Wednesday 20 January 2010

It’s not just politics - families do need fathers

The role of the father is one that has been more stereotyped than any other. We have two main characters: the bumbling, useless, out-of-his-depth father and the househusband, the super-dad who does it all — and there's very little in between.
But set against these clichés, new research has identified two fresh trends in fatherhood today: men who spend more time with their children than ever before and fathers who are completely absent.
Two hundred years ago, the father was the focal point of the family — the paterfamilias — and acted as moral mentor and teacher. But the Industrial Revolution took many men away from home to work, leaving mothers to raise the children single-handedly.
Now, as more mothers return to the workforce, the set-up is similar to that of a couple of centuries ago, with the domestic workload, including the raising of the children, more evenly distributed between both parents. When surveyed, 75 per cent of fathers said they would trade career advancement for more time with their children, and the number of dads present at their children's births has risen from 27 per cent in 1974 to nearly 90 per cent today.
Inevitably, fatherhood has now become a political issue too. The Tories have called for fathers to be more involved with their children and have attacked “deadbeat dads” who abandon their responsibilities, while Labour wants to counter criticism that it has been too focused on mothers' rights by putting fatherhood at the centre of its social policy.
Health minister
Andy Burnham will announce tomorrow that prospective fathers will receive lessons on breastfeeding and supporting their partner through childbirth. Meanwhile, a families green paper will propose measures to get fathers more involved in their child's upbringing from before birth and beyond, including forcing single mothers to name the biological father on the birth certificate and encouraging hospitals to allow fathers to stay overnight after the birth of a child.
But it's not all just a desperate vote-winning strategy. Research has, to an extent, confirmed the importance of dads: children benefit greatly from having increased interaction with their fathers and show better cognitive abilities when their fathers are highly involved during their development. Fathers offer greater tactile stimulation and are more likely to physically interact when they play, whereas mothers are more verbal and toy-mediated in their interaction.
Studies have shown that the young rely more on their fathers for factual information and look to their mothers for day-to-day care and emotional support: children are twice as likely to receive As in school when their fathers are involved in their education. And the benefits start early; babies are twice as likely to be breastfed if their fathers have received instruction about the benefits before birth, and further studies reveal that fathers who are around at the birth are far less likely to flee.
So while these initiatives certainly won't guarantee Labour safely through the next election, they may well help improve family life for future generations.

Wednesday 13 January 2010

I am exploding the myths about health and winter

How is it that I can travel to a tiny Austrian village in the Alps to ski each year with minimal hassle yet can't go five stops on the Bakerloo line in winter to get to my Harley Street clinic?It seems we Londoners are out of touch with our seasons and how to cope with them. But in a way you can't blame us because so much nonsense is written about health and winter. The best-known myth is that going out in cold weather increases your chances of catching a cold. There is no evidence that you can get a cold from exposure to cold or wet weather: viruses cause colds. There are more colds at this time of year simply because people are cooped up indoors in sustained contact with others who might be contagious. However, cold weather may make the lining of your nose drier and more vulnerable to viral infection.
Another popular myth is that we lose most of our body heat through our heads: again, untrue. Head heat loss is usually less than 20-30 per cent of total heat loss. As one scientist who researched this put it: “If we lost 45 per cent of body heat through our heads, going out without a hat would feel like going out with no trousers.”
The complementary medicine brigade is responsible for more rubbish: echinacea, a herbal supplement which people use to treat colds, has been shown not to help prevent colds in adults and is useless in the treatment of children aged two to 11. In a similar vein, many swear that vitamin C wards off colds. But large-scale, controlled studies have produced no conclusive data as to its effectiveness. It's big money for manufacturers, however.
What is true is that a 5C drop in temperature has been associated with a 12 per cent increase in admissions for heart attacks and that 53 per cent more heart attacks take place in the winter than summer. The cold can cause arteries to constrict, reducing blood flow and therefore oxygen supply to the heart, leading to a heart attack. Research has also shown that very cold weather may increase the risk of blood clots via its effect on platelets in the blood. So we do need to be better prepared for our winters and if you're starting a new fitness regime, take the cold weather into account.
Always start gently — it won't then be such a shock to your system. Your cardiovascular system can adapt to slow, progressive changes but it has more difficulty adapting to sudden ones. You'll feel less sick and dizzy at the end of your workout and may actually keep it up beyond January.
Look on this month as a warm-up, a time for getting into the habit of exercise and healthy eating, rather than expecting unrealistic results. And whatever you do, try to do it indoors and avoid sudden exertion outside — it's this that can precipitate heart attacks and strokes.

Wednesday 6 January 2010

Help for those who aren't waving but drowning

January is traditionally grim. The come-down after Christmas and New Year's celebrations hits us, we still haven't begun our tax returns, and the threat of an unbroken year of work stretches before us. So it's not surprising that January is when doctors are overrun with patients seeking advice for anxiety and depression.
Depression, stress and anxiety are certainly increasing: as life becomes more complex and demanding, we as a species have yet to evolve coping techniques and so are suffering as a result. The phrase “not waving but drowning” comes to mind.
Traditionally the medical profession has stuck those unable to cope on antidepressants. But the times they are a-changin'. It's now known that a combination of talk therapies and drugs works best. Research has shown that cognitive-based therapy, when conducted well, works as quickly and thoroughly as the drugs. When a person continues using the skills they learn with CBT, relapses are prevented — something the drugs don't do.
This is all great news but there is a problem: accessibility is limited.
As more people are diagnosed with depressive-type disorders, the national charity the Mental Health Foundation is quite rightly calling for more talk-based therapies to be made available, including meditation and yoga in the form of Mindfulness Based Cognitive Therapy. The
National Institute for Clinical Excellence has approved MBCT, a treatment based on meditation techniques, as a suitable treatment which can cut relapse rates for depression by half.
The report claims that Mindfulness meditation can affect the workings of the brain and even its structure, and that people undertaking Mindfulness training showed increased activity in the pre-frontal cortex — the area of the brain which is less active in people who are depressed.
A large majority of GPs think this treatment would help their patients but only one in five has access to the therapy. What is most concerning is that three-quarters of GPs have prescribed medication to people with long-term depression, believing another form of treatment would actually have been better for them. That really goes against all the training and ethical guidelines that we medics should follow.
And here lies the problem. The best treatments may well be the talk therapies but they are simply not available to most.
I have another slight reservation: MBCT usually consists of an eight-week course in Mindfulness meditation, with elements of CBT and yoga, which sounds wonderfully holistic but I feel this is a wildly impractical aim in an already overburdened NHS. Also, every doctor knows that it's hard enough to get patients to finish a course of antibiotics, so I'm certainly not convinced a depressed, demotivated patient will bother attending meditation and yoga classes.
We clearly need to find a middle ground that provides good patient care with long-term lasting results which is accessible to all who need it. But then, isn't that the great challenge in all areas of the NHS, and one that may now be an impossible pipe dream without a radical overhaul of the way our health service is run and funded?