained further insights into the genetics of the condition, which it is hoped could lead to new treatments.

Researchers have identified genetic differences at 108 positions in the genome (the complete set of DNA that "defines" an individual organism) that are more likely to be present in people with schizophrenia.

The study compared the genetic make-up of more than 36,000 people with schizophrenia with that of more than 110,000 controls. They found differences in 108 positions in the genome, 83 of which had not previously been reported.

A particularly interesting finding was evidence of genetic differences in genes active in the immune system. Whether or not the immune system plays a role in the development of schizophrenia is a possibility not previously considered by most experts.

This study provides further evidence of a genetic element to the condition, but it does not prove that the genetic differences actually cause schizophrenia.

However, it is hoped these results will lead to new avenues of research that can be explored, and may eventually lead to better treatments for the condition.

 

The genetics of schizophrenia

It has long been suspected the cause of schizophrenia, which affects 1% of the population, is a combination of multiple genetic and environmental factors.

 

Family studies have shown the increased risk from having one parent with the disorder is about 7%, but this increases to 46% if both parents are affected. Other studies have shown that if one identical twin develops schizophrenia, the other has a 48% risk, even if they are raised separately.

Where did the story come from?

The study was led by researchers from Cardiff University and involved hundreds of researchers from around the world as part of the Schizophrenia Working Group of the Psychiatric Genomics Consortium.

It was funded by the US National Institute of Mental Health and grants from governmental bodies and charities.

The study was published in the peer-reviewed journal Nature.

The UK media reported the study accurately. The Independent's coverage was particularly informative, providing independent expert opinions on the findings.

It also included a balanced viewpoint from charities highlighting the need for holistic care regardless of whether new drug treatments are developed.

People living with schizophrenia usually require a combination of medication and talking treatments, such as cognitive behavioural therapy (CBT), to better control their symptoms.

 

What kind of research was this?

This was a genome-wide association study that aimed to combine all of the data from published and unpublished studies that had analysed the genetic make-up of people with schizophrenia, comparing this data with the genetics of people who do not have the condition.

This type of study is able to identify small variations in genes present more frequently in people with a particular disease, compared with people without the disease.

But it is only able to show an association and cannot prove that the genetic variations found cause the disease.

This type of study is useful, however, as it can point to new areas that may be involved in the disease process. These can then be investigated further in other types of studies and could eventually lead to new treatments.

 

What did the research involve?

The researchers obtained data from all the available genome-wide association studies of people with schizophrenia from around the world. This included 46 European case-control samples, three east Asian case-control samples, three European family-based studies, and results from Icelandic population studies.

Overall, the genetic make-up of 36,989 people with schizophrenia was compared with that of 113,075 healthy controls. This involved sophisticated analysis looking at 9.5 million genetic variants.

 

What were the basic results?

The researchers found variations in 108 loci (positions in the genome) that met genome-wide significance, 83 of which had not been previously implicated in schizophrenia. Genome-wide significance means there is a statistically significant possibility a variation is associated with a condition.

Of these 108 loci, 75% coded for proteins. Several of the proteins are thought to have a role in schizophrenia. Variations were found in a gene that codes for the dopamine receptor, the main target of medication to treat schizophrenia, and other genes involved in neurotransmission and synaptic plasticity.

The researchers also found variations occurred in genes expressed in the brain, as well as in genes expressed in the immune system.

 

How did the researchers interpret the results?

The researchers concluded that they have identified variations in genes expressed in the brain. More specifically, they found variations in the gene that encodes a protein that has been a target for drug therapies for schizophrenia for years, as well as in other genes involved in neurotransmission.

They have also found variations in genes expressed in the immune system, which they say provides "support for the speculated link between the immune system and schizophrenia".

However, they are also excited about the fact there are variations in a number of other genes and how this creates "the potential to provide entirely new insights into aetiology [the cause of the disease]".

 

Conclusion

This large genome-wide association study has found genetic variations in 108 loci more likely to be found in people with schizophrenia than in healthy controls.

While some of these variations fell in genes that code for proteins that are already targets for drug treatments for schizophrenia, variations at 83 of the loci had not previously been implicated as being involved in schizophrenia. This provides new insights for further research.

The study's strengths include the large number of cases and controls involved.

But this study cannot prove that these genetic variants cause schizophrenia. It remains likely that a combination of environmental factors and genetic susceptibility increases the risk of the condition.

A further consideration is the huge variability in the level of severity and the type of symptoms that can be present within the "umbrella" diagnosis of schizophrenia.

It is hoped the identification of these genes will pave the way towards a greater understanding of this complex condition.

Read more about schizophrenia, the current treatments for the condition and the available support.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Latest News: Probiotics may improve blood pressure

Tuesday July 22 2014

Results suggested that probiotics can lead to a moderate improvement in blood pressure levels

Probiotics usually come in the form of yoghurt

“Eating probiotics may lower blood pressure,” The Daily Telegraph reports.

Probiotics, so-called “friendly bacteria”, have been found to moderately reduce blood pressure in a new study.

The study is what is known as a systematic review, which is essentially a study of studies. Researchers combined the results of nine randomised controlled trials (regarded as the “gold standard” in evidence-based medicine).

The results suggest that probiotics led to a modest but significant reduction in blood pressure.

The reliability of any systematic review depends on the included studies, and the researchers point out that there were some weaknesses in the studies they included. For example, six of the trials were only conducted on 20 to 40 people. With such a small sample size, any effect on blood pressure could have been the result of chance.

As the lead researcher is quoted as saying in the media, more research is required before doctors can confidently recommend probiotics for high blood pressure control and prevention.

Proven methods to improve blood pressure levels include quitting smoking, sticking to the recommended levels of alcohol consumption, eating a healthy diet (in particular, reducing salt consumption) and taking regular exercise.

 

Probiotics are not medicine

In general, probiotics are regulated as foods, and don’t undergo the rigorous testing and approval process that medicines do.

 

This means we don’t know whether a probiotic yoghurt, supplement or tablet contains what is stated on the label, and whether the amount of "good" bacteria in it is enough to have a beneficial effect. The bacteria in probiotic freeze-dried tablets may not even be "live".

 

It's also worth noting that the different probiotic strains have completely different effects on the body. Don't assume that the beneficial effects seen with one strain are the same as other similar strains.

 

However, what we can say is that probiotics appear to be safe. If you wish to try them – and you have a healthy immune system – they shouldn't cause any unpleasant side effects.

Where did the story come from?

The study was carried out by researchers from Griffith University and Gold Coast Health, Australia. No source of funding was reported.

The study was published in the peer-reviewed medical journal Hypertension.

The story was accurately reported in the media, though the Daily Express’s claims that eating “a pot a day [could] … help save your life” is probably overstating the findings of the study.

 

What kind of research was this?

This was a systematic review and meta-analysis that aimed to determine the effect of probiotic consumption on blood pressure. Systematic reviews aim to identify all the evidence related to a specific research question and synthesise the findings from individual studies or reports in an unbiased way. Meta-analysis is a mathematical technique for combining the results of individual studies to arrive at one overall measure of the effect of a treatment.

The researchers also aimed to use their results to provide information on the most effective probiotic and dose, and how long probiotics need to be taken.

A systematic review, when performed well, should give the best possible estimate of the true effect of probiotics on blood pressure.

 

What did the research involve?

The researchers searched databases of published literature and trials to identify randomised controlled trials (RCTs) that had given people probiotics and had assessed the effect on blood pressure.

Once they had identified relevant trials, the researchers assessed them to see if they were well-performed and extracted data.

The results of all the trials were then combined to produce a "bottom line" on the effectiveness of probiotics on blood pressure.

 

What were the basic results?

The researchers included nine RCTs with 543 participants in total. Six of the trials had between 20 and 40 participants.

Some trials involved healthy people, others included patients with hypertension (high blood pressure), hypercholesterolemia (high levels of cholesterol in the blood), metabolic syndrome (a combination of diabetes, high blood pressure and obesity) or who were overweight or obese. The species and dose of probiotics used, and how they were given, also varied across the trials.

Trials used either yoghurt, fermented and sour milk, probiotic cheese, encapsulated supplements or rose-hip drinks.

The trials gave people between a single species and three species of probiotic at the same time, and the daily dose of probiotics varied between 109 colony-forming units and 1012 colony-forming units. A colony-forming unit is an estimate of the amount of micro-organisms, usually bacteria or fungi, in a given sample.

The duration of the trials varied from three weeks to nine weeks.  

After combining the results of the trials the researchers found that:

  • Probiotic consumption significantly reduced systolic blood pressure by 3.56 mm Hg compared to control (systolic blood pressure is the "top" number and is the blood pressure in the arteries when the heart beats).
  • Probiotic consumption significantly reduced diastolic blood pressure by 2.38 mm Hg compared to control (diastolic blood pressure is the "bottom" number and is the blood pressure in the arteries between heart beats).

By combining the results of different sub-groups of studies they found that:

  • Using dairy products as the source of probiotics resulted in significant reductions in systolic and diastolic blood pressure, whereas using other sources of probiotics did not.
  • Using multiple species of probiotics resulted in significant reductions in systolic and diastolic blood pressure, whereas using a single species did not.
  • Using a dose of at least 1011 colony-forming units per day resulted in significant reductions in systolic and diastolic blood pressure, whereas using lower doses did not.
  • Taking probiotics for at least eight weeks resulted in significant reductions in systolic and diastolic blood pressure, whereas taking probiotics for shorter periods did not.
  • People who had blood pressure of 130/85 mm Hg (higher than ideal but still normal) or higher had significant improvements in diastolic blood pressure but people with blood pressure less than 130/85 mm Hg did not.

 

How did the researchers interpret the results?

The researchers concluded that their results suggest consuming probiotics may improve blood pressure by a modest degree, and that this effect may be greater if blood pressure is high to begin with, multiple species of probiotics are consumed, probiotics are taken for eight weeks or longer, and if each dose contains at least 1011 colony-forming units.

They go on to say that “the reduction [in blood pressure] reported in this meta-analysis is modest; however, even a small reduction of [blood pressure] may have important public health benefits and cardiovascular consequences.”

 

Conclusion

This systematic review and meta-analysis has found that probiotic consumption results in moderate reductions in blood pressure.

The results of a systematic review depend on the included studies, and the researchers point out that there were some weaknesses in the studies they included. They say that “more randomised, controlled studies with larger sample groups, longer durations and adequate blinding of conditions trials are needed to confirm the effect of different probiotic species and products on BP [blood pressure] and hypertension.”

Analysis of subgroups of studies led the researchers to conclude that blood pressure improvements may be greater among those with elevated blood pressure, when the daily dose of probiotics is at least 1011 colony-forming units, when more than one species of probiotic is taken and when probiotics are taken for at least eight weeks.

However, they also point out that these conclusions are based on the results of only a few studies, and the majority of them were very small – six of the trials were only conducted on between 20 and 40 people.

As the lead researcher is quoted as saying in the media, more research is required before doctors can confidently recommend probiotics for high blood pressure control and prevention.

Proven methods to improve blood pressure levels include quitting smoking, sticking to the recommended levels of alcohol consumption, eating a healthy diet (in particular, eating a low salt diet) and taking regular exercise.

Read more about how to improve your blood pressure.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Latest News: UN in Syria vaccination drive against polio

The United Nations called for help Tuesday to vaccinate 765,000 young Syrian children against polio in a bid to prevent a resurgence of the crippling disease across the restive Middle East.

"Inside Syria, 765,000 children under the age of five live in hard-to-reach areas where conflict and restriction make it extremely difficult to reach them with humanitarian assistance including regular access to vaccines," UN agencies said.

Polio is a potentially fatal viral disease that half a century ago killed or crippled hundreds of thousands of people, mainly children, most famously US president Franklin D. Roosevelt.

In 1988, the disease was endemic in 125 countries, and 350,000 cases were recorded worldwide, according to UN figures.

The UN agencies said polio had struck again in Syria after a 14-year absence because the civil war had disrupted what had been routine childhood immunisations, with millions fleeing their homes.

Polio vaccination coverage in Syria has declined from an average of 99 percent to 52 percent, they said.

At least 60 percent of Syria?s hospitals have been destroyed or damaged, and less than a third of public ambulances are still functional.

We got to a point where we had to work with very limited resources to defeat what had been a long forgotten enemy in this region", said World Health Organization polio specialist Chris Maher.

He warned that the disease is "one that does not know borders or checkpoints and can travel fast, infecting children not just in war-torn Syria but across the region".

More than 6.5 million children are now in need of assistance, according to the UN agencies, which urged access for aid workers to children trapped in war zones inside Syria.

"Our job is far from over. In the coming months, we have to reach more and more children, especially those who have not been reached because of the insecurity and violence," said Maria Calivis, Middle East director of the UN children's agency UNICEF.

The UN agencies said they had completed the first phase of the biggest polio vaccination campaign they had ever undertaken in the Middle East, reaching 25 million children under the age of five.

Latest News: Worldwide FGM ban sought at 'Girl Summit' in London

British Prime Minister David Cameron called on Tuesday for a worldwide ban on female genital mutilation and child marriage as he launched the first UN-backed "Girl Summit" on issues that affect millions around the globe.

Cameron announced that parents in Britain would face prosecution for failing to prevent their daughters from being subjected to FGM, while setting out steps to tackle both practices in developing nations.

"Our aim is to outlaw FGM and child marriage everywhere for everyone," Cameron told the summit in London, to applause from an audience of experts and campaigners from around the world.

FGM, which affects tens of millions of women, particularly in the Horn of Africa, ranges from removal of the clitoris to the mutilation and removal of other female genitalia. It can leave girls at risk of prolonged bleeding, infection, infertility and even death.

Cameron acknowledged that ending FGM and child marriage was no easy task, saying they ranked alongside the global health threats of polio and tuberculosis in terms of the commitment needed to tackle them.

But he argued: "All girls have the right to live free from violence and coercion, without being forced into marriage or the lifelong physical and psychological effects of female genital mutilation.

"Abhorrent practices like these, no matter how deeply rooted in societies, violate the rights of girls and women across the world, including here in the UK.

"I want to build a better future for all our girls and I am hosting the Girl Summit today so that we say with one voice -- let's end these practices once and for all."

The summit, which is co-hosted by the United Nations Children's Fund (UNICEF), will produce an "international charter" calling for the eradication of FGM and child marriage within a generation.

The summit will also launch new programmes to prevent child and forced marriage in 12 developing nations.

Speakers at the event included Malala Yousafzai, the Pakistani schoolgirl who recovered from being shot in the head by the Taliban and is now a campaigner for girls' education.

"We should have the right to change traditions and we should make the changes. We ask that there be no more FGM or child marriage," Malala told the summit.

"We should not be followers of traditions that go against human rights... we are human beings and we make traditions."

- 'Accelerate our efforts' -

UNICEF warned in a new report that while the rate of FGM and child marriage has fallen over the past three decades, population increase in developing nations alone could reverse this trend if "intensive action" is not introduced.

More than 130 million girls and women have experienced some form of FGM in the 29 countries in Africa and the Middle East where the practice is most common, it said.

More than 700 million women worldwide were married as children, UNICEF added.

"The numbers tell us we must accelerate our efforts," said UNICEF executive director Anthony Lake.

"FGM and child marriage profoundly and permanently harm girls, denying them their right to make their own decisions and to reach their full potential."

Cameron confirmed that Britain would introduce legislation under which doctors and teachers would be required by law to report FGM, while parents who allow their daughters to be cut will be prosecuted.

British lawmakers earlier this month said the prevalence of FGM in the country was a "national scandal", warning that up to 170,000 women may have had the procedure and another 65,000 young girls were at risk.

A damning report from the House of Commons home affairs committee condemned the failure of the government, police, health and education authorities over many years to address what it said was an "extreme form of child abuse".

Latest News: White House: Health subsidies not halted by ruling

WASHINGTON (AP) — The White House says health subsidies under the Affordable Care Act will continue to flow for the time being despite a major setback delivered by a federal appeals court.

The ruling potentially derails billions of dollars in subsidies for many low- and middle-income people who bought policies. But White House spokesman Josh Earnest says while the case works its way through the courts, it has "no practical impact" on tax credits. He said the White House is confident in Justice's legal case.

Earnest says there's mixed legal opinions on whether people who buy insurance through state-based markets can get subsidies.

The ruling affects consumers in the 36 states served by the federal marketplace.

Latest News: Obama admin. says health subsidies will continue

WASHINGTON (AP) — A federal appeals court delivered a potentially serious setback to President Barack Obama's health care law Tuesday, imperiling billions of dollars in subsidies for many low- and middle-income people who bought policies.

The Obama administration immediately declared that those policyholders will keep getting financial aid for their premiums as it seeks review of the ruling. White House spokesman Josh Earnest said the decision would have "no practical impact" on tax credits as the case works its way through further court appeals.

In the case, decided by the U.S. Court of Appeals for the District of Columbia Circuit, a group of small business owners argued that the law authorizes subsidies only for people who buy insurance through markets established by the states — not by the federal government.

A divided court agreed, in a 2-1 decision that could mean premium increases for more than half the 8 million Americans who have purchased taxpayer-subsidized coverage under the law. The ruling affects consumers who bought coverage in the 36 states served by the federal insurance marketplace, or exchange.

The majority opinion concluded that the law, as written, "unambiguously" restricts subsides to consumers in exchanges established by a state. That would invalidate an Internal Revenue Service regulation that tried to sort out confusing wording in the law by concluding that Congress intended for consumers in all 50 states to have subsidized coverage.

In reaction, Justice Department spokeswoman Emily Pierce said the decision was incorrect, inconsistent with the intent of Congress, and at odds with the goals of the health care law.

The administration is expected to seek a hearing from the full 11-member appeals court.

The issue is crucial to the success of the health law because most states have been unable or unwilling to set up their own exchanges. The inaction stems in many instances from opposition by Republican governors to the Affordable Care Act.

The small business owners filing the lawsuit say the tax credits enacted by Congress were intended to encourage states to set up their own health benefit exchanges and that the penalty for not doing so was withdrawal of tax credits for lower-income residents.

Supporters of the act say the purpose of the tax credit was not to promote the establishment of state exchanges, but rather to achieve Congress's fundamental purpose of making insurance affordable for all Americans.

The case revolves around four words in the Affordable Care Act, which says the tax credits are available to people who enroll through an exchange "established by the state."

The challengers to the law say a literal reading of that language invalidates the IRS subsidy to people in the federal exchanges. The opponents say that people who would otherwise qualify for the tax credits should be denied that benefit if they buy insurance on a federally facilitated exchange.

"It is implausible to believe that Congress gave the IRS discretion to authorize $150 billion per year in federal spending, particularly when Congress had directly spoken to this issue," the challengers to the IRS subsidy said in a court filing. "Major economic decisions like these — indeed, any decisions granting tax credits — must be made unambiguously by Congress itself."

The Obama administration and congressional and state legislative supporters of the Affordable Care Act say the challengers are failing to consider the words of the statute in its entirety.

"Congress did not provide that the tax credits would only be available to citizens whose states set up their own exchanges," says an appeals court filing by congressional and state legislative supporters of the Affordable Care Act. Congressional lawmakers and state legislators supporting the act said that limiting the subsidies to state exchanges could destabilize important aspects of the law, such as the individual mandate requiring most people to buy insurance.

The judges on the case were Thomas Griffith, an appointee of President George W. Bush; A. Raymond Randolph, an appointee of Bush's father; and Harry Edwards, an appointee of President Jimmy Carter, who dissented.

A lower court had ruled that the law's text, structure, purpose, and legislative history make "clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges."

But the appeals court concluded the opposite — that the letter of the law "unambiguously restricts" the law's subsidies to policies sold through exchanges established by the state.

Latest News: Obamacare hit by ruling, but subsidies to continue

WASHINGTON (AP) — A federal appeals court delivered a potentially serious setback to President Barack Obama's health care law Tuesday, imperiling billions of dollars in subsidies for many low- and middle-income people who bought policies.

The Obama administration immediately declared that those policyholders would keep getting financial aid for their premiums as it seeks review of the ruling. White House spokesman Josh Earnest said the decision would have "no practical impact" on tax credits as the case works its way through further appeals.

In the case, decided by the U.S. Court of Appeals for the District of Columbia Circuit, a group of small business owners argued that the law authorizes subsidies only for people who buy insurance through markets established by the states — not by the federal government.

A divided court agreed, in a 2-1 decision that could mean premium increases for more than half the 8 million Americans who have purchased taxpayer-subsidized coverage under the law. The ruling affects consumers who bought coverage in the 36 states served by the federal insurance marketplace, or exchange.

In Tuesday's ruling, two judges appointed by Republican presidents voted against the administration's interpretation of the law while one appointed by a Democratic president dissented. The Obama spokesman said the administration would seek a hearing by the full 11-judge court. The court has a majority of judges appointed by Democratic presidents, including four appointed by Obama.

The majority opinion concluded that the law, as written, "unambiguously" restricts subsides to consumers in exchanges established by a state. That would invalidate an Internal Revenue Service regulation that tried to sort out confusing wording in the law by concluding that Congress intended for consumers in all 50 states to have subsidized coverage.

In reaction, Justice Department spokeswoman Emily Pierce said the decision was incorrect, inconsistent with the intent of Congress, and at odds with the goals of the health care law.

The administration is expected to seek a hearing from the full 11-member appeals court.

The issue is crucial to the success of the health law because most states have been unable or unwilling to set up their own exchanges. The inaction stems in many instances from opposition by Republican governors to the Affordable Care Act.

The small business owners filing the lawsuit say the tax credits enacted by Congress were intended to encourage states to set up their own health benefit exchanges and that the penalty for not doing so was withdrawal of tax credits for lower-income residents.

Supporters of the act say the purpose of the tax credit was not to promote the establishment of state exchanges, but rather to achieve Congress's fundamental purpose of making insurance affordable for all Americans.

The case revolves around four words in the Affordable Care Act, which says the tax credits are available to people who enroll through an exchange "established by the state."

The challengers to the law say a literal reading of that language invalidates the IRS subsidy to people in the federal exchanges. The opponents say that people who would otherwise qualify for the tax credits should be denied that benefit if they buy insurance on a federally facilitated exchange.

"It is implausible to believe that Congress gave the IRS discretion to authorize $150 billion per year in federal spending, particularly when Congress had directly spoken to this issue," the challengers to the IRS subsidy said in a court filing. "Major economic decisions like these — indeed, any decisions granting tax credits — must be made unambiguously by Congress itself."

The Obama administration and congressional and state legislative supporters of the Affordable Care Act say the challengers are failing to consider the words of the statute in its entirety.

"Congress did not provide that the tax credits would only be available to citizens whose states set up their own exchanges," says an appeals court filing by congressional and state legislative supporters of the Affordable Care Act. Congressional lawmakers and state legislators supporting the act said that limiting the subsidies to state exchanges could destabilize important aspects of the law, such as the individual mandate requiring most people to buy insurance.

The judges on the case were Thomas Griffith, an appointee of President George W. Bush; A. Raymond Randolph, an appointee of Bush's father; and Harry Edwards, an appointee of President Jimmy Carter, who dissented.

A lower court had ruled that the law's text, structure, purpose, and legislative history make "clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges."

But the appeals court concluded the opposite — that the letter of the law "unambiguously restricts" the law's subsidies to policies sold through exchanges established by the state.

Latest News: Britain plans new laws to prevent female genital mutilation

By Kylie MacLellan and Emma Batha

LONDON (Reuters) - Britain will introduce new laws to combat female genital mutilation (FGM) including making it compulsory for teachers and health workers to report cases, Prime Minister David Cameron said on Tuesday.

The government, hosting a one-day London summit on FGM and forced marriage, also announced 1.4 million pounds (1.4 million pounds) of funding for an prevention programme and said it would enact legislation that would see parents prosecuted if they fail to prevent their daughter undergoing such a practice.

"It's absolutely clear what we are trying to achieve...and that is to outlaw the practices of female genital mutilation and childhood and early forced marriage; to outlaw them everywhere, for everyone, within this generation," Cameron said.

He urged countries to sign up to an international charter, launched at the summit, which calls for the eradication of both practices and said 21 countries had already done so.

FGM, the partial or total removal of external female genitalia, is a tradition practised widely in many African and Muslim countries and often justified as a means of suppressing a woman's sexual desire to prevent "immoral" behaviour.

Around 103,000 women aged between 15 and 49, and another 10,000 girls aged under 15 who have migrated to England and Wales are estimated to have undergone FGM, according to a report on Tuesday from City University London.

Worldwide, more than 130 million girls and women have undergone FGM and more than 700 million women alive today were children when they were married.

Ministers and officials from Pakistan, Somalia, Ethiopia, India, Bangladesh, Burkina Faso, Zambia and others also pledged to step up efforts to tackle both issues.

But UNICEF warned that population growth, particularly in Sub-Saharan Africa, meant the number of FGM victims would soar and there would be no decline in the number of child brides unless global action was dramatically accelerated.

Cameron said ending FGM and child marriage was a global challenge on a par with eradicating poverty and tackling diseases.

"We are dealing with a preventable evil. This does not need to happen," he told the summit attended by more than 500 delegates from 50 countries.

Malala Yousafzai, the Pakistani schoolgirl and girl's rights campaigner who was shot in the head by the Taliban in 2012, said getting girls into school was the best way to fight child marriage and FGM.

She told the summit it was wrong to think that Islam was against women's education and empowerment and urged those who thought so to go back to the Koran.

FGM has been a criminal offence in Britain since 1985 but new legislation in 2003 introduced a maximum prison sentence of 14 years. The 2003 act also made it an offence for British citizens to carry out or procure FGM abroad, even in countries where the practice is legal.

(Editing by Catherine Evans)

Latest News: NHS 'wasting millions on supplies'

Hospital at home?

Does online technology offer a revolution in healthcare?

Read full article

Latest News: VIDEO: Schizophrenia 'impact and stigma'

New treatments for schizophrenia could be possible as vital clues behind the factors causing the mental illness are discovered.

A team led by Cardiff University has found more than one hundred genetic risk factors linked to schizophrenia following the biggest ever study of its kind.

It follows several years of work involving more than 300 scientists in 35 countries worldwide.

Dr David Crepaz-Keay is head of empowerment and social inclusion for the Mental Health Foundation and was diagnosed with schizophrenia himself as a teenager.

He told BBC Wales health correspondent Owain Clarke that schizophrenia can take on various forms and he hopes the research will stop the illness being seen as a "monster" and increase understanding.

Latest News: HIV pills show more promise to prevent infection

There is more good news about HIV treatment pills used to prevent infection in people at high risk of getting the AIDS virus: Follow-up from a landmark study that proved the drug works now shows that it does not encourage risky sex and is effective even if people skip some doses.

The research was discussed Tuesday at the International AIDS Conference in Melbourne, Australia, and was published by the British journal Lancet Infectious Diseases.

It involves 1,600 gay men and transgender women who took part in the original study showing that daily use of the drug Truvada lowered the risk of getting HIV.

After the study ended, they were offered the chance to keep getting the pills for free, and three-quarters of them agreed. All were studied for another 17 months.

None who took the pills at least four days a week became infected. Even use two or three days a week lowered the risk of infection compared to taking the pills less often or not at all. Researchers could tell how often the drug was taken because they measured it in blood samples.

"We're encouraged," said study leader Dr. Robert Grant, an AIDS expert at the Gladstone Institutes, a foundation affiliated with the University of California, San Francisco. "There's a demand, there's some forgiveness for missed doses. And it's safe."

Mitchell Warren, who heads a nonprofit group that works on HIV prevention research, said in an email from Melbourne that "the story is now clear" that this approach "is real, it works, and it should be made available to people at risk now as part of high-impact combination prevention."

Condoms remain the best way to prevent HIV infection but not everyone uses them all the time, so health officials recommend other options for certain groups, such as gay men.

Some health officials had worried that taking Truvada might give a false sense of security and make men less likely to use condoms or to limit their partners. However, study participants reported no increase in these behaviors, and there was no rise in syphilis or herpes, other sexually spread diseases that might suggest risk-taking.

The study was done in South America, Africa, Thailand, United States and paid for by the U.S. National Institutes of Health.

Truvada already is sold for treating HIV. It's a combination of two drugs, tenofovir and emtricitabine, or FTC, made by California-based Gilead Sciences Inc. Its wholesale price is $800 a month in the U.S. but generic versions are available in other countries and they cost as little as 31 cents a day in Africa, Grant said.

"The main challenge is to find a way to make it more available," he said.

___

Online:

AIDS information: http://www.aidsinfo.nih.gov

and http://www3.niaid.nih.gov/topics/HIVAIDS/

Latest News: Greek Orthodox church in Gaza shelters Muslims fleeing war

By Nidal al-Mughrabi

GAZA (Reuters) - About 1,000 Palestinian Muslims fleeing Israeli shells devastating their Gaza neighbourhood have found shelter in a building they otherwise would rarely if ever enter, the city's 12th-century Greek Orthodox Church.

Despite its thick walls dating back to the Crusades, the Church of Saint Porphyrius was still not a very safe haven. Shortly after they arrived, Israeli aircraft bombed a nearby field, spraying shrapnel on the church and damaging graves.

But children from the Shejaia district, where some 72 Palestinians - many of them women and children - were killed during fighting between Israeli forces and Hamas militants on Sunday, were busy playing football in the yard on Tuesday.

Their mothers watched on mattresses and plastic chairs provided by the church, along with food, blankets and toys.

"We have opened the church in order to help people. This is the duty of the church and we are doing all we can to help them," Archbishop Alexios told Reuters as the sounds of small children echoed outside his office at the church.

"At the beginning there were 600 people and today they became a thousand - mostly children and women. Some of those children are a week old," said the head of Gaza's Greek Orthodox minority, the largest of the Christian communities here.

Only about 1,400 Christians - Orthodox, Catholics and Protestants - live among the 1.8 million Muslims, meaning they make up 0.08 percent of the population in the crowded Gaza Strip dominated by Hamas, an Islamist group.

Their life as a religious minority has not always been easy

When the then Pope Benedict quoted a medieval scholar describing Islam as violent and irrational in 2006, unknown militants attacked five churches in Palestinian areas, including Saint Porphyrius - even though it is Orthodox, not Catholic.

NOWHERE ELSE TO GO

Palestinian officials, including from Hamas, denounced that violence and it was not repeated. It all seemed far away now as Gazans reached out to help neighbours who have lost their homes in the two-week Israeli offensive.

"The mosque nearby and the neighbours of the church are all helping. We are still in need of mattresses, blankets, food and most important is petrol, as we suffer blackouts. If there is no electricity we cannot have water also," said the archbishop.

Since the start of the offensive, more than 100,000 Palestinians – about 6 per cent of Gaza's entire population - have sought shelter with the United Nations Relief and Works Agency (UNRWA), crowding into 70 schools, the organisation said.

Refugees streaming from Shejaia in the eastern part of Gaza City to the church in the southwestern area of al-Zaytun said they did not know where else they could go now.

"We have escaped from our houses and came here and they bombed the church. Where should we go? Let them tell us where we should go," insisted Jawaher Sukkar, who fled with her children.

Accusing Israel of targeting civilians, she said: "The shells chased us as we ran ... can you imagine, a boy falling the ground and his mother cannot stop to pick him up?"

One possible reason for the shelling close to the church is that Israel's military believes militants have used cemeteries to launch rockets fired at its cities and to hide weaponry.

Despite the overcrowding and danger, Alexios said there has been some joy in the church in the midst of tragedy.

"Yesterday, a woman gave birth to a baby, a new life. Man should be hopeful.. There is death but also there is life too," he said with a smile.

(Editing by Jeffrey Heller and Tom Heneghan)

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