Is it surprising bosses are stricken by stress?

  Antonio Horta-Osorio, chief executive of Lloyds banking group, has been signed off work for medical reasons, reportedly stress and "extreme fatigue". But should people be surprised that bosses suffer?

Memorably described as the financial world's Jose Mourinho, there were high hopes for Antonio Horta-Osorio's stewardship of Lloyds.

The Portuguese boss was said to have "a laser-like focus" and was so dedicated to the job, that on his first day at Lloyds he arrived so early that the front doors were not even open.

Now his temporary departure has left share prices down and employees, investors and the government - who have a large stake - wondering when he will return.

The financial sector and big businesses have always been known as a high-pressure environment.

Geraint Anderson, a former City analyst and "Cityboy" columnist, describes the City as having a "testosterone-fuelled, macho" culture.

"The 'lunch is for wimps, if you want a friend buy a dog' culture is just as strong now if not stronger," he says.

The average working week in the finance sector is about 60 hours and that's just during the week - people often work at the weekend as well.

One might then argue that it's not surprising that Horta-Osorio is suffering from "extreme fatigue". But at the same time there is a strong expectation that big company bosses, like senior politicians, should have an unusually high tolerance for the stresses of working all the time.

But in reality, the work ethos of high finance makes stress a bigger problem by discouraging people from seeking help.

"Mentioning stress or fatigue or anything that's perceived as a sign of weakness is sneered at, which makes the whole environment difficult for those who are stressed," says Anderson.

"People bottle it up and don't share it so to have to put up a front of invulnerability can be a difficult thing to maintain, especially doing a hyper-competitive job with long hours and with the added pressures of job losses."

Of course, stress is an issue for all workers. Amy Whitelock, senior policy and campaigns officer at Mind, says the key thing is that stress can affect people in different ways.

Continue reading the main story Antonio Horta-Osorio: chief executive of Lloyds banking group who has been signed off for "extreme fatigue"Joseph Lombardi: Chief financial officer of Barnes & Noble who quit, reportedly as a result of "exhaustion"Jeff Kindler: chief executive of Pfizer who left the company last year saying the demanding role had worn him outKjell Magne Bondevik: Norway's prime minister took indefinite leave in 1998 citing stress-induced depression however he has since returned and been re-elected While ordinary workers suffer under the pressure of overwork, redundancy worries and poor work-life balance, senior managers may be less willing to speak up because of their position and the impact it could have on their careers.

"Everyone can experience stress. Senior people speaking out can be really powerful and help others to speak out," says Whitelock.

But what if you're at the top of the company?

"[Bosses] are not viewed as invulnerable masters of the universe. Some are good and I think a lot are doing well in conditions beyond their control," says Anderson.

However there is an assumption that "if they've climbed the greasy pole to get there then they have what it takes", he notes.

John Binns is one such executive who has been affected by this.

A partner for 10 years at accounting and consulting firm Deloitte, he was signed off work in 2007 with depression.

At the time, he thought it was the end of his career.

What surprised him was the reaction of his bosses who told him he was a valued member of the team. They said they wanted to do everything for him so that he could get back to work.

"That was a surprising message, I wasn't expecting to hear that. With depression, your self-esteem takes a huge blow so it was an extraordinary message for me," he says.

"People can get better and have a level of work they had before. What's happening is people aren't talking about it."

Ben Willmott, employee relations advisor for the Chartered Institute of Personnel Development, says the working culture is dictated to by the top of the company.

Continue reading the main story Large organisations should offer feedback and carry out staff surveys to identify problemsInvestigate why some areas have a high staff turnover Companies need to create a culture where mental health can be openly discussed without discriminationA good work/life balance should be promotedEmployees should be advised on where they can get helpIf an employee has been off with sick leave, their return should be gradually phasedEmployees should reduce stress by interacting with colleagues, taking a lunch break and do some form of physical activity during the day such as go for a walk Source: Mind"Chief executive teams have high levels of autonomy. They're used to working under pressure and managing their own workloads.

"In certain sectors at board level there is a sort of a belief that senior executives should be able to cope but executives should be looking after each other.

"Companies should look at resilience training for chief executives to look at how they manage their own stress and how they respond to pressure."

He says where there are signs of burnout, such as people sending emails on Sundays or at night regularly, then other team members should ask them if they're coping.

Everyone has periods of work where they have a bout of activity but if the unsustainable is becoming sustainable, then that's when help may be needed, according to Willmott.

"Pressure is a positive in a business environment but prolonged exposure to pressure is when you get problems."

When Binns returned to work, he set up a mental health champion scheme where employees can speak to any one of eight partners who have been trained in mental health issues.

It is outside of line management and HR and managers can even speak to them confidentially if they have concerns about staff they look after. The scheme is seen as ground breaking and other companies are implementing it.

"Because of my experience, my engagement with the company has been strong, my productivity has been better so it's paid them back," he says.

"We've got a long way to go - we can't make that culture change overnight."

And the culture is hard to address. What happened after the Lloyds announcement, falling share price and speculation about the chief executive's future, is just the sort of thing that adds to the pressure on bosses.

"People would be looking for strong leaders in a time of crisis," says Anderson.

And yet a crisis is just the time when a strong leader is most likely to be affected.

Laser op 'can change eye colour'

  After the brief laser procedure, the colour change is said to take a few weeks to take effect A US doctor is trying to pioneer a laser treatment that changes patients' eye colour.

Dr Gregg Homer claims 20 seconds of laser light can remove pigment in brown eyes so they gradually turn blue.

He is now seeking up to $750,000 (£468,000) of investment to continue clinical trials.

However, other eye experts urge caution because destroying eye pigment can cause sight problems if too much light is allowed to enter the pupil.

Stroma Medical, the company set up to commercialise the process, estimates it will take at least 18 months to finish the safety tests.

'Irreversible'

The process involves a computerised scanning system that takes a picture of the iris and works out which areas to treat.

The laser is then fired, using a proprietary pattern, hitting one spot of the iris at a time.

When it has hit every spot it then starts again, repeating the process several times.

Continue reading the main story

The pigment is there for a reason. If it is lost you can get problems such as glare or double vision”

End Quote Larry Benjamin Stoke Mandeville Hospital, UK However the treatment only takes 20 seconds.

"The laser agitates the pigment on the surface of the iris," Dr Homer - the firm's chairman and chief scientific officer - told the BBC.

"We use two frequencies that are absorbed by dark pigment, and it is fully absorbed so there is no danger of damage to the rest of the eye.

"It heats it up and changes the structure of the pigment cells. The body recognises they are damaged tissue and sends out a protein. This recruits another feature that is like little pac-men that digest the tissue at a molecular level."

After the first week of treatment, the eye colour turns darker as the tissue changes its characteristics.

Then the digestion process starts, and after a further one to three weeks the blueness appears.

Since the pigment - called melanin - does not regenerate the treatment is irreversible.

Lasers are already used to remove the substance in skin to help treat brown spots and freckles.

Dr Gregg Homer said he first had the eye laser idea in the mid-1990s Safety concerns

Other eye experts have expressed reservations.

"The pigment is there for a reason. If the pigment is lost you can get problems such as glare or double vision," said Larry Benjamin, a consultant eye surgeon at Stoke Mandeville Hospital, in the UK.

"Having no eye pigment would be like having a camera aperture with a transparent blade. You wouldn't be able to control the light getting in."

Dr Homer said that he only removes the pigment from the eye's surface.

"This is only around one third to one half as thick as the pigment at the back of the iris and has no medical significance," he said.

He also claimed patients would be less sensitive to light than those born with blue eyes. He reasoned that brown-eyed people have more pigment in the other areas of their eyeballs, and most of it will be left untouched.

"We run tests for 15 different safety examination procedures. We run the tests before and after the treatment, and the following day, and the following weeks, and the following months and the following three months.

"Thus far we have no evidence of any injury."

Testing in Mexico

Dr Homer originally worked as an entertainment lawyer in Los Angeles, but gave up full-time practice in the mid-1990s to study biology at Stanford University in California.

He said he filed his first patent for the laser treatment in 2001. But it was not until 2004 that he began carrying out experiments on animals at a hospital facility.

To fund his research he used his own savings, attracted investments from venture capital funds and secured a government grant. Dr Homer said he has raised $2.5m to date.

Dr Homer said his treatment only removes pigment from the eyeball's surface

Tests on humans initially involved cadavers, and then moved on to live patients in Mexico in August 2010.

"From a regulatory perspective it is easier," Dr Homer said, "and I can speak Spanish fluently so I can closely monitor how everyone is doing."

Seventeen people have been treated so far. All are very short-sighted. They have been offered lens transplants in return for taking part.

Dr Homer said the work is checked by a board of ophthalmology experts to ensure it is up to standard.

The new funds will be used to complete safety trials with a further three people.

Stroma Medical then intends to raise a further $15m to manufacture hundreds of lasers and launch overseas - ideally within 18 months.

A US launch is planned in three years' time, because it takes longer to get regulatory approval there.

Stroma Medical believes the treatment will be popular; its survey of 2,500 people suggested 17% of Americans would want it if they knew it was completely safe. A further 35% would seriously consider it.

There is also evidence of a growing desire to alter eye colour overseas - a recent study in Singapore reported growing demand for cosmetic contact lenses.

New GP registration system tested

 Ministers have wanted to alter registration rules for years Some patients in England will be able to switch GPs so they can register close to work, under a new pilot agreed between doctors and the government.

Two or three major trials to test the system are expected to start in the next year.

The deal with the British Medical Association also means patients who move a short distance away will be able to stay with their existing practice.

Doctors have also agreed to a pay freeze for 2012-13.

That aspect of the deal applies to the whole of the UK, as does the introduction of new incentives into the performance-related pay part of the GP pay package to tackle the growing problem of unnecessary hospital admissions.

Reluctance

The agreement on registration comes after many years of talks between government and doctors.

Labour first floated the idea of relaxing the rules regarding registration when they were in office.

The proposals were then taken on by the coalition.

Doctors' leaders had initially been reluctant to agree to the suggestions, but have now agreed to pilot them.

Continue reading the main story

This is a good deal for GPs, a good deal for patients and a good deal for the NHS”

End Quote Andrew Lansley Health Secretary Two models will be tested.

Under the first, patients will be allowed to stay with their practice near home while allowing them to visit another one close to their work.

The second one will involve patients giving up their registration with their home GP.

Dr Richard Vautrey, of the BMA, said: "Most GPs were against the complete abolition of practice boundaries because of the potential negative impact on continuity of care, so we're pleased that we have been able to agree this alternative which will help commuters as well as patients who move out of a practice's boundaries but want to stay registered."

Health Secretary Andrew Lansley added: "This is a good deal for GPs, a good deal for patients and a good deal for the NHS."

The decision to allow patients to stay registered with their GP when they move home applies to the whole of England.

In many ways it formalises what already happens in practice in many cases - although it will still be up to the discretion of GPs.

Poor patient literacy 'hampers healthcare'

 Medical and Dental Defence Union of Scotland  Patients aren't expected to understand medical jargon, but how do doctors ensure that those who lack basic reading skills get the right care? There has been a surge of written information in leaflets and online but, in this week's Scrubbing Up, Dr Barry Parker of the MDDUS, says doctors should not see those as substitutions for talking things through with patients.

One in six people in the UK have a literacy level below that expected of an 11-year old.

This is alarming enough in terms of the ability to manage day-to-day activities, but problems may be even more widespread if we consider health literacy, which is an individual's ability to read, understand and use healthcare information to make decisions and follow instructions for treatment.

Literacy difficulties may stem from a variety of factors including conditions such as dyslexia, health problems, disrupted schooling or stresses acting as barriers to learning in childhood.

Unfortunately, stigma still surrounds adults who struggle to read and they are often too embarrassed to disclose any literacy difficulties, even in the confidential setting of a doctor's consulting room.

Patients with reading difficulties may have developed effective strategies to conceal problems and minimise any impact on their lives, such as avoiding form filling and declining to read aloud when in company.

They may have excellent verbal communication skills, and it is therefore not always easy for anyone - doctors and other healthcare professionals included - to detect there is a problem that could have an adverse effect on the patient's health.

Potentially toxic

Understanding medication instructions can be particularly hazardous.

For instance, a very commonly prescribed painkiller such as paracetamol can be bought over the counter in pharmacies and supermarkets.

Whilst safe in the recommended dose, it may quickly become toxic if the correct timing of the dose or number of tablets is exceeded, and those with literacy problems may be unaware of this if they assume it is only a mild painkiller and cannot easily read the instructions.

Some more powerful drugs such as methotrexate, used for rheumatoid conditions, have unusual dose instructions, such as "take once per week", which again may lead to confusion and potentially severe consequences if inadvertently taken daily.

Of course, doctors can only make allowances for literacy difficulties if they know they exist, but there are signs for them to look out for such as a patient having difficulty completing forms in surgery, having unexpected problems responding to recall letters or struggling to follow written advice.

There is currently a wealth of health information available to the public in the form of leaflets, posters and websites, and these are often recommended by health professionals either to encourage healthy lifestyle advice or to teach patients more about their medical conditions.

While this is welcomed in terms of making the public more 'health aware', over-reliance on the written word may be dangerous to those who struggle with reading, and the increasing use of email advice brings further risks.

Patients should request that information is provided in the way they feel most comfortable with and understand.

Doctors, in return, should work in partnership with patients, for example, by ensuring that information is given verbally as well as in writing.

For patients, if you have such difficulties, please report them to your doctor or other health professional so that they can give you information in a format that is easy to understand and you get the best possible care. They may be able to help you access information on support such as adult literacy courses, and you can also seek help from family or friends.

And for all those working to provide health care, it is important to remain vigilant at all times to detect problems, and perhaps ask specifically about such difficulties more often.

Information leaflets should be kept simple and as easy to read as possible, avoiding medical jargon and including diagrams where possible. They are best used as an addition and not an alternative to verbal communication.

Signs of ageing halted in the lab

 Will it one day be possible to stop ageing? The onset of wrinkles, muscle wasting and cataracts has been delayed and even eliminated in mice, say researchers in the US.

It was done by "flushing out" retired cells that had stopped dividing. They accumulate naturally with age.

The scientists believe their findings could eventually "really have an impact" in the care of the elderly.

Experts said the results were "fascinating", but should be taken with a bit of caution.

The study, published in Nature, focused on what are known as "senescent cells". They stop dividing into new cells and have an important role in preventing tumours from progressing.

These cells are cleared out by the immune system, but their numbers build up with time. The researchers estimated that around 10% of cells are senescent in very old people.

Cleanup Scientists at the Mayo Clinic, in the US, devised a way to kill all senescent cells in genetically engineered mice.

The animals would age far more quickly than normal, and when they were given a drug, the senescent cells would die.

The researchers looked at three symptoms of old age: formation of cataracts in the eye; the wasting away of muscle tissue; and the loss of fat deposits under the skin, which keep it smooth.

Researchers said the onset of these symptoms was "dramatically delayed" when the animals were treated with the drug.

When it was given after the mice had been allowed to age, there was an improvement in muscle function.

One of the researchers, Dr James Kirkland, said: "I've never seen anything quite like it."

His colleague Dr Jan van Deursen told the BBC: "We were very surprised by the very profound effect. I really think this is very significant."

The treatment had no effect on lifespan, but that may be due to the type of genetically engineered mouse used.

Eternal youth?

The study raises the tantalising prospect of slowing the signs of ageing in humans. However, senescent cells cannot be just flushed out of human beings.

Dr Deursen said: "I'm very optimistic that this could really have an impact. Nobody wants to live longer if the quality of life is poor."

He argued that young people were already clearing out their senescent cells.

"If you can prime the immune system, boost it a little bit, to make sure senescent cells are removed, that might be all it needs.

"Or develop a drug that targets senescent cells because of the unique proteins the cells make."

Dr Jesus Gil, from the Medical Research Council's Clinical Sciences Centre, said the findings needed to be "taken with a bit of caution. It is a preliminary study".

However, he said it was a fascinating study which "suggests if you get rid of senescent cells you can improve phenotypes [physical traits] associated with ageing and improve quality of life in aged humans".

South Asian children 'less active'

Pupils at Frederick Bird School understand the importance of staying active. South Asian children are less physically active than other children according to findings of research being carried out for the British Heart Foundation.

Asian children are more likely to spend their evenings studying, playing computer games or watching TV than playing outdoors or doing sports.

Current recommended guidelines from the Department of Health suggest that young children should be vigorously active for at least an hour a day. Ideally they should be active for a number of hours each day.

A study monitoring the activity levels of 208 children in Coventry has found that British Asian children are as active as other children while at school and during weekends. However, in the evenings, they are less likely to be playing or running around.

Of the children taking part in the study, 96 were white European, 65 were British South Asian and 47 children were from other ethnic backgrounds.

The children were aged between seven and nine. They each kept diaries and wore a physical activity and heart rate monitor for eight days at a time to collect data on their levels of activity.

Continue reading the main story

Certainly some parents encourage their children to be very academic and might not encourage them to be physically active.”

End Quote Dr Krystyna Matyka Consultant paediatrician Emma Air, a research associate at Warwick University, said the findings so far indicate that children from South Asian backgrounds tend to be less active.

"It tends to be after school where the activity patterns are different.

"We're finding no difference in their physical activity patterns at school, lunch or break. They seem to do similar amounts of activity at weekends. But it's weekdays after school when they are less active," she said.

'Role models'

Dr Krystyna Matyka, a consultant paediatrician and associate clinical professor at Warwick Medical School, is leading the research.

She explained that the study used the the children's diaries to assess what type of activities they participated in after school.

"There are cultural reasons for having other things to do in the evenings, like perhaps going to mosque.

"People have commented on a lack of effective role models for South Asian children doing lots of physical activity. Certainly some parents encourage their children to be very academic and might not encourage them to be physically active."

Aameela, is a Year 6 student at Frederick Bird Primary School who took part in the research. She said: "After school I eat my tea, do my homework and go to the mosque."

Kashif and Jabedul are both aged eight and are also pupils at Frederick Bird Primary School.

"I like to play on my computer," said Kashif. "But my mum and dad like me to tidy up, pray, then go outside."

"I do my homework, and play of course on my PS3. Sometimes I go out with my mates and play football," said Jabedul.

"My parents really care about me getting good GCSEs," he added.

Future risks

The research has now moved into the second phase where children are monitored during exercise. In particular the researchers are looking at heart rate variability. Primary results suggest that South Asian children react differently to exercise.

Dr Matyka said: "We are measuring how the heart responds in different situations. It should go faster at some points and slower at others.

"We have found that the response rates in South Asian children is lower than children from white European backgrounds, which suggests there is an increased metabolic risk. Whether that does mean in 20 or 30 years time they will develop a heart attack is very difficult to say."

It is well documented that South Asian adults are at higher risk of developing type 2 diabetes and heart disease than the general population because of genetic risk factors and lifestyle.

However, Ellen Mason, of the British Heart Foundation, is concerned that people think heart disease only affects older generations of Asians.

"We know that South Asian children are more likely to get heart disease than any other ethnic group in the UK. That's why we are desperate to reduce this inequality because we don't want to see another generation die young from heart disease."

"It might be to do with behaviour that carries on within families. It does very much affect people who are second or third generation Asian."

The charity plans to use the findings to encourage Asian parents to be better role models when their children are young.

Some Asian families are already adopting a more active lifestyle.

Faatima, aged eight, said: "My mum goes to the gym in the mornings. She used to play badminton as a kid, and she makes us play badminton in the park."

The study is expected to be completed in early 2012 , after more research to determine how the health and fitness levels of South Asian children can be improved.

You can hear more on Asian Network Reports on the BBC Asian Network at 12:30 GMT and 18:00 GMT weekdays and after on BBC iPlayer