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Prasad Prasad on his way to victory in this year's Conic Hill race Picture: Peter Grassl

It’s May, and the Scottish hill race season is about to hit its stride. The next two Saturdays see two of the key early season races – Stuc a’Chroin tomorrow, Ben Lomond seven days later – with the evening “sprint” of Dumyat sandwiched between.

The Stuc race is something of a monster: 1,500 metres of ascent, 22km of distance and some very rough ground. It doesn’t just take in the popular Munro of the name, but also the Corbett Beinn Each, the knobbly connecting ridge and a non-trivial double crossing of the shoulder between Glen Ample and Strathyre. That the course record – set in 1997 by the accomplished Bingley Harrier Ian Holmes – stands at only seconds under two hours says a lot about the arduous nature of the event.

This year’s race – which starts at 1pm in Strathyre – also sees a curiosity, in that one of the country’s best hill runners will be competing for the first time, despite having lived just along the road for much of his life.

Prasad Prasad is a seriously strong hill athlete – the obvious joke is that he’s so good, they named him twice. Born in Hampstead and brought up in Hertfordshire, he moved to Callander aged 12. “I’d like to do Stuc,” he says, “as it’s local and everyone thinks I’ve won it when I haven’t even entered it yet.”

The reason everyone thinks he’s won it is because his hill racing CV comprises a long string of first places and podium finishes, including a remarkable effort on Ben Lomond in 2010 – the only time he has run that race. Since the path alterations, the all-time Ben Lomond record (62 minutes 16 seconds by John Wild in 1983) hasn’t been threatened, but Prasad’s 65 minutes 51 seconds for the out-and-back from Rowardennan was not just the best by over two minutes on the day but also the fastest time in recent years.

“Ben Lomond was a bit of a surprise,” he says. “I’m very fortunate not to seem to need a lot of training to be pretty fit. I’d been suffering with shin splints and working on my feet all the time means that they take ages to clear up. I’d run only five times in the seven weeks before Ben Lomond, with the shin splints flaring up each time – my feet had even gone back to being soft-skinned and so I got some lovely blisters on the descent which never normally happens. I just went out hard from the start and hoped for the best – and it turned out OK.”

The 36-year-old works in a restaurant in the Trossachs and trains on both Ben A’an and Ben Ledi. Running over the latter en route to work is a world away from the frustrations of the standard morning commute. The guidebook walking time for Ben Ledi by the main path is two hours 20 minutes. Not if you’re a leading hill runner, however. “Ben Ledi is usually about 30 minutes up,” Prasad says, “timed from the wooden barrier at the bottom up to the trig point, although I’ve been just under 28 minutes. Equally it can take 34 minutes on a slow day!

“It’s close to home and good running, so I tend to run up there a lot. That said, no two days are the same up there, so I really don’t mind going up and down the same hill a lot. Also, we do a sport where there’s a lot of travelling for pretty short runs, so to drive a one-hour round trip to run Ben Vorlich in under an hour seems bit of a waste just to train.”

Prasad came to the sport late, initially via cycling. “As a kid I had really bad asthma,” he recalls. “As it got better during high school I liked a bit of hillwalking, but didn’t really think of it as exercise. I started cycling when at university aged about 19 and raced from about 20 – I seemed to be OK at climbing pretty early on but wasn’t a very successful cyclist for about four years – then got steadily stronger and better. I probably realised that I was actually OK at it in 2000.”

For such an accomplished athlete, he doesn’t train much. “I don’t tend to run many miles,” he says, “injury is never far away. I typically run two to four hours a week, although I do more now and then. I still do a bit of hillwalking and I’ve been out on the bike for a few two-hour rides to get a bit more endurance for Stuc, plus a few slightly longer runs at a steady pace. Training is largely dictated by the weather and who wants to come out – generally I’ll run hard on my own and then just run with whoever is about midweek.”

For all that he is unlikely to be far off the pace on Stuc a’Chroin, Prasad doesn’t necessarily see himself as a winner. Modesty plays its part, but the longer distances aren’t his favoured hunting grounds. “I’m better at short races,” he says. “I’m terrible at navigation and I run pretty much flat out in races, so don’t tend to pace longer stuff very well – but I like the feeling of running hard.

“I was a much more dedicated cyclist than runner. I had training plans, a coach, watched my diet and fluid intake, did intervals and all the rest – but tactically I wasn’t that good. I like working hard and suffering, so would work twice as hard as most folk in a bike race while they would sit in the shelter behind and pop out in the last few miles as I was tiring and beat me.

“Luckily running doesn’t work like that. If you’re strongest then at least in a short race you normally win and that definitely suits my racing style. So I’d say I took bike racing a lot more seriously but I have better running results – and I’m glad, as I don’t think I want to go back to 20-hour training weeks.”

As might be expected, Prasad has on occasion combined cycling and running to good effect. “I have done some off-road duathlons,” he says, “especially the Glentress winter ones, and I quite like them. I can run faster than most bikers and bike faster than most runners, so I do OK.” The third prong doesn’t appeal, however: “No triathlons, as my swimming is on par with my navigation skills!”

For footwear, he “gets on well” with the Salomon SpeedCross 2, while in club terms he’s a member of Squadra Porcini, “a Callander-based club originally cycling but now multisport. I used to bike-race for them – a nice friendly lot with no aspirations for anything but enjoying getting out, and a coffee at Dun Whinny’s after!”

Don’t expect to see him on all the high-profile race days. “I’m not bothered about chasing round to do lots of races this year,” he says. “Durisdeer looks like a nice route and as it’s a championships year should be a decent field, so I should give it a bash.” The Dollar hill race at the end of June is one of his favourites (he came second in both 2009 and 2010), while he represented Team GB at the 2010 world mountain running championships in Slovenia – placed 61st out of 149 finishers – and says he “might try for that again”.

He has never been up Ben Nevis, let alone run the race, neither has he run any of the Lakeland classics. “I wouldn’t mind trying Grasmere,” he says, “but it might be worth recceing a bit. Working most weekends, it’s pretty hard to get the time off to go down for the English races – a lot of the time I race and then go in to work after.”

All in all it sounds a well-balanced existence – keen and committed without letting the training become too life-consuming, and performing at a high level while retaining a strong sense that it’s meant to be fun. “No one in my family is particularly sporty and most of them think it unlikely that I am,” Prasad says. “Fortunately I have a sporty wife and so free time is usually a nice walk in the hills or a bike ride – usually to a cafe!”

When winter conditions interrupt the training routines, he simply switches to a different discipline: “I like getting up the hills if it’s snowy and so tend not to run as much when it’s proper winter stuff – running round a forest track seems like a waste. Hills are where I’m happiest.” The shin splints wouldn’t allow much road running anyway – “plus I find it really boring” – but as might be expected he’s no slouch on the roads when he does give it a go. Asked about his victory in last year’s Crieff 10K, Prasad jokes that 10K racing is his speciality: “I’ve done three and am undefeated so far – although that might be due to the fact that no one fast has been at any of those!”

Quite what tomorrow’s race above Strathyre will bring remains to be seen. The Glen Rosa Horseshoe is the longest race Prasad has run thus far – much the same ascent as the Stuc race, and a couple of kilometres shorter. He entered in 2010 and finished third. Tomorrow he is aiming for “somewhere around two hours 15 minutes”, but says he’ll be “happy to finish uninjured, so the time won’t matter”.

As for tactics, it will be like any other race: “I’ll start fast and hope that nobody else gets in front of me before the finishing line”.

● Results from Stuc a’Chroin here. Prasad won in two hours 10 minutes 34 seconds – which was 13 minutes 41 seconds clear of runner-up Craig Mattocks. Remarkable.

Race report from Duncan Ball of Penicuik Harriers.

<em>Picture: SuperFantastic</em>

Picture: SuperFantastic

Passive smoking is responsible for more than 600,000 deaths worldwide each year, including 165,000 child deaths, according to the most comprehensive study so far on the issue.

That means that around one in every hundred deaths can be laid at the door of second-hand tobacco.

The shocking figures, published in The Lancet journal today, have reignited calls for tougher action to protect people, particularly children, from the effects of other people smoking.

The study, written by Annette Prüss-Ustün, of the WHO Tobacco Free Initiative, based in Geneva, and colleagues, is the first to assess the global impact of second-hand smoke.

Using data from 2004 (because this was the most recent year to have comprehensive data across the 192 countries studied) they estimated both number of deaths and years lost of life in good health, known as DALYs.

Worldwide, 40 per cent of children, 33 per cent of male non-smokers, and 35 per cent of female non-smokers were exposed to second-hand smoke in 2004.

This exposure was estimated to have caused 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, and 21,400 from lung cancer.

In total, 603,000 deaths were attributable to second-hand smoke in 2004, which was about one per cent of worldwide mortality. Almost half (47 per cent) of deaths from second-hand smoke occurred in women, 28 per cent in children, and 26 per cent in men.

There were 10.9 million DALYs (disability-adjusted life year) lost because of exposure to second-hand smoke, around 0·7% of total worldwide burden of diseases in DALYs in 2004. Almost two thirds (61 per cent) of DALYs were in children. The largest disease burdens were from lower respiratory infections in children younger than five years, ischaemic heart disease in adults and asthma in adults and children.

Deaths in adults occurred across all income groups, although in children, were more common in lower and middle income households. In Africa, however, an estimated 43,375 deaths due to passive smoking occurred in children, compared to 9,514 in adults.

“Two thirds of these deaths occur in Africa and south Asia,” the authors write. “Children’s exposure to second-hand smoke most likely happens at home. The combination of infectious diseases and tobacco seems to be a deadly combination for children in these regions and might hamper the efforts to reduce the mortality rate for those aged younger than five years as sought by Millennium Development Goal 4.”

Worldwide, children are more heavily exposed to second-hand smoke than any other age-group, they add. “They are not able to avoid the main source of exposure – mainly their close relatives who smoke at home.”

These deaths should be added to the estimated 5·1 million deaths attributable to active smoking to obtain the full effect of both passive and active smoking, the authors write. Smoking, therefore, was responsible for more than 5·7 million deaths in 2004.

Sheila Duffy, chief executive with the campaigning group ASH Scotland, said the study reinforced the immense scale of harm caused by tobacco smoke worldwide.

“Although we have made great progress in Scotland by making public places smoke-free, exposure to this poisonous substance is still commonplace in homes and cars. Children can be particularly badly affected by exposure to tobacco smoke, increasing their risk of developing respiratory problems and other conditions.

“In Scotland, around 300,000 pre-teen children live with at least one parent who smokes. Because we know second-hand smoke can cause so many avoidable health problems, reducing exposure must be a priority. We need to see much more work done to raise the awareness of harm that tobacco smoke causes, and a positive campaign to highlight the benefits to families of introducing smoke-free homes and cars in Scotland and to help people understand how to protect themselves and their children effectively.”

The authors of WHO study say that policy makers should take action to protect children and adults. “First, although the benefits of smoke-free laws clearly extend to homes, protection of children and women from second-hand smoke in many regions needs to include complementary educational strategies to reduce exposure to second-hand smoke at home. Voluntary smoke-free home policies reduce exposure of children and adult non-smokers to second-hand smoke, reduce smoking in adults, and seem to reduce smoking in youths. Second, exposure to second-hand smoke contributes to the death of thousands of children younger than five years in low-income countries. Prompt attention is needed to dispel the myth that developing countries can wait to deal with tobacco-related diseases until they have dealt with infectious diseases. Together, tobacco smoke and infections lead to substantial, avoidable mortality and loss of active life-years of children.”

A noseeNose knows, y’know

Researchers have developed an “electronic nose” that can tell the difference between pleasant and foul odours.

Smelling devices have long been used to “sniff out” diseases and health conditions like cancer and asthma, and work by analysing particulate matter in air or on a subject’s breath. Dogs also have long been used to detect the presence of certain types of cancer.

But previous devices – and dogs – have been hampered by the ability to analyse only scents they’ve been pre-programmed to identify. The new electronic nose, or eNose, developed by an Israeli company can identify whether new smells are pleasant or malodorous. In studies with humans, the device managed to agree with humans 90 per cent of the time as to if an odour was pleasant or not.

Now, if I can just get my dog to appreciate that some of her “room-clearers” are more toward the unpleasant end of the odour scale, then we’d really be making progress.

PETA protests shocking treatment of meth-addled sheep

Animal rights group PETA has decried a study conducted in part by Taser that examined the effect of shooting thousands of volts of electricity into a herd of sheep that had been fed the drug methamphetamine.

People for the Ethical Treatment of Animals described as “inhumane” the study in which 16 Dorset sheep were anaesthetised, given “meth” and then subjected to electric shocks administered to varying degrees and at increasing time intervals by the hand-held shock devices. The study showed that none of the larger animals suffered heart-related problems but some of the smaller animals suffered an increase of “ventrical irritability” first brought on by the methamphetamine. The sheep were later euthanised.

“Sheep don’t do drugs and don’t resist arrest – and they aren’t good stand-ins for humans who do,” says Kathy Guillermo, of PETA. “Taser is apparently so dead set on proving that stun guns aren’t dangerous, it’s willing to subject sheep to deadly and irrelevant experiments that may violate the law to do it.”

The authors of the peer-reviewed study, who include Taser’s medical director, Jeffrey Ho, describe their experiment: “Because of the prevalence of methamphetamine abuse worldwide, it is not uncommon for subjects in law enforcement encounters to be methamphetamine-intoxicated. Methamphetamine has been present in arrest-related death cases in which an electronic control device (ECD) was used. The primary purpose of this study was to determine the cardiac effects of an ECD in a methamphetamine intoxication model.”

No flies on bacon-scent study

Avoiding artery-clogging high-fat food like bacon may help you live a little longer but now a study suggests that even avoiding the smell of bacon fat may have a similar effect.

Several studies conducted on fruit flies suggest that sensing a common smell from high-fat foods may be as harmful as consuming the fat itself. Flies put on a food diet were found to live about 30 per cent longer than those living on a high-fat diet. But when the dieting flies were given carbon dioxide, which to them indicates the presence of a yummy treat, the percentage that lived longer dropped in line with flies who were not dieting.

Blocking the perception of scent could trick the flies – and other animals – into believing there were no snacks around, which sends a signal to the body to conserve nutritional supplies by slowing down their metabolism.

“It’s a very exciting result,” evolutionary biologist Tadeusz Kawecki of the University of Lausanne in Switzerland told ScienceMag.org. “At this stage, it seems far-fetched, but it clearly works for flies.”

Even the Daily Mail has (at the time of writing) been unable to whip up a health scare about the volcanic ash cloud which has grounded planes across northern Europe.

By all accounts, the fall out of the volcanic eruption in Iceland would be far more damaging to the internal workings of aircraft than they would to humans – especially when it is so high in the atmosphere.

The Health Protection Agency (in England) has sought to dampen any fears – even if the plume drops towards the ground, the concentrations of particles at ground level aren’t likely to cause significant effects on health, it says.

Health Protection Scotland also played down the risks with consultant epidemiologist Colin Ramsay saying people in Scotland should not be “unduly alarmed”.

“Currently the dust is high in the atmosphere and not reaching ground level in Scotland,” he says. “It is not expected that significant quantities of ash will reach ground level in Scotland and therefore negative health effects are unlikely.”

Even if exposure to high amounts of volcanic dust took place, he adds, symptoms would be minor and short-lived. “It may irritate the mucous membranes resulting in short term symptoms such as a runny nose, sore throat, dry cough, irritated or itchy eyes and minor skin irritation. Similarly, those with existing respiratory conditions such as chronic bronchitis, emphysema and asthma may be affected and experience some exacerbation of any breathing difficulties, however these effects should also be transient and are considered unlikely.”

The Guardian also quotes helpfully from a University of Edinburgh professor of respiratory toxicology, Ken Donaldson, who says the risk to members of the UK public and the world’s population generally is “negligible”.

He adds – and this sounds rather gorgeous – that “even people who are in the plume of volcanoes where the ash comes to earth and they wade through it like snow show very little adverse health effects”.

Asthma UK, however, is warning that volcanic ash can be a trigger for people with asthma at ground level and when it is in high concentrations.

Clinical lead Cher Piddock is quoted on the charity’s website saying: “At the moment the ash is very high in the atmosphere and does not pose an immediate problem. We advise people with asthma to monitor the news closely and ensure they keep their reliever inhaler on them at all times.

“If people are concerned about their condition, they can speak to an asthma nurse specialist on our Adviceline on 0800 121 62 44.”

Of course, the plume – and the consequent cancelling of flights – may have indirect health consequences in raising the blood pressure of frustrated travellers. I wonder if the Mail has thought of that yet.

<em>Picture: SuperFantastic</em>

Picture: SuperFantastic

Smokers should be banned from lighting up in cars to protect children from the effects of tobacco, a leading Scottish doctor has warned.

Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh, called on the Scottish government to lead the way, following a report from the RCP London, called Passive Smoking in Children, published today.

The report details the health damage suffered by children which can be attributed to passive smoking, and calls for a raft of measures to try to tackle the problem.

According to the report, passive smoking in the UK takes a yearly toll on the health of children, including:

  • One in five of all Sudden Infant Deaths (cot death) – 40 per year
  • Over 20,000 cases of lower respiratory tract infection
  • 120,000 cases of middle ear disease
  • At least 22,000 new cases of wheeze and asthma
  • 200 cases of bacterial meningitis

The most important factors governing exposure to children are whether their parents or carers smoke and whether smoking is allowed in the home, the report says. Passive smoking exposure is nearly nine times higher for children who live in homes where both parents smoke (compared to children in non-smoking families), and is also an issue where older siblings smoke.

The report calls for measures including a prohibition of smoking in cars and other vehicles and a comprehensive strategy to reduce the prevalence of smoking in adults, particularly younger adults. This should include increases in the real price of tobacco and generic, standardised packaging, the report says.

Dr Dewhurst said: “Passive smoking exposure levels in children have fallen by 40 per cent in Scotland since the introduction of smoke-free legislation, but exposure levels in children of smokers remain high, and demand further legislative action.

“We fully endorse today’s report which calls for an extension of smoke-free legislation throughout the UK in order to include public areas frequented by children and in cars.

“Scotland has led in the UK in the introduction of smoke-free legislation and we call on the Scottish government to extend this legislation as a matter of priority.”

Professor Terence Stephenson, President of the Royal College of Paediatrics and Child Health (RCPCH), said: “We should be making cars totally smoke-free if there are children travelling in them. Second-hand smoke has been found to be strongly linked to chest infections in children, asthma, ear problems and sudden infant death syndrome, or cot death. We strongly support the policy recommendations in this new report and repeat the call for new approaches to address this problem so that we protect the health of children and young people.”

Professor John Britton, Chair of the RCP Tobacco Advisory Group said: “This report isn’t just about protecting children from passive smoking; it’s about taking smoking completely out of children’s lives.”

In the fifth of a series of interviews with people who influence Scotland’s health and health services, The Caledonian Mercury meets long term conditions supremo Susan Douglas-Scott, who says that doctor doesn’t know best – we do.

Susan Douglas-Scott

Susan Douglas-Scott

Susan Douglas-Scott trained as an occupational therapist because she liked helping people to have the best lives they could and to be as independent as possible.

That may have been a few years ago, but you could say her current job is an extension of that, albeit on a Scotland-wide scale.

As chief executive of the Long Term Conditions Alliance Scotland, she is at the centre of the drive to shift healthcare out of acute hospitals and into people’s homes and communities. What’s more, her (largely government-funded) organisation wants us all to take far more responsibility for our health – if not quite taking over from doctors and nurses and the other professionals, then certainly being the loudest voice in the healthcare team.

“We’re very much looking at partnership approaches,” she says. “We want health professionals to work with us, to see us as people with lives and families, and jobs or activities. The person with a long term condition knows what that means for them, and knows what they need or want to get on with their lives.

“We’ve got to get away from the culture of ‘doctor knows best’, when actually the person who knows best is the person with the long term condition.”

The Long Term Conditions Alliance Scotland is an umbrella organisation for the many charities and organisations connected with chronic diseases. It brings together more than 100 voluntary and community organisations covering conditions from Alzheimer’s to tuberous sclerosis. As well as those conditions generally thought of as chronic, such as asthma and diabetes, it also covers things like cancer, HIV/Aids and heart disease, in recognition of the fact that people are living for a long time with these conditions.

The alliance reckons that more than two million people in Scotland have one or more long term condition – that’s around two in five of us. I wouldn’t be surprised if that’s an underestimate; looking around my family, friends, neighbours and acquaintances, the percentage afflicted with at least one long term condition is certainly higher than that. And in any case, as the population ages, more of us will live long enough to contract chronic conditions associated with ageing, such as Alzheimer’s, while better treatments will keep others – with cancer, for example – alive for much longer.

Little wonder, then, that the Scottish government has long term conditions in its sights. Already costly to the health service and the wider economy, the bill is set to soar as we get older.

Part of the problem is that people with long term conditions are more likely than the rest of the population to be admitted to hospital. Often, she says, this is unnecessary. Had there been proper “anticipatory” care, had the individual had support at home, had he or she been given an element of control over their condition and the management of it, the costly hospital admission might have been avoided.

She quotes the warning of Professor David Kerr, author of the Kerr Report (Building a Health Service Fit for the Future), who said that unless the focus of care was changed from the current model, based on acute illness, to one looking at long term conditions, and from hospitals to community based care, our health services would be overwhelmed. Indeed, she says, there were estimates that a new hospital would have to be built every month to keep up with demand as the population ages.

So, conversely, would her approach mean closing hospitals?

“No, not at all – I think we will still need hospitals,” she says. “In any case, they’re all very busy places. But I do think there’s too much separation between primary and secondary care, and I think a lot more could be happening in the community.

“The Kerr Report was an exciting thing for us, not because it makes specific recommendations about particular conditions, but because it talks about self-management – helping people to live independently. That’s really important because it means that people feel in control and, ideally, to work out the things that are important to them, and to manage risk. You can’t manage risk if you don’t understand what’s happening. But self-management has to be flexible as well, and recognise that people have different needs.”

“With rights come responsibilities – you can’t abnegate everything to someone else.”

That’s not to say she wants to be rid of doctors and nurses and the rest of the healthcare team – she simply wants the patient to be an equal partner. Or rather, the “person with the long term condition”, as the alliance doesn’t like the use of the word “patient”. That fits in with the Scottish Government’s NHS quality strategy, I say – it tries to avoid calling people patients too. I feel remarkably slow as I realise that it was presumably the alliance which was behind that particular terminology.

“I think it [the quality strategy] is the next key policy,” she says, modestly passing over any influence she may have in drawing it up. “I’m hoping that it will be well-received and will help to change the culture of the NHS. But it will take time – the NHS is a huge organisation – it’s not going to do a three-point-turn in 10 seconds.”

The alliance, which holds its annual conference in Perth tomorrow, is putting its money where its mouth is, in that it offers funding to projects encouraging self-care. Some of these are inspirational, although Ms Douglas-Scott is reluctant to pick out one above the others. Recent winning ideas have included an exercise programmes for people with multiple sclerosis, an asbestos-related conditions self-management programme and the interestingly named Pink Ladies First, which won funding to develop self-management programmes for women living with anxiety and depression.

There is also a strong focus on mental health, which includes the recognition that having a long term condition can, in itself, contribute to poor mental health.

Although treatments have got so much better and are allowing people to live for longer, having a long term condition isn’t a breeze, says Ms Douglas-Scott. There are the side-effects of medication, for example. Some conditions can limit what you do, and some have other, less obvious effects. “I used to work in HIV and in epilepsy,” she says. “The thing about some conditions like these is that they can still be stigmatised. And drugs, while they may be keeping you alive, can be unpleasant to take. There are a lot off issues around long term conditions which can really affect people’s mental health and wellbeing.”

Self-management helps, she says, because it empowers the individual with the long term condition, as does truly person-centred healthcare. But, as all those gathering in Perth for their conference tomorrow will know, there’s still a way to go before the NHS offers person-centred care and welcomes the patient as an equal.

But culture change is possible, she believes. Today’s undergraduates across all healthcare disciplines, including medicine, are being taught to be more person-centred in their approach, she says, so that’s bound to make a difference over time. And health services are willing to change, she believes. “I think we’re pushing at an open door.”