Somerville: the city where policies are based on how happy they make residents
This sounds like an advance for public mental health that could be tried in many other places! Does anyone know of examples where they reside? I wish the Adelaide City Council (South Australia) had asked the residents of the entire metropolitan area before spending our rates and taxes on yet another sports stadium renovation.
Not only does Adelaide have plenty of mentally ill homeless people who live in the city centre, sheltering in parks and gardens, but it also has homeless and displaced people living in quite well-concealed tents in the parklands. They recently decided to evict them all, and a homicide resulted.
Saturday, December 29, 2012
Thursday, December 27, 2012
We Have Lift Off!! at PLoS Public Health Blog
Have a look here on PLoS blogs, where a separate Public Health stream took off on November 27 2012.
We Have Lift Off!!
We Have Lift Off!!
Wednesday, December 26, 2012
No health without public mental health!
This was the title of the Royal College of Psychiatrists position statement in October 2010, see:
http://www.rcpsych.ac.uk/pdf/Position%20Statement%204%20website.pdf
Quote:
...costs of mental illness will double in real terms over the
next 20 years [98]and it is also expected that demand for health and mental
health services will increase as a result of unemployment, personal debt,
home repossession, offending and other forms of ‘economic fallout’[245].
A strategy which invests in promotion, prevention and early intervention not
only can reduce the burden of mental ill health and inequality but also makes
sound economic sense [246]. page 31.
Have we seen any signs that mental health promotion is taking hold in the UK or elsewhere since the Global Financial Crisis put the contrast between needs and compulsory funds reduction in the spotlight?
I haven't gone into the background on this topic yet, but I'm certainly intrigued enough to make a study of it over the next few weeks. Has anyone else discovered any evidence that national health systems have extracted their digits??
On the positive side, I have heard of early intervention centres for psychosis and other youth mental health difficulties having success with numbers of individual cases in Australia. There has been no news about the category I'm in: mature, unemployed skilled white-collar workers, suddenly deprived of income, ineligible for pensions or state benefits and very depressed. Yet the RCP report (above) mentions my category as a real standout in the push for greater consideration of mental health as a public health, community-wide issue.
In Australia, we were dismayed by the dismantling of the Better Access to Mental Health Care Program (known as Better Access by most), cutting the number of mental health care visits available on Medicare (the national health insurance scheme paid with 1.75% of income) to people without extra private cover. Worldwide it is known that the lower socio-economic strata have worse health and more worries to contend with, yet they are the ones worst hit by cuts to publicly subsidised services. Hello, rich company executives... do you want your workers collapsing in nervous heaps, becoming unproductive and ruining your bottom line? How about campaigning for better value for everyone's health dollar so that you'll receive better returns on your investment dollar??
Since psychiatrists put out the rallying paper two years ago, psychiatrists haven't been noticeable on their soapboxes calling for better care for their less well-heeled neighbours. One or two psychs in Australia have been heard uttering encouraging phrases,, but most are still attending drug-company sponsored seminars and social activities- they're not down at the local community centre joining the depressed and unemployed on any mutually engaging tasks! My own shrink seems personally more warm and willing to try less well-tested aids to recovery, and I have certanly benefitted. However, she really has NO IDEA "how the other half lives", and I'm sure most of her colleagues are the same. They just never mix with the likes of us, who are just as worthy human beings, well educated, but down-trodden by social and financial circumstances we have little resources to cope with. Psychologists are much more likely to feel some affiliation with the average mental health client as their training and remuneration are not congruent with somewhat insulated upper-class backgrounds. However, the upper echelons of the psychology profession are also the province of may rich and remote people who don't see why their increasingly high recommended fees are way beyond the capacity to pay of folks like me. You see, psychologists, at least in Australia, have been concerned that they deliver almost the same services as psychiatrists, yet have always been paid far less. In recent years, many have increased their fees to equal those of the cheapest psychiatrists. At the same time the Medicare fee-setters have increased the amount psychiatrists can receive from Medicare per visit, plus the Scheduled Fee allowed to be charged (the maximum a psychiatrist is advised to ask for on the open market), while they haven't increased corresponding amounts for psychologists very much at all. Fair enough, psychiatrists have done a whole lot longer training and know how the physical health interacts with the mental, so they can prescribe powerful medications. However, psychologists usually have a far greater array of techniques available to them for creating change in the minds of their clients, particularly along the lines of Cognitive (Behavioural) Therapy. Either of these professions continually increasing their fees seems to put the public and their mental health more at risk, so I'd like to see everyone come to an agreement to moderate their desires for a while!
Meanwhile, if you're interested, have a look around your own community and see if psychiatrists are becoming more open and friendly and if psychologists are showing their faces in public, willing to mix with people who might become their clients. A lot of the mystery and stigma of mental illness and psychological difficulties might be relieved by professionals making themselves known as human beings and saying "Hello" to their neighbours. I don't mind that my neighbour is a Social Worker (also currently unemployed and rather depressed)- why should you worry if yours is a shrink?
How about making public mental health an open topic rather than keeping the professionals and clients in separate paddocks?
Here, at least, is a report on public mental health and schools:
Mental Health in Schools and Public Health from UCLA.
It's not only the mental health field that needs more doctor engagement; Web 2.0 working means modern folk need it from primary care as well, as Bill Sinn says here:
http://www.rcpsych.ac.uk/pdf/Position%20Statement%204%20website.pdf
Quote:
...costs of mental illness will double in real terms over the
next 20 years [98]and it is also expected that demand for health and mental
health services will increase as a result of unemployment, personal debt,
home repossession, offending and other forms of ‘economic fallout’[245].
A strategy which invests in promotion, prevention and early intervention not
only can reduce the burden of mental ill health and inequality but also makes
sound economic sense [246]. page 31.
Have we seen any signs that mental health promotion is taking hold in the UK or elsewhere since the Global Financial Crisis put the contrast between needs and compulsory funds reduction in the spotlight?
I haven't gone into the background on this topic yet, but I'm certainly intrigued enough to make a study of it over the next few weeks. Has anyone else discovered any evidence that national health systems have extracted their digits??
On the positive side, I have heard of early intervention centres for psychosis and other youth mental health difficulties having success with numbers of individual cases in Australia. There has been no news about the category I'm in: mature, unemployed skilled white-collar workers, suddenly deprived of income, ineligible for pensions or state benefits and very depressed. Yet the RCP report (above) mentions my category as a real standout in the push for greater consideration of mental health as a public health, community-wide issue.
In Australia, we were dismayed by the dismantling of the Better Access to Mental Health Care Program (known as Better Access by most), cutting the number of mental health care visits available on Medicare (the national health insurance scheme paid with 1.75% of income) to people without extra private cover. Worldwide it is known that the lower socio-economic strata have worse health and more worries to contend with, yet they are the ones worst hit by cuts to publicly subsidised services. Hello, rich company executives... do you want your workers collapsing in nervous heaps, becoming unproductive and ruining your bottom line? How about campaigning for better value for everyone's health dollar so that you'll receive better returns on your investment dollar??
Since psychiatrists put out the rallying paper two years ago, psychiatrists haven't been noticeable on their soapboxes calling for better care for their less well-heeled neighbours. One or two psychs in Australia have been heard uttering encouraging phrases,, but most are still attending drug-company sponsored seminars and social activities- they're not down at the local community centre joining the depressed and unemployed on any mutually engaging tasks! My own shrink seems personally more warm and willing to try less well-tested aids to recovery, and I have certanly benefitted. However, she really has NO IDEA "how the other half lives", and I'm sure most of her colleagues are the same. They just never mix with the likes of us, who are just as worthy human beings, well educated, but down-trodden by social and financial circumstances we have little resources to cope with. Psychologists are much more likely to feel some affiliation with the average mental health client as their training and remuneration are not congruent with somewhat insulated upper-class backgrounds. However, the upper echelons of the psychology profession are also the province of may rich and remote people who don't see why their increasingly high recommended fees are way beyond the capacity to pay of folks like me. You see, psychologists, at least in Australia, have been concerned that they deliver almost the same services as psychiatrists, yet have always been paid far less. In recent years, many have increased their fees to equal those of the cheapest psychiatrists. At the same time the Medicare fee-setters have increased the amount psychiatrists can receive from Medicare per visit, plus the Scheduled Fee allowed to be charged (the maximum a psychiatrist is advised to ask for on the open market), while they haven't increased corresponding amounts for psychologists very much at all. Fair enough, psychiatrists have done a whole lot longer training and know how the physical health interacts with the mental, so they can prescribe powerful medications. However, psychologists usually have a far greater array of techniques available to them for creating change in the minds of their clients, particularly along the lines of Cognitive (Behavioural) Therapy. Either of these professions continually increasing their fees seems to put the public and their mental health more at risk, so I'd like to see everyone come to an agreement to moderate their desires for a while!
Meanwhile, if you're interested, have a look around your own community and see if psychiatrists are becoming more open and friendly and if psychologists are showing their faces in public, willing to mix with people who might become their clients. A lot of the mystery and stigma of mental illness and psychological difficulties might be relieved by professionals making themselves known as human beings and saying "Hello" to their neighbours. I don't mind that my neighbour is a Social Worker (also currently unemployed and rather depressed)- why should you worry if yours is a shrink?
How about making public mental health an open topic rather than keeping the professionals and clients in separate paddocks?
Here, at least, is a report on public mental health and schools:
Mental Health in Schools and Public Health from UCLA.
It's not only the mental health field that needs more doctor engagement; Web 2.0 working means modern folk need it from primary care as well, as Bill Sinn says here:
New age of patients wants a new age of engagement from doctors
Saturday, November 17, 2012
Amazing & simple: Cherries May Prevent Gout Flares
Cherries May Prevent Gout Flares
Several years ago I wrote about gout because it is mistakenly believed to be due to "high living". Really, it's just a special version of arthritis that requires different medicine. Discovering that something as easy to get and delicious to eat as cherries can improve gout so much is fantastic, I think!
I'm not a doctor, but I can't see any harm in regularly consuming some fresh, dried or preserved cherries- as long as they're not the brandy-soaked ones!
Several years ago I wrote about gout because it is mistakenly believed to be due to "high living". Really, it's just a special version of arthritis that requires different medicine. Discovering that something as easy to get and delicious to eat as cherries can improve gout so much is fantastic, I think!
I'm not a doctor, but I can't see any harm in regularly consuming some fresh, dried or preserved cherries- as long as they're not the brandy-soaked ones!
Friday, November 16, 2012
Not really an account of common, garden variety mental illness
A Young Reporter Chronicles Her 'Brain On Fire' : NPR
This is a good story & I will read the book as soon as I can... But this story is not going to change the stigma surrounding long term mental illness.
This young woman suffered a devastating and un-hingeing brain infection that left her temporarily as nutty as a fruitcake. She can't remember very much of what it felt like to have hallucinations, and paranoid delusions that her family & friends were "after her". She didn't get a chance to compare what real thoughts felt like vs. crazy ones within the same day or hour. She has had an awful experience, but it wasn't the experience of schizophrenia, bipolar disorder or psychotic depression.
If you suffer from one of those nasty chronic mental health conditions, this book won't make other people understand you much better; in fact, some of your friends and relatives might be trying to get you diagnosed with something else so you WILL miraculously recover & never look back.
Handle with care.
This is a good story & I will read the book as soon as I can... But this story is not going to change the stigma surrounding long term mental illness.
This young woman suffered a devastating and un-hingeing brain infection that left her temporarily as nutty as a fruitcake. She can't remember very much of what it felt like to have hallucinations, and paranoid delusions that her family & friends were "after her". She didn't get a chance to compare what real thoughts felt like vs. crazy ones within the same day or hour. She has had an awful experience, but it wasn't the experience of schizophrenia, bipolar disorder or psychotic depression.
If you suffer from one of those nasty chronic mental health conditions, this book won't make other people understand you much better; in fact, some of your friends and relatives might be trying to get you diagnosed with something else so you WILL miraculously recover & never look back.
Handle with care.
Sunday, November 4, 2012
Dismay over anti-obesity program cuts
Dismay over anti-obesity program cuts
I'm not dismayed by where the cuts ARE; I'm distressed that funds aren't put into change management in neighbourhoods. Why not fund some people to go into neighbourhoods & work with locals to find solutions to sedentary habits. Regular community walks, runs, swims, dancing, gym work in parks etc. could gradually become part of local community routine. It would be better than stupid advertisements that only get to us if we do something sedentary- like watch TV or read the bus shelter walls! No good telling humans what to do if they don't want to do it- SHOW THEM HOW and encourage them to keep doing it. How many times have you told your kids to tidy their rooms or your wife to walk the dog?? Help the kids by organising a routine and if you think the dog MUST be walked- do it yourself!
Less mouth, more action!
I'm not dismayed by where the cuts ARE; I'm distressed that funds aren't put into change management in neighbourhoods. Why not fund some people to go into neighbourhoods & work with locals to find solutions to sedentary habits. Regular community walks, runs, swims, dancing, gym work in parks etc. could gradually become part of local community routine. It would be better than stupid advertisements that only get to us if we do something sedentary- like watch TV or read the bus shelter walls! No good telling humans what to do if they don't want to do it- SHOW THEM HOW and encourage them to keep doing it. How many times have you told your kids to tidy their rooms or your wife to walk the dog?? Help the kids by organising a routine and if you think the dog MUST be walked- do it yourself!
Less mouth, more action!
Friday, November 2, 2012
No antidotes to these two new drugs- why use them?
Since the 1950s, people have had their lives extended significantly by the availability of the anti-clotting drug warfarin. It's a nasty substance by nature (still used as rat poison!), but when used wisely, provides life extension and better quality of life for many users. It has created a public health revolution by allowing many formerly "doomed" sufferers from various heart conditions to survive for many years- many achieving a normal lifespan. It doesn't have side effects like nausea or dizziness, doesn't give you a dry mouth or stop you from doing normal, everyday activities.
Both of the new drugs can also be swallowed rather than injected and they have no real side effects either. Their promoters are saying they have a huge advantage over warfarin in that their dosage doesn't need adjustment once the correct amount is worked out for you at the beginning of treatment. Warfarin has always been anxiety-provoking for doctors prescribing it because dosing is uncertain; a doctor can't say "OK, you're 75 kilos, therefore you need 5 mgs a day to stop your blood clotting inappropriately". You may need to change the dose up or down depending on what you eat or if you're on other medications. Making sure the clotting ability of your blood is reasonable, even though suppressed, can be a tricky balancing act.
Warfarin is tricky to take because it only works correctly if the clotting level of the blood is kept in a narrow range. Obviously you wouldn't want to stop the blood from clotting when you sliced your finger with the vegetable knife! However, if you had an artificial heart valve or your heart had irregular rhythm (eg. atrial fibrillation), you wouldn't want your blood to clot on its own in the spots where it wasn't flowing along fast enough- like near faulty valves or in the bottom of your heart. So sometimes people have to change their dose up and down frequently and that's inconvenient, however, if they do accidentally take more than they need, a doctor can give them some Vitamin K via injection. This usually works unless the high dose has been continued too long, when even transfusions of blood plasma might not stop the bleeding. Luckily, not many people reach this stage and there are only occasional deaths due to the medicine rather than the disease [Seventeen deaths in Australia in 5 years; hundreds would have died from their heart conditions if not on warfarin].
However, with these newly introduced drugs, Dabigatran & Rivaroxaban, there is NO ANTIDOTE a doctor can give if too much is swallowed. All they can do is cross their fingers and advise praying to your deity of choice. Meanwhile you could bleed to death or have a blood vessel burst in your brain & disable you for life.
This review claims both new medications are REVERSIBLE, just like warfarin. That's OK if there is nothing wrong with you, but if you're bleeding for some reason it takes hours for the drug to flush out of your system and allow blood to clot normally again. Saying these new drugs are "reversible" IS WRONG in my opinion because they're not instantly reversible via antidotes! Read and educate yourself if you haven't heard about the controversy.
https://www.cardiology-review.com/lessons/pdf/PER_201202-01.pdf
Both of the new drugs can also be swallowed rather than injected and they have no real side effects either. Their promoters are saying they have a huge advantage over warfarin in that their dosage doesn't need adjustment once the correct amount is worked out for you at the beginning of treatment. Warfarin has always been anxiety-provoking for doctors prescribing it because dosing is uncertain; a doctor can't say "OK, you're 75 kilos, therefore you need 5 mgs a day to stop your blood clotting inappropriately". You may need to change the dose up or down depending on what you eat or if you're on other medications. Making sure the clotting ability of your blood is reasonable, even though suppressed, can be a tricky balancing act.
Warfarin is tricky to take because it only works correctly if the clotting level of the blood is kept in a narrow range. Obviously you wouldn't want to stop the blood from clotting when you sliced your finger with the vegetable knife! However, if you had an artificial heart valve or your heart had irregular rhythm (eg. atrial fibrillation), you wouldn't want your blood to clot on its own in the spots where it wasn't flowing along fast enough- like near faulty valves or in the bottom of your heart. So sometimes people have to change their dose up and down frequently and that's inconvenient, however, if they do accidentally take more than they need, a doctor can give them some Vitamin K via injection. This usually works unless the high dose has been continued too long, when even transfusions of blood plasma might not stop the bleeding. Luckily, not many people reach this stage and there are only occasional deaths due to the medicine rather than the disease [Seventeen deaths in Australia in 5 years; hundreds would have died from their heart conditions if not on warfarin].
However, with these newly introduced drugs, Dabigatran & Rivaroxaban, there is NO ANTIDOTE a doctor can give if too much is swallowed. All they can do is cross their fingers and advise praying to your deity of choice. Meanwhile you could bleed to death or have a blood vessel burst in your brain & disable you for life.
This review claims both new medications are REVERSIBLE, just like warfarin. That's OK if there is nothing wrong with you, but if you're bleeding for some reason it takes hours for the drug to flush out of your system and allow blood to clot normally again. Saying these new drugs are "reversible" IS WRONG in my opinion because they're not instantly reversible via antidotes! Read and educate yourself if you haven't heard about the controversy.
https://www.cardiology-review.com/lessons/pdf/PER_201202-01.pdf
Monday, October 15, 2012
Sunday, October 14, 2012
Why national health insurance is good for everyone, not just the "poor".
When the Australian government taxes us at least 1.75% of our income IF WE EARN ABOVE $20 000 as an individual (then we are FREE), it provides us with free medical & hospital care, plus screening for all the common cancers. We also get any prescribed item for $35, even expensive cancer drugs, up to around $1200/year, then they are $5.
If the USA made everyone pay a similar levy (and didn't call it tax), that's Obamacare. People would be fools to knock it back.
Nicholas Kristof writes about his dear friend from childhood & university who is dying far too young because there was no system in place that looked after the health problems no one wants to think about:
A Possibly Fatal Mistake - NYTimes.com
If the USA made everyone pay a similar levy (and didn't call it tax), that's Obamacare. People would be fools to knock it back.
Nicholas Kristof writes about his dear friend from childhood & university who is dying far too young because there was no system in place that looked after the health problems no one wants to think about:
A Possibly Fatal Mistake - NYTimes.com
Friday, September 28, 2012
Saturday, September 22, 2012
Portion Sizes and Beyond — Government's Legal Authority to Regulate Food-Industry Practices — NEJM
Portion Sizes and Beyond — Government's Legal Authority to Regulate Food-Industry Practices — NEJM
The government in whatever country, state, county or city has regulations on so many substances you can take into your body, why are industry heads protesting these particular issues?
1. Anything ADDED to food and presently labeled as a "food additive" is regulated to permissible maxima or within certain bounds.
2. The content of REFINED foods, such as wheat flour is regulated in many places by the amount of protein or the amount of folate, even certain vitamins, so that the community gets a partly guaranteed healthy intake.
3. The amount of additives you can put into our shared "fresh" air is regulated but we call it POLLUTION! In many places your car can be banned from the road if it emits more than a regulation amount of carbon monoxide, particulate matter (SMOKE) or other volatile substances.
4. The amount of additives we can DISCHARGE into waterways is also regulated so our drinking water is OK and aquatic animals are not killed.
So WHY THE HELL are people getting so irate with an attempt to regulate what goes into our stomachs?
As someone interested in the long term health of the planet, I would be happy to see everyone deprived of extra sugar that is not a natural component of a food, ie. no one should reject a farmer's oranges because they are "too sweet".
I'm also happy to see "standard" portion sizes of drinks that already have sugar added CONTROLLED. What's wrong with that among all the so-called "diet" drinks that have NO genuine sugar added, just some FOREIGN substance like aspartame or saccharine that our bodies have no natural enzyme or pathway to process.
PORTION CONTROL is new? Bull sh*t! Isn't there anyone out there who has subscribed to a nutrition service which delivers "portion-controlled" meals to the door, instead of you having to serve yourself smaller meals?? ...And what do you think of places like McDonalds who allow you to choose "small", "normal" or "large" portions? WHOSE portions are these if not the food-regulator-for-McDonald's portion-controller's?
GET OVER IT
The government in whatever country, state, county or city has regulations on so many substances you can take into your body, why are industry heads protesting these particular issues?
1. Anything ADDED to food and presently labeled as a "food additive" is regulated to permissible maxima or within certain bounds.
2. The content of REFINED foods, such as wheat flour is regulated in many places by the amount of protein or the amount of folate, even certain vitamins, so that the community gets a partly guaranteed healthy intake.
3. The amount of additives you can put into our shared "fresh" air is regulated but we call it POLLUTION! In many places your car can be banned from the road if it emits more than a regulation amount of carbon monoxide, particulate matter (SMOKE) or other volatile substances.
4. The amount of additives we can DISCHARGE into waterways is also regulated so our drinking water is OK and aquatic animals are not killed.
So WHY THE HELL are people getting so irate with an attempt to regulate what goes into our stomachs?
As someone interested in the long term health of the planet, I would be happy to see everyone deprived of extra sugar that is not a natural component of a food, ie. no one should reject a farmer's oranges because they are "too sweet".
I'm also happy to see "standard" portion sizes of drinks that already have sugar added CONTROLLED. What's wrong with that among all the so-called "diet" drinks that have NO genuine sugar added, just some FOREIGN substance like aspartame or saccharine that our bodies have no natural enzyme or pathway to process.
PORTION CONTROL is new? Bull sh*t! Isn't there anyone out there who has subscribed to a nutrition service which delivers "portion-controlled" meals to the door, instead of you having to serve yourself smaller meals?? ...And what do you think of places like McDonalds who allow you to choose "small", "normal" or "large" portions? WHOSE portions are these if not the food-regulator-for-McDonald's portion-controller's?
GET OVER IT
Friday, July 6, 2012
My Say on: "Six Weeks to OMG: Get Skinnier Than All Your Friends: Experts' view of controversial diet plan"
Six Weeks to OMG: Get Skinnier Than All Your Friends: Experts' view of controversial diet plan - Mirror Online:
'via Blog this'
My say:
For once I agree with SOMETHING a diet promoter claims! Personal trainer, Paul Khanna (writing under the pseudonym Venice Fulton), says that merely using his diet will not give you an eating disorder, because eating disorders are within people. He also, admirably states that magazines, newspapers & the media in general will not cause you to become eating disordered, although I haven't seen his sources for this. Most "policies" on eating disorders & dieting by magazines, even governments (eg. Australia's), link the media to frank anorexia or bulimia, although the studies done have not shown a dose-response relationship. Colleagues & I in Adelaide & Sydney [Australia] performed a dose-response study of media consumption & dieting behaviours that could possibly be linked to eating disorders and found no connection, let alone "causation".
However, I think Paul Khanna needs to emphasise caution in dieting behaviour rather than competition, along with the caveat that his variety of dieting is for ADULTS ONLY and for adults with mature approaches to life and their emotions concerning obesity.
Personally, I believe most sensible adults won't try this diet, but some with concerns about weight & appearance may make themselves more psychologically unhealthy by following it's tenets.
'via Blog this'
My say:
For once I agree with SOMETHING a diet promoter claims! Personal trainer, Paul Khanna (writing under the pseudonym Venice Fulton), says that merely using his diet will not give you an eating disorder, because eating disorders are within people. He also, admirably states that magazines, newspapers & the media in general will not cause you to become eating disordered, although I haven't seen his sources for this. Most "policies" on eating disorders & dieting by magazines, even governments (eg. Australia's), link the media to frank anorexia or bulimia, although the studies done have not shown a dose-response relationship. Colleagues & I in Adelaide & Sydney [Australia] performed a dose-response study of media consumption & dieting behaviours that could possibly be linked to eating disorders and found no connection, let alone "causation".
However, I think Paul Khanna needs to emphasise caution in dieting behaviour rather than competition, along with the caveat that his variety of dieting is for ADULTS ONLY and for adults with mature approaches to life and their emotions concerning obesity.
Personally, I believe most sensible adults won't try this diet, but some with concerns about weight & appearance may make themselves more psychologically unhealthy by following it's tenets.
Saturday, June 23, 2012
Can Autism Really Be Diagnosed in Minutes? [reblog & comments]
Can Autism Really Be Diagnosed in Minutes? | Healthland | TIME.com:
'via Blog this'
This Dr Wall and his brief diagnostic method using a video of the child plus some questions that carers can answer via web portal seem fantastic to me. Kids all over the country & around the world can be assessed at the earliest possible time and directed towards local therapeutic services. Having a false positive [classifying a child as autistic when they're not] is not going to HARM a young child because a skilled teacher or therapist will quickly spot their abilities and refer them on for further assessment or back to mainstream schooling.
To me, Dr Wall's method is a boon to public health- it will ultimately save health dollars by eliminating lengthy waiting periods where early intervention is life-changing. The bonus is also the fact that people in remote areas are not so disadvantaged because the assessment can use electronic media instead of face-to-face contact.
For the objectors: Sure, autism warrants a thorough and comprehensive assessment to plot the best educational & social path for the child. However, the details can wait while the principles for intervention with autistic kids are put in place, especially in teaching them attention to social cues, which allows them to learn as much as they can in language, play & academic subjects.
Three cheers for Dr Wall!
'via Blog this'
This Dr Wall and his brief diagnostic method using a video of the child plus some questions that carers can answer via web portal seem fantastic to me. Kids all over the country & around the world can be assessed at the earliest possible time and directed towards local therapeutic services. Having a false positive [classifying a child as autistic when they're not] is not going to HARM a young child because a skilled teacher or therapist will quickly spot their abilities and refer them on for further assessment or back to mainstream schooling.
To me, Dr Wall's method is a boon to public health- it will ultimately save health dollars by eliminating lengthy waiting periods where early intervention is life-changing. The bonus is also the fact that people in remote areas are not so disadvantaged because the assessment can use electronic media instead of face-to-face contact.
For the objectors: Sure, autism warrants a thorough and comprehensive assessment to plot the best educational & social path for the child. However, the details can wait while the principles for intervention with autistic kids are put in place, especially in teaching them attention to social cues, which allows them to learn as much as they can in language, play & academic subjects.
Three cheers for Dr Wall!
Monday, June 18, 2012
The Most Annoying, Pretentious And Useless Business Jargon - Forbes
The Most Annoying, Pretentious And Useless Business Jargon - Forbes:
'via Blog this'
The same goes for the suits trying to 'corporatise health! I hate it!
'via Blog this'
The same goes for the suits trying to 'corporatise health! I hate it!
Thursday, June 7, 2012
ScienceDirect.com - Brain, Behavior, and Immunity - Anti-depressant medication use and C-reactive protein: Results from two population-based studies
ScienceDirect.com - Brain, Behavior, and Immunity - Anti-depressant medication use and C-reactive protein: Results from two population-based studies:
'via Blog this'
After reading the abstract of this paper recently, having first seen it when first published, an idea occurred to me. briefly, some British public health researchers looked at the relationship between major depression & cardiovascular disease risk in around 8 000 Scottish people.
Unfortunately, it's been known for a while that having depression shortens your expected life span, especially through an increase in heart attacks & strokes. This was not a nice fact for me, being a depression sufferer as I obviously can't just say "I'll improve my life expectancy by NOT being depressed".
However, this 2010 paper suggests that the risk is only significantly elevated in people who have primarily taken the old tricyclic antidepressants [the ones like Tryptanol that seem to make you feel better emotionally but also make you feel like a slug & paralyse the bowels!]. People who had taken SSRIs [like the much-maligned Prozac], did NOT have nearly the same risk of heart disease.
Briefly, the hypothesis of the authors was that increased cardiovascular risk was "carried" by higher blood levels of a substance named "C-reactive protein" [CRP} which is a "marker" of inflammation in the body- where the body is mustering immune resources against some real or sensed invasion. On an everyday level we experience inflammation when we catch a germ [eg. red & swollen nose with a cold] or when our body is injured [eg. my finger going red & swollen when my elderly, foul-mouthed cat bit me while I tried to administer a life-saving pill]. I understand that the inflammation measured indirectly by levels of CRP is more subtle and happens in blood vessel walls etc when the cells are crusted with fatty deposits or damaged by the ripping apart that calcium deposits cause when their anchoring is disturbed by strong blood flow [eg. high blood pressure].
To stop meandering with explanations, I think the increased heart disease in the depressed people who mainly took tricyclic antidepressants is related to their slug-like side effects, independent of the fact of BEING depressed. Taking most of these drugs slows down everything you do, including your thoughts. The notices on the packets of tablets that say "This medication may interfere with the ability to drive a vehicle or operate machinery", are very true and relate to the slug-like effects. The whole body seems to become heavier and most people on tricyclics for more than a few weeks DO become heavier. We all know the effect of weight increase on heart attack risk; well, tricyclics are probably slowing down the whole body- slowing the expansion & contraction of the heart & blood vessels just as they slow down the muscle contractions & mucus secretions in the bowels. Blood vessels might become clogged up more quickly, producing the higher levels of that inflammatory indicator, CRP.
Are my somewhat simplistic connections sounding quite sensible, or am I chasing entirely the wrong clues?
I'd love people to comment, particularly if they know something about the biochemistry of heart disease!
'via Blog this'
After reading the abstract of this paper recently, having first seen it when first published, an idea occurred to me. briefly, some British public health researchers looked at the relationship between major depression & cardiovascular disease risk in around 8 000 Scottish people.
Unfortunately, it's been known for a while that having depression shortens your expected life span, especially through an increase in heart attacks & strokes. This was not a nice fact for me, being a depression sufferer as I obviously can't just say "I'll improve my life expectancy by NOT being depressed".
However, this 2010 paper suggests that the risk is only significantly elevated in people who have primarily taken the old tricyclic antidepressants [the ones like Tryptanol that seem to make you feel better emotionally but also make you feel like a slug & paralyse the bowels!]. People who had taken SSRIs [like the much-maligned Prozac], did NOT have nearly the same risk of heart disease.
Briefly, the hypothesis of the authors was that increased cardiovascular risk was "carried" by higher blood levels of a substance named "C-reactive protein" [CRP} which is a "marker" of inflammation in the body- where the body is mustering immune resources against some real or sensed invasion. On an everyday level we experience inflammation when we catch a germ [eg. red & swollen nose with a cold] or when our body is injured [eg. my finger going red & swollen when my elderly, foul-mouthed cat bit me while I tried to administer a life-saving pill]. I understand that the inflammation measured indirectly by levels of CRP is more subtle and happens in blood vessel walls etc when the cells are crusted with fatty deposits or damaged by the ripping apart that calcium deposits cause when their anchoring is disturbed by strong blood flow [eg. high blood pressure].
To stop meandering with explanations, I think the increased heart disease in the depressed people who mainly took tricyclic antidepressants is related to their slug-like side effects, independent of the fact of BEING depressed. Taking most of these drugs slows down everything you do, including your thoughts. The notices on the packets of tablets that say "This medication may interfere with the ability to drive a vehicle or operate machinery", are very true and relate to the slug-like effects. The whole body seems to become heavier and most people on tricyclics for more than a few weeks DO become heavier. We all know the effect of weight increase on heart attack risk; well, tricyclics are probably slowing down the whole body- slowing the expansion & contraction of the heart & blood vessels just as they slow down the muscle contractions & mucus secretions in the bowels. Blood vessels might become clogged up more quickly, producing the higher levels of that inflammatory indicator, CRP.
Are my somewhat simplistic connections sounding quite sensible, or am I chasing entirely the wrong clues?
I'd love people to comment, particularly if they know something about the biochemistry of heart disease!
Thursday, May 24, 2012
Tuesday, May 22, 2012
Doctors Unaware of Cancer-Treatment Side Effects
Side Effects of Cancer Treatment
As I've been researching topics for my MPH & talking to friends who've had cancer, I'm sure many doctors have no idea what they're expecting their patients to endure. Cancer is still an awful killer, despite all the agonies involved in receiving the "amazing" new treatments. For myself, I'd think very carefully about having a fast-growing cancer treated at all. I must blog!!!
Doctors Unaware of Cancer-Treatment Side Effects | IdeaFeed | Big Think:
'via Blog this'
As I've been researching topics for my MPH & talking to friends who've had cancer, I'm sure many doctors have no idea what they're expecting their patients to endure. Cancer is still an awful killer, despite all the agonies involved in receiving the "amazing" new treatments. For myself, I'd think very carefully about having a fast-growing cancer treated at all. I must blog!!!
Doctors Unaware of Cancer-Treatment Side Effects | IdeaFeed | Big Think:
'via Blog this'
Thursday, May 17, 2012
Mental health for this one human
The Mental Health Blog Party almost escaped me as the past few days my mental health has taken a dip. I've been following my shrink's advice pretty well, except that the last two weeks I haven't had as much exercise each day and my flavoured fish oil supplement ran out.
She has been very thorough in getting my total physical health checked out with blood tests and ultrasounds for my suspiciously sore wrists. Now the arthritis has been diagnosed, I have mild pain control when I need it plus the fish oil and glucosamine supplements to attempt to hold deterioration back and even maybe regrow some joint covering. My slight thyroid deficiency has been dosed up, I don't have constantly cold hands and feet & I was at least more cheerful before I forgot the fish oil.
Therefore, today I drove into town and fetched my Melrose Lemon-Lime, de-odorised Fish Oil (as made for the Australian Rheumatology Association), guzzled a big 15ml dose and took myself somewhere in the sun. Off down to the beach I went to capture some warmth & sunlight before the black clouds roll in with forecast rain. Plus, I treated myself to a big fat boisonberry icecream cone! Let's hope I'm back on track in a day or two.
There has been a little stigma attached to being depressed but more misconception, in that many people think that depression is ONLY a part of bipolar and they expect me to go all effusive & extravagant in between episodes. It's hard to explain the complexities of different mental disorders to ordinary people. To many people depression= MAD and Mad= totally out of control & round the twist!
It doesn't help the cause when the media dwell on poor souls like entertainer Matthew Newton, who has been out of control with his manic-depressive problems, ie. bipolar and in the headlines. There is a certain moral stance that people take when they hear that some violence has occurred during a manic episode such that they blame the person's character, rather than their inability to control their illness. Sure, if Matt Newton had murdered his girlfriends, he should be held partially responsible for his actions in not keeping his illness under control before it got to an extreme stage. However, loss of control involving some hitting or punching is hard to predict and is something a therapist and BP person need to work out. Good Control takes time, patience and a certain amount of luck.
The relative "fame" of Matt Newton's parents in Australia also makes people bitter towards him, saying things like "he's a spoilt child and should be punished for his crimes like anyone else". This is a man of 35 whose illness did not become fullblown or diagnosable until his late twenties, so his behaviour is hardly a result of childhood experiences. I would be happy to never hear anything more about the poor bloke or his confused parents (who are NOT young any more]. Maybe in a few years it would be good to see Matt settled in a quite niche writing scripts for TV or movies, but that's the limit. If he becomes more ill and needs further containment, I definitely don't want to know, but I hope his true friends stick with him, whatever.
For my own illness, maybe some stigma has been involved in my not being able to get a job for the past five years. I don't know. However, if I lose what little hope I have of being employed again and being able to secure some sort of a future, then my friends may never hear anything from me again, either. That's my life with a mental illness.
Mind Body Organisation is hosting this blog party, so give them a look too.
She has been very thorough in getting my total physical health checked out with blood tests and ultrasounds for my suspiciously sore wrists. Now the arthritis has been diagnosed, I have mild pain control when I need it plus the fish oil and glucosamine supplements to attempt to hold deterioration back and even maybe regrow some joint covering. My slight thyroid deficiency has been dosed up, I don't have constantly cold hands and feet & I was at least more cheerful before I forgot the fish oil.
Therefore, today I drove into town and fetched my Melrose Lemon-Lime, de-odorised Fish Oil (as made for the Australian Rheumatology Association), guzzled a big 15ml dose and took myself somewhere in the sun. Off down to the beach I went to capture some warmth & sunlight before the black clouds roll in with forecast rain. Plus, I treated myself to a big fat boisonberry icecream cone! Let's hope I'm back on track in a day or two.
 |
| Classic madness= bedlam |
It doesn't help the cause when the media dwell on poor souls like entertainer Matthew Newton, who has been out of control with his manic-depressive problems, ie. bipolar and in the headlines. There is a certain moral stance that people take when they hear that some violence has occurred during a manic episode such that they blame the person's character, rather than their inability to control their illness. Sure, if Matt Newton had murdered his girlfriends, he should be held partially responsible for his actions in not keeping his illness under control before it got to an extreme stage. However, loss of control involving some hitting or punching is hard to predict and is something a therapist and BP person need to work out. Good Control takes time, patience and a certain amount of luck.
The relative "fame" of Matt Newton's parents in Australia also makes people bitter towards him, saying things like "he's a spoilt child and should be punished for his crimes like anyone else". This is a man of 35 whose illness did not become fullblown or diagnosable until his late twenties, so his behaviour is hardly a result of childhood experiences. I would be happy to never hear anything more about the poor bloke or his confused parents (who are NOT young any more]. Maybe in a few years it would be good to see Matt settled in a quite niche writing scripts for TV or movies, but that's the limit. If he becomes more ill and needs further containment, I definitely don't want to know, but I hope his true friends stick with him, whatever.
For my own illness, maybe some stigma has been involved in my not being able to get a job for the past five years. I don't know. However, if I lose what little hope I have of being employed again and being able to secure some sort of a future, then my friends may never hear anything from me again, either. That's my life with a mental illness.
Mind Body Organisation is hosting this blog party, so give them a look too.
Thursday, April 26, 2012
Stigma & prejudice in mental health
Stigma is a trending topic in mental health, although not much in the media. There are several campaigns underway in Australia, mainly utilising posters plus occasional TV Specials & radio. As an individual I haven't noticed much from these campaigns- maybe a fefw Tweets, some sidebars on blogs & a little in specialist health news pages in newspapers or online.
What I HAVE noticed is a moderate amount of actual stigmatisation and prejudice towards the mentally ill, especially concerning public figures, eg. actors or politicians. I'm refusing to use the term "celebrity" any more in the hope that its use will decrease- one can only try!
My personal encounter with prejudice against the mentally ill took the form of a Twitter "conversation" with broadcaster & popular comedian and Gruen Transfer host Wil Anderson [Twitter @Wil_Anderson]. I've known him through media for many years, although I've been no particular fan or knocker- he has seemed a pleasant and positive guy. My opinion was shattered when I saw him post a very negative comment about Matthew Newton (the guy I previously wrote about in my post "...").
Here are some images of the Tweets in question:
_________________________________
Short-lived campaigns are not enough
Norman Sartorius
Nature 468, 163–165 (11 November 2010) doi:10.1038/468163a
Published online 10 November 2010
The stigma of mental illness will be reduced only if region-specific awareness initiatives become a permanent
fixture of health and social services, argues Norman Sartorius
_________________________________________
"
What I HAVE noticed is a moderate amount of actual stigmatisation and prejudice towards the mentally ill, especially concerning public figures, eg. actors or politicians. I'm refusing to use the term "celebrity" any more in the hope that its use will decrease- one can only try!
My personal encounter with prejudice against the mentally ill took the form of a Twitter "conversation" with broadcaster & popular comedian and Gruen Transfer host Wil Anderson [Twitter @Wil_Anderson]. I've known him through media for many years, although I've been no particular fan or knocker- he has seemed a pleasant and positive guy. My opinion was shattered when I saw him post a very negative comment about Matthew Newton (the guy I previously wrote about in my post "...").
Here are some images of the Tweets in question:
_________________________________
Short-lived campaigns are not enough
Norman Sartorius
Nature 468, 163–165 (11 November 2010) doi:10.1038/468163a
Published online 10 November 2010
The stigma of mental illness will be reduced only if region-specific awareness initiatives become a permanent
fixture of health and social services, argues Norman Sartorius
_________________________________________
"
Anderson is well known as host of popular Australian panel
show The Gruen Transfer and prior to that The Glass House, both on ABC. His
radio and television career has made Anderson a highly recognised comedian in
Australia, but he is foremost a standup comedy performer
Anderson aroused controversy over some jokes he made about
the late father of Australian Idol finalist Shannon Noll at the 2006 Melbourne
International Comedy Festival.[1]
From 2001 to 2004 he was best known as one half of Triple
J's breakfast radio team, co-presenting with Adam Spencer on the show which
aired nationally across Australia.
^ Speaker Profile of Wil Anderson at The Celebrity Speakers
Bureau
Media Madness: Public Images of Mental Illness
By Otto F. Wahl was worried when reprinting
for 2nd edition that lots might have written etc but not.
David Granirer is a counsellor, stand-up comic, the author
of The Happy Neurotic: How Fear and Angst can lead to Happiness and Success,
and the founder of Stand Up For Mental Health.[1] David lives with his wife and
two kids in Vancouver, BC.
^ video: David Granirer's Take on Stigma at http://www.youtube.com/watch?gl=CA&hl=en&v=_TUCjBWV7IA^ http://www.standupformentalhealth.com
http://www.standupformentalhealth.com/documents/Cracking-Up-Mental-Illness-and-Stand-Up-Comedy-A-Social-Representations-Approach-to-Anti-Stigma-Resistance.pdf
on May 17, 2010
^ David Granirer Mental Health ConsultinChallenging the Stigma of Mental Illness
Challenging the Stigma of Mental Illness, Patrick Corrigan, David Roe and Hector Tsang,Chichester, Wiley, 2011, pp. 224, ISBN 978–0–470–68360–6 (hb), £60.00
Understanding and challenging stigma are pressing issues for people with mental health difficulties and for those involved in service provision or mental health promotion. It is currently the focus of national alliances and campaigns such as ‘Time to Change’ in England, ‘See Me’ in Scotland', ‘See Change’ in Ireland and ‘Opening Minds’ in Canada. While there may be a broad consensus that the impact of social stigma may be seriously damaging to people's self-esteem and impair their chances of recovery, there is still a relatively weak evidence base as to what may be effective in tackling stigma (Yanos et al., 2008;Tew et al., 2011).
In Challenging the Stigma of Mental Illness, Patrick Corrigan and colleagues seek to provide a practically focused text that is grounded in the experience and narratives of …
Sunday, April 8, 2012
Portrayal of mental illness on social media
Some public figures have been using Twitter & other social media to air their own prejudices about mental illness. They particularly concentrate on any OTHER public figures who appear to be having a miserable time, eg. Matthew Newton [sometime actor & presenter].
I was particularly incensed to see a local comedian and radio personality post the following about Matt Newton this morning:
If you look at Wil's statements, you'll see that he doesn't really know what mental illness is and he doesn't know what behaviours may be produced during episodes of mental illness that the "owner" might find difficult to control (or impossible if they haven't LEARNT how to control them).
You can also see that Wil wasn't monitoring the content of his own Tweets as he claims I am outrageous because I made a comment about mental illness (which was the topic I was embracing anyway) and he didn't! If I was a wellknown performer dependent on a positive reputation for income I might have been more careful. However, Wil may be relying on many of his fans having warped ideas about mental illness such that they find it amusing to hit people when they are down. I don't know how he is running his career, so I don't know if his current fans have any particular leanings- but I know when I USED TO BE a fan of his on TripleJ that I admired his ability to make clever humour out of most topics. Lucky the topic of mental illness didn't come up when I was listening to his shows, eh?!
I was particularly incensed to see a local comedian and radio personality post the following about Matt Newton this morning:
You can also see that Wil wasn't monitoring the content of his own Tweets as he claims I am outrageous because I made a comment about mental illness (which was the topic I was embracing anyway) and he didn't! If I was a wellknown performer dependent on a positive reputation for income I might have been more careful. However, Wil may be relying on many of his fans having warped ideas about mental illness such that they find it amusing to hit people when they are down. I don't know how he is running his career, so I don't know if his current fans have any particular leanings- but I know when I USED TO BE a fan of his on TripleJ that I admired his ability to make clever humour out of most topics. Lucky the topic of mental illness didn't come up when I was listening to his shows, eh?!
Monday, March 19, 2012
Australians are measuring up!
For too long governments and health departments have been TELLING US STUFF!
The problem with telling us heaps of juicy health information is that we don't often do what we're told.
Now they WANT US TO DO THINGS.
HOORAY!
LET'S DO STUFF together, as pairs and families and communities. We'll all get healthier & our heads won't be full of junk about vitamins, sunlight, cancer, fibre, heart-rate and laziness!
WE MIGHT EVEN LIKE OURSELVES MORE
Saturday, March 17, 2012
Sunday, February 26, 2012
An explosion of public health issues
Although I haven't posted anything new in 2012 (much to my own surprise), I have been thinking over a heap of issues about which I'm quite concerned.
First, the ruckus over the "new" mental health policy turn in Australia. My concerns are with the apparent change in emphasis from getting a large number of undiagnosed and untreated people in the community onto some sort of treatment path vs. providing special assessment and treatment centres for young psychosis sufferers and people who are showing behaviours suspected to be on the verge of psychotic illness. To me this seems to be unbalanced because there are epidemiologically many more people with depression, anxiety and associated conditions [eg. obsessive compulsive disorder, hoarding problems, panic attacks] than young people with early psychosis or some signs of it.
First, the ruckus over the "new" mental health policy turn in Australia. My concerns are with the apparent change in emphasis from getting a large number of undiagnosed and untreated people in the community onto some sort of treatment path vs. providing special assessment and treatment centres for young psychosis sufferers and people who are showing behaviours suspected to be on the verge of psychotic illness. To me this seems to be unbalanced because there are epidemiologically many more people with depression, anxiety and associated conditions [eg. obsessive compulsive disorder, hoarding problems, panic attacks] than young people with early psychosis or some signs of it.
- Then there is the associated fracas concerning the backing of new treatments for mental illness by the prominent psychiatrist, Professor Ian Hickie. There has been a lot of public and academic mud-slinging about an article published in the British Medical Journal claiming to review studies of agomelatine (a derivative of melatonin, a naturally occurring human brain chemical). More on the academic and clinical side, there has been debate about the safety of some recently introduced atypical antipsychotic medications Some atypical antipsychotics [mainly Clozapine, Risperidone, Olanzapine, Quetiapine, & Aripiprazole] are approved for treating schizophrenia and others are approved for acute mania, bipolar depression, psychotic agitation, bipolar maintenance, and other indications. How can we be sure that Agomelatine and atypical antipsychotics approved and used in Australia now have really undergone exhaustive clinical testing? What evidence has the TGA used to decide whether these agents should be publicly subsidised? It's very difficult for anyone to get any straight information out of the TGA, so I'm not hopeful of shedding much light on this one, although there may be some clues on other blogs from people on the 'inside'.
- The anti-vaxers are crowing over their court "victory" against the Health Care Complaints Commission, although this matter has been covered well in Losing in the Lucky Country blog. Anyone with an interest in public health would love the AVN to disappear, but there are some vocal supporters who don't seem to want to go away, although a Whooping Cough outbreak in WA makes their mission look counter-productive at the moment.
- Another matter that concerns me is the apparent rise [and recent leveling out] in asthma and allergy prevalence in Australia, especially in very young children. Surveys still show that proper asthma care plans are rarely made in conjucntion with a primary care doctor or clinical nurse consultant. In addition, there is controversy surrounding antibiotic use for conditions known to trigger asthma attacks, such as sinus iinfection. There needs to be a full and open debate on the burden the community bears due to asthma and associated condiitons because it is a true public health issue, affecting up to 20% of the population at any time- as much as depression.
- My MPH dissertation research opened up a heap of public heath issues that I'd like to talk about in the blog,, eg. the lack of success in reducing medication dosing errors in Australian hospitals and nursing homes. Also there is the fact that some medications may affect some people adversely due to possession of particular genes, while this is not being made clear by doctors. There are pathology tests available to test whether someone may react adversely or might need a much larger or smaller dose than average, which can be done before a patient swallows the first pill. Yet a colleague and I could not even get doctors to talk about surveying them about their use of these tests, let alone do an actual survey of GPs and specialists. We discovered plenty of reasons why these doctors didn't want to use the tests, but nothing on which specialties might be under-using them with direct consequences for patient safety. Maybe everyone is doing the right thing, but we can't find out as the evidence is not allowed to be collected.
- The last topic I'll list is the debate on whether we should have universal free basic health care in Australia or whether we should divide the system into privately vs publicly insured sub-populations. We have a mixture at the moment, but no sensible regulation based on what people actually receive in return for their private investment. I would rather have basic universal coverage and I would like a clear list of conditions, medications and procedures [like an NHS List] which would be covered and a clear list of conditions that could ONLY be covered in the private user-pays system. This is probably a vain hope in a country that cannot produce a proper list of medical and surgical performance indicators, let alone just one measure per Principal Diagnosis, on which the nations doctors and hospitals could be compared. There is no quality without quantitative measurement in my neck of the woods! Then there is no qualitative measurement of patient service-completeness & "satisfaction", without a standardisation of care based on numbers either.
- Obviously I could devote quite a few posts to these issues. So- if anyone reads this post- tell me what most interests you and I'll tackle that first.
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