August 01, 2012

Pole to Pole …

Dr Harbinder Sandhu, Assistant Professor (Division of Health Sciences) and Registered Psychologist was recently recognised for the psychological work and research she is doing with British adventurer and explorer Mark Wood at the Ice Awards held at the Coventry Olympic Stadium, in July 2012. Here she talks about her work with Mark and how she supported him in preparation for his latest expedition.

Mark Wood, explorerIn November 2011, Mark Wood set off on his attempt at the first expedition to ski solo to both the North and South Poles unsupported and unaided. He spent a total of 62 days in extreme environments, completely alone, in temperatures as low as -43°C. He reached the South Pole in January 2012 and finished his expedition in April 2012.

As a Psychologist when I first met Mark, I was instantly interested in the expedition that Mark was planning to do. It amazed me that one individual was planning to embark on one of the toughest journeys on the planet, on his own, isolated and unaided facing dangers of the extreme cold weather conditions, deprivation and other physical dangers such as polar bears! The journey was no doubt going to be physically challenging for Mark, but what was just as important was the mental challenge that Mark was going to face. I remember one of the first questions I asked Mark was “what was motivating him to do this?” and his reply was to simply do what he loves doing: 'exploring' and setting himself one of the toughest challenges yet whilst being able to educate people and connect them with the issues of climate change.

A recent review published in The Lancet outlined key psychological symptoms that have been reported by people on polar expeditions, these include; somatic symptoms (for example fatigue and headaches), sleep disturbance, impaired cognitive performance, negative affect (e.g. anxiety, low mood), interpersonal tension and conflict (Palinkas and Suedfeld, 2008).

I worked with Mark for several months leading up to his expedition, exploring the above and providing psychological support and training. I also met with Mark after he completed the South Pole and before he embarked on his journey to the North Pole. This gave me a real insight into what Mark had been through on his journey to the South Pole, how he had overcome his fears and managed to adapt and work through the cognitive challenges and emotional deprivation that he had come up against day after day, isolated and alone in freezing temperatures. Having now completed his full expedition, I will continue to work with Mark and more recently Dr Ronald Roberts (Senior Lecturer, Kingston University) who has also published in this field. Together we will be analysing our unique data set and aim to publish some interesting findings, adding to our understanding of surviving in extreme conditions.

Extreme Psychology or Polar Psychology is a subfield of Psychology which studies human behaviour in extreme and unusual environments. Leading experts have also overlapped this with studying human behaviour in short term situations such as 'Battlefields and Disasters'. However research into polar psychology has served a very useful analogy in understanding physical demands likely to be faced by people on long duration space voyages and therefore is used by various space centres such as the National Aeronautics and Space Administration (NASA) and also more recently within the health field with insight into the management of stress.

I very much look forward to continuing my research in this specialised area.

For further information about Mark's journey please visit: http://www.markwoodexplorer.com/ or Facebook: http://www.facebook.com/MarkWoodExplorer

Dr Harbinder Sandhu C.Psychol, AFBPsS can be contacted on: Hardinder.k.sandhu@warwick.ac.uk


February 01, 2012

Linking poetry and medicine

Professor Donald Singer, Professor of Clinical Pharmacology and Therapeutics at Warwick Medical School, talks about this award-winning literary competition which entwines medicine and poetry.

The deadline is looming for entries to the 2012 Hippocrates poetry & medicine awards . Midnight on Friday 3 February is the closing date for submissions of unpublished poems on a medical theme. The poem must be of up to 50 lines written in English in either of 2 categories: an Open International Prize and a UK NHS-related Prize.

With a 1st prize for the winning poem in each category of £5,000, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem. In each category there are also 2nd and 3rd prizes of £1,000 and £500 plus 20 commendations of £50.

Anyone in the world may enter the Open category whilst the NHS category is open to UK National Health Service employees, health students, and those working in professional organisations involved in education and training of NHS students and staff.

To date for the 2012 Awards there have been entries from 5 continents, from 26 countries from Argentina to Australia, Brazil to Burma, Italy to India, South Africa to Switzerland, Ghana to Germany, and with poems submitted from 33 US states, 5 Indian states, 4 Canadian provinces, and from throughout the UK.

We have continued the policy of having a panel of 3 judges, an internationally recognised poet, a broadcaster with experience of judging literary awards, and an expert in medical science or practice. Unusually for poetry awards, [or for refereeing medical articles], judging is anonymous.

This year, the Hippocrates Award winners will be announced by judges, Marilyn Hacker, Martha Kearney and Professor Rod Flower, FRS, at an Awards Symposium at the Wellcome Collection rooms in London, Sat 12th May at the end of a one day 3rd International Symposium on Poetry and Medicine.

The competition was honoured by The Times Higher Education Awards, receiving the 2011 award for ‘Excellence and Innovation in the Arts’.

The Fellowship of Postgraduate Medicine is a major supporter of the 2012 Hippocrates Awards, which are also supported by the Cardiovascular Research Trust.


January 18, 2012

How Warwick is working to understand and therefore prevent, child abuse

Professor Jane Barlow, Professor of Public Health at Warwick Medical School, talks about the research examining the rise of child abuse and maltreatment

Without question, the first two years of a child’s life are crucial because research has shown that the parent-infant relationship during this period influences so many aspects of the child’s early and later development and it has significant impact on their rapidly developing brain.

child health

Sadly, recent estimates (All Babies Count, 2011) show that maltreatment during infancy is still common:

  • Around half of all serious case reviews in England are for a child under the age of one year
  • Between 8-12% of all children on a child protection plan are less than 1 year of age; neglect is the most common category of abuse for children under 1 year of age followed by emotional abuse, physical abuse, multiple abuse and sexual abuse
  • Non-accidental head injuries are high in infancy, and result in up to a third of the deaths in this age-group, with significant brain damage occurring in around half of the survivors

Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan.

Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant’s physical and emotional needs. The poor outcomes that are associated with drug-dependency appear to be linked to the multiple difficulties experienced by such parents, e.g. mental health problems, family relationships, socio-economic factors, etc.

An increase in understanding about the crucial importance of early relationships for infant wellbeing, has led us to a focus on the development and delivery of services that are aimed at supporting parenting and parent-infant interaction, particularly in families experiencing serious problems, and where there is a high risk of abuse.

Warwick Infant and Family Wellbeing Unit (WIFWU) is working on a number of research projects that are aimed at preventing such abuse.

We are working with Oxfordshire Social Care to develop a perinatal care pathway in which women experiencing a range of serious problems during pregnancy (alcohol/drug dependency; serious mental health problems and domestic violence) will be provided with an intensive programme of intervention aimed at supporting them through the first year of the baby’s life. It’s also aimed at addressing early parenting difficulties.

We are working closely with the NSPCC on a newly developed intervention called the Parents under Pressure (PUP) programme, which is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby’s development. The intervention is also aimed at helping families to address wider problems related to housing and social factors.

At Warwick, we are evaluating the effectiveness of this programme using a randomised controlled trial.

If you are interested in these or any other aspects of the work of Warwick Infant and Family Wellbeing Unit visit the WIFWU website or please contact: Professor Jane Barlow – jane.barlow@warwick.ac.uk


January 06, 2012

Seasonal Ineffective Disorder

Dr Bart Sheehan is Associate Clinical Professor of Old Age Psychiatry within the Divsion of Mental Health and Wellbeing at Warwick Medical School. Here he gives his take on those New Year's resolutions...

SAD (Seasonal Affective Disorder) is a type of winter depression that affects an estimated 7% of the population every winter between September and April; in particular during December, January and February - so says SADA, the UKs only charity for this disorder.

Note the key months: December, January and February. These are the months when a majority of the population plan, declare and then fail at a New Year’s resolution. If we are more likely to be depressed, isn’t it surely the worst time to try?

But maybe not. A non-systematic review, i.e. a quick survey of the ethersphere, found me no evidence that resolve (the human characteristic of bravery), persistence and dedication, have seasonal variations. SAD itself might also be NAD - 'nothing abnormal detected' (more medical abreviations).

The whole concept is controversial, many dispute its reality and it isn’t an accepted diagnosis in the main classifications. Trials of the most popular therapy using Heath Robinson-esque light boxes, are inconclusive. Indeed, the only really established association between season and mood is that suicide peaks in April/May/June - and intriguingly also in the Antipodean spring/summer.

The one certainty though is the new year's resolution will usually fail. Our capacity for self-deception is endearing - we strive, mess up, and try all over again. An acquaintance has a good solution, he succeeds in giving up his particular vice for the month of January then has a planned relapse on 1 February, lasting the rest of the calendar year. No failure there.

Happy New Year!


November 17, 2011

The health bill and what it means for GPs and patients

Veronica Wilkie

GPs have been in the news since last summer because of what has been seen as a controversial health bill. Here, Dr Veronica Wilkie, Senior Clinical Teaching Fellow at Warwick Medical School, gives a beginner's guide to proposed changes.

'Liberating the NHS' was published as a white paper shortly after the Coalition Government came to power. At its core was a drive to increase the input of 'coal face' GPs, and reducing what was trumpeted by the newspapers as unnecessary middle management and bureaucracy. You will all be aware of the incredible amount of news that this generated and GPs and myths and legends that were reported by the media. As a result there was a 'pause' in the Bill and The Future Forum, lead by Professor Steve Field, undertook a listening exercise. There were 4 core themes:

  • Choice and Competition
  • Public Accountability and Patient Involvement
  • Clinical Advice and Leadership
  • Education and Training

The report (and it’s a very readable report) came up with a number of key suggestions for change: competition must be used to improve services and regulators should not encourage competition for its own sake; increase integration rather than competition; be careful about fracturing systems of workforce training. It also recommended that the commissioning groups should be clinically lead, not GP lead.

As a result things have moved on in the NHS, although the bill hasn’t yet finished its passage through the eagle-eyed House of Lords. There has been a significant amount of structural change within the NHS, and a change in how many managers there are, with many excellent managers being lost to private sector employment due to the uncertainty over their future careers. It’s worth noting that delivering healthcare is complex and requires good managers as well as good clinicians. GPs now work with 'Cluster PCTs' often covering a quarter or a fifth of a whole region, and the strategic health authorities (SHAs) that used to lead the NHS direction are now no longer regionally based but work as cluster SHAs covering several regions.

Every GP and GP practice is now interacting with Clinical Commissioning Groups (CCG) that are starting to commission in shadow form. These often have very few people working with them and are still under the direction of PCTs whilst they go through a series of accreditation steps, ensuring that by the time April 2013 comes commissioning is handed over safely and with continuity.

These changes have also come in a time of huge economic uncertainty and although money in real terms increases in the NHS, it in no way keeps pace with healthcare inflation. There are huge challenges and the NHS has never needed clinical leadership more. A paper in the BMJ last week showed that General Practice and Pharmacy (largely in primary care) were the only sectors of the NHS that had managed to reduce their costs, with all other aspects of the NHS actually increasing their spend year on year. Primary care costs less than 20% of the NHS budget but carries out more than 80% of the activity.

Many CCGs are interacting more with local practices and all clinical professions than the PCTs had done so before the Coalition Government came to power, and experience within the Institute of Clinical Leadership at Warwick Medical School which runs action learning sets with CCG Boards, clinical leads in primary care and with clinicians in secondary care, shows that there is some excellent work occurring to integrate patient care.

Clinicians are working across the primary and secondary care sectors to integrate care according to the needs of patients rather than the needs of the institutions and financial contracts, working in creative ways to keep patients cared for safely in their own homes rather than being admitted to hospital. However much more needs to be done, and there needs to be more openness and dialogue with patients, their carers, and those who commission and provide healthcare before the NHS can really say it follows the central tenet of Liberating the NHS “No decision about me without me”.

Patients need good quality healthcare; it’s a brave government who interferes with what the public perceives as their NHS and every one who works for the NHS needs to look within themselves to provide the shared leadership skills to make this change and any future changes in policy work.

Find out more about the Clinical Leadership courses at Warwick Medical School.


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