Accessing health care over the holidays!

There are a number of ways to access health care in the UK during the vacation:

  1. If you are in or visiting Bristol, you can access care as usual from the Students’ Health Service.
  2. If you want advice about an ongoing issue for which we have seen you, please make a telephone appointment with a GP. Not all medical concerns can be resolved in this way.
  3. THINK AHEAD- if you are running low on a regular medication,  please send repeat prescription  requests by post, with a stamped addressed envelope.  There will be cases when this is not appropriate, e.g. you need up-to-date blood pressure or blood tests.

This useful link gives further advice,

http://www.nhs.uk/chq/pages/1011.aspx

 

  1. If you are away from Bristol and need medical care you can contact a local GP and sign on as a ‘temporary resident’. We advise our students not to sign on as a ‘permanent patient’ if they are returning to Bristol as a student after the vacation, as this causes problems with transfer of medical notes.  Please follow this link for information regarding accessing healthcare in this way

http://www.nhs.uk/chq/Pages/how-can-i-see-a-gp-if-im-away-from-home.aspx?CategoryID=68&SubCategoryID=158

 

  1. Remember that other clinics may meet your needs e.g. local family planning service, STI clinic or minor injury services. Details of these can be found on the link above.

 

  1. Remember that ‘A+E/999 calls’ are for medical emergencies.  If your local GP is closed and you want medical advice for a problem that cannot wait until the surgery re-opens (but is not an emergency), please call 111 to get advice (as you would normally do in Bristol).

National Smile Month! 19th May- 19th June 2014

Each year the British Dental Health Foundation promotes dental health awareness with its National Smile Month, this year it will be May 19th – June 19th.

 

http://www.nationalsmilemonth.org/page/smile-month-explained

 

Further advice about looking after your teeth while you are a student can be found at

 

http://www.bristolstudentdentalpages.co.uk

 

Students are vulnerable to tooth decay and the beginnings of gum disease – looking after your teeth between 18 and 25 will have long term positive effects as well as saving you a lot of money over your lifetime.

 

Seeing a dentist once a year will help to identify problems while they are small, therefore easier (and cheaper) to sort out. There are lots of preventive things that dentists can do to stop decay in its tracks. One of the simplest things is just having your teeth cleaned, which is enormously beneficial to your gums and helps prevent bad breath. If you haven’t had a snog for a while it could be your teeth need a scale and polish . . .

 

Unfortunately dentistry is no longer free for students but you can get help on grounds of low income by filling in an HC-1 form for NHS treatment. Always use your term time address so that other family income doesn’t have to be included.

See http://www.bristolstudentdentalpages.co.uk/finding-a-good-dentist/nhs-access  for further advice.

 

Looking after your teeth now is so important. As the Smile Month website says, most adults wish they had looked after their teeth more when they were younger. By being good to your teeth and gums as a student, you will have a healthier, trouble free mouth both now and in the future, and that will save you a lot of money.

 

David Obree

Dentist

Redland Road Dental Practice

 

 

Five Ways to Wellbeing at Exam Time

Exam time is a difficult time for everyone, though for some more than others.

So it’s important to remember that you can do things to help yourself remain calm and in control, throughout those weeks when your adrenaline can be flowing a little more rapidly.

 

Here are some evidence based ways that we can look after our mental health, a bit like a ‘5 a day for the mind and soul’.

 

  1. Keep Connected; stay in touch with the people around you, the people who care about you and who can support you in life
  2. Be active; go for a walk/ run/ swim, breathe in some fresh air. Exercise on the Downs. Release that adrenaline in a positive way
  3. Take Notice; notice the world around you, the changing seasons, walk around and observe what is happening. Be aware of your feelings
  4. Keep learning; learning new things can be fun if you make time for it, and for yourself too
  5. Give; do something nice for someone else. Cook a meal/ help out your community/ volunteer. It is scientifically proven that being nice to others releases a happy hormone (oxytocin) and makes you feel better too!

 

However, if doing all these things isn’t enough to support you through a difficult time then remember we are here to help, as are the Counselling service, and other services in the university, like the Multifaith Chaplaincy.

It is normal for exam time to be stressful, that adrenaline can help focus the mind and bring your performance up a notch, but if it feels out of control, and overwhelming then please ask for help sooner rather than later.

Good Luck!

Mental Health Awareness Week 12-18 May 2014; Anxiety

As a GP I really like it when a student comes to see me about their anxiety. Not only because it means they are keen to get help and get better, but also because there are so many things we can offer to ease their symptoms. In the last few years, here at Students’ Health Service, we have tried really hard to provide a variety of treatment options for what is the commonest mental health problem that we see; anxiety.

Anxiety affects people differently (about 1 in 20 people will have it at some time), but in general it makes you feel afraid and tense. It can lead to physical symptoms, as your adrenaline rushes around more than usual. People complain of palpitations (fast heart beat), sweating, nausea (feeling sick), chest pains, and shaking. You can also get headaches, and feel out of breath. It can be normal to feel like this, eg before an exam, but when it starts to interfere with everyday life it can become very challenging. Some people get panic attacks, where the symptoms feel overwhelming, and it can feel like the world is closing in on you, or that you might die. Please ask for help if this is happening. Ideally, please see a GP before it gets this bad.

So what can we offer you?

A variety of psychological (talking based) therapies are available. Relaxation techniques and Mindfulness can be learnt, and the Student Counselling Service provides very regular groups. Just sign up on their website.

http://www.bristol.ac.uk/student-counselling/

Self Hypnosis has been shown to be effective, and a GP can refer you for this; a one off free session provided by Matt Edwards in a confidential environment. Here is a blog written by a student who saw Matt last year;

http://studenthealth.blogs.ilrt.org/2013/02/04/i-tried-self-hypnosis-for-my-anxiety-you-could-too-a-student-writes/

 

Online CBT (cognitive behavioural therapy) is available for those who would prefer this method; sign up via the SCS website.

Free NHS groups, and 1 to 1 therapy are accessed via the LIFT Psychology service; no GP referral required, just contact them on

http://lift.awp.nhs.uk/bristolandsglos/

However, if psychological approaches are not enough, or might take too long and your symptoms are too challenging to manage daily, then medication can be extremely helpful, and can work within a few days of starting it. Any of the GPs will be happy to discuss this option with you.

So remember, anxiety is normal and common, but sometimes it can become overwhelming or a daily stress, so get help and talk to us soon!

The Succeed Foundation’s Vision is “A World Free From Eating Disorders”

The Succeed Foundation has a simple mission to free the world from eating disorders. Through fundraising and investment in innovative research, and the promotion of ground-breaking evidence-based treatments and preventions, the charity aims to tackle eating disorders in measureable ways.

Every individual with an eating disorder is unique. They will not all respond to the same treatment. In partnership with researchers and clinicians, we develop a broad range of approaches and transform the science into practical tools that sufferers can beneficiate in their daily life as a self-help tool. We want to move from awareness to action.

The Succeed Body Image Programme

 The charity has a wealth of sound scientific research behind it thanks to its association with a number of academic institutions; including the University of the West of England; their Centre for Appearance Research is monitoring the Body Image programme in the UK, headed by research fellow and Doctor Phillippa Diedrichs.

The Succeed Body Image Programme (SBIP) is a cognitive dissonance-based intervention.

Dissonance theory suggests that if individuals act in ways that contradict their beliefs then they will typically change their beliefs to align with these actions. The Succeed Body Image Programme therefore, actively engages its participants in of a series of verbal, written and behavioural exercises that critique the unrealistic, ultra-thin-ideal standard of female beauty.

The SBIP is designed to help individuals across all spectrums to establish and maintain a positive body image. Using highly interactive, peer-led, small groups, it is a two-day, intervention program designed by experts and implemented through trained peer leaders on college campuses throughout the UK.  As the first peer-led, evidence-based eating disorders prevention program shown to truly work, The Body Image Program does not specifically focus on eating disorders; rather, it emphasizes creating and reaffirming positive and healthy personal body image through a variety of structured discussions, activities, and exercises. The phenomenal program has a proven track record – not only on improving body image issues, but on encouraging healthy confrontation and communication skills as well. It is the first scientifically supported evidence-based eating disorders prevention program designed.

Fat Talk Free

Fat Talk describes all of the statements made in everyday conversation that reinforce the thin ideal and contribute to women’s dissatisfaction with their bodies. We want to raise the nation’s consciousness about the danger of fat talk and our initiative is to eliminate that kind of talk from our lives and stop appearances critiques and accept the way we are.

This can be achieved by simply changing our conversation.

Our Success depends on collaboration and monitoring our work we want to focus in what works.

to access the support contact the Succeed Foundation Directly

www.succeedfoundation.org

Carers may find this link helpful too;

http://www.succeedfoundation.org/work/skillsforcarers

 

 

When you hear the word ‘counselling’ what do you think of?

Two people in a room; one talking and the other just nodding and listening? 
Films have a lot to answer for, and for me that image conveys nothing of the aliveness of the relationship that counselling offers.

For instance, when was the last time that a friend or someone in your family really listened to your experience, without confusing it or comparing it with their own? 

The real trick of counselling is that it creates the circumstances that mean you can fully be yourself. By providing relational sounding boards and mirrors it allows you to see and hear the self you are in this moment. Sometimes someone else can see you changing when you can’t see it yourself.
Most people emerge from experiences of counselling feeling better than they did at the start, more able to function and on a positive trajectory in terms of their mental health, but the chances of this are much increased if they can come along with some openness to the process, some belief it could help in some way. This is one of the reasons we ask people to refer themselves, rather than being required to come: they need just a tiny bit of belief, and it can be just tiny.

The other surprise to some is that counselling is not just about two people in a room, in fact increasingly this is less and less so. The Student Counselling Service now offers about 300 students direct support each week and whilst some of them will be in individual appointments, most of these are either initial assessments to establish the best pattern of care for someone, one off follow ups to these meetings to support a person’s self help, 20 minute initial meetings to establish support choices, or 20 minute ‘Drop ins’ to offer immediate triage and signposting to support, or to help keep them on track with ‘Beating the Blues’ (our online CBT support programme). Even our regular sessions tend to be for fewer than 6 weeks.

Over 100 of the total seen are accessing our regular closed groups or coming just this week to an open group, or attending one of our workshops. And that’s without keeping a count of the number of people who use our resource library and website self help pages.

Because of the range of what we offer we registered over 1600 students last academic year, and so far this year we are experiencing a 20% increase on that. We can’t work with everyone but we have a number of useful contacts in the wider community of Bristol, so that no one needs to feel alone with their concerns.

And just one little plug for group work. If counselling helps you see aspects of yourself you can’t yet see , imagine what it might feel like if other students just like you provided the sounding board, or if someone in the group told a story that made you feel you were not the only one struggling with similar things. It is a powerful moment, and every group sees it, when someone says, ‘it’s such a relief…I thought it was just me’.

http://www.bristol.ac.uk/student-counselling/

 

World Immunisation Week 24 – 30 April 2014; “Are you up-to-date?”

Back in 2012 I watched a BBC documentary ‘Ewan Macgregor: Cold Chain Mission’ http://www.unicef.org.uk/asp/cold-chain-ewan-mcgregor/index.asp. This filmed the actor’s mission as an ambassador of UNICEF to deliver vaccines, and immunise children in some of the world’s remotest places. This particular programme followed his journey to India and Nepal and highlighted the incredible journey he made trekking 2 days over the Himalaya whilst maintaining the ‘cold chain’ of the vaccines he was delivering to remote mountain villages. The cold chain is the essential system of transporting and storing vaccines within a safe temperature range (2°c to 8°c) from the place of manufacture to the point of administration. This ensures people receive an effective vaccine that has retained its viability by not being exposed to temperatures outside of this range. So you can only imagine how difficult this was given the circumstances of this trip!

A couple of things have stayed with me since watching this programme, namely;

• The complicated planning and effort it took the team to maintain the cold chain whilst trekking in the mountains, to preserve the efficacy of the vaccines they were delivering (without a vaccine fridge!). It really was a mission!

• The determination of these few health care workers to ensure even the remotest of children was protected against disease.

• The remoteness of where people live and their lack of basic medical care – to include limited access to vaccinations.

• The relief I saw in the parents as their children were immunised. They understood all too well the importance of immunisation, quoting that the measles vaccine being offered ‘will keep their children safe.’ I got the impression they had perhaps seen at first hand the devastating, sometimes fatal effect of measles infection in a child.

Immunisation is recognised as one of the most successful and cost effective health interventions ever introduced. It prevents 2 – 3 million deaths every year. New vaccines now protect against diseases such as pneumonia and rotavirus diarrhoea- two of the world’s biggest killers in children under 5. We also now have vaccines to protect against cervical cancer for adolescents and adults.

As highlighted in the BBC documentary, large numbers of people are not immunised, and for those who start but don’t finish immunisation schedules this is due to:

-inadequate supply of vaccines

-lack of heath care workers

-insufficient political and financial support

Here in the UK, we are extremely fortunate to have a system in place that is easy to access, evidence based, safe and funded by the NHS to ensure we are all protected against the most devastating ‘vaccine- preventable’ diseases. We now have a schedule that is started in pregnancy to protect pregnant women against influenza, and their babies, when born, from whooping cough – this continues through to the birth of their babies – the first few months of life, toddler age, pre-school age, on to teens and then later on in life above the age of 65 years.

We are very lucky indeed.

However, many people here in the UK are still not being vaccinated or are not up-to-date with the schedule. Unlike some other countries, we have robust systems in place to immunise our population, so why is this?

Lack of education about vaccination is one of the key reasons why adults consciously choose not to be vaccinated themselves, or not to vaccinate their children. Here in the UK, there have been many ‘scare’ stories and ‘controversies’ concerning immunisation that have influenced uptake of vaccinations and unfortunately we are now seeing the after effects of these, one being the recent measles outbreak.

A common misconception is that vaccines are unsafe. Remember they have been widely available for many years- some since the 19th century! They are thoroughly tested for safety before they are made routinely available, and each vaccine’s safety is then continually monitored even after it’s been made available. So in fact they are very safe and millions of children and adults are vaccinated every year without long term adverse effects.

I have at times consulted with students who at the age of 18yrs have never received a vaccine in their lifetime – as their parents did not consent to this. Fortunately, this happens infrequently and the person attending the appointment makes an informed choice, based on what they have read and what we discuss in the consultation, to complete a primary course of vaccinations, to ensure they have adequate immunity in their adult lives.

However, as more research and evidence becomes available, immunisation schedules change – so ‘lack of knowledge’ can be as a result of changes, rather than decision not to immunise. The schedule you received as a child may have changed by the time you reach adulthood. Some people also ‘miss’ receiving vaccinations due to illness on the day of vaccination.

Specific goals for this world immunisation week are:

 

  1. 1.      For you to know what vaccines are available to protect you against disease
  2. 2.      Check your vaccination status. Perhaps print off the UK schedule and check on behalf of members of your family. Make sure they are all ‘up-to-date’ – remember schedules do change…
  3. 3.      Book an appointment at SHS for any vaccines you think are missing

Young people attending Universities and Higher Education are known to be at ‘higher risk’ for certain infections, including meningitis C and mumps/measles. These infections are spread through respiratory contact- coughing and sneezing, so easily transmitted. By ensuring that you are up-to-date with your immunisations you will protect both yourself and others, via ‘herd immunity’. Herd immunity is ‘the indirect protection from infection of susceptible members of the population, and the protection of the population as a whole, which is brought about by the presence of immune individuals.’ No vaccine is 100% effective- measles vaccine is 90-95% effective, and some people are unable receive a live vaccine like MMR, e.g. the immunocompromised, so by you making sure that you’re up-to-date with your vaccinations you will be giving yourself the best protection available and also contributing to increased herd immunity in the population around you for those who most need protection.

So, are YOU ‘Up-To-Date’?

You need to ensure you have received the following vaccines:

Number of Injections

Vaccine

5

Tetanus, Diphtheria and Polio

2

combined Measles, Mumps and Rubella

1

(2 as from August 2104)

Meningitis C

3

HPV- Gardasil (females under 18 yrs only)

Annual

Influenza vaccine – ‘at risk’ groups only

 

Remember, you are able to find out if you have missed any of your immunisations by checking:

-Your GP immunisation records

-Your parent’s records

-Your school, as some immunisations are given in schools and not documented in your GP records

If you find you are not ‘up-to-date’ with your immunisations schedule, we encourage you to come in to SHS so we may help you complete your schedule.

If you are planning a trip abroad, especially to ‘high risk’ destinations, please always check you are ‘up-to-date’ with your travel immunisations at least 6-8 weeks before you travel.

We have a safe and adequate supply of vaccines in the practice and we take care of the cold chain, so all you need to do is book an appointment with one of the nurses either by phone or online, and they will then administer any free NHS vaccines you are missing.

You haven’t got to cross the Himalaya to receive a life protecting immunisation; you can have them here at SHS, but if you do intend to cross the Himalaya, please ensure you are also up-to-date with your travel immunisations as well!

 Useful Links:

UK Immunisation Schedule:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/227651/8515_DoH_Complete_Imm_schedule_A4_2013_09.pdf.

 

Measles Outbreak:

http://www.nhs.uk/Conditions/vaccinations/Pages/measles-outbreak-advice.aspx.

http://www.bbc.co.uk/news/health-22277186.

 

History of vaccination, ‘From antiquity to the present day…’

http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1279889314367.

 

Travel Immunisations:

http://www.fitfortravel.nhs.uk/home.aspx.

 

World Health Day 7th April 2014: safer travel for all Bristol students

World Health Day is celebrated on 7 April every year to mark the anniversary of the founding of the World Health Organization in 1948. Each year a theme is selected that highlights a priority area of public health. In past years themes as diverse as road safety, climate change and high blood pressure have been chosen. The topic for 2014 is vector-borne diseases, which could be of great personal relevance to a large number of students who make international journeys whilst they are studying at the University of Bristol.

Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another. Vector-borne diseases are illnesses caused by these pathogens and parasites. Vector-borne diseases account for a massive 17% of the estimated global burden of all infectious diseases.

The most well known and deadly vector-borne disease is of course Malaria but the world’s fastest growing vector-borne disease is Dengue with a 30-fold increase in disease incidence over the last 50 years. Others you may have heard of are Yellow Fever and Schistosomiasis. Vector borne diseases are most commonly found in tropical areas and places where access to safe drinking-water and sanitation systems is problematic. However, globalization of trade and travel and environmental challenges such as climate change and urbanization are having an impact on transmission of vector-borne diseases, and causing their appearance in countries where they were previously unknown.

 

So World Health Day 2014 has a particular relevance for people on the move, which includes many UoB students. Large numbers of you will travel to countries where vector borne diseases pose a threat. This includes some of our International Students who return home during the course of their degree. Many of the risks of global travel can be minimized by precautions taken before, during and after travel. Whether you are a student planning an exciting trip during one of the university holidays, or whether you are an International Student intending on going home during your degree, it is important that travellers to developing countries consult a travel medicine clinic well in advance of the intended journey. We run travel clinics at Students’ Health service, which are open to our International Students too.

 

‘Golden age’ of antibiotics ‘set to end’

My last blog ‘More to pharmacies than meet the eye’ highlighted the increased services pharmacies now provide and that they are an excellent first ‘port of call’ for advice and treatment options if you are feeling unwell with a minor illness. At the same time as writing this, another article in the BBC health news caught my attention that somewhat relates to this blog- that of the growing threat of antibiotic resistant infections. http://www.bbc.co.uk/news/health-25654112.

England’s Chief Medical Officer Dame Sally Davies described the growing resistance to antibiotics as a ‘ticking time bomb’ and said ‘the danger ranked alongside terrorism on the list of national threats’. It has been described as a ‘global issue,’ and, rather alarmingly, a threat to mankind with ‘the prospect of a return to the pre-antibiotic era.’ As a nurse and prescriber, I find it extremely hard to imagine a time when we no longer have life- saving treatments available to us that we have relied upon for so many years. Most of us have been born into a world containing antibiotics. Penicillin went into widespread use in the 1950s, but infectious agents are older than humanity and continually evolving. Two bacterial infections that illustrate the problem are:

1. Multi-drug resistant (MDR) tuberculosis (TB). Of note, TB is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB (WHO).

2. Infections from enterobacteriaceae e.g. E. coli- which can cause urinary tract infections (UTIs), cystitis and kidney infections. UTIs are common in general practice, accounting for 1-3% of all consultations. Almost half of all women report at least one UTI sometime during their lifetime, and after an initial UTI, 20% to 30% of women experience a recurrence. This is a common infection we see in female student patients at SHS.

We are also seeing alarming increases worldwide in gonorrhoea infections; this is again becoming extremely difficult to treat due to resistance to antibiotics.

So what is causing this problem?

Inappropriate use and prescribing of antibiotics is causing the development of resistance.

Inappropriate use includes:

  • not completing a course of antibiotics as prescribed
  • skipping doses of antibiotics
  • not taking antibiotics at regular intervals
  • saving some for later

Inappropriate prescribing includes:

  • unnecessary prescription of antibiotics
  • unsuitable use of broad-spectrum antibiotics
  • wrong selection of antibiotics and inappropriate duration or dose of antibiotics

Make antibiotic prescribing a priority in primary care by:

  • developing an antibiotic stewardship tool for prescribers

Within Bristol, we have ‘antimicrobial prescribing guidelines’ for the community as a tool to refer to and follow, ‘to provide a simple, best clinical judgment approach to the treatment of common infections; to promote the safe, effective and economic use of antibiotics and to minimise the emergence of bacterial resistance in the community.’

Frequently, patients who I see in my appointments ask for ‘antibiotics’ for their sore throat, colds and other minor illnesses. The majority of these illnesses we see in general practice are caused by viruses. Antibiotics will only treat bacterial infections, not viruses, so rest assured that careful clinical reasoning lies behind a decision not to prescribe antibiotics. If you are prescribed antibiotics, please take note of the ‘appropriate use’ points as above.

Remember the pharmacy is there for advice, treatment and referral if you do develop a minor illness. The patient.co.uk website is also an excellent source of information for patients and health care professionals alike http://www.patient.co.uk/.

 

More to Pharmacies than meets the eye

Did you know that perhaps one in seven GP appointments could be dealt with by pharmacies? This equates to 40million appointments per year. You may think of your local pharmacy as just a place to pick up your prescriptions or toiletries – but there is more to a pharmacy than meets the eye.

A recent article in the BBC health news

http://www.bbc.co.uk/news/health-25744060. highlighting the services pharmacies now provide, struck a chord with me. Having qualified as an independent nurse prescriber in 2011, many of the consultations I now deal with involve minor illness – i.e. sore throats, coughs, colds, sinusitis etc… Interestingly numerous student patients who present have not self treated by taking any over the counter medicines to help ease their symptoms. For those that are unsure about what to take, many have not consulted with a pharmacist for advice. In reality, after careful assessment, the majority of minor illness we see in general practice tends to be of viral origin – so antibiotics are not indicated – advice is then to take regular ‘over the counter’ medications i.e. paracetamol, ibuprofen (if safe to take) rest and fluids. These medications can be bought very cheaply from your local pharmacy.

A pharmacist can deal with and advise on cold and flu symptoms.

The Pharmacy Voice chief exec states that ‘Pharmacy is the third largest health profession (in the health sector) after medicine and nursing, yet people still don’t really know who we are and what we do’.

Pharmacists have been given increasing responsibility within the NHS, and many professionals, like myself, can also now prescribe ‘prescription only medicines’; medicines that only a Doctor might previously have prescribed for you. They are also able to sell Pharmacy ‘P’ medications i.e. antibiotics eye drops for eye infections, emergency contraception, vaginal thrush treatment; and provide stop smoking advice, pregnancy testing and sexual health screening.

 

‘Community pharmacies are perfectly capable of taking the strain from GP and A+E departments that are bursting at the seams.’ One out of every four people who go to A&E could have been treated elsewhere in the community, or could have self-treated. Your local pharmacy can help treat common illnesses.

Please pick up this leaflet from SHS or download from the following: http://www.bristolccg.nhs.uk/media/25934/feelingunwell_choosewell.pdf.

 

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