Sunday, 30 October 2016

Forget 42, the answer is actually 0.06% – and I wouldn't be at all surprised if Edith isn't turning in her grave

I've 2 people to thank  for my extra hour in bed this morning. The first is Judith S who at 12.15 last night reminded me I had an extra hour to write my blog and of course William Willett. Now Willett, (like Judith, was a member of the #EarlyRisersClub - that is people who start their day around 05.00) liked to get a round of golf in first thing in the morning. He didn't understand why so many people stayed in bed while the sun was shining. Willett lobbied the British Government to introduce Daylight Saving Time (DST). He died in 1915 before this was introduced in May of the following year. We have been putting our clocks forward in the Spring and back by 1 hour in the Autumn ever since.

Research on the effect of DST has consistently shown that burglary, violent crime, traffic accident rates all fall when the clocks go forward in the Spring. On the down side, researchers at the Karolinska Insistute in Sweden, found that heart attacks rose by 5% during the same period. More prosaically, DST meant that dairy farmers often had problems with confused cows needing to be milked. Today many UK farms use robotic milking systems, where cows are free to walk into a milking parlour at any time and be milked by a machine, and completely free from human intervention.

However, human interventions did feature in my reading last week. I read the recently published report The Use of Psychological Therapies (IAPT) in England. IAPT services are NHS approved brief intervention therapies for people with depression or anxiety. Last year there were 1,399,088 new referrals of which 953,522 resulted in people entering treatment. Just over 50% completed their course of treatment, with 55% of patients from the least deprived areas recovering whereas only 35% from the most deprived areas did. Challenging socio-economic factors and the stigmatisation of mental health problems continue to be contributing factors that result in these disappointing outcomes.

Predicting outcomes in health care is often difficult to do. Take the example of the creased ear lobe and its link to a higher risk of heart disease. Franks sign, as it's sometime known as, is a diagonal ear lobe crease that was named after Dr Sanders Frank. In 2014 a large Danish study involving some 11000 participants clearly showed there was an association between ear lobe creases and cardiovascular disease. It is an association and not a predictive sign. And before you rush to your mirror there are other more reliable tests available. 

Demonstrating reliability and generalisablity in research is critical. I'm not sure the claims made in the Cavell Nurses Trust report 'Skint, shaken, yet still caring'. published last week really demonstrated this. Edith Cavell was a British nurse who during the First World War saved the lives of soldiers from both sides without distinction or favour. The charity provides support and help to the 2152000 nurses, midwives and health care assistants who work in the NHS. Last year they helped some 1400 individuals who for various reasons found themselves in difficult circumstances last year as well as providing £500,000 in financial support.

The Cavell report uses Daily Mail style headlines in publishing its results. It compares nurses, midwives and health care assistants with other groups in the population. Nurses were said to be twice as likely to be unable to afford the 'basic necessities' of life. These were described as a home in decent state of repair, being able to replace broken furniture or repairing a faulty fridge or cooker. 61% of nurses said their health was good - 74% of the rest of the population claim good health. Nurses were said to be 3 times more likely to have experienced domestic abuse in the last year. Most nurses and midwives are generally as happy as the rest of us, but they reported higher levels of anxiety than other groups. Disappointingly there was no discussion as to what might account for these findings.

According to the Office of National Statistics the average UK salary is £27,600. The average nurse salary is £26,252, which compares well to the average salaries of some other employment groups; Occupational Therapists £26,037; Dispensing Opticians, £23,458; Bus Drivers £22,176; Teachers £18,604; and Care Workers £12,650.  For others groups the comparisons are not so good; Pilots £90,146; Doctors £69,463; Professors £49,679; Quantity Surveyors £41,086; and Midwives £29,448. Its not clear to me as to why such differences might mean that nurses have greater financial problems than the rest of us.  

It is absolutely true that the UK health care system is experiencing huge pressures. For all those working in the NHS will feel the impact of these pressures. Stress, physical illness, anxiety and sheer exhaustion are likely to be the result for many.  However, I doubt these experiences would give rise to greater rates of domestic abuse being experienced by nurses than the rest of us. The Cavell Trust Action Plan, sets out a series of  'good deeds' but these don't really help in answering these questions. And sadly, apart from being slightly sensationalist, I'm not sure what this report was aimed at achieving, and I don't think it does anything positive for those it purports to champion... 

...and by the way, the clocks go forward again on March 26th 2017. 

Sunday, 23 October 2016

Just how BIG is ‘big data’? - the answer is blowin’ in the wind

I read with interest the mixed views on Bob Dylan being awarded the 2016 Nobel Prize for Literature the other week. He was cited as bringing new poetic expressions to the great US song tradition. For many he was a Marmite type of performer. People either liked him or they didn’t. His music was part of my youth and I was in the camp that liked him. His words are always elegant and eloquently constructed even if at times discovering the meaning behind his words took a bit of work. However, since 1959 he has sold over 100 million records. And that's a big number.

An equally big number is 3,000,000,000 (3bn). That’s the number of genes in the human genome, and in 2003 the last of the base pairs were finally identified. It must have been an amazing moment for those involved. 50 years before little was known about how genetic factors contribute to human disease. It was in 1953 that James Watson and Francis Crick described the double helix structure of deoxyribonucleic acid – more commonly known to most of us as DNA. DNA is the compound that holds the genetic instructions for building, running and maintaining living organisms. It was the Human Genome Project that eventually led to the cataloguing of the complete set of DNA in the human body.

The Human Genome Project provided researchers across the world with freely available data and in so doing, opened up opportunities to better understand human diseases and how we might more effectively diagnose, treat and prevent them. To date, some 1800 disease genes have been identified, and there are now more than 2000 genetic tests for human conditions. The project would not have been achieved (and 2 years before schedule and under budget) without the possibility of harnessing 'big data'. This term was first used in a 1997 paper published by NASA. Big data is both ubiquitous and increasingly readily accessible.

I am not a statistician, but I love numbers and what they can tell us. Having access to big data opens up a whole new world. Let me take you for quick stroll through some of the numbers that make up this world. More data has been created in the last 2 years than in the entire history of the human race; about 1.7 megabytes of new data will be created every second for every human being living on the planet (currently 7.4bn people); the digital universe is expected to grow to 44 Zettabytes by 2020 (a Zettabyte contains 1000 Exabyte’s – a single Exabyte can stream the entire Netflix catalogue more than 3000 times); we perform 40000 searches on Google every second (3.5bn per day, 1.2 trillion per year); Facebook users send 31.25 million messages and view 2.77 million videos every minute; there will be 6.1bn smart phone users globally by 2020; 300% of all data passes through the cloud (Google uses up to 1000 cloud networked computers in answering a single query in no more than 0.2 seconds). And if you want more, have a look at this!

What is also interesting is that only about 0.5% of all this data is ever analysed or used. It’s estimated that in the US better use of big data could save the US health care system US$ 300bn a year. Of course the problem is that most of us lack the ability to manage and interpret large data sets, and that is true for both organisations and individuals (Barrack Obama has well over 1 million Facebook friends for example).

The internationally respected management consultant group McKinsey, note that there is already a world shortage of skilled data analysts and this is a situation unlikely to improve in the short term. I work for a University, and knowledge creation and knowledge exchange is our business. I think we have a responsibility to respond to this skill gap in the future workforce. In the CBI/Pearson Education and Skills Survey published last week, most employers report being satisfied or very satisfied with their graduates attitudes, relevant work experience and skills. Satisfaction with graduates' numeracy was 91%; technical skills 88% and literacy, 86%. Maintaining these high levels of satisfaction in a rapidly changing technologically enhanced workplace is crucial.

This was something the University leadership community discussed at length at our Planning Day last week. We also noted that in a rapidly changing world, we need to use big data ourselves to more effectively deliver an intuitive learning experience for our students and in shaping our relationships with our industry partners. As Socrates said, 'the secret of change is to focus all your energy not on fighting the old, but on building the new'. As with the triumph of unlocking the secrets of DNA, understanding and using big data can help us better understand how we can more effectively do this. Without being able to use it, as Dylan nearly said, 'the answer[s] my friend, will be blowin’ in the wind'.

Sunday, 16 October 2016

Reflecting on the need for psychological first aid in 2016

Last Monday, (10th October) was World Mental Health Day (WMHD) 2016. Established 24 years ago by the World Federation for Mental Health, every year a different theme is used to both raise awareness, generate ideas for change and to share experiences. This years theme focused on the need for psychological first aid (PFA) and the support that should be provided to those in distress. We live in a world that at times feels characterised by unprecedented levels of conflict, natural and man-made disasters and personal trauma (such as abuse, neglect and sexual exploitation). Recognising what we can do to 'be with' and 'help' people experiencing trauma and crisis is important and critical to their mental health and well-being.

However, I think the risk of not recognising the trauma being experienced by others is very real. We are bombarded by 24 hour news stories from around the world and as a consequence, its easy to see why we might become inured to the impact on the mental health and well-being of others that such crisis's can bring. For example, on Wednesday evening when I returned from work, the main news item on the 10 o'clock news was the fact that Marmite was disappearing from our supermarket shelves as a consequence of a pricing dispute between one of the UKs biggest supermarkets and its main supplier. Sadly, the humanitarian crisis in Syria was way down the list of news items presented, and even then the story was framed in a dispute between the motives of both Russia and the US involvement in the dispute. Not good.

Of course recognising a mental health and or well-being problem is not always easy. Most mental health struggles do not occur in isolation to other experiences in our lives. I know from my research into the relationship between childhood sexual abuse experiences and adult mental health problems that experiencing trauma or some other crisis and its impact on one's mental health and well-being can be immediate and for some people also happen over a long period of time. I was reminded of this 'impact gap' last Tuesday during my journey back from London to Manchester.

I had left plenty of time to make the journey on the London underground, to get to the mainline station, buy a sandwich and small bottle of wine, and wait 10 minutes for the train to start boarding. It wasn't to be. I could see that the underground platform was already crowded as I approached it, but as there was a tube train already there I assumed that people would get on and the platform would become less congested. The train doors didn't open, and an announcement was made that there was a problem further up the line, and we would be delayed. After 15 minutes the numbers of people on the platform continued to grow, and my anxiety levels started to rise to such an extent that I started experiencing physical distress. I had to leave the station and get a taxi in rush hour traffic resulting in my missing my train back to Manchester.

It wasn't just the anxiety of missing my train that I was experiencing. On reflection I think it was also a memory of what happened on the same tube line way back in 1975. Then a train didn't stop at Moorgate station and crashed into the tunnel wall killing 43 people and injuring many, many more. I was living in London at the time, and I had travelled to work on the train before the one that crashed. I moved to Wales later that year, but for the 7 months between the crash and the move I never travelled on a tube train again. It was many years later that I finally started to travel on them once more. Coincidentally, I started my mental health nurse education and training in the October of 1975.

Thankfully my state of anxiety was short lived, and it wasn't really a crisis that required PFA. Unfortunately that is not always the case for many people caught up in a distressing traumatic situation. Critically, PFA is not something that only professionals are able to do. If you want to know more, about PFA, the WHO have produced a wonderful guide. However, in use, PFA does not necessarily involve a detailed re-telling of the event that caused the distress, but it will involve listening to people; its about providing practical care and support, which does not intrude; it might be about assessing concerns; and helping people address their basic and immediate needs. Absolutely it will involve comforting people and helping them feel calm; and protecting them from further harm. 

Some people will need PFA immediately or very soon after their crisis experience, others may find it useful slightly further down their road of recovery. It will very much depend upon an individual's experience, resilience store, and their emotional and physical resources. PFA appears to be most beneficial when the actions and responses help others to feel safe, calm and hopeful; able to access social, emotional and physical support; being connected to others, but also feeling able to help themselves as individuals and communities. Thankfully most of us won't find ourselves in a position of needing PFA, or of a need to provide it. But WMHD 2016, more so than in other years, helped me, to quietly reflect on all those whose lives will have been changed through such lived experiences. 

Sunday, 9 October 2016

Thinking About Women, Dogs, Long Lives and Care Free Days

I've just enjoyed 2 'free from' days. Last Friday (an annual leave day) I decided after tweeting 'good morning' to the wonderful folk that are the #earlyrisersclub (those people who start their day around 05.00) that it would be good to spend some time free from email, phone calls, text messages, tweets and so on. I found the experience a liberating one. I wasn't tempted to communicate with the outside world – well at least not digitally. I did speak to Mary, and took her dog out for a walk with Cello, and spoke with Kevin who was tending to his boat  on the beach. It was a quiet yet enjoyable couple of days. I did wonder if life might be like that in retirement (now just 2 years away). Of course a 'free from' couple of days will be different from living a life 'free from' workplace conversations, conference presentations, meetings and so on.

I do know that one of the things I am going to do when I retire is to write a book of collected stories of older women and their dogs. It's not such a bizarre idea as it sounds. I am an ethnographer, with leanings to social anthropology with much of my research drawing on psycho-dynamic theory. I am interested in how people build and engage with relationships, and have often used thoughts about the construction and use of interpersonal relationships to frame my writing. I am a people watcher and whilst I've been accused of sometimes being too silent, I do like listening to conversations. It is easy to do both activities in my small village in Scotland.

There are 140 people living there. The village has 2 hotels with bars, 2 slipways for launching boats, 1 village high street, a community hall (complete with a newly acquired defibrillator), a lifeboat station and a tiny, newly open tea room and shop. A number of the houses and cottages are owned by people who don't live in the village but come for holidays and so on. It's a great place to be. And if your mental health and wellbeing isn't where it should be, leaving aside my professional qualifications, there are 2 psychotherapist's, 1 GP, and 1 specialist in acute medicine, a retired dentist, 2 retired psychiatrists, and a slightly colourful lady who will offer you a range of alternative therapies, living in the village.

Like many small communities people care about others and will go out of their way to help. This is particularly true in terms of looking out for the elder members of the village. The oldest resident, Paddy, who is now aged 101, was once the former village GP. The 2011 census showed there were 91 people over the age of 65 living in the village, and 66% of the population were female. A large number of people sharing both demographics are for a whole host of reasons single. Women continue to live longer than men, but the life expectancy gap is getting closer. In the UK, women aged 65, can on average, can expect to live for another 21 years, whereas for men it is only a further 18 years. In my village, a lot of these older single women also have dogs and I often come across them as I walk Cello. I would love to capture their life stories and at the same time hear something about how they came to choose their dogs and the contribution their dogs make to their quality of life.

The World Health Organisation assesses Quality of Life (QoL) as being based upon an individual's perception of their position in life, in the context of the culture, and value systems in which they live and in relation to their goals, expectations, standards and concerns. Such perceptions will reflect everything from their physical and mental health, family situation, education, wealth, employment, religious and cultural beliefs, and the persons lived environment. Internationally, the UK is ranked 13th for its QoL (see here) but perhaps not surprisingly, only ranked 23rd for its Happiness Score.

In a world characterised by both dispersed families and a growing number of multi-generational homes, maintaining one's QoL in later life can be a challenge both for those growing older and at times for those around them, their family and friends. At a societal level, an increasing concern is that as the numbers of people living beyond 85 – 90 continues to grow, will there be enough younger people available to support those of a pensionable age. At an individual level, the challenge can become too difficult for many. A growing number of people seek to live out their last years in a residential care setting, and for some this will be due to frailty, poor health and a need for care to be available 24 hours a day.

Today, 1 in 7 people in England over 85 live permanently in a residential care setting. Even so there is a great deal of evidence to show that many of such people don't always have their needs properly assessed and responded too. The consequence is that many have have repeated and often unnecessary admissions to acute hospitals, something that should be entirely avoidable. It is the Care Quality Commission who are responsible for checking the quality of care in residential care homes. They say there are some 15400 care homes (other independent bodies recognise there are some 22000 residential care settings). It doesn't seem to be working, and so I was interested last week to get my hands on a copy of the NHS England report The Framework for Enhanced Health in Care Homes, which was published late September.

Unusually the report was co-developed and co-produced by health and social care staff, families, older people themselves as well as the usual policy suspects and experts. It is brilliant in its assertion of a number of principles that should shape successful enhanced health care in such settings: Person centred change – that is putting the needs of the older person at the centre of any changes (and supporting carers and families to accept this); Co-production of care – making sure the whole system acknowledges the interrelationship of services they provide; Quality – drawing on both research informed evidence as well as evidence from experts by experience; Leadership – effective leadership that is able to transcend organisational and disciplinary boundaries. 

Many of these principles are not new, and perhaps some will think they should be underpinning current services – but clearly they are not. The report is worth a read, but more importantly, we all need to contribute to delivering the necessary actions required to make the QoL for the elder members in our society better, wherever it is they choose to live, whether this be in caring communities such as my village, residential care settings or anywhere else. 

Sunday, 2 October 2016

Sweet dreams are made of this: being on your own, outside, and reading a book

Friday morning I overslept. It doesn’t happen often. I didn't wake up until 06.10. Yesterday was the same. My body clock let me down and not only did I oversleep, when I did wake up I felt absolutely exhausted. I think I know the reason why. Partly it was a consequence of long term Statin use which as well as protecting my heart and brain, also leaves me feeling fatigued and often with aching muscles. Partly it was due to an irritating eye infection. Mainly I think my problem was a consequence of the sleep robbing anxiety of meeting some tight delivery times for what have been sustained and complex work demands. Although experience tells me the state of my current mental health and wellbeing is probably self-limiting the results of the Survey of Mental Health and Wellbeing published last week showed I am not alone in experiencing such problems.

Whilst the survey drew on 2014 data it provided an important check on the health and wellbeing of the population. The results showed that one in three adults, (those aged between 16 -74) with conditions such as anxiety or depression were accessing mental health treatment. This is an increase since 2007, with women in particular showing higher rates of anxiety and depression than previously. Work related stress is but one of the known causes of anxiety and depression. There are a wide range of other known associations. These include: social isolation; being a member of some ethnic groups; poor housing and fuel poverty; childhood abuse (physical and sexual) and neglect; poor physical health; bullying, bereavement; job loss; being a carer; poor family relationships; problems with alcohol and illicit drugs; and being female.

The survey also revealed a higher (and growing) rate of young people, (aged 16-24 years old) are experiencing mental health problems such as anxiety and depression, with a rise in the number of young females engaging in purposeful self-harming behaviours. In last week's blog I noted that these days on average children get their first smart phone aged 10 years old. Clearly smart phones, computers, TVs and tablet devices are absolutely brilliant for enabling children and young people to explore the world they are growing up in and understanding themselves in relation to others in that world. Increasingly from a much earlier age children are experimenting with communication, information discovery, relationship building and unfortunately, at times, perhaps also putting themselves at risk of exploitation by others. 

Nick Harrop, YoungMinds Campaign Manager has noted that engaging in social media can put a great deal of pressure on girls to live their lives in the public domain, to present themselves as a 'personal brand' from a young age in their desire to seek reassurance in the form of number of 'likes' and 'shares' or 'retweets'. Other research by YoungMinds revealed that 81% of parents felt that access to social media resulted in their children being more vulnerable to experiencing mental health problems. It would be wrong of me to assume these are the same parents that buy their children a smart phone in the first place.

However, it was the work of Jim Horne of Loughborough University's Sleep Research Centre that caught my attention last week. His research discovered that only just over 50% of all 11 – 17 year olds are getting eight hours or more sleep. His sleep expert team report that young people in this age group tend to need at least 8 hours of deep sleep to be able to concentrate at school and maintain their mental health and wellbeing. Whilst I think smart phones and other devices are brilliant at enabling children and young people to connect with the world they live in, Jim Horne notes that the white light from the screens affects how people get to sleep and of course, the gadgets themselves can be a constant distraction. 

All of the above raised the question in my mind as to what is normal sleep? How do we ensure we get the rest we need to ensure a well-balanced mental health and wellbeing experience? Well last November there was a Hubub survey (a collaboration between Radio 4, Durham University and the Welcome Trust) which suggested that nearly 70% of people felt they needed to get more rest than they were currently getting. Interestingly, reading; being in the natural environment; and spending time alone were the top 3 ways people said they gained restful time. Sleep didn’t feature in the study at all. What surprised me more than anything else was that neuroscientists today tell us that our brains are in fact far busier when we are not concentrating on a task. And as you can see from this blog, hopefully order, as some of us know it, can be restored.