Living with a long-term condition

At any one time in the UK, as many as 17.5 million adults may be living with a chronic disease.
There are thousands of chronic conditions which affect people from mid-life onwards, including:

• Heart disease.
• High blood pressure.
• Arthritis.
• Diabetes.
• Depression.
• Asthma.
• Irritable bowel syndrome.

Although many of these diseases can be serious or even potentially fatal, modern medicine has meant that most people can control their condition with close supervision, medication, surgery and other treatments, living with it for decades.
The older you are, the more likely it is that you have to manage some sort of chronic health problem. Almost three-quarters of people aged over 75 suffer from one or more longstanding illnesses. But even among 16- to 24-year-olds, one in four will be living with a long-term condition.

Day-to-day problems

Once someone is diagnosed with a chronic lifelong condition, they face problems such as:

• Ongoing physical symptoms, which may be controlled by medication, slowly progress or come and go.
• The need to take medication regularly, managing any side effects, or have other therapies or interventions.
• Managing work and sustaining an income despite their condition, which can cause financial difficulties.
• Psychological problems resulting from stress and anxiety.

All these factors can contribute to a reduced quality of life and sometimes a sense of social exclusion. Those who get involved in managing their condition by learning about the issues and working with their doctors, nurses and therapists, tend to cope better and gain more control over their bodies and lives.

Learning about your condition

Learning about your condition is the key to recognising what is happening to you. There are plenty of good information sources such as:

• Your GP practice.
• The local pharmacist.
• Your local library (they may be able to help you search online for reliable information).
• Patient support groups (most have some sort of national self help group which can provide information and even local meetings - try searching online for your condition if you haven't already).
• If you're worried then your GP (or sometimes specialist nurse) should be able to help check you out.

Recognising symptoms

You can help yourself by knowing what to do when symptoms get worse, or how to recognise significant new symptoms.

Using medicines

Learn how to use your medicines effectively (remembering which ones to take at the right times) and recognise any side effects:

• When prescribing a medicine, the pharmacist should always check that you understand how to use it. If you have any questions, go back and ask them.
• Read the information that comes with the medicine. It's good to know the possible complications or side effects (but try not to let these prey on your mind as most are usually rare or minor).
• Always keep a written note of what medicines you are on. This may be useful if you're suddenly taken ill, lose your medicines while out or need to check for side effects.
• Most medicines are recommended to be given at a specific time of day. In some conditions timings may be critical (such as in Parkinson's disease) so always make sure you understand when you should be taking them and why.
• If you have lots of medicines or problems remembering what to take, talk to your pharmacist about the many devices that people can use to help, such as dosette boxes (to carry your daily/hourly tablets) or even call services. Maybe just setting a timer at home or on your mobile phone will help.
• If you live in England and are being prescribed a new medicine for certain existing or newly diagnosed long-term conditions (asthma, chronic obstructive pulmonary disease, type 2 diabetes, high blood pressure, or if you have been given a new blood-thinning medicine) you may be able to get extra help and advice from your local pharmacist. Under a new free NHS service, you will be given a series of private appointments with the pharmacist to check how you are getting on with the medicines. Ask your pharmacist about this new medicine service.

Employment issues

You may find you have to deal with work issues such as negotiating flexible hours or time off:

• If you feel able to do so, talk to your employers, about your condition. However, you're not obliged to, and some people prefer to keep health issues private. If you can talk to someone, even if it's a supportive colleague rather than the boss, you may feel better for having someone who understands what you are dealing with, and who may be able to offer support over specific issues in the workplace.
• If you can, get advice about illness-related issues from your union.
• Find out what your entitlements are, regarding sick leave or flexible working.
• If things are getting difficult, your employers may be able to consider part-time work, different hours, a work-break or some sort of flexible working arrangement.

Staying positive

Coping with the psychological consequences of the illness can be tough, but staying positive can really help your outlook:

• It can be difficult with a chronic condition to stay optimistic, especially if you're continually battling unpleasant symptoms, but trying to spot what gives you particular stress or depression and finding strategies to deal with them will really help.
• Deal with practical or emotional issues as they develop, rather than letting them fester or weigh you down. If you take steps to take control, no matter how small, this empowerment alone will start to make you feel better.
• Following a regular lifestyle with a balanced diet, daily exercise (if possible) and plenty of rest and sleep is vital to coping with stress.
• Take time out regularly to relax or do something you enjoy.
• Most people benefit from having someone they can offload their feelings to - a family member, friend or maybe a professional.

Talk to your GP if you feel you need support from a counsellor, or you can't seem to get on top of things.

Help is available

There is a lot of help available for people living with a chronic condition:

• You can access help from social services or other voluntary and governmental sources or support agencies, including claiming benefits but local help can vary from area to area. It can be difficult finding out what is available locally and how to access it - talk to your surgery or local support groups for your condition.
• Your local social services department may be able to help, guiding you to claiming benefits or by appointing you a case manager if appropriate. Your GPs surgery may also be able to offer some advice.
• Check with relevant agencies - for example your bank, your employer or your faith organisation, to see if they have anything which could help your situation.
• Many charities offer help relevant to chronic conditions. The Red Cross hires out wheelchairs and other equipment for example, while Age UK can offer all sorts of advice for the elderly from claiming benefits to finding carers or a care home.

The NHS now runs self-management programmes (known as 'Expert patient programmes') designed to:

• Help people reduce the severity of their symptoms in chronic illness.
• Work more closely with NHS professionals.
• Improve their confidence and resourcefulness.

These may be general, with people attending who have a range of different conditions, or specific to one condition (such as arthritis, diabetes or stroke). The sorts of topics covered include:

• Setting goals and making action plans.
• Problem solving skills.
• Developing communication skills.
• Managing emotions.
• How to pace daily activities.
• Managing relationships with family, friends and work colleagues.
• Communicating with health and social care professionals.
• Finding other health care resources in the local community.
• Understanding the importance of exercise, keeping active and healthy eating.
• Managing fatigue, sleep, pain, anger and depression.

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

Dyspareunia (painful intercourse)

Causes of dyspareunia

Lack of sexual arousal is by far the most common cause of painful intercourse. When a women's body is ready for sex, the vagina expands both lengthways and widthways. While this is happening, it becomes moist and lubricated to avoid any friction. The vagina wasn't designed to be penetrated in its unaroused state.
If you're sure you're fully aroused but still experiencing pain, check with your GP that you aren't suffering from an underlying condition. These can include:

• Childbirth - it's quite common for women to suffer some discomfort after childbirth, particularly if there was an episiotomy (a cut to make delivery easier).
• Menopause - intercourse may be more painful during the menopause as lower oestrogen levels cause a thinning of the vaginal wall. Ask your GP or local menopause clinic about oestrogen cream, which usually resolves the problem quite quickly.
• Urinary infections - cystitis or vaginal irritations such as thrush, vaginitis and genital warts are also likely to cause soreness. Once the underlying condition has been diagnosed, a course of treatment should solve the problem.
• Sensitivity to condoms - you may be irritated by certain makes of condoms, contraceptive creams or lubricants. Experiment with different brands.

The problem with pain is that it blocks sexual arousal, which causes further pain. Many women find that they're caught up in a pain cycle - having experienced painful intercourse before, they fear more pain which blocks arousal, causing more pain and so the cycle continues.
If the pain is in your lower abdomen or to one side, you should see your GP to rule out any gynaecological disorder such as:

• Endometriosis
• Prolapse
• Ovarian cysts
• Fibroids
• Pelvic inflammatory disease

Another possible cause is uterine retroversion, a natural condition where the womb tilts towards the back of the pelvis. In all these conditions, you may find that a different position, where thrusting is not so deep, is more comfortable.
If you experience ongoing vulval discomfort then you should check with your GP to see whether you're experiencing vulvodynia or vulval vestibulitus. You can get more information on these conditions from the Vulval Pain Society.

Treatments for dyspareunia

There are a number of self-help techniques wich may help:

• Relax. This is the most important thing you can do. Have a bath, use deep-breathing techniques or buy a relaxation tape from your local health shop.
• Work on relationship issues. You need to be sure that your head and heart are in the mood for sex as well as your body. If you're unhappy about something with your partner then sort it out first.
• Exercise your pelvic floor. This will increase the blood flow to your genital area and make you more conscious of any sensations of physical arousal.
• Use lubrication to speed up the process; keep a tube by the bed.
• Stimulate your sympathetic nervous system with exercise, or anything that will speed up your heart rate. Research suggests that your body will be more sexually responsive 15 to 30 minutes later.

Don't worry if none of the self-help techniques work for you, it's likely that whatever is causing the pain is treatable once appropriate help has been found.
If you've been suffering from painful intercourse for a while, it's essential to check that you're not suffering from an underlying condition.
READMORE:http://www.bbc.co.uk/health

Sterilisation

What is sterilisation?

Sterilisation is a permanent method of contraception, suitable for women or men who are sure they never want children or don't want more children. Male sterilisation is called vasectomy.

How does it work?

Sterilisation works by stopping the egg and the sperm meeting. This is done by blocking the fallopian tubes (which carry the egg from the ovary to the womb) in women or the vas deferens (the tube that carries sperm from the testicles to the penis) in men.
Myths about sterilisation:

• It can easily be reversed. Not true - vasectomy and female sterilisation are difficult to reverse, involving major surgery that isn't available on the NHS.
• Vasectomy is like castration. Not true - vasectomy only involves cutting the tubes that carry sperm to the penis, nothing else is touched.

Male sterilisation

Usually under local anaesthetic, a small cut is made in the skin of the scrotum. The vas deferens are cut and tied or sealed with heat. The operation takes about 15 minutes and can be carried out in a clinic, hospital outpatient department or some general practice settings.
Vasectomy is very effective - about one in 2,000 male sterilisations fails.

Female sterilisation

Under local or a light general anaesthetic, a small cut is made in the lower abdomen. The fallopian tubes are cut and tied, or sealed or blocked, usually with clips.
Around one in 200 females sterilisations fails. The clip method is more effective.
Women considering sterilisation should always be given information about long-acting reversible contraception as these methods are as effective, or more effective, than female sterilisation.

When can I stop using other contraception?

Women should use contraception up to the operation and for four weeks afterwards.
Men will need to use contraception after vasectomy until a semen test shows there are no sperm. This test is usually done around eight weeks after vasectomy.

Advantages and disadvantages

The advantages of sterilisation include:

• After sterilisation has worked you don’t need to think about contraception ever again.
• There are no known serious long-term health risks.

The disadvantages of sterilisation include:

• The tubes may rejoin and you will be fertile again - although this isn't common.
• It cannot be easily reversed.
• It takes at least two months for vasectomy to be effective.

Other things to consider include:

• Sterilisation doesn't protect you against sexually transmitted infections.
• After sterilisation your sex drive and enjoyment of sex should not be affected.

Can anyone be sterilised?

Sterilisation is only for women and men who are sure they don't want children or any more children. It is a permanent method.
Although sterilisation isn’t 100 per cent reliable, and also a reversal can be attempted (although not on the NHS), it should be considered permanent and irreversible for anyone undergoing it. You shouldn't consider sterilisation if you're unsure, under any stress (for example after birth, miscarriage or abortion) or have any family or relationship crisis.
Research shows that more women and men regret sterilisation if they were sterilised when they were under 30, had no children or were not in a relationship.

Where can I be sterilised?

Sterilisation is free on the NHS from contraception clinics, sexual health clinics or general practice.
READMORE:http://www.bbc.co.uk/health

Contraceptive injection

What is it?

The contraceptive injection contains the hormone progestogen. There are two types of injection:

• Depo-Provera provides contraception for three months (12 weeks)
• Noristerat provides contraception for two months (eight weeks)

Depo-Provera is the most used injectable method in the UK. Injectable contraception is a long-acting method of contraception.

How does it work?

The main way it works is by stopping the ovaries releasing an egg (ovulation) each month. It also:

• Thickens the mucus in the cervix, making it difficult for sperm to reach an egg
• Makes the lining of the womb thinner so it's less likely to accept a fertilised egg

Myths about the contraceptive injection:

• It makes you infertile. Not true - but normal fertility can take up to a year to return after using Depo-Provera
• You can only use it for two years. Not true - it can be used for longer providing you do not have any risk factors for osteoporosis (being over 45, poor diet, low exercise or family history of osteoporosis)

How reliable is it?

It's more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year. All long-acting reversible methods are very effective because while they're being used you don't have to remember to take or use contraception.

How to use the contraceptive injection

The hormone is injected into a muscle, usually in your bottom. Depo-Provera can also sometimes be given in the leg or arm. The injection can be started up to and including the fifth day of your period. If started at any other time, additional contraception has to be used for seven days.

Advantages and disadvantages

The advantages of the contraceptive injection include:

• It's very effective
• It doesn’t interrupt sex
• You can use it if you can't use oestrogens or are breastfeeding
• It may reduce heavy painful periods and help with premenstrual symptoms for some women
• It may give you some protection against cancer of the womb
• It may give you some protection against pelvic inflammatory disease
• It isn't affected by other medicines

The disadvantages include:

• Your periods may change in a way that is not acceptable to you, or they may stop
• Irregular bleeding may continue for some months after you stop the injection
• You may put on weight when you use Depo-Provera
• Some women report having headaches, acne, mood changes and breast tenderness
• The injection lasts for eight or 12 weeks, so if you have side effects they will continue during this time and for some time afterwards
• Your periods and normal fertility may take some time to return - more than a year for some women
• The evidence about the risk of breast cancer in women using hormonal contraception is contradictory, but research suggests that women who use hormonal contraception may have a slightly increased risk of being diagnosed compared to women who don’t use it

Other things you may want to consider include:

• Once you've had the injection you don't need to think about it until it needs replacing
• You don't need a cervical screening test or internal examination to have the injection
• It doesn't protect you against sexually transmitted infections
• Depo-Provera affects your normal oestrogen level, which may cause thinning of the bones, but once you stop, any risk is reversed - women aged under 18 and over 45 will be carefully counselled about this

Can anyone use it?

Most women can have the contraception injection, but it may be unsuitable if you:

• Think you might already be pregnant
• Want a baby within the next year
• Don't want your periods to change
• Have thrombosis, heart or circulatory disease
• Have active liver disease
• Have breast cancer now or within the past five years
• Have migraines with aura
• Have diabetes with complications or have had diabetes for more than 20 years
• Have risk factors for osteoporosis

Where can I get it?

Injectable contraception is free on the NHS from contraception clinics, sexual health clinics and general practice.
READMORE:http://www.bbc.co.uk/health

HIV

What is HIV?

HIV stands for Human Immunodeficiency Virus (HIV). The virus infects and gradually destroys the cells in the body that usually combat infections leaving the body susceptible to diseases it would normally be able to fight.
Without treatment, the immune system will become too weak to fight off illness and a person with HIV may develop rare infections or cancers. When these are particularly serious, the person is said to have AIDS (Acquired Immune Deficiency Syndrome).

How is HIV transmitted?

HIV can only be passed on through infected blood, semen, vaginal fluids or breast milk.
HIV is mainly transmitted through vaginal or anal intercourse without a condom or by sharing a needle or syringe with someone who's living with HIV.
Other ways that HIV is transmitted are:

• By giving oral sex (although this is rare and will usually only occur if a person has cuts or sores in their mouth).
• From a mother to her baby during pregnancy, birth or breastfeeding (though less than one per cent of babies born to HIV positive mothers in the UK acquire HIV).
• From a needle stick injury in a healthcare setting (although there has not been a case in the UK for more than five years).
• From a blood transfusion or blood products (in the UK all blood and organs are carefully screened to prevent this but in some countries this may not happen).

It's impossible to transmit HIV through saliva and HIV cannot be passed on through casual contact such as kissing or sharing glasses or cutlery. HIV is a very fragile virus so doesn't live long outside the body.

Symptoms of early HIV infection

Not everybody experiences symptoms when they are infected with HIV, but over 70 percent of people who acquire HIV experience some early symptoms, usually in the first few weeks after infection.
These may feel like severe flu and the most common combination of symptoms are a fever, severe sore throat and a rash, all occurring at the same time (which is rare in an otherwise healthy person). These symptoms get better on their own and they may be the only symptoms a person with HIV experiences before becoming very ill with an extremely damaged immune system several years later.

Who's at risk of HIV?

Anyone who's sexually active or shares needles and injecting equipment could be at risk of HIV.
Over 90,000 people are living with HIV in the UK. Around three quarters are gay and bisexual men or African men and women, but the number of people who are diagnosed with HIV who don't belong to either of these communities is increasing every year.
Over a quarter of people living with HIV in the UK are undiagnosed, so unaware of their HIV infection. It‘s important that you don't make assumptions about whether or not your partner has HIV.

What should I do if I think I may have HIV?

If you're worried you might have caught HIV, it's important to get tested. You can take a free and confidential test at any sexual health clinic.
You can also request a test from your GP (which will be put on your medical record) or through a private or online clinic which will charge you.
New tests can reliably diagnose HIV from four weeks after infection, so people no longer have to wait three months to take a test. If you think you've put yourself at risk of HIV, visit a sexual health clinic as soon as possible to get advice.
If you've put yourself at risk of HIV infection in the last 72 hours, you can request PEP (post-exposure prophylaxis) treatment, which will considerably reduce the risk of HIV infection, at any sexual health clinic.

HIV treatment

Although there's no cure for HIV, extremely effective treatment called antiretroviral therapy can keep the virus under control and allow someone with HIV to have an active, healthy life. Treatment is most effective if started early and it‘s important that HIV positive people take their drugs exactly as prescribed in order to stay well.
Someone with HIV who's diagnosed early and responds well to treatment will have a near-normal life expectancy, but some people experience side effects from their medication, such as nausea, diarrhoea, prolonged headaches and changes to body shape. Depression and mental health problems are also more common amongst people living with HIV and there's still little known about the impact of HIV and antiretroviral therapy on the ageing process.

Routine HIV testing

Because of the benefits of early HIV treatment and the risk of passing on HIV if you're undiagnosed and untreated, it‘s important that you're aware of your HIV status. If you're sexually active, it's a good idea to have a regular HIV test as part of maintaining good sexual health. For gay men, an HIV test is recommended at least once a year.
In the UK, all pregnant women are offered an HIV test as part of their routine antenatal care and HIV tests are increasingly being offered in other parts of the NHS, for example as part of the routine health checks when registering with a GP.
READMORE:http://www.bbc.co.uk/health

Narcolepsy

What is narcolepsy?

Narcolepsy is a neurological condition affecting the area of the brain that controls waking and sleeping. The word comes from the Greek and means 'seized by sleepiness'.

Symptoms

The main symptom is falling asleep suddenly. About four out of five people with narcolepsy also experience cataplexy, a sudden loss of muscular tone and control which is usually triggered by emotion, for example laughter. It may cause the jaw to drop and the head to slump, or the legs to collapse.
These attacks can last for seconds or many minutes and can occur many times a day.
Other possible symptoms include temporary paralysis on falling asleep or waking up and visual hallucinations. People may wake during the night with their heart racing, feeling flushed and agitated, and with intense cravings for sweets.
Schoolchildren with narcolepsy may become the focus of ridicule and bullying in school and it becomes difficult for them to engage in usual school activities and study.
Later in life, it can affect someone's education, relationships and career prospects. Consequently, someone with narcolepsy often also has low self-esteem, depression and relationship problems.

Causes and risk factors

Narcolepsy appears to be a condition where normal elements of sleep – specifically elements of REM (Rapid Eye Movement) or dream sleep suddenly occur during a person’s wakeful state.
The cause of narcolepsy remains unclear. Research has identified several different factors which may play a part. Some people may be predisposed to the condition by their genetics – it is much more common among people with certain genetic profiles.There may be abnormal functioning of certain neurotransmitters (brain messenger chemicals) – for example research has identified that it may be caused by a shortage of the chemical brain messenger called hypocretin. Meanwhile other research suggests that narcolepsy may be the result of an autoimmune process, when the body attacks itself.
Suggested initial triggers include infections such as measles or mumps, accidents and the hormonal changes that take place in puberty (because for many people affected, narcolepsy begins in adolescence).
It's believed around one in 2,000 people has narcolepsy. Men and women are affected in equal numbers. It most often begins between the ages of 15 and 30.
Because narcolepsy tends to start in adolescence, the symptoms are often mistakenly put down to behaviour associated with this stage in life. Those who fall asleep in class may be labelled as lazy and blamed for staying up too late. Often the possibility of drug misuse is explored before the possibility of narcolepsy, adding to the distress suffered. These problems may explain why it takes an average of ten years before the real nature of the illness becomes apparent and as a result a diagnosis of narcolepsy is often not made until mid-life.
Many people are also misdiagnosed as having other medical conditions such as:

• Anaemia
• Heart conditions
• Low blood sugar
• Hypothyroidism
• Epilepsy
• Multiple sclerosis

To properly diagnose narcolepsy, the person’s sleep must be monitored overnight using an EEG or electrical tracing that demonstrates distinct brain wave patterns. Invariably it comes as a great relief for someone to know what their problem really is.

Treatment and recovery

Although it's not yet possible to cure narcolepsy, symptoms can be treated to enable someone to lead as normal a life as possible.
Sleep hygiene is important. This simply means taking steps to ensure plenty of good quality sleep, including a regular bedtime and between seven and a half to eight hours sleep every night. Frequent brief naps may also help and should be spaced evenly throughout the day. This can reduce excessive daytime sleepiness but should aim to not interfere with normal daytime activities.
Heavy meals and alcohol should be avoided. During the day rooms should be well ventilated, especially classrooms. It helps if schoolmates, teachers and family are made aware of the problem and how best to support the affected person who may otherwise be teased or bullied.
People with narcolepsy should avoid driving or operating heavy machinery when they are sleepy.
Stimulant drugs such as amphetamines improve symptoms in 65-85 per cent of patients but can produce side effects ranging from headaches and irritability to gastrointestinal problems. A newer drug called Modafinil also promotes wakefulness although it is not yet clear exactly how it works. Antidepressant drugs are often prescribed when cataplexy is a problem but experts have recently pointed out that there is little evidence to suggest they offer much benefit.
Attacks can be kept to a minimum by:

• Reducing stress
• Taking short naps throughout the day
• Taking regular exercise
• Keeping to strict bedtimes

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

Female genital mutilation

What is female genital mutilation?

It’s one of the most political areas of women's health. Worldwide it’s estimated that well over 120 million women have been subjected to it. Supporters of the practice say it’s an important part of cultural and religious life, and some compare it to the practice of male circumcision that is more widely accepted in the Western world, but opponents say that not only is it potentially life-threatening – it’s also an extreme form of oppression of women.
In some countries where it’s more widely practised it’s officially illegal - those who persist in the practice in Senegal will now face a prison term of between one and five years, for example. But it’s still carried out quietly, within the family and out of sight of officials.
Female circumcision is mainly carried out in western and southern Asia, the Middle East and large areas of Africa. It’s also known to take place among immigrant communities in the USA, Canada, France, Australia and Britain, where it’s illegal. In total it’s estimated that as many as two million girls a year are subjected to genital mutilation.
There are three main types of circumcision:

• The removal of the tip of the clitoris
• Total removal of the clitoris and surrounding labia
• The removal of the clitoris and labia and the sewing up of the vagina, leaving only a small opening for urine and menstrual blood - a process known as infibulation

So drastic is the mutilation involved in the latter operation that young brides have to be cut open to allow penetration on their wedding night and are customarily sewn up afterwards.

Why is female genital mutilation carried out?

Female genital mutilation conforms to several cultural beliefs.
The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls ineligible for marriage if they have not been circumcised.
Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.
Girls who have not been circumcised may be considered ‘unclean’ in many cultures, and can be treated as harlots by other women. Many men believe the folklore which says they will die if their penis touches a clitoris.

What are the risks of female genital mutilation?

Health workers say that the operation is often carried out in unsanitary and so potentially dangerous conditions . Razor blades, scissors, kitchen knives and even pieces of glass are used, often on more than one girl, which increases the risk of infection. Anaesthesia is rarely used. Some girls die as a result of haemorrhaging, septicaemia and shock. Infections and scarring can also lead to long-term urinary and reproductive problems.

What is the future?

Due to health campaigns, female circumcision has been falling in some countries in the last decade. Several international organisations such as the World Health Organisation and the United Nations are actively working to stop the practice, and an increasing number of countries have outlawed it.
In Kenya, a 1991 survey found that 78 per cent of teenagers had been circumcised, compared to 100 per cent of women over 50. In Sudan, the practice dropped by 10 per cent between 1981 and 1990.
Several governments have introduced legislation to ensure the process is only carried out in hospitals by trained doctors.
Other countries such as Egypt have banned the operation altogether, but there is significant opposition to change because of the traditional nature of the process. Health workers think a less confrontational approach such as Ntanira Na Mugambo, which combines education with an understanding of the thinking behind female genital mutilation, could be more successful.
Ntanira Na Mugambo, also known as 'circumcision by words', has been developed in rural areas of Kenya by local and international women's health organisations.
It involves a week-long programme of community education about the negative effects of female genital mutilation, culminating in a coming of age ceremony for young women.
The young women are secluded for a week and undergo classes in:

• Reproduction
• Anatomy
• Hygiene
• Respect for adults
• Developing self-esteem
• Dealing with peer pressure

Family members also undergo health education sessions and men in the community are taught about the negative effects of female circumcision.
Health workers believe the programme works because it does not exert a blunt prohibition on female genital mutilation, but offers an attractive alternative.
READMORE:http://www.bbc.co.uk/health

Smoke inhalation

What is smoke inhalation?

The three major problems associated with inhaling smoke during a fire are:

• Heat damage to the tissues of the respiratory tract.
• Asphyxiation (when the body fails to get sufficient supplies of oxygen to the tissues. Inhaling smoke blocks the intake of oxygen in the lungs, and boosts levels of the gas carbon monoxide which interferes with the ability of the blood to carry oxygen).
• Inhalation of smoke particles and chemicals such as carbon monoxide and cyanide causing direct irritation of the lung tissues. Heat damage is usually limited to the tissues of the mouth and upper throat.

Fortunately, smoke cools rapidly once it is inhaled. Animal experiments have shown that if air at 142C is inhaled it has cooled down to 38C by the time it has reached the chest.

Causes and risk factors of smoke inhalation

One of the main risks of being involved in a fire is smoke inhalation. Inhaling hot smoke can have a devastating effect on the delicate tissues of the respiratory system and their normal functioning.
About four per cent of burn victims die from their injuries - and in many of these cases the crucial factor is smoke inhalation.
The full extent of the damage may only become apparent days after the incident itself.

Symptoms of smoke inhalation

Symptoms may include:

• Cough.
• Shortness of breath.
• Sore throat.
• Headache.
• Confusion.

Heat damage can destroy the cells that line the mouth and throat. Often this leads to the build up of fluids within the lining of the airways (called oedema), which can obstruct the airways and make breathing painful and difficult.
There may also be intense coughing, wheezing, a sore throat and copious production of phlegm or mucus which may be stained with sooty particles.
Maximal airway oedema actually occurs 24 hours after inhaling smoke, so patients with smoke inhalation need close observation and may need respiratory support or even intubation (where a tube is passed down into the airways to assist with breathing).
Serious smoke inhalation can lead to damage to the smaller airways deeper down in the respiratory system. These airways may become blocked by damaged material. The minute hairs, or cilia, that line these airways and help to ferry contaminants out the respiratory system may also be damaged. In this case, the patient may find breathing more and more difficult, as asphyxia sets in. They may become blue or cyanosed, especially around the lips and mucus membranes or noticeable on the fingertips (as oxygen levels in the blood drop), and start breathing faster to try to get more oxygen in.
As oxygen levels drop they may become confused and even lose consciousness. There is also a risk of developing pneumonia, or even complete respiratory failure. Alternatively their lips may appear unusually bright ‘cherry red’ which is the effect of carbon monoxide in the blood and which can disguise the cyanosis of low oxygen levels.
In addition to interfering with oxygen carriage by the blood, carbon monoxide is poisonous and causes headache, nausea and vomiting. Sometimes the person appears well, with no obvious symptoms, until the effects of carbon monoxide become apparent.
As well as direct tissue damage, smoke inhalation may provoke dangerous chemical reactions within the body. Pollutants contained in smoke can trigger the immune system to react, resulting in damage to the tissues. The immune system produces a cellular response and also chemicals called cytokines which seek out and helps neutralise inhaled contaminants.
Too much of a specific cytokine called tumour necrosis factor-alpha (TNF) can stimulate a chain reaction that leads to the death of cells and general irritation in the lung, called a pneumonitis, which further interferes with the process of taking oxygen in to the body.
So anyone who has been involved in a fire and may have inhaled smoke should be carefully checked and monitored for sometime afterwards. They may need intensive medical treatment.
READMORE:http://www.bbc.co.uk/health/physical_health

Soft spot or gap on baby's head (fontanelle)

All babies are born with at least two fontanelles. The anterior fontanelle is a diamond-shaped dip in the top of the head towards the front, measuring about 4cm to 5cm (1.5in to 2in) across. Most babies also have a smaller triangular dip at the back of the head called the posterior fontanelle.

How they are formed

These gaps are formed where the plates, or flat pieces of skull bone, meet. As the baby's head grows, so the plates grow together and the fontanelles disappear. The posterior fontanelle is usually gone by four months and the anterior fontanelle by about 15 months, although it may still be seen on x-rays until two years of age.
Although there's no bone in these spots, the brain is protected by a very tough, thick membrane. The fontanelle may seem to pulsate (it's best to look for this when your baby is quiet), which is simply the pulsation of blood through the veins with every heartbeat.
The fontanelle may also bulge slightly, which is normal if temporary or your baby is crying. However, if the bulge is persistent, see your doctor as this could be a sign that pressure in the skull is abnormally high.
The fontanelle may also sink down considerably - a sign that your baby is dehydrated.

Possible problems

Occasionally, the fontanelles fail to close at the normal time. This is usually a sign of other problems. These are rare but include:

• Hydrocephalus, or 'water on the brain' - increased pressure inside the skull, usually because of abnormal drainage of cerebrospinal fluid, keeps the fontanelles open and causes the baby's head to increase rapidly in size
• Congenital hypothyroidism - a large fontanelle was traditionally used to test for underactivity of the thyroid gland, but blood tests are now done on all newborns to rule this out
• Other rare syndromes, such as dwarfism, developmental delay and bone abnormalities

These problems are rare and you probably would have noticed other symptoms by now. However, if you're still worried, ask your health visitor or doctor to check your baby's head at your next routine visit.
READMORE:http://www.bbc.co.uk/health

Sore throat and cough

What are sore throats and cough?

A cough is a sign that nerves in the pharynx (upper throat), larynx (throat), trachea (main breathing tube) or large bronchi (breathing tubes in the lungs) are irritated.
A sore throat, also known as pharyngitis, is visible as inflammation or redness of the tissues, sometimes with yellowish/white pus on the tonsils.

Symptoms of sore throats and coughs

The symptoms of a cough depend on the type. For example, viral croup typically causes a barking cough with rapid and harsh breathing.
In whooping cough, there's a characteristic spasmodic cough followed by a whooping noise as the child draws in breath.
Coughs associated with asthma are often worse at night or on breathing cold air. Associated symptoms may include fast or noisy breathing, fever, vomiting (especially in small children), a stuffy nose and other symptoms of a cold.
The symptoms of a sore throat include pain, especially on swallowing, sore swollen glands in the neck and drooling of saliva.

Causes of sore throats and coughs

The most common cause of a cough in childhood is an upper respiratory tract infection, usually viral (such as the common cold) but it can be bacterial.
More serious infections include croup (viral laryngotracheitis), bronchiolitis, whooping cough and pneumonia.
It's not unusual for a child to have a recurrent cough due to repeated infections, but this can also be a sign of an underlying problem, such as asthma, allergies, gastro-oesophageal reflux or cystic fibrosis.
Occasionally, a cough may be due to inhalation of a foreign body, such as a small toy or peanut.
Sore throats are usually caused by a viral infections, although as children get older a bacteria called beta-haemolytic streptococcus becomes more common.

Treatments for sore throats and coughs

Treating a cough depends on the cause. For example, if a child has asthma, they will probably need to take inhalers. Over the counter cough medicines have been shown to be of little benefit.
Simple painkillers and plenty of cold drinks, ice cream and jelly can help to soothe a sore throat. Older children may use gargles.
For both a cough and sore throat, it's important to get medical advice and a diagnosis early, especially if the child has a fever or is generally unwell, or if the cough is recurrent. Antibiotics are used to treat bacterial infection.
Croup is treated with steroids. Other viral infections get better by themselves. If breathing problems are present, the child may need to go hospital where they may need to have breathing support.
Get immediate medical help if your child isn't breathing properly, is breathing faster than normal, if it looks as if breathing is hard work for your child, if they can't talk, looks blue around the lips or becomes drowsy.
READMORE:http://www.bbc.co.uk/health

Human growth hormone: What is it?

Human growth hormone: What is it?Human growth hormone is a protein that is secreted by the anterior pituitary in short pulses, mostly during the first hours of sleep and in response to stress. It is released throughout a person's lifetime and controls the production of other hormones called growth factors, throughout the body.
It particularly stimulates body growth and development in children, as well as playing an important role in child and adult metabolism, regulating the amount of muscle and fat and has effect on blood sugar levels. It also has a role in immunity and healing. Growth hormone was first isolated in 1956 and its structure was identified in 1972.

Why is it used?

Human growth hormone (HGH) therapy has been used to help growth hormone deficient children in the UK to grow normally since 1959. All supplies of HGH are now manufactured using artificial techniques called recombinant technology, but before 1985 the only source of human growth hormone was from brain tissue of human cadavers. This held an infection risk of a prion (slow virus) disease called Creutzfeldt-Jakob disease (CJD). There are other causes of CJD however, and recombinant growth hormone therapy is now the only type of growth hormone used as it is safe and cannot cause CJD.
Between 1985 and 2003, 26 cases of CJD were identified in adults who had received cadaverous human growth hormone, as children, before 1977. CJD has an incubation period of up to 30 years so most cases following the use of cadaver HGH have now been identified, although it is possible that a few more will show up. In scientific circles, it was clear as early as 1977 that there was a risk of transmission. This date has now become the determining factor in who can claim for compensation.
In 1959, severely reduced height children were given HGH to help them grow. With HGH they could reach a height close to the normal of just over 180cm. It was hailed at the time as a great medical breakthrough but was in limited supply so could only be used in the most severe cases.
HGH has found a wide range of other uses now that it can be artificially synthesised in unlimited quantities in the laboratory.
In children, it is used, in a variety of conditions where growth is restricted, not just growth hormone deficiency. For example it may be used in small for gestational age babies, Turner syndrome, Prader-Willi syndrome, and chronic renal disease.
In adults it is also used in growth hormone deficiency, which may have started in childhood, or developed later in life, causing fatigue, sleep problems, psychological upset and muscle weakness.
There may be a role for HGH in treating HIV associated muscle wasting but its use is not fully established yet.
HGH has been used illegally by athletes to build muscle bulk but research has cast doubts as to whether there is any objective improvement in performance and there are possible risks such as the development of diabetes. HGH has also been promoted by some alternative therapists as an anti-ageing treatment but again there is no scientific evidence to support its use.

What are the risks?

Elevated levels of HGH due to benign tumours of the pituitary gland lead to swelling of the soft tissues in the body; abnormal growth of the hands, feet and face; high blood pressure and an increased tendency to sweat with excessive hair growth, a condition known as acromegaly. Injections of HGH without any underlying deficiency may cause diabetes.
READMORE:http://www.bbc.co.uk/health

Hand, foot and mouth disease

What is hand, foot and mouth disease?Many people panic when they're told they have hand, foot and mouth disease. They think they’ve got the infection that affects cattle, sheep and pigs, but the animal infection is called foot-and-mouth disease and is completely unrelated.

Causes and risk factors

Hand, foot and mouth disease is common in small children but can occur at any age. It's caused by one of several viruses, most commonly coxsackie virus A16, one of a group of viruses called enteroviruses. This is quite contagious, especially in the first week of illness, and is spread through direct contact.

Symptoms

The name of the infection comes from the fact that a rash develops on the palms of the hands and soles of the feet (and sometimes spreads further out to the legs and bottom), accompanied by sores in the mouth.
The rash takes a couple of days to appear and consists of small, flat or raised red spots, some with blisters. Similar spots in the mouth, usually on the tongue, gums and inside of the cheeks, may progress into mouth ulcers.
The child is also usually feverish, has a sore throat and feels generally unwell.

Treatment and recovery

Hand, foot and mouth disease is rarely serious. Most people need no specific medical treatment and are better within a week or so. Complications are rare, but occasionally it can lead to mild viral meningitis.
You can take simple remedies for any unpleasant symptoms, such as pain relief for the ulcers and blisters or to lower fever. Children should be given paracetamol or ibuprofen syrup. Aspirin is no longer recommended for children under 16, because of a possible link with a serious problem called Reye's syndrome.
You can also try giving them soft cold foods such as yoghurt or ice cream, and plenty of cold drinks, to ease the discomfort of a soft mouth.
Children are sometimes excluded from nursery or school during the first few days of the illness in an attempt to prevent it spreading, but this can be difficult as the viruses that cause it are widespread in the community.
READMORE:http://www.bbc.co.uk/health

Autism and Asperger syndrome

What is autism and Asperger syndrome?To people with autism and Asperger syndrome, the world can appear chaotic with no clear boundaries, order or meaning.
These disorders can vary from very mild, where the person can function as well as anyone else around them, to so severe that they are completely unable to take part in normal society.
People with autism are usually more severely disabled, while those with Asperger syndrome tend to be more able, although this isn't always so. Because of the range of severity and symptoms, the conditions are collectively known as autistic spectrum disorders. They affect more than 580,000 people in the UK.

Symptoms of autism

The main three symptoms are:

• Difficulties with social interaction - being unaware of what's socially appropriate, finding chatting or small talk difficult and not socialising much. People with autism may appear uninterested in others and find it very difficult to develop friendships and relate to others, while those with Asperger syndrome are more likely to enjoy or want to develop social contacts, but find mixing very difficult.
• Problems with verbal and non-verbal communication – those affected may be able to speak fluently or, more commonly in autism, may be unable to speak at all. There may also be difficulties understanding gestures, body language, facial expressions and tone of voice, making it difficult to judge or understand the reactions of those they are talking to or to empathise with people's feelings. As a result, they may unintentionally appear insensitive or rude to others. They may also take others comments literally and so misunderstand jokes, metaphors or colloquialisms.
• Lack of imagination and creative play - such as not enjoying or taking part in role-play games. They may also find it difficult to grapple with abstract ideas. There may be overriding obsessions with objects, interests or routines, which tend to interfere further with building social relationships (this is known as stereotyped or repetitive behaviour).

These behavioural difficulties can cause a great deal of stress for members of the family.
A child with autism may appear unaffected as a baby and reach the usual developmental milestones, including early speech. But as they grow into toddlers, they may fail to develop normal social behaviour and speech may be lost.
As a child grows, the typical difficulties of autistic spectrum disorders are:

• Repetitive behaviour and resistance to changes in routine.
• Obsessions with particular objects or routines.
• Poor coordination.
• Difficulties with fine movement control (especially in Asperger syndrome).
• Absence of normal facial expression and body language.
• Lack of eye contact.
• Tendency to spend time alone, with very few friends.
• Lack of imaginative play.

People with Asperger syndrome are usually more mildly affected than those with autism. In fact, many people with milder symptoms are never diagnosed at all, and some argue that Asperger syndrome is simply a variation of normal rather than a medical condition or disorder. Even so, many do find that it gives them particular problems getting on in the world and they may become aware they are different from others. This can result in isolation, confusion, depression and other difficulties, all of which could be defined as 'disease'.
Some children with Asperger syndrome manage (or in fact even do very well) in mainstream schools, especially if extra support is available. However, even when children cope well academically, they may have problems socialising and are likely to suffer teasing or bullying. More severely affected children need the specialist help provided by schools for children with learning disabilities.
With the right sort of support and encouragement, many with Asperger syndrome can lead relatively normal lives. Helping them develop some insight into the condition is an important step towards adjusting to, or at least coping with, the way the rest of the world works. Some do very well, especially in an environment or job where they can use their particular talents.
Autism tends to produce more severe symptoms. For example, a child with autism may fail to develop normal speech (the development of spoken language is usually normal in Asperger syndrome) and as many as 75 per cent of people with autism have accompanying learning disabilities.
Seizures are also a common problem, affecting between 15 and 30 per cent of those with autism.
Conversely, children with autism are sometimes found to have an exceptional skill, such as an aptitude for drawing, mathematics or playing a musical instrument.

Causes of autism

The cause of autistic spectrum disorders is not yet clear. Genetics play an important role, and researchers are examining a number of chromosome sites that could be implicated. It's likely that autism occurs when a small number of genes interact in a specific way, possibly linked to some external event or factor.
This genetic link means there may be an inherited tendency, so autism and Asperger syndrome may run in families. Brothers or sisters of a child with the condition are 75 times more likely to develop it themselves.
Doctors' ability to diagnose these disorders has improved in recent years, but older people, particularly with milder problems, may never have been diagnosed. When a child is diagnosed, parents often realise they've had the same problems themselves.
Boys are more likely to be affected than girls, though research suggests that when girls have the condition they may be more severely affected.
A variety of other environmental factors that affect brain development before, during or soon after birth, also play a part (possibly acting as a trigger). Despite reports suggesting a possible link between MMR vaccination and autistic spectrum disorders, scientific evidence has confirmed the vaccination does not increase the risk.
There's no specific test for autistic spectrum disorders. Diagnosis is based on a consideration of symptoms, and milder cases may be missed.

Treatments for autism

There is no specific cure or particular medical treatment for autism, but much can be done to maximise a child’s potential and this is key to managing the condition. Appropriate specialist education, speech, language and behavioural therapy are all important. There are many different approaches (for example, the Lovaas method is an intensive behaviour therapy approach, while the Son-Rise programme is focussed on relationships).
Other interventions are based around theories about possible causes of autistic spectrum disorders – these may for example involve using foods and supplements, or medicines, which might affect the mechanical, physical and biochemical functions of the body.
While many people feel they've achieved good results with some of these interventions, none of them is a cure-all, and many lack scientific evidence to demonstrate their benefits.
Others claim dietary changes or alternative remedies have helped, but these, too, are mostly unproven.
Medication is sometimes recommended when it's felt to be of benefit to the child, for example to control seizures, depression or other symptoms.
As the precise events that lead to autistic spectrum disorders aren't yet known, it isn't possible to prevent them. Neither is there yet a simple screening test to identify people carrying genes that might increase susceptibility to autism.

Drug abuse

The use of chemicals to alter the way we feel and see things is one of the oldest activities of the human race.
But a person's use of a drug such as tobacco, alcohol, cannabis or heroin can become uncontrolled, or start to control them. Even when the use of drugs leads to serious physical and mental problems, the person using may still not want to stop.
If they do decide to give up, they may then find it's much harder than they thought.

Symptoms of drug abuse

There are a lot of bewildering different words used to describe drug use and addiction problems. Not every expert will agree with the definitions here, but being consistent about the terms used helps to reduce the confusion and anxiety everyone feels when faced with this problem.
Each drug has different patterns of:

• Use
• Intoxication
• Overdose
• Hangover

For each different drug, the term 'substance abuse' can cover different levels of use, including:

• Experimenting with use
• Bingeing
• Using large amounts without appearing intoxicated
• Using large amounts to get intoxicated

Why do people use drugs?

People can use a substance for more than one of the above reasons, and may also use several drugs, or different combinations, for different reasons.
Untangling why a person uses drug is rarely an easy task, but most people use a drug because they enjoy the effects, or feel the effects help them cope with issues in their life. This may seem like a simplistic or insensitive statement, but it's easily forgotten by the people around the drug user, who are concerned for their wellbeing.
Worried parents often ask for tell-tale signs of drug use, but the simple answer is that it's very hard to spot. Many users who have contact with mental health services manage to conceal their use from mental health professionals, so it's obviously difficult to identify.
Parents usually know their children better than anyone else, and maintaining an open atmosphere in which communication is kept up is often the best way to find out what's going on.
This is not always easy with teenagers, who are often secretive as they discover how they can control aspects of their own life and activities, as they might view the methods parents use to find out if they are using drugs as intrusive and controlling. And angry confrontations with teenagers might push them further into a cycle of resentment and refusal to communicate.

Psychological addiction to drugs

The media's portrayal of a person giving up drugs usually focuses on the immediate effects of withdrawing from heroin. It's important to remember that there's often more to an addiction than the physical withdrawal symptoms.
In fact, for some drugs such as cannabis, there's a debate about whether there are actually any physical symptoms of withdrawal. People who use cannabis regularly over a long period may find there are certain situations in which they come to rely on the drug. If they stop using it they may feel very disabled.
This is a situation that can develop for almost any substance that affects the mind and this aspect of addiction can be harder to overcome than the physical symptoms.
Mental symptoms can include:

• Anxiety
• Depression
• Disrupted sleep and rest
• Difficulty controlling mood
• Reduced wellbeing

The pattern of these symptoms will depend on the drug being used, the psychological make-up of the person using it and the circumstances under which they are attempting to remain drug free.
The term 'craving' is often used when talking about addiction. If a person is experiencing any of the symptoms listed above and they know that by using the drug all these problem will go away, it's not surprising that they develop an overwhelming desire to use and that this dominates their thoughts.

Physical addiction to drugs

It's ironic that through films such as Trainspotting quite a lot of people feel that they understand the physical effects of withdrawal from heroin. They rightly see it as an unpleasant and difficult experience - and a good reason not to experiment with it.
The irony is that alcohol has much worse and more dangerous withdrawal effects. It's possible, but very rare, for someone experiencing heroin withdrawal to need to be admitted to hospital, while someone who is physically addicted to alcohol should not attempt to stop using it without consulting a doctor.
Again, as with psychological dependence, the length and severity of withdrawal differs according to the drug, how much has been taken and for how long.
For most addicts, their problem is a mixture of both physical and psychological aspects. There are some instances when it's difficult to distinguish between the two.
The stimulants cocaine and amphetamine are classic examples of this - people coming down after using these drugs feel very low and lack energy. When they take cocaine, they feel very high and use up lots of energy. Their feelings afterwards could be partly because of feeling tired and adjusting to a normal mood again, but there are other theories that suggest these feelings are because the body is re-establishing its chemical balance.

Admitting you've a drug problem

The saying that admitting you have a problem is half of solving the problem is very applicable. The next step is to get support. You're much more likely to succeed in dealing with your drug problem if you have help and support.
If you're physically addicted, it may be dangerous just to stop - especially if you're using alcohol or tranquillizers. Even if it isn't dangerous to stop abruptly, a doctor may be able to prescribe medication to help you through the first phase of withdrawal, and may be able to offer support in areas of your life which may have driven you to use drugs in the first place.
Not all family doctors are happy to help with this problem, so if yours isn't it's probably best to approach your local drug dependence unit (DDU). It's also vital to get other forms of support and counselling - see the resources listed below.
READMORE:http://www.bbc.co.uk/health

Overeating

Somewhere between anorexia and bulimia lay the rest of us. We may not have the view of our body that anorexics have of theirs, but there still may be some self deception going on when we look in the mirror. We may not binge to the extent it makes us sick, but we may still look at a plate after we have emptied it and feel regret, or not remember actually putting all that food into our mouths.
Society pulls us in two directions. On one hand is the army of dieticians, doctors and nurses rightly telling us that obesity is an epidemic in the UK. The newspapers and television also promote the belief that to be thin is to be cool, beautiful or desirable. On the other hand we have unlimited access to rich foods high in calories. Part of the problem is what dieticians call ‘calorie density’; you get a lot more calories in an ounce of chocolate than you do in an ounce of celery. In our fast-food society there is a lot of calorie dense food not only available relatively cheaply, but assertively advertised.

Calculate your body mass index

Trying to fight the cravings the advertisers trigger in us and rigidly keep to the recommended daily calorie count of 2,000 for women and 2,500 for men is hard, and obsessively monitoring our BMI (a measure of how our height and weight relate to each other) is difficult too. Use the BMI calculator to check your body mass index.
Calorie recommendations are only guidelines some people will need quite a bit more or less, and BMI is a better measure of how much obesity there is in a population rather than in an individual. This can turn eating, one of our most basic mechanisms of self-care, into an almost clinical procedure.
The problem might be that in listening carefully to the medical professions, media and advertisers we have stopped listening to the most important voice in deciding what to eat – our own.

The different types of hunger

Paediatrician and Zen meditation teacher Jan Chozen Bays suggests that there are seven different types of hunger:

• Eye hunger. It's the old saying about ‘eyes being bigger than the stomach’, if the dessert trolley had its contents mixed together in a liquidiser would it look so good after you have eaten the steak? The eyes also have an effect through portion sizes, bigger plates mean bigger portions; people tend to finish what they are served, but research shows that when people are given a smaller plate that is just as full but holds less food they are just as happy.
• Nose hunger. Another old one, early in the 20th century a scientist called Ivan Pavlov showed how the smell (and sight) of food leads to an automatic watering of the mouth. Next time you walk past your favourite restaurant take a moment to examine how the feelings in your mouth change as you begin to smell the food as you pass by. The problem is that this happens whether you are hungry or not.
• Mouth hunger. An obvious one, but it's not just the flavour that the mouth craves it's also the texture. Would fish and chips or chicken tikka masala be as good to eat if they had been blended into a milkshake consistency?
• The stomach. It's reasonable that we should eat because we feel that empty rumbling stomach. The error that we make is to think that our stomach tells us when to eat; actually we tell it. If we eat at a certain time of day, when we see things associated with that time of day (driving home, sunset and so on) our body responds to these triggers by setting of the stomach muscles moving in anticipation of having some food to process. We can retrain the stomach to respond to different expectations if we want to.
• Cellular hunger. Have you ever had a fixed craving for one particular food, something out of the ordinary and not associated with passing a restaurant or seeing an advert? The thought of it just comes at you out of the blue, and triggers all of the types of hunger we have just discussed. Unless it's because it's a food you have been expressly forbidden to eat for medical reasons and you are feeling rebellious, then you should probably eat that food. There may well be an element or food group in it that your body needs. For instance if you have been doing strenuous lifting around the house and your arms are feeling weak – then that fantasy about a steak is your muscles asking for protein so they can repair themselves.
• Mind hunger. We all have opinions about what is a good diet and these are influenced by the various rules of eating that we take on from diet gurus. Can they all be right? Can a vegetarian-based diet and a high-protein meat diet both be right? Some writers have tried to link differences to body type or blood group. Being an informed eater is one thing, but examine all your eating rules; how did you get them? What do you think will happen if you go against them? What is the evidence for those beliefs other than the opinion of a food guru?
• Heart hunger. We can associate certain emotions with hunger. They may remind us of past happy times and so when we feel sad or lonely we fall back on these foods to lift our mood. The problem is when we begin to associate any food with being distracted from those negative emotions.

Next time you’re hungry ask yourself which hunger is at work, it's usually more than one. Ask yourself where your hunger comes from and will it make you eat or will you step back and make a considered choice. Mindfulness can be a useful approach in doing this.
READMORE:http://www.bbc.co.uk/health

Combined contraceptive pill

What is the combined contraceptive pill?

The combined oral contraceptive pill is usually just called the pill. There are many different types, but all contain two hormones - oestrogen and progestogen. These are similar to the natural hormones women produce in their ovaries.

How does the pill work?

The main way the pill works is by stopping the ovaries releasing an egg each month (ovulation). It also:

• Thickens the mucus in the cervix, making it difficult for sperm to reach an egg
• Makes the lining of the womb thinner so it is less likely to accept a fertilised egg

How reliable is the pill?

The pill's effectiveness depends on how carefully it's used - it's more than 99 per cent effective when taken according to instructions. This means that fewer than one woman in 100 using this method for a year will get pregnant.
Myths about the pill:

• The pill makes you put on weight. Not true - Research has shown there is no evidence to suggest this, although some women find their weight changes during their cycle due to fluid retention. However we do know that poor diet, lack of exercise and drinking too much alcohol contribute to weight gain.
• The pill makes you infertile. Not true – women who stop the pill get pregnant as easily as those who've never used the pill and you don't need regular breaks off the pill. However some women find it may take a few months for their periods to return or settle into a regular pattern.

How do you use the pill?

The pill can be started up to and including the fifth day of a period. If taken at this time it is effective straight away. If started at any other time, additional contraception has to be used for seven days.
The pill is taken every day for 21 days until the pack is finished.
You then have a break of seven days when you have a 'withdrawal bleed', which is usually shorter and lighter than a normal period. Everyday pills have 21 active pills and seven placebo tablets. These are taken without a break and must be taken in the order listed on the pack.

Advantages and disadavantages

The advantages of using the pill include:

• It doesn’t interrupt sex
• It usually makes your bleeds regular, lighter and less painful
• It may help with premenstrual symptoms
• It reduces the risk of cancer of the ovary, womb and colon
• It reduces acne in some women
• It may protect against pelvic inflammatory disease
• It may reduce the risk of fibroids, ovarian cysts and (non-cancerous) breast disease

The disadvantages of the pill include possible temporary side-effects such as:

• Headaches, nausea, breast tenderness and mood changes
• Breakthrough bleeding (unexpected bleeding on pill-taking days) and spotting

If these don't stop within a few months, changing the type of pill may help.
The pill can have some serious side-effects, but these aren't common. They may include:

• Raised blood pressure
• A very small number of women may develop a blood clot, which can block a vein (venous thrombosis) or an artery (arterial thrombosis, heart attack or stroke)
• A small increase in risk of being diagnosed with breast cancer
• A small increase in the risk of cervical cancer if the pill is used continuously for more than five years

Other things to consider include:

• Initially, you'll be given three months' supply of the pill. If there are no problems, such as a rise in your blood pressure, you will then be given up to a year's supply
• You don’t need a cervical screening test or an internal examination to have the pill
• The pill does not protect you against sexually transmitted infections

Who can use the pill?

The pill may not be suitable for all women, but for most the benefits outweigh the possible risks.
The pill may be unsuitable if you:

• Think you might already be pregnant
• Smoke and are over 35, or are over 35 and stopped smoking less than a year ago
• Are very overweight
• Take certain medicines - always check
• Have had a previous thrombosis
• Have a heart abnormality, circulatory disease or high blood pressure
• Have very severe migraines or migraines with aura
• Have breast cancer now or within the last five years
• Have active liver or gall bladder disease
• Have diabetes with complications, or have had diabetes for more than 20 years

What if I forget to take the pill?

It's important to take the combined pill at a regular time each day. You have 'missed a pill' if you take it more than 24 hours later than your usual time.
Missing one pill anywhere in the pack, or starting your pack one day late, is not a problem, but missing more than one pill or starting the packet more than one day late could affect your contraceptive cover - seek advice as you may not be protected until you have been taking the pill again for seven or even nine days with some types of pill.
If you're sick within two hours of taking the pill it will not have been absorbed properly. Take another pill as soon as you feel well enough. If you continue to be sick, seek advice. If you have severe diarrhoea for more than 24 hours, this makes your pill less effective
 READMORE:http://www.bbc.co.uk/health

Severe acute respiratory syndrome

What is SARS?

The symptoms of SARS first appeared in the Guangdong province of China in November 2002, although it wasn't reported to the World Health Organisation (WHO) at that time.
Then a Chinese professor of respiratory medicine treating people with the syndrome fell ill. He travelled to Hong Kong, carrying the virus with him. This led to an explosion of cases in the province towards the end of February 2003.
In just a few weeks, thanks to international air travel, SARS spread around the world. It wasn't until July 2003 that the WHO was able to declare that the outbreak had been contained. By this time, at least 8,098 people had been infected, 9.6 per cent of whom had died.
Between July 2003 and May 2004, four small and rapidly contained outbreaks of SARS were reported. Three of these were linked to laboratory releases of the SARS virus.

Symptoms

The main symptoms of SARS are:

• High fever (above 38°C)
• Dry cough
• Breathing difficulties
• Headache
• Muscular aches and stiffness
• Loss of appetite
• Malaise or tiredness
• Confusion
• Rash
• Diarrhoea

These symptoms are typical of many severe respiratory infections. There have only ever been a few cases of SARS reported in the UK, so if you’ve similar symptoms, it's far more likely to be a more typical form of pneumonia. Even if you've recently returned from south-east Asia, there's little risk that you have SARS as the virus has been contained.

Causes and risk factors

It took scientists several months to pin down the cause of SARS, but eventually it was identified as a viral infection with a previously unknown type of coronavirus now known as SARS CoV.
Coronaviruses cause infections of the upper respiratory tract and are spread like the common cold. They are also quite tough and can survive in the environment for at least three hours.
Most new infectious diseases in humans come from animals, and this is thought to be the case with SARS. SARS CoV has been found in Himalayan palm civets, a racoon dog and a Chinese ferret badger. It has also been detected among people working in a live animal market in the area where the outbreak first began, and high levels of antibody to the virus have been found in people trading masked palm civets.
You're unlikely to catch SARS. For it to spread there must be close contact with an infected person. It's less infectious than flu, and has a short incubation period of two to seven days. People with SARS are most likely to be infectious once they have active symptoms of the disease, such as fever and cough. However, it's not known how long before or after symptoms begin that a person remains infectious.
Although SARS is currently contained, people travelling to the area where it first appeared may want to check with the World Health Organisation or Foreign & Commonwealth Office for the latest advice.
Anyone who develops serious illness or breathing problems with fever and cough, especially after travelling abroad, should get urgent medical advice.

Treatment and recovery

So far, no specific treatment appears to be especially effective against SARS. Antiviral drugs such as ribavirin (given with or without steroids) were used in a number of cases in the 2003 outbreak, although it isn't clear how effective they were.
With supportive care, the majority of patients started to show improvement by day six or seven of infection. About ten per cent of patients got rapidly worse and needed mechanical help (that is, a ventilator) to breathe. In this group, other illnesses tended to complicate the infection and it was more likely to prove fatal.
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Vitamin B6

What is Vitamin B6?

Vitamin B6 occurs naturally in poultry, fish, pork, cereals, eggs, vegetables and fruit. It’s also widely available as a dietary supplement.

What are the benefits of vitamin B6?

Vitamin B6, also known as pyridoxine hydrochloride, is essential for the breakdown of food by the body, and turning carbohydrates, proteins and fat into energy. It’s also needed for the production of neurotransmitters (chemical messengers in the nervous system) and proper functioning of the nervous system and the immune system. It’s also involved in the synthesis of hormones and red blood cells.
Vitamin B6 supplements are often taken for a variety of reasons, including to help:

• Fight stress
• Increase energy
• Manage symptoms of pre-menstrual syndrome

B6 has also used in conjunction with magnesium to treat the behavioural problems of autism. However the use of supplements is a contentious area. Scientists argue that most people get adequate levels of B6 if they follow a good balanced diet, and there’s little evidence that vitamin B6 supplements can benefit different diseases.

What are the risks from vitamin B6?

It’s not possible to take in too much vitamin B6 through a normal diet but research has shown that long term use of high doses of supplements of vitamin B6 may affect the sensory nervous system leading to loss of sensation in the hands and feet and permanent nerve damage (‘sensory neuropathy’).
A deficiency of B6 has been linked with:

• Muscle weakness
• Irritability
• Depression
• Poor memory and concentration

What are the recommendations for vitamin B6?

The Reference Nutrient Intake (RNI) or daily amount recommended by experts in the UK is:

• 1.4 mg/day for men
• 1.2 mg/day for women

Most people get this through a healthy diet and a serious deficiency is unusual. However there’s some research to suggest that some people may have mild deficiencies, especially the elderly (who often follow a more limited diet). People on a high protein diet with no leafy green vegetables or cereals, and those who drink heavily may need more B6.
There’s some evidence that the contraceptive pill can interfere with vitamin B6 and women taking the pill may need a higher intake of B6.
High dose vitamin B6 supplements (tens or hundreds of times higher than the RNI) are still promoted by some sources, for example to help treat depression and pre-menstrual syndrome, and to prevent heart and blood vessel disease (B6 plays a part in lowering blood levels of a chemical called homocysteine – high levels of homocysteine have been linked to heart disease but It’s not clear exactly what the relationship is). However the evidence for any benefit is very controversial.
In 1997, the UK Department of Health’s Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) considered evidence from more than 100 scientific papers, as well as evidence submitted by interested parties. They then released a Statement on Vitamin B6 Toxicity, recommending that the maximum daily intake of B6 from dietary supplements should be 10 mg/day.
READMORE:http://www.bbc.co.uk/health/physical_health