Feeding problems

What causes them?

The kind of feeding problem may depend on the age of the child.
Some new mothers take a while to get the hang of breastfeeding and may worry they're not producing sufficient milk or their baby isn't satisfied. But as long as the baby is gaining weight at the normal rate, there's no need for concern.
Occasionally, early feeding problems are due to anatomical difficulties (for example, a severe cleft palate or oesophageal atresia) or more general illness, but these are usually quickly identified.
Minor infections, such as a cold, can interrupt established feeding patterns, but rarely for long.
Gastro-oesophageal reflux disease (GORD) can also make feeding difficult, affect weight gain and cause great stress for parents.
More serious conditions can interfere with the absorption of food and weight gain, including coeliac disease, cystic fibrosis, inflammatory bowel disease and food intolerance.
In toddlers and older children, emotional and social factors can cause feeding problems. Older children, especially girls, are more likely to develop eating disorders such as anorexia nervosa and bulimia.

Who's affected?

Feeding problems are common throughout childhood and affect both boys and girls.

What are the symptoms?

The symptoms of feeding disorders can vary, but common symptoms include:

• Refusing food
• Lack of appetite
• Colic
• Crying before or after food
• Failing to gain weight normally
• Regurgitating or vomiting
• Diarrhoea
• Abdominal pain
• Constipation
• Behavioural problems

What's the treatment?

Many feeding problems, especially in small babies, sort themselves out without the cause ever being established, but do get medical advice if you're at all concerned or if your baby is failing to gain weight.
In older children, try not to make food an issue but be as flexible as you can in adapting to the eating habits that suit them. For fussy eaters, try a wide range of foods, perhaps in more frequent, small meals.
Emphasise health rather than weight gain.
Midwives, health visitors or local National Childbirth Trust groups can be a great source of advice for parents worried about feeding problems.
If you think there may be a serious underlying problem, especially in older children, talk to your doctor.
READMORE:http://www.bbc.co.uk/health

Fainting

What causes it?

A faint occurs when insufficient amounts of oxygen are reaching the brain. There may be many reasons for this.
The most common is a vasovagal attack, where overstimulation of a major nerve (called the vagus) slows the heart rate and lowers blood pressure. This overstimulation may be caused by intense stress, fear, pain or anything that suddenly increases pressure inside the body, such as blowing a trumpet.
Fainting may also result from low blood pressure (hypotension), often when someone stands up suddenly or is dehydrated and low in body fluids.
More rarely, fainting is due to abnormalities of the heartbeat.

Who's affected?

Anyone may be affected by fainting, but people who are unwell or dehydrated are at greater risk. Fainting - or feeling faint - is also common in pregnancy.

What are the symptoms?

The person may start to feel light-headed, dizzy, nauseous and sweaty. They may have ringing in their ears and feel weak. Some people, however, have little or no warning symptoms.
They then collapse to the ground and are unconscious for a few moments before coming round. They may feel woozy or nauseous for a little while afterwards and may vomit.

What's the treatment?

After fainting, a person should return to normal fairly quickly. If they don't, or have problems such as weakness or inability to speak, it may be more than a simple faint.
The aim of treatment is to get more blood and oxygen to the brain. Falling to the floor usually achieves this because the head is then at the same level as the heart. Once on the floor they should be put in the recovery position.
If a person is feeling faint but isn't yet unconscious, they should lean forwards with their head between their knees or lie down with their feet raised above the level of their head.
In most cases the person soon feels better, especially if given a drink and allowed to rest. If they don't regain consciousness within a minute or two, or if they have symptoms afterwards, urgent medical help should be sought.
Repeated episodes of fainting should also be investigated further.
READMORE:http://www.bbc.co.uk/health

Mother-to-baby infections and GBS

What is a mother-to-baby infection?

In the uterus (womb), a baby grows in a sterile environment, but as soon as the mother's amniotic membranes rupture - her waters break - microbes enter this environment and the baby is exposed to bacteria and viruses for the first time.
Some infections can be passed onto the baby while they are still inside the uterus, even before the waters have broken.
As the baby's squeezed out of the uterus through the cervix and into the birth canal, he or she gets covered in the organisms that normally live in the mother's vagina or on her skin.
These may be 'friendly' bacteria that grow in or on the woman (such harmless growth is called 'colonisation'), but may also include harmful microbes, such as the bacteria that cause gonorrhoea or the virus that causes genital herpes.
Bodily fluids, including blood, may cover a baby, exposing them to infections such as HIV or hepatitis B and hepatitis C.

Group B streptococcus (GBS)

One woman in four carries this bacteria in her vagina, although she may have no symptoms and be unaware it's there. Babies can come into contact with it while still in the uterus or during birth. If the mother has had a previous baby with a GBS infection, precautions should be taken.
Some women may go into premature labour (before 37 weeks) because of the infection. Or she may have a premature rupture of amniotic membranes (more than 18 hours before delivery), or a high fever (over 38°C). Premature and low-birth weight babies are more at risk of developing GBS.
GBS is the most common cause of life-threatening infection in newborn babies in the UK. GBS can either present early, within the first 6 days of life, or late onset, occurring after day 6. Early onset is much more common than late onset.
Although most babies who are exposed to it don't develop problems, every year it is estimated that 700 babies develop pneumonia, meningitis or septicaemia as a result of infection. About one in ten of these die.
It isn't known why some babies are vulnerable and others aren't. Babies are given antibiotics in hospital if they show any signs of being unwell. They are also given antibiotics if they are well, but have certain risk factors. Babies have to be given antibiotics through a drip and not orally which means they have to stay in hospital (even if they seem very well).
GBS is difficult to eradicate, but if a woman is known to be at high risk of passing on the infection, she can be given powerful intravenous antibiotics as soon as labour starts. This is usually enough to prevent mother-to-baby infection.
The bacteria may be detected on a vaginal or rectal swab during pregnancy, or in the mother’s urine. In theory this means that screening could be done on all pregnant women to see if they carry the bacteria.
However, at the moment, the evidence is uncertain whether a screening program would be beneficial overall. Different people have different views about a national screening program. In the meantime, research continues to look for an answer.
READMORE:http://www.bbc.co.uk/health

Mouth ulcers

What are they?

A mouth ulcer is an exposed nerve. The lining of your mouth is incredibly sensitive and any break in its surface exposes the nerves that lie in and beneath it. Anything that touches them, whether it's food, liquid or a toothbrush, causes pain that means it can be difficult to eat, drink and even talk.

What causes them?

Accidental damage is responsible for many - brushing your teeth too hard, minor burns from hot food and drinks, biting the inside of the mouth accidentally, a tooth that's become rough, or orthodontic braces that rub against the gums.
These last for a week or more unless the damage continues happening, in which case they will not disappear until the cause - for example, a rough tooth - is treated.
The other common type is an aphthous ulcer, which occurs when someone's feeling stressed or under the weather. They often appear for the first time during puberty and they can run in families.
These can take a couple of weeks to heal and are likely to keep appearing until someone's feeling relaxed and well again.
Other more serious causes of mouth ulcers include herpes infection, inflammatory bowel disease and immune disorders, but these are usually accompanied by other symptoms around the body.
Sometimes a deficiency in iron, vitamin B12 or folate is the underlying cause, which is why anyone who keeps getting ulcers or who has ulcers that are not healing should consult their doctor.

Can I prevent them?

Practise good dental hygiene, taking care not to damage your teeth and gums, and visit the dentist as often as advised.
Eating a healthy, varied diet, which includes fruits, vegetables, wholegrains, milk, fish and lean red meat, will supply your body with the necessary vitamins, zinc and iron to maintain a strong immune system that can resist infections.
Avoiding food and drinks that are too hot is sensible, and try to relax and keep stress under control.

What's the treatment?

Gargling and swallowing soluble paracetamol relieves the pain, and rinsing the mouth with iced water before a meal makes eating possible.
Pastilles and gels that contain anaesthetic have been the mainstay of treatment for years.
Those looking for a more natural treatment use camomile tea. Allow it to cool, then swill it around the mouth before swallowing it.
Other popular remedies include echinacea, myrrh, licorice with the glycyrrhizic acid removed (called deglycyrrhizinated licorice or DGL) and products containing hyaluronan.
READMORE:http://www.bbc.co.uk/health

Nosebleeds

What is a nosebleed?

A nosebleed - more formally called epistaxis - can occur without any obvious cause. The blood usually comes out through just one nostril, although it may affect both.

Nosebleed symptoms

Fairly obviously, loss of blood from the nose is the major symptom. Some children can sense a bleed starting before it's obvious. The child may also be aware of blood entering the throat from the back of the nose especially if they hold their head back or lie down (this can cause a bad taste).

Causes and risk factors

Many nosebleeds are idiopathic - that is there is no obvious cause, or the cause is unknown. But in children frequent colds and the drying effect of central heating can cause irritation of the delicate mucous membrane that lines the nose. This becomes inflamed, crusted or cracked, and is much more likely to bleed.
Bumps to the nose, especially once it's inflamed, and vigorous nose blowing can trigger a bleed. The common childhood pass time of picking your nose can cause it to bleed. Some children just have a tendency to nosebleeds, for no obvious reason.
Rare causes include cancers and illnesses that prevent the blood from clotting properly.
Nosebleeds are described as either anterior or posterior depending on which part of the nose the bleeding comes from. Children almost always have anterior nosebleeds, from a vein (unlike older adults where it's more likely to be posterior and come from an artery).

Nosebleeds - treatment and recovery

Most nosebleeds in children can be easily treated. Keep the child as calm as possible. Tell them to tip their head forward and breathe through their mouth while you pinch the soft parts of the nose together between your thumb and index finger, just below the bony part of the nose.
Then press the pinched nose firmly towards the face. Keep this position for five full minutes (ideally ten) making sure the child's head is held up well above the level of the heart.
If bleeding persists, apply a cold pack against the face whilst still pinching the nose and get medical advice. If nosebleeds are frequent, treatment such as cautery to seal the blood vessels may be needed.
READMORE:http://www.bbc.co.uk/health/physical_health

Ears popping when flying

Why do the ears make a popping sensation?

The ear consists of three chambers:

• The outer ear canal which leads up to the ear drum.
• The middle ear chamber behind the drum which is filled with air.
• The very specialised inner ear.

The air in the middle ear is constantly being absorbed by the membranes that line the cavity, so the internal pressure can easily drop, putting tension on the tissues there. Fortunately, air is frequently resupplied to the middle ear during the process of swallowing.
Usually when you swallow, a small bubble of air passes from your throat or back of your nose, through a narrow tube known as the Eustachian tube which is usually closed, into your middle ear. As it does this, it makes a tiny click or popping sound.
This action keeps the air pressure on both sides of the eardrum about equal. If the air pressure isn't equal, for example if the Eustachian tube isn’t working efficiently or if pressures suddenly change, the ear feels blocked or uncomfortable.

What happens in an airplane?

The pocket of air in the middle ear is particularly vulnerable to the changes in air pressure as you go up in a plane.
The higher the plane, the lower the air pressure around you, although inside the cabin you're protected, to some extent, from these pressure changes. Pressure in the middle ear remains higher until the Eustachian tube opens up to allow the pressure to equalise. Until this happens the relatively lower pressure outside the middle ear pulls the ear drum and tissues of the middle ear outwards, making them feel very uncomfortable.
The eardrum is stretched and can't vibrate properly, so sounds become muffled. When the Eustachian tube opens, air travels out from the middle ear, making a popping noise as pressure equalises.
During the descent in a plane, the opposite happens as pressure builds up outside the ear, pushing the eardrum inwards.
Abnormal pressure can develop in the middle ear, pulling in or stretching the ear drum, when the Eustachian tube is blocked for other reasons - as the result of a bad cold, for example, or a nasal allergy - or because it's narrow as a result of childhood ear infections.

Treatment and recovery

The following can help to relieve the problem:

• Swallowing activates the muscle that opens the Eustachian tube, and you swallow more often when chewing gum or sucking sweets so try this just before and during descent.
• Yawning is an even stronger activator of the muscles.
• Avoid sleeping during descent, because you may not be swallowing often enough to keep up with the pressure changes.

The most forceful way to unblock your ears is to pinch your nostrils, take in a mouthful of air and use your cheek and throat muscles to force the air into the back of your nose, as if you were trying to blow your thumb and fingers off your nostrils. You may have to repeat this several times before your ears pop.
Decongestants shrink internal membranes and make your ears pop more easily. Ask your pharmacist for advice. However, you should avoid making a habit of using nasal sprays, because after a few days they may cause more congestion than they relieve
READMORE: http://www.bbc.co.uk/health/physical_health

Ear health

Waxy ears

One of the most common complaints seen by GPs is a blocked ear, usually caused by wax that has been pushed into the ear by a cotton bud.
As well as the blocked sensation, waxy ears can reduce hearing, cause a ringing sound (tinnitus) and, occasionally, pain.
There's no need to clean your ears with a cotton bud. The ear has its own internal cleaning mechanism. Fats and oils in the ear canal trap any particles and transport them out of the ear as wax. This falls out of the ear without us noticing.
When we try to clean the ear, this wax gets pushed back and compacted. There's also no need to dry ears with a towel, cotton buds or tissue paper. Let them dry naturally or gently use a hair-drier on low heat.
Olive oil can help to soften the wax and enable it to come out. Apply two drops in each ear twice a day. Wax-softening drops can also be bought from a pharmacist.
Sometimes, the wax needs to be syringed out by a GP or practice nurse.

Itchy ears

These can be irritating, and when ears are affected with eczema or psoriasis they can cause constant discomfort. But scratching or poking damages the ear's sensitive lining, allowing infection in, called otitis externa.
This can also happen when ears gets waterlogged through swimming. The ear canal swells, becoming narrow and painful. Hearing becomes a problem and discharge often appears.
Treatment requires antibiotic drops and strong painkillers. In severe cases, the ear needs to be cleaned by an ear specialist.

Piercing

Anything that damages the skin can allow infection in. This is often the case with ear piercing, especially when the skin isn't cared for properly during or after the piercing. Follow care advice carefully.
Many people are allergic to certain inexpensive metals, such as nickel, which can make the outside of the ear swell and feel uncomfortable.

Sunburn

The tops of the ears are exposed to the sun and sensitive to its harmful UV rays. Skin cancer affects ears, too.
Make sure you apply suncream and wear a hat that keeps your ears in the shade.
READMORE:http://www.bbc.co.uk/health/physical_health

Hepatitis C

What is hepatitis C?

Hepatitis C is an infection with the hepatitis C virus. Although there is no vaccine to protect against infection, there is effective treatment available.
Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but eight out of 10 don’t know they have it because they have no symptoms. About 75% of these people go on to develop a chronic hepatitis.
Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier.
Elsewhere in the world, hepatitis C is even more common – the World Health Organization estimates that three per cent of the world’s population (about 170 million people) have chronic hepatitis C and up to four million people are newly infected each year.

Hepatitis C symptoms

In most cases, the initial infection doesn't cause any symptoms. When it does, they tend to be vague and non-specific.
Possible symptoms of hepatitis C infection include:

• Fatigue
• Weight loss
• Loss of appetite
• Joint pains
• Nausea
• Flu-like symptoms (fever, headaches, sweats)
• Anxiety
• Difficulty concentrating
• Alcohol intolerance and pain in the liver area

The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have hepatitis C.
Unlike hepatitis A and B, hepatitis C doesn't usually cause people to develop jaundice.
About 20-30 per cent of people clear the virus from their bodies - but in about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.
About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years (some experts believe that, with time, everyone with chronic hepatitis C would develop cirrhosis but this could take many decades).

Hepatitis C causes

Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs - nearly 40 per cent of intravenous drug users have the infection and around 35 per cent of people with the virus will have contracted it this way.
Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection.
Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present.
Hepatitis C can be sexually transmitted, but this is thought to be uncommon. It can be passed on through sharing toothbrushes and razors. It is not passed on by everyday contact such as kissing, hugging, and holding hands - you can't catch hepatitis C from toilet seats either.
If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted.
Most people diagnosed with hepatitis C can identify at least one possible factor which may have put them at risk but for some, the likely origin of the infection isn't clear. Because it can remain hidden and symptomless for so many years, it may be very difficult to think back through the decades to how it might have begun.

Preventing hepatitis C

There are a number of ways to reduce the risk of the infection being transmitted. Those most at risk of contracting the infection are injecting drug users, who should never share needles or other equipment.
Practising safe sex by using condoms is also important.
People with hepatitis C infection aren't allowed to register as an organ or blood donor.

Hepatitis C test

If you think you could have been in contact with the hepatitis C virus at any point in the past, you can have a test to find out if you've been infected. You should ask you GP. Local drug agencies and sexual health clinics (sometimes called genito-urinary medicine or GUM clinics) may also offer testing.

Hepatitis C treatments

People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy.
Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.
Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs help the body's immune system to overcome the virus, and are often used together as dual or combination therapy which has been shown to be effective in 55 per cent of cases. Some strains or genotypes of the hepatitis C virus are more likely to respond than others. Even if the virus isn't completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate.
A number of new drugs, known as direct acting antivirals or DAAs, are being developed which work in a different way, by targetting the virus itself. Two of the drugs, which are types of a group known as protease inhibitors that block vital enzymes that the hepatitis C virus needs to reproduce, are now approved for use in Hepatitis C. They may help to clear the virus from the body when used in combination with the standard treatments, pegylated interferon alpha and ribavirin.
Many people also find that complementary and lifestyle approaches help. There is little evidence these can reduce levels of the virus, but they may help to deal with symptoms and improve quality of life.
READMORE:http://www.bbc.co.uk/health/physical_health

Hepatitis B

What is hepatitis B?

Hepatitis B is a viral infection of the liver, which follows a very variable course. The hepatitis B virus (HBV) can cause an acute illness that resolves itself quickly without causing long-term liver damage. However, in about 20% of cases it causes a chronic illness that lasts more than six months, sometimes for life, with symptoms that come and go. In 15-40% of those with chronic infection cirrhosis, liver cancer or liver failure develop, and so the infection may eventually be fatal.
Hepatitis B is not very common in the UK, with new infections occurring in about 7 out of every 100,000 of the population every year, usually in adults. Worldwide, however, it is a major health problem. In Asia and most of Africa, most people pick up the infection around the time of birth or during childhood. As a result, two billion people worldwide are infected with hepatitis B, with 350 million suffering from chronic HBV infection. It is the 10th leading cause of death worldwide.
The virus is usually transmitted through contact with infected blood or body fluids. Only a tiny amount of blood is needed to transmit the virus because it's so infectious. The hepatitis B virus may also be present in saliva, vaginal secretions, breast milk and other bodily fluids.
In the UK, infection commonly occurs through unprotected sexual intercourse, the sharing of contaminated needles by drugs users, accidental injury with a contaminated needle (if needles used for tattooing, body piercing or acupuncture are contaminated) and sharing razors.
In countries where screening of blood products isn't routine, or where medical equipment isn't adequately sterilised, hepatitis B may be transmitted during medical treatment.
Many people contract hepatitis B while on holiday, especially in countries where it is very prevalent, when unprotected sex, experimenting with drugs and accidents needing medical treatment are far more likely.

Hepatitis B symptoms

The incubation period of the hepatitis B virus before symptoms develop is between six weeks and six months.
In the acute phase symptoms vary. Roughly one-third of cases have no symptoms - this is called a silent or subclinical infection, or sometimes anicteric infection, meaning there is no jaundice or yellow appearance of the skin and membranes. In another third of cases, the infection causes mild symptoms similar to those of a flu-like illness, with weakness, aches, headache, fever, loss of appetite, diarrhoea, jaundice, nausea and vomiting.
In the final third of cases, the acute phase of infection can cause severe illness that last many months. In addition to the flu-like symptoms, there's abdominal pain, diarrhoea and jaundice.
Jaundice occurs in hepatitis infections because the liver becomes unable to remove a substance called bilirubin from the blood. This is a pigment that builds up in the body, causing the skin and whites of the eyes to turn yellow.
Rarely, rapid liver failure develops, which may need a life-saving liver transplant.
In as many as one in five cases, the infection then goes into a chronic phase, where people may be apparently healthy with no symptoms but carrying and shedding the virus (known as healthy carriers). Alternatively, they may develop a chronic active hepatitis, with similar symptoms to the acute phase of the infection and also fatigue, poor appetite, nausea and abdominal discomfort.

Hepatitis B causes

In the UK, the people most at risk of contracting hepatitis B are injecting drug users, people who have unprotected sex with different partners, close family members of someone with the infection, babies born to infected mothers and travellers to high-risk countries who come into contact with infected blood and other bodily fluids.
Hepatitis B is considered an occupational hazard for healthcare workers, the police and the emergency services.

Preventing hepatitis B

Practising safe sex by using condoms and not sharing needles when using drugs can reduce the risk of infection. The same advice applies when travelling.
When having any body piercing, tattoo or acupuncture, make sure the business is registered with the local authority, that the needles used are disposable and that an autoclave is used for any equipment that's sterilised. If the proprietor cannot confirm these, go elsewhere.
Normal social contact carries no risk of infection. You can't catch hepatitis B from toilet seats or by touching an infected person. Clothing with the virus is thought to be killed by a normal hot wash in a washing machine, and by washing-up liquid and hot water for plates and cutlery.

Hepatitis B vaccine

There's an effective vaccination to protect people from hepatitis B infection. It's available from your GP or high street travel centres, who will advise you whether you need it.
Family and other household members of an infected person should be vaccinated against hepatitis B. Healthcare workers, the police, the emergency services and anyone who is likely to come in contact with infected blood through their job should also be vaccinated.

Hepatitis B treatments

The majority of people with hepatitis B don't need specific treatment other than rest, and they eventually make a full recovery. However, it is important that the infection is monitored to check whether chronic disease develops, and the person is given advice about the risk of passing the infection on.
If the infection lasts more than six months (chronic hepatitis infection, where the virus continues to actively reproduce in the body) you may need more specific drug treatment to reduce the risk of permanent liver damage (cirrhosis) and liver cancer. Your GP should refer you to a specialist in either liver disease (a hepatologist) or general digestive diseases (a gastroenterologist). They may recommend treatment either with treatment called interferon, or with antiviral drugs.
Interferon (either alpha interferon or longer lasting pegylated interferon) is given as regular injections and helps boost the immune system to fight the infection. The response to interferon is variable, and some people who initially get better get worse again when the treatment is stopped. Others find that the side effects of interferon mean that they cannot continue with treatment.
Several different antiviral drugs, known as nucleoside analogues, are also now used to treat chronic hepatitis. They aren't a cure, but they do suppress the virus. These drugs may also have side effects - although not usually so severe as with interferon - and the virus may become resistant to them.
Occasionally, when there is severe damage to the liver, a liver transplant is recommended.
READMORE:http://www.bbc.co.uk/health/physical_health

Hepatitis A

What is hepatitis A?

Hepatitis A is an infection of the liver caused by the hepatitis A virus.
According to the World Health Organisation, there are an estimated 1.5 million new cases of illness due to hepatitis A each year worldwide, and many more people become infected without developing symptoms. It's particularly common in less developed countries where poverty or poor sanitation are important factors.
Africa, northern and southern Asia, parts of South America, and southern and eastern Europe all have high rates of the disease. In these countries almost every adult carries antibodies to hepatitis A suggesting that it is quite usual for people to be exposed to the infection, usually in childhood, and to develop immunity.
The infection isn't common in the UK, although it's still the main type of infective hepatitis seen. (There are several other types of viral hepatitis, such as hepatitis B and hepatitis C.) In 2005, for example, there were 457 laboratory reports of confirmed hepatitis A virus (HAV) infection in England and Wales.
The majority of people from the UK who become infected with hepatitis A contract it when abroad in a country where it is very common.
Hepatitis A is an acute infection, rather than chronic (long-term). Rarely, it can cause life-threatening liver damage.

Hepatitis A symptoms

The incubation period of the virus before symptoms develop is between two and six weeks. How severely someone is affected varies from person to person. Some may not have any symptoms at all, while others may have just mild symptoms similar to those of a flu-like illness. This is particularly common among infants and young children.
The older someone is, the more severe the infection and symptoms are likely to be.
Possible symptoms include weakness, tiredness, headache, fever, loss of appetite, nausea and vomiting, abdominal pain and diarrhoea and dehydration. These may all occur for a week or more before jaundice appears.
Jaundice occurs in hepatitis infections because the liver becomes unable to remove a substance called bilirubin from the blood. This is a pigment that builds up in the body, causing the skin and whites of the eyes to turn yellow.

Hepatitis A causes

The hepatitis A virus is found in the faeces of infected people. It's spread because of poor personal hygiene, such as when people don't wash their hands after using the toilet.
The most common causes of infection are contaminated food or water and person-to-person contact. In countries where sanitation and sewage disposal are poor, drinking water may become contaminated, causing major outbreaks of hepatitis A.
Food prepared or washed with contaminated water can also easily transmit the infection. Fruits, salads, raw vegetables and any uncooked foods are considered to be high risk, as are ice, iced drinks and ice cream. Food that comes into contact with contaminated seawater, for example, shellfish, can also transmit the infection.
There have also been outbreaks of hepatitis A among intravenous drug users although other types of hepatitis (B and C) are usually of more concern in this group.

Preventing hepatitis A

How to avoid infection:

• Ensure high level of personal hygiene
• Avoid eating raw or inadequately cooked salads, vegetables and shellfish
• Check whether tap water is safe to drink before you go
• Get vaccinated against hepatitis A if visiting high-risk countries

Hepatitis A treatments

There's no specific treatment for hepatitis A, but fortunately the majority of people recover within a few weeks. On average, around one in five people between the ages of 15 and 39 with hepatitis A is admitted to hospital for supportive treatment such as intravenous fluids, medication for pain and itching, and general nutritional support.
About 15% of people will have a prolonged or relapsing illness lasting up to 9 months. Tragically, a small number of people die when the infection overwhelms the body. This is more likely to happen to people over the age of 60.
A person with hepatitis A should avoid drinking alcohol until their liver is completely back to normal, as alcohol is toxic to liver cells and will slow its recovery.
Ensuring good personal hygiene practices - washing your hands after using the toilet and maintaining good food preparation - is essential in avoiding infection with hepatitis A, especially if you visit a high risk area.
When visiting high-risk countries, it's a good idea to avoid eating raw or inadequately cooked salads and vegetables, ice cream, unpeeled fruit and shellfish. Also avoid unpasteurised milk and drinks with ice, and check whether tap water is safe to drink before you go.
There's an effective vaccination to protect people from hepatitis A infection. It's available from your GP or high street travel centres, who will be able to advise you whether you need it for the country you are visiting. It's recommended for anyone travelling to the high-risk regions of the world.
Those people who have already had hepatitis A usually have life long immunity.
READMORE:http://www.bbc.co.uk/health/physical_health

Cystitis

Causes of cystitis

Cystitis usually occurs as the result of an infection.
Although anyone can get cystitis, adult women are most commonly affected. Most women get at least one attack in their lifetime.
For some women cystitis is a rare event, for others it happens four or five times a year. Cystitis is more common in sexually active women, during pregnancy and after the menopause.

Symptoms of cystitis

Common symptoms are a sharp pain when passing urine, and an urgent and frequent need to pass urine, often with little or no urine being passed.
Other possible symptoms include blood in the urine, backache, loin pain, lower abdominal aches and generally feeling unwell.

Preventing cystitis

Drink at least eight glasses of water a day. Drinking one glass of cranberry juice a day is also believed to help prevent cystitis.
After visiting the toilet, women should always wipe themselves from front to back. Loose clothing and cotton underwear help, too.
Avoid potential irritants such as perfumed bath oils and vaginal deodorants. Don't douche. Always wash before and after sex, and pass water as soon after sex as possible.

Cystitis treatments

Treatment options include:

• Drinking plenty of water throughout the day, including cranberry juice
• Making urine less acidic by mixing a teaspoon of bicarbonate of soda with half a pint of water (over-the-counter remedies containing sodium citrate or potassium citrate are available in solutions or sachets)
• Your GP may prescribe antibiotics if a bacterial infection is present
• Over-the-counter painkillers such as paracetamol and ibuprofen

Ask the doctor for advice if this is the first time cystitis has occurred, if the symptoms don't improve after 24 hours or get worse, if blood is present in the urine or if symptoms are accompanied by fever, loin pain or lower backache.
READMORE:www.bbc.co.uk/health/physical_health

Hernia

What is a hernia?

A hernia simply means a protrusion of body tissues through a weakness or hole in other body tissues. It most often refers to a part of the intestines protruding through the muscular wall of the abdomen (although other types of hernia are sometimes seen elsewhere in the body). The most common are inguinal hernias and, especially in small children, umbilical hernias.

Hernia symptoms

When a hernia first occurs you may have a feeling that something has given way and may experience a little pain. This soon wears off. Later, a lump appears. This doesn't hurt and may get bigger when you cough. It may intermittently disappear and reappear as the herniating tissue slips back into place and then protrudes again.
Although in most cases hernias just cause discomfort and are a bit of a nuisance, the real worry is that they'll strangulate. This means the tissue gets stuck through the weakness or hole, and its blood supply is cut off. Without an emergency operation to release it and restore its blood supply, some of the tissue will die leading to serious illness.
If you suspect you may have a hernia, you should get a doctor to confirm the diagnosis.

Hernia causes

The abdominal wall is a sheet of muscle that acts like a corset to stop the organs of the abdomen - principally, the intestines - from falling out. When a weakness or tear occurs in this muscle, part of the intestine bulges through and appears as a lump under the skin.
In the past, hernias were often called ruptures. They are most common in the groin (inguinal hernias). Men are particularly predisposed to inguinal hernias because of their anatomy - there is what amounts to a tunnel through the tissues of the groin which allowed the testes to descend from the abdomen into the scrotum during development. Intestinal tissue can also pass into this tunnel, forming a hernia.
Anything that raises the pressure within the abdomen, such as heavy lifting (for example, weights or building materials), coughing, even straining on the toilet, can cause a weakness or tear in the abdominal wall, or force intestinal contents out through a weakness. Vigorous exercise often results in hernias.
Sometimes the weakness is already present - for example, from birth around the umbilicus (umbilical hernia) in children or under the scar of an operation (incisional hernia).

Hernia treatments

In the past, trusses or supports were used to keep the hernia in place, but these days it's better to have a simple operation to repair the weakness before further problems arise.
Hernia operations are the most common operations performed on men in the UK. The NHS performs more than 100,000 hernia repairs every year. Most operations are done in under an hour and you can go home the same day.
A special mesh material is used for the repair and, depending on the local hospital arrangements and your own fitness, it may be done under local or general anaesthetic and sometimes by keyhole surgery.
With some advanced techniques you can be back to work in under a week, although this depends on your job and what the surgeon advises.
To prevent a hernia occuring, try to maintain your ideal weight and lift correctly, bending at the knees and keeping your back straight. Stopping smoking will help to prevent excessive coughing. Eating a good, high-fibre diet (with plenty of water) will help to avoid constipation and the need to strain on the toilet, which increases pressure inside the abdomen.
READMORE:http://www.bbc.co.uk/health

Japanese encephalitis

What is Japanese encephalitis?

Japanese encephalitis is a viral disease spread by mosquitoes, which transfer the virus from infected animals - usually pigs and wading birds - to humans. Areas such as rice fields, where mosquitoes thrive and there is a lot of pig farming, are especially risky.
It was first recognised in Japan in the late 1800s (hence the name) and has since been found throughout most countries of east and South East Asia where it is the leading cause of viral encephalitis. Approximately 30,000 to 50,000 cases are reported every year, and there are about 10,000 deaths, mostly in children. In fact it’s now thought that many more people have the infection (research shows that by the age of 15 most people in South East Asia have had it) but symptoms are usually minimal so it doesn’t get reported.

Causes and risk factors

Japanese encephalitis is caused by a Flaviviridae virus (or flavivirus), which is transmitted by the bite of an infected mosquito.
Transmission of the disease is most likely during the summer months in temperate areas and during the rainy season and early dry season in tropical areas, when the mosquito populations are the highest.
Japanese encephalitis is rare in travellers and the risk to short-term visitors to the region is very low, especially if they are just visiting urban areas. However, it has a high fatality rate, and can cause chronic complications so it should be taken seriously.

Symptoms of Japanese encephalitis

Most people who are infected show only mild symptoms or no symptoms at all. However, in severe cases the disease may be fatal.
Japanese encephalitis begins like flu with headache, fever, and weakness. As it progresses to inflammation of the brain there may be confusion and delirium. Gastrointestinal problems, including vomiting, may also be present. About one third of these patients will die, and 25-30 per cent have neurological damage including paralysis, speech difficulties, Parkinson’s-like syndrome or psychological problems. Children are most vulnerable.

Treatment and prevention of Japanese encephalitis

At present, there is no medical ‘cure’ for Japanese encephalitis once infection has occurred although supportive care in hospital can help. A vaccine has been developed and is used in Asia to immunize children. It is licensed for use in the UK and the USA for people who plan to travel to South East Asia. Allergic reactions can occur in up to one in 100 people vaccinated but are mostly minor.

Reducing the risk

The best way to reduce the risk of contracting the disease is to reduce exposure to mosquitoes. This can be done by avoiding being outside in the cooler hours between dusk and dawn when mosquitoes are most actively feeding. The use of mosquito repellent, portable bednets, aerosol room insecticides and permethrin, which can be applied to clothing, is also recommended.
Related viruses
Scientists researching the Malaysian outbreak in 1998 have isolated a mysterious second virus, a member of the Paramyxovirus family, which is believed to have caused some of the deaths. The new virus is similar to the Hendra virus that killed two people and 15 horses during outbreaks in Australia in 1994 and 1995. The method of transmission is as yet unclear. Health experts believe it may be killed through the use of soap, detergent or disinfectant.
READMORE:http://www.bbc.co.uk/health

Removal of wisdom teeth

Removal of painless wisdom teeth

Recent guidelines from the National Institute for Health and Clinical Excellence (NICE) recommend that impacted wisdom teeth (which haven't come through the gum normally) that are otherwise healthy shouldn't be removed. Only if the tooth is diseased or causing other problems in the mouth, such as severe pain, should it be taken out.
These recommendations are for the NHS. If a patient feels differently, teeth can be removed privately.
There are two main reasons behind the NICE recommendations:

• There's no reliable research to suggest the removal of disease-free impacted wisdom teeth has any benefit to the patient
• There is always some risk from surgery (including nerve damage, damage to other teeth, infection, bleeding and, rarely, death), which can't be justified if there are no benefits from the operation

People who might need the operation
Your dentist will be able to advise you whether surgery is necessary.
The problems that might mean it should go ahead include untreatable tooth decay, abscesses, cysts or tumours, disease of the gums and other tissues around the tooth, or when the tooth is in the way of other surgery or orthodontic work.
READMORE: http://www.bbc.co.uk/health

Food poisoning

What is food poisoning?

It's estimated there are more than nine million cases of gastroenteritis each year in England. For an increasing number of people, it's due to food poisoning, something that's preventable.
Gastroenteritis describes symptoms affecting digestion, such as nausea, vomiting, diarrhoea and stomach pain. Food poisoning is the type of gastroenteritis caused by eating or drinking something contaminated with micro-organisms or germs, or by toxic substances produced by these germs.
These illnesses are often accompanied by fever, muscle aches, shivering and feeling exhausted.

Causes of food poisoning

Micro-organisms enter the body in one of two ways:

1. In the food - the food isn't cooked thoroughly, so the micro-organisms aren't killed off, often the case with barbecued food
2. On the food - the person preparing the food doesn't wash their hands before handling the food, for example

Campylobacter infection is the most common cause of food poisoning seen by GPs. It likes to live in milk and poultry.
Other common causes include salmonella, listeria, shigella and clostridia. Some take a few hours to cause symptoms, others a few days. Serious infections with E. coli are, fortunately, uncommon.

Preventing food poisoning

• Always wash your hands thoroughly before preparing food, after going to the toilet and after handling pets
• Keep kitchen work surfaces clean
• Make sure food is defrosted completely before cooking
• Keep pets away from food
• Ensure food is cooked thoroughly before eating. Meat shouldn't have any pink bits
• Serve reheated food piping hot
• Keep raw meat and fish covered and store at the bottom of the fridge
• Store all perishable foods at 5°C (41°F) or less
• Keep raw food covered
• Rinse fruit and vegetables under running water before eating
• Throw away any food that's past its use-by date, doesn't smell right and/or has fungus on it

Treatments for food poisoning

Most infections last 24 to 48 hours, during which time fluid is often lost from vomiting and diarrhoea. To prevent dehydration, drink plenty of cooled boiled water and use rehydration powders if the symptoms continue.
Sometimes antibiotic treatment is necessary; this can be determined by testing for the micro-organism responsible.
It's especially important anyone whose work involves handling or preparing food stays away from work while they have symptoms to avoid infecting others. They must also notify, and seek advice from, their local environmental health department.
If someone suspects that food bought from, or eaten in, a specific shop, takeaway or restaurant is responsible, they should also inform their local environmental health department, so food hygiene standards can be investigated.

Anal stenosis

Symptoms

The restriction of the anal canal prevents the normal expulsion of faeces, resulting in difficulty and pain when trying to open the bowels, and leading to constipation. Babies may also experience pain when trying to open their bowels.

Causes and risk factors

Anal stenosis may be present from birth, when it might be accompanied by malformations of the anal opening. This happens in one in several thousand births.
Sometimes the opening appears further forward than normal. In girls, it's usually immediately behind or inside the female genitalia. In boys, there may be no obvious opening at all or just a small area of bulging skin or a tiny channel under the skin.
More commonly, stenosis develops as a result of scarring from a tiny fissure, or crack, in the anal canal. This is usually the reason why adults develop anal stenosis, but it can also occur in babies.
Anal stenosis may also develop after surgery to the anus, for example after the removal of piles or haemorrhoidectomy.

Treatment and recovery

Low-risk treatments:
Laxatives, suppositories and other treatments are used to help loosen motions and lubricate the anal canal, to make it easier to empty the bowels. There's little risk the person affected will come to any harm from these treatments if they're used as prescribed and only for a matter of months while the problem settles. (It must be remembered that the risks are considerably less than those that might occur if the affected person becomes very constipated).
Individuals suffering from anal stenosis aren't likely to become dependent on the laxatives and suppositories.
However, its also important to make dietary changes (such as plenty of raw fruit and vegetables to provide natural fibre, and plenty of fluid to avoid dehydration) in order to keep the motions soft. Regular exercise also helps keep a regular bowel habit.
Surgical treatments:
In mild cases, gentle and gradual dilation by the regular passage of normal motions may be enough. But quite often surgery is needed, especially in more severe cases. The surgical treatment of anal stenosis depends on the extent of the problem. In most cases all that's needed is for the anal canal to be stretched. Often this can be done by the doctor in the hospital clinic, without the need for anaesthetic.
If the stenosis is severe, dilation may performed under anaesthesia. More major surgery is only needed if the anal canal needs reconstructing or (in small children with congenital anal stenosis) it needs repositioning or there are other malformations that require surgery.
READMORE:http://www.bbc.co.uk/health

Acrodysostosis

What causes it?

The gene responsible for acrodysostosis has not yet been identified and the condition may result from different genetic problems rather than one specific condition.
It appears to be inherited in an autosomal dominant fashion. This means that if one parent is carrying the gene, they will be normal but there is a one in two chance that any child of theirs will have the condition and seems to be more common among older parents.

What are the symptoms?

People with acrodysostosis have certain bones that mature rapidly, before they've had enough time to grow fully. The bones most often affected are those of the nose and jaw, and the long tubular bones of the hands and feet.
This abnormal bone development results in a collection of characteristic features, including a typical facial appearance (short nose, open mouth and prominent jaw), small hands and feet.
Those with acrodysostosis often have some degree of mental retardation and learning difficulties.

What's the treatment?

There's no cure for acrodysostosis but appropriate support by orthopaedic surgeons and paediatricians is important.
Antenatal diagnosis may be made by ultrasound examination of the bones in babies whose mother has the condition, but routine screening isn't done.
READMORE:http://www.bbc.co.uk/health

Growth problems

Symptoms
In babies, growth problems usually appear as a failure to put on weight (or occasionally excessive weight gain), although length and head circumference are also important.
From toddlers onwards, height is measured as well as weight and there may be concern if either or both fall below normal. Accompanying symptoms, such as poor appetite or chronic diarrhoea, may be clues to the diagnosis.

 

Causes

Many factors can cause real or apparent failure to grow at a normal rate.
When small babies don't gain enough weight this is known as failure to thrive. The causes range from physical illness (such as inherited conditions or malabsorption) to practical problems with feeding (difficulty breastfeeding, mistakes with formula feeding) and emotional neglect. Premature babies or babies of small parents may seem to have growth problems but be quite normal, while breastfed babies can have a dramatic initial weight gain.
The height and weight of older children varies greatly. There may be growth spurts as well as periods when there seems to be little growth, but they should generally follow the standard growth curve. Growth problems may be due to illness (for example, food absorption problems such as coeliac disease, cystic fibrosis, Crohn's disease or any prolonged illness), infections (growth may slow temporarily with common childhood infections), poor eating habits (rarely affects growth) or psychological problems.
Eating disorders, such as anorexia, can have a serious impact on growth.

Who's affected?

Growth problems are common throughout childhood but are usually temporary. There's rarely a serious underlying problem and most late developers eventually catch up.

Diagnosis and treatment

Children should be regularly measured and their weight and height monitored on standard growth curves (available from your health visitor).
Treatment of growth problems depends on the cause, but you should ensure that babies are getting all the nutrients they need and that older children are eating healthily.
READMORE:http://www.bbc.co.uk/health

Eye allergies

Hay fever eyesSeasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season, usually from exposure to grass and tree pollen.
Vernal conjunctivitis is a more severe form of this disease seen in children. The eyes are sticky with a stringy discharge, and it's painful, especially when opening the eyes on waking.
The inner membranes of the eyelid swell and the conjunctiva develops a cobblestone appearance. Corneal damage may occur if the condition is left untreated.
Perennial allergic conjunctivitis tends to occur all year round, with house dust mite and cat allergies. The symptoms are usually milder than those in seasonal allergic conjunctivitis.

Eczema eyes

Although rare, atopic keratoconjunctivitis is the most severe manifestation of allergic eye disease. It occurs predominantly in adult males and is the eye equivalent of severe eczema.
This persistent condition results in constant itching, dry eyes and blurred vision. It's associated with corneal swelling and scarring. Eyelid eczema and infection are common, and lens cataracts may develop over time.

Contact lens allergy

Contact lens wearers may develop giant papillary conjunctivitis, triggered by constant local irritation by the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms, but occasionally wearing contact lens has to be suspended.
Never use steroid eye drops unless under the direct supervision of a doctor. Although they're effective for treating eye allergies, they can lead to unwanted side-effects such as glaucoma and cataract formation.
They may also encourage infections of the eye, with resultant corneal scarring.

Eye allergy treatments

Regular use of anti-allergy eye drops such as sodium chromoglycate, nedocromil, olopatidine and lodoxamide can help to treat mild seasonal disease.
Non-sedating oral antihistamines - cetirizine, loratadine, mizolastine and fexofenadine - can also help, especially when there's an associated nasal allergy.
Corticosteroid eye drops occasionally have to be used for more severe eye allergies, but this should be for short periods only.
READMORE:http://www.bbc.co.uk/health

How safe is it to have frequent x-rays?

Radiation is all around usAlthough doctors do worry about exposing people repeatedly to x-rays, and there's no doubt that too much exposure to this form of radiation can be harmful, it's important to keep the risks of x-rays in perspective.
We're constantly being exposed to natural radiation from the environment around us - from the earth, through cosmic rays from outer space, even from the food we eat. For example, in the UK, radon gas seeps naturally from the ground and accumulates in homes in many areas (some places are worse than others) accounting for more than half of natural radiation exposure.

The dose from chest x-rays is very small

The dose of radiation you receive each time you have an x-ray is very small, especially given this background of natural radiation. It's certainly many thousands of times smaller than the dose of radiation needed to cause skin burns or radiation sickness. The only risk that needs to be considered is the risk of causing cancer but this is also very small.
The exact dose of radiation depends on the nature of the x-ray but, for example, a chest x-ray is the equivalent of just a few days of natural background radiation. This corresponds to a less than one in 1 million additional risk of developing cancer (a very tiny increase when you realise that we have a one in three chance of getting cancer anyway).
Some x-ray tests have a higher dose of radiation but, even so, the increased risk of cancer is still small. For example, a barium meal test or a CT scan of the chest are equivalent to a few years’ exposure to natural radiation ( for example a single chest CT scan gives approximately 70 times the radiation of a chest x-ray, or approximately 2 years worth of normal environmental background radiation) and an increased risk of cancer of between one in 1,000 and one in 10,000.

X-rays compared with other risks

This means that even if you had chest x-rays taken every week, the increased risk wouldn't be very much. And these risks have to be put into the perspective not just of the benefits of doctors being able to keep an eye on your lungs but also of other risks we choose to expose ourselves to, such as from sports, driving or smoking (very risky indeed).

Exceptions

An unborn child may be more vulnerable to damage from x-rays, and women who could be pregnant should always talk to the radiographer before an x-ray.

READMORE:http://www.bbc.co.uk/health/physical_health

Circumcision

What is it?Circumcision of boys is an operation in which the foreskin is removed from the penis. This is the small flap of skin at the tip that can usually be pulled back over the end of the penis. Some people believe the foreskin is redundant and gets in the way of good hygiene. Others believe it is a very sensitive and vital part of the male anatomy that shouldn't be removed.

Why's it done?

Circumcision is done for a variety of reasons. In some religions, such as Judaism and Islam, it's an important ritual. In some cultures, it's done for hygiene reasons. However, there's no compelling medical reason for circumcision and in the UK it's no longer routinely performed on healthy children - fewer than one in ten teenage boys has been circumcised.
Circumcision may be done when the foreskin is narrowed or tight and cannot be pulled back. Other medical reasons for circumcision include recurrent attacks of balanitis (infection under the foreskin) or an unusual condition that tends to affect adult men called balanitis xerotica obliterans.
It's been shown that tiny patches of lymph glands on the underside of the foreskin may process infectious organisms including HIV, helping them to enter the body. Recent research has suggested that circumcision may help to reduce the risk of contracting HIV.

Who's affected?

Ritual circumcision is performed on newborn babies. Timing may be important - in the Jewish faith, for example, circumcision is done on the eighth day.

What's involved?

Circumcision is a painful operation. However, with small babies, local anaesthetic may be sufficient, but they may still experience pain. Local anaesthetic avoids the risks of a general anaesthetic and is a numbing medicine that can be injected at the base of the penis or in the shaft, or applied as a cream. In older children, circumcision is best performed with the child completely asleep under general anaesthetic.
Once the foreskin has been cut away, healing takes up to seven days. Dissolving stitches that don't need to be removed are usually used. Simple pain relief, such as paracetamol or ibuprofen, should be given regularly after the surgery.
Occasionally, there may be complications after the operation, including infection and scarring. Parents or carers should be vigilant for these and get advice immediately if problems develop.
READMORE:http://www.bbc.co.uk/health/physical_health

How we can help children improve their health

The health of our children and young people matters to us, and it matters to them. We want them to understand what makes them healthy, what keeps them healthy, and what to do when they have worries, are not feeling so good, or are simply ill.

In this week's Scrubbing Up, Barbara Hearn, deputy chief executive of the National Children's Bureau, says the launch of the government's Children's and Young People's Forum presents a key opportunity to improve services for them.

Teenage years are the transition years. Adolescents face choices that will affect their health now and in the future.
But while they can get information from parents, will it be up to date? When they ask their mates, will they be well informed?
While health promotion plays a key role, a significant and early point of private contact with health services for a teenager is their GP.
Some children and young people express feeling embarrassed and judged when they seek advice from their GP. They can find it hard to describe their own health concerns and find it hard to understand their doctor's response.
While GPs continue to improve in terms of their own confidence and capacity to make a child patient feel comfortable it is not yet a guaranteed good experience for those under 18's everywhere.
Practices need to be attuned to just how intimidating an all adult environment can be for teens and pre-teens to enter.
Three changes are required. Firstly, better professional development. GPs do have some training in child development but it is insufficient.
Learning how to talk to 12 -18 year olds; and even more importantly, how to listen to what they have to say; how to encourage them to speak up; and to be confident that they understand what is said to them before they leave, takes time.  

“Start Quote

Practices need to be attuned to just how intimidating an all adult environment can be for teens and pre-teens to enter”

End Quote

We can include young people as the 'teachers' here to help GPs learn how to interact effectively with their younger patients.

GPs would benefit from feedback about their manner, the quality and simplicity of their communication, their clarity in explaining diagnoses, treatments and next steps -thereby going beyond theory to learning by doing.
Secondly, the 10-minute patient slots are simply too short to establish a relationship with a tentative young person.
Once it was clear that a patient was under 18, a double slot could automatically be booked, and re-booking done with the same GP or only GPs that have had the training.
Thirdly, to ensure the services GPs are offering are the right ones, young patients should be involved - alongside other patients - in decisions about the services their GP surgery provides.
'Break the myth' In addition, children and young people are rightly a target for public health services.
The fact of their youth means there is time to prevent damaging behaviours and flippant attitudes developing. And time to help them establish good patterns of managing their health for the rest of their lives.
It is time to break the myth that has grown-up over the 60 years of the NHS, that health services manage your health for you making it OK to get 'hammered' and end up in A&E; or to try a drug and see what happens; or remain ignorant of what is going on inside your body while fretting over glamour and goodies on the outside.
Involvement of young people invariably moves into the 'too difficult' box, to be dealt with later, but later never comes.
Young people are avid learners. They contribute through voluntary activity far more than adults and are deeply committed to and interested in the health services.
We need to think of these reforms not as 'do to populations' but 'do with them'.
Children and young people are those with the time and energy to put into making our communities healthy. And in doing so they are able to educate themselves and their peers in ways which can change lives.
READMORE:http://www.bbc.co.uk/news/health

Molar pregnancy

What is a molar pregnancy?

A molar pregnancy is one condition in a range of problems known as trophoblastic disease, where a pregnancy doesn’t grow as it should. It's sometimes called a hydatiform mole.
There are two different types of molar pregnancy, which differ in how they form and how they need to be treated.
In a normal pregnancy, genetic material from the mother and father combines to form new life. In a molar pregnancy, this process goes wrong. In a complete molar pregnancy, the maternal chromosomes are lost, either at conception or while the egg was forming in the ovary, and only genetic material from the father develops in the cells. In a partial molar pregnancy, there is a set of maternal chromosomes but also two sets of chromosomes from the father (ie, double the normal paternal genetic material).
Complete molar pregnancies develop as a mass of rapidly growing cells but without a foetus – it cannot therefore develop into a baby.
In a partial molar pregnancy, a foetus may start to develop but because of the imbalance in genetic material, it's always abnormal and can't survive beyond the first three months of pregnancy.
A molar pregnancy is often harmless, but if untreated can keep on growing and become invasive, spreading to the organs around it, or even further afield to the lungs, liver or brain. Very rarely, in two to three per cent of cases, it may become malignant. These cancerous types of trophoblastic disease are called choriocarcinoma and placental site trophoblast tumours.

Symptoms of molar pregnancy

A woman with a hydatidiform mole often feels pregnant and has symptoms such as morning sickness, probably because the cells of the molar pregnancy produce the pregnancy hormone hCG (human chorionic gonadotrophin). This is also the hormone that is used in a pregnancy test, so she may have a positive result. Some women have no pregnancy symptoms (as with many normal pregnancies).
As the mole grows faster than a normal foetus would, the abdomen may become larger more quickly than would be expected for the dates of the pregnancy. The woman may experience abdominal pain, and also severe nausea and vomiting (hyperemesis).
Bleeding from the vagina is another common warning sign that things are not as they should be. Symptoms similar to pre-eclampsia - high blood pressure, protein in the urine, swelling of the feet and legs - may also occur in the first trimester or early in the second.
Most molar pregnancies are diagnosed at the first ultrasound scan, which shows a mass of cells without the presence of a foetus in a complete molar pregnancy or an abnormal non-viable foetus and placenta in a partial mole.

Causes of molar pregnancy

It remains unclear why a hydatidiform mole develops. However, there are a number of possible reasons, including defects in the egg, maternal nutritional deficiencies and uterine abnormalities. Women under 20 or over 40 are at higher risk.
Having a diet that's low in protein, folic acid and carotene also increases the risk of a molar pregnancy. The number of times a women has been pregnant, however, doesn't influence her risk.

Treatment of molar pregnancy

Once it has been established that a woman is carrying a hydatidiform mole rather than a healthy foetus, suction evacuation is used to remove the pregnancy from the womb. This is curative in about four out of five molar pregnancies.
It's then important to monitor the woman’s progress and repeatedly measure human chorionic gonadotropin (hCG) to be sure that everything settles back down to a normal, non-pregnancy level.
About 15 per cent of women who have had a complete molar pregnancy and 0.5 per cent of those with a partial molar pregnancy will require additional treatment, either because hCG levels hit a plateau or start to rise again, or because of persistent heavy vaginal bleeding.
Further treatment may involve the use of chemotherapy (usually methotrexate combined with folinic acid), especially if there's any concern about invasive or malignant disease.
More than 99 per cent of hydatidiform moles are cured, and even the more aggressive choriocarcinoma has a cure rate over 90 per cent.

Subsequent pregnancies

Following successful treatment, most women can have children if they wish. However, it's strongly recommended that a woman who has had a molar pregnancy doesn't become pregnant again for 12 months. Although the likelihood is small, there's a real risk of malignant disease developing and the increase in pregnancy hormones this would cause can't be distinguished from those of a real pregnancy. Consequently, good contraception is required, as is regular monitoring by a hospital specialist.
READMORE:http://www.bbc.co.uk/health

Malaria

What is malaria?

Malaria is caused by an infection of the red blood cells with a tiny organism or parasite called a protozoa. There are four important species of the malaria protozoa (Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae) and each has a slightly different effect.
These organisms are carried from person to person by the Anopheles mosquito. When it bites an infected person, the mosquito sucks up blood containing the parasite, which may then be passed on to the mosquito's next victim.

Symptoms of malaria

The main symptom of malaria is a fever that occurs in regular episodes, with sweating and shivers (known as rigors), and exhaustion (because of anaemia). In some cases, it can affect the brain or kidneys.

Who'sat risk of malaria?

Malaria occurs where the Anopheles mosquito breeds, predominantly in rural tropical areas. From a UK perspective, it's a threat to people travelling to malarial regions in Africa, the Middle East, Asia and central America.
Each year about 2,000 people return to the UK with malaria, and approximately 12 people a year die as a consequence of the disease.
Malaria is a major killer in many countries where resources for prevention, proper diagnosis and drug treatments are lacking. If diagnosed promptly, it can be easily treated but the symptoms can be vague and UK doctors may not immediately be thinking about tropical infections.
About 90 per cent of travellers who contract malaria do not become ill until after they return home. Only about 12 per cent of these will become seriously ill.
On average, symptoms develop 10 days to four weeks after being bitten, but symptoms can appear up to a year later.
The most severe form of the disease is cerebral malaria, which is fatal in up to six per cent of adults, mainly because it's not diagnosed until it's too late.
Don't make the mistake of assuming you're safe from infection if you have previously lived in a malarial region - you may build up some immunity to the disease but this can be lost quickly. And if your children were born in the UK, they'll have no immunity at all.
If you're going to visit, travel through, or even just stop over in a malarial country you'll be at risk, even if you have lived there before.

Preventing malaria

By far the most important step is to avoid being bitten by mosquitoes by:

• Using effective insect repellent
• Wearing long sleeves and full-length trousers
• Staying in accommodation with screen doors and closing windows

Before you travel, check whether your holiday destination is affected by malaria. You can find your destination on the Scottish Centre for Infection & Environmental Health website.
Take the recommended antimalarial drugs. Generally speaking, these are taken from one week before you travel until one month after you return, but this can vary depending on the type of drug and the country you're visiting.
Even when taken exactly as advised, antimalarial drugs are not 100 per cent effective, so you should still take the other preventive measures listed above.
A major problem is the steady increase in malaria's resistance to drugs used in both prevention and treatment. Always talk to your doctor if you are worried - don't just stop taking antimalarials without getting medical advice.
If you develop symptoms, get help quickly - and don't forget to tell the doctor you've travelled to a malarial area.
Treatment is with antimalarial medication.
In the past decade, considerable progress has been made in the search for a malaria vaccine, and it's hoped one will be available within the next five to 10 years.
Readmore:http://www.bbc.co.uk/health