The Minimed lecture series aims to ‘separate the wheat from the chaff’ for non-medical people

HOW CAN YOU boost your chances of being around to celebrate your 85th birthday? How are Ireland’s sexual practices changing? And how can we encourage morally sound decisions about healthcare?

Those are some of the topics to be covered in the upcoming MiniMed Open Lecture Series of public talks at the Royal College of Surgeons, which start tomorrow. The course can help sift the wheat from the chaff for non-medical people in an information-rich world, according to Prof Alice Stanton, who will be discussing cardiovascular health and risk factors.

“It can be difficult to work out what is reliable information, or where there is an ulterior motive or where people are being careless or scaremongering,” says Stanton, associate professor of molecular and cellular therapeutics at RCSI.

“I think the average person would welcome coming along to talks like this where they are getting information from someone who is practising in the area.” Her advice on keeping in good nick into older age will focus on how to minimise atherosclerosis, or fatty irregularities in arteries.

“Those irregularities can fracture and rupture and that is commonly followed by clotting within the vessel causing a total blockage – that’s the most common cause of heart attacks and strokes,” explains Stanton, noting that risk factors include smoking, being overweight and having high blood pressure and cholesterol.

“You can adjust those risk factors through lifestyle very effectively. Then if lifestyle isn’t enough, we do really have a huge number of drugs that are proven to reduce blood pressure, cholesterol and clotting, and they are very effective.”

But the statistics do not augur well. "How are we doing in Ireland? Very badly," she says. "The recent Slán 2007 National Surveyshows that 60 per cent of Irish people over 45 years are hypertensive, and 80 per cent have high cholesterol."

And of those at high risk of heart attack or stroke in Ireland, only a tiny fraction are on medication to help their condition, despite the correct drugs being shown to quarter the risk, notes Stanton.

She would like to see cardiovascular screening programmes in place here. “It’s not about having amazingly expensive tests – people should be having their blood pressure, cholesterol and blood sugar measured, their weight checked and to be asked if they are smoking or not,” she says.

“I would like it if the Irish health service was providing free health checks every five years for people over 40, but that’s not going to happen soon, so it’s going to be up to individuals to go to their GPs themselves for regular checkups.”

And while we learn more about our hearts and the need to protect them, what about our sex lives? Recent studies have lifted the lid on sexual health and practices in Ireland, from abuse to contraception to attitudes and norms, explains Prof Hannah McGee, the newly appointed Dean of Medicine and Health Sciences at the RCSI.

“We have seen ourselves traditionally as a nation that has been very coy, very hidden about sexual health issues, that we have been very immature in dealing with them and we have had very little Irish-based evidence about it,” says McGee, who will be talking about the “good and bad news” relating to sexual health in Ireland.

Three major studies have recently contributed to a deeper understanding of the issues, including the prevalence of abuse and violence, she explains.

The Sexual Abuse and Violence in Irelandstudy surveyed a sample of more than 2,100 men and women about their experiences and attitudes. "We had about 800 people tell us about unpleasant things that had happened to them, and 47 per cent of them had never said it out loud to any other person. So they hadn't gone to the guards, their mother, their boyfriend," says McGee.

“And when the study came out in 2002, not one person said, ‘I don’t believe it, you are exaggerating’. There was almost a sad recognition that this is probably true, there are high levels of abuse in childhood and adulthood, and people are not talking about it.”

Subsequent surveys included the Irish Contraception and Crisis Pregnancystudy and the Irish Study of Sexual Health and Relationships(both available at www.crisispregnancy.ie). Their findings included that older people in the 18-64 age range had often only had a single partner, usually their spouse, explains McGee. "But zoom forward to the 20 year olds and they are having multiple serial monogamy relationships, so we look much more like other Europeans now than we would have done in the past." The average age of first sexual intercourse has also fallen considerably – the 18-24 age group cited a median age of 17 – and younger women in the 18-30 age bracket were particularly likely to say they wished they had waited longer.

The studies are helping to inform and target awareness campaigns, says McGee, and they bring sexual health issues out into the open as never before. “If the problem is so hidden that you haven’t studied it, then you don’t even know where to begin.”

And while we are talking more openly about sex, the debate is also growing here around ethical issues in medicine, another topic in the lecture series. “Medical ethics is part of moral decision making, how you make decisions regarding medical care,” explains David Smith, associate professor of healthcare ethics at RCSI.

Those decisions face healthcare practitioners, patients and their families in a raft of situations – like when patients refuse life-saving treatments, when resources are limited and have to be allocated between patients, or when issues of patient consent or confidentiality arise – and Smith plans to highlight the ethical balancing acts through a number of examples.

“Sometimes, a conflict can occur between what a patient thinks is in their best interests and what a healthcare practitioner might think is in the patient’s best interests,” according to Smith. Many hospitals now have research and clinical ethics committees, and guidelines to help stakeholders make ethical decisions.

And while Smith believes Ireland currently has a healthy level of debate about medical ethics, he reckons legislation is the real driver to open up discussion. “When a country decides to legislate or enact a law that can either limit treatments or allow something that a lot of people object to, I think that’s when the real discussion takes place,” he says.

17

is the median age of first sexual intercourse in the 18-24 age group

60%

of Irish people over 45 years are hypertensive

80%

of Irish people over 45 years of age have high cholesterol

The five-lecture Mini Med School series starts tomorrow and runs on selected Wednesday evenings at the Royal College of Surgeons, Dublin 2, until May 26th. For more details call 01-4028662 or visit www.rcsi.ie/minimed2010