It came...and it went...?

As of today, Swine flu has 32 confirmed cases in the UK, with 1,658 around the World. There has been widespread panic, which has been fuelled by the media - with such headlines as "the end of humanity as we know it". I believe that one was down to our friends at the Sun. People need to get some perspective.

More people die annually in car accidents than from flu, and cars are a weapon of our invention. The word is that the actual rate of death from swine flu is no more than that of normal flu, and the papers are reporting that the death rate is actually decreasing.

This kind of mass panic has happened before: vCJD was meant to be one of the big killers of our time, that was spread through prions in infected meet. Thousands of cows were culled, and European trade ground to a halt. 164 people are reported to have died from vCJD, which is a lot less than was initially thought there would be.

SARS came in 2002, a pneumonia-like disease that came close to pandemic status affecting over 8,000 people between 2002 and 2003; eventually 774 people died with the disease. In 2006, the word was that one in four people might die of Avian flu, when in fact the global death toll was 257.

I suppose the question should be - can we win? This kind of thing keeps happening more and more frequently and eventually something will arrive that cannot be conquered. Horace said 'If you try to eradicate Nature, she will in time rise up silently and confound your foolish arrogance', and that was in the 1st Century BC. You could say that Horace was well ahead of his time; perhaps he wasn't, as the same thing has been happening throughout all human history.

At the end of the day, when all is said and done - we will all die. We won't be here indefinitely. Who's to say the human race will even be here indefinitely. There is always a danger that something is just around the corner that will be the end of civilisation as we know it.

I just don't think it's swine flu.

Swine Flu - Uh-oh!

Ok, so I haven't posted in a while - my apologies. Been a bit busy setting up a company with a couple of friends - have a look at http://www.clicketyclicksheffield.co.uk. Enough plugging...now to discuss a hot topic that's currently going on...

Looks like we will be getting another flu pandemic. Swine flu apparently started in Mexico and has spread out to the USA, Europe and as far away as New Zealand. Mexico reports that a hundred people have died from it so far.

So is this new? No: there have been several flu outbreaks with big impact over the last century. In 1918, a flu pandemic broke out in Spain and killed more than 50 million people, affecting up to 40% of the World's population. In 1957, Asian flu killed two million people, but it was minimised by fast action from authorities who made a vaccine available quickly. One million people were killed in 1968, when an outbreak was detected in Hong Kong.

Swine flu rarely passes from pigs to humans. In this respect, it is unusual that humans have contracted the disease, but it's not unusual that it has spread so quickly. Influenza is a respiratory disease, and so is spread by breathing, coughing - basically anything originating from the lungs. It's likely that this particular strain has undergone some mutation to allow it to cross the barrier from pigs to humans.

Viruses work by infecting a cell, taking over it, and using the host cell's replication techniques to make more of itself. The cell then begins to throw out copies of the original virus that infected it, which go along and infect more cells - thus beginning the cycle again. Antiviral drugs work by inhibiting enzymes involved, and preventing viral replication. Oseltamivir and Zanamivir have been recommended for treatment in Swine Flu. Luckily, with all the worry about Avian Flu, many governments have stockpiled antiviral drugs, and so this is perhaps some good news: the World is ready, and this may be slowing down its progress.

With the modern era of air travel and overcrowding, it will be difficult to completely stop swine flu. Let's see how things pan out.

For more info, read the BBC's FAQ on Swine flu.

We've all got a bit of narcissus in us

A recent BBC News article discussed the development of narcissism amongst pupils in schools in the UK. Narcissism originates from Narcissus, who was a Greek hero that fell in love with his own reflection, and died because of it.

Parents are increasingly placing high expectations on their little ones and the schools and teachers that educate them. People are increasingly putting a focus on self-esteem and boosting confidence, but this has had a negative knock-on effect. People have ended up feeling 'entitled' and only focussing on themselves, being selfish.

One could argue that this has had a wider effect on society. People are so encouraged to focus upon themselves and improve their own situation that this occurs at the expense of others. Looking back to the 40's, 50's and 60's people were community-focused, and genuinely wanted to help each other. People went to their neighbour for salt and pepper, now many do not know anyone in their street. People expect things now, whereas before they appreciated it if they were lucky enough to have something. People expect to have children, have money, to eat well, receive benefits if they are in need (or not, even), and receive expert treatment on the NHS. Yet people complain when they do not receive what they believe to be what everyone else is getting.

I am proud of our NHS. It does a lot of things for a lot of people, and when people complain that they are not receiving something, or feel that they are missing out they kick up a fuss. They should feel lucky and fortunate to be able to receive free healthcare. It is a bonus, not a right.

This week I've been in a nursing home. Oh the joy.

Actually, it's not been as bad as I thought it would be. The home I've been working in has 28 residents, both residential and nursing. The only difference being that the nursing residents require some sort of qualified nurse input, be it dressings or behavioural management. There is also a £100 difference per week. Residential residents pay around £350 per week, and nursing residents pay around £450. That's not exactly cheap - and what makes it worse is that many of their methods and much of the equipment is out-dated and obselete.

There's only one qualified member of staff on a shift, supported by three carers that do most of the daily care that is needed like getting people up, taking them to the toilet etc. They also have two apprentices that earn £30 per week and attend college one day a week. The carers are on minimum wage, with senior carers earning just 10p more per hour.

The staff are fantastic, however slightly lacking in experience, qualifications and up-to-date training. A central few of the carers have worked at the home since it opened, fifteen years ago, and some of the residents have lived there for that duration. The Sister leading the shifts this week was from South Africa, and had been over here for three years earning some money to pay for some print machines that she and her husband wanted to purchase. She was very experienced, and was effective at managing the shift.

I've had the opportunity to teach some of the carers some useful techniques, such as how to effectively use a slide sheet, maintaining pressure care and a bit on Parkinson's. Pressure care isn't something they do well - the owner won't pay the money to hire or buy a proper bi-wave (also known as airwave) mattress that ripples along maintaining effective circulation, preventing pressure sores. As a result, many of those residents with pressure sores just aren't improving.

The main thing that has let the home down was the manager. She was an enrolled nurse (which are obselete nowadays), and appeared to be taking some liberties with her job. I was told that she had employed her husband as a handy man, but he never did any work. She arrived late, and left two hours early - and there were rumours of her holding onto some payments from residents that paid in cash; someone told me that she had admitted a patient on cash payment terms and not told the owner until the following week that they had been admitted, pocketing a week's payment. Someone had tipped the owner off and he was beginning to check up on her, ringing later in the afternoon to see if she had left or not. She'll get found out eventually.

CSCI, the Commission for Social Care Inspection, gave the home two out of three stars - a "good" rating. To be honest, I've been to establishments much worse. It's just a shame it's not managed properly and has some pitfalls.

I'm not a massive fan of nursing homes as it is - and this one hasn't yet changed my mind.

The Desperation of those on JSA

The Jobcentre have had an influx of new people coming onto benefits. In the last year, the number on benefits has doubled. This could be due to the recent economic downturn. Even though it has been reported as early as 2001, hardly anybody saw it coming. Thousands of people have been made redundant, and the number of those going on to benefits has dramatically increased.

I've spent all week with groups on the CMP, and there are constant themes that echo throughout them all. People are desperate to get into work., that is all they can focus on. They are willing to take any and all work - all they require is the opportunity to find a place that will take them. Representatives from the Job Centre who came to talk to them were bombarded with questions - questions that they couldn't answer. What is certain is that there is much more available than is let on; they have "pots" of money that they can allocate to anyone they wish to be used for certain purposes, such as buying a suit for an interview or issuing travel warrants.

They are a good thing, but the benefits received almost seem to hinder a person's ability to get into work. A person has to be on benefits for a period of time, something like six months, before they can go on any training courses that would benefit them getting back into a job - such as first aid. Perhaps this is because if they allowed people to go on them immediately, the up-take would be too high and the budget not flexible enough.

Those on incapacity benefit can work for up to 16 hours for a year whilst still receiving their benefit. That can only be done for a year, when the receiver must either continue the work (perhaps extending their hours), or go back on benefits - which seems to be the preferred choice of the advisers. Work trials can be arranged, where people can work for a period of three weeks at a company. There is much bitterness surrounding this scheme; those I have met that have had trials have done several, and not been offered a job. However, the company has continued to have people on trials. Perhaps this is something to do with the company receiving money from the government, and the worker only receving costs such as transport and meal allowance.

Working has lots of good side-effects. When you go to a party, the first question someone asks you is "so what do you do?" and it can be very difficult to say "nothing". Working gives people a sense of belonging, worth, not to mention financial gain. It also improves social wellbeing and skills that could be transferred to another job. And instead of the government having to fork out billions in benefits, people pay into the system rather than taking from it. It also stimulates the economy,with people having more money to go shopping and engage services.

The Tories are planning "work for benefit" schemes, where those on job seeker's allowance for more than twelve months do some sort of volunteering or community project. George Osborne has said that the culture of "money for nothing" needs to end. Meanwhile, GB ploughs more and more money into the economy.

Most people want to work. But for every one that wants to get back to work, there must be ten that have no intention of doing so. Which is a shame; if only they knew what good it would do them.

Community rehabilitation programmes

I've been spending this week with a Condition Management Programme run from a Primary Care Trust. Condition Management Programmes (CMP) run in conjunction with the Job Centre Plus and their "Pathways to Work" programme all across the UK, and their aim is to encourage those that have been on incapacity benefit (now called employment and support allowance) for a long time to get back to work through running workshops concentrating on:

• Stress management
• Managing their condition
• Goal setting
• Time management
• Coping strategies
• How to be assertive

Most of their customers have some sort of mental health problem, such as depression, that has prevented them from working. There are some who have had accidents at work or have suffered long term chronic illnesses such as spondylosis or disc prolapses. Most benefit and the changes in the person are noticeable. Many then actively seek work and feel better in themselves. There is no doubt that the service is effective. A great deal of support is given, with free six month gym passes and travel expenses paid for. Free lunches are also provided, all in an effort to keep people attending and show up in the first place. I went to a session on Monday, and there was a diverse group of people. One lady was an out of work mental health nurse, one had an accident at work, and another alcoholic.

One lady, who opened up immediately, was obviously keen to participate in the group. She had left the Army three years ago, and had served in the Royal Artillery. Suffering constant flashbacks and what was obviously post-traumatic stress disorder, she had turned to recreational drugs and had been dishonourably discharged from the Army, losing her pension. She had used amphetamine and ended up with what she called "phet psychosis". Thankfully, she had sought treatment and was under the care of a CPN. She was on olanzapine, which relieved her symptoms and she was "back in touch with reality" now.

The programme really does benefit the people that enter it, and many go on to get good jobs and the difference in their life is tangible. I sincerely hope that she manages to finish the programme and get her life back on track.

For more info, here's some research that's been done on CMP's.

I got rhythm

Image copyright Bertil Videt

Sleep is fantastic. I love it - which is why I'm always in two minds about working nights. Sleep is a natural process that everybody does, and many other organisms do it too. It's needed to "recharge our batteries", and we spend a third of our lives doing it. Sleep has five different levels, four non-REM and one REM; the whole process is cyclic and lasts about 90 minutes, which is why 90 minutes is a good length of time to have a nap.

Without enough sleep, executive functions decrease affecting language, memory, planning, rapid judgement and change, and reduced awareness of sense of time. 17 hours of being awake is equivalent to two glasses of wine, the legal limit for drink driving in the UK.

Our natural circadian rhythm is maintained by melatonin, secreted by the pineal gland. This rises and falls and controls lots of body processes that speed up during the day and slow down during the night. If you're working a night shift, it's important to eat well and maintain a proper sense of time. Those who work lots of nights, or even permanent nights, can often end up losing track of weeks, months and years due to never seeing the day time properly.

As for the ward on a night shift, well - as most people will testify - it's completely different in comparison. The pace can be slower, and more time is provided for individual patient care. There's also often a lot of good staff banter that goes on that there isn't time for on a busy day shift. Patients' confusion often increases, and a lot of people pass away at night; often more so than during the day.

Old Florry herself reportedly only got four hours a night, the same as Margaret Thatcher, I certainly can't cope with that much.

I think it's time I had a nap...