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This is the first of three blogs on one of our favourite subjects: Engagement – the art of talking to somebody about a shared issue, and finding an outcome that will change their world for the better.

As specialists in healthcare PR, we are often challenged to communicate about ‘the elephant in the room’ – in other words, issues that are so obvious, yet so embarrassing or debilitating that they are almost impossible to discuss. The potential to break taboos is made slightly easier by the multitude of communications channels now available. However, fundamental, to any conversation with a patient or customer is a genuine insight and the promise of a value exchange in terms of outcome. Furthermore, the conversation must be conducted using a tone that is appropriate – as well as compelling. Research gives us these critical insights. But there’s research, and there’s research….

Options range from pure quantitative research, to focus groups, all the way through to deep ethnographic (behavioural) research. What we gain are the insights so crucial for engagement in meaningful ways.

When and why to use Research?

Different audiences and issues require different approaches, as ROAD’s director of insight, Justine, explains: “We approach every project with an open mind and without prejudice. We use discussion, observation, interaction, as well as more quantifiable research methods, so we gain in-depth and insightful understanding of their specific issues and the obstacles in the way: The lives they live, the issues they face, the things they aspire to.”

Befriending the elephant in the room

Much of ROAD’s recent patient engagement projects have fallen into the ‘difficult to discuss’ category. Recent examples include sexual health, ageing, deafness and incontinence. We take nothing for granted, and we always ‘keep it real’. Our patient engagement work for Pfizer’s haemophilia division is a good example.

Haemophilia is a rare condition affecting only males. It is well-documented that once these boys graduate from the intense protection of their families towards independent adulthood, compliance with their medication regime falls as new behaviours and concerns take hold. Unfortunately, this has negative implications for their long-term health. Conveying health messages to young adult males can be a real challenge. Creating real life content about sex, drugs, alcohol, relationships, sport, fights, and other potentially dangerous activities – using films and streetwise digital format enabled the materials to really connect. Perhaps the most powerful platform created involved older teenagers giving advice to younger boys via podcasts.

If helping to break taboos makes for better health outcomes, it’s something we’re proud to do.

Look out for our next blog – Part II on consumer and patient engagement soon… In the meantime, if you’d like to find out more, please contact Ruth Delacour , Account Director at ROAD.

How should a GP, nurse or indeed, a parent, explain to a newly diagnosed child that they are going to need to have radiotherapy? And that their treatment will mean having a moulded metal mask made for their head, and staying very still whilst they undergo radiotherapy? What is the best way of explaining a condition such as epilepsy to a child? How should breast cancer or a stroke in a parent or grandparent be explained? Providing answers to the above takes expertise, and our client, Medikidz, is helping to provide it.

Describing itself as ‘the world’s first medical education company for children’, Medikidz was founded by two doctors from New Zealand who were frustrated by the lack of materials written specifically for children, so they joined forces to create their ‘Marvel comic meets medicine’ concept.  Medikidz has published 70 comic books and other materials covering a wide range of conditions – from Asthma to Hepatitis to Ulceritive Colitis. To date, over 3,000,000 titles have been distributed in various languages, but there remains a list of 300 treatment areas yet to cover!

Produced in partnership with pharmaceutical companies, patient groups and charities, all titles are written by doctors and peer reviewed. Each book features five superheroes who live on the planet Mediland, which is shaped like the human body. At the centre of each book is a child who is taken on an imaginary trip to learn what has gone wrong, and how the medics are trying to fix it.

Many books are based on real life case studies. Take Matteo, the star of soon-to-be-published title, Medikidz Explain ICU (intensive care unit). He was six years old when his mother, Julie, was unconscious for 3½ weeks during treatment for pneumococcal pneumonia at an intensive care unit. Having no tailored information to guide him, Matteo’s father admits to the difficulty in explaining what had gone wrong, and why Matteo’s mother was away in hospital: “A nurse suggested I should bring him to see Julie, even though she was unconscious. He was so relieved to see her, he kissed her, and soon went off to play football, having been reassured. If the Medikidz book had been available at the time, it would have helped me have the courage to involve Matteo earlier. Thankfully, Julie’s outcome was a good one.”

MAKING THINGS MEANINGFUL

In the words of Dr Adrian Raudaschi, Medikidz’ Digital Director, who is also a practicing GP, “What I love most about working at Medikidz is making a meaningful difference to children’s lives through education.” 

 
For sure, this type of patient education for children provides a forward thinking approach and uses meaningful methods of communication. We think these qualities provide an opportunity for all involved in child health.

This blog takes a look at some of the interesting facts about Vitamin D. But first, have a look at the infographic we’ve produced as a snapshot of the market here in Britain.

Vitamin D –  AKA ‘The sunshine vitamin’ allows our bodies to absorb calcium, iron, magnesium and zinc, so it is crucial for tooth and bone development. 80% of our Vit D is synthesised by our bodies when our skin is exposed to sunlight, so the further we live from the equator, the more we rely on our diet for the remaining 20%. Although Vit D was discovered in the early 1900s, still more is being discovered about its role in diseases affecting the young and the old – diseases such as osteoporosis, multiple sclerosis and even diabetes.

RICKETS: A HORROR RETURNS

Over the past few years, doctors and public health workers have been saddened to discover the Vit D deficiency disease, rickets, making a comeback. Rickets is characterised by misformed bones, dental problems, and muscle weakness. It occurs when the process of mineralisation behind bone growth goes wrong. This may be due to over-use of sun block, not getting out into the sun enough, or for cultural reasons involving covering the skin. Despite having high sunshine levels, the Middle East has the highest rates of rickets in the world due to cultural practices, and a lack of Vit D supplementation for breast-feeding women.  The good news is that rickets is reversible if children are treated with Vit D, and the results are miraculously quick in terms of treating any muscle weakness.

FORTIFIED BRITAIN?

In England, during the decades following the introduction of food fortification in the 1940s, when Vit D was added to margarine and some cereals, it was thought rickets had been wiped out, but it reappeared after the 1970s when different ethnic groups migrated to the UK: Children of Asian, Afro-Caribbean and Middle Eastern parents have darker skin, which needs more sunlight to get enough Vit D, so these children were more likely to get rickets. In 2010, the BJM reported that doctors in Newcastle (where sunlight levels are lower than in the South) were seeing 20 cases per year. It would seem that good patient education for this entirely preventable disease is of great importance once again. But, is supplementation or food fortification also needed? With our wealth of ethnicity, and so many variations in our diet, some say that fortification would fail to provide a ‘catch all’ approach. Yet, as a nation, we don’t seem to have taken Vit D deficiency to heart. In 1999, Britain was the only EU country that didn’t have an RDA (recommended daily allowance) for Vit D.

BABIES, CHILDREN, 65+ 

In England, all pregnant and breastfeeding mothers are advised to take daily 10mg Vit D supplements to ensure adequate foetal stores for early infancy, addressing the fact we live in a climate where sunlight levels are low. (Observational studies have shown that a mother’s Vit D level during pregnancy can even influence the growth of infants. Southampton University is carrying out randomised controlled trials of Vit D supplementation for pregnant women to find out more.) In addition, Vit D drops are advised for children aged 6 months to 5 years. Yet, recent research commissioned by BUPA points to only 1 in 25 parents giving them.

As people aged 65+ years are not exposed to much sun, they too should take a daily supplement containing 10mg Vit D to avoid osteoporosis and bone fractures. (Daily supplements are more effective than weekly ones.)

CAN’T BITE, CAN’T FIGHT.

We’ve come a long way in the past 100 years in our understanding of nutrition. When soldiers were recruited to fight in the Boer War (1899 – 1902) of the 8,000 sourced from Manchester,  6,800 displayed signs of incapacity caused by a childhood illness such as rickets, presenting significant implications from a military point of view. Such was the poor state of the recruits’ teeth thanks to a lack of Vit D (and poor oral hygiene) the term, ‘can’t bite, can’t fight’ arose. Intriguingly, though, medics noted that Scotsmen fared better than most recruits – which the Scots themselves attributed to habitual doses of cod liver oil, even before Vit D had been discovered. The Scots’ belief was dismissed as an old wives’ tale, and sadly it took several decades before the truth was out: Oily fish does contains high levels of Vit D.

Today, with genetic profiling and other laboratory techniques, we are discovering even more benefits of the sunshine vitamin.

The highly debilitating disease, multiple sclerosis (MS), has been implicated in lack of Vit D for some time. This is a disease almost unheard of near the equator, with incidence rising incrementally towards the poles. Although MS affects women more than men, as long ago as the 1960s, it was noted by the military (which keeps large data sets of long-term medical records) that a healthy, outdoor lifestyle amongst US veterans provided the ideal protection from MS.

NEVER MIND THE STAR SIGN

The powerful effect of the seasons – ergo, Vit D levels – can also be seen in the number of people suffering from immune disorders. Even within Britain, there is a north-south divide in the incidence of such diseases, with more cases the further north you look. In the 1980s, Vit D was found to normalise blood glucose levels by increasing insulin release. Then in the 1990s, the link was established between the seasons and glycaemia (blood glucose). Now, it has been proven that adequate Vit D reduces the risk of type 1 diabetes because it suppresses acquired immunity. As for Type 2 diabetes, Vit D can help decrease insulin resistance (the first feature of this increasingly common, and enormously costly, disease).

In the light of the above, you may wish to know that April is the least ‘lucky’ month in which to be born: Should your birthday fall around then, your mother will have spent the majority of her pregnancy without much exposure to sunlight. (Unless she’s been jetting off to the Caribbean, of course…)

THE SPORTS CONNECTION

Lately, there’s been an increased focus on the link between Vit D and athletic performance.  Dr Graeme L Close, Senior Lecturer in Sports Nutrition at Munster Rugby, has been asking: Why do jockeys (known for their leanness) have far lower levels of Vit D than their bulky brethren, the rugby player? He is testing the hypothesis that the answer may lie with Vit D’s role in muscle mass.  Certainly, ballet dancers who are given Vit D supplements (as opposed to a placebo) were found to be able to increase their vertical jump height and lower their injury rate. Now that must be a good pointe…

INDOOR LIVES: A TICKING TIME BOMB?

We know that lifestyle changes over the past 50 years have affected our health immeasurably, as seen with obesity and the corresponding diabetes epidemic, amongst other diseases. Are we facing a ticking time bomb of Vit D deficiency that’s storing up problems for later life as children and young adults replace outdoor time with time spent indoors on computer games? Perhaps we should get kids outside with their handheld devices and take full advantage of the wireless era!

Further research into Vit D’s effects on health are needed. A key problem is controlling the trials effectively because Vit D isn’t like a measurable drug, able to be monitored accurately precisely because we can synthesise it from sun exposure.  Yet, the message is not to give up, afterall, it took 40 years for the medical world to accept that sunshine would prevent rickets.

In the meantime, we can take comfort during these long winter months that dark chocolate is high in Vit D. Now, that’s a win-win situation.

 

Fertility: Beating the clock and the cost

Posted by hannah in Client news - (Comments Off)

As our infographic shows, fertility is changing. Read the full blog below.

PITY THE SPERM

Ponder this: The average sperm count for a man in his mid 30s is now 50 million per millilitre – a decline of over 30% since 1989. That’s a significant fall, especially if you happen to be trying to get pregnant, so it comes as no surprise that a 10 minute at-home sperm count check has just gone on sale here in Britain – one of several ‘lab-at-home’ diagnostic tests made available recently.

The causes put forward for ‘the great sperm decline’ are many, with the most probable being our move towards a sedentary life in the latter half of the 21st Century.  Put simply, men sitting at their desks or on a comfy sofa makes for warmer testicles, which makes for lower sperm production. Also blamed is the rise in alcohol consumption, with sperm cells being especially sensitive to toxins – as are eggs. (Fertility experts will insist on couples cutting down their booze consumption if they’re serious about having a baby.) Other theories put forward for the decline involve environmental agents such as potential hormone disrupting chemicals found in detergents and flame retardants. Whatever the causes, what’s for sure is that our contemporary lifestyles don’t favour abundant sperm production.

PITY THE EGG

At the same time that sperm counts have fallen, many women have been putting off having their first child until they are in their mid 30s or 40s, even though their biological fertility starts to decline sharply after the age of 35. Add in the fact that women usually only release one egg per month, and suddenly men, with their ‘factories’ churning out millions per day, seem comparatively less threatened…

Without wishing to sound flippant, treating infertility is now big business, with three key changes delaying couples from starting a family: The extending of education into the early to mid 20s, the extreme increase in the cost of a home, and the rise in the cost of living. The average age for giving birth to a first baby is now 30 in the UK. Thus, as unromantic as it sounds, the unrealistic cost of affording a home is causing middle income Britain to delay having children.

The sad irony for many is that, physical and emotional costs aside, delaying conception in order to afford the cost of child-rearing can reduce fertility and – at the same time add – add the cost of IVF at around £5,000 a go. And potentially still no baby. Fortunately, less invasive and expensive options are available, although less data is available for these.

However, infertility isn’t just a numbers game. It’s a quality of life issue. Contemplate the psychological aspects of an absence of siblings (and cousins) in China. Consider the extremely low birth rate in Japan (1.4 per woman) with its corresponding impact on social care and taxation, as so few children are born to support the elderly. (Japan has the oldest population on the planet, with a median age of 46 and average lifespan of 84. A quarter of its population are over 65.) On the positive side, some note that reduced overall fertility is key to reducing the pressure on the planet’s resources.

Demographics aside, though, the choice of when to procreate is in my opinion one of the toughest decisions women face today: A perfect storm of biology and economics. And that’s besides the differing ticks of the ‘biological clock’ which can pitch the needs of men and women in very different directions.

 

The European Commission states that ageing is one of the greatest social and economic challenges of the 21st century for European societies.  Here in Britain,  between 2010 to 2030, we will witness a 50% growth in people aged 65+ – with the number reaching 80+ rising at an astonishing rate. This presents both social and economic implications.

Economically speaking, the care required for a person aged 85+ is estimated to be around three times that for a someone aged 65 to 75, but the social implications are also enormous. Being able to provide the right level of care for the elderly is proving exceptionally difficult, as borne out by shocking revelations in 2013 about below-par care of the elderly within care homes.  Indeed a recent survey of 2,000 adults by Populus Data Solutions revealed fewer than 1 in 4 adults willing to consider moving into a home if they became frail in their old age, with fears of being badly treated by staff cited as their number one concern.

The level of care outside of homes is also a concern.  Health Secretary, Jeremy Hunt, said Britain should be ashamed of the way it treats grandparents, with more than half of over-75s living alone, and 5 million older people saying TV is their main form of ‘company’.  Yet, scientific studies have proven over and again that lack of social connection and interactivity can be extremely detrimental to health. The NHS has responded to this situation by crying out for an army of ‘Good Samaritans’ to look in on lonely elderly neighbours and make sure they are coping this winter. It has also issued a call for 100,000 volunteers to sign a pledge committing to visit older people and check they are warm and have everything they need.

Sometimes a holistic and truly pragmatic approach is needed: Today, the primary care title, Pulse, reports that Clinical Commissioning Groups (CCGs) are paying for home insulation and paying off patient debt to help improve health. NHS Oldham CCG will spend £200K this winter on new boilers and insulation for 1,000 homes, plus ‘help with debt reduction’ so that local people can keep warm. It estimates this will save £300K a year in reduced hospital admissions and social costs.

TECHNOLOGY CARES

Meanwhile, welfare technology is becoming more prevalent in institutional care settings, and the gauntlet has been well and truly thrown down to technology to help manage this crisis. For example, intelligent aids such motion sensors placed around the home and in clothing, remote vital sign monitors, communication technology and tracking devices. Such devises may be available, but they’re costly, and progress is slow. However there are promising reports: In Italy, the Bolzano project in the small [and wealthy] city of northern Italy involved IBM fitting a small group of elderly residents’ homes with sensors that report information back to a central database which is closely monitored by the city. From there, care workers can be dispatched when needed. City planners foresee a 30% saving in assistance and care costs, and the feedback from residents has been positive, with one stating, “It feels like I have a friend at home watching over the house”.

Increasing investment in technology seems to be one way we are moving forward in order to tackle this issue, but technology can never truly replace human contact. As humans, we are hard-wired to need company, the human touch, whatever our age. Meeting this most basic of needs will surely remain one of the biggest social challenges of our time, and all of us must step up to tackle it.

It’s a rather depressing thought that after so many decades of health improvements, the Western World is now starting to see life expectancy fall, and even sadder that this is largely due to diseases that are lifestyle related – in other words, preventable. Type 2 diabetes is a clear case in point, being related to poor diet, obesity and lack of exercise, and whilst it may not be considered a ‘killer disease’, it places a huge burden on those affected and their families, and mops up a staggering 10% of the NHS budget – and rising…

In part, the economic downturn is to blame. Recently, the WHO warned that youth unemployment in the UK is a ‘public health time bomb’ and there is evidence of a move towards consumption of cheaper, less nutritious food which will store up further health problems for the future.  Paradoxically, unhealthy foods are often cheaper than healthy options, and I have no shame in regularly asking the hapless baristas at my local health club, “How come an apple, which only has to be picked and wend its way here on a truck, costs the same as a packet of crisps, with all the slicing, frying, packaging, advertising and marketing that takes?!” (I think they’ve started to avoid serving me…)

Arguably, health prevention has never been high up on the agenda within the NHS which seems to be in full on fire-fighting mode. Things may change now that local authorities are responsible for public health following legislative changes this April. We shall see. In the meantime, the private sector is filling the void. ROAD’s client, Esaote, has developed a package of ultrasound technologies called ‘Prevention Suite’ which enables practitioners (GPs, radiologists and other clinicians) to assess the heart and surrounding vessels in one step, providing accurate risk scores for development of cardiovascular disease.  

But, does showing the patient early signs of CVD – the actual arterial plaques starting to be laid down – make any difference?  Well, early findings from studies involving hundreds of patients across Europe are showing that this approach not only provides accurate prediction of CVD, but also shows individuals do modify their behaviour, having seen the evidence on the screen for themselves.

Sadly, such tools do not always reach those in greatest need where they can have the biggest impact. Working for a provider of NHS Health Check infrastructure taught us that the neediest are often the hardest to reach – in particular, middle aged men who aren’t engaged with their health, and rarely (if ever) visit their GP.

We also know from working with SCA Hygiene that the burden of care long-term falls largely on relatives and friends, often at great cost to their health, too. Speaking as one of the so-called ‘sandwich generation’ and juggling work with my children and sometimes care of elderly family members, I urge all stakeholders to consider the preventative approach. It will pay – on so many levels.

Am I having a stroke? My self-diagnosis indicates that I must be as I have looked up my symptoms and they match what I have found on Google! However, a more objective analysis might lead somebody else, such as my doctor, to suggest that I actually just have a migraine.

Ten years ago, it was estimated that only about 15% of patients would look up information about their condition and their symptoms before visiting their GP. However, with the internet becoming increasingly accessible, and half of the UK population owning Smartphone’s for easy access, it is no surprise that this number has changed dramatically. Recent research by Global Market Insight revealed that 90% of those surveyed had looked at online healthcare information before consulting their GP, with 19% saying they did so ‘always’ and 14% admitted they had bought prescription and non-prescription medication online.

So what stops us from making a trip to the GP thus potentially putting our health at risk? The reasons seem to vary greatly with gender. The Aviva Health of the Nation Index Report found that Men, on the whole, tend to play down their illness and don’t want to “waste doctor’s time.”  30% of men claimed they rarely become ill compared to 21% of women. If the illness is seen to be embarrassing, this is also a preventing factor.  See our case study for TENA For Men

For women, the most common reason was finding time to go to the doctors. 51% of women said they would suffer in silence if unwell as there were jobs to be done. And many would rather wait to see if symptoms disappeared before going to the doctors. GP availability is often limited, with most practices being closed at weekends or only being open for a couple of hours. But even when we do make appointments, a large number of those appointments are missed. The BBC recently reported that 40,000 outpatient hospital appointments are missed every year at Cornwall’s main hospitals and a staggering 1,300 patients failed to turn up to scheduled operations. David Cameron has recently announced a £50 million scheme for surgeries to be open from 8am-8pm seven days a week. It will be interesting to see the impact this will have on the number of visits we make to the doctors.

There are, however, also benefits to having such easy access to information.  The BBC has recently reported that women from more affluent areas were catching their breast tumours earlier than those from more deprived areas. Could this in part be down to having easier access to the internet to look up the common signs and symptoms?

Take the quick test to see if you might be a cyberchondriac!

Six signs you’re a cyberchondriac:

  • You check health information websites to get relief from anxiety
  • You always focus on the worst case scenario
  • You ‘symptom surf’ for vague and generic symptoms
  • You bookmark and favourite medical searches
  • You search for medicines that you believe will treat your self-diagnosed illness
  • The time you spend checking health symptoms online is interfering with your life

Source: eircom news

 

‘What is there to like about the Winter?’ It’s the question many of us are asking – except for the ski-obsessed, the sun-shy, and those who get to knock-off work when dusk falls. Yes, the cold and flu season has started, and the clocks haven’t even gone back yet… Yet, on reflection, how lucky we are that we live in an era where soaring temperatures, stuffy noses and aching joints can be controlled by medication.

ANTIPYRETICS: WELL-ESTABLISHED RELIEF
Antipyretics are drugs or herbs that reduce fever, and multiple versions are now available to treat the raised body temperatures that accompany infection. The word ‘antipyretic’ is derived from the Greek words for ‘against’ (anti) and ‘fever’ (pyreticus). Interestingly, one of the first herbs used to counter fever and pain involved the bark of the willow tree, and grazing animals have been observed chewing willow, presumably for its restorative properties. The active compound is salicylic acid. (from the Greek for ‘willow’ – salix). Aspirin is in fact acetylsalicylic acid, and was first isolated in 1897 by Felix Hoffmann, a chemist working for the Germany company, Bayer (two years after Bayer marketed heroin, incidentally). Bayer still manufactures Aspirin over 100 years later. As well as being an antipyretic, Aspirin is also an anti-inflammatory drug, as is Ibuprofen, making them both members of the NSAID group of drugs, although aspirin works in a different way to the latter.

HOW THEY WORK
Antipyretics work on the brain’s hypothalamus (which is involved in several metabolic processes, and secretes certain neurohormones) 
causing the hypothalamus ‘press an over-ride switch’, stopping the signalling molecule, interleukin, from inducing a raised temperature. Although these drugs aren’t associated with treating the underlying cause, they make many episodes of colds and flu more bearable for the sufferer – not to mention those charged with caring for them. (We won’t mention ‘man flu’…)

FLU JABS: DO THEY WORK?
Britain’s ageing population, the 2009 swine flu epidemic, and the fact that very young children and people over 65 have weakener immune systems, have combined to create a strong drive by the NHS to get patients immunised this winter. The best time to have the jab is from the beginning of October, and children are now being offered the less invasive nasal spray form of the vaccine by the NHS.

This graph, courtesy of influenzanet, an online flu surveillance system, clearly shows jabs to be effective in preventing outbreaks. Flu incidence peaks between mid December and mid January, ruining many a Christmas holiday. We’re convinced the extra handshakes and greet-kissing in the season of goodwill play a large part in spreading infection, but we were surprised to learn that there’s no evidence that using public transport increases the chance of getting flu. (So much for using ‘infection risk’ as an excuse to catch that post-party cab, then.)

Source: Influenzanet

NHS television advertisement from 2009: Catch it, Bin it, Kill it

http://www.youtube.com/watch?feature=player_detailpage&v=zT9fxhrjoQc

Top Tips for Prevention
- Wash hands regularly
- Cover mouth when sneezing & coughing
- Keep surfaces clean
- Don’t share towels
- Try not to touch nose or mouth
- Stay at home
- Catch coughs and sneezes in the crook of your elbow, not your hand


Yes, it’s that time of year for parents. Now that the thrill of not having to entertain the children or pay for holiday care has worn off, the morning trip to school is getting darker, and we are entering the season of tummy bugs, flu and…. ‘Head lice’ – those two small words that get parents itching with frustration and real (or imagined) infestation. Head Lice are the scourge of the classroom in today’s Western world, where, thankfully, infestation is a word rarely associated with humans. Sad but true, many an evening is taken up with treating, shampooing and combing, to the cries of ‘Stop combing my ears!’ and ‘When will this be over?!’ from the little darlings. So first, a few common myths to dispel:

1. Nits actually refer to the eggs, not the insects that lay them. Nits are pale and shaped a bit like a computer mouse – unlike the lice which are brown. They can be found ‘glued’ to the hair shaft, meaning they can only be removed using conditioner to loosen them, and a special, very fine-toothed comb. Empty egg shells may also be found. The lice themselves must be eradicated using a special over-the-counter solution, and fortunately, many of today’s preparations don’t contain traditional insecticides

2. Lice crawl rather than jump (unlike fleas) so they can only be caught from an infected head coming into contact with another – as when children (or adults) sit, play or sleep in close proximity

3. Bed sheets do not have to be washed: The lice in no way wish to leave their lovely, warm, well-stocked larder for your linen. Well, there’s one thing off your minds…

Other health issues that get parents worrying at this time of year include winter vomiting illnesses such as the norovirus (short for ‘Norwalk’ – a place in Ohio, where a large outbreak occurred in a school during 1968). Norovirus is the most common stomach bug in the UK, affecting all ages. It is famous for its virulence and intensity of symptoms which can render hospitals to shut down wards in order to contain or fend off an outbreak. As well as person to person contact, the virus can also spread by aerosolisation and subsequent contamination of surfaces.

Key advice for children infected is to avoid dehydration by taking in plenty of fluids, and importantly, they should stay away from school for 24 hours after symptoms end. Unfortunately, as the Norovirus doesn’t have a protective lipid (fat molecule) membrane, it is less susceptible to alcohol and detergent than bacteria, although chlorine-based disinfectants will render it inactive. Another major downside is that any immunity gained is usually temporary and incomplete after infection.

Flu or influenza is also something for parents to be prepared for. An annual flu vaccine for children is available on the NHS for all two and three year olds, which is given as a nasal spray, and is on offer from this autumn. In some parts of the country, primary school children between the ages of four and 11 will also be offered the vaccine, and over time, all children between two and 16 will be vaccinated each year against flu using the nasal spray.

Whilst the spectre of a global epidemic, such as the 1918 Spanish Flu (which infected a staggering 40% of the world’s population, and killed around 50 million people) may seem far off, rest assured, pathologists and epidemiologists are kept very busy around the world by checking incidence and spread patterns: Flu epidemics could spread far and wide, as with Swine Flu in 2010, which was the first flu epidemic for 40 years. (NB Although the Swine Flu strain of the virus may have originated in pigs, it is now a wholly human disease.)

Verrucas are another ‘stone in the shoe’ of many parents: Warts that appear on the sole of the foot. All warts are caused by the HPV (Human Papilloma Virus) which causes an excess amount of keratin (a hard protein) to develop in the top layer of skin, forming a hard, rough, texture. Verrucas are more common in children and teenagers than adults, especially those who go swimming regularly. Wearing flip flops around the pool is advisable to prevent infection, as is the wearing of a protective sock if infected. Verrucas can also be treated using a solution containing active ingredients such as salicylic acid, and removal is advisable if they are painful, and to prevent them spreading. In fact, most warts are harmless and clear up without treatment, but it can take up to two years for the viral infection to leave the system, and for the wart to disappear.

Diseases aside, it’s also worth noting figures from the Health & Social Care Information Centre which show that eye-examination rates among the under-15s have fallen to a 10-year low, with only 19% having their eyes checked. The figures also reveal that 14 per cent of eight-year-olds show signs of tooth decay.

The infographic at the top of this blog reflects what parents are really worried about: See the ‘Top 10 Health Concerns’ according to a publication last year by Jane M. Garbutt Randall Sterkel Shannon Gentry, Michael Wallendorf and Robert C. Strunk – ‘What are parents worried about? Health problems and health concerns for children’. A total of 1,119 parents completed the survey. Social concerns were removed: We’ll save those are for another blog…


All over the world, a myriad health apps are being conceived, created and marketed to an ‘app happy’ culture of consumers, as well as to health professionals. In the USA, an interesting map has arisen, writes Gabriella Rosen Kellerman in The Atlantic: On the West Coast, the consumer-orientated developers are hard at work testing the apps and securing venture capital to get them onto phones and tablets, whereas on the East Coast, doctor-focused apps are being developed in partnership with government bodies, the pharmaceuticals industry, and insurance companies. Industrious app activity aside though, how will we really benefit in terms of health outcomes?
With today’s obesity epidemic, and Britain the most obese nation in Europe, dieting and exercise apps should receive first attention, and it’s no surprise that a recent report quoted in Female First suggests one in three Britons turn to their smartphone when dieting, with 81% of those surveyed saying they experience more successful weight loss by using apps than before they used them. Several reasons are given as to why, including the ability to check calorie content and receive help to stay motivated.

However, critics such as Sherry Pagoto, Ph.D. writing for Psychology Today argue that weightloss apps contain a major flaw in that they include only a very narrow range of behavioural strategies. She explains: “The vast majority of apps are tools for weight, diet, and activity tracking, and although apps do a great job here, these strategies represent a very small segment of a much larger body of effective behavioural strategies that are used to help people lose weight.” Pagoto explains that a common problem she hears from patients is, ‘I don’t have time to exercise’, making the valid point that a weight loss app does absolutely nothing to help someone work through such issues – issues that prevent people from reaching their weight loss goals. Indeed, Pagoto cites two studies that show dietary tracking using a smartphone is no more effective at helping people eat less than using paper-and-pencil diaries (Acharya et al 2011; Burke et al 2012). So, the question is, what differentiates a health app that only targets ‘the lowest hanging fruit’ from which has far wider, long-term benefits? What makes a good app? Afterall, with word of mouth recommendation and good communications, quality will out. Part of the answer would seem to lie with provision of advice that is precisely tailored to the user (based on the data they entered). Here lies the rub…

PUT THE DATA AWAY AND LET’S GET PERSONAL
Interestingly, mobile apps that connect users via social networks tend to be more effective than those which don’t, assuming users utilize the social function. This was certainly the case regarding a weight loss programme ROAD launched just ahead of the proliferation of smart phones and apps: The programme’s online chat forum was absolutely instrumental in motivating other users to keep up the effort, because it tapped into the human hardwired responses to share and care. Pagoto urges, “I would love to see apps do much more to link users. For example, users who have common interests and/or characteristics could be suggested to one another (just like Twitter does). Users tightly connected socially will not only use the app longer, but will probably lose more weight and keep it off longer.” This brings to mind the endurable appeal of Weight Watchers, with its group settings and socialising function – much lambasted as the company was by the recent BBC series, The Men Who Made Us Fat.

Another solution was proffered in the fascinating Horizon documentary, Monitor Me, presented by Dr Kevin Fong: Fong waxed lyrical about the potential for mobile health apps to “switch the focus away from ‘illness’ and towards ‘wellness’ by mobilising self-harnessed health data”. He also points out, “We have made real progress in being able to measure physical activity using GPS and accelerometers (movement sensors), but we remain 100% reliant on the user for diet tracking.” The solution, he suggests, could lie with sensors to detect the mere act of eating, thus significantly advancing mobile technology for weight loss by providing opportunities to insert mini-interventions at the start of an eating episode. In other words, a ‘catch them before they fall’ facility.

WHERE MAN AND MACHINE MEET
Health app builders could seemingly take a lesson from telehealth pioneers who have used text messaging to target patients to improve adherence to medication or treatment. Dr Ruth Chambers, OBE, Clinical director for practice development and performance at Stoke-on-Trent CCG, describes in The Guardian Healthcare Network how ‘Flo’ – the NHS’s simple telehealth app – is being used to target asthma, hypertension, smoking and weight within general practice, acute hospital, community and mental health settings. Interestingly, when patients were asked what they liked about Flo, they replied: Having a “friend”; feeling more supported in improving their health; feeling that the NHS cares about them.
The long term success of health apps would seem to lie in getting the right balance between ‘man and machine,’ ‘listening’ to what people’s ultimate goals are, and addressing issues that concern education and motivation. Only then will behaviour change follow. Whilst robots can be built to ‘look cute’ it’s a lot harder to teach them what it takes to ‘be human’.

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