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Friday, 30 December 2011

A good time to get weight in trim

New Year is a familiar time for people to make resolutions and aims to improve lifestyle.

Why bother about overweight?
Excess weight increases the burden of cardiovascular risk (high blood pressure, raised cholesterol and diabetes mellitus); causes premature ageing of arteries, leading to heart attacks, strokes and other serious disorders of the heart, brain and circulation; contributes to risk of sleep dusturbance and sleep apnoea syndrome; causes premature joint ageing with arthritis; non-alcholic fatty liver disease is the commonest cause worldwide of liver damage; and increased risk of cancers - weight gain and overweight estimated to be linked to 1 in 5 cancers.
People who have no difficulty in maintaining normal weight may find it difficult to understand the challenges. For those who are currently overweight, the challenges in regaining a more healthy weight include beating the psychological, physical and social addiction to causes of overweight, and resisting peer pressure.

Getting started
Importants steps on the path to reducing excess weight include being ready to think about action, to think about taking action and to prepare to take action. That might mean telling friends and family you are serious about losing weight, and to seek whatever help may work - e.g.  family doctor or nurse or other health professional, and support groups for the overweight.

What works? 
Smaller portion size, cutting down on processed foods and increasing exercise are the big 3 factors that help. Keep a weight chart and if possible find a friend with whom to lose overweight. Wear a belt. Pace your eating and drink water with your food. Eat regular small meals. Avoid snacking, Research evidence suggests that successful measures include recording weight regularly, knowing the approximate energy intake of what you eat, and regular activity.
It is also clear that insight into the personal health risks of overweight provide extra incentive to lose weight. Better of course to reduce excess weight before serious clinical effects of overweight occur.
There are many support groups and diet plans available to order, often at high cost.

Research evidence suggests that success in maintaining weight loss is associated with clear strategies for coping with life stresses and with 'continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss'. In contrast, unsuccessful weight maintainers are erratic or inconsistent in recording their weight and being vigilant in keeping to healthy types and amounts of food and in continuing regular activity.
Once overweight people have maintained a weight loss for 2-5 years, the chances of longer-term success in maintaining a healthy weight are much greater.
 There an increasing variety of 'apps' for smartphones and PCs, that reinforce the combined impact of healthier dietary intake and maximising exercise. Many are free, with myfitnesspal an excellent example. These and other free lifestyle apps are like your personal health bank. The more active you are, the more energy balance you have towards losing weight, the more you eat, the less reserves in your health bank.

© DRJ Singer

Thursday, 29 December 2011

Favourite poems on a medical theme from entries in the 2012 Hippocrates initiative poll

@HealthMed To mark the launch of the 2012 International Hippocrates Prize for Poetry and Medicine, the organisers invited nominations of favourite poems with a medical theme. The top 5 favourites were:

Dylan Thomas – Do not go gentle into that good night
William Butler Yeats - When you are old
Dannie Abse - The Pathology of Colours
Jo Shapcott - Of mutability
Stevie Smith - Not waving but drowning

You can see examples of comments received and find links to many of the submitted favourite poems on the earlier blog on favourite poems on a medical theme.

'Medical' was to be interpreted in the broadest sense, with only one nomination to be made by any one person. Nominations were to be for poems written by a poet from anywhere in the world and in any language. The poem were to be contemporary or from any historical period.

The Hippocrates Prize of £5000 for the winning poem is one of the highest value awards in the world for an unpublished poem in English on a medical theme.

Entries for the 2012 Awards are now closed. 2012 Hippocrates Prize judges include New York poet and critic Marilyn Hacker and medical researcher Professor Rod Flower, Fellow of the Royal Society. Awards will be presented on Saturday 12th May 2012 at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection in London.

Wednesday, 28 December 2011

Stopping smoking - why and how?

@HealthMed UK No Smoking day is 14th March 2012: some helpful Q & As.

But no need to wait until then to stop ...

Why bother?
Apart from the obvious: cost, smell on clothes and breathe, and taste impairment and eventual loss of taste? Smoking is the single most preventable cause of disease and death.
For primary prevention, smokers and their advisers need to be well informed of the personally relevant risks of smoking and benefits of stopping. For younger smokers, risks include premature ageing of the skin, increased risk of impotence, risk to the developing baby in the womb, and increased risk in offspring of serious chest disorders. For older smokers, the more pressing risks are increased risk of cancer of the lung, mouth, throat, bladder and many other types of cancer; premature ageing of arteries, leading to heart attacks, strokes and other serious disorders of the heart, brain and circulation; and serious lung disorders including chronic obstructive lung disease and emphysema. And in the long-term, it is estimated that around half the smokers who do not give up smoking will die from one or more of these and other smoking-related diseases.
For non-smokers and confirmed ex-smokers the question has to be - why bother? Give up now to improve your medical and financial health.
For current smokers, the challenges are to beat the psychological, physical (nicotine), and social addiction, including resisting peer pressure. Useful ammunition to help smokers to stop smoking includes being aware that giving up tobacco can help you live longer, and that the risk of getting cancer is less with each year you stay smoke-free.

Help from friends and family
Now is a good time for smokers to be ready to think about stopping, to think about stopping and to prepare to stop. That might mean telling friends and family you are serious about stopping, and to seek whatever help may work - e.g. from pharmacist, family doctor or nurse, or other health professional, and smoking cessation support groups. The US National Institutes of Health recommend:
- 'Try not to view past attempts to quit as failures. See them as learning experiences'.
- 'Make a plan about what you will do instead of smoking at those times when you are most likely to smoke'.
- 'Satisfy your oral habits in other ways'. 
Their website provides excellent advice on other ways to help to smoking including how to plan stopping, setting a stop date, and having alternative strategies for times you associate with smoking. 

Stop smoking apps
There are now several free or low cost 'apps' which may be helpful. For example, the UK NHS mobile 'Quit smoking' app provides links for UK smokers to the NHS Stop Smoking helpline and other UK NHS Stop Smoking Servces. 'My Last Cigarette' - MLC provides a dashboard with daily changing reminders of dangers of smoking, and updating estimates of effects of stopping smoking on risk of heart disease, lung disease and other serious medical problems, money saved since stopping, life expectancy gained, and number of smoking-related deaths since the time a smoker has stopped.

Benefits of training health professionals and funding nicotine replacement treament
A controlled study in Germany reported benefits from extra training for family doctors, and further benefit when costs of anti-smoking treatment are subsidized. However, for these over 10/day cigarette smokers, although very helpful for those who succeed in stopping, outcomes were very modest: by
12 months after intervention, 1 in 30 had stopped with usual support, 1 in 10 when their family doctor had received training and been paid a €130 incentive for each patient who stopped, and 1 in 7 where patients also had costs of treatments subsidized.

Unexpectedly rapid benefits from banning smoking in public places
More recent encouragement for anti-smoking campaigns has come from evidence of the rapid time to benefit from stopping: around 1 in 5 fewer heart attacks within 1 year of stopping in countries which have moved to ban smoking in public places. That provides clear evidence to smokers that their cardiovascular risk reduces very rapidly after stopping smoking.

Avoiding temptation to smoke
A recent review of a large number of trials of ways to help people to stop smoking concluded that the evidence for success was 'strongest for interventions focusing on identifying and resolving tempting situations'.

If you are a smoker you quit, what worked for you? Please add a comment ...

© DRJ Singer

Monday, 19 December 2011

Notes on Leonardo da Vinci at the National Gallery, London

Despite reports of a sell-out, good news for the visitor to London that morning queuing (and not too early) has at least up to mid-December been rewarded by entry to the Leonardo da Vinci: Painter at the Court of Milan exhibition' at the National Gallery in London, described by the organizers as ''the most complete display of Leonardo's rare surviving paintings ever held.' 
What’s to see? Sketches in red crayon, chalk and ink, work by his pupils, paintings in evolution and finished, and a tantalising copy of La Cenacolo [‘The Last Supper’], supported by preparatory drawings of key figures at the supper.  During my visit, the paintings were the main attraction, not many visitors showing interest in the sketches. Therefore although the rooms seemed very busy, by avoiding the crowds close to the walls, it was easy to have unhurried close views of all exhibits.

The drawings
There was a surprising contrast between drawings detailing accurate anatomy of human bone and  muscle vs. cross-sections of human skull and brain, which, apart from the frontal sinus, are imagined from perceived wisdom of the time. Most striking were ventricles as a mid-line set of 3 chambers, reported in the gallery notes as attributed by Leonardo to locations for imagination, intellect, memory and the seat of the soul.

Close inspection of the sketches revealed how hatching brings out soft contours and boundaries, part of Leonardo’s sfumato style;- the hatching upper left to lower right, typical of the work of a left-handed artist. And little waste, several sheet showing not only many different figures or views from multiple angles but unrelated engineering drawings.
Thanks to colleague DS for alerting me to the 1977 exhibition at the Royal Academy of Arts of Leonardo's Drawing from the Royal Collection.  Copies of the exhibition catalogue are still available with some detective work.

The paintings?
-  their excellence even more evident by pairings with works by members of his workshop;
-  the ‘Musician’ illustrating Leonardo’s interest in physiology, with eyes painted at different times reflected in asymmetric pupil size - the nearer right eye much larger, indicating that light was much lower than when the left eye was painted; and not explained by contrasts in room lighting – the darker background for  the left side of the face would have caused left pupil enlargement;
- examples of later owners aiming to improve or sanctify Leonardo’s originals – for example, in the later National Gallery version of Virgin on the Rocks, addition of halos and a crucifix.
- numerous symbols explained, from the ermine for purity, to violets for humility, and the red-faced goldcrest, clutched by a breast-feeding Christ child, for torture, in ‘The Madonna Litta’.
-  mood – wonderful examples of melancholy, adoration, serenity; and the sullen, in Beatrice d’Este, wife of the Duke of Milan, Ludovico Sforza.

And within the exhibition there is a mystery. Beatrice is described as ‘La Belle Feronnière’. However ‘The ‘Lady with an Ermine’, Cecilia Galerani, the ~16 year old mistress of the Duke of Milan has the phrase ‘La Bele Feroniere' in golden capitals at the top of the dark background. The curators leave this for observant visitors to decode: obvious explanations – a misattribution, or a view that the sitter was in common for both portraits. Upstairs part of the exhibition provides engaging insight into the Last Supper, all the better for passing a series of Titian portraits – including a 'Young man with quilted jacket', a more self-confident subject, painted around 20 years later than (c. 1510) and perhaps in homage to the more tense features of the sitter for Leonardo's ‘Portrait of a Musician’ (from c. 1490).
Access to the heavily restored ‘original’ Last Supper in Milan is now very restricted. Identified hazards include further pollution from the Milan air, volatile lipids from the skin of visitors and acid damage from carbonic acid generated by exhaled carbon dioxide. In the 1970s, when I first saw the fresco in the Refectory of Santa Maria della Grazie in Milan, with a pre-med student friend, other than by ticket, viewing was unrestricted. My recollections are of a large faded painting in poor state of preservation – and photographs from the Second World War recording the remarkable survival of a sandbag-protected Cenacolo, the other walls severely damaged by wartime bombing.

What next? The Prado has announced discovery after restoration a painting contemporary to the Mona Lisa, considered to be from his studio - either a copy or a simultaneous portrait of the same sitter, a similar Tuscan landscape revealed by removal of later black background. This to be displayed soon alongside the Mona Lisa at the Louvre, to be seen toogether for the first time in over 500 years.

Further sources:
Leonardo exhibition catalogue

The Louvre: all the paintings
Leonardo's Notebooks
Paper engineered Leonardo inventions

© DRJ Singer

Sunday, 18 December 2011

US - European perspectives on potential impact of promoting cycling

As a response to my summer notes on 'city cycling', I was sent a link by @jenicarhee to a graphic (see below) on potential impact of regional schemes to promote cycling. Projected advantages include for health, environment and financial benefit. This approach lends itself to regular update on actual outcomes and imaginative ways to assess impact. See for yourself via: 'How bikes can save us [infographic]'.