MPs say cuts are "false economy" in drive to improve poor people"s health

MPs are calling on the prime minister to fulfil her pledge to end the “burning injustice” of shorter lifespans for the poor by boosting public health, after the missed opportunity of the childhood obesity strategy.

But the health select committee is saying in a hard-hitting report that cuts to public health funding since responsibility was handed to local authorities in 2013 will make this more difficult. Cuts are “a false economy”, because keeping people healthy in their communities protects the NHS from the expensive consequences of treating diabetes, heart disease and other chronic illnesses in times to come.

Dr Sarah Wollaston, Tory chair of the committee, said people were rightly scathing about the government’s recent watered-down childhood obesity strategy, which “demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing”.

“Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims.”

Speaking to the Guardian, she said people were “hugely disappointed because it was the opportunity to signal intent that this wasn’t going to be business as usual”.

Wollaston added: “People were hugely encouraged by Theresa May’s words and determination. I don’t doubt her intent. What I feel is now at risk is that the people who are going to be tasked with making a difference won’t have the tools to do the job, and at a time of shrinking health budgets it’s even more difficult for them to narrow health inequality.”

Although the childhood obesity figures appear to be levelling off – with about a third of kids overweight or obese by the time they leave primary school – the truth is that the change is in the children of affluent families. The gap between rich and poor children is widening.

“Childhood obesity is this huge future growing disaster not only for these individual children but for the NHS in terms of costs from managing type 2 diabetes,” Wollaston said.

She urged the government to listen to the criticism and act. Linking public health to planning and licensing applications, thereby allowing local authorities to say no to more fast food outlets and off-licences, “would send a very strong signal”, Wollaston said.

She believes the government should also rethink the absence of restrictions on advertising and marketing junk food to children. “There’s nothing there about advergames – the deliberate targeting of children where they think they are playing a game when they are actually having stuff flogged to them. And [it’s] particularly disappointing that there was nothing about the saturation advertising to children and the use of cartoon characters,” she said.

“There was very clear evidence that Public Health England presented about impulse purchases and pester power and end of aisle displays and checkout displays. Everyone recognised that it wasn’t just a single hit here. You had to look at it across the board, yet whole tranches of public health messaging are going to be undermined by the fact that advertising hasn’t been touched at all.”

Funds to local authorities for public health were slashed by £200m last year and more cuts are to come. The report says this is short-sighted and talks of “a growing mismatch” between spending on public health and the significance attached to prevention in NHS chief executive Simon Stevens’s plan. Keeping people well and out of hospital is fundamental to the sustainability of the NHS in his plan.

The report calls for a Cabinet Office minister to be given responsibility for embedding the interests of health in every government department, a proposal welcomed by the Royal Society for Public Health. “A ‘health in all policies’ approach is key to addressing wider determinants of health and health inequalities, such as housing, education and employment, and enhanced cross-departmental working at a national level will help enable this,” said Shirley Cramer, its chief executive.

The Kings Fund agreed. “The government’s weak plan on childhood obesity underlines the need for a minister at the centre of government to coordinate public health policy across departments but, more importantly, to hold departments strongly to account for their actions. Funding reductions are already resulting in significant cuts to key services such as sexual health services and support for people who want to stop smoking,” said David Buck, senior fellow, public health and health inequalities.

Prof John Middleton, president of the Faculty of Public Health, said the report “demonstrates the false economy of cutting local authority public health budgets because of the added pressures this puts on NHS resources. Councils in England have worked extremely hard for many years to maintain the services they offer their communities with reduced funding. Nevertheless, sexual health services, drug treatment clinics and other health services funded by councils have been hit hard by these cuts.”

MPs say cuts are "false economy" in drive to improve poor people"s health

Brains and bone saws: a day with the chief medical examiner of New York City

The smell in the autopsy room is indescribable. It lingers on your clothes and in your hair long after you leave. Staff are constantly cleaning the linoleum floors and wiping down every surface with harsh disinfectants. But if anything, it adds to the uniquely acrid odor.

You never get used to the smell, says Jennifer Hammers, deputy chief medical examiner for Kings County, New York – but you do get beyond it.

I’ve been allowed a privileged glimpse at a regular Wednesday in the Brooklyn office of the Chief Medical Examiner of New York City. The office is one of the busiest of its kind in the country.

Around 70,000 people die in New York City each year, and about 8,000-9,000 of them end up at the medical examiner, requiring further investigation. Of those, 5,000 are autopsied.

Barbara Sampson, Chief Medical Examiner of New York City Photograph: Ben Zucker for the Guardian

Only the lonely

In the basement, the staff are hard at work in the autopsy suite, carefully examining the bodies and photographing relevant organs for their reports.

Most cases brought to the medical examiner are not crime related. In a city of over 8 million people, with many immigrants and transplants from other parts of the country, there is no shortage of the lonely.

Of the seven bodies brought in today, three have died alone in their apartments. In the summer, without air conditioning, it can take as little as two days before the smell of a body causes neighbors to make a call.

One gentleman found alone in his home is now lying before me on a steel gurney. James Daniels, a lead forensic mortuary technician, is carefully removing the scalp before cutting the skull with a bone saw so the brain can be examined for any signs of aneurysm, stroke or other potential causes of death.

An examination table in the “decomposition room” Photograph: Ben Zucker for the Guardian

Over 60 forensic mortuary technicians like Daniels work in New York City. While the 31 medical examiners in New York City are all highly trained physicians who completed special fellowships, technicians don’t have any educational requirements.

Typically, technicians join when they are young and only have a high school education. They learn the intricacies of their job on site. Without them, the office would cease to function. They are the ones dispatched to collect the bodies for autopsy. They are often the first people from the office a family encounters when grieving.

Being the doctor’s doctor

In addition to the medical examiners, there are x-ray technicians who scan for bullets and broken bones; DNA and toxicology laboratory staff; consulting dentists for matching dental records for identification; anthropologists who specialize in discovering the race, age and height of skeletal remains and figuring out what tools caused blunt force traumas; mortuary technicians who assist with autopsies; a variety of administrators; death scene investigators; and professional photographers who take careful photos of every autopsy for detailed record keeping.

One of the photographers on staff also takes professional photos of food, Hammers tells me with a smile.

While the doctors examine the body and determine the cause of death, the technicians do a lot of careful and very skilled cutting to assist them. They also clean the bodies after the autopsy is completed, making sure that it is in a pristine state when handed over to a funeral director.

For Daniels, who started with the Office of the Chief Medical Examiner as a young man in 1989, it was an unexpected career choice, as he hated the idea of being around dead bodies and avoided funerals entirely.

Most of the medical examiners, on the other hand, said they always loved the idea of solving a mystery, of being “the doctor’s doctor”. They wanted to be the ones to determine the real cause of a death or diagnose a pathology.

Nadia Bissette-Dolor, who works in the Office of the Chief Medical Examiner of New York City, stands by a window used by families to identify bodies of the deceased. She says family members rarely ask to view the body, but a small number do. Photograph: Ben Zucker for the Guardian

Daniels had a more pragmatic reason for joining the office: he needed a job, and working for the city meant stable employment. When he first started, he dreaded touching bodies and entering strangers’ homes. It was fear of the unknown, he explains. But these days, working as a lead technician, there is little left unknown when it comes to the dead.

Daniels was on the job during 9/11. He also responded to Flight 587, which crashed in Queens in November 2011, killing everyone on board. That time created his worst memories of the job. But it also gave him the greatest sense of the work’s importance: none of those families would otherwise have had closure. He now “loves the job”, he says.

The case that hits home

No matter how long they have been working at the Office of the Chief Medical Examiner, and how many bodies they have seen, everyone has a case that hits home.

For Barbara Sampson, the chief medical examiner for New York City, it was a 9/11 case. The terror attack on 9/11, which Sampson refers to as the biggest homicide in US history, was a difficult time for all of the staff at the office. They worked round the clock to identify bodies, and the images they saw still haunt most of them fifteen years later.

Identification often had to be done from DNA analysis of fragments of remains and is still ongoing as new DNA techniques are discovered.

One particular case sticks out for Sampson: a Belgian man who died during the collapse of the World Trade Center towers. His parents were elderly, and while they knew that he had died, without official scientific confirmation, they could not get closure. His remains had not been identified. They were afraid they would pass away never having his death confirmed.

Two years ago, Sampson’s office was able to identify the Belgian man’s remains through DNA analysis. “I had the honor of telling them we had found their son. That was one of the most incredible experiences of my life,” she says. Thirteen years after 9/11, the parents could finally put their son to rest.

The desk of the Deputy Chief Medical Examiner Photograph: Ben Zucker for the Guardian

For Aglae Charlot, an elegant senior medical examiner with a pronounced French accent who has worked at the office since 1987, it was a teenage girl who came in a few years back. The girl died in the hospital of an unusual illness, from which her mother also suffered. The illness can be idiopathic or caused by Aids. The hospital had assumed it was idiopathic since the mother had the same illness.

When Charlot investigated, she found the teenager did actually have Aids, which she must have been suffering from for five or six years.

Upon further investigation, she discovered the mother’s boyfriend had died of Aids.

Infecting a child and causing her death is murder, she explains to me, her jaw tensing. Charlot knew she could probably trace the particular strain of Aids back to the boyfriend, but what would it change? He was dead, so could not be charged, and it would only cause more pain for the living. She put Aids as the cause of death on the certificate, and left it at that.

Seeing the lighter side

“We all have an odd sense of humor,” says Christopher Brock, a bearded young medical examiner sitting in front of a file cabinet covered by photos of his wife and two young children. “We are often smiling, and I think you have to when you are surrounded by this every day.”

In Hammers’s office, her crooked playfulness is on display in a framed, fake blood-spattered sign above her desk that reads: “Braainns.”

Humor can provide a release in an environment that is fraught with stress. “One of the things a lot of people don’t realize is that we deal with the living just as much as we deal with the dead,” says Brock. “We provide answers to families.”

Check out station at the morgue Photograph: Ben Zucker for the Guardian

Much of the week is spent performing autopsies, and the rest of it filling out paperwork, testifying in court and speaking with the families of the dead.

At a time when primary care physicians rarely have more than two minutes to speak with a living patient, it’s strange somehow that the medical examiners can spend hours explaining their findings to the families, comforting them and helping them deal with their grief.

“Every family really wants to know what happened to their loved one and have their questions answered in order to have closure,” says Hammers. “Even if it is a hard answer like in the case of a suicide, it wouldn’t be what they prefer to hear but it allows them to have an answer and then work their grief around that and move through it.”

As Brock puts it, when it comes to the deceased: “We are their last physicians.”

Brains and bone saws: a day with the chief medical examiner of New York City

Kids, sport, concussion, and the long lasting effects of minor brain injury | Pankaj Sah

Head knocks in childhood are by no means uncommon, yet they may have lasting negative effects. New research has found a link between concussion in childhood and adverse medical and social outcomes as an adult.

Researchers from the United Kingdom, United States and Sweden looked at data from the entire Swedish population born between 1973 and 1982 – some 1.1 million people – to analyse the effect of experiencing a traumatic brain injury in the first 25 years of life.

Compared to those who had sustained no injury, people who had experienced at least one traumatic brain injury in childhood – around 9% of those studied – were, as adults, more likely to die early or be treated for a psychiatric illness and receive a disability pension, and less likely to have completed secondary schooling.

At first glance, the findings seem unsurprising: common sense suggests, for example, that a child who has sustained severe brain damage in a car accident would encounter more educational obstacles than a child who hasn’t.

Accordingly, the study found that the more severe the brain injury, the worse the outcomes in adulthood (this was also the case for repeated brain injuries). But the research also found a significant link between concussion – the mildest and most common form of brain injury – and subsequent problems.

In the study, concussions comprised more than 75% of the childhood brain injuries recorded. The researchers found being exposed to a concussion, or mild brain injury, was associated with a 18%–52% increased risk of negative outcomes, including early death, low educational attainment, and being on welfare. The most marked increase in risk was found for psychiatric inpatient hospitalisation and the disability pension.

Traumatic brain injury occurs when the brain is damaged by external force such as a fall, car accident, assault or being struck by an object such as might occur during sport. It’s usually classified according to its severity, or based on the anatomy of the injury. Moderate to severe traumatic brain injury can result in irreversible structural damage to the brain, and in some cases death.

A concussion, on the mild end of the brain injury spectrum, results when force causes the brain to twist upon itself or strike the skull. Bruising and cell damage can occur, but any structural damage from the injury cannot be picked up by MRI or CT imaging, which can make diagnosis difficult. Using specialised imaging methods such as functional MRI (fMRI), however, changes in patterns of brain activity are apparent soon after a concussion.

Research shows even a seemingly innocuous knock that wouldn’t qualify as a concussion can trigger changes in brain physiology and affect the functioning of neurons. There is some evidence that repeated concussions could be associated with the development in later life of a neurodegenerative disease called chronic traumatic encephalopathy. More long-term research is needed to determine how permanent or reversible brain changes following a single concussion are.

The new study found an association between the age at first head injury and subsequent health and social outcomes. Children who were older, and particularly those who were older than 15, were substantially more likely to have problems in adulthood.

Although the study findings are yet to be replicated, the authors suggest heightened neuroplasticity – the ability of the brain to adapt and change its networks and behaviour – in younger years may be protective in the long term.

While there are still many unknowns when it comes to concussion, the latest findings point to the importance of minimising head trauma in childhood. Because children have weaker necks and torsos than adults, less force is needed to cause a brain injury. For toddlers and preschoolers, the study’s authors suggest improved parental supervision is key, as falls are the most common cause of traumatic brain injury for young children.

In older children, reducing the incidence of sports-related concussions may be trickier. Wearing hard helmets in sports generally reduces the risk of severe head injuries such as skull fractures and bleeding inside the skull, but is ineffective against the rotational forces – forces that cause the head to turn rapidly and the brain to twist on itself, as can occur with whiplash for example – that can cause concussion. There’s also no evidence that the soft headgear worn in some Australian football codes can protect against brain injury.

Many concussions occur without noticeable signs such as disorientation or slurred speech, and for that reason go undiagnosed. The danger of an unrecognised concussion on the sporting field – which predisposes a player to subsequent concussion – is that it increases the risk of lasting damage. The lack of awareness about the symptoms, treatment and management of concussion is an unrecognised public health problem.

The health benefits of sport are well established and should be supported. However, the nature of contact sports means that head knocks are sometimes unavoidable.

Given Australia’s strong sporting culture, the solution might not be to change the fundamental rules of these sports or prevent children from playing them. Rather, by investing in research and improving awareness at the grassroots level, we can improve the diagnosis and management of concussive episodes in kids.

This article was co-authored by Donna Lu, science writer at the Queensland Brain Institute, and was originally published on The Conversation. Read the original article.

Kids, sport, concussion, and the long lasting effects of minor brain injury | Pankaj Sah

Trial shows tantalising signs that new Alzheimer"s drug could benefit early-stage patients

A trial of a new Alzheimer’s drug has shown it could benefit patients in the earliest stages of the disease, raising hopes that a treatment for the devastating condition may finally be on the horizon.

While the trial was designed to assess the safety of the treatment and not whether patients fared better on the drug, an “exploratory analysis” of the data revealed that the treatment appeared to slow the mental decline of patients who responded to the therapy.

The small study of only 165 people with mild symptoms of the disorder found that a dozen monthly injections of the antibody aducanumab removed clumps of protein that build up in the Alzheimer’s brain.

A leading theory of the disease holds that the steady accumulation of a protein called amyloid-beta in the ageing brain kills off healthy neurons and brings about the memory and cognitive impairments experienced by Alzheimer’s patients.

In the trial, the strongest glimpse of mental improvement was seen in patients who had the highest dose of drug and who showed the greatest reduction in amyloid plaque proteins in follow-up brain scans. These patients did not worsen at all after six months of treatment. But the small number of patients enrolled in the study means that two much larger trials, which are now recruiting 2,700 patients in 20 countries, are needed to confirm whether the tantalising signs of benefit are real.

Alzheimer’s experts welcomed the results, but cautioned that it is too early to know whether the drug will be a help for patients. Other antibody treatments have looked impressive in early studies only to fail later on in larger trials.

Comparison brain scans, with amyloid beta protein shown in red. The different dosages of aducanumab being tested are shown on the right. Photograph: Ayres, Michael/Sevigny et al/Nature

John Hardy, a neuroscientist at UCL who first proposed that amyloid was a driver of Alzheimer’s disease, said: “It’s very interesting and nice to see all these positive data, and it has caused genuine excitement in the field, but it’s a very small number of patients and too small to draw any definitive conclusions from.”

The results from the trial led by the US biotech firm, Biogen, and a Swiss company called Neurimmune, are reported in the journal Nature. The data were first released at a scientific conference in March last year.

Aducanumab was hailed as a potential treatment for Alzheimer’s when scientists found the antibody in people who aged without suffering the sort of mental decline that goes hand in hand with old age. It appeared that the antibody prevented the build-up of amyloid plaques and staved off dementia.

When injected into Alzheimer’s patients, one or two in every thousand of the antibodies enter the brain where they latch on to wayward amyloid-beta proteins. Researchers at Biogen believe that other cells called microglia then arrive and clear the aberrant proteins from the brain. The drug appears to be most effective if the accumulation of amyloid protein is blocked before it causes too much damage. The process may start 15 years before people show symptoms.

In the latest trial, some patients experienced side effects. MRI scans showed a shift in the brain fluid that was more common at high doses and in people who carry the APOE type-4 gene, which is a major risk factor for Alzheimer’s disease. The scientists are now working on ways to avoid the side effect or diminish the problems by reducing the doses patients receive.

David Allsop, professor of neuroscience at Lancaster University, said the side effects will have to be overcome if the therapy is to find widespread clinical use. “Nevertheless, these findings could be a gamechanger if the effects on memory decline can be confirmed in more extensive follow-on studies.”

There are 850,000 people with dementia in Britain, a number that is expected to reach one million by 2025. Alzheimer’s is the most common form of the condition. “If this drug works, we’ll have a treatment for patients suffering from this devastating disease,” said Biogen’s Alfred Sandrock.

“These results provide tantalising evidence that a new class of drug to treat the disease may be on the horizon, said David Reynolds at Alzheimer’s Research UK.

James Pickett at the Alzheimer’s Society was similarly optimistic: “These results are the most detailed and promising that we’ve seen for a drug that aims to modify the underlying causes of Alzheimer’s disease.”

Trial shows tantalising signs that new Alzheimer"s drug could benefit early-stage patients

Junior doctors to stage five consecutive days of strikes in September

The British Medical Association has announced a new wave of strikes by junior doctors in England this month – the first since its members rejected the government’s final offer on their new contract.

Junior doctors are to stage five days of strikes with “full withdrawal of labour” between 12 and 16 September, the British Medical Association has announced.

There will be a full withdrawal of labour, including junior doctors working in emergency departments, between 8am and 5pm on the days in question.

The industrial action will further test the NHS, already said by trusts to be at breaking point due to increasing demand for services, staff shortages, and insufficient funding.

There have been five previous walkouts in the dispute, all this year. The longest lasted for two consecutive days, and the first all-out strike – including junior doctors working in emergency departments – was held in April. More than 100,000 operations and outpatient appointments have been cancelled as a result of industrial action to date.

In May a compromise deal was agreed between the BMA and Jeremy Hunt, the health secretary, but last month members of the doctors’ union voted against accepting it by a margin of 58% to 42%. As a result, Hunt is pushing forward with plans to impose the contract on junior doctors – those below the level of consultant – in October.

About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final- and penultimate-year medical students who were eligible to vote, took part in the ballot on the settlement.

Dr Johann Malawana, then chair of the BMA’s junior doctors committee, had recommended the revised terms and conditions as the best deal junior doctors could get, but resigned after the ballot results were announced, and was replaced by Ellen McCourt.

The Department of Health accused the BMA of putting confrontation before cooperation in order to score political points. A spokesman said: “As doctors’ representatives, the BMA should be putting patients first not playing politics in a way that will be immensely damaging for vulnerable patients. What’s more, the BMA must be the first union in history to call for strike action against a deal they themselves negotiated and said was a good one.

“Whilst there are many pressures on the frontline, funding is at record levels, with the highest number of doctors employed in the history of the NHS. Co-operation not confrontation is the way forward to make sure patients get the best treatment and the NHS is there for people whenever they need it.”

Junior doctors to stage five consecutive days of strikes in September

NYC subway exposes commuters to noise as loud as a jet engine

Hearing loss is normally associated with old age or years of touring in a rock band. But preventable noise-induced hearing loss is actually pretty common in the general population, affecting around 15% of Americans according to the National Institute of Deafness and Communication Disorders (NIDCD).

When that damage is done to the sensory hair cells in the ear, people can’t regenerate them, so the damage is permanent, explains John Oghalai, professor of otolaryngology at Stanford University and director of the Children’s Hearing Center at Lucile Packard Children’s Hospital Stanford. While there is ongoing research into finding ways to regenerate sensory hair cells and improve cochlear implants, there is no perfect solution to hearing loss right now, which makes the need to lessen our exposure to loud noise that much more important.

But when you live in a city, like the majority of US residents, it can be hard to avoid loud noise, between trains, buses, honking cars and the sound of millions of people living on top of each other.

To get a sense of how much volume many of us experience just by going to work or meeting a friend for a meal, I decided to measure the normal din that 8.5 million New Yorkers experience every day.

Since New Yorkers love to eat out – and the eateries in this city are notoriously loud – I measured the volume in two restaurants: a popular New Orleans style casual eatery in Brooklyn and a trendy Southern food restaurant in Manhattan during Sunday brunch.

During dinner time, the Brooklyn restaurant clocked in at 91 decibels. At the Manhattan brunch spot, the noise level varied between 92 decibels as people strained to be heard above the reggae music, to a low of 72 decibels with UB40’s 1980s hit Red Red Wine, which allowed everyone to shout a little less.

For comparison, a food blender registers at around 90 decibels. Imagine dining out as a blender is going off at the next table.

According to the Occupational Safety and Health Administration (Osha), exposure to 90 decibels risks damaging hearing after eight hours, so each time the waitstaff pull a long shift, they may be causing damage to their ears.

What constitutes too loud is up for debate. The Osha permissible exposure limit is 90 decibels for all workers for an eight-hour day. But there is no way to determine the exact volume at which most people would develop hearing loss without actually exposing people to hearing damaging levels of noise on purpose, which would be unethical. The National Institute for Occupational Safety and Health has found “significant noise-induced hearing loss” at the levels permitted by Osha.

Sometimes, dining out in Brooklyn can be hazardous to your long term hearing. Photograph: Bloomberg/Bloomberg via Getty Images

Even if New Yorkers can avoid loud restaurants, 5.7 million people travel by subway each weekday. While the noise inside a subway car is only 75-85 decibels – provided no one is shouting and there are no performers – the noise of a train passing the station is another matter. In Times Square, one of the busiest subway stations in the city, the noise level ranges from 80 decibels to 96 decibels when the express trains barrel through the station.

Other stations measured, including the 86th street station on Manhattan’s Upper West Side briefly hit an ear-splitting 101.9 decibels.

The eastbound trains at Union Square, another popular station, registered in at around 95 decibels, as New Yorkers and tourists alike looked pained and covered their ears with their hands. For perspective, 100 decibels is also the volume of a power lawn mower or a jet taking off at 305 meters.

Most of us try to spend as little time in subway stations as possible, and MTA employees wear hearing protection, but anyone who commutes in the city easily spends 15-30 minutes, five days a week listening to industrial-level noise while waiting for their train to pull in.

Everyday city noises are impossible to avoid but there are a few things people can do to help stave off hearing damage. It can be a good idea to use foam earplugs if you are stuck waiting for the express train. The same rule applies to loud concerts, says Oghalai.

For headphones, there is a simple rule: if you can hear someone else’s music when they have them on, the volume is too loud, Oghalai says. For eating out, there are now noise ratings included in many restaurant reviews.

Companies like Apple provide a function to limit the maximum volume on their devices if you are concerned as well.

From daily commutes, to eating out, to sitting in your apartment and hearing the honking of cars from a sixth-story window when the mailman blocks the street below with his van (a robust 83 decibels), New York is full of noise no matter where you go.

But for those lucky enough to escape, there is somewhere nearby they can go for quiet. In the suburbs, the sound inside a house in upstate New York with the soothing hum of central air and two elderly dogs wheezing in the background is a relaxing 33 decibels, just above the volume threshold for rustling leaves.

NYC subway exposes commuters to noise as loud as a jet engine

Can social media help maternal mental health?

She irritates your parents. She baffles your grandparents. The preoccupied young mum feeding, with one hand, organic sweet potato puree to her eager eight-month-old, and checking her Facebook notifications with her smartphone in the other. A stereotype which would pass for a member of the Modern Tribe and one I’m sure you already recognise. Perhaps she is closer to yourself than you would like to admit.

To say that parents will have to adjust to a new way of life when they have a baby is perhaps the most cliched of all understatements. Social contact becomes less face-to-face due to the physical and logistical challenges a new baby brings. Leaving the house for a simple errand becomes a near military operation incorporating sleep schedules, changing supplies, feeding equipment. A spontaneous evening out to the cinema with friends? An impossibility. Text messages become almost nostalgic, phone calls time consuming and social media quickly fills the social void for the new parent, who is likely to be surviving on caffeine, chocolate and very little sleep.

Connecting with people via social media is immediate, with responses often instant. Positive replies can become an addictive gratification, bringing confirmation of the image people want to project of themselves, be it intelligence, charisma or wit. Social media offers an uninhibited space in which people can express themselves freely, bringing with it the bounty of validation of who they are, where they fit within a social circle and their place within a community. Arguably, this is the essence of good mental health and is particularly pertinent when talking about women – and men – when they have a baby.

The elephant in the nursery

Although social media presents an opportunity to make a connection with other new parents who, reassuringly, may be going through the same uncharted newborn territory, it may reveal the elephant in the nursery. The pressure to appear as the perfect parent is omnipresent online, and these platforms are particularly unhelpful when they present the Hollywood edit of parenthood. Carefully crafted sepia-toned Instagram glimpses of yoga mum or zen dad may actually disguise a multitude of imperfect truths. Research has found there are many barriers to disclosure of perinatal mental health problems including embarrassment, stigma and “failure at being perceived as not coping”. What role does social media play in facilitating this unhelpful undermining of confidence and capability of a new parents? Is social media a witness to the development of perinatal mental health problems or a sly accomplice?

My interest in the relationship between social media and maternal mental health has developed during the five years I have been working as a GP, as well the last 18 months working as a clinical fellow for the Royal College of General Practitioners (RCGP). Despite mental health problems during the perinatal time affecting one in five women and one in 10 men, only 50% of these cases are identified, meaning many people are struggling on without receiving appropriate treatment they need. The RCGP is working to raise awareness on these issues, and social media has helped in many of these projects such as #MumTalk in conjunction with Sport Relief , open access e-learning modules in conjunction with Health Education England and most recently the Perinatal Mental Health Toolkit which was launched in July 2016 on the RCGP website.

The toolkit offers more than 300 free resources to help professionals care for those directly affected, as well as information for women who are affected. Social media has helped recruit women with lived experience to contribute in this important work, as well as sharing links across the healthcare online global community.

Shared support

Through this role, I have met many inspiring women who show courage and conviction in telling their stories on blogs, such as Laura Clark @butterflymum83 and Eve @littlemissevec. In sharing their recovery narrative so eloquently, they encourage others to come forward and seek help. There are also Twitter discussion groups, the most established of which is the brilliant #PNDHour (weekly, Wednesdays 8-9pm), which is run by Rosey @PNDandMe and recently hosted by Laura @cooksferryqueen, both of whom have had postnatal depression. This platform in particular is unusual in that health professionals are welcome to contribute – the voice of a woman with expertise through her experience is considered equal to that of a professional expert by training, and both groups can learn much from each others’ contributions. Misconceptions such as “I thought it meant I was a bad mother” and “I didn’t think I could take antidepressants if I was breastfeeding” are commonly challenged, and damaging myths debunked.

However, there is a risk that professional boundaries of the doctor/patient relationship become blurred and less visible to both parties, with unintentional consequences possible. This should not discourage GPs from contributing to these forums but the principles guiding their practice in the consultation room should be maintained on line, as discussed in the RCGP Social Media Highway Code,including respecting privacy, treating others with consideration and maintaining confidentiality. This is in addition to a general consensus within the profession that social media is inappropriate for giving personalised medical advice on an individual basis.

Peer support or trigger trouble?

Another innovative development of digital technology in mental health is online peer support groups. These are often quoted by women with lived experience as an important part of their recovery. One of the most established of these is the one run by the charity Action of Postpartum Psychosis . Importantly, these groups need moderators who have access to training and clinical supervision so they can redirect someone to seek medical help when appropriate and moderate any unhelpful or unkind behaviour from those participating. This kind of forum may carry “trigger warnings”. Triggering is a fairly new phrase for a familiar concept of bringing up negative emotions or memories from other people’s words and is also something to be considered when discussing mental health online. Trolling or cyberbullying, misinformation and misdiagnosis are all potential risks from using social media to discuss maternal mental health. But the prospect of reaching so many women who are socially isolated, facing self-stigma or just living with undetected illness and encouraging them to come forward is a persuasive argument for exploring this area further.

Social media has been a great driver for recognition of Perinatal mental health,raising professional and public awareness and influencing policymakers and commissioners – most recently future investment from NHS England has been promised. The full benefit of the public and healthcare professionals using social media in the ways described here are only just becoming apparent and are yet to be fully understood, with a quality evidence base slowly developing. So whilst social media is far from a panacea in terms of helping women facing perinatal mental health problems, there is great scope for health professionals to further exploit its full potential.

References:

Khan L. Falling through the gaps: perinatal mental health and general practice. 2015; London: Royal College of General Practitioners and Centre for Mental Health.

National Institute for Health and Care Excellence. Clinical Guideline 192. Antenatal and postnatal mental health: clinical management and service guidance. 2014; London: NICE.

Can social media help maternal mental health?

Astronaut coffee and DIY heart surgery – Designs of the Year unveiled

David Bowie’s final album cover, a build-your-own robotic surgeon and a coffee cup that allows astronauts to drink in space are among the Designs of the Year, a 70-strong lineup of ingenious innovations that will be exhibited at the Design Museum’s new home in Kensington from 24 November.

Launching the museum’s west London incarnation, housed in the concrete tent of the former Commonwealth Institute on the edge of Holland Park, the exhibition will join a new permanent collection, on show for the first time in the institution’s 27-year history – some of this year’s highlights might one day join the anglepoise lamp and the Eames plywood chair in the design canon.

But the exhibition does more than scout out the next design icons. Holding up a mirror to the creative industries, Designs of the Year is an annual barometer of the design world’s preoccupations, anxieties and dreams – as well as a reminder of its conscience, with a welcome emphasis on useful problem-solving, rather than luxury sofas.

Following a period of unprecedented global migration, responses to the refugee crisis loom large on the list this year. A simple icon-based communication system designed to illustrate first aid kits and provide clear way-finding in refugee camps features alongside Ikea’s contribution to the crisis in the form of a flat-pack shelter, made from lightweight insulated panels that clip on to a simple frame. It’s a step up from the usual tents, though the design has yet to be perfected: the city of Zurich had to return 62 of the cabins it had ordered to house asylum seekers after tests showed the enclosures were “easily combustible”.

Pictograms from Buero Bauer’s first aid kit for use in refugee camps Photograph: Design Museum

They could have done with the expertise of Design that Saves Lives, a structural assessment methodology created by Arup engineers that will also feature in the exhibition, developed in response to the collapse of the Rana Plaza textile factory in Bangladesh in 2013, which killed 1,100 workers. Now adopted across the country, the assessment process has seen around 4,000 similar factories surveyed and upgraded to prevent such disasters in the future. Like many other projects on show, it is design as strategic process, rather than the creation of a final photogenic product.

The sleeve design for David Bowie’s Blackstar. Photograph: Design Museum

Alongside humanitarian interventions, the shortlist also reflects the ongoing interest in open-source, DIY “maker” culture and crowdsourced design, as designers continue to bypass conventional routes to manufacture and consumers demand an increasing say in how their products are made.

Inspired by the publishing trends, three Royal College of Art graduates have developed an on-demand clothing company, Unmade, allowing people to order customised garments at the click of a button. Using digitally coded knitting machines and a simple online interface of adjustable graphic patterns, every item is made to order, yet sold at a similar price to mass-produced high street clothing.

Fellow RCA graduate Frank Kolkman has taken the DIY approach a few alarming steps further with a speculative project that imagines a future of robotic keyhole surgery in the home. Kolkman was inspired by the gruesome discovery that some Americans without health insurance are using YouTube to share videos in which they perform medical hacks on themselves as an alternative to professional care.

The OpenSurgery domestic surgery theatre. Photograph: Juuke Schoorl

His project, Open Surgery, follows self-care culture to its ultimate conclusion, with a series of open-source robots made from 3D-printed and laser-cut parts, combined with hacked surgical components bought online. Although still requiring a surgeon to operate it remotely, the machines could theoretically be replicated almost anywhere at a fraction of the cost of commercial surgical instruments. A heart bypass from the comfort of your armchair?

Meanwhile, a pair of south London councils, working together with the NHS, have a slightly more down to earth application for self-care in the home, in the form of SH:24, an online sexual-health testing service. Freeing up clinical capacity to deal with more complex cases, the service allows people to order free home sampling kits for chlamydia, syphilis, gonorrhoea and HIV, send them back to the lab and receive results by confidential text message.

The Lumos bike helmet, displaying a left-turn signal. Photograph: Max Wagenblass

The transport category is also brimming with clever inventions, including a crowdfunded light-equipped bicycle helmet with a built-in accelerometer, providing automatic brake lights and turning signals, a super-light e-bike, and Gogoro, an electric scooter sharing scheme in Taipei. Structured around quick battery-swapping stations, avoiding lengthy recharging times, Gogoro has been hailed as a gamechanger, with the potential to do for scooters what Tesla did for cars.

A winner will be selected in each category – architecture, digital, fashion, graphics, product and transport – and the overalldesign of the year will be announced on 26 January 2017.

• Beazley Designs of the Year will be at Design Museum, London from 24 November to 19 February.

Astronaut coffee and DIY heart surgery – Designs of the Year unveiled

From a German doctor to a Dutch nurse: Europeans playing a vital role in the NHS

Some 57,000 Europeans are employed by the NHS, and their position has looked increasingly uncertain since Britain voted to leave the EU. It’s an issue highlighted by the Institute of Public Policy Research, with the thinktank warning that the health service could collapse if those European workers left the UK. Chris Murray, who compiled the report, said: “It is critical to public health that these workers do not seek jobs elsewhere. All EU nationals who work for the NHS, or as locums in the NHS system, should be eligible to apply for British citizenship.”

So, how do European nationals working for our health service feel post-Brexit? Six of them explain.

Spanish pharmacist

^{Ricardo, 38, Bournemouth: ‘I am not sure how the NHS will cope without Europeans’}
After Brexit, me and my wife started thinking of places to go: Spain, Scotland, Canada. My wife is Scottish and works in academia, so we need to find somewhere we could both work. I feel betrayed by the referendum vote, and in some ways it looks like we are going to be allowed to stay for as long as we are useful. This country has decided to shut its doors to globalisation – despite the fact that it’s here to stay.

In my department, more than 50% of the pharmacists come from the EU

Ricardo

I know not everyone voted for Britain to leave the EU because of immigration, but it played a huge part for a lot of people. It makes me feel unwelcome, but I like my life here: I have a great job and met my wife in Britain. My future here now seems very uncertain, which is a shame because Europeans are very important to the NHS. Just to give you an example: in my department more than 50% of the pharmacists come from the EU. Likewise, most hospitals have hired (or are hiring) nurses from Europe. I am not sure how the NHS will cope without us.

Nurse from the Netherlands

^{Helena, 52, Wales: ‘The way I feel now I am not sure I would even accept British citizenship’}
It has now been around two months since Brexit. At the moment I still feel like I am going through the five stages of grief: denial, anger, bargaining, depression and acceptance. Why should I have to apply for dual nationality and pay thousands to do so? I feel as though the goal posts have been shifted and I can no longer remain here on the same terms on which I arrived from the Netherlands in 1995. To be honest, the way I feel now I am not sure I would even accept British citizenship if offered it. I do not really feel welcome in the UK any more, and I am not sure if I will stay or go.

Shortly after the referendum result was announced my husband got a letter from the university where he works to say they would support EU-citizen-staff and family members who wanted to get permanent citizenship. I have not yet heard anything from my employer, despite being an NHS nurse for more than 14 years. Maybe EU nationals are not important, but this is surprising given the high number who work here. I know that without us the NHS would be unsustainable. There is no budget, investments and slack in the NHS to grow, develop and modernise. A few weeks ago, when I was back in the Netherlands, I had to accompany a family member to hospital and the healthcare service was so much better. It feels tempting to go back home.

Quality improvement officer from Germany
_{Chuck, 52, London: ‘With 20 years of experience in the NHS, I have a lot to offer this country’}

With 30 years of healthcare experience (20 of it in the NHS) I have a lot to offer this country. But I am one of many. We have nurses, doctors and therapists from all countries. Clinical innovation, for example, seems to be supported by high numbers of academic clinicians from Greece, Spain and Italy.

Even if we are being made to feel welcome at work, I no longer feel that welcome on on the streets

David

I am a German expat and have been living in Britain for the past two decades because I like the country, the people, the culture and the NHS. NHS executives have been very supportive and sent messages saying that European colleagues are valued, needed and welcome here. However, the government’s position is not clear, and my wife and I worry about changes in the public mood. Even if we are being made to feel welcome at work, we no longer feel that welcome on the streets. Because of this, we are thinking about leaving Britain. The referendum was the most painful reminder that I don’t have a vote in the country I live in and contribute to.

Doctor from Germany

^{Stephanie, 42, Portsmouth: ‘The UK can’t afford to loose more committed staff members’}

I am in the process of applying for a permanent residency card, which I require if I want to apply for naturalisation (the legal act by which a non-citizen in a country may acquire citizenship). However, currently the German government only allows dual citizenship if the other country is an EU country, and I don’t want to give up my German passport – hopefully I can sort it out before Article 50 is triggered. The whole process is so complex and expensive, however, almost as though it’s designed to put people off. I am a German GP and married to a British citizen. My son already has dual nationality and I feel this is my only option.

Although my primary degree is from a German university, I did my postgraduate and general practice training in the UK. There is a shortage of GPs at the moment, and Jeremy Hunt’s plan was to recruit 5,000 from abroad to solve the crisis. It is therefore vital that EU nationals working here as doctors are encouraged to stay. The UK can’t afford to lose more committed staff members.

Cardiologist from Austria

^{Daniel, 43, Surrey: ‘I feel upset that some of the people I treat want me out of the country’}

I am already looking for positions in other European countries. Despite the fact that I love my job, my colleagues and my patients, I do not feel that this is the place for my children to grow up. Their opportunities have been taken from them, and it only looks like things will get worse.

EU nationals are critical for the NHS. I come from Austria, and many of my fellow doctors come from all over Europe. We rely on nurses from across the EU, who are all highly qualified and motivated to do their work. The UK alone simply does not have enough trained staff to keep up with the needs of its citizens, and there are too few in training programmes. The staffing problems will just get worse.

I feel upset to know that some of the people I treat want me out of “their” country. I feel that they probably call me all sorts of names behind my back. We Europeans should all work together towards a brighter future for the whole world.

Surgeon from Austria
_{Peter, 35, Liverpool: ‘I will serve the NHS as long as I can’}

My plans, post-Brexit, are to continue serving the people of the UK via the NHS as long as the government allows me to. I would not take British citizenship now, however, if offered it. I was eligible for British citizenship 10 years ago, but I have no interest in giving up my own EU citizenship, especially after the referendum. I would not want to limit my access and rights of free movement in the EU. Working conditions in the NHS are in a steady decline, and many EU countries are opening their arms to fully trained doctors and nurses.

• Some names have been changed
  

From a German doctor to a Dutch nurse: Europeans playing a vital role in the NHS