Talking about death is a part of my work – I worry I say the wrong thing

I am a NHS hospital consultant and work in a healthcare team that specialises in the care of adults with cystic fibrosis (CF). This is a genetic condition that affects various organs, but primarily the lungs. It results in recurrent and severe chest infections that ultimately cause the lungs to fail. There have been considerable advancements in new therapies that we are hopeful will change the natural history of the disease. Nevertheless, it remains a life-shortening illness and coping with the death of young adults brings many challenges to the team that I work in.

Patients move to our CF centre when they are 18 years old. The doctor-patient relationship is a dichotomous and delicate balance of professional distance and empathy. But it does not fully guard against emotion when we see those we look after approach death. Over the years we develop bonds with our patients and their families and witness many life events. We share in their laughter and tears. Occasionally I am the focus, a patient recently said to me: “You’ve lost weight … you need to look after yourself better.” That made me chuckle.

Clinical care satisfies the needs of today, but research brings the hope for tomorrow

Patients strive to lead normal lives and I am frequently in awe of their achievements. Some of their journeys are truly Homeric in stature. But years of infections and damage to the lungs take their toll. The hope of a better tomorrow is a powerful support but the reality of declining health can dismantle the scaffold. Broaching these end-of-life conversations is often difficult as the words uttered can confirm patients’ fears.

It is so important to choose those words carefully as they can linger in the family’s memory. I remember one young 22-year-old woman who was not responding to treatment in hospital; her death was imminent. It was important for her to have some sort of control. I asked her: “You are in the driving seat now, what would you like us to do with your treatment?” She wanted to stop it, and I did. Some months after her death her mum called into the hospital and said: “Thank you for putting my daughter in the driving seat”. I’ve cherished those words.

Many patients now have young families of their own and the death of a parent is a traumatic experience. We arrange for our patients to engage with a specially trained counsellor to express their thoughts in words and pictures. A personalised memory book is produced, which includes advice for the future without them.

I’ll always remember the young girl, after losing a parent, who put her thoughts down in a letter. It was a remarkable achievement for one so young. She said the book helped her and reminded her of the parent she had lost. The presence and tactility of a book is tangible. A father whose son died wrote to me: “It is impossible to balance the awfulness of our heartbreak with the comfort that this book provides, but what is paramount is that it provides amazing comfort to us all.” Their letters are the most powerful I have ever read.

In the liminal transition from life to death a peace descends in the half light. I reflect on what I could have done differently. Should I have changed the treatment plan? Could I have phrased things a little better? Some parents have lost all their children to this disease and they have been made to endure grief that is simply unendurable. So when I go home at night my family are hugged that little bit tighter, as nobody is immune to loss. Death casts light on my own mortality and the impermanence of life comes sharply into focus.

In the following days and weeks we redouble our efforts. Clinical care satisfies the needs of today, but research brings the hope for tomorrow. It is so important to be part of that hope. I walk into the hospital ward to hear new stories and guide as best I can. It is an enormous privilege to do what I do.

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Talking about death is a part of my work – I worry I say the wrong thing

I worry I can"t be a good mother and a good doctor

I leave the house of my first home visit of the day – a middle aged businessman – and walk back to my car. I recall the heat of his skin on my hand, his yellow, sunken cheeks, his racing pulse.

An ambulance is on its way – I opted for the semi-urgent type, the type that comes within two hours, the type for people who are quite sick but not very sick. I wonder whether I should have chosen the very sick type, the one that races down the road, flashing blue lights and all.

A message lights up the screen of my phone – “I’ve found a button in her poo.”

I often ask myself the question: is it really possible to be a great doctor and a hands-on mother? I’m not sure it is

I think now of my two-year-old daughter. I picture her careering around the room at playgroup, biscuit hanging from her mouth and dribble falling from her chin. Then come the usual worries: is she really enjoying playgroup; is the childminder overly strict with her; does she eat too many biscuits and did she really eat a button? If I’ve chosen to be out at work, do I even have any right to tell the childminder how to look after her? At that age, maybe my daughter doesn’t even know I’m not there.

Back at the surgery, the waiting room begins to fill. Swimming round my head is an endless list of things I need to do that I will never have time to do: the patient cases I should be writing up, the audit I need to conduct, the extra out-of-hours shifts I must work, the exam I need to prepare for – all in order to complete my GP training. I try to forget the morning’s events so that I can prepare for the afternoon ahead. It’s important to give each patient the best version of me.

My pregnant bump presses against the edge of my desk and I feel the familiar kick in the ribs from the one inside. As if she’s saying: “Remember I’m in here, Mummy.”

I have just one week left before I go on maternity leave. I plan to take a year off and then return to work part-time. Already I am wondering how it will be possible for me to do this. It’s not that I don’t want to go back – I love my job – it’s just that I’m not sure it’s the right thing to do for my family. The cost of putting two children in childcare and the worry that I will miss out on their early years are my main concerns. Alongside this, the fact that I am still training means that I have extra work to do outside of my already very busy job. But if I don’t finish my training, all the years of work I’ve done will go to waste.

I often ask myself the question: is it really possible to be a great doctor and a hands-on mother? Personally I’m not sure it is – I feel like I am continually striving to achieve the impossible and never feel satisfied that I am doing either job well. To be a good doctor I need to invest time in keeping my knowledge up to date but simultaneously my two-year-old needs to be the focus of my attention. I know I am in a position of privilege; I have choices women historically would never have had and (potentially) a very rewarding career ahead of me, but it all feels too much.

It’s a dilemma women up and down the country face – to work, to stay at home or to do a bit of both. I have one friend who feels that it is important for her daughter to see her going out to work every day so that she can aspire to the same. I have another who has given up her career to be at home with her child.

For now I have decided that the best way for me is to accept things as they are, to manage my expectations of what I can achieve at both home and work and hope everything works out all right in the long run. I will try my best to forget work on the days I spend at home and to trust that my children are in good hands on the days that I’m not.

That evening, as I try to convince my two-year-old that her princess dress isn’t really suitable attire for bed, I think again of the yellowness of that man’s skin and the look of desperation in his wife’s eyes. I promise my daughter we’ll go for ice-cream in the morning if she will just let me put her pyjamas on. After all, I know only too well that life is short.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

I worry I can"t be a good mother and a good doctor

Glycemic Index And Glycemic Load: Should You Ever Worry About Them?

Should you ever be concerned about glycemic index or its glycemic load?

Low-carb diets, such as the Atkins, South Beach and Paleo will always emphasise the fact that high-glycemic foods raise your blood sugar and insulin, stimulating your appetite and promoting overeating and obesity.

Yet evidence now shows that glycemic index makes no difference to your weight and blood sugar levels.

What is the glycemic index?

The glycemic index (GI) measures the rise in blood sugar levels in a person over the two to three hours following the eating of an amount of food that contains 50g of carbohydrate.

Expressed as a percentage, the GI of pure glucose sugar is 100% while that of for instance of an apple is 39%.

Many mainstream nutritionists will tell you to eat foods that are low on the glycemic index for a more stable blood sugar level and to help heal health conditions, such as Candida and hypoglycemia.

But there is one big problem with the GI: it does not take into account the amount of carbohydrate in any particular meal.

So to make the GI more relevant to daily eating, the idea of the glycemic load or (GL) was introduced.

What is the glycemic load?

The GL figure is found by multiplying the GI of the food times the available carbohydrate content of a serving of that particular food and then dividing by 100.

So for example, a watermelon ranks as 72 on the glycemic index, which is classed as being high.

Taking a 100g serving size of watermelon, which has just 5g of available carbohydrates in it, its glycemic load or GL would be as follows: 72 x 5/ 100 = 3.6. So the GL is just 3.6 for a 100g serving of water melon.

So should eating certain foods with regards to them having a higher GI or GL values be of any concern to you and your health?

Well, the answer is no!

Let me explain why.

How quickly sugar enters the bloodstream is not actually the most important factor here and should not be something to be concerned about when eating healthy, natural, whole foods.

Why fruit is good for your healthy blood sugar levels

Another great aspect about the consumption of fruit is that it promotes the satisfaction of the appetite.

This is because the natural elevation of the blood sugar level after eating them is one of the key mechanisms that the human body uses to satisfy appetite and reduce food intake.

When you consume whole foods like fruits for example, they contain not only the carbohydrates that your body needs to be healthy, but also all the other nutrients essential to your health, including fiber.

Fiber slows down the absorption of sugar from the foods (whole fruits and vegetables for example) that you eat, into the bloodstream, which allows for the controlled and healthy release of the hormone insulin, that transports the sugar from your blood into your body’s cells.

Eating a healthy level of fat in your diet (but not high levels of fat) is also very important in this equation as it will allow for a healthy level of blood sugar to always be maintained.

It should be noted that dehydrated/dried fruits will contain much more concentrated sugars, which could cause blood sugar issues for some people.

The same goes with the drinking of fruit juices, which contain no fiber and so very quickly enter the bloodstream.

But for the average healthy person eating a healthy plant foods diet with plenty of fruit and low levels of fat in it, this should not be an issue.

The mistake low carb dieters and promoters are making is thinking that the GI and GL foods are actually relevant to a healthy way of eating.

At best the GI and GL are a nutritional curiosity and at worst a misleading and potentially health damaging way of looking at what foods we should or should not be eating.

If you want to live healthily and eat the best foods to support your body, then it is best to forget both the GI and GL and instead focus on eating healthy, natural whole plant foods together with a healthy level of fat in your diet.

This will naturally help bring you the health you deserve, including normal blood sugar levels.

There’s absolutely no reason to fear fruit!

About the author: Yulia Tarbath is a Certified Nutritionist at Rawsomehealthy, author, parent and international speaker with nearly 8 years of experience on a raw foods, vegan lifestyle. With over 70,000 followers around the world, Yulia and her husband Paul are authorities on living a balanced, nutritionally sufficient plant-based lifestyle. Through their videos, blogs, coaching and online programs, they are supporting both women and men around the world in cleansing and healing their bodies naturally, as well as achieving the shape and health of their dreams. Sign up to their FREE 5-day raw food menu plan here. 

References:

1. http://ajcn.nutrition.org/content/85/3/922.1.full


2. https://www.pritikin.com/your-health/health-benefits/healthy-weight-loss/536-glycemic-index-new-study-finds-popular-weight-loss-tool-worthless.html


3. https://www.sciencedaily.com/releases/2016/09/160907143112.htm

Glycemic Index And Glycemic Load: Should You Ever Worry About Them?

GPs should not worry about offending obese patients, finds study

GPs who raise the issue of their patients’ obesity in the surgery will not offend them and are likely to help them reach a healthy weight, a new study has shown.

Doctors are notoriously nervous of telling people they are overweight and worry that initiating any discussion will lead to a long, fruitless conversation about failed diets and eating habits that will go on long beyond a 10-minute consultation.

But a trial of a 30-second intervention in which the GP suggests the patient’s weight may be affecting their health and offers them a place on a weigh-loss programme reveals advice can make a major difference, according to research published in the Lancet medical journal.

More than 130 GPs who took part in the trial, involving more than 1,800 patients, were asked to start a conversation that might go like this:

GP: While you’re here, I just wanted to talk about your weight. You know the best way to lose weight is to go to [a weigh-management programme such as Slimming World or Rosemary Conley] and that’s available free on the NHS?

Patient: Oh?

GP: Yes, and I can refer you now if you are willing to give that a try?

The patients were randomly assigned to be offered either an NHS-funded place on a 12-week weight-management programme or advice to lose weight. The researchers found that 77% of those offered a weight-management programme said yes, and 40% went to all the sessions. At the end of a year, those people had lost 2.43kg (0.38 stone) on average, while those given advice by the GP had also lost weight, but less, at an average of 1.04kg.

Prof Paul Aveyard from the University of Oxford, who is a practising GP, said GPs do not talk to patients about their weight unless that is the reason they have come to the surgery. “We weigh people and that’s it. Whereas with smoking, every time we see them, once a year, we have to tell them effective ways to stop smoking,” he said.

Trials from the 1970s had shown that if GPs tackled people about smoking, they were more likely to quit. But this is the first study to see whether it works in obesity too, he said.

“GPs worry a lot about offending people. It is a very personal thing. Secondly, they do worry that the conversation will go on a long time and not actually lead anywhere,” he said.

There was also the wish not to take on one more of society’s ills, Aveyard said. “The GP might easily say this is more than my job is about,” he added.

Although weight management programmes can be prescribed for free for those who need them on the NHS, patients are usually left to make their own arrangements. In the trial, patients left with a voucher and an appointment for the first of their 12 free sessions. More than half went to practically all of them, said Aveyard.

The average BMI of those in the trial was 35 – a BMI of over 35 is considered severely obese – which meant that people needed to lose 20 to 30 kilos to get down to a healthy weight. Obesity can lead to type 2 diabetes, heart problems, stroke and cancer.

Even losing a few kilos can make a difference to people’s health. Slow and steady progress in bringing weight down is the goal of programmes which aim to change people’s attitudes to food as well as what they eat. The rapid weight-loss from most conventional diets is short-lived and people tend to put it on again once the diet ends.

Dr Iain Turnbull, a GP in Swindon who took part in the trial, said one of the main reasons they do not mention weight when somebody arrives with a cough or a chest infection is constraint on time. “We don’t really have the opportunity to talk to them about weight management on top of everything else,” he said. “The reality of modern GP practice is that it is a terrifically high-pressured and time-intensive specialty.”

But the study enabled him to keep the discussion brief and his patients were not offended. “I didn’t have any negative feedback from patients. They seemed quite pleased that I’d brought up the issue.”

Paul Cooper from Northampton weighed 96 kg when his GP brought up the issue as part of the trial. “I couldn’t see my feet,” he said. In his case it was easier, as he was diagnosed with type 2 diabetes at the consultation. He chose not to go on a weight-management programme, but tackled his diet using a fitness app instead and is now 84 kg and continuing to lose weight in what he hopes is a sustainable manner.

He was not angered by the GP telling him his weight was a problem. “Personally I think the doctor is the only person you would accept it from,” he said.

Boyd Swinburne and Bruce Arroll from the University of Auckland in Australia have said the study calls for a rethink of how obesity is tackled in primary care everywhere. “It is surprising that this is the first study in primary care to investigate a brief intervention for obesity, perhaps reflecting the nihilism about weight loss that pervades medical care,” they write.

Tam Fry, spokesman for the National Obesity Forum, said: “The paper effectively runs a coach and horses through the excuses that GPs in general have trotted out when challenged to talk to their patients about losing weight. Their principal argument has been that it’s pointless since no good weight-loss programmes exist. Nonsense. They do and have done so for years.

“Now that the evidence is out in the open, family doctors should take action to prevent obesity and weight-related health problems that clog up their waiting rooms.”

Dr Alison Tedstone, the chief nutritionist at Public Health England, said: “It’s important that GPs talk to their overweight and obese patients about losing weight and help them to find further support, as many do already. An extra 30 seconds could make all the difference; it doesn’t take long and can be raised in a supportive and sensitive manner.”

GPs should not worry about offending obese patients, finds study

Get the jab and don’t worry about kissing: how to avoid cold and flu

Colds and flu may seem trivial, but for some they can be incapacitating or even life-threatening. The terms cover a group of respiratory illnesses caused by three influenza viruses and more than 200 common-cold viruses. They are more prevalent in the winter because we huddle close to people who are harbouring the viruses, and because cold air affects the nose’s ability to fight infection. Here is everything you need to know to stay healthy this winter …

My boss said that if I can stand up, it’s not flu. Is this true?

Your boss may not be objective or, indeed, correct. But the general point is that flu comes on more suddenly, feels worse and lasts longer than a cold. It causes a sudden high temperature, shivering, deep tiredness, weakness and aching muscles. Other symptoms are similar to those of a cold, such as a sore throat, a dry cough and a runny nose. Kids can experience stomach aches, diarrhoea and vomiting.

I get that flu is nasty, but it passes. Why all the fuss?

There are three types of flu: type A is the most dangerous and can cause worldwide outbreaks (pandemics); type B makes people feel ill; and type C is relatively mild. On average, flu kills 600 people a year in the UK; in bad years, that figure can rise to thousands. Most people make a full recovery, but serious complications, such as pneumonia, can affect anyone, especially babies, pregnant women, those with long-term medical problems and older people whose immune systems are impaired.

Should I get a flu jab?

There are a few ways to avoid flu: stay away from other people; wage war against flu spreaders who leave their snotty tissues lying around; or get a jab. Two vaccines are available in the UK. The nasal flu vaccine is being rolled out gradually to all children over the age of two, while the inactivated flu vaccine is offered on the NHS to vulnerable adults (over-65s, pregnant women, those with serious medical conditions such as asthma, plus care-home residents, carers and healthcare professionals). If you are not in a vulnerable group, you can get the jab privately – many pharmacists and workplaces offer it for a small charge. Babies under six months old are too young to be vaccinated against flu, but pregnant women are encouraged to have the jab to protect themselves and their newborn babies. Children are vaccinated partly to protect them, but also because they are walking virus reservoirs – they remain infectious for two weeks longer than adults and are more likely to pass on the virus.

Can I get flu from the jab?

No. It contains inactivated virus, so you may feel a bit shivery and your arm may ache, but it’s nothing that a couple of paracetamol won’t sort out. Allergic reactions are rare, but potentially dangerous. There was a small rise in reported cases of the neurological condition Guillain-Barré syndrome (GBS) among people who had a swine flu vaccine in 1976, but it’s not clear why. If there is an increased risk of GBS after flu vaccines, the chance is still only about one in a million.

Is swine flu still a thing?

Swine flu – so-called because pigs get a similar virus – was a relatively new strain of flu that caused a pandemic in 2009-10. It has been around for a while now, so lots of people have immunity and it’s part of the annual flu vaccine. It caused far fewer serious cases than expected, since many older people had been exposed to the strain in their youth and had retained some immunity.

What about Tamiflu?

The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) were doled out by the bucketload during the swine flu scare. Questions remain about their effectiveness. Professor Stuart Pocock of the London School of Hygiene and Tropical Medicine, a co-author of an extensive analysis of the evidence, says: “There is some shortening of duration of flu symptoms (by about 24 hours) and a reduction in the risk of lower respiratory complications. This needs to be set against an increased risk of nausea and vomiting.” The drugs don’t prevent flu, but can mitigate its severity once you develop it. A report by the Academy of Medical Sciences and the Wellcome Trust in October 2015 said that pregnant women who are hospitalised with flu should be given the treatment and that clinicians should weigh up the pros and cons of treating children and those in high-risk groups. If a particularly virulent strain of flu comes along, offering antivirals widely may be justified. Until then, it isn’t.

Is it true that the nasal spray for children doesn’t work?

Recent US data showed that the nasal flu vaccine wasn’t very effective from 2013-16 overall and seemed to give little or no added protection in the winter of 2015 in children aged 2 to 17. In the UK, the Joint Committee on Vaccination and Immunisation has reviewed the evidence from the UK, the US, Finland and Canada; it says there is evidence of good overall effectiveness and that children should continue to use the nasal spray.

Why didn’t the flu vaccine work for me last year?

Some years it will be more effective than others. Partly, it depends on you. One year, you may be in rude health and not mix much with ill people; another, you may be run down and unlucky. Another factor is the vaccine: every year, 143 national flu centres in 113 countries monitor current and emerging strains of flu virus and test existing vaccines on them. The results are passed on to six World Health Organisation centres (two in the US and one each in the UK, Australia, Japan and China), which meet to recommend the composition of the vaccine for the northern and southern hemispheres. It’s a good system, but sometimes the experts are flummoxed by a rogue strain.

I’ll be all right – I take echinacea and vitamin C all winter

Hopefully, you will be fine, but it may not be due to the products you are taking. Echinacea is enthusiastically marketed to prevent and treat colds – the US market alone is worth more than $ 28m – but the evidence shows a modest benefit at best and certainly doesn’t justify the commercial claims. High-dose vitamin C (1,000-2,000mg/day), garlic, exercise and homeopathy don’t prevent colds, either. In fact, pregnant women and people with impaired kidney function are advised to avoid vitamin C supplements; a normal, balanced diet provides plenty of vitamin C.

What can I take for my cold?

Professor Bruce Arroll of the University of Auckland says: “There is no effective treatment for the common cold, but there are treatments that can help with the symptoms. The evidence is not great for anything except ipratropium nasal spray (Rinatec). There is no role for antibiotics for the cold or respiratory symptoms (when there is no diagnosis of pneumonia or emphysema).”

Many studies are poorly designed, conflicting or inconclusive, but it seems that honey may help a cough. Nasal saline and humidified air may be helpful for sleep and are unlikely to cause any harm. Chinese medicinal herbs, ginseng, echinacea and vitamin C don’t appear to offer any benefit. Ibuprofen helps aches and pains and reduces fever more effectively than paracetamol, especially in children. There is no benefit in taking paracetamol and ibuprofen together, despite the fact they are often sold in combination. Arroll adds: “Nasal and oral decongestants are probably effective and worth trying if [you are] very congested. Vicks is also worth trying, based on one study.”

My partner has a stinking cold. Should I decamp to the couch?

Cold viruses are not as infectious as you might think. An infected person can spread their virus by coughing or sneezing close to you or touching a door handle with their virus-infested hands. But you can kiss and have sex with your infected partner without running a high risk of catching the virus, although why you would want to beats me.

Get the jab and don’t worry about kissing: how to avoid cold and flu

I"m a hospital consultant and I worry about five-day junior doctor strikes

I am worried. Nothing new, you might say, for a consultant working in acute medicine at a busy district general hospital. This time it is not about the acutely unwell patient in front of me but about the announcement by the British Medical Association junior doctor committee (BMA JDC) that junior doctors in England may take part in more industrial strike action. Five days a month of rolling strikes during which there will be withdrawal of all cover from 8am-5pm. These are planned to happen from October onwards unless the government stops the imposition of the junior doctor contract.

As well as being worried I am puzzled. Back in May 2016 the JDC recommended to its members that they accept the new contract, the now leader of the JDC saying at the time it was safe for patients and junior doctors. Despite this the contract was rejected by the membership due to ongoing concerns about weekend pay and people who work part-time. The membership and the rest of us have been waiting to see what would happen next. Junior doctors tell me they do not even know what would need to change within the contract for the BMA JDC to be happy with it. This is surely a damning insight into the BMA’s lack of communication and leadership at such a critical time.

Then the announcement of the longest and most severe set of strikes the NHS has experienced are announced. They appear to be completely out of proportion to the issues that the BMA JDC and its membership still have with the contract. It is not even the whole contract they want rewriting, but elements of it. Despite that, NHS trusts will have to cancel elective procedures, outpatient appointments and draw up emergency rotas if the strikes go ahead. While the BMA has issues with the employer and the employment contract, it will inevitably be the staff and patients caught in the middle of the strikes who will suffer the most.

I am worried about my junior doctor colleagues, many of whom are starting to lose faith in their trade union, the BMA, but fear repercussions if they voice these concerns. They tell me they cannot see how a full strike will help them. They are stressed as they realise the impact of such strike action. They are battling with ethical and moral dilemmas with many not knowing what to do for the best. Some will lose money during the strike making it hard for them and their families financially. Is this really what the BMA JDC intended? There may be a BMA hardship fund for those junior doctors worst affected but there is no hardship fund to support the staff left behind with added stress and work to contend with at an already busy time of year. I feel the BMA JDC have convinced the membership that the issues of NHS under funding, seven-day services etc can be all put together into the justification for the proposed strike.

Many junior doctors tell me they do not want to strike this time – they are in a profession that cares for patients and they fear harm will come to patients during a full and protracted strike. Did any of the voting that junior doctors took part in earlier this year really give the BMA JDC the mandate for these current proposed strikes?

While other NHS staff will provide all the cover and care they can for patients during the strikes, it is clear that patient harm is a real and valid concern. Junior doctors also feel their training could be extended if they miss more than 14 days of work in a year, which is a possibility. What damage is being done to the profession in the public’s eyes? Public support for junior doctors feels as if it is a surrogate for public distrust of the government. The medical profession is one of the most trusted professions but with industrial action planned, the public support will not last forever.

In every strand of this I worry about the patients who will be unduly affected by this strike. They did not ask for this, they have no contract of employment to negotiate; they simply want to be cared for by the NHS.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

I"m a hospital consultant and I worry about five-day junior doctor strikes

Witch-hunts thrive in a climate of worry

All the Australian states have mandatory reporting programs. All are meant to have a test of reasonableness, but John McTernan, former director of communications to the Labour prime minister Julia Gillard, says the end result has been in excess of-reporting of the least minor factor, and authorities who have been overwhelmed. He believes the identical could take place here if the NSPCC has its way.

“Abuse goes unrecognised because of mistakes by personal social employees or teachers,” he says. “You can’t legislate to cease that and nor can you pass laws to end systemic failures induced by bad management.”

He is unimpressed by the British government’s response, saying it has allow the issue create and construct prior to rushing out statements and announcing inquiries without getting certain who is going to chair them. As he rightly says, we now have an inquiry into the inquiries.

In Australia, the Gillard administration final year attempted to solve such difficulties by launching a Royal Commission into institutional responses to youngster abuse. Above here, there are some much more fundamental inquiries to be asked about the NSPCC’s proposal. To be fair, it appears to want to limit mandatory reporting of little one abuse to “closed” institutions, like children’s houses, but that raises all kinds of troubles. Why ought to any individual feel kid abuse occurs in boarding schools but not in day colleges?

If you concentrate on the likes of teachers or social employees, will you not finish up placing folks off carrying out this kind of jobs at all because of the ambiance of suspicion? Currently some teachers, particularly males, are fearful of putting a comforting arm round a kid who falls above in case they are seen as acting inappropriately. And if mandatory reporting is widened to include all adults, you are swiftly into the reporting of each and every final suspicion, as happened in Australia. Not only can the authorities not cope, but you create a climate of fear in which witch-hunts thrive.

We are near sufficient to that currently. There are calls for party whips to hand more than their tiny black books, which in common imagination contain the dark deeds of MPs and were used to blackmail them into toeing the party line. It is reminiscent of Property of Cards and the fictional Francis Urquhart. Previous movie of Tim Fortescue, a former Tory whip, talking of the secrets and techniques that whips held towards people, including the abuse of small boys, has fuelled demands for “dirt books” to be delivered into the public domain.

However one senior Tory informed me that Fortescue, who is now dead, had been merely displaying off. “Francis Pym, who was the chief whip at the time, would by no means have condoned child abuse and nor would he have allowed Fortescue, who was extremely junior, to do so. The reality is that daily life in the whips’ office was considerably a lot more mundane.”

Of program, the abuse of kids is repugnant and a significant cultural change is necessary to uncover and root it out. But making use of the law to insist on necessary reporting, even in a limited way, is a blunt instrument that could have all kinds of unintended consequences – not least innocent people currently being wrongly accused. For now, the authorities need to deliver some variety of coherence to the many inquiries that have sprouted – possibly emulating Australia’s Royal Commission – and to damp down the febrile ambiance.

Witch-hunts thrive in a climate of worry

Google: 100,000 lives a year misplaced via worry of data-mining

Concern of information-mining of healthcare could be costing as a lot of as 100,000 lives a yr, according to Google’s Larry Web page.

Speaking out in response to fears in excess of his company’s vast haul of private details, Web page produced the case that not only is Google not going also far with collecting and analysing this kind of details – it really is not going far sufficient.

“For me, I’m so thrilled about the prospects to improve factors for folks, my be concerned would be the opposite,” he informed the New York Times’s Farhad Manjoo. “We get so concerned about these things that we really do not get the benefits … Correct now we do not information-mine healthcare information. If we did we’d probably save one hundred,000 lives subsequent 12 months.”

Webpage was speaking right after Google’s introductory keynote to its I/O developers conference, the place the company showed off a rehauled design for the 12th major release of Android, as nicely as its Android Wear operating program for smartwatches, and its third attempt to dominate the living space, Android Television.

The keynote closed with the introduction of Google Match, the company’s new fitness and wellness monitoring platform. With sensors on mobile gadgets, including Android Put on smart watches, users will be able to share well being Data with apps this kind of as weightloss programme Noom, which can keep track of weight, consuming routines and workout information to make recommendations that will increase your overall health. The platform is comparable in scope to the HealthKit attribute announced by Apple in early June.

“I believe technology is modifying people’s lives a lot, and we’re feeling it,” Web page told Manjoo. “In the early days of Street View, this was a huge issue, but it is not really a huge problem now. Men and women recognize it now and it’s quite helpful. And it doesn’t really modify your privacy that a lot. A lot of these items are like that.”

The I/O keynote was the focus of two separate protests, a single focusing on Google’s ownership of Boston Dynamics, a robotics business which is entangled in obligations to the US military’s R&ampD wing Darpa, and the second on the company’s function in the gentrification of San Francisco. But Sunder Pichai, Google’s head of Android, Chrome and Google Apps who led the presentation, was unperturbed.

“I feel in some approaches it’s very good that there is an open debate about it and I consider we needed it,” he informed the NYT. “There is been a great deal of development and the region is trying to adapt to that development and that has been a concern.”

Webpage concurred. “We’re in San Francisco, so we assume that. There’s a wealthy history of protest in San Francisco.”

• Google I/O 2014: smartwatches, Google Match – and Android Lollipop?

Google: 100,000 lives a year misplaced via worry of data-mining

Ditching the diet regime previously? Do not worry, you have nevertheless accomplished your heart some good

These integrated greater thickness of the carotid artery walls, larger blood pressure, and enhanced risk of diabetes.

Participants have been classed as normal weight, overweight, or obese, in childhood and at the ages of 36, 43, 53, and 60 to 64. Their heart health between 60 and 64 was utilised to assess the impact of their lifetime publicity to body mass.

Prof John Deanfield, of University University London, said that the study was special in following men and women for much more than 60 many years and making it possible for researchers to assess the effect of modest, genuine-daily life adjustments in excess entire body body fat. “Our findings recommend that shedding fat at any age can outcome in extended-term cardiovascular well being rewards, and assistance public wellness approaches and life style modifications that support people who are obese or obese to shed weight at all ages,” he stated.

Only 2 per cent of the participants remained in a lower fat category for a sustained time period, the research, published in The Lancet Diabetes &amp Endocrinology, says.

BMI is calculated by dividing a person’s fat in kilograms by the square of their height in metres. A figure over 25 is generally regarded as overweight, and above thirty as obese.

Elizabeth Cespedes and Dr Frank Hu from the Harvard College of Public Well being, additional: “Overweight men and women may possibly have even greater health advantage from lifestyle adjustments such as increased physical action than do regular excess weight individuals.”

They mentioned the study emphasised the value of public wellness policies to aid men and women attain and specifically maintain a healthy BMI, and they hoped long term function would seem at what bodyweight reduction was essential for distinct overall health benefits.

Edited by Andrew Marszal

Ditching the diet regime previously? Do not worry, you have nevertheless accomplished your heart some good

Why we shouldn"t worry about teens making use of mobile phones | Joanna Moorhead

‘I wonder regardless of whether there may be a few shocks in store for men and women who consider mobile phone technological innovation spells doom for today’s youngsters. It seems to me that the opposite might be the case.’ Photograph: Getty Images

Like most twelve-yr-olds, my daughter received her 1st mobile phone a number of months ago – just as she started out secondary school. Yr seven is the time when existence really opens up for younger men and women: suddenly they are travelling solo to college and going out on their own, meeting up with pals to go buying or to the park or to the cinema. It manufactured sense to me as a mother or father, as it does to most mothers and fathers with youngsters of this age group, to get her a telephone.

Do I be concerned about her connection with her cellphone, not just now but on into the adolescent many years that are nearly upon her? Yes, I do – and so do many other parents. So I welcome today’s information that Imperial University is launching a examine into the use of mobiles, focusing on two,500 year seven college students who will be assessed now and again in two years’ time. The research is not seeking at well being risks around the use of mobile phones – of brain tumours and so on – although these will continue to be monitored in the years and decades ahead. Rather, it really is hunting at cognitive issues connected with the use of mobiles: such as how the use of phones may affect children’s memory or interest span.

I seem forward enormously to what the study reveals, but I wonder whether or not there may be a few shocks in shop for individuals who feel mobile phone technologies spells doom for today’s youngsters, eating up their brain cells with mindless chit-chat and pointless online video games. It appears to me that the opposite may be the case: my older daughter, who is 15 and uber-linked (even for a 15-year-previous), looks to me to have honed her rapid-wittedness hand in glove with her mobile mobile phone. Multitasking? Fast contemplating? Dilemma solving? Information gathering? My daughter utilizes her smartphone for all this and much more and I consider you’d agree that all the above are helpful, existence-enhancing attributes for a teenager.

Another massive advantage mobile phones offer youthful men and women is independence, some thing that they crave and that parents want for them. My 12-12 months-previous can do all kinds of duties by herself that I, aged twelve, would have relied on my mother and father to do: she can find out cinema occasions, supply garments she would like in retailers, check what time the vet opens so we can get the rabbit’s claws clipped. Her globe has opened up thanks to her mobile mobile phone, in an fully positive way, and it will undoubtedly have knock-on effects for her development.

So what are my worries about mobiles? Effectively, considerably much more than both brain tumours or arrested cognitive growth, I’m concerned about addiction. I truthfully cannot don’t forget the final time I noticed my 15-yr-outdated without having her smartphone, other than possibly when she was in the swimming pool on holiday final summer time (and even then, it was positioned close by on a sunbed). Teenagers can appear obsessed with their mobile: checking them every single couple of minutes, texting individuals all the time, checking to see how a lot of “likes” they’ve got following they’ve posted on social media, refusing to place their phones to 1 side when they are sitting round the table for Sunday lunch …

Then once more, that reminds me of some other individuals I know – me and my husband. We’re fairly wedded to our phones as well. Challenge us about it (our youngsters certainly do) and we’ll cheerfully reassure you that it’s all to do with function, that we’re just monitoring some information story, or that we’re waiting for an essential call. Sadly, however, I have to admit that the cause I check my telephone also frequently is almost certainly for the same motives my daughters do the same with theirs: boredom and insecurity. Youngsters, of course, have these issues by the bucketload, and I sometimes think mobiles have made adolescents of us all.

So in many techniques I suspect that, no matter what the Imperial University survey discovers, the individuals we should be seeking most closely at is not our youngsters, it really is ourselves. After all, we’re grappling with the newness and the unknowns of mobile cellphone technologies just as our children are, and the items they’re receiving incorrect may possibly be the factors we’re not function-modelling very well for them. Time, and this review, will hopefully tell us far more.

Why we shouldn"t worry about teens making use of mobile phones | Joanna Moorhead

The superbugs the WHO warns we need to worry

WHO officials have warned of a crisis that is threatening to turn these widespread infections, which are at present very easily taken care of with a brief program of medicines, into significant killers yet again.

Staphyococcus aureus (MRSA) – skin infections, wound infections, bloodstream infections, arthritis

Streptococcus pneumoniae – skin infections, sore throats, pneumonia, meningitis, bronchitis, conjunctivitis

Nontyphoidal Salmonella - diarrhoea

Shigella species - diarrhoea and dysentry

Neisseria gonorrhoeae – gonorrhoea

The superbugs the WHO warns we need to worry