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Issue 88

A free publication for Doctors and Patients

Learning to listen, listening to learn:

Public and patient involvement in health Report by Dr. Tom Fitzgerald In April, 150 Local Involvement Networks (LINks) will go “live”. The LINKs are a new opportunity for local people to engage with local health services. Public and Patient Involvement (PPI) has been a major theme in contemporary UK health policy. Mechanisms for PPI include: the Commission for PPI in Health (CHIPPIH), PPI Forums (PPIFs) for each NHS trust, Local Authority Oversight and Scrutiny Committees (OSCs) PPIFs were introduced to replace Community Health Councils (CHCs). The CHCs scrutinised all health services provided in local communities; in their later years, CHCs became politicised and unfit for purpose. PPIFs were established to act as “a critical friend” to their partner NHS trusts.

that best serves their needs. Time and effort was required to overcome mutual suspicion and cynicism between trusts and PPIFs. More progressive trusts recognise their forum as a useful resource. PPIFs have their limitations. NHS trusts must work with their PPIF to fulfil their statutory responsibility to listen to the views of local people. However, trusts are not obliged to make changes to their services or strategy on the basis of that dialogue. The Local Government and Public Involvement in Health Bill 2006-07 proposes radical changes in existing PPI mechanisms, including abolition of the CHPPIH and PPIFs, replacing them with new Local Involvement Networks (LINks), for every local authority area with social services responsibilities The proposals describe strengthening

PPIFs monitor standards in trusts, seek the views of local people and consider the wider impact of changes to the provision of services. Increasingly, NHS trusts adopt a marketing perspective, seeking to put patients at the heart of everything they do. PPIFs provide NHS organisations with robust feedback on service provision and plans for reconfiguration.

local accountability, whilst streamlining participation. Many patient and community groups are concerned they will be marginalised when LINKs are introduced. Local authority OSCs and LINKs will have relationships with large numbers of acute and mental health trusts, as well as a range of alternative providers. In London, co-terminosity between PCTs and local authorities ensures integrated co-ordination between primary health and social care. Elsewhere, NHS trust catchment areas may overlap the boundaries of several local authorities. LINKs are likely to focus on community-based services. To provide truly patient-centred services, acute trusts need a strong independent body representing the views of patients and local people. LINKs will ensure that NHS organisations meet the needs of local people. On occasions, trusts corporate interests may conflict with those of local communities. In competitive local health economies, trusts have to compete for market share. This will make acute trusts more customerfocused. LINks represent an exciting opportunity for local people to get involved in shaping the sort of health services that they need and want.

This constructive criticism may help trusts improve and provide services local people want, delivered in a way

Omega 3 EPA : Nature’s very own anti-depressant Report by David McEvoy Since Dr Malcolm Peet, a consultant psychiatrist at Sheffield Swallow Court Hospital released his findings about the effects of Ethyl Epa on people suffering from depression and low moods, many other studies have been performed using Ethyl Epa to help treat depression and related disorders.

Researchers have recently found that a diet high in Tran’s fatty acids could affect the mood stabilising hormones within the brain, this is thought to be due to the saturated fats slowing down the messaging system within the brain, should this happen then the onset of depression could occur.

The vast majority of the studies performed consistently confirmed that Ethyl Epa, a natural substance found in omega 3 fish oil, helps relieve depression and low moods.

While the benefits of high grade EPA have been well documented, the scientific community still don’t know exactly how EPA works on the brain.

The idea that high grade omega 3 EPA could be used to help combat depression and other related disorders came from the late Dr Horribin, who as early as the 1970s was a pioneer in lipid research involving the brain and central nervous system. EPA is part of the Omega 3 chain of ecosanoids and is most commonly found in fatty fish such as fresh salmon, mackerel, pilchards and sardines. Over the past 100 years the diet patterns of most people in the west has shifted dramatically to include far more hydrogenated oils and Trans fatty acids (bad fats).

One theory released by Dr Basant Puri is that it eases the passage of the signals over the tiny gaps in the brain called synapses. Another theory was that the high Grade Epa actually worked similar to lithium and had anti depressant properties of its own. Until recently it was widely accepted in the medical community that once a human reached maturity that the adult brain could not grow anymore. In a recent paper just released by Dr Puri his findings show other wise. Dr Puri scanned a 21 year patient before treating him with high grade Pure Epa, after the course of treatment he rescanned the young man only to find that the grey matter of the brain had increased in size. As well as EPA being very good for helping to balance mood it has other well documented effects on the body, these included blood thinning properties, decrease risk of heart attack, decrease growth rate of atherosclerotic plaque, and slightly lower blood pressure There is also some limited scientific evidence to show that high grade EPA has helped people suffering from bipolar disorder, PMS, chronic fatigue syndrome / ME, huntington’s disease,


fibromyalgia, obsessive compulsive disorder, schizophrenia, ADHD, and ADD Although more research needs to be done in these areas, the current evidence looks very promising. Omega 3 fish oil contains another nutrient called DHA. There is a currently a controversial argument as to which omega 3 nutrient is the more beneficial in dealing with depression and related disorders. This Argument is born from doctors who have used high grade Epa , Horribin, Puri and Peet They claim that the higher the ratio of Epa to Dha the more effective the results have been. Just recently Dr Andrew Stoll has also come out in support of this theory. Any good doctor or nutritionist will tell you that the best way to get any nutrient is to eat a very balanced diet of the correct amount of carbohydrates , protein and omega essential fatty acids. In the case of Omega 3 epa this would be in the form of fish. Unfortunately due to the high concentration levels of epa needed to obtain a therapeutic dose you would have to consume a large amount of oily fish daily and sadly due to the pollution levels found in our oceans today this is not advisable. The large majority of scientific trails using high grade Omega 3 Ethyl Epa point towards this natural oil being very beneficial for many conditions. The argument about the DHA rages on and probably will until some solid scientific evidence is presented to us. In the mean time a product with a high EPA to DHA ratio is considered more beneficial by some leading UK doctors.


to your mood!

Report by Dr. Liz Miller Have you ever wondered why some days you can leap out of bed and get everything done by 11 am, and other days, you can hardly get out of bed to make a cup of coffee? Somedays start off well and go bad, and other days, somehow with a bit of determination everything comes right in the end. Everyone always has a mood, all of the time. Not just when you notice it, but all of the time. You don't always notice it because the body has a habit of adapting. When nothing new happens we take things for granted and stop noticing whatever

we are seeing, thinking or feeling. Let me give you an example. Rub the back of your hand with your first finger, you can feel the skin under your finger moving. Stop moving your finger and hold it still. After a minute you can no longer feel the skin under your finger. Move your finger again. This is because the body has adapted to the feel of your skin. You only notice your mood if it changes, or if it stopping you doing what you want to do. You may notice that you feel better or worse than you did first thing in the morning. You notice you are anxious about an up and coming event, when you want to settle down quietly and read. You may not notice it so much if you are milling around with a lot of other people who are also anxious. Everyone has a mood, every minute of every hour of every day. No one can escape their mood. Which is good,

because with practice you can learn to recognise your own mood and change it if you need to. You can also learn to recognise other peoples' moods. This helps you know how they are feeling, even before they tell you and to build better relationships. To conclude, in the short term, mood tells you how a person feels, thinks and is likely to behave. Children are the best mood monitors on the planet. They never give bad news when their parents are in a bad mood. They wait until everything is quiet and peaceful before they drop their bombshell. That way, even if someone gets angry, he or she will be a lot less angry than if they had given the bad news to a someone who was already in a bad mood.


Fad Diets and Eating Disorders Report by Stephen Lau Eating disorders are abnormal addictive behaviours, which cause food addiction problems. Many are suffering from food addiction because of fad diets. Fad diets are the popular diets touted to make you thin or to cure a certain health problem you may have. Fad diets come and go. Examples of fad diets are the Atkins Diet, the Weight Watchers Diet, and the South Beach Diet, among many others. Nearly all of these fad diets are based on the principle of calorie restriction, which essentially means depriving yourself of food or eating only certain types of food while avoiding others, and following diligently some set of rules of eating. Unfortunately, many of these fad diets failed for two reasons.

Secondly, dieting impairs your body's metabolism, which ultimately will turn back on you. Diets, even the relatively healthy ones, are only short-term solutions to your weight or health problems. Down the road, these fad diets will create more problems than what they have solved. For years, many nutrition experts have warned against going for fad diets, which often promote unhealthy preoccupation with food, instead of normal eating. Abnormal or unhealthy eating behaviours play havoc with your body's metabolism, which is the rate at which you burn calories. Your metabolic rate holds the key to weight loss.

Firstly, many individuals fail to adhere to these dieting plans. They do not have the discipline to follow through the set of rules of eating dictated by each fad diet plan. They succumb to the urge of eating. Who would blame them? After all, normal eating is a normal instinct in any individual.

When you go on a fad diet, you are in fact "starving" your body, which, out of its natural instinct for survival, will automatically reduce its metabolic rate. As a result, you are not exactly losing the weight you so desperately wish to lose. The initial weight loss from any fad diet may be only the loss of water due to the sudden change in your eating patterns, not the extra pounds you want to shed.

To force oneself to eat abnormally is against human instinct. Abnormal eating creates behavioural problems, which often lead to addictive behaviours and food addiction problems, such as anorexia and bulimia.

Worse, when you stop dieting, you metabolic rate goes up again, but not to where it originally was; in other words, yo-yo dieting (on-and-off dieting) may lead to malfunctioning of your body's metabolism until it can no longer burn calories efficiently. The implication is that your body has learned to maintain its weight with fewer calories. In other words, your effort in dieting has been a waste of good intentions. The net result is ultimate weight gain for you, not the weight loss you had hoped for. Dieting is only a temporary weight control solution. According to


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dietitians, unless you change your lifestyle, or can adhere diligently and persistently to your chosen diet regimen for the rest of your life, losing weight permanently is impossible. The danger of embracing one fad diet after another is that your overt preoccupation with your weight and appearance, such as counting calories, carbohydrates, and worrying about fat content of you food, may turn into an obsession, which will develop into eating disorders down the road.

Medical Matrix : Issue 88  

A free newspaper publication for doctors and patients