MPH Master pieces

a final post...

I retire next week so this is my final post. I failed to produce a portentous post for my 500th blog; failed again for the 10th anniversary of the blog; and now I intend to fail again for my final blog. Instead I'm going to repeat the only post which I know for sure is true: here it is! (ok so it was originally posted on a warm summer evening not a dark winter night): 

 

The exam season is over, the sun is shining, summer has arrived and so today we have something completely non-scientific: my top tips on how to run. I say 'non-scientific' but we could class this as 'Grade IV evidence' (expert opinion). In fact I'd like to grade it a lot higher, because this is one of the very very few things I know for myself: everything else I think I 'know' is merely something I have read. 

Enough epistemology - here are the tips. 

1. At the end of your run, the correct cognitive state is  'That was wonderful! I could do it all over again!'. If you're gasping for air and thinking 'I'm almost dead' then you're trying too hard. Judge it right and within a couple of weeks you'll be amazed at how your marvellous body responds. 

2. Enjoy the sunset on your run, and the flowers, and the fresh air going in and out of your lungs (see top tip #1). Corollorary: run in the countryside, not on a boring track and certainly not a gym treadmill.

3. Evolution has given you a useful pad at the front of your foot. Focus on hitting the ground with that, not your heel. If you hit the ground with your footpad, that wonderful cantilever of ankle, knee and hip (not forgetting the big toe) takes over and does the rest. No knee problems, no back problems, no hip problems. 

4. Your foot needs to hit the ground 3 times per second - that's pretty fast. When you come to a hill, shorten your stride but don't slow your cadence. 

5. Don't go thump-crash, thump-crash. Try to glide: put some coins in your pocket - they shouldn't jingle. 

6. At the end of your run, the correct cognitive state is  'That was wonderful! I could it that all over again right now!'. Or did I already mention that?

And there you have it. Guaranteed to keep you running for at least 40 43 years. 

 

Is bullying a public health problem?

Don't know the answer to that one, but the resulting distress is clearly a health problem and stopping the bullying could count as primary prevention. So here is a trial with a modest but potentially important result. Cost £58 per pupil, which could add up to £60k in a large secondary school. I can't see it being widely adopted, or am I getting pessimistic in my old age?

Meanwhile I have been reading a book published 40 years ago by Adam Curle, a Quaker who won the Gandhi peace prize. He tells an interesting story about Danilo Dolci who went to Sicily to do some project or other but stayed on because he was 'distressed that the rural people did nothing to resist the power of the Mafia, which dominated and exploited almost every aspect of their lives'. Curle says that Danilo drew a parallel with schools in which a teacher is frightening and domineering - the children are so concerned to stay int he teachers good books that they pay little attention to each other. The way forward is to encourage the children to connect with each other. That changes the whole dynamic of the bully. Likewise the rural poor and the Mafia. Curle comments that it was surprising to many that Danilo was not assassinated.  

Organisational culture

I don't often come across articles from the management literature - this one has a rather simple basic message but some of the references look interesting enough to follow up. One of them is by Stephen Shortell who over the years has published several interesting studies of hospital teams. 

Promoting physical activity

I think the Chief Medical Officer for England recently issued new guidelines on physical activity for the UK population. I say 'I believe' because it's proved remarkably difficult to track down on Google. I read somewhere that this update from CMO shifts the emphasis away from the previous 100% focus on cardiovascular fitness (10 000 steps a day etc) and remembers the old rule of 'stamina, strength and suppleness', perhaps because of the increasing attention to falls in old people. But you do need all three 'S'. 

The equivalent recommendations from the USA are however easy to find. The full suite of documents is massive but this one is quite fun to browse; perhaps more as a lookup for all those things that people have suggested over the years - wearable activity monitors (aka FitBits); stair use prompts; video games etc etc. 

Standing at work

The British Medical Journal is obsessed with putting everything in plain view. So it's interesting to read the peer-review comments on this paper and see also the authors' responses. One of them answers a query which occurred to me - does standing at work really make much difference?

Lead

Sometimes Google lets you down. It cannot, for example, distinguish 'lead' from 'lead', the former being what you want Top People to do so that we can all follow them dutifully, whilst the latter is a toxic substance that you definitely don't want to get in your mouth / digestive tract / blood. 

All of which explains why I can't tell whether this 'Lead Action Card' has been updated recently. It's worth a quick skim. 

British citizen dies of rabies

By an awful coincidence, it was reported today that a British patient who contracted rabies while on holiday in Morocco has died of the disease. I don't want to make any big thing out of a tragedy but it does confirm that you have to be prepared for rare events. 

Rabies

Rabies is almost unknown in the UK but that doesn't mean it can't happen. This is the latest guidance. More detail than you need unless dealing with an incident but it's one of those things which is worth skimming now so that when you do need it, you remember it exists

Cardiac screening of footballers

The death of any young person is a tragedy. When that death occurs suddenly on a football pitch, in plain view of millions of viewers, the tragedy soon becomes a call for action - why was this elite athlete not given a proper medical? How could they have missed a lethal cardiac problem?

The Football Association rose to the challenge and here are the results. It's an impressive piece of research carried out over 20 years. The conclusion, alas, is that screening is most of the sudden cardiac deaths would not have been prevented by screening. Whether it's worth doing anyway is another question. The report doesn't seem to indicate any harms, and given this programme is run for professional footballers it isn't taking resources away from other more effective healthcare programmes. What do you think?

Typhoid

Typhoid update: the balance has changed between treatment (used to be good) and vaccine (used to be useless) for typhoid: see here for the latest thinking.