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Friday, 27 July 2012

Shift work and cardiovascular risk

@HealthMed It is well-known that shift workers have increased risk factors for serious heart disease, for example as reported in Knuttson's 1986 Lancet paper on papermill workers. They are more likely to smoke and tend to have higher blood pressure, cholesterol and weight and be more likely to have diabetes than  workers whose work pattern is confined to the daytime. They are also more likely to have insomnia, itself an independent risk factor for cardiovascular disease. Clinical pharmacologist Daniel Hackem from Ontario and his colleagues from Norway, Sweden and the USA had now raised further public and health professional interest in this disease link in a paper published in the British Medical Journal.

They looked at 34 previous studies of over 2 million shiftworkers. Together, there were over 17,000 heart events, over 6000 heart attacks and almost 2000 strokes. They concluded that stroke risk was around 5% higher and coronary event risk 24% higher in the shift-workers. Surprisingly, despite their large dataset, the researchers found no associated increase in mortality.

They take care to point out, as with any other observational study, that this is not necessarily a cause and effect relationship. People who take on shift work may be different in some unconnected way that puts up risk of vascular disease. Lower socio-economic status is an obvious important confounder. The work itself may be more stressful, at the same time as their being fewer other staff members in support 'out of hours'. Shift workers may also take more caffeine to try to stay alert during often long shifts.

Nonetheless there are several key messages reinforced by this report.

Shift-workers are more likely to have an excess of a wide range of cardiovascular risk factors. They  should therefore be encouraged to seek regular medical advice and their employers to raise awareness of these health risks and to support their staff in seeking regular medical advice. Shift-workers should also be supported in ensuring a healthy lifestyle despite the constraints on exercise and diet of unsocial hours of work.

Clinical pharmacologists and other health professionals should make sure to take a good occupational health history, including identifying whether a patient does shift work. They should make sure particular  care is taken to identify and reduce severity of cardiovascular risk factors in shift workers, supported by effective regular advice on healthy lifestyle. And where drug treament is indicated, prescribing treatment targets should be adjusted to take account of the increased cardiovascular risk to be prevented.

Employers should also make sure that patterns of shift work follow international guidance regarding avoiding abrupt shift changes, maximum shift duration and ensuring sufficient staff are working 'out of hours' to ensure that work is done both safely for employers' outcomes as well as their workers' health.

Wednesday, 18 July 2012

Haiku from the 2013 Hippocrates Awards launch at the Lichfield Festival

@HealthMed The 2013 Hippocrates Award for poetry and medicine was launched on 12th July at the Lichfield Festival.  Entries are now open for the 2013 Hippocrates Prize for poetry and medicine, which is for unpublished poems in English of up to 50 lines text, excluding title and line spacing.  Judges for the 2013 Hippocrates Awards include poet Jo Shapcott, Past-President of the Poetry Society, and winner of the Queen's Gold Medal for Poetry. Awards will be presented at an international symposium for poetry and medicine to be held on Saturday 11th May, 2013 at the Wellcome Collection rooms in London.
To mark the launch of the 2013 Hippocrates Awards at the Lichfield Festival, a discussion about haiku was followed by opportunity for the audience to write their own. The audience of scientists and engineers were enthusiastic in creating haiku on the day, with the aim of introducing a wide range of medical themes in this accessible short Japanese poetry format.
Here is a selection of the haiku composed by the Lichfield Festival audience.
Gray, pounding rain, wet.
The Sun comes through at last.
A double rainbow.

I’m enjoying this.
But blood pressure much lower
If I were fishing.

Walking to Lichfield
The branches block my way.
Welcome to Garrick.

New life expected:
Years of hope and dreams fulfilled .
May she be born whole?

Back pain, stabbing deep,
Stop, sit, rest, doze, read, hope
Beats pills and patches

Knee cracks painfully.
Salve smoothed on halts agony.
Oh for youth again!

Sonograms sent
Via the internet and distance.
Diagnosis ensues.

I wandered lonely
As a cloud - too late to see
The surgery was shut

Anxiety lurks,
Dampening every spirit.
A rain-soaked August

The old woman’s day
Passes in drug-induced sleep,
Missing the bird’s song

A pain in the neck,
Squeezing, prodding and poking.
Head turns to the Sun

Little old lady,
Frightened bloodied broken. No!
She is my mother.

The op is today.
The high hospital window
Shows a wide world view.

Movement gone, mind free
But Sun still breaks through the clouds.
And life continues.

A frozen shoulder
Crackling like Titanic ice.
Pain moving on, on.

Paranoid – he said:
Seven years towards the cure
Thankfully alive!

Here I am in pain
Waiting for the Sun to shine.
Rain it comes again

English summers now,
Clouds floating across the sky.
Then Sun peeping through!

Penicillin cures
Every patient. Hopes it does.
Bugs need to be foxed

Non malignant mass:
A friend sitting on my face.
Silky with stitches. 

Doctors writing pad:
Poetry, prescription.

Eyes weeping,
Pollen season comes creeping.
Throat sore again.

Lichfield Science talk:
Sorry to leave your lecture.
On way to Norfolk.

Written within the water.
Placebo effect.

Sun this morning lights,
Warms the back and spirits wax.
Joints loosen again.

Intelligence strayed.
Arms like thin weak-branches,
Cold anorexia

Where did my summer go?
Rain-drenched days washed the sodden land.
Continental drift.

Wild dolphins play.
Darkness of depressing lifts,
Healing with a smile

Humanity weeps.
Distended bellies, halved limbs.
No more weapons, please.

My toes are frozen.
The snow falls all around me.
Get me to a fire.

No chips, no pudding,
Clogged arteries last summer.
What can I do now?

Statins, ACE Inhibitors.
Save heart of my heart   

Pain is a quandary,
A clock that chimes at 4am.
Sleep is pure relief.

All down the wide shore
Sand ghosts snake along the ground.
We do not know why.

Scarlet poppies grow,
Stunning splashes of colour.
Escape from your mind.

Tuesday, 17 July 2012

Avocados and health?

@HealthMed Prompted by a press enquiry about strength of evidence for 'healthy' foods:

Avocados are a high calorie food. They also contain over 200 types of plant steroids, the actions of many of which are still unclear. In laboratory studies, extracts of avocado, and some of the individual bioactive chemicals present in avocados, appear to reduce the growth of certain types of cells.

This supports the idea that there may be actions of avocado and its constituents against inflammation and cancer, and other disorders in which abnormal cell growth and activity occur, although this is yet to be tested on humans.

There is also theoretical evidence that plant steroids present in avocados could help to reduce pain and inflammation caused by joint diseases such as osteoarthritis.

We know enough about these avocado constituents to know that they have very powerful properties in the test-tube. There appears to be sufficient evidence to suggest that rigorous studies should be carried out in humans to see if these effects are relevant outside the laboratory.

Saturday, 14 July 2012

2013 Hippocrates Awards for poetry and medicine launched at Lichfield Festival

The 2013 Hippocrates Prize for poetry & medicine was launched on 12th July at the Lichfield Festival

Entries are now open for the 2013 Hippocrates Prize for poetry and medicine, which is for unpublished poems in English of up to 50 lines text, excluding title and line spacing.  Awards will be presented at an international symposium for poetry and medicine to be held on Saturday 18th May, 2013 at the Wellcome Collection rooms in London.

2011 Open winner Michael Henry, 2012 Commended poet Tricia Torrington, 2010 and 2011 NHS winner Wendy French, Jenny Arthur and Donald Singer at Lichfield Festival launch of 2013 Hippocrates Awards

The Hippocrates Awards
With a 1st prize for the winning poem in each category of £5,000, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem. In its first 3 years, the Hippocrates Prize has attracted around 4000 entries from 44 countries, from the Americas to Fiji and Finland to Australasia. Awards are in an Open category, which anyone in the world may enter, and an NHS category, which is open to UK National Health Service employees, health students and those working in professional organisations involved in education and training of NHS students and staff. Co-organizers are medical professor Donald Singer and poet and translator Michael Hulse. 
 The Hippocrates poetry and medicine initiative received  the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards. This award aims to recognise the collaborative and interdisciplinary work that is taking place in universities to promote the arts. Entries were open to teams and all higher education institutions in the UK. Major support for the Hippocrates initiative has come from the Fellowship of Postgraduate Medicine, with additional support from the Wellcome Trust, the Cardiovascular Research Trust, Heads, Teachers and Industry and the University Warwick's Institute of Advanced Study
2013 Hippocrates Prize judges: Roger Highfield, Jo Shapcott and Theodore Dalrymple
The judges for the 2013 Hippocrates Prize are Jo Shapcott, winner of the Queen's Gold Medal for Poetry, science writer and Science Museum Group Executuve Roger Highfield and doctor and writer Theodore Dalrymple.

See also 
- International Hippocrates Research Forum for poetry and medicine. This includes poets, academics and health professionals in the UK, Europe and the USA.

Friday, 13 July 2012

Lichfield Festival 2012 Lecture - Poetry and Medicine, the Hippocrates Initiative and haiku.

@HealthMed The 2012 Lichfield Society Lecture organised by Jenny Arthur, LSES, at the Lichfield Festival was on themes arising from the first 3 years of the Hippocrates initiative for poetry and medicine and included readings by winning poets Wendy French, Michael Henry and Tricia Torrington, followed by a panel discussion.

One of the many interesting questions raised at the Lichfield Festival session devoted to the Hippocrates Initiative was whether sophisticated medical science is a suitable theme for poetry. In fact many of the poems in the each of the initial three 46 poem anthologies of winning poems in the 2010, 2011 and 2012 Hippocrates awards deal with complex medical themes in an accessible way.

M Henry, T Torrington, W French, J Arthur, D Singer.
Indeed the open international winning poem in 2012 by Mary Bush from Texas - 'Woman's work' - dealt with tissue engineering. This featured both within an interview with Mary Bush on the BBC's Woman's Hour and was the theme for an article in the latest issue of international science journal Lab Times.

There was also a discussion about haiku followed by opportunity for the audience to write their own. The audience of scientists and engineers were enthusiastic in creating haiku on the day, aimed at introducing a wide range of medical themes in an accessible short format.

See a selection of the impromptu haiku created by the Lichfield audience

Saturday, 7 July 2012

Microcirculation and the 2012 UK-US international Conference

@HealthMed The MicroCirc2012 conference at Keble College Oxford, 4-6 July, was co-organized by the British Microcirculation Society and the US Microcirculatory Society

Why study the microcirculation? The microvessels - small arteries, capillaries and small venules - play a vital role in providing nutrition to and removing waste products from vital organs. Microvessels are also critical for healthy maintenance of blood pressure. 

D Singer and PhD student H Saedon at MicroCirc2012
And in a wide range of diseases, a spectrum of inflammatory factors, acting on and/or derived from the microcirculation, contribute to disease causation and severity, and provide both biomarkers and targets for prevention and treatment of serious diseases from cardiovascular syndromes to diabetes, inflammatory disease and cancer, and from early abnormalities in the fetal circulation to diseases of ageing. 

A series of delegates posts are now appearing from the MicroCirc2012 conference, from a wide range of specialists, from molecular biologists to imagers, and from 1st year PhD students to senior academics. 

See more about the microcirculation and the 2012 Conference in reflections of principal organizer Professor Chris Garland, posts from delegates and in video interviews with Professor Giovanni Mann from King's College London, and Professor Steven Segal from Columbus, Missouri, USA.