Search This Blog

Monday, 2 March 2015

As merry as the day is long? Shakespeare on seasonal mood ...

Easy to over-interpret, however when Beatrice says in Much Ado about
Winter - North of Scotland
Nothing
she is " ... As merry as the day is long", interesting to consider: was this a throw-away line, a mask for her true mood, or the mirror of "... As sad as the day is short"?  We also have
young prince Mamillius saying "... a sad tale's best for winter." [Winter's Tale. II.i.25]

Hippocratic writings [On Airs, Waters, and Places: ~400 BCE] recognize the potential for seasonal variation to influence patterns of disease in general. And not a new idea that people are lower in spirits in winter months: the Roman writer Jordanes refers to winter depression in his history of the Goths [Getica: 551 AD]. Describing depression as 'the blues' dates from 1741 and 'winter blues' [la dépression hivernale] describes what many people may experience. 

However SAD syndrome (Seasonal Affective Disorder) was only formally reported as such and named in 1984 by Rosenthal and colleages at the National Institute of Mental Health in the USA. Rosenthal was initially motivated by wishing to discover the cause of his own experience of depression during the dark northern US winter. His key contribution was to suggest that reduced exposure to light is a major factor causing SAD and that exposure to more light during the day may reverse features of SAD. 
 
Of note, Much Ado (as Love's Labour's Won) is currently paired by the RSC in Stratford with the bleaker Love's Labour's Lost with its unfulfilled ending, and the poem "Winter", "When icicles hang by the wall". The only "merry note" appears to be from an owl. Chilled Dick the shepherd is "blowing his nail", greasy Joan, has "... nose, red and raw...", and the "Parson (is) drowned out by coughing flock".

Shakespeare often used winter as a metaphor for hard times and troubled characters, from the direct contrast from the opening of King Richard III
"Now is the winter of our discontent, made glorious summer ..."

to Sonnet 5
"For never-resting time leads summer on
To hideous winter and confounds him there;
Sap cheque'd with frost and lusty leaves quite gone,
Beauty o'ersnow'd and bareness every where
."


There is inevitable speculation about the extent to which Shakespeare was revealing on stage aspects of his own depression, or reflecting human experience, and the influence of uncertainties of life at his time.

For the present day, there are now also biochemical hypotheses for the cause of SAD - infections are common in winter and the inflammatory chemicals (cytokines) released by the body's defence cells to fight infection may have the unwanted effect of depressing mood, through toxic actions on brain cells. This may both provide new causes for depression as well as opportunities for treatment, through blocking these harmful chemicals.

Folk wisdom and health

Shakespeare and the history of heartbreak  The Lancet
 
Sadness and the four humours in Shakespeare

New UK initiative from 2nd March on driving and legal or illegal drugs

2nd March 2015: 
It was previously an offence to drive whilst impaired through drink or drugs.


New regulations in England and Wales, in place from 2nd March 2015, aim to reduce risk of RTAs caused by drivers who are taking illegal drugs while driving, or legal drugs which impair their ability to drive. 

It is now an offence, as it has been for alcohol, to drive with certain drugs above a specified level in the blood. Sixteen legal (see Table below) and illegal drugs are covered by the law, including cannabis, cocaine, ecstasy and ketamine. 

There is now a zero tolerance approach to 8 drugs most associated with illegal use. There will also be a 'road safety risk based approach' to 8 prescribed drugs most associated with RTA risk. It remains the "driver’s responsibility to decide whether they consider their driving is, or they believe might be, impaired on any given occasion." (page 7)

Recreational drugs are well-established as causes of road traffic accidents (RTAs). DrinkAware lists several important reasons why alcohol leads to accidents. Alcohol
  • affects judgement and reasoning
  • slows down reactions
  • upsets sense of balance and coordination
  • impairs vision and hearing
  • makes users lose concentration and feel drowsy.
DrinkAware note legal limits for alcohol in the breath as 35 microgram/100 
mL for England and Wales (80 milligram/100 ml in blood) and lower at 22 microgram/100 mL in breath for Scotland (50 milligram/100 ml in blood).

Cannabis use also increases driving risk in several ways and has, for example, been implicated in 1 in 4 RTAs in France.  Furthermore alcohol and cannabis are often used together and in combination can increase risk of a road traffic accident.

For recreational drugs, safety when driving may be impaired both during use and during drug withdrawal.  

Several commonly prescribed drugs are also expected to reduce alertness and lead to increased risk of road traffic accidents.

People who are having difficulty sleeping may already when awake have reduced ability to concentrate on key tasks, including driving. Poor quality of sleep combined with night sedation may  together reduce alertness further.

Other drugs may have sedative effects as a less obvious action – for example opiate like drugs used to treat pain.

Patients who are concerned about the effects of their prescribed drugs on their safety while driving should consult their pharmacist of medical adviser.

The Government's website notes that:
 'the new law provides a medical defence if you’re taking your medicine in accordance with instructions – either from a healthcare professional or printed in the accompanying leaflet – provided, of course, you’re not impaired.'

It also notes that:
'If you’re driving and you’re on prescription medicine, it may therefore be helpful for you to keep some evidence of this with you in case you’re stopped by the police.'

The following blood level limits for prescription drugs are noted to be:

‘Medicinal’ drugs (risk based approach) Threshold limit in blood
amphetamine 250µg/L
clonazepam 50µg/L
diazepam 550µg/L
flunitrazepam 300µg/L
lorazepam 100µg/L
methadone 500µg/L
morphine 80µg/L
oxazepam 300µg/L
temazepam 1,000µg/L


UK Government's drug driving website

Drug Driving: Guidance for Healthcare Professionals

DrinkAware website

Tuesday, 3 February 2015

Entries closed for the 2015 Hippocrates NHS Prize for Poetry and Medicine


Entries have come from throughout the UK for the £5000 2015 Hippocrates NHS Prize for Poetry and Medicine.

Poet Rebecca Goss, author, journalist and broadcaster John Humphrys and Psychiatrist Femi Oyebode will be Judging awards in the 2015 Hippocrates Prize NHS and Open Categories.

Shortlisted and commended poets will be informed by email and information about the shortlist and the commended entries posted on the Hippocrates Prize website. The winners in the 2015 Hippocrates NHS and Open Prize will be announced by the judges on Saturday 23rd May in London at the Hippocrates Awards ceremony.

There has been a dramatic increase in international interest in recent years in the interface between medicine and the humanities in general, and in medicine and poetry in particular.  The Hippocrates Prize has attracted interest from over 60 countries since its launch in 2009.

To find out more about medicine and poetry, see our article in the Lancet, and recent features in The New Yorker and Times Higher Education


See updates on:
entries for the 2015 Hippocrates Young Poets Prize
entries for the 2015 Hippocrates Open International Prize

Entries from over 30 countries for the 2015 Hippocrates Open Prize for Poetry and Medicine


Entries for the £5000 2015 Hippocrates Open Prize for Poetry and Medicine have arrived from over 30 countries:  Australia, Belgium, Bhutan, Canada, Costa Rica, France, Germany, Ghana, Greece, Holland, Hungary, India, Ireland, Israel, Saudi Arabia, Nepal, Netherlands, New Zealand, Nigeria, Norway, Pakistan, Phiippines, South Africa, Romania, Singapore, Sri Lanka, the UK, Ukraine, United Arab Emirates and the USA.

Poet Rebecca Goss, author, journalist and broadcaster John Humphrys and Psychiatrist Femi Oyebode will be Judging awards in the 2015 Hippocrates Prize Open and NHS Categories.

Shortlisted and commended poets will be informed by email and information about the shortlist and the commended entries posted on the Hippocrates Prize website. The winners in the 2015 Hippocrates Open Prize will be announced by the judges on Saturday 23rd May in London at the Hippocrates Awards ceremony.

There has been a dramatic increase in international interest in recent years in the interface between medicine and the humanities in general, and in medicine and poetry in particular.  The Hippocrates Prize has attracted interest from over 60 countries since its launch in 2009.

To find out more about medicine and poetry, see our article in the Lancet, and recent features in The New Yorker and Times Higher Education


See update on entries for the 2015 Hippocrates Young Poets Prize.

Monday, 2 February 2015

Entries from 11 countries for the 2015 Hippocrates Young Poets Award for Poetry and Medicine

Entries for the £500 Young Poets Award in the 2015 Hippocrates Prize for Poetry and Medicine have arrived from Australia, Canada, England, Nepal, Nigeria, Scotland, Singapore, South Africa, Sri Lanka, Ukraine and the USA.

The 2015 Hippocrates Young Poets Award will be judged by distinguished poet Simon Rae.

Shortlisted Young Poets will be informed by email and the shortlist posted on the Hippocrates Prize website. The 2015 Hippocrates Young Poets Prize will be announced in London at the Hippocrates Awards on Saturday 23rd May.
2015 Hippocrates Young Poets judge Simon Rae


Simon Rae is a poet, biographer, broadcaster, playwright and novelist. He presented Poetry Please! on Radio 4 for many years and wrote rude poems about politicians for the Guardian newspaper for even longer. In 1999 he won the National Poetry Competition after twice coming runner-up. His collection, Gift Horses, was published in 2006. More recently he has written three novels for younger readers, Unplayable, Keras and Medusa’s Butterfly, and his first detective story, Bodyline, comes out in spring 2015.

He presented Radio 4's Poetry Please for five years and wrote a regular topical poem for the Saturday Guardian for ten years. His most recent book of poems was Gift Horses, published in 2006 by Enitharmon Press.

The winner in the 2014 Hippocrates Young Poets Prize was Conor McKee from Sidney Sussex College Cambridge for his poem I Will Not Cut for Stone.

The winner in 2013 of the inaugural Hippocrates Young Poets Prize was Rosalind Jana from Hereford Sixth Form College in England, for her poem Posterior Instrumented Fusion for Adolescent Scoliosis.

There has been a dramatic increase in international interest in recent years in the interface between medicine and the humanities in general, and in medicine and poetry in particular.  The Hippocrates Prize has attracted interest from over 60 countries since its launch in 2009.

To find out more about medicine and poetry, see our article in the Lancet, and recent features in The New Yorker and Times Higher Education.  


See update on entries for the 2015 Hippocrates Open Prize for Poetry and Medicine.

Thursday, 15 January 2015

2015 International Hippocrates Prize for Poetry and Medicine - deadline 31st January

Poetry and medicine features as the theme for an excellent review by Alastair Gee in this week's issue
of the New Yorker. His article ranges from discussion of historical use by Arab physician Avicenna of poetry to aid learning in his treatise medicine – to current interest by medical journals in publishing poetry on their areas of special interest.

The Hippocrates Prize for Poetry and Medicine features in the article, at £5000 (~USD 7,500) the most valuable international award in the world for an unpublished poem.

Entries have already been received from 20 countries, from Australia to the USA, for the 2015 awards, for which the closing date is 12 midnight GMT on 31st January.

There is also a further £5000 first prize for the Hippocrates NHS prize for the poetry and medicine and £500 for the Young Poets award.

Judges for the 2015 Hippocrates Prize Open and NHS Categories are Poet Rebecca Goss, author, journalist and broadcaster John Humphrys and Psychiatrist Femi Oyebode.

Enter the Hippocrates Awards online

More about the Hippocrates Awards

Read the New Yorker article

Sunday, 4 January 2015

What works as healthy lifestyle for losing excess weight?

A good time to get weight in trim? New Year is a familiar time for people to make resolutions and aims to improve lifestyle.
However advice on how to lose excess weight may be confusing and contradictory. Here is some helpful information on why overweight may be unhealthy and what works to help to reduce overweight.

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? 
What works best is to combine increased activity with reduced energy intake – much more effective than either approach on its own.
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.
 
Apps
 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.

Updated from an earlier post in December 2011 © DRJ Singer
@HealthMed  

Tuesday, 30 December 2014

Keeping weight in check - does the weight of the adviser matter?

A wide range of advisers - from family doctors to pharmacists - can be effective in providing lifestyle advice aimed at reducing risk of serious diseases of the heart, brain and circulation - including advice on diet and exercise aiming to help with weight loss.
However a new study, organised by the Royal Society for Public Health, suggests that people seeking advice on weight loss are less likely to take it seriously from someone who is overweight, whether from a health professional or another source, including hairdressers and celebrities.
In response to this report, the Royal Society for Public Health is recommending that NHS staff not only advise 'do what I say'  but also 'do what I do' when it comes to advise on weight loss – ie NHS staff and others involved in advice on reversing overweight should be aware of the importance of acting as role models to help the public at risk to engage in losing weight.
A major challenge for the NHS as "more than half its 1.3 million-strong workforce, are estimated to be overweight or obese".

See more on the study

Wednesday, 24 December 2014

Call for papers for 2015 International Symposium on Poetry and Medicine and Hippocrates Awards

Registration is open for the 6th International Symposium on Poetry and Medicine to be held on Saturday 23rd May 2015  in London. The symposium will include poster sessions, lectures, round table discussions and poetry readings (by former President of the Poetry Society Jo Shapcott and 2012 Hippocrates Awards judge Marilyn Hacker). The 2015 Hippocrates Open International, International Young Poet and NHS Awards will be announced at the end of the Symposium

The programme includes sessions on historical and contemporary themes, illness and poetry, poetry as therapy, poetry in the education of medical students, nurses and doctors, and poetry as an aid to health professionals..

Abstract submission is open - deadline 31st March 2015.
 
The Hippocrates initiative was named winner of the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards, announced on 24th November 2011 in London. This award aims to recognise the collaborative and interdisciplinary work that is taking place in universities to promote the arts. 
The deadline for entries for the 2015 Hippocrates Prize for poetry and medicine, which is for unpublished poems in English, is 12 midnight GMT on 31st January 2015.  

The Hippocrates poetry and medicine initiative has been supported by the Fellowship of Postgraduate Medicine, the Wellcome Trust, the Cardiovascular Research Trust, Heads, Teachers and Industry, and the National Association of Writers in Education. 
In its first 5 years, the Hippocrates Prize has attracted over 6000 entries from 61 countries, from the Americas to Fiji and Finland to Australasia.
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 each category there is also a 2nd prize of £1,000, 3rd  prize of £500, and 20 commendations each of £50.  
The judging panel for the 2015 Hippocrates Awards for Poetry and Medicine comprises poet Rebecca Goss, BBC broadcaster and author John  Humphrys poet and psychiatrist and poet Professor Femi Oyebode.

Wednesday, 17 December 2014

Digital Health: Catapulting Personalised Medicine Forward

In a new collaboration, on 27th November 2014 the UK’s Digital Catapult, the Fellowship of Postgraduate Medicine, IDEALondon, and Vital Transformation brought together leading experts working at the frontiers of research where personalised medicine and medicines, and health technologies intersect.
 
Round table sessions featured demonstrations of how next-generation technologies and social media will integrate with public health, thus facilitating the burgeoning market for personalised medicines. The symposium included disruptive start-ups and technology practitioners finding common ground in bringing secure personal health data to the public and advice on stratified medicines to prescribers and their patients.
 
The Digital Catapult, launched in November 2014, aims to place electronic and mobile technologies at the forefront of their future public health strategy. 

Publications arising from the symposium will be published in the FPM journal Health Policy and Technology.