Every adult has a right to respect dignity, privacy, equity and a life free from abuse. That is the firmly held belief of all those who work here at Students’ Health Service, and we see our role partly as being here to protect ‘vulnerable adults’. Many of us hear that phrase and think of adults with learning disabilities, say, but it also encompasses any adult who, because of mental ill health, emotional disturbance, physical disability, cultural or social isolation, may lack the resources to protect themselves against significant harm or exploitation. So it can, unfortunately, describe some of the students we look after, and even someone you might know, though you may not have considered them ‘vulnerable’ before.

If you are worried about someone, that they may be being abused or exploited, or if you are worried about yourself, then we are here to help you. The whole team receives training in supporting adults with safeguarding issues, and we can engage other services to help us if we need to. Examples of abuse include physical violence in a relationship, sexual abuse, including where someone is pressurised to consent, not just where consent was withheld, psychological abuse through intimidation or hostility, and financial abuse such as theft, and misuse of benefits. We are also aware of occasional cases of racial and discriminatory abuse, and are able to offer support in these situations too.

Abusers can be someone the vulnerable adult knows well, or a person in a position of authority above them. Whatever the situation we can ensure confidentiality and sharing of information on a need to know basis, and we will not disclose personal information inappropriately.

If you suspect abuse, please report it. If you would like our support then please talk to any one of our clinical team, and we will ensure you are cared for with the respect and dignity that everyone deserves.

Other support;

Hate crime unit; http://www.avonandsomerset.police.uk/community_safety/hate_crime/help-and-support.aspx

Domestic abuse; http://www.avonandsomerset.police.uk/community_safety/crime_reduction/violent_crime/domestic_violence/index.aspx

http://www.wellaware.org.uk/organisations/12984-bristol-freedom-programme

http://www.nextlinkhousing.co.uk/

 Honour based violence; http://www.karmanirvana.org.uk/

For the team at Students’ Health the ‘Festival Season’ usually heralds a significant increase in the number of cases of Trench Foot we deal with. A combination of knee deep mud for 3 days and cheap footwear is guaranteed to lead to a consultation for a grim looking foot with bits hanging off.

However we have also noted over the last few years a significant increase in the number of people worried about how they are feeling after taking a ‘legal high’ whilst partying.  These after-effects can last days, and as we have little research available on them we can’t be sure that they won’t have long term detrimental effects too.

Names of legal highs include; benzo fury, bubble, m-cat, liquid E, and scoop.

So before you head off to Glasto/ Bestival/ Winchester Chamber Music Festival 2013 (just kidding!) perhaps consider this…

• Legal highs are substances that are taken like illegal drugs, such as cocaine, but not currently covered by the misuse of drugs laws, and therefore legal to possess or use.
• Just because they are legal they are not necessarily approved for use or safe. Most are not suitable for human consumption. They are usually sold as ‘plant food’ or ‘bath salts’.
• Some legal highs contain illegal compounds.
• Risks are unpredictable as their components can change from one pill to the next. Recent research at the club drugs’ clinic in London found that 2 items, identically packaged, purchased from the same website on the same day were in fact 2 completely different chemical compounds when analysed. You would have no idea what you are actually taking.
• Some previously legal highs have now become illegal, eg Black Mamba, Annihilation and Mexxy, and others are being looked at all the time by the Advisory Council on the Misuse of Drugs.
• Their effects include drowsiness, paranoid states, reduced inhibitions, seizures, coma and death. Some completely destroy the bladder, leading to permanent incontinence.

Taking legal highs is a risky business, and if you are interested in reports from users then click on the link below.

http://www.talktofrank.com/drug/legal-highs

We want you to enjoy the summer and all the festivals, whatever your musical tastes! Please think seriously about the consequences of  entering the ‘legal high lottery’.

Feeling pale and pasty? Feel like a quick visit to the tanning salon to use the sun bed? Think again….

Recent research published in the British Medical Journal has shown evidence that the increase in use of artificial sources of ultraviolet radiation such as indoor tanning devices like sun beds is associated with an increase in risk  of the 3 main skin cancers including malignant melanoma, an aggressive form. This risk is increased if the first exposure to artificial UV radiation is before the age of 35 yrs.

The authors of the study estimated that 3438 cases of malignant melanoma could be prevented each year in Western Europe by avoiding exposure to indoor tanning. The World Health Organisation has now classified tanning beds as a group 1 carcinogen alongside tobacco smoking and asbestos.

Still feeling pale and pasty? Feel like planning a holiday somewhere hot and sunny? Think again…..

It has long been recognised that excessive exposure of the skin to the direct UVA and UVB rays of direct sunlight increases the risk of developing skin cancers of all types. Episodes of sunburn greatly increase this risk as skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Take measures to be ‘sun safe’

Avoid the sun when the sun is strongest in the middle of the day.

Cover up when you are out in direct sunshine for a prolonged time.

Use high factor sunscreen with UVA and UVB protection and reapply it regularly.

Still feeling pale and pasty? There is an answer……

Opt for a spray tan and take a walk, quite literally, on the sunny side of the street. Exposure to a moderate amount of direct sunlight is actually beneficial.

Vitamin D is vital for good health, growth and strong bones and is made in the skin with the help of sunlight. We also get a small amount from the foods we eat (oily fish, egg yolk and fortified foods eg. some breakfast cereals).

To prevent deficiency of Vitamin D it is estimated that we need 2 to 3 sun exposures per week in the summer months (April to September), lasting 20-30 mins, to bare arms and face. This needs to be in direct sunlight and not through a window. This is not the same as suntanning and sunburn should be avoided at all costs.

How can we help?

If you have any new or changing skin lesions, and particularly if you have been a heavy user of indoor tanning and sun beds, or have a history of multiple episodes of sunburn, the doctors at the Students’ Health Service

would be very keen to take a look at them. The earlier any skin cancer is caught, the better the outcome of treatment.

Further information:

Sunsmart- www.cancerresearchuk.org/sunsmart

Sun Awareness Fact sheet- www.bad.org.uk/site/734/default.aspx

Sun and Health- www.patient.co.uk/health/sun-and-health

Reference:

BMJ 6 October 2012 Volume 345.

Editorial p7, Research p14/15, Personal View p31

For someone who never went to medical school Dr Google seems to be an incredibly popular and sought after ‘specialist’.  A significant number of people will turn to the internet for information and advice before seeking professional help, and this is a good idea in the right context. There are some fantastic resources out there, and so I thought it might be helpful to list a few of them, to improve the quality of the results our patients are getting when they go online, and to save time for those who get drawn into elaborate and complex searches featuring more and more worrying symptoms and diagnoses!

First off, a safe and reliable place to start for all medical queries;

www.patient.co.uk

Next up, for info on local services, how the NHS can help, conditions, and health costs;

www.nhs.uk

And for travel advice

www.fitfortravel.nhs.uk

Lastly for mental health advice and support;

www.mind.org.uk  or

 www.bigwhitewall.com

which is an award-winning online mental wellbeing service. It offers the first online pathway for mental health and wellbeing, placing people at the centre of their own care.  It enables people to access well governed, safe therapeutic services through self-referral from the comfort of their own homes.

Apps;

The NHS has also realised the need for a reliable single source of credible and safe online resources and has recently launched its Health Apps Library, at last month’s NHS Healthcare Innovation Expo in London.

Here at SHS we are particularly interested in the ‘Patient Access’ App, as we already have the online facility allowing our patients to book appointments and re order repeat prescriptions via the internet, but it would be brilliant to have a phone app too, making it potentially even simpler. We will be looking into how to adopt this app, but it is something that the local health community may need to fund, so watch this space.

The Sound Doctor App; An Audio app which enables patients to listen to information about their long term conditions and therefore help them look after themselves more easily and get the best out of life.Leading doctors, nurses, patients and other relevant health professionals have been interviewed to provide a really comprehensive look at a number of long term conditions.All the information is presented in short chapters of between 3 and 5 minutes each with several interviewees in each chapter.

ActiveMe App; Developed by NHS experts in CFS/ME, activity record charts are widely used to help patients and
practitioners work together to develop a daily baseline of energy use before increasing it in regular steps
to enable you to achieve your goals.Fast, easy, portable and discreet, ActiveME can help you balance your activities.

Type 1 Diabetes (Alcohol guide) App; Having type 1 diabetes means that it is important to know how to keep safe when having alcohol. This guide aims to help you find out what to do to keep safe and how alcohol can affect your body.This App has been designed based on ideas and suggestions provided during the qualitative interviewing of young people with type 1 diabetes aged between 18 and 21. It has been developed in collaboration with the Poole Hospital Diabetes Centre in the UK for use by their patients.

PillManager App; helps you manage your medications, never forget them, and also helps with re ordering them too.

These are just a few to get you thinking.

See our website for loads more Useful Links

http://www.bristol.ac.uk/students-health/links/

“OMG! She’s running late AGAIN! I’ve got a lecture in half an hour… what shall I do…? I’ll just wait for a bit and see… how can she always run late? What’s the point of booking an appointment time if I am never seen on time?! Grrrr…”

Meanwhile, in a room down the corridor…

“OMG I’m running late again! Why does this always happen to me? I hate keeping people waiting, but it’s so difficult to balance the lists of ailments that some people bring, and the complex mental health issues of others. All in 10 minutes. Now the phone’s ringing…

Yes, ok I’ll speak to that mum later, send me an email and I’ll call her back once we have consent from the student.

Now who’s at the door, grrr, an urgent prescription, ok just this once, but please leave it in my basket next time.

Right, where was I? Write myself a note to check if those results are back this afternoon.

Ok, next person, ‘buzzzz’.

Now the minutes are ticking by as they gather their things together in the waiting room… then strolling down to my door, and here we are…

Hi, come in have a seat. How can I help today? Three things to discuss? OK, let’s see what we can do…

Sorry the phone’s ringing, let me just see what that is, the on-call biochemist? Ok yes, put them through. Sorry, I just need to ask about a result…

Now where were we?

Panic attacks, and depressed you say, ok, tell me all about it…”

At the Students’ Health Service we are very aware of time keeping issues, and that quite often our patients have to wait to see us. We would, of course, rather that this was kept to a minimum, but we hope that you will understand that there are some things that can’t be rushed, and that we try to give each person the time they need, when they need it.  Everyone’s time is precious, we really do understand that.

We have all taken part in extra communications skills training in the last year, to try to identify more efficiently ways of working, but there will always be difficult situations, and therefore we hope that you will understand the challenging line we tread when trying to run to time.

Thank you for being patient.

Art and Wellbeing by Dr Emma Webb

Appreciation of beauty is a part of maintaining happiness whether you find it in the arts, the natural world, human connections or other experiences. It has a positive effect on our sense of well being. Appreciation of art can enrich us through its message whether that is political, sociological or psychological or more simply via its direct emotional effect.

There is a broad spectrum of evidence to show how the arts achieve positive outcomes for patients, for staff, for the patient-staff relationship, for hospitals, mental health services and in the health of the general population.

In healthcare environments the experiences of patients and staff can be improved by artwork. Participation in the arts can be a valuable tool for improving one’s own physical, social and emotional wellbeing. Arts are now used in medical training to gain insight into patient health and to explore ethical issues as well as being used as a psychotherapeutic treatment for mental health problems.

Visiting Bristol Museum and ArtGallery recently, I was particularly drawn to the sculpture ‘A Ton of Tea’ by the Chinese contemporary artist Ai Weiwei. It is unexpected and as well as its political symbolism, also has an amazing texture and fragrance when you get close to it.

The ‘Sands of Time’ by David Maitland is a beautifully colourful photographic depiction of the skeletal remains of sea invertebrates found in a sample of sand – fascinating, microscopic beauty.

Back at Students’ Health Service we are looking forward to enhancing our own surroundings with the addition of some artwork to our walls. I hope that it will be engaging, interesting and enjoyable for all our visitors.

You can visit;

BristolMuseum and ArtGallery – ‘No Borders’ contemporary art in a globalised world. Free exhibition until June 2013

BristolMuseum and ArtGallery – Wildlife Photographer of the Year

On a daily basis I am amazed by the number of students who have seemingly no idea what to take for their pain or fever. The same issue has been noticed by our colleagues at the local Emergency Department, who are somewhat frustrated with having to deal with people who haven’t yet tried a simple painkiller for their sore throat, headache, or sprained ankle.

So I thought it might be useful to write a short blog about painkillers (or analgesia, to use the technical term!), for future reference next time you have a pain somewhere, or a raised temperature.

Salicin, from powdered willow bark, is a method of pain control dating back to Hippocrates in the 4^th century BC. Over the centuries it was modified, and since 1897 we have known it as aspirin.

Paracetamol is much newer, coming from France originally, then modified in Germany in 1899, to a form very similar to the one still manufactured in huge quantities today.

Indomethacin was the first Non Steroidal Anti Inflammatory Drug (NSAID) in the 1960s. The commonest NSAID we recommend is ibuprofen.

Opioids have been around since as early as 3400BC and have caused problems alongside bringing benefits, ever since! Methadone came along in the 1930s.

There is a reason that these medications have been around for a long time, and that is because they work. I regularly encounter a strange reluctance to take anything at all, despite seeing patients with raging sore throats or disabling headaches because ‘it will mask the symptoms for you, doctor’, or it’s seen as a form of ‘personal failure’ to need a medicine.

I have to admit that I am baffled by both approaches, as any significant clinical signs will not be ‘masked’ (other than fever, and we ask about history of fever, not just current fever), and how can it be a ‘failing’ to use the wonders of science to treat illness. We wouldn’t deny another pain relief, so why do we deny ourselves?

So please, if you are suffering with pain or fever, and are not allergic to these medications, try the following from the pharmacy or supermarket (no prescription required);

 Paracetamol;               1 gram (2 tablets) up to 4 times a day (adult dose)

 Ibuprofen;                    400-600mg 3 times a day with food (total 1800mg)

 Cocodamol;                 8/500 tablets, 2 to be taken 4 times a day (instead of paracetamol)

Paracetamol and ibuprofen are synergistic and therefore taking both will give you even greater benefit.

Read the packets for dosage and side effect information, and if unsure ask the pharmacist for advice.

 Don’t suffer, take something and take comfort in the fact that our ancestors were onto a good and painfree thing!

Ignoring your parents, and other ways to save your life

by John Wilford

“Don’t do that”

“Put that down”

“Don’t talk with your mouth full”

 Familiar ‘instructions’ heard by kids, of all ages.  Now the truly disgusting ones…

 “Sit down!”

“Sit still!”

 Mum, you got it so wrong.

 If you are reading this sitting down, please, get up. Standing comfortably? Then we’ll begin…

 Sitting is killing us.  It has become a ‘goto’ topic for the BBC on slow news days, and a recent article on the Harvard Business Review blog condemns sitting as our generation’s smoking.  There is an increasing body of evidence, generated by clever academic types on both sides of the Atlantic, showing just how bad sitting is for us.

Research in the USA shows people spending more time sitting (9.3 hours per day) than asleep (7.7 hours).  Like it or not, the UK is in the same ballpark.

Add up the time spent sat at your desk, in the library, in lectures, seminars, meetings and tutorials.  Time spent sat in the car or on the bus. Then there’s ‘leisure sitting’ – watching TV, at the computer or games console.  Sitting, just sitting. Oh, sit.

Further research suggests that if you sit for more than 6 hours a day, you are 40% more likely to die within the next 15 years than someone sitting for just 3 hours.  The bombshell is that this is true even if you exercise. Sedentary behaviour (sitting/lying whilst awake) is not just a lack of physical activity; it’s bad in its own right. As soon as you sit down, your leg muscles switch off, calorie burn drops to 1 per minute and after 2 hours your ‘good cholesterol’ has dropped 20%.  Whether you are an exerciser or not.  Higher rates of sedentary behaviour correlate with greater risk of mortality, independent of levels of physical activity. 

Sitting is a habit – and a bad one.  Like smoking, or biting your nails (Sorry Mum…).  It’s automatic and easy.  But it is a habit that can be broken. 

Look at what makes you sit, and where and when you could do without it.  On the phone? Stand up.  Having a short meeting? Ignore the chairs. On the laptop? Raise it up and stand (use window sills, cabinets, even the ironing board). This is before we even get to walking more – park your car further away from destination, take the stairs not the lift, etc etc…..

Yes, there are times that you will need to sit.  But limit it.  Get up and move around frequently. Swap standing and moving for sitting wherever possible.

Take a stand against sitting – sit less, move more.

Despite references to eating disorders in texts dating from the time of the ancient Pharoes, and even a mention in Shakespeare’s Measure for Measure, the development of effective treatments has been slow. 

However, a treatment called cognitive behavioural therapy (CBT) is now yielding results.   Indeed, as a result of research demonstrating its effectiveness, CBT is now recommended as the first line treatment for people who have not responded to a self-help approach.  

 At the heart of CBT lies the deceptively simple idea that eating disorders are driven by an irrational fear of uncontrollable weight gain.  This fear leading to counterproductive forms of dieting which, whilst intended to prevent weight gain, often have the opposite effect and thereby cause more distress and further reinforce the original fear.  CBT tackles the belief that strict diets are the only way to prevent weight gain by encouraging clients to see what really happens when they give up dieting and take up healthy exercise.

 For many with eating disorders the idea of consuming between 1,900 and 2500 kilocalories a day just to see what happens is a terrifying prospect and indeed the treatment is not for the faint-hearted.  But what most people find is that their body burns the energy they consume and their weight remains within healthy limits. 

 Treatment therefore provides a safe and supportive environment in which to take the plunge, give up dieting and see what happens.  And, at the end of six months treatment, if people don’t like the results of their experiment in normal eating, then they are free to return to the diets they were using beforehand.  

 Evidence suggests that about three quarters of people who complete the treatment find it useful.  Whilst this is a promising start, the quest to refine the treatment and thereby improve recovery rates goes on.

Doing CBT is a substantial commitment.  It takes time, energy, hard work, determination, perseverance and courage.  As I tell my clients, “you have to do all the hard work yourself”.  But if living with an eating disorder is ruining your life then it might be worth considering if treatment could be right for you.  If you’d like to talk to someone about whether CBT could help you overcome an eating disorder your GP will be happy to discuss it with you and to make a referral for treatment if necessary.

http://www.bristol.ac.uk/students-health/services/eating-disorders/

Happy Chinese New Year to All Our Students.

A blog by Dr Clare Grant

Over the weekend, Chinese New Year was celebrated all around the world, including here in Bristol. Although Chinese students at the University weren’t lucky enough to get a statutory holiday to celebrate the New Year, I’m sure they enjoyed welcoming in the year of the Snake. Chinese New Year traditionally marks the end of the Winter Season, so that’s already one good reason to celebrate….roll on some Spring-like weather! Traditionally, it’s also a very family orientated time of year, when relatives get together and enjoy good food and each other’s company.

There are so many ways of keeping in touch with family once you leave home and come to University, even when leaving home means travelling thousands of miles to study in a different country. In fact, sometimes it feels hard to escape family ties: there always seems to be some way in which they can contact you! But, as we all know, it’s at family times like Chinese New Year, when the rest of our relatives get together without us, that we can feel particularly isolated and unsupported.

There are many International students at the University, with the largest single group being  from China. The personal and professional benefits of spending some time abroad studying in Bristol can be huge, but it can also be challenging studying away from home. All of the Bristol University Support Services (Students’ Health Service, Student Counselling, Disability Services, Multifaith Chaplaincy and Careers Service) are here to help our International Students as well as our home ones. These support services may be quite different to the ones provided by Universities in other countries, so it’s definitely worth having a look at their individual websites to see what they offer and how they might be able to help you.

Here at Students’ Health Service, we are experienced in helping International Students with their medical problems, wherever they come from in the world. In any one day, we can see students from at least 15 different countries! We are also aware of the physical and psychological health problems that can be associated with coming to study abroad. If you are experiencing health problems, please do make an appointment with one of our doctors or nurses, (our reception staff will help you decide who it’s best to make the appointment with): whichever country you come from, we are here to help you whilst you are studying at Bristol University.