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Sex after hysterectomy

Tue, 03 Jan 2012 11:21:00 GMT -

Sex after hysterectomy

Having a hysterectomy doesn’t mean the end of having sex. Find out how a hysterectomy might affect your sex life, how long you should wait before having sex again, and how to cope with issues such as vaginal dryness.

When you have a hysterectomy, you’ll be advised not to have sex for around four to six weeks. If you don’t feel ready after six weeks, don’t worry – different women feel ready at different times. It takes time to recover from any surgery, but having a hysterectomy can have a strong emotional impact too, which can affect how you feel about sex.

It’s worth bearing in mind that a study of 413 women in the Netherlands found that sexual wellbeing improved after hysterectomy, and that there was some reduction in sexual problems (such as pain) after the surgery. However, around 1 in 5 women developed new sexual problems after hysterectomy. If you experience problems with sex after your operation, don’t suffer in silence. There is help – you can talk to your GP, a counsellor or an organisation such as the Hysterectomy Association.

Feeling sexually attractive

A hysterectomy is the removal of the uterus (womb), and sometimes the ovaries, fallopian tubes or cervix as well. Which organs are removed will depend on your own circumstances, and why you’re having the hysterectomy. You can find out about the different types of hysterectomy.

Losing the uterus can make many women worry about feeling less womanly after their operation, or losing their sexual attractiveness. Many women also talk about feelings of loss or sadness after a hysterectomy. These feelings should pass. You may find it helps to focus on your recovery – eating healthily, getting some exercise (your doctor will tell you how much activity you should aim for) and talking to your partner or friends about how you’re feeling.

If you’re finding it hard to cope with these emotions, talk to your consultant or your GP. You may be able to have counselling to help you work through your feelings. You can find a counsellor near you.

It can also help to read about how other women have got through similar experiences. You can read about women’s experiences of hysterectomy at healthtalkonline.

Sex and menopause

Having your ovaries removed will trigger the menopause, whatever your age. The changing hormone levels during menopause can affect your sex life. Find out more about sex after menopause, and how to deal with any problems.

Sex drive

Some women have less interest in sex after having a hysterectomy. If this happens to you, your interest in sex may return in time as your recovery progresses. If you and your partner feel it’s a problem, try to talk about it together so that it doesn’t become an unspoken issue between you. You can also talk to your GP, or find a counsellor who can offer help with sexual problems. You can find out some tips from a psychosexual therapist on talking about sex.

Lack of sex drive can be made worse by depression, menopausal symptoms, relationship problems and stress. These problems are often temporary, but if symptoms of menopause or depression persist then see a doctor for treatment. Treating menopausal symptoms may boost your sex drive indirectly by improving your general wellbeing and energy levels.

Find out more about keeping the lust alive.

Sensation and orgasm

Having a hysterectomy doesn’t mean you can’t have an orgasm. You still have your clitoris and labia, which are highly sensitive. It’s not known what role the cervix may play in orgasm – some experts have argued that removing the cervix can have an adverse affect, but others have found that it doesn’t.

In a study comparing different surgical methods of hysterectomy, a number of women noticed reduced sexual sensation. This included reduced feeling when their partner penetrated their vagina, a dry vagina and less intense orgasms. If, before hysterectomy, you had noticeable uterine contractions during orgasm you may miss these afterwards.

If you find that your hysterectomy has made your vagina feel more dry than it used to, try using a sexual lubricant. You can buy these over the counter at a pharmacy.

Your surgeon will have advised you to do pelvic floor exercises to help your recovery. These exercises can also tone up the muscles of your vagina and help improve sexual sensation. You can find out more about pelvic floor exercises.

Other women in the surgical study pointed out that their hysterectomy had removed their pre-surgery symptoms (for example, heaving bleeding or pain), and they had a greater sense of wellbeing and happiness.

Further information

How hysterectomy is carried out

Recovering from hysterectomy

Heavy periods

Endometriosis

Menopause

Female sexual problems

Top 10 diets review

Tue, 20 Dec 2011 00:00:00 GMT -

Top 10 diets review

Internet searches for diets spike in January, but with so many options to choose from it can be hard to find a weight loss plan that’s right for you.

To help, the British Dietetic Association (BDA) here examines the pros and cons and gives its verdict on the 10 most searched-for commercial diets.

Many of the diets listed here are quick fixes and may not be sustainable or healthy in the long term. They could make your weight more likely to fluctuate or ‘yo-yo’. The key to losing weight and keeping it off is to reduce your calorie intake and be more active. Read Start losing weight for more information.

Dukan diet

The Dukan diet is a low-carbohydrate (carb), high-protein diet. There’s no limit to how much you can eat during the plan’s four phases, providing you stick to the rules of the plan. During phase one, you’re on a strict lean protein diet. This is based on a list of 72 reasonably low-fat protein-rich foods, such as chicken, turkey, eggs, fish and fat-free dairy. This is for an average of five days to achieve quick weight loss. Carbs are off limits except for a small amount of oat bran. Unlike the Atkins diet, Dukan’s phase one bans vegetables and seriously restricts fat. The next three phases of the plan see the gradual introduction of some fruit, veg and carbs and eventually all foods. The aim is gradual weight loss of up to 2lb a week and to promote long-term weight management. There’s no time limit to the final phase, which involves having a protein-only day once a week and taking regular exercise.

Pros:
You can lose weight very quickly, which can be motivating. It’s a very strict and prescriptive diet and some people like that. It’s easy to follow. You don’t need to weigh food or count calories. Apart from keeping to low-fat, low-salt and high-protein foods, there’s no restriction on how much you can eat during your first two weeks.

Cons:
At the start of the diet you may experience side effects such as bad breath, a dry mouth, tiredness, dizziness, insomnia and nausea from cutting out carbs. The lack of wholegrains, fruit and veg in the early stages of the diet could cause problems such as constipation.

BDA verdict:
Rapid weight loss can be motivating but it is unsustainable and unhealthy. The Dukan diet isn’t nutritionally balanced, which is acknowledged by the fact that you need a vitamin supplement and a fibre top up in the form of oat bran. There’s a danger this type of diet could increase your risk of long-term health problems if you don’t stick to the rules. The diet lacks variety in the initial phases so there’s a risk you’ll get bored quickly and give up.

Evidence shows that the best way to lose weight is to make long-term changes to how many calories you consume and how active you are. Aim to lose weight at around 0.5kg to 1kg a week (1lb to 2lb), until you achieve a healthy BMI.

Atkins diet

The Atkins diet is a low-carb, high-protein weight loss programme. You start with a low-carb diet designed for rapid weight loss. This lasts at least two weeks depending on your weight loss goal. During this phase, you’re on a protein, fat and very low-carb diet, including meat, seafood, eggs, cheese, some veg, butter and oils. In contrast to the Dukan diet, Atkins allows unlimited fat and some veg, such as peppers, cucumber and iceberg lettuce, during phase one. During the next three phases, the weight loss is likely to be more gradual, and regular exercise is encouraged. More carbs, fruit and veg are introduced to your diet with the aim of working out what your ideal carb intake is to maintain a healthy weight for life. Phase one is designed to help you lose up to 15lb in two weeks, reducing to 2lb to 3lb during phase two.

Pros:
You can lose weight very quickly, which can be motivating. The diet also encourages people to cut out most processed carbs and alcohol. With its diet of red meat, butter, cream, cheese and mayonnaise, it’s one of the few diets out there that appeals to men. 

Cons:
Initial side effects can include bad breath, a dry mouth, tiredness, dizziness, insomnia, nausea and constipation from cutting out carbs and fibre. The high intake of saturated fat may increase your risk of heart disease and there are concerns that a lack of fruit, veg and dairy products and a high protein intake may affect bone and kidney health in the long term.

BDA verdict:
Rapid weight loss can be motivating but it is unsustainable. The Atkins diet isn’t nutritionally balanced. By limiting fruit and veg it contradicts all the advice on healthy eating that we have tried so hard to pass on to people. The meal choices are limited so there’s a risk many people will get bored quickly and drop out or take a ‘pick and mix’ approach.

Cambridge diet

The Cambridge Weight Plans are based around buying and eating a range of meal-replacement products with the promise of rapid weight loss. There are six flexible diet plans ranging from 415kcal to 1,500kcal or more a day, depending on your weight loss goal. There is also a long-term weight management programme. The bars, soups, porridges and shakes can be used as your sole source of nutrition or together with low-calorie regular meals. While on the programme, you receive advice and support on healthy eating and exercise from a Cambridge adviser.

Pros:
Many people on very low-calorie diets (VLCDs) find the weight loss to be sudden and quite dramatic. The meal replacements are all nutritionally balanced so you're likely to be getting all the vitamins and minerals you need albeit not from real food.

Cons:
Initial side effects can include bad breath, a dry mouth, tiredness, dizziness, insomnia, nausea and constipation from cutting down on carbs and fibre. The hardest part of the plan is sticking to it. Giving up normal meals and swapping them for a snack bar or a shake can be boring and feel socially isolating. This isn’t a plan you can stick to in the long term.

BDA verdict:
You need to like the meal-replacement products to stay with the plan. Rapid weight loss can be motivating but it is unsustainable. A VLCD that involves eating 1,000 calories a day or fewer should not be followed for more than 12 continuous weeks. If you are eating fewer than 600 calories a day, you should have medical supervision.

South Beach Diet

The South Beach Diet is a low-GI diet originally developed for heart patients in the US. There’s no calorie counting and no limits on portions. You're encouraged to eat three meals and two snacks a day and follow an exercise plan. People who have more than 10lb to lose start with phase one. This is a two-week quick weight loss regime where you eat lean protein, including meat, fish and poultry, as well as some low-GI vegetables and unsaturated fats. Low-GI carbs are re-introduced during phases two and three, which encourage gradual and sustainable weight loss.

Pros:
If you can avoid phase one and start on phase two, there are fewer dietary restrictions in the rest of the plan than some other popular diets. After phase one, the diet broadly follows the basic principles of healthy eating. No major food groups are eliminated and plenty of fruit, veg and low-GI carbs are recommended.

Cons:
The severe dietary restrictions of phase one may leave you feeling weak and missing out on some vitamins, minerals and fibre. You may initially experience side effects such as bad breath, a dry mouth, tiredness, dizziness, insomnia, nausea and constipation.

BDA verdict:
The first two weeks are the most difficult to get through. We’re concerned that this diet promises such a large weight loss, up to 13lb, in the first two weeks. Although this won't be all fat. Some of this weight loss will include water and carbs - both of which will be replaced when you begin eating more normally. Once you get past the initial phase, the diet follows the basic principles of healthy eating and should provide the nutrients you need to stay healthy.

Slimming World diet

Slimming World’s weight loss plan encourages you to swap high-fat foods for low-fat foods that are naturally filling. You choose your food from a list of low-fat foods they call 'Free Foods', such as fruit, vegetables, pasta, potatoes, rice, lean meat, fish and eggs, which you can eat in unlimited amounts. There’s no calorie counting, no foods are banned and you’re still allowed the occasional treat. You can get support from fellow slimmers at weekly group meetings and follow an exercise plan to become gradually more active. The plan is designed to help you lose about 1lb to 2lb a week.

Pros:
No foods are banned so meals offer balance and variety and are family-friendly. The portion size from each food group will vary depending which plan you follow. The 'Body Magic' booklet they provide gives ideas to help you raise your activity levels. Meeting as a group can provide valuable support.

Cons:
Slimming World doesn’t educate you about calories. Without having learned about calories and portion sizes, you may struggle to keep the weight off in the long term when you come off the programme.

BDA verdict:
The group meetings encourage members to share successes, ideas and recipes with each other but they may not appeal to everyone. While the meal plans may lack some flexibility, they are generally balanced. However, without learning about calories and portion sizes, you may struggle to make healthy choices once you’ve left the programme.

Slim-Fast diet

The Slim-Fast diet is a low-calorie meal replacement plan for people with a BMI of 25 and over. It uses Slim-Fast’s range of products. The plan recommends three snacks a day from an extensive list, including crisps and chocolate, two meal replacement shakes or bars and one regular meal, taken from a list of recipes on the Slim-Fast website. You can stay on the diet for as long as you want depending on your weight loss goal. Once reached, you’re advised to have one meal replacement shake a day, up to two low-fat snacks and two healthy meals. The plan is designed to help you lose about 1lb to 2lb a week and you can follow the diet for as long as you want.

Pros:
Meal-replacement diets can be effective at helping some people to lose weight and keep it off. The plan is convenient as the products take the guesswork out of portion control and calorie counting. No foods are forbidden although you are encouraged to eat lean protein, fruit and vegetables.

Cons:
On their own, meal-replacement diets do little to educate people about their eating habits and change their behaviour. There’s a risk of putting the weight back on again once you stop using the products. You may find it hard to get your 5 a day of fruit and veg without careful planning.

BDA verdict:
If you don’t like the taste of the meal replacement products, you won't stay with the plan. The Slim-Fast plan can be useful to kickstart your weight loss regime, but it’s important that you make full use of the online support to learn about the principles of healthy eating and how to manage everyday food and drink.

LighterLife diet

The LighterLife weight loss plans combine a very low-calorie meal-replacement diet with weekly counselling. With LighterLife Total, for people with a BMI of 30 or more, you eat four 'food packs' a day, consisting of shakes, soups, mousses or bars, and no conventional food. LighterLife Lite, for those with a BMI of 25-30, involves eating three food packs a day plus one meal from a list of approved foods. You stay on the plans until you reach your target weight. The meal plans can lead to very rapid weight loss and you’re advised to see your GP before starting. How long you stay on the diet depends on how much weight you have to lose.

Pros:
The counselling can help you understand your relationship with food, so hopefully you can make lasting changes to keep the weight off for good. With the meal replacements, there’s no weighing or measuring, so it’s a hassle-free approach to weight loss.

Cons:
Initial side effects of the diet can include bad breath, a dry mouth, tiredness, dizziness, insomnia, nausea and constipation from cutting down on carbs and fibre. Surviving on a strict diet of shakes and soups and other meal replacements isn’t much fun and can feel socially isolating.

BDA verdict:
Rapid weight loss can be motivating but it is unsustainable. LighterLife’s VLCD and its counselling component may work for some, particularly people who have struggled to lose weight for years, have health problems as a result of their weight and are clinically obese with a BMI of more than 30. A VLCD that involves eating 1,000 calories a day or fewer should not be followed for more than 12 continuous weeks. If you are eating fewer than 600 calories a day, you should have medical supervision.

WeightWatchers diet

The WeightWatchers plan is based on the ProPoints system, which gives a value to foods and drink based on protein, carbs, fat and fibre content. It is essentially a calorie-controlled diet where you get a personal daily ProPoints allowance, which you can use how you like. There’s no limit on the amount of fruit and most veg you can eat. You also get a weekly ProPoints safety net in case you go over your allowance, and an individual exercise plan. The weekly meetings and confidential weigh-ins provide support and extra motivation to encourage long-term behaviour change. The plan is designed to help you lose up to 2lb a week.

Pros:
No foods are banned so you can eat and drink what you want providing you stick to your points allowance. The ProPoints system is easier to follow for some than calorie-counting and less restrictive than other plans. This is because it introduces a safety net of points, which can be saved up for a special occasion, such as a night out, a small amount of alcohol or treats.

Cons:
When you begin, working out the points system can be just as time consuming as simply counting calories. Some people feel pressured into purchasing WeightWatchers branded foods.

BDA verdict:
The ProPoints plan is generally well balanced and can be a foundation for long-term changes in dietary habits. The support group approach can help keep people motivated and educate them about healthy eating. But it’s vital that you make the connection between the points system and calories if you want to avoid putting the weight back on once you leave the programme.

Rosemary Conley diet

Rosemary Conley’s Diet and Fitness plans combine a low-fat, low-GI diet with regular exercise. You can follow her recipes or buy from her range of calorie-controlled ready meals and snacks. You’re encouraged to eat food with 5% or less fat, with the exception of oily fish, porridge oats and lean meat. A network of local Rosemary Conley clubs offers weekly exercise classes, support and motivation. You learn about calorie counting and portion size, which can help you sustain your weight loss beyond the programme. The diet is designed to help you lose a stone in seven weeks. How long you stay on the plan depends on your weight loss goal. 

Pros:
The programme is based around calories, with a focus on cutting fat. The 'portion pots', which are used to measure foods such as rice, cereal, pasta and baked beans, teach you about portion control. Physical activity is an integral part of the weight loss plan, with exercise sessions suitable for all ages, sizes and abilities offered at their weekly classes with trained leaders.

Cons:
Some low-fat products aren't necessarily more healthy because they can still be high in sugar and calories. It is unrealistic to expect people to go out with their portion pots and, therefore, portion control may be more tricky away from the home.

BDA verdict:
The diet and exercise plans offer a balanced approach to weight loss that teaches you about portion size, the importance of regular exercise for weight management and making healthier choices. The educational element is very useful for long-term weight management once you have left the programme.

Jenny Craig diet

The Jenny Craig programme has three main features: one-to-one support, a meal delivery service and tailored exercise plans. The weekly, personalised telephone consultations provide advice, motivation and support. The diet adviser assesses your reasons for gaining weight and, over the course of the programme, helps you to change your behaviour. The meals and snacks are packed into single-sized portions to suit your weight-loss needs. You need to add certain fresh fruits, veg and low-fat dairy products. The programme is designed to help you lose between 1lb and 2lb a week until you reach your target weight.

Pros:
All the meals, including snacks, are calorie-counted, portion-controlled and delivered to your door. You eat real food, receive telephone support and learn about portion size, calories and exercise, which can all help you make healthier choices beyond the programme.

Cons:
The meals don’t contain fruit, veg or dairy, which will be an additional expense. This isn’t an approach that you can stick to in the long term so it’s vital to learn how to prepare or choose healthy food yourself rather than relying on someone else.

BDA verdict:
If you don’t like the Jenny Craig meals then this diet won’t work for you. If you want a diet where most of the work is done for you then the Jenny Craig programme can be a good solution. The concern with pre-packaged meals is whether dieters will realise there is no magic trick and be able to replicate the meals, with the same portion sizes and calories, once they are on their own.

10 myths about stop smoking treatments

Mon, 12 Dec 2011 10:09:00 GMT -

10 myths about stop smoking treatments

There are many myths and misconceptions surrounding stop smoking medicines such as nicotine replacement therapy (NRT) and prescription tablets. Here are 10 common myths, and the truth behind them.

Types of NRT:

• patches
• gum
• mouth spray
• nasal spray
• lozenges
• microtabs - tablets you put under your tongue which dissolve and release nicotine 
• inhalator - a plastic mouthpiece plus nicotine cartridges that you draw on like a cigarette, releasing nicotine vapour into your mouth and throat (not lungs) 

Quitting smoking isn’t easy. But a growing number of stop smoking medicines make it easier than ever for you to break your addiction to nicotine.

The three types of NHS-endorsed stop smoking aids available to help you quit are:

• nicotine replacement therapy (including patches, gum, lozenges, microtabs, inhalators and mouth and nasal sprays)
• Champix (varenicline) tablets
• Zyban (bupropion) tablets

An NHS stop smoking adviser can help you find the medication that suits you, but you can try them in any order and sometimes more than one product can be used at the same time. They are generally used for 12 weeks, with the option of using them for longer if you need to.

Read more about stop smoking treatments.

1. MYTH: Stop smoking treatments don’t really work

THE FACTS: Research suggests that nicotine replacement therapies and the prescription stop smoking tablets (Champix and Zyban) can double and sometimes even triple your chances of successfully quitting.

All stop smoking treatments work best when used as part of a programme that includes:

• setting a quit date
• having a plan for dealing with things that make you reach for a cigarette
• getting support from a doctor or trained stop smoking adviser

Read more about how the NHS Stop Smoking Service can help you quit.

2. MYTH: Nicotine therapy causes cancer

THE FACTS: This is wrong. Nicotine doesn’t cause cancer. It’s the other toxic chemicals in cigarettes, such as tar and carbon monoxide, that damage your health. Nicotine replacement therapy gets nicotine into your body without the dangerous poisons.

3. MYTH: It's dangerous to use more than one nicotine replacement product at a time

THE FACTS: No, it isn’t. In fact, using more than one product at a time – known as combination therapy – can be a good thing as it often increases your chances of success. A popular strategy is to use nicotine patches to reduce everyday cravings plus a nasal spray, gum, lozenges, inhalator or mouth spray for sudden cravings.

Read more about how to cope with cravings.

4. MYTH: Champix will make me feel depressed

THE FACTS: Champix has been linked with occasional reports of depression and even suicidal thoughts. However, it’s not clear whether these side effects were due to the medicine or quitting smoking, and for most people it’s perfectly safe.

Talk over any concerns with your doctor or NHS stop smoking adviser beforehand, especially if you’ve had depression or another mental illness before. Be aware of your moods while you’re taking the tablets and tell your doctor if you notice any change.

5. MYTH: Nicotine replacement therapy is expensive

THE FACTS: You can get NRT either free, or on prescription at a cost of £7.20 each week, from your local NHS Stop Smoking Service or your GP. That’s up to a third cheaper than buying your patches or gum from the pharmacy and is a lot cheaper than continuing to smoke.

As with a lot of medication, it’s important to complete the full course, in this case to make sure you’re properly weaned off nicotine.

Zyban and Champix are nicotine-free pills you take to reduce your craving for tobacco and help with withdrawal symptoms. In studies, Champix has been shown to work better than Zyban.

6. MYTH: Stop smoking treatments will cure me

THE FACTS: NRT and prescription medicines are not a miracle cure. They reduce cravings and withdrawal symptoms but they don’t make them go away completely.

You will still need to put a lot of effort into quitting but, as thousands of ex-smokers will testify, the medications really help.

7. MYTH: I can’t use stop smoking treatments if I’m pregnant

THE FACTS: If you’re pregnant, it’s a great time to quit as smoking is much more dangerous to you and your baby.

Talk to your stop smoking adviser or midwife about your treatment options as the prescription tablets Champix and Zyban are not recommended in pregnancy. However, NRT products such as patches, gum, lozenges, microtabs, the inhalator and nasal sprays may be recommended if you're finding it hard to quit.

You can also call the NHS Pregnancy Smoking Helpline on 0800 169 9 169. 

Read about stopping smoking in pregnancy.

8. MYTH: I’ve had a heart attack so I can’t use NRT

THE FACTS: Nicotine replacement therapy has been shown to be safe in most people with heart disease. However, because nicotine can increase your heart rate and blood pressure, it’s a good idea to talk to your doctor before using nicotine replacement products if you’ve had a heart attack or if you have serious heart problems, such as an irregular or rapid heartbeat (arrhythmia) or chest pain (angina).

9. MYTH: Nicotine replacement products are as addictive as smoking

THE FACTS: Most people using nicotine products do not become dependent on them. In fact, the biggest problem with NRT is that people don't use enough of it for long enough. The nicotine from patches, gum and so on is released into your system much more slowly and in a different way than nicotine from a cigarette. Your body absorbs it more slowly and less reaches your brain.

10. MYTH: I shouldn't take Zyban because it causes seizures

THE FACTS: There is a very small risk of having seizures (fits) when using Zyban. The risk increases if you’ve had seizures in the past. Therefore, it isn’t recommended for anyone with a condition such as epilepsy.

NHS stop smoking advisers help you quit

Tue, 06 Dec 2011 12:47:00 GMT -

NHS stop smoking advisers help you quit

NHS stop smoking advisers are free, friendly and flexible and can massively boost your chances of quitting for good.

Find your local NHS Stop Smoking Service in:

England

Scotland

Wales

Northern Ireland

Did you know that wherever you live in the UK, you have easy access to a free service that’s proven to help you stop smoking?

The NHS Stop Smoking Service is a national network of advisers who are trained to help you quit. They will give you accurate information and advice on how to quit, and give you professional support during the first few weeks after you have stopped smoking. 

They also make it easy and affordable for you to get stop smoking treatment, such as Champix (varenicline) or Zyban (bupropion) if it’s suitable for you, or nicotine replacement therapy such as patches and gum.

You will normally be offered a one-to-one appointment with an adviser, but many areas also offer group and drop-in services as well. Depending on where you live, the venue could be a local GP surgery, pharmacy, high street shop or even a mobile bus clinic.

Jennifer Percival, who trains NHS stop smoking advisers, says that a combination of support and treatment is proven to give you the best chance of stopping smoking.

“The majority of people who see an adviser will get through the first month after quitting without smoking a cigarette. And overall, you’re up to four times more likely to stop smoking for good if you receive help from an NHS Stop Smoking Service,” she says.

How to contact a stop smoking adviser

Your GP can refer you, or you can phone your local NHS Stop Smoking Service to make an appointment with an adviser:

In England

• Find stop smoking services in England.
• Call the free NHS Smokefree Helpline on 0800 022 4332.

In Scotland

• Find stop smoking services in Scotland. 
• Call the free Smokeline on 0800 84 84 84. 

In Wales

• Call the free Stop Smoking Wales Helpline on 0800 085 2219.

In Northern Ireland

• Call the free Smokers’ Helpline on 0800 85 85 85.

What happens at the first stop smoking session?

At your first meeting with an adviser, you’ll talk about why you smoke and why you want to quit, as well as any past attempts to quit that you've made. You'll also be able to decide on a quit date.

You’ll be offered a breath test which shows the level of carbon monoxide (a poisonous gas in cigarette smoke) in your body. 

“You don’t need to be sure you want to quit or have a quit plan in mind before this meeting,” says Jennifer. “You can use the time to talk your situation through with the adviser without making a commitment. If you do decide to quit, the adviser can help you form an action plan and set a quit date, usually in a week or so.”

Stop smoking aids

At your first session, you’ll also discuss NHS-endorsed treatments available to help you stop smoking. These are nicotine replacement therapy – including patches, gum, lozenges, microtabs, inhalators and mouth and nasal sprays – and the stop smoking tablets Champix (varenicline) and Zyban (bupropion).

“No one is forced to use treatment,” says Jennifer, “but we will encourage it because the results are better. All the treatments we recommend can double your chances of quitting.

“We can help you decide which type of treatment is right for you and how to use it. In some cases, we can directly supply you with the treatment before you leave, or we can arrange for you to receive a prescription or a voucher for it. In the case of nicotine replacement therapy, it often works out at least a third cheaper than buying it from a pharmacy.”

She points out that NHS advisers only provide evidence-based treatments. “We won’t suggest or recommend hypnosis or acupuncture as there’s not enough evidence they help you stop smoking.”

Read more about stop smoking treatments.

Preventing relapse

As a general rule, you will have weekly face-to-face or phone contact with your adviser for the first four weeks after you quit smoking, then less frequently for a further eight weeks.

At each meeting, you’ll receive a supply of treatment or a prescription for it, and have your carbon monoxide level measured. You’ll have an emergency number for out-of-hours times when you crave a cigarette and want help to avoid lighting up.

“Going on the 12-week programme requires you to commit to not having a single puff of a cigarette,” says Jennifer. “Measuring carbon monoxide levels is not about checking up on you. It’s more to motivate you to stay smokefree by showing how you body is already recovering."

NHS stop smoking advisers are also very experienced in helping you identify difficult situations when there may be a strong temptation to relapse and start smoking. And they can help you come up with ways to cope with or avoid these situations. 

“If you do relapse, we won’t judge or nag you or take it personally. We’re a friendly face that understands how difficult it is to quit, and we’ll help you get back on track to becoming a non-smoker," says Jennifer.

Find out how to cope with cravings.

Common quit smoking questions

Read the answers to common questions about stopping smoking, including: 

• Why should I stop smoking if I’m pregnant?
• Who can use nicotine replacement therapy?
• Where can I get help to stop smoking?

Get tested for HIV if you think you've been at risk

Tue, 29 Nov 2011 14:41:00 GMT -

Get tested for HIV if you think you've been at risk

If you’re worried you could have HIV, get tested now. The sooner you are diagnosed, the better your chances of staying healthy and living a normal life span. Find out why and how to get an HIV test.

Getting tested for HIV means that, if you’re HIV positive, you can start your treatment before the infection causes too much damage to your body and health. This is known as ‘early diagnosis’.

Why to get tested

It’s important to get tested because someone with undiagnosed HIV can look and feel healthy for years, but the infection will be damaging their health. They can also pass the infection on to others.

Jason Warriner, clinical director at HIV charity the Terrence Higgins Trust (THT), says: “If the infection is diagnosed early, when a person is fit and well, and they get treatment and care, we’re looking at normal life expectancy. But they’ve got to be getting treatment and care, and it’s got to start early.”

It’s estimated that 91,500 people in the UK have HIV, and around 1 in 4 of these people (22,000 in total) don’t know they have it.

HIV is passed on via bodily fluids (such as blood, semen or vaginal fluid), for example during sex without a condom, or through sharing needles to inject drugs. Find out more about getting HIV.

Early diagnosis and treatment

Once HIV is in a person’s body, it infects and destroys cells (called CD4 cells) in the blood. CD4 cells are responsible for fighting infection, and are vital for your immune system.

If you know you have HIV, doctors can regularly test your blood to see how your immune system is doing. The tests measure the number of CD4 cells in your blood (your CD4 count), and the amount of HIV in your blood (the viral load).

Your doctor will know when it’s best for you to start HIV treatment, which is usually given as a combination of tablets. Starting treatment can raise your CD4 count and lower your viral load.

“We try to get people started on treatment when their CD4 count is 350,” says Warriner. A healthy adult who doesn’t have HIV can have a CD4 count of between 600 and 1,200. “When the CD4 gets down to 200, opportunistic infections can start, such as TB, oral candida, Kaposi’s sarcoma (KS) and pneumonia.”

Why late diagnosis is serious

If you have HIV and it isn’t treated, the HIV will eventually damage your immune system so much that you are likely to develop a serious, life-threatening condition, such as pneumonia. It typically takes about 5 to 10 years for the virus to damage the immune system in this way.

If you’re diagnosed with HIV at this stage (known as ‘late diagnosis’), antiretroviral drug treatment will work. However, your overall prognosis (your health outlook) may be affected. In 2009, half of adults diagnosed with HIV were diagnosed late.

 “The vast majority of people who die from HIV are those who are diagnosed late,” says Warriner. “When people aren’t diagnosed with HIV until they present late, at A&E or their GP, with symptoms of a serious infection, then that can affect their prognosis.”

Getting an HIV test

The only way to know whether you have HIV is to have an HIV test. You may feel worried about getting tested, but if you do have HIV, the sooner you find out, the better.

You can get tested at: 

• sexual health clinics or genitourinary medicine (GUM) clinics at hospitals (find sexual health services near you)
• your GP surgery (ask your doctor or practice nurse whether your surgery offers HIV testing) 
• some contraception and young people’s clinics  
• Fastest clinics, which are rapid testing clinics run by THT
• a private clinic  
• an antenatal clinic, if you are pregnant 
• local drugs agencies, if you are an injecting drug user

It is up to you to choose where you would feel most comfortable being tested.

Prevent HIV

You can protect yourself against HIV by using a condom every time you have vaginal, anal or oral sex. This will also help prevent you passing on the infection if you have it.

Find out more about:

• HIV symptoms
• HIV test
• HIV treatment
• Coping with a positive diagnosis
• Living with HIV 

 

Foot problems and the podiatrist

Fri, 11 Nov 2011 14:14:00 GMT -

Foot problems and the podiatrist

A podiatrist or chiropodist can help you with common foot problems, including ingrown toenails and bunions.

What does a podiatrist do?

Podiatrists can be thought of as a type of foot doctor. They can give you and your family advice on how to look after your feet and what type of shoes to wear. They can also treat and alleviate day-to-day foot problems including:

• toenail problems such as thickened, fungal or ingrown toenails
• corns and calluses
• verrucas
• athlete's foot
• smelly feet
• dry and cracked heels
• flat feet
• bunions

How can a podiatrist help?

You may want to see a podiatrist for advice and treatment if you have painful feet, thickened or discoloured toenails, cracks or cuts in the skin, growths such as warts, scaling or peeling on the soles or any other foot-related problem.

Podiatrists can also supply orthotics, which are tailor-made insoles, padding and arch supports to relieve arch or heel pain. You put the orthotic device into your shoe to re-align your foot, take pressure off vulnerable areas of your foot or simply to make your shoes more comfortable.

Even if your feet are generally in good condition, you might consider having a single session of podiatry to have the hard skin on your feet removed, toenails clipped, to find out if you’re wearing the right shoes (take your shoes with you for specific advice on footwear) or just to check that you’re looking after your feet properly.

What’s the difference between a podiatrist and a chiropodist?

There’s no difference between a podiatrist and chiropodist, but podiatrist is a more modern name.

What happens at the consultation?

At every consultation, the podiatrist will cut your toenails, remove any hard skin and check your feet for other minor problems such as corns, calluses or verrucas. Usually, any minor problems that are picked up can be treated on the spot. It’s usually completely painless (even pleasant) and takes between 30 and 60 minutes.

Can I get podiatry on the NHS?

Yes, you can. If you want NHS podiatry treatment, the first step is to see your GP, practice nurse or health visitor. They can refer you to an NHS podiatrist if you qualify for free treatment.

Podiatry is available on the NHS free of charge in most parts of the UK, although availability will vary from region to region.

Each case is assessed individually. This means that whether or not you receive free treatment will depend on how serious your condition is and how quickly it needs to be treated.

If you have diabetes, arthritis or blood circulation problems, you’ll be given priority for NHS treatment by a chiropodist or podiatrist. Otherwise, you’ll be put on a waiting list.

If your condition is not affecting your health or mobility – such as a verruca that looks ugly but doesn’t hurt when you walk – you probably won’t be eligible for NHS podiatry.

Can I see a podiatrist at home?

If your foot problems are so bad that you find it difficult to walk, it may be possible to arrange for a chiropodist to come to your home. Tell your GP if you need to have a home visit and they should be able to find you a suitable chiropodist or podiatrist.

Can I see a podiatrist privately?

If free NHS treatment isn’t available, your GP can still refer you to a local clinic for private treatment, but you will have to pay.

You can also book an appointment with a podiatrist directly, without a GP’s referral.

You can use The Society of Chiropodists & Podiatrists' website to find a local podiatrist or chiropodist.

How can I make sure the podiatrist is qualified?

Anyone who calls themselves a podiatrist or chiropodist must register with the Health Professions Council (HPC).

Go to the HPC website to check if your podiatrist or chiropodist is registered.

It’s also worth checking that they are a member of one of the following organisations:

• The Society of Chiropodists and Podiatrists
• The Institute of Chiropodists and Podiatrists
• British Chiropody and Podiatry Association

How much does private podiatry cost?

Private fees can vary depending on where you live and the podiatrist’s experience. Ring a few local podiatry clinics to check their prices.

"Being a mentor was an amazing experience"

Tue, 25 Oct 2011 14:28:00 GMT -

"Being a mentor was an amazing experience"

Karen, 42, volunteered for Kids Company as a mentor for 18 months, working with a six-year-old boy from a disadvantaged background in London.

“I decided to volunteer because I saw a lot of children and young people in my neighbourhood who were missing out, through no fault of their own. I felt that I was in a good place in my life, and that I had experiences that I could share to make a positive contribution and help somebody.

"I’d heard of a local charity called Kids Company, that works with vulnerable inner-city children. The focus of the charity is entirely on the child, and aims to give them ways of leading more positive and fulfilling lives.

"The volunteer mentors help children and young people to achieve goals, build confidence and self-esteem and have some fun. Sometimes that increase in confidence comes from you encouraging them to have a go at an activity that they fancy trying but feel a bit shy about, like dancing, or a sport. Once they do it, they can gain a real sense of achievement.

"Sometimes it’s the fact that you spend one-to-one time with them, doing things that are completely focused on the child. These children may have a parent or carer that isn’t able to provide as much of that one-to-one time as they want to, for all sorts of reasons, and that’s why the mentors have such a valuable role.”

Getting started

“Once I’d approached the charity and they’d accepted my application, I had an interview, a CRB (Criminal Records Bureau) check and then two days’ group training. One day was spent learning some psychology theory, and another day with a psychologist and other potential mentors, where we talked about our life experiences and what we could bring to a mentoring relationship.

"We practiced scenarios, doing role plays, applying what we know to different situations, and then getting practical advice on what to do if your mentee, or their parent or guardian, acts in a certain way. Mostly this was about learning to deal with difficult behaviour, in case it should arise. So, for example, how to talk to your mentee if they behave in a challenging way. It helps you to be prepared. We also attended ongoing group counselling sessions, to talk about any difficulties we may be having.” 

Being a mentor

“My mentee was six when I first met him. He’s a lovely boy, very polite, funny and lively. He loves football, so I wanted to find out a lot about it. He was always impressed if I could say which club a certain footballer played for, or talked to him about his football cards. It helped to build a relationship and a rapport with him.

"My role was described by the charity as a skilled helper; you don’t try to be another parent or a social worker. My time with him was about taking him out, and letting him enjoy himself, and offer him some fun. We had a lot of trips out; we went to the beach by train, we spent an afternoon at London Zoo, and I took him to the Maritime Museum. But, most of all he enjoyed physical activities, like playing football in the park, going to an adventure playground, and swimming.

"I gradually introduced some interesting facts and topics of conversation, found out what he enjoyed at school, and encouraged him to do a bit of reading. My aim was to stimulate his thinking and build on his interests.

"For the mentors that work with older children, teenagers and young people, it’s more about helping them with life skills. So mentors can explain what they do for a living, and maybe use this as an opportunity to help the mentees find out what they might enjoy doing as a job, and find their place in life.

"I spent four hours with my mentee every other weekend. We were asked to spend a minumim of an hour a week, but you have to think about what would be beneficial for the mentee, and to make sure you have enough time to gain their trust and build up a bit of a rapport, as well as time to do an activity together.

"Mentors had to complete paperwork after every session, which included a brief run-through of what we’d done, some observations about the child, what they seemed to enjoy, and so on. Plus, we would have to alert the charity if there was an issue we were concerned about, for instance if we felt that the child’s safety was at risk.

"The charity asks that you commit to a child for a minimum of six months, and I did it for 18 months. I felt as though we covered a lot of ground in that time, which was great for both of us.”

I’d recommend it to anyone

“Mentoring is one of the best things I’ve ever done. You shouldn’t expect to get a thank you as such, but it’s a really rewarding experience; it had a great feelgood factor. Being able to connect with my mentee felt like such an achievement, and making a positive impact on his life gave me a real sense of purpose.

"I learnt a lot about myself through this experience, too. It taught me that my assumptions about life weren’t always right, and that you never really know what people’s circumstances are until you get to know them. I try not to judge people so much.

"I would recommend mentoring to anyone. Everybody has some experience they could share with someone else, and it can be a meaningful exchange for both sides. I was surprised to find that all sorts of people, from every background and all ages, enjoy mentoring. I definitely plan to be a mentor again in the future.”

Teeth whitening

Fri, 21 Oct 2011 13:39:00 GMT -

Teeth whitening

More and more people are paying for brighter, whiter teeth. But does teeth whitening work and is it safe? Here are the answers to common questions about the treatment.

What is teeth whitening?

Teeth whitening involves bleaching your teeth to make them lighter. Teeth whitening can’t make your teeth brilliant white, but it can lighten the existing colour by several shades.

Who can perform teeth whitening?

The General Dental Council, the organisation that regulates dental professionals in the UK, has decided that teeth whitening is a form of dentistry. This means that you should only have your teeth whitened by a dentist or another dental professional, such as a dental hygienist or dental therapist, on the prescription of a dentist.

Some beauty salons offer teeth whitening, but this is illegal if there's no dental professional present, and it may put your oral health at risk.

You can also buy DIY home teeth whitening kits but these may also carry risks.

What happens during teeth whitening at the dentist?

If you have teeth whitening you will need to make several visits to the dental surgery over a couple of months.

The dentist will take an impression of your teeth to make a mouthguard and will instruct you how to use it with a bleaching gel. Then, using your mouthguard at home, you regularly apply the gel for a specified period of time over two to four weeks. Some whitening gels can be left on for up to eight hours at a time, which shortens the treatment period to one week.

Another type of teeth whitening system that a dentist can provide is called laser whitening, which is also known as power whitening. This is where a bleaching product is painted onto your teeth and then a light or laser is shone on them to activate the whitening. Laser whitening takes about an hour.

Can any dentist whiten teeth?

Yes, provided they are registered with the General Dental Council. Registered dental therapists and dental hygienists can also carry out teeth whitening on the prescription of a dentist.

To find out if a dental professional is registered with the GDC you can check online or call 0845 222 4141.

What about home kits and beauty salons for teeth whitening?

As a result of the General Dental Council's decision, you should only go to a registered dental professional for teeth whitening because whitening by people who aren't qualified, for example in beauty salons, is illegal. Home kits also carry risks.

What are the risks of home kits and salon teeth whitening?

Some home kits don’t contain enough of the whitening product to be effective. More generally, if a dental professional is not doing the whitening, the mouthguard provided may not fit properly so some of the bleaching gel may leak out onto your gums and into your mouth, causing blistering and sensitivity.

Where teeth whitening is carried out in beauty salons by staff without any training or dental qualifications it not only carries a risk to your oral health, but is also illegal.

Can you have your teeth whitened on the NHS?

You can only have your teeth whitened on the NHS if there's a medical reason for it. For example, this might be to lighten teeth that have discoloured because the nerve has died.

Otherwise, teeth whitening by a dentist or other dental professional can only be done privately because it’s considered to be a cosmetic treatment. Costs vary and, as a general rule, laser whitening is more expensive than professional bleaching.

Find out which dental treatments are available on the NHS.

How do you go about getting teeth whitening?

Your dentist will advise you whether whitening is right for you. It may be that teeth whitening isn’t suitable, for example if you have gum disease or crowns.

Find your nearest dentist here.

What questions should I ask the dentist before going ahead?

Don’t be afraid to ask simple questions about the types of whitening treatment available, what results you can expect and whether the work is guaranteed for a certain amount of time. Also, ask them what they consider to be the risks in your particular case, for example increasing sensitivity of the teeth.

Try to talk to other people who have had the same treatment or visit another dentist for a second opinion until you feel confident. Always ask for a written treatment plan and price estimate before going ahead.

Is teeth whitening permanent?

No, teeth whitening isn’t permanent. It can last from a few months to up to three years, but this varies from person to person. Generally, the whitening effect won’t last as long if you smoke or drink red wine, tea or coffee, which can all stain your teeth.

Will teeth whitening work on false teeth?

No. Teeth whitening won’t work on dentures, crowns, fillings or veneers.

What are the risks of teeth whitening?

No matter what treatment you use, there is a chance your gums can be sensitive to the chemicals used in teeth whitening, especially if you already have sensitive teeth. There’s also a chance of burns to gums and some of the whitening kits used at home can harm tooth enamel.

What if I’m not happy with the results?

If you’re concerned that teeth whitening by a dental professional has harmed you, contact the Dental Complaints Service on 08456 120540. This is an expert, free and independent service that can help if you have a complaint about private dental care.

If you think your teeth whitening has been carried out illegally (that is, by someone not qualified or registered to perform it) contact the General Dental Council on 0845 222 4141 or email illegalpractice@gdc-uk.org. 

Read more about how to look after your teeth.

'Cystic fibrosis won't stop me singing'

Thu, 13 Oct 2011 11:08:00 GMT -

'Cystic fibrosis won't stop me singing'

Despite having a serious health condition, 22-year-old Bianca Nicholas has recorded her first single and dreams of becoming a professional recording artist.

What is cystic fibrosis?

• Cystic fibrosis (CF) is one of the UK’s most common life-threatening inherited diseases.
• Cystic fibrosis affects more than 9,000 people in the UK.
• The disease affects the internal organs, especially the lungs and digestive system, by clogging them with thick, sticky mucus. This makes it hard to breathe and digest food.
• There is no cure for CF, but there are therapies and medicines to make it easier to live with the condition.

Thousands of young women in the UK dream of becoming pop stars, but few have a serious illness to contend with on top of their musical commitments.

Bianca Nicholas from Beckenham in Kent has sung a duet with Will Young and performed for Prince William and Prince Harry and the Duchess of Cambridge. She’s just launched her debut single, Hold On To Your Dreams.

Bianca also has cystic fibrosis, an inherited disease which causes the internal organs, especially the lungs and digestive system, to become clogged with thick, sticky mucus. Symptoms of cystic fibrosis include a troublesome cough, repeated chest infections, digestion problems and poor weight gain.

The illness requires rigorous physiotherapy and medication. Each day, Bianca has to spend up to 20 minutes doing breathing exercises and takes between 30 and 40 tablets as well as using nebulisers and inhalers. She also has to inject herself each morning with growth hormone.

But she hasn’t allowed her illness to blight her passion for music. “My therapies and treatments are time-consuming and sometimes my illness get me down, but I find that singing really lifts my mood and cheers me up,” she says.

Bianca’s musical career started when, at 15, she was granted a wish by Starlight Children’s Foundation, a national charity that brightens the lives of seriously and terminally ill children by granting them once-in-a-lifetime wishes and providing entertainment in hospitals and hospices. Starlight arranged for Bianca to go to a top recording studio in London and record a number of cover singles for a special CD.

Bianca has gone on to sing live at many Cystic Fibrosis Trust and Starlight events over the last seven years, including the recent Boodles Boxing Ball where she launched her single by singing live in front of 850 high-profile guests, including Pippa Middleton and former Spice Girl Geri Halliwell.

As well as boosting her confidence, Bianca believes her singing has also improved her physical health.

One of the many effects of cystic fibrosis is that breathing is very difficult because of sticky mucus in the lungs. Bianca thinks that her singing helps to keep her lungs clear. 

“I used to need to have my chest pummelled each morning to clear the mucus, but since I’ve been singing, my lungs have been clearer, and I generally only need to do breathing exercises. Singing is a type of deep breathing exercise and I feel it helps to strengthen my lungs, which in turn seems to help my condition.

“Having cystic fibrosis has never stopped me from trying to realise my dreams. I feel so lucky that the one thing I love doing more than anything else, singing, is keeping me healthy too.”

Why most of us should eat fewer calories

Wed, 12 Oct 2011 14:56:00 GMT -

Why most of us should eat fewer calories

Many of us are eating too much, and not being active enough. That’s why nearly two thirds of the adult population in England is overweight or obese.

Find out how much you should be eating, and how to cut the calories.

• How much should you eat?
• How much are you eating?
• How you can eat less
• Get more active

The latest research shows that in England over 60% of adults are overweight or obese. That means many of us are eating more than we need, and need to eat less.

Over time, consuming more calories than we need leads to weight gain, and carrying excess weight puts us at greater risk of a whole range of serious health problems

And it’s not just food we need to cut down on: some drinks can also be high in calories.

When we eat and drink more calories than we need, our bodies store the excess as body fat. If this continues over time we become overweight, and can become obese. Being overweight or obese causes an increased risk of type 2 diabetes, heart disease, stroke and some cancers.

Most adults need to lose weight, and to do this they need to eat and drink fewer calories. Combining these changes with increased physical activity is the best way to achieve a healthier weight.

You can find out whether you are a healthy weight by using our Healthy weight calculator.

How much should you eat?

The amount that you need to eat to maintain your body weight depends on a range of factors, including your size and how physically active you are.

As a guide the average man needs around 2,500 calories a day to maintain a healthy body weight, and the average woman needs around 2,000 calories a day.

Remember, if you are very physically active because of the type of job you do, or you are a professional athlete, you may need more calories than this to maintain a healthy weight. If you do very little physical activity – for example, you are housebound – or if you are overweight or obese, you may need fewer calories.

An important part of a healthy diet is eating the right amount of calories, so that you balance the energy you put into your body with the energy you use.

If you need to lose weight, aim to lose about 0.5-1kg (1-2Ib) a week until you reach a healthy weight for your height. You should be able to lose this amount if you eat and drink about 500 to 600 calories fewer a day than you need.

A healthy diet is not only about eating the right amount. It also means eating a wide range of foods, to ensure you get all the nutrients you need. You can still eat less when following a balanced diet. Learn more about a balanced diet in The eatwell plate.

How much are you eating?

Most of us are eating and drinking more than we need, and we often think we are more active than we actually are, too.

It is estimated that the average person eats around 10% more calories than they need every day. This might not sound much, but over time it will cause significant weight gain. 

Foods and drinks that are high in fat or sugar contain lots of calories, and eating or drinking these often or in large amounts can make it easy to have more calories than you need.

If you are overweight or obese, you could be eating over 500 calories more than a person of a healthy weight does every day. So it’s time to think about where your extra calories are coming from, and to make changes to your diet to reduce the number of calories you consume. 

It is likely that it’s not just one snack, meal or drink that you need to change: you are likely to be having more calories than you need across the whole day.

As a guide, the average man needs around 2,500 calories a day to maintain a healthy body weight, and the average woman needs around 2,000 calories a day

How you can eat less

You can reduce the number of calories you eat by making healthier choices when it comes to food and drink.

Often, that will mean swapping high fat or high-sugar foods for alternatives that contain fewer calories, or eating these foods in smaller portions or less often.

And it’s not just foods: drinks can be high in calories, too. To consume fewer calories you should choose drinks that are lower in fat and sugar or consume high-calorie drinks less often. Don't forget alcohol is also high in calories.

As well as choosing foods and drinks lower in fat and sugars, also think about reducing the size of your portions. Research suggests that we tend to eat more when we are served more, even when we don’t need the extra calories.

When serving yourself at home resist filling your plate, and think about if you are really hungry before having an extra helping. When eating out, avoid supersizing or choosing large portions of food or drink.

Knowing the calorie content of different foods and drinks can be useful when it comes to achieving or maintaining a healthy weight. It can help us to keep track of the amount of energy we put into our bodies, and ensure that we are not eating too much.

The calorie content of many foods and drinks is provided on the packaging as part of the nutrition label. You can look at the calorie figure to assess how a particular food or drink fits into your daily intake. Find out more in Understanding calories.

These tips can help you to get started:

• Swap sugary fizzy drinks for diet versions with low or no calories. Even better, swap some soft drinks for sparkling water with a slice of lemon.
• Swap the frying pan for the grill when cooking meat, you don’t need to add any oil.
• Swap creamy or cheesy sauces for tomato or vegetable-based sauces on your pasta, or meat and fish dishes.
• Choose wholegrains, including wholemeal and wholegrain bread, or wholegrain breakfast cereals. Wholegrain foods contain more fibre and other nutrients, and we digest wholegrain foods more slowly so they can help make us feel fuller for longer.
• Swap a cake or biscuits for a currant bun, or some malt loaf, plain or with reduced-fat spread.
• Read food labels: they can help you choose foods that are lower in calories, as well as lower in saturated fat and sugars.
• Alcohol is also high in calories, so cutting down could help you control your weight.

Get more active

If you are overweight or obese, you should combine eating fewer calories with more physical activity in order to gradually lose weight and help you to keep the weight off.

Adults should do at least 150 minutes of moderate-intensity aerobic activity a week. Moderate-intensity activity means an activity that causes your heart rate to rise, and you to break a sweat: for example, fast walking or cycling.

You can split the 150 minutes into 30 minutes on five days of the week, and split that 30 minutes into sessions of at least 10 minutes. Physical activity can help you to achieve a healthy weight, and brings a range of other important health benefits.

After getting active, remember not to reward yourself with a treat that is high in calories. If you feel hungry from your activity try to choose foods or drinks that are lower in calories but still filling. 

Learn more in 150 minutes your way.

Learn more

If you currently eat too much, then making changes towards a healthy, balanced diet will also help you to reduce the number of calories you eat and drink, as well as helping to make sure that you get all the nutrients you need.

• You can learn about the foods we need to eat for a balanced diet in The eatwell plate.
• Read about the steps you can take towards a healthy diet in Eight tips for healthy eating.
• Get tips on cutting down on saturated fat in Eat less saturated fat.
• Get tips on cutting down on sugar in Sugars.
• Get tips on weight loss in Start losing weight. 

That's Fit

That's Fit

Some Good News? Are Americans Cutting Back on Sugar Intake?

Fri, 29 Jul 2011 12:00:00 EST - By Amanda Chan for AOL Healthy Living Corbis Despite the increases in childhood obesity in the United States, Americans are technically consuming less sugar than they did about a decade earlier, according to a new report. And two-thirds of this decrease is due to people drinking fewer sugar-sweetened sodas. The study, published in the American Journal of Clinical Nutrition, shows that the percentage of our diets that is comprised of sugar dropped from 18 percent between 1999 and 2000 to 14.6 percent between 2007 and 2008. "We were surprised to see that there was a substantial reduction over the years," study researcher Dr. Jean Welsh, of Emory University in Atlanta, told Reuters. Researchers analyzed data from a study of 42,316 people ages 2 and older to see how much added sugar -- that is, sugars that are not naturally included in foods, like fruit -- they consumed. To continue reading this article, visit The Huffington Post's health and wellness destination site, Healthy Living.

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I Ditched Dieting -- And So Should You

Fri, 29 Jul 2011 11:00:00 EST - By Anna Guest-Jelley for Blisstree.com Corbis I first started experimenting with intuitive eating about five years ago. When I heard "eat when you're hungry, stop when you're full," I thought "Genius!" What could be better than finally giving myself permission to eat whatever I want?!" I also thought "How stupid do you think I am? If I could do that, I wouldn't need intuitive eating!" (Clearly, I still had some internal work to do.) Not one to be easily dissuaded, though, I decided to give this trusting-yourself-to-eat-right thing a try. And eat I did. I just never got to the intuitive part, or the satiety part, or the listening to my body part, or the -- well, you get the point. After 65 diets and about 20 years, any kind of intuition about food just wasn't in my toolbox. That was so much the case, in fact, that I didn't even realize that I didn't get it. I just did my best and fumbled along. I considered the idea of "listening to my body" to be either a) a bunch of new-age mumbo jumbo, b) a diet in disguise, c) something completely beyond the scope of possibility for me or d) workable once I put some rules in place (aka, made it a diet). I like to keep my options open, so I played with some variation of all four of those for a while. But I'd say my favorite was option d. After all, planning a new diet is something I'm quite familiar with. It's comfy, and it always seemed to have that new-car smell: "On Monday, things are gonna change -- seriously this time!" After a bit, I pretty much forgot about the tiny intuitive part of this that I was still hanging onto and slipped back into dieting full-time. (I this sounds like a full-time profession, it sort of was -- at least if you consider how much time and energy I put into it.) Somewhat by accident, though, (or maybe not), I ran back into these ideas. I was reading fabulous blogs about loving your body, intuitive eating and Health at Every Size, and I was starting to consider writing my own blog. I gathering information about my body like a mad curvy scientist. Then, recently, it hit me: Intuitive eating means eating what works for my body! (Yes, I realize this is perhaps the most obvious sentence ever written.) It's not boundary-less and it's also not riddled with "rules." It's a middle way, which as someone who has lived most of her life in the black/white zone of dieting, comes as quite a relief. What I realized is that the information my body is giving me -- via energy levels, illness, or sheer pleasure -- is what I'm supposed to be listening to. I've always known this on a surface level, but it took me much longer to feel it deep in my bones and belly and skin. For example, I'm allergic to garlic (it gives me a crazy migraine within 15 minutes), so I just don't eat it. I rarely have a desire to, either, because my body gives me immediate feedback that it's a very unwelcome house guest. Now I realize that eating the intuitive way (or for me, the "Anna way") involves looking for and listening to more feedback like this (although usually less dramatic). Eating the [your name here] way is an ongoing process of tuning in and learning what works for you. Sometimes this changes, and that's okay. In fact, it's expected and welcome. Who knew that intuitive eating would bring me right back to me? (Well, besides everyone.) Anna Guest-Jelley is the Founder of Curvy Yoga, which is all about lovin' the body you have today. Through Curvy Yoga, she offers yoga designed to fit the bodies of people of all shapes, sizes and abilities as well as messages of body positivity and meeting yourself where you are-both on and off the mat. Connect with her on Facebook and Twitter. More from Blisstree.com: The Body Positive: How Author Dayna Macy Got Out Of A Size 18 And Into A Healthy Relationship With Food The Body Positive: Less-Than-Perfect Is Good Enough For Me The Body Positive: When A Fat-Loss Expert Gets Called Fat

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Kate Bosworth's Fit Routine

Fri, 29 Jul 2011 10:00:00 EST - By Jennipher Walters for Shape.com Angela Weiss / Getty Images As reports come in that Kate Bosworth and her long-term boyfriend Alexander Skarsgård have split, we have little doubt that some new cute guy will scoop her up. Why? Because Bosworth is such a cutie! Here's how she stays in shape for movies and just for her everyday life! 5 Ways Kate Bosworth Stays in Shape 1. Running. One of Bosworth's favorite workouts is running. It burns calories, tones the legs and makes you feel great. She also loves to walk her dog! 2. Weight training. When it comes to staying toned and movie-ready, Bosworth knows that weight training is the way to go. It's all about building that lean muscle! 3. She takes on active roles. Talk about a fit career! By starring in movies like "Blue Crush," Bosworth works her fitness into her work. For the surfing movie, she gained a reported 15 pounds of calorie-burning muscle! 4. She goes on vacay. Because Bosworth works hard, she makes sure to take time out for herself when she needs it with vacations. She's been known to frequent The Hazelton Hotel in Toronto to de-stress and recharge. 5. She eats her veggies. Like most of us know, working out is only part of the equation when it comes to being healthy and staying in shape. Bosworth sticks to a healthy diet by loading up on veggies at every meal and keeping her portion sizes in check. More from Shape.com: 50 Diet Foods Under 50 Calories Quick and Easy Chia Seed Recipes The Most Common Weight-Loss Traps for Women

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Should We Fear Our Genetics?

Thu, 28 Jul 2011 12:00:00 EST - By Elizabeth Nolan Brown for Blisstree.com Getty My extended family is mostly women, and a lot of us share the same body type. We are not a particularly tall people, nor of ample bosom. What we lack up top, however, we make up for in hips. Most of us also have very prominent rear-ends. It's a body type that can start out in life bringing all the boys to the yard but, without proper maintenance, it all goes south -- literally. And that, my friends, is what scares me. In high school, all but one of my mother and her four sisters were very thin (the eldest sister was considered quite chubby in high school, we're told, though in photos she looks perfectly average-sized by today's standards). Oh, they always had booties -- in our family, it's known as the 'Bronner Butt,' after some generously derrièred great- great- somethings of ours -- and wide hips, but with tiny waists the effect becomes more narrow-hourglass than pear. There are photos of them visiting relatives in California, and I don't think my mom is wearing a shirt that covers her stomach in a single one (halters and bell-bottoms as far as the eye could see!-this was the 1970s). Marching around in sequined majorette leotards and white go-go boots, their legs look as long as their ironed-straight hair. But the average American woman puts on the equivalent of one pound per year as she ages, and they are no exception; all have put on at least that much since high school, if not more, and it mostly shows up around their hips, thighs, and lower extremities. What's been strange -- like my own small-scale longitudinal study -- is to see this process accelerated in my generation. While my mom and aunts remained slim and trim well into their thirties, some of their children began gaining weight after high school. I hate my own body in high school photos, though I was considered thin by everyone around me. My hips and thighs look gargantuan to me now. I know this is neurotic -- at about 20 pounds heavier than I am now in those photos, the extra weight is noticeable, but hardly extreme. There are men who like my leaner body better, but there are always men who prefer a little extra -- I suppose there's no other way to say it -- junk in the trunk. At 5-foot-6-inches I'm one of the taller of our family's 12 female grandchildren, and I've seemed to inherit more of my dad's genetic heritage than my mother's: crooked spine, curly hair and fast metabolism. I still worry sometimes about the dramatic Bronner butt transformations I've seen, but by this point in life, I've channeled my fear of metabolic fate into a positive focus on healthy living and nutrition (instead of obsessive dieting). Heredity is not destiny, or so the saying goes. And it's not as if healthy eating is a strong point in my extended family, even when they were younger (my mom says in high school she'd go all day on a Payday and a Coke). A certain amount of weight gain may be inevitable as people age, but as recent studies on long-term weight change have found, it's also heavily correlated to eating certain types of food and beverages, or engaging in certain habits or behaviors. In other words, habits trump heredity? Well, let's hope. More from Blisstree.com: The Body Positive: When A Fat-Loss Expert Gets Called Fat The Body Positive: Less-Than-Perfect Is Good Enough For Me Genetics and Exercise: Are You a Natural Born Gym Rat?

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What Nutritionists Order When Eating Out

Thu, 28 Jul 2011 11:00:00 EST - For AOL Healthy Living Getty A new study has found that only 1 out of 6 diners pay attention to posted nutrition information on menus -- and while some is better than none, the reality is that the each meal eaten outside of the home tacks on an average of 134 calories to your day. What's worse is that even for those who are conscious of calorie counts at restaurants, another recent report analyzing foods from 42 restaurants found that nearly 1 in 5 of those numbers may actually be incorrect. So with conflicting messages, what is a health conscious dieter to do? To help you navigate your next menu, we asked four nutritionists to tell us how they order at various types of restaurants, from a pizza place to an ice cream parlor to a burger joint. The experts we spoke to include registered dietitians Julie Upton and Katherine Brooking, founders of AppForHealth.com, registered dietitian and spokesperson for the American Dietetic Association, Toby Smithson and registered dietitian and resident nutritionist for "The Biggest Loser," Cheryl Forberg. Here's their guide to maximizing nutrients, cutting back on calories, taking healthy shortcuts and yes, even indulging in moderation. Burger Joint What Our Experts Choose: -I look for a veggie burger and order it without mayo. I won't eat at a burger place if they do not offer a veggie burger or a salad with cheese (I eat cheese on my salad so that I can get protein at that meal). Watch out for any extra add-ons that will increase the fat and saturated fat of the meal, like mayonnaise or special cream sauces. Also watch the high-fat sides like french fries. Ordering a salad with the dressing on the side as a side dish helps you meet the recommendations of filling half of your plate with vegetables! -- Toby Smithson, RD -I usually get a burger -- but protein-style, without fries but with lots of veggies! Luckily I love mustard, which unlike ketchup, has no sugar. Occasionally I'll have cheese or avocado on my burger as well. To drink, opt for water or iced tea. --Cheryl Forberg, RD Ice Cream Parlor What Our Experts Choose: -I'll usually just take a few tastes with the tasting spoons that they usually have. If I want something more, I'll try to have all-fruit sorbet or frozen yogurt. Once in a great while, I'll indulge and have a scoop of rich, chocolate ice cream! --Cheryl Forberg, RD -Just go for a kid size or one-scoop serving of a more traditional flavor like vanilla, chocolate or strawberry. If you go really exotic -- fudgy, chunky, nutty -- that just means more calories. Opt for a cone -- less ice cream can fit into a cone than a cup -- and cones have hardly any calories. --Julie Upton, RD -Because I have diabetes, I look for a "sugar free" ice cream or frozen yogurt. Just because it says sugar free doesn't mean I can eat as much as I want, but it does offer less carbohydrates. --Toby Smithson, RD -Well, if I find myself at the ice cream parlor, I am definitely going to enjoy some ice cream! Try not to have an ice cream treat more than once every couple of weeks ... even less if you are aiming to lose weight. When you do go, stick with one scoop in a regular-sized cone. And make sure you savor the experience! Skip the sundaes and heavy toppings. My favorite: Mint Choco Chip!! --Katherine Brooking, RD To keep reading this article, visit The Huffington Post's health and wellness destination site, Healthy Living.

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Ready for 2012 Already?

Thu, 28 Jul 2011 10:00:00 EST - Darryl Dyck / AP Are you getting pumped for the Olympic Games in London already? Never fear, NBCUniversal introduces you to some of the athletes who will be competing. Get a head start on the excitement!

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Why We Indulge in Emotional Eating

Wed, 27 Jul 2011 12:00:00 EST - For AOL Healthy Living Getty Anyone who's sought solace in pizza or a pint of ice cream knows that food can be comforting. But experts still don't know exactly why we gravitate toward fatty or sugary foods when we're feeling down, or how those foods affect our emotions. Taste and the pleasant memories associated with junk foods surely play a role, but that may be only part of the story. According to a small new study, hormones in our stomachs appear to communicate directly with our brains, independent of any feelings we have about a particular food. Most research on food and emotion has looked at the overall experience of eating -- the tastes, smells, and textures, in addition to nutrients. In this study, however, the researchers took that subjective experience off the table by "feeding" the volunteers through an unmarked stomach tube. To read this article in full, visit The Huffington Post's health and wellness destination site, Healthy Living. More from Health.com: Love to Eat? The Trick to Staying Slim Foods That Boost Your Mood 25 Diet-Busting Foods You Should Never Eat

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Jessica Biel's Favorite Ways to Work Out

Wed, 27 Jul 2011 11:00:00 EST - By Jennipher Walters for Shape.com Gregory Bull / AP Jessica Biel knows that when it comes to staying fit (and man, oh, man does she look fit!), it's all about making workouts fun, challenging and never boring. Because of this, Biel loves doing a variety of workouts and is always trying new things. Read on for the Jessica Biel workout! The Workout Routine Jessica Biel Loves 1. Circuit strength training. Those toned arms don't come without some heavy lifting! Biel makes the most of her time in the gym and with her trainer by doing a series of back-to-back moves that build muscle and burn calories! 2. Running. When it comes to cardio, Biel is a running fan. No matter where she is filming, she can always squeeze in a quick jog or some sprinting intervals for a workout on the road. 3. Sports. One to always keep things fresh, Biel likes to play just about any sport, including football with friends and volleyball on the beach. 4. Hiking with her pups. For a fun and refreshing outdoor workout, Biel enjoys taking her pups out for hikes on the trails in Los Angeles. A fun workout outside of the gym that also keeps her pets fit! 5. Plyometrics. Plyometrics like jump-squats and jumping lunges aren't easy, but they do wonders for boosting fitness, which is why Biel does them. The results of these workouts certainly speak for themselves! Biel looks great and so fit and toned! More from Shape.com: Top New Fitness Classes You've Got to Try The Best Time of Day to Eat for Weight Loss 7 Ways to Save Money on Summer Travel

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Body Image: Why "Perfection" Isn't Necessary

Wed, 27 Jul 2011 10:00:00 EST - By Deborah Dunham for Blisstree.com Getty As I stood in the check-out line the other day, I couldn't help but notice the headlines of all the magazines around me: "Slim Down This Summer;" "Lose 10 Pounds;" "Get Stronger, Leaner, Faster;" "Tone Your Thighs;" "Kiss Cellulite Goodbye." Screw that, I thought. What's wrong with the way I am? As women, we're constantly bombarded with these you-need-to-improve messages, making us feel like we're not good enough. Like there's something fundamentally wrong with the way we are. It's become a cultural norm to inundate us with bullshit messages that equate happiness and femininity with losing weight and having a "perfect" body. And for those of us who are athletes, we're constantly challenged with the messages that we must do more, work harder ... all so we can get better. Some of the advice is fine if you indeed want to change. But what if you don't? Yesterday I was at the pool putting in laps for my morning mile. When I stopped to adjust my goggles, the girl next to me (let's call her an acquaintance and often athletic rival), asked why I was swimming so much lately. (Normally, I'm a twice-a-week swimmer, but given my unrelenting Achilles injury, I've had to drop all running and cycling from my repertoire for the time being, which puts me at the pool every morning for cardio.) After I explained my situation, she said, "Well, maybe you'll get better and faster now." WTF? What if I don't necessarily want to get better and faster? I already consider myself a decent swimmer (good, but not great); I can do 1.2-mile open water swims for a half-Ironman (and beat this girl's butt at most of them). So what's wrong with the way I swim now? I wanted to ask. Instead, I pulled my goggles back down and swam away. But I kept stewing over the question all day, which made me realize this is probably a much bigger issue. Every day, we women are told we're not good enough. Don't believe me? Watch any commercial, read any magazine, look at any billboard. You'll see ads promising to help you "get happier, richer, thinner NOW." They're all trying to capitalize on the fact that women need help, when in fact, many times we don't. We're perfectly fine just the way we are, thank you very much. Maybe we should stop letting these people dictate how we feel about ourselves. Maybe we should stop letting others try to tell us we aren't slim enough, toned enough, strong enough or fast enough. This is not to say that we don't have room for improvement. I know I do, and given the fact that 25 percent of the American population is considered obese, others do too. The point is that all of this pressure to become better all the time leaves us no room to just "be." It's no wonder that 50 percent of adults walk around stressed out all the time. (Which, incidentally, doesn't help at all with self-improvement of any kind.) Our parents' generation wasn't labeled as "broken" in the mid-1900s. For the most part, they held the same jobs for much of their lives, drove the same car, lived in the same house and kept the same friends. They didn't walk around stressed out; many of them were happy and satisfied, despite the lack of a quest for something new, different, or better. In her book, "Bodies," psychoanalyst Susie Orbach claims we now see our bodies as projects -- not places to live, as she explained to The New York Times: What I am seeing is franticness about having to get a body. I wish we could treat our bodies as the place we live from, rather than regard it as a place to be worked on, as though it were a disagreeable old kitchen in need of renovation and update. She says we are at war with ourselves and our lives. I think she's right. And I think outside influences are to blame. So, to all the media and people (including the girl at the pool) out there trying to improve us: SHUT UP. We don't always have to be better. Being good is sometimes good enough. More from Blisstree.com: The Body Positive: When A Fat-Loss Expert Gets Called Fat Running and Body Image: What Is a "Runner's Body" Anyway? Body Image: Do Ads Make You Feel Better or Worse?

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Happy Meals Are Getting Healthier

Tue, 26 Jul 2011 12:00:00 EST - By Amanda Chan for AOL Healthy Living AFP/Getty Images We all know what's always included in a McDonald's Happy Meal: a burger or chicken nuggets, french fries, a toy, a soft drink. And fruit? McDonald's announced today (June 26) that it will automatically include both produce AND french fries in every Happy Meal, meaning parents and kids no longer have to opt for either fries or fruit. And because produce will be included in all Happy Meals, french fry-holder sizes will get smaller -- from 2.4 to 1.1 ounces, ABC News reported. The revamped Happy Meals will be introduced in September 2011, and will be available in all 14,000 McDonald's restaurants by spring 2012. While apples will be the main produce option, some McDonald's restaurants may offer carrots, pineapple slices, raisins or mandarin oranges depending on the region and time of the year, according to ABC News. Customers can also request two bags of apple slices instead of apple slices and french fries. In addition to the Happy Meal changes, McDonald's also plans to reduce sodium in all of its menu items by 15 percent by 2015. To continue reading this article, visit The Huffington Post's health and wellness destination site, Healthy Living.

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Is Training Just a Time Suck?

Tue, 26 Jul 2011 11:00:00 EST - By Hailey Eber for Blisstree.com Getty Marathon training ... it takes time. A lot of time. No really, it does. This, of course, should be fairly obvious. Running 20- or 30-some miles a week will cut into the time you might have previously used to see friends, watch "Twin Peaks" on Netflix, get a manicure or call your mother. It somehow requires quite a different amount of time than putting in 15 or 20 miles a week. And, it's not just the running that's a time suck. Take this past Tuesday, for example. I awoke 90 minutes earlier than usual to get to an early pre-work chiropractic appointment while still having enough time to take the puppy to the dog park. By the time we'd had a good wrestle at the park and I'd packed a healthy breakfast, lunch, pre-run snack, running clothes and multiple water bottles, I was -- of course -- running late. I rolled into the chiro in that dangerous 15- to 20-minute late zone, where your doctor/hairdresser/old college friend is pretty annoyed but hasn't yet assumed you're dead. I tried to make some charming joke about being "the worst patient ever," then ripped off my clothes and changed into the sexy chiropractic gym shorts and hospital gown in record time. 25 minutes and several deep breaths later, I'd been adjusted. "You should come at least once a week," my tall, handsome chiropractor said. Really dude, I thought to myself. Is this where we're at? Are you being that chiropractor? I'm typically a reluctant "only if I haven't been to yoga for a month and can hardly walk" sort of chiropractic patient. But when I told my guy I was training for the marathon, he was like "I like to see my marathoners once a week." I imagined a squad of stringy 40-something men clad in spandex, regularly biking over to see him. I wasn't one of those marathoners. But, I was a chick who had already met her health insurance deductible for the year, had minor scoliosis and a minor leg length discrepancy and some funkiness in my hip, so I figured why the hell not. Now, I can tell you why not: It's just another thing to cram into the day. I rushed out of the office and landed at my desk in the pretty-much-on-time-but-certainly-not-the-first-worker-bee time zone that I regularly inhabit. Tragically, there was no time to stop for my iced Americano. At 12:15 p.m., I slithered out of the office for an early lunch carrying a dirty old pair of running shoes that I'd been using to break in my latest orthotics. At 12:34, I squeaked into the podiatrist in the nearly totally on-time zone. I imagined it'd be a quick, 10-minute appointment for minor adjustments and maybe a short, annoying lecture about how I needed to stretch my calves more or do some special ankle exercises. Instead, it was a 40-minute appointment that seemed to unravel in slow motion. "I don't like what he did here," my podiatrist said, thumbing my new orthotics and referring to some unknown, far-off him. Who was he? I imagined an evil orthotics-making elf in a far-off land, living in luxury, slapping together random bits of foam and plastic that he claims are specially made for my feet, cackling as he cashes my check. "I'm gonna take new molds and send these back to him," she said. Awesome. I appreciated her attention to detail, but the additional office visits and slaughtered lunch hours that it would require instantly flashed before my eyes. I'm sure full-blown lunch hours are still commonplace in some far-off happy land (maybe where the orthotics elf lives) -- where everyone also has health insurance and gets eight hours of sleep per night -- but it is not the land that I live in. Or the office that I work at. Tuesday is typically the day I attempt to leave work at six p.m. on the dot and rush to running class on the Upper East Side. This involves a taking a train from Grand Central Station at rush hour, an act that even on the best of days can lead to a solipsistic evaluation of life and why I've chosen to live in a city dependent on sardine-can transport when I could be spending hours each day commuting in a happy, gas-sipping, Japanese-auto bubble, air-conditioned to perfection, soundtrack-ed with all my favorite tunes from my college years. This past week, as I was rushing off to make class on time, or at least manage to throw on my workout clothes and meet up with the group after they'd stretched (which is usually how I work it), I realized I just couldn't do it. The summer heat had reached a sweltering peak. After a day filled with rushing and juggling, speeding uptown to run in Central Park suddenly seemed torturous; impossible. The heat. The angry bicyclists. The broken water fountains. It would be a treadmill day. I grabbed the first train back to Brooklyn. (Well, the first train I was able to shove myself onto in the muggy subway station, which was actually the third train.) I've always had a troubled relationship with time... and sleep. I regularly run 10 to 15 minutes late for everything. There are never enough hours in the day, so why not try surviving on five hours of sleep (or less, but that's the vaguely acceptable, not too horrific number I'm going to throw out here)? I never speak to my mother, or anyone, for a long period of time on the phone without simultaneously doing something else...usually my dishes. I went through a long period from pre-9/11 to 2008, when I liked to get to the airport a few minutes late, just to add a little excitement to the travel process. (Nothing says adventure like sweat trickling down the back of your neck in the ticketing line, or trying to charm your fellow passengers into letting you cut at security.) That period came to an abrupt and tragic end when I wasn't allowed on an international flight that I was just a few minutes too late for. Running, however, calls bullshit on my cram-as-much-as-you-can-into a day style. A six-mile "easy" training run at the "easy" pace of 10:30 per mile will take not less than one hour and three minutes, plus at least a couple of minutes of dynamic stretching before, and a few more minutes of stretching afterward. It will essentially kill an entire weekday night. It is not a three or four mile run done at a quick pace that can be crammed in before work or a dinner with friends; it is a fairly long, slow run that gobbles up an extra 45 minutes. A long, 14-mile training run will kill much of Saturday, by the time one has run said 14 miles, stretched (no really, it's important after 14 miles), gulped done some recovery vittles, and sat on the couch wallowing in exhaustion. Oh, and sleep. You actually need to get that proverbial "healthy night of sleep" not the "somehow I stayed up watching mediocre late night TV and then I had to get up early" sleep. And then there are the multiple appointments with healthcare professionals to prevent injuries/fund their kids' college education (see above). Last night, I came home from said six-mile run at the gym and cooked a gourmet dinner consisting of whole wheat bread, olive oil, almonds, olives and some lettuce -- Julie and Julia would be so proud. I peeled off my sweaty clothes and hopped in the shower. A chafed spot on my upper arm ignited as soon as the water hit it, as did several sharp, thin lines of irritated skin on my sternum. Clearly, it's time for some new sports bras. If only I had the time ... Training Week One Summary Miles logged: 22 Longest run: 10.5 miles (admission, this week's planned 14 mile long run was broken into two parts, see above notes on time, hellish weather) Long run fuel: Sport Jelly Beans, fruit punch flavor. I dreamed of Swedish fish, but alas, didn't make it to the candy store. Post-run recovery food: Banana+strawberry+raspberry+almond butter smoothie -- again New equipment purchased: Nothing, I'm sad to report ... More from Blisstree.com: 30 Years Down 8 Weeks to Go Running for a Cause But Not Without Headphones I'm Just Not That Into My Podiatrist

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Sophia Bush Talks (Healthy) Food

Tue, 26 Jul 2011 10:00:00 EST - By Alanna Nunez for Shape.com Jason Merritt / Getty Images for Montblanc What's in Sophia Bush's fridge? "Right now nothing!" the "One Tree Hill" star says. Bush, who is currently living in North Carolina, is well-known as an animal rights activist and environmentalist within the Hollywood sphere and says that she tries to ensure the food she eats comes from local farms where animals are raised and treated humanely. "There are a couple of farms here in North Carolina that I like," she says. "And you know the farmers, and know that the animals weren't living in cages and that they were treated humanely." Still, the star says that when she gets busy, she tends to eat out a lot and that instead of home cooking, her fridge is often stocked with to-go boxes. When the actress is at home, here are three foods she can't live without: 1. Oatmeal. Bush says she tries to keep a lot of healthy, whole grains in the house, including oatmeal. And why not? Oatmeal is nutritious, versatile and makes for a satisfying breakfast (not to mention it's a superfood for better sex)! What's not to like? 2. Brown rice. This whole grain is another smart choice. A half cup of brown rice has almost 2 grams of fiber, while its counterpart, white rice, has none. And not only can you cook brown rice with basically anything, but it's full of manganese -- which is an anti-aging property -- and antioxidants. 3. Kilwin's ice cream. Ok, so the ice cream itself isn't really that healthy. But it is healthy to indulge once in a while. "When I'm in North Carolina, I can't get enough of it," Bush says. "I'm like a bloodhound; I can pick up the scent a mile away." It's all about balance -- it is important to maintain a healthy diet of whole grains, fruits and vegetables, but it's also important to enjoy yourself once in a while, and sometimes that means letting yourself give in to your cravings -- whatever they may be. More from Shape.com: Why Men Lose Weight Faster Than Women Photos: Are These Celebs Too Thin? 20 Tricks to Get Toned Abs Faster

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GIVEAWAY REMINDER: Manduka Yoga Gear

Mon, 25 Jul 2011 14:00:00 EST - Manduka We run a lot of yoga-related giveaways on That's Fit. The reason? Not only do they seem to induce a lot of excitement from our readers, but yoga totally embodies the message behind That's Fit: awareness of one's body, enjoyment of exercise and a focus on health. Manduka is a company that fits perfectly into this mantra -- and one that caters to yoga novices and experts alike. This week, one lucky That's Fit reader will win a "Beginners Luck Package" (which includes a yoga mat, yoga mat bag and yoga strap) from Manduka -- totally free. All you have to do is enter our giveaway below for your chance to win. To enter, check out our original giveaway!

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America's Most (and Least) Walkable Cities

Mon, 25 Jul 2011 12:00:00 EST - By Laura Schocker for AOL Healthy Living Getty Can you walk to your local grocery store, restaurants and other amenities? Or does each trip require a car ride? The answer may have an impact on your health. According to one study, people of average height who live in walkable neighborhoods weigh eight pounds less (10 pounds for men, six pounds for women) than their car-bound counterparts. And now Walk Score, a Seattle-based company that evaluates the walkability and transportation of cities all across the country, has released its rankings of the most -- and least -- walkable cities in the U.S. Using new census data and advanced algorithms, Walk Score's latest ratings rank the 50 largest cities based on whether various amenities are within walking distance, assigning each a walkability score between 0 and 100 (from "car-dependent" to "walker's paradise," respectively). Taking the crown this year was New York City, ousting the previous winner, San Francisco. According to Walk Score CTO Matt Lerner, the change is a result of the 2010 census data -- formerly industrialized neighborhoods in areas like Brooklyn, for instance, have become more livable over the past 10 years since the 2000 census. Take a look at Walk Score's results -- their heat maps of each city reflect the walkability by neighborhood (red is bad, green is good). And, as Lerner points out, "Even un-walkable cities have some very walkable neighborhoods." Don't live in one of these cities? You can search your Walk Score for any U.S. address (and see the full rankings of thousands of cities) on their website. To read the rest of this article and find out which cities are the 10 most walkable -- and which cities are the least walkable -- visit The Huffington Post's health and wellness destination site, Healthy Living.

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How (and Why) to Kick Your Sugar Addiction

Mon, 25 Jul 2011 11:00:00 EST - By Dr. Natasha Turner for Blisstree.com Getty Just think how our eating habits have evolved with our busy lifestyle. We shovel in a fast bite at our desk and inhale dinner while standing over the kitchen counter, so we can spend more time on work and errands. We also eat late at night in front of the TV, or even skip meals altogether. Then, think about our food choices: Packaged, processed convenience foods loaded with hidden salt, fat and sugar. (And in the dog days of summer, you may have even opted for a dinner of popsicles or ice cream.) These foods not only do a number on our waistline; they wreak havoc on our hormones. Energy Highs and Lows When we consume foods high in sugar (glucose), the glucose enters the bloodstream, quickly causing blood sugars to rise. The pancreas responds by secreting insulin which then causes a surge of sugars to enter the cells to either be used as energy or stored as fat for later use. Blood sugars then fall to normal or possibly just below normal levels. While this is happening, we experience a "sugar rush" of hyperactivity (all too commonly seen in kids) only to be followed by the "crash"-fatigue, drowsiness and poor concentration. Naturally, as blood sugars fall, the body works to maintain balance by causing a craving-most likely for more sugar-and the whole process starts all over again. Sugar's Long-Term Effects Aren't Sweet Most foods containing sugar, especially refined white sugar, have very little nutritional value and are often referred to as "empty" calories. Beyond this, insulin is also secreted in proportion to the amount of sugar consumed. Since insulin is the only hormone that instructs the body to store energy as fat, it's a nemesis if it becomes too high. Repeatedly eating sugar throughout the day eventually leads to chronically high insulin and ultimately to insulin resistance. Let me explain. Imagine insulin as a truck that carries sugar into cells and enters the cell upon arrival by using the garage door opener. Think of insulin resistance as the insulin truck arriving at the cell, but the garage door opener won't work until six insulin trucks are waiting, rather than just one. Soon, we will have a traffic jam of insulin trucks throughout the body, or chronically high insulin. At this juncture, weight loss becomes very difficult and there is often an increase in blood pressure, cholesterol, triglycerides, abdominal fat, breast and prostate cancer risk and more. Need a few more reasons to avoid sugar? Here are some of the hormonal and health consequences of having a sweet tooth: Blisstree.com Your Best Sweetener Options For optimal health (and insulin levels) I recommend that you cut out or reduce your sugar intake. Sugar comes in a variety of forms and faces, including: table sugar (sucrose), rice syrup, maple syrup, honey, agave syrup, foods/drinks containing high fructose corn syrup, packaged foods, candies, soda, juice, etc., as well as sucralose, aspartame, saccharin and all other forms of artificial sweeteners. Instead reach for natural alternatives such as date paste, raisins, honey, apple sauce, coconut sap, erythritol and stevia. Spices such as cinnamon, vanilla or cocoa can also add flavor and sweetness to recipes. More from Blisstree.com: Lent Survival Guide: 8 Natural Tips and Recipes to Curb Sugar Cravings Nutrition Facts Decoder: Natural Sugar vs. Added Sugar 10 Foods You Didn't Know Contained (So Much) Sugar

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Jenna Fischer Talks Fitness

Mon, 25 Jul 2011 10:00:00 EST - By Jennipher Walters for Shape.com Michael Caulfield / WireImage Based on her shy yet hilarious character Pam on "The Office," you wouldn't think that Jenna Fischer had such a bikini-ready body under those khakis, but clearly she does! In fact, in real life, Fischer has quite the healthy attitude. Here are the top things we can learn from her about fitness! Top 3 Fitness Lessons From Jenna Fischer 1. Fitness for two. Fischer may be pregnant, but that's not stopping her from hitting the gym. As a mom-to-be, she's keeping her body fit and in shape! 2. She laughs about her imperfections. All women -- even the seemingly perfect ones -- have things they'd like to change about themselves, Fischer told SHAPE back in November 2009. Instead of focusing on the negatives, this funny girl laughs them off! 3. She pays attention to her diet. Fischer knows that when it comes to getting results, eating a healthy diet -- in addition to workouts -- is essential. Even when she's too busy to get to the gym for a few days, she makes sure her diet is super clean to stay healthy and trim. More from Shape.com: How Mila Kunis Got Fit for Friends with Benefits The Best Abs in Hollywood Does More Sweat Mean You Burn More Calories?

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Does Your Personality Determine Your Weight?

Fri, 22 Jul 2011 12:00:00 EST - By Riddhi Shah for AOL Healthy Living Getty How spontaneous or neurotic you are could dictate how much you weigh, says a new study. Yes, that's right -- type A personalities are more likely to have a higher BMI and impulse shoppers are more likely to go through cycles of losing and gaining weight, according to research recently published by the Journal of Personality and Social Psychology. In the first study of its kind, three researchers from the Department of Health and Human Services followed nearly 2,000 subjects over a 50-year life span. They found that those scoring high on the impulsivity scale were likely to be 11 kilograms (about 24 pounds) heavier than those on the lower end of that scale. Which personality types are likely to be thin? The researchers found those who scored high on the conscientiousness scale were likely to be leaner. They also found that those low on agreeableness "predicted a greater increase in the Body Mass Index across the adult life span." Essentially, the meaner you are, the likelier you are to gain weight as you age. To read the rest of this article, visit The Huffington Post's health and wellness destination site, Healthy Living.

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RECIPE: Eggplant-Shallot Stew and Whole-Wheat Couscous

Fri, 22 Jul 2011 11:00:00 EST - By Elizabeth Nolan Brown for Blisstree.com Getty This week, I picked up both eggplant and shallots at the farmer's market. While searching for ways to cook the eggplant (I'm very bad at eggplant), I came a recipe for eggplant and shallot stew, which sounded so good I wanted to make it immediately. Of course, I was missing almost all ingredients aside from shallots and eggplant, for the recipe (from Eating Well magazine), so here is my own riff on it (à la raisins, cashews and whole-wheat couscous, and minus what sound like complicated spice-grinding and mustard-seed-popping processes). Eggplant and Shallot Stew with Whole Wheat Couscous Servings: About 3 // Time: Less than ½ hour Ingredients: 1 medium-sized eggplant, peeled and cut into small cubes 3/4 cup diced shallots grapeseed oil 2 serrano peppers* ½ cup raisins ½ cup raw cashews (pinenuts would probably be good, too) 1 cup water 2 cloves peeled garlic 5 fresh basil leaves,* chopped 1 teaspoon fennel seed dashes of tumeric, cumin and ground black pepper grated parmesan (if you want) (* because I also had them from the same farmer's market haul) Preparation: In medium saucepan, heat a tablespoon or so of grapeseed oil. Add chopped peppers, letting them toast a little before adding other ingredients. Add eggplant, shallots, raisins, cashews, water, garlic, basil, fennel seed, spices and pepper. Stir. Bring to a boil. Reduce heat to medium-low, cover and let simmer (at least until eggplant is fork-tender, 3-5 minutes, but I let mine go about 15 minutes, so make everything really soft and the flavors all blended). Begin couscous-for whole-wheat, medium-pearled couscous, it's 1 cup couscous to 1 ¼ cups water, + a teaspoon or so of olive oil. Bring to a boil, then cover and remove from heat. Fluff/stir after about 5 minutes. Coarsely mash the eggplant shallot mixture. Sprinkle couscous with pepper and grated parmesan. Serve stew with or on top of couscous. More from Blisstree.com: Summer Seasonables: Tabbouleh Salad Recipe Summer Seasonables: Lentil, Strawberry and Cucumber Salad Recipe Summer Seasonables: Raw, Vegan Berry Muesli Recipe

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10 Best Workout Songs for Summer

Fri, 22 Jul 2011 10:00:00 EST - For Shape.com Marc Piasecki / FilmMagic It's a big month for dance music -- with even Maroon 5 borrowing heavily from the genre. The only person to appear twice on this month's list of the top 10 workout songs is Dutch musician, DJ, and producer Tiesto. He turns up with a track from his new mix album and an update of his single C'mon, which now features a vocal by Busta Rhymes. Here's the full list, according to votes placed at RunHundred.com, the web's most popular workout music website. "Moves Like Jagger," Maroon 5 & Christina Aguilera, 128 BPM "C'mon (Catch 'Em By Surprise)," Tiesto, Diplo & Busta Rhymes, 130 BPM "Judas (R3HAB Remix)," Lady GaGa, 128 BPM "I Wanna Go," Britney Spears, 131 BPM "Last Friday Night (T.G.I.F.)," Katy Perry, 127 BPM "Barbra Streisand," Duck Sauce,128 BPM "International Love," Pitbull & Chris Brown, 121 BPM "Don't Ditch," Tiesto & Marcel Woods, 129 BPM "Don't Wanna Go Home," Jason Derulo, 122 BPM "Lights," Ellie Goulding, 121 BPM More from Shape.com: Eat Healthy Like Bethenny Frankel 25 Fat-Burning Workouts to Get You In Shape This Summer The Truth Behind 8 Common Running Myths

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3 Things You NEED to Know About 7-Eleven Slurpees

Thu, 21 Jul 2011 13:00:00 EST - By Abby Lerner for Shape.com Tim Sloan, AFP/Getty Images Forget cake and presents. When 7-Eleven Inc. celebrates its birthday, the convenience store gives away free Slurpees to customers! 7-Eleven turrned 84 a week and a half ago (7/11/11), and while the company has been giving away Slurpees annually since 2002, this year's event was anticipated to be larger than ever. A free, ice cold Slurpee can be tough to resist in the summer heat. So to help you decide if the icy drink is worth it, we pulled together a few fast facts on Slurpees. 3 Things You Should Know About Slurpee Drinks Before Your First Sip 1. Consider your Slurpee a summer indulgence, not just another drink. In an average 11-oz slurpee (the size 7-Eleven is giving away on July 11th), depending on flavor, you'll get around 175 calories, 48 grams of carbohydrates (more than the average person should be consuming in a day) and a boatload of harmful chemicals. (Have you ever seen an electric blue fruit at the farmer's market?) 2. While "diet slurpees" may have fewer calories, according to some scientific studies, they're even worse for you than the full-sugar flavors. Here's why: To make up for the lack of real sugar, diet flavors contain aspartame. As aspartame is extremely toxic to many people, the addition of this can be detrimental to your health. 3. Don't be fooled by Crystal Light flavors. Just because the Crystal Light packets you dump in your water bottle contain zero calories, zero sugar and zero carbs, it doesn't mean the Slurpee version is the same. A 16 oz cup comes in at 80 calories. This is still a fine low-cal treat, but we just want you to be aware that it's not calorie free. More from Shape.com: 50 Seemingly Healthy Foods That Are Bad for You What's the Real Deal on Detox Diets? 3 Butt and Thigh Moves Celeb Trainers Swear By

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Illnesses & Conditions News Headlines - Yahoo! News UK

The latest Illnesses & Conditions news headlines from Yahoo! News UK. Find videos, pictures and in-depth Illnesses & Conditions coverage

New cancer cases 'up 30% by 2030'

2012-02-04T00:02:03Z -

New cases of cancer could rise 30% in the UK by 2030, experts have warned.

Breast cancer fund to restore money after outcry

2012-02-03T20:10:38Z -

A major US breast cancer foundation Friday reversed its decision to stop funding Planned Parenthood after outcry over the move sparked a political and fundraising backlash by women's health advocates.

Malaria kills twice as many as thought - study

2012-02-03T19:54:47Z -

LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease. Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States. ...

Lifestyle changes can help prevent 30% of cancers: WHO

2012-02-03T19:29:28Z -

More than 30 percent of cancers can be prevented by lifestyle changes, the World Health Organization said Friday, on the eve of World Cancer Day.

US recommends routine HPV vaccination for boys

2012-02-03T17:50:45Z -

US health authorities on Friday urged all boys age 11-12 to get a routine vaccination against the most common sexually transmitted disease, human papillomavirus, or HPV.

Malaria kills twice as many as thought - study

2012-02-03T16:31:59Z - LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease. Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States. ...

Fluid biopsy pinpoints cancer cells

2012-02-03T14:40:58Z -

Cancer treatment could be transformed by a new "fluid biopsy" technique that spotlights tumour cells carried in the bloodstream, say scientists.

Three die in Legionnaires' outbreak

2012-02-03T11:01:22Z -

A third British holidaymaker has died from contracting Legionnaires' disease while on holiday in Spain, the Valencia regional government has said.

Brains of addicts are inherently abnormal: study

2012-02-02T21:48:26Z -

Drug addicts have inherited abnormalities in some parts of the brain which interfere with impulse control, said a British study published in the United States on Thursday.

Siblings' brain scans may hold key to addictions

2012-02-02T19:07:23Z - LONDON (Reuters) - Drug addicts and their non-addicted siblings share certain features in the brain, suggesting a susceptibility to addiction is inherited but is also a flaw that can be overcome, scientists said on Thursday. Researchers who scanned the brains of 50 pairs of brothers and sisters of whom one was a cocaine addict found that both siblings had brain abnormalities that make it more difficult for them to exercise self-control. ...

Pakistan shuts drugs factory after deaths

2012-02-02T17:05:08Z -

Pakistan has closed at least temporarily a pharmaceutical factory accused of manufacturing medicine suspected to have killed more than 100 heart patients, an official said Thursday.

Analysis - Lilly Alzheimer's drug an unlikely ace in the hole

2012-02-02T14:45:13Z - NEW YORK (Reuters) - A treatment for Alzheimer's disease is the drug industry's longest shot, and any brave investors willing to place a bet on the outcome are likely to focus on Eli Lilly & Co. Lilly and Pfizer Inc are the farthest along in developing experimental medicines for the memory-robbing disease. But Lilly, as the far smaller company, has much more upside for its share price if it hits pay dirt. The field is littered with high-profile failures, one of the most recent being a previous Lilly compound. ...

US study finds Alzheimer's spreads like infection

2012-02-02T14:34:58Z -

A new US study has found that Alzheimer's disease spreads from one part of the brain to another like an infection, a discovery that could aid the development of treatments to slow its progress.

Cancer drug 'too expensive for NHS'

2012-02-02T00:17:13Z -

A drug hailed as a breakthrough in extending the lives of men with late-stage prostate cancer is too expensive for use on the NHS, a watchdog has said.

Scientists decode how the brain hears words

2012-02-02T00:15:30Z -

US scientists said Wednesday they have found a way to decode how the brain hears words, in what researchers described as a major step toward one day helping people communicate after paralysis or stroke.

Government says home-grown cancer pill too costly to use

2012-02-02T00:04:32Z - LONDON (Reuters) - Britain's health cost watchdog NICE sparked a major row on Thursday by snubbing a pricey new prostate cancer pill discovered at the country's top cancer research centre, a decision critics said was bad for patients and research. If the draft ruling is upheld after further consultation, Zytiga, which is marketed by Johnson & Johnson, will not be reimbursed on the state-run National Health Service (NHS). The drug was hailed as a significant advance by cancer doctors after a clinical trial showed it extended the lives of patients with advanced prostate cancer by an average of ...

Scientists shift on brain speech center: study

2012-02-01T12:37:47Z -

The part of the brain used for speech processing is in a different location than originally believed, according to a US study that researchers said will require a rewrite of medical texts.

Heart failure 'has link to brain'

2012-02-01T00:10:11Z -

Heart failure, which affects around 900,000 people in the UK, is linked to a decline in mental processes and a loss of grey matter in the brain, according to new research.

US approves new drug for rare cystic fibrosis

2012-01-31T19:18:08Z -

US regulators on Tuesday approved Kalydeco, a new, gene-targeted drug treatment for people who have a rare kind of the incurable lung disease cystic fibrosis.

Cancer 'slowed by cooked tomatoes'

2012-01-31T09:44:57Z -

A nutrient in cooked tomatoes has been shown in laboratory studies to slow the growth of - and even kill - prostate cancer cells, scientists have said.

US approves new drug for common skin cancer

2012-01-30T17:44:25Z -

US authorities on Monday approved a new drug to treat the most common form of skin cancer, basal cell carcinoma, which is rarely lethal but can spread if left untreated.

Doctors 'should check blood pressure on both arms'

2012-01-30T15:08:38Z -

Measuring blood pressure on both arms rather than only one can reveal an elevated risk of heart disease or even death, according to a study released Monday.

Big Pharma donates drugs for neglected diseases

2012-01-30T12:08:25Z -

LONDON (Reuters) - The world's major pharmaceutical companies joined forces with governments and leading global health organizations Monday to donate drugs and scientific know-how to help control or wipe out 10 neglected tropical diseases by 2020. Drugmakers have been criticised in the past for not doing enough to fight diseases of the poor as they concentrate instead on conditions more prevalent in rich nations, such as high cholesterol. ...

Call to talk about bowel cancer

2012-01-30T00:16:07Z -

A Government campaign has been launched to raise awareness of the symptoms of bowel cancer.

US settlement puts India's Ranbaxy on the ropes

2012-01-29T22:08:38Z -

Indian drugs giant Ranbaxy faces a tough road ahead after US authorities imposed stiff conditions to settle a long legal battle over manufacturing safety violations at its plants, analysts say.

Body clock gene 'link' to diabetes

2012-01-29T18:04:21Z -

Defective versions of a "body clock" gene greatly increase the risk of type 2 diabetes, a study has shown.

Tea 'may cut heart disease rates'

2012-01-27T17:18:40Z -

Heart disease rates could be reduced by 10% if everyone took to drinking large amounts of tea, a study has suggested.

Cancer carers urged to seek support

2012-01-27T06:37:34Z -

More than a million people in the UK who care for a loved-one with cancer are potentially missing out on vital support and benefits, according to research by a leading charity.

Study finds early signs of autism in baby brains

2012-01-26T17:04:55Z -

LONDON (Reuters) - Children who develop autism already show signs of different brain responses in their first year of life, scientists said on Thursday in a study that may in the future help doctors diagnose the disorder earlier. British researchers studied 104 babies at 6 to 10 months and then again at 3-years-old, and found that those who went on to develop autism had unusual patterns of brain activity in response to eye contact with another person. ...

Heart risks 'not as suggested'

2012-01-25T22:05:14Z -

Doctors may be giving middle-aged men and women a false sense of security about their chances of suffering a heart attack or stroke, research suggests.

Blood test 'may detect' Alzheimer's

2012-01-25T18:35:52Z -

Early signs of Alzheimer's disease could one day be diagnosed using a simple blood test, a pilot study has suggested.

Roche targets Illumina in $5.7 billion gene play

2012-01-25T16:13:20Z -

ZURICH/LONDON (Reuters) - Roche Holding AG is offering $5.7 billion (3.6 billion pound) in cash to buy U.S. gene sequencing company Illumina Inc in an unsolicited takeover bid that marks a major play by the Swiss drugmaker in the gene technology field. Gene sequencing is central to personalised medicine, which allows scientists to predict a patient's response to a particular drug, both during clinical practice and in drug trials. Roche is already the world's largest maker of cancer drugs, where gene analysis is progressing fastest, as well as a major maker of diagnostic tests. "This ... ...

Roche offers $5.7 billion to buy gene firm Illumina

2012-01-25T10:39:24Z -

(Reuters) - Roche Holding AG is offering $5.7 billion (3.6 billion pounds) in cash to buy U.S. gene sequencing company Illumina Inc in an unfriendly takeover bid that marks a major play by the Swiss drugmaker into the gene technology field. Gene sequencing is central to personalised medicine, which allows scientists to predict a patient's response to a particular drug, both during clinical practice and in drug trials. Roche is already the world's largest maker of cancer drugs, where gene analysis is progressing fastest, as well as a major maker of diagnostic tests. "This ... ...

Woman gets dropped heart transplant

2012-01-25T05:11:19Z -

A heart that was dropped on the ground while being transported to a hospital has been successfully transplanted into a 28-year-old hair stylist.

Bowel cancer patients 'need choice'

2012-01-25T00:09:26Z -

Hospitals which fail to offer bowel cancer patients a full range of appropriate treatments should be fined, a charity has said.

Fried food 'not heart disease risk'

2012-01-25T00:09:26Z -

Frying food in olive or sunflower oil does not increase the risk of heart disease or early death, researchers say.

Diabetics mark 90th anniversary

2012-01-23T00:27:42Z -

It is 90 years today since the first human - a 14-year-old boy - was successfully treated with insulin to control diabetes.

Sex ruled safe for heart patients

2012-01-20T04:54:14Z -

Sex is safe for most heart patients - if you can walk up two flights of stairs without chest pain or gasping for breath, a leading doctor's group in the US says.

Gene role in gullet cancer studied

2012-01-19T17:07:19Z -

A single gene may be a key player in the development of oesophageal cancer, which affects the gullet, research has shown.

Cancer victory led to 8-stone loss

2012-01-18T10:45:41Z -

A 20-year-old woman who was inspired to lose nearly half her body weight after winning her fight against cancer has been named Slimming World's Miss Slinky 2012.

Scientific American Topic - Mental Health

Science news and technology updates from Scientific American

Anti-GM Groups Attempt to Sully Transgenic Control of Dengue Fever

Thu, 12 Jan 2012 14:00:00 EST -

Genetically engineered mosquitoes developed by British biotech firm Oxitec as an approach to controlling dengue fever have been caught up in controversy since 6,000 of them were deliberately released to an uninhabited forest in Malaysia in a trial in December 2010.

[More]

Emotion Selectively Distorts Our Recollections (preview)

Thu, 12 Jan 2012 07:00:00 EST -

On September 11, 2001, Elizabeth A. Phelps stepped outside her apartment in lower Manhattan and noticed a man staring toward the World Trade Center, about two miles away. Looking up, “I just saw this big, burning hole,” Phelps recalls. The man told her that he had just seen a large airplane crash into one of the skyscrapers. Thinking it was a horrible accident, Phelps started walking to work, a few blocks away, for a 9 a.m. telephone meeting. By the time she reached her eighth-floor office at New York University, a second jet had struck the other tower, which collapsed after an hour. Later, she saw the remaining tower fall.

[More]

Casual Marijuana Smoking Not Harmful to Lungs

Tue, 10 Jan 2012 18:25:00 EST -

It wouldn't have mattered if Bill Clinton inhaled, as far as his lungs are concerned. Smoking up to a joint per day doesn't seem to decrease lung function, according to a study published in Jan. 11 edition of Journal of the American Medical Association.

[More]

Five Hidden Dangers of Obesity (preview)

Tue, 10 Jan 2012 08:00:00 EST -

By now it is common knowledge that being severely overweight puts people at increased risk of suffering from heart disease, stroke and diabetes and that obesity--defined as weighing at least 20 percent more than the high side of normal--is on the rise. According to one estimate, the U.S. will be home to 65 million more obese people in 2030 than it is today, leading to an additional six million or more cases of heart disease and stroke and another eight million cases of type 2 diabetes. Many clinicians have already begun seeing families in which the grandparents are healthier and living longer than their children and grandchildren.

[More]

Shelf-Preservation: Researchers Tap Century-Old Brain Tissue for Clues to Mental Illness

Mon, 09 Jan 2012 07:00:00 EST -

Among the bloodletting boxes, ether inhalers, kangaroo-tendon sutures and other artifacts stored at the Indiana Medical History Museum in Indianapolis are hundreds of scuffed-up canning jars full of dingy yellow liquid and chunks of human brains. [More]

How Has Stephen Hawking Lived to 70 with ALS?

Sat, 07 Jan 2012 06:00:00 EST -

Stephen Hawking turns 70 on Sunday, beating the odds of a daunting diagnosis by nearly half a century. [More]

Baby Monkeys with 6 Genomes Are Scientific First

Fri, 06 Jan 2012 19:00:00 EST -

They look like ordinary baby rhesus macaques , but Hex, Roku and Chimero are the world's first chimeric monkeys, each with cells from the genomes of as many as six rhesus monkeys.

[More]

Two Big Myths about Grief

Thu, 05 Jan 2012 11:00:00 EST -

Virtually all of us experience the loss of a loved one at some point in our life. So it is surprising that the serious study of grief is not much more than 30 years old. Yet in that time, we have made significant discoveries that have deepened our understanding of this phenomenon--and challenged widely held assumptions.

[More]

Diagnosis of Borderline Personality Disorder Is Often Flawed

Wed, 04 Jan 2012 10:30:00 EST -

This past June renowned clinical psychologist Marsha M. Linehan of the University of Washington made a striking admission. Known for her pioneering work on borderline personality disorder (BPD), a severe and intractable psychiatric condition, 68-year-old Linehan announced that as an adolescent, she had been hospitalized for BPD. Suicidal and self-destructive, the teenage Linehan had slashed her limbs repeatedly with knives and other sharp objects and banged her head violently against the hospital walls. The hospital’s discharge summary in 1963 described her as “one of the most disturbed patients in the hospital.” Yet despite a second hospitalization, Linehan eventually improved and earned a Ph.D. from Chicago’s Loyola University in 1971.

[More]

Deep-Brain Stimulation Found to Fix Depression Long-Term

Tue, 03 Jan 2012 16:20:00 EST -

Deep depression that fails to respond to any other form of therapy can be moderated or reversed by stimulation of areas deep inside the brain. Now the first placebo-controlled study of this procedure shows that these responses can be maintained in the long term.

[More]

Why Women Report Being in Worse Health Than Men

Fri, 30 Dec 2011 11:00:00 EST -

When asked to rate their own health, women , on average, consistently report being in worse health than men do, and a new study from researchers in Spain says this is because women have a higher rate of chronic diseases -- contradicting a previous theory that women's lower self-rated health is simply a reporting bias.

[More]

Aging Brains Match Youth in Some Mental Tasks

Wed, 28 Dec 2011 15:45:00 EST -

Since physical abilities decline as people age, many people think the elderly are also less able to perform mental jumping jacks as they age. New research indicates this might not be true with all brain-powered tasks: In some ways the elderly are fit to compete with their younger counterparts.

[More]

Forgetting is Key to a Healthy Mind (preview)

Fri, 23 Dec 2011 13:35:00 EST -

Solomon Shereshevsky could recite entire speeches, word for word, after hearing them once. In minutes, he memorized complex math formulas, passages in foreign languages and tables consisting of 50 numbers or nonsense syllables. The traces of these sequences were so durably etched in his brain that he could reproduce them years later, according to Russian psychologist Alexander R. Luria, who wrote about the man he called, simply, “S” in The Mind of a Mnemonist.

[More]

Fearless Youth: Prozac Extinguishes Anxiety by Rejuvenating the Brain

Thu, 22 Dec 2011 14:44:00 EST -

Once adult lab mice learn to associate a particular stimulus--a sound, a flash of light--with the pain of an electric shock, they don't easily forget it, even when researchers stop the shocks. But a new study in the December 23 issue of Science shows that the antidepressant Prozac (fluoxetine) gives mice the youthful brain plasticity they need to learn that a once-threatening stimulus is now benign. The research may help explain why a combination of therapy and antidepressants is more effective at treating depression, anxiety and post-traumatic stress disorder (PTSD) than either drugs or therapy alone. Antidepressants may prime the adult brain to rewire faulty circuits during therapy.

[More]

The Top 10 Science Stories of 2011

Thu, 22 Dec 2011 11:00:00 EST -

Inevitably, year-end lists invite plenty of debate and criticism, and Scientific American 's is no exception. Certainly, we could have included the discovery of new worlds beyond our solar system, including Kepler 22 b, an exoplanet in the "Goldilocks" zone of habitability, as well as the first known Earth-size exoplanets . Or noted the accumulating evidence suggesting that hydraulic fracturing, or fracking, to retrieve natural gas is likely to contaminate water supplies. (Final New York State regulations, expected in mid-2012, could determine the future of fracking in the U.S.)

[More]

Neurons Offer Clues to Suicide

Wed, 21 Dec 2011 08:00:00 EST -

A certain type of brain cell may be linked with suicide, according to a recent investigation. People who take their own lives have more densely packed von Economo neurons, large spindle-shaped cells that have dramatically increased in density over the course of human evolution.

[More]

How Ralph Steinman Raced to Develop a Cancer Vaccine--And Save His Life (preview)

Tue, 20 Dec 2011 12:04:00 EST -

Peering through a microscope at a plate of cells one day, Ralph M. Steinman spied something no one had ever seen before. It was the early 1970s, and he was a researcher at the Rockefeller University on Manhattan’s Upper East Side. At the time, scientists were still piecing together the basic building blocks of the immune system. They had figured out that there are B cells, white blood cells that help to identify foreign invaders, and T cells, another type of white blood cell that attacks those invaders. What puzzled them, however, was what triggered those T cells and B cells to go to work in the first place. Steinman glimpsed what he thought might be the missing piece: strange, spindly-armed cells unlike any he had ever noticed.

[More]

Japan Says Stricken Nuclear Power Plant in Cold Shutdown

Fri, 16 Dec 2011 12:00:00 EST -

TOKYO (Reuters) - Japan declared its tsunami-stricken Fukushima nuclear power plant to be in cold shutdown on Friday, taking a major step to resolving the world's worst nuclear crisis in 25 years but some critics questioned whether the plant was really under control.

[More]

Women's Response to Alcohol Suggests Need for Gender-Specific Treatment Programs

Fri, 16 Dec 2011 11:00:00 EST -

Alcohol abuse does its neurological damage more quickly in women than in men, new research suggests. The finding adds to a growing body of evidence that is prompting researchers to consider whether the time is ripe for single-gender treatment programs for alcohol-dependent women and men.

[More]

Motions Unmask Moods

Fri, 16 Dec 2011 08:00:00 EST -

None of us can stand perfectly still. No matter how hard we try, our bodies constantly make small adjustments, causing us to sway slightly as we stand. A new study finds that people with bipolar disorder tend to sway more than those who are unaffected, which may lead to new ways to treat and diagnose the illness.

When psychologists diagnose bipolar disorder, they typically look for mood swings between agitated mania and bleak depression. Previous studies have linked bipolar disorder to abnormalities in the cerebellum and basal ganglia, regions of the brain that are also important for motor control. This connection led Indiana University psychologist Amanda Bolbecker and her colleagues to hypothesize that people with bipolar disorder might also have problems with motor skills.

[More]

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Komen reverses move to cut Planned Parenthood funding

Fri, 03 Feb 2012 22:02:14 +0000 - WASHINGTON (Reuters) - The Susan G. Komen for the Cure foundation backed down from its decision to cut funding for Planned Parenthood, which provides abortion and birth control services, following a massive outcry by supporters of the world's largest breast cancer charity.

Malaria kills twice as many as thought: study

Fri, 03 Feb 2012 21:58:39 +0000 - LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease.

Nerve disorder does not recur after later vaccines: study

Fri, 03 Feb 2012 19:07:17 +0000 - NEW YORK (Reuters Health) - Despite concerns by some that vaccines might cause a crippling nerve disorder called Guillain-Barré syndrome, a new study finds that people who receive vaccines after previously having been diagnosed with the condition do not experience any flare-ups.

Bossy mom at snack time tied to kid's weight: study

Fri, 03 Feb 2012 01:47:49 +0000 - (Reuters) - Mothers who push their toddlers to eat more at snack time may end up with slightly chubbier children by the age of three, according to a U.S. study.

Green tea drinkers show less disability with age: study

Fri, 03 Feb 2012 21:00:26 +0000 - NEW YORK (Reuters Health) - Elderly adults who regularly drink green tea may stay more agile and independent than their peers over time, a large study of Japanese adults suggests.

Anxiety therapy doesn't work as well in elderly: study

Fri, 03 Feb 2012 21:48:15 +0000 - NEW YORK (Reuters Health) - A form of talk therapy called cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new study.

Breastfeeding tied to stronger lungs, less asthma

Fri, 03 Feb 2012 09:00:55 +0000 - NEW YORK (Reuters Health) - Kids who were breastfed as babies may have better lung function, and a lower risk of asthma, than those who were formula-fed, two new reports suggest.

Traffic-related asthma costs two cities big money

Fri, 03 Feb 2012 22:28:14 +0000 - NEW YORK (Reuters Health) - Traffic pollution may cost two California cities millions each year in managing children's asthma, a new study suggests.

Ulcer-causing bug tied to higher diabetes risk

Thu, 02 Feb 2012 19:21:41 +0000 - NEW YORK (Reuters Health) - People who have been infected with the ulcer-causing bacteria Helicobacter pylori are more than twice as likely to develop diabetes later on as people who do not have signs of the infection, according to a new study of Latino adults in California.

Siblings' brain scans may hold key to addictions

Thu, 02 Feb 2012 19:10:00 +0000 - LONDON (Reuters) - Drug addicts and their non-addicted siblings share certain features in the brain, suggesting a susceptibility to addiction is inherited but is also a flaw that can be overcome, scientists said on Thursday.

New Scientist - Mental Health

New Scientist - Mental Health

Disrupted body clock may prime you for schizophrenia

Thu, 19 Jan 2012 17:00:00 GMT - Genetic mutations that interfere with circadian rhythms could also trigger the symptoms of mental illness

Hijack your own dreams to improve your skills

Tue, 20 Dec 2011 18:00:00 GMT - It's like Inception, in real life: lucid dreams offer people the ability to control their dreams and improve not only skills, but also mental health

Abused children's brains work like soldiers' do

Tue, 06 Dec 2011 16:23:00 GMT - Brain scans show that children from violent homes detect threats in the same way that soldiers do

Alzheimer's damage reversed by deep brain stimulation

Wed, 23 Nov 2011 17:30:00 GMT - Brain shrinkage in people with Alzheimer's disease can be reversed in some cases – by zapping the degenerating tissue with electrical impulses

Older brains lack quick-fire connections

Wed, 23 Nov 2011 00:00:00 GMT - Brain scans show that the striatum, an area of the brain that allows for fast responses, is less well connected in the older brain

Mental problems gave early humans an edge

Mon, 07 Nov 2011 11:38:00 GMT - Did an autistic inventor start a Stone Age technological revolution? Were the first spiritual leaders bipolar? A daring new theory makes the case

To avoid PTSD, no debrief for Japan's quake survivors

Tue, 01 Nov 2011 17:01:00 GMT - After the Japanese earthquake and tsunami in March, medics were warned off giving immediate counselling – it may make post-traumatic stress more likely

Brain-training games stop depression before it starts

Tue, 01 Nov 2011 11:00:00 GMT - Depression could be staved off before it even appears using a computer game so simplistic that even the psychologist testing it once bet it wouldn't work

Drug hallucinations look real in the brain

Fri, 28 Oct 2011 10:36:00 GMT - Brain scans suggest that the visions induced by an Amazonian shamans' brew may be as real as anything the eyes actually see

People with autism unaffected by social reputation

Wed, 19 Oct 2011 12:00:00 GMT - While non-autistic people act more charitably when they are being watched, those with autism act just as generously as when they are alone

Infant anaesthesia link with learning difficulties

Tue, 04 Oct 2011 12:57:00 GMT - Only infants who underwent two or more procedures were at greater risk of learning problems later on

Data gold mine lifts veil on world of online poker

Mon, 03 Oct 2011 14:32:00 GMT - Software has provided a mass of statistics about online poker, one of the world's biggest draws, and could help pinpoint problem gamblers

Monkeys meditate for marshmallows

Fri, 30 Sep 2011 14:55:00 GMT - Marmosets can learn to tune their brain to certain frequencies. Immune to placebo effects, they could objectively test brain-training treatments for epilepsy

Epigenetic clue to schizophrenia and bipolar disorder

Fri, 30 Sep 2011 10:03:00 GMT - People with schizophrenia and bipolar disorder have changes in related gene activity caused by their environment, studies of twins reveal

'Autistic' mice created - and treated

Thu, 29 Sep 2011 16:45:00 GMT - Some of the classic symptoms of autism – limited language development, irregular social interaction, and repetitive behaviour – have been recreated in mice

Maker of cognitive training game seeks FDA approval

Mon, 26 Sep 2011 12:19:00 GMT - A game that claims to reduce symptoms of schizophrenia will be put before the FDA – but would approval be a boon or a burden for the industry?

Deep impact: The bad news about banging your head

Wed, 14 Sep 2011 08:00:00 GMT - Concussion has long been seen as a temporary and fairly harmless affliction. But as Bob Holmes explains, the repercussions can last a lifetime

Psychiatric illness is biggest source of Europe's ill health

Tue, 06 Sep 2011 15:10:00 GMT - Almost 40 per cent of Europeans experience mental illness such as depression or anxiety each year

Beware the lone wolf radicals

Sun, 04 Sep 2011 12:00:00 GMT - Home-grown killers such as Anders Breivik have a distinct psychology that should make it easier for police to spot them before they strike, says Kathleen Puckett

Crossing the borderline: Fixing personality disorders

Fri, 26 Aug 2011 14:28:00 GMT - It's time to reject the notion that people with personality disorders are beyond help, says Peter Aldhous

Autism risk rises for siblings of autistic children

Wed, 17 Aug 2011 14:25:00 GMT - Younger siblings of children with autism have an even higher chance of developing the condition themselves than previously thought

Delirium in hospital can be a killer for the elderly

Wed, 27 Jul 2011 17:00:00 GMT - Elderly patients are falling victim to an insidious epidemic of dementia. Can changes to the way they are cared for in hospital reduce the toll?

Childhood autism spikes in geek heartlands

Mon, 20 Jun 2011 14:12:00 GMT - Dutch study supports idea that hi-tech hubs attract geekier employees, who are more likely to have children with autism

Drug-loaded brain electrode could prevent seizures

Wed, 08 Jun 2011 14:37:00 GMT - A new polymer-coated electrode might be able to monitor brain tissue for unusual activity then deliver drugs to affected area

Slow-moving Alzheimer's can buy people more time

Tue, 07 Jun 2011 23:01:00 GMT - People with Alzheimer's deteriorate at one of two speeds, so it's possible to predict when cognitive functions might decline

Emergency Medicine Journal current issue

Emergency Medicine Journal RSS feed -- current issue

Highlights from this issue

2012-01-11T15:30:57-08:00 -

This month we range from Politics to philosophy, from basic science to standards of care. There is a spread of material on the resuscitation of cardiac arrest and lots of pre-hospital care; triage at ‘front’ and ‘rear’, trauma transfer times, airway care in the field and even how to improve ambulance safety.

The meaning of words

In this month's editorial, Hughes (see page 90) shows how easy it is to become confused with the political language of the performance culture in UK Emergency Medicine and translates some into simple terms that can be understood! On a much simpler and certainly more fundamental level, Body and Foex (see page 91) consider the philosophical difference between pain and suffering. Do we see and try to manage the disease/injury or care for the patient? Try their thought experiments to find out.

Real science

Tura et al (see...

A&E quality indicators

2012-01-11T15:30:57-08:00 -

International readers may need reminding that in April 2011 a new set of clinical quality (A&E) indicators was introduced in the NHS in England to replace the previous 4 h waiting time standard, the new indicators providing a platform with which to measure the quality of care delivered in A&E departments in England. The indicators were developed by the national clinical director for urgent and emergency care, working with the College of Emergency Medicine, the Royal College of Nursing and informed patient representatives.

At the beginning of October last year the government released data for May 2011, related to A&E attendances for that month and drawing on just over 1.4 million detailed records of attendances at major A&E departments, single specialty A&E departments (eg, dental), minor injury units and walk-in centres in England.1

Five indicators are reported:

left department before being seen for treatment rate;

re-attendance rate;

...

Optimising well-being: is it the pain or the hurt that matters?

2012-01-11T15:30:57-08:00 -

In recent years there has been a commendable focus on patient-centred medicine, with increasing attention being paid to the timely assessment and management of acute pain. 78% of patients who attend the emergency department report pain, the severity of which is often used to determine clinical priority at triage. Clinical guidelines are increasingly including the timely provision of appropriate analgesia as a clinical standard. Pain scoring has been widely adopted, causing pain to be considered as the ‘fifth vital sign’ by some. Interestingly, there remains little evidence to support the benefit of this approach for patients. The aim of this review is to explore some of the assumptions that made in defining and addressing ‘pain’, and to explore whether it is truly ‘nociception’ or ‘suffering’ that ought to be addressed. Through two thought experiments, it is demonstrated that the current approach to pain relies heavily on addressing ‘nociception’ but does little to address the ‘suffering’ that is undoubtedly they key determinant of well-being in patients. It is demonstrated that the current naturalistic approach risks neglecting many ‘non-nociceptive’ sources of suffering, including physical (eg, nausea, vertigo, dyspnoea, pruritus) and mental (anxiety, depression, fear, anger) symptoms. In the humane quest to relieve suffering, there is a clear need to examine current practice. Indeed, the philosophical enquiry presented even questions whether our culture risks overemphasising the importance of pharmacological analgesia and calls for emergency physicians to take a more holistic approach to meeting patient needs.

Comparative quality analysis of hands-off time in simulated basic and advanced life support following European Resuscitation Council 2000 and 2005 guidelines

2012-01-11T15:30:57-08:00 - Aim

To compare hands-off time (HOT) in simulated advanced life support (ALS) following European Resuscitation Council (ERC) 2005 guidelines and ERC 2000 and to provide quantitative data on workflow.

Subjects and Methods

Observations with 18 professional paramedics, performing 39 megacodes (mega-code training; MCT) were videotaped during ALS re-certification. Teams were randomly assigned to train according to ERC 2000 or ERC 2005. HOT, hands-off intervals (HOI) and other variables describing interventions and workflow were analysed.

Results

In group ERC 2000 17±3 HOI appeared with a mean duration of 17.5±10.8 s (mean±SD). Overall HOT was 382±47 s, equivalent to a mean hands-off fraction (HOF) of 0.45±0.05. 15±5 ventilation-free intervals (VFI) were observed, with a mean duration of 21±10 s. In contrast after ERC 2005 variables resulted in 18±3 HOI with a mean duration of 10.0±4.0 s (p<0.001 vs ERC 2000), overall HOT 196±33 s (HOF 0.23±0.04; p<0.001), 24±12 VFI with a duration of 24±7 s (p<0.05). The first HOI lasted for 60.4±33.1 s in ERC 2000 and 17.6±4.3 s in ERC 2005 (p<0.001). In ERC 2000 6.1±2.6 interruptions for two bag/mask ventilations (BMV) lasted for 5.4±0.8 s, whereas in ERC 2005 9.6±3.1 interruptions for two BMV took 6.5±2.2 s (p<0.001). In both groups HOI were used thoroughly for basic life support/ALS-based interventions.

Conclusion

The application of ERC guidelines of 2005 markedly reduced the first HOI and mean duration of HOI at the cost of delayed secure airway management and ECG analysis in this MCT model.

Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest

2012-01-11T15:30:57-08:00 - Objective

Therapeutic hypothermia has proved effective in improving outcome in patients after cardiac arrest due to ventricular fibrillation (VF). The benefit in patients with non-VF cardiac arrest is still not defined.

Methods

This prospective observational study was conducted in a university hospital setting with historical controls. Between 2002 and 2010 387 consecutive patients have been admitted to the intensive care unit (ICU) after cardiac arrest (control n=186; hypothermia n=201). Of those, in 175 patients the initial rhythm was identified as non-shockable (asystole, pulseless electrical activity) rhythm (control n=88; hypothermia n=87). Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A follow-up was completed for all patients after 90 days, a Kaplan–Meier analysis and Cox regression was performed.

Results

Hypothermia treatment was not associated with significantly improved neurological outcome in patients resuscitated from non-VF cardiac arrest (CPC 1–2: hypothermia 27.59% vs control 18.20%, p=0.175). 90-Day Kaplan–Meier analysis revealed no significant benefit for the hypothermia group (log rank test p=0.82), and Cox regression showed no statistically significant improvement.

Conclusions

In this cohort patients undergoing hypothermia treatment after non-shockable cardiac arrest do not benefit significantly concerning neurological outcome. Hypothermia treatment needs to be evaluated in a large multicentre trial of cardiac arrest patients found initially to be in non-shockable rhythms to clarify whether cooling may also be beneficial for other rhythms than VF.

'Scurvy': presentation and skin manifestations of a not so uncommon condition

2012-01-11T15:30:57-08:00 -

An 84-year-old man attended our emergency department with a 5-month history of poor oral intake since the death of his wife. He complained of lethargy, dyspnoea, epistaxis and myalgic pains. He was severely thin with purpuric skin lesions over his knuckles, elbows and shins (figures 1 and 2).1

Scurvy was suggested and confirmed by dermatology. The patient was started on ascorbic acid (400 mg/24 h) and initially improved, but died later of a nosocomial infection.

Scurvy is a state of vitamin C (ascorbic acid) deficiency. Ascorbic acid is used in the synthesis of collagen, neurotransmitters and helps in dietary iron absorption. Deficiency results in poor wound healing, defective capillary walls and anaemia.

The UK incidence of clinical scurvy is unknown, but the prevalence of vitamin C deficiency is estimated at 25% in men and 16% in women and is associated with low income, poor diet...

Value of a rigid collar in addition to head blocks: a proof of principle study

2012-01-11T15:30:57-08:00 - Background

All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines.

Objective

To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard.

Method

The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured.

Results

The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar.

Conclusion

Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.

Slow infusion metoclopramide does not affect the improvement rate of nausea while reducing akathisia and sedation incidence

2012-01-11T15:30:57-08:00 - Objective

To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation.

Methods

A prospective, randomised, double blind trial, from 1 March 2007 to 1 May 2008 in the ED of Pamukkale University Faculty of Medicine. Patients with moderate to severe nausea were randomised and divided into two groups: group 1 received 10 mg metoclopramide as a slow intravenous infusion over 15 min plus placebo (SIG); group 2 received 10 mg metoclopramide as an intravenous bolus infusion over 2 min plus placebo (BIG). The whole procedure was observed, and nausea scores, akathisia and vital changes were recorded.

Results

140 patients suffering from moderate to severe nausea in the ED were included in the study. There was no significant difference between the groups in terms of mean nausea scores during follow-up (p=0.97). A significant difference in akathisia incidence was observed between the groups (18 (26.1%) in the BIG and 5 (7%) in the SIG) (p=0.002). There was also a significant difference in sedation incidence between the groups (19 (27.5%) in the BIG and 10 (14.5%) in the SIG) (p=0.05).

Conclusion

Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea.

Serum procalcitonin predicting mortality in exertional heatstroke

2012-01-11T15:30:57-08:00 - Background

The aim of this study was to test if Procalcitonin PCT value at the time of admission is a predictor of mortality and/or a diagnostic marker of concomitant infection in exertional heatstroke.

Methods

68 patients with exertional heatstroke admitted to the multidisciplinary intensive care unit were studied. Serum PCT was detected by means of a specific and ultrasensitive immunoluminometric assay within 2 h of admission. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was evaluated within 24 h of admission.

Results

There was no significant difference in PCT levels between concomitant infection and non-infection patients (p=0.712). Elevated PCT level in exertional heatstroke patients was associated with a more critical pathological state. PCT values in patients with multiple organ dysfunction syndrome (MODS) were significantly higher than those without MODS (p=0.007.). PCT values were also positively correlated with APACHE II scores (r=0.588, p=0.016). PCT values in non-survivors were higher than in survivors at univariate regression analysis (p=0.017). After adjusting for confounders, PCT concentration also remained an independent determinant of mortality (OR 2.98; 95% CI 1.02 to 4.41; p=0.039). Receiver operating characteristic curve for PCT concentration was located above the reference line, which shows an association with mortality. The area under the curve for PCT concentration (0.705; 95% CI 0.547 to 0.862) was statistical significantly (p=0.019). As a predictor of mortality, PCT value was inferior to APACHE II score.

Conclusions

PCT value at the time of admission is an independent predictor of mortality, but maybe not a good indicator of concomitant infection in exertional heatstroke.

Unexpected splenic injury

2012-01-11T15:30:57-08:00 -

A 31-year-old man presented to the emergency department at 04:50 complaining of left-sided abdominal and flank pain that started from the previous afternoon. The pain had initially settled but he woke up with a recurrence of the pain. The pain settled with the administration of rectal diclofenac and an intravenous pyelogram was normal. The patient was stable and blood tests were unremarkable. He was admitted by the surgeon, reviewed by senior surgeons in the morning and discharged.

After 2 days, he returned with persistent abdominal pain. Abdominal examination was unremarkable. Emergency department ultrasound showed significant intra-abdominal free fluid and a lesion in the spleen (figure 1A,B). A CT scan confirmed the presence of free fluid in the abdomen, intrasplenic laceration together with peri-splenic haematoma. The patient admitted to jet skiing the week before the pain started. He was readmitted. The pain settled over the next few days and...

Recent massive blood transfusion practice in England and Wales: view from a trauma registry

2012-01-11T15:30:57-08:00 - Background

Few studies have characterised massive blood transfusion (MBT) practice in UK trauma. This study describes the Trauma Audit and Research Network experience of MBT over a 4-year period, and examines variables predictive of MBT and mortality following MBT.

Methods

Prospectively collected data between 2005 and 2009 from the Trauma Audit and Research Network database were analysed. MBT incidence was examined, and patient characteristics, blood component usage and mortality compared to non-MBT patients. Clinical and injury features predictive of massive transfusion, and risk factors predictive of death in MBT, were analysed using multivariate logistic regression.

Results

157 patients (0.4%) received MBT, with a mortality rate of 40.3%. MBT patients were younger, more likely to be male and to have sustained more severe trauma (median age 39.2 years, median Injury Severity Score 27, 78% male, p<0.01). No patients received platelets and fresh frozen plasma (FFP) in 1:1 ratios with packed red cells. Multivariate analysis showed: age, admission pulse rate, systolic blood pressure, and injury type; thoracic, abdominal, pelvis, were significant predictors of MBT. Injury Severity Score and admission pulse rate were also independent predictors of death in MBT, but level of platelet and FFP use were not found to be statistically significant.

Conclusion

MBT is a rare event with high mortality in UK trauma. Haemostatic resuscitation is not currently practiced in the UK and the authors were unable to show that FFP and platelet use were significant predictors of survival in MBT.

Theme: Suicide and suicidal behaviours

2012-01-11T15:30:57-08:00 - Question 1

Which of the following are true regarding suicidal intent and suicide?

A previous suicide attempt is the best predictor of a future suicide attempt.

10–15% of those attempting suicide succeed, but 60–70% of successful suicides have no prior history of attempts.

Patients who attempt suicide have low CSF serotonin levels.

Borderline personality disorder is the Axis II diagnosis most closely associated with suicide.

Question 2

Which of the following are true regarding assessment of potentially suicidal patients?

A ‘SAD PERSONS’ score of <6 has a negative predictive value (NPV) of >95%.

No single psychological test can accurately predict suicidal attempts.

Scoring systems might help in determining the need for hospitalisation.

Suicide is often provoked by a treatable or reversible short-term crisis.

Question 3

Which of the following are true regarding treatment of suicidality?

Suicidal patients frequently...

Is computer-assisted telephone triage safe? A prospective surveillance study in walk-in patients with non-life-threatening medical conditions

2012-01-11T15:30:57-08:00 - Background

Patients often establish initial contact with healthcare institutions by telephone. During this process they are frequently medically triaged.

Purpose

To investigate the safety of computer-assisted telephone triage for walk-in patients with non-life-threatening medical conditions at an emergency unit of a Swiss university hospital.

Methods

This prospective surveillance study compared the urgency assessments of three different types of personnel (call centre nurses, hospital physicians, primary care physicians) who were involved in the patients' care process. Based on the urgency recommendations of the hospital and primary care physicians, cases which could potentially have resulted in an avoidable hazardous situation (AHS) were identified. Subsequently, the records of patients with a potential AHS were assessed for risk to health or life by an expert panel.

Results

208 patients were enrolled in the study, of whom 153 were assessed by all three types of personnel. Congruence between the three assessments was low. The weighted values were 0.115 (95% CI 0.038 to 0.192) (hospital physicians vs call centre), 0.159 (95% CI 0.073 to 0.242) (primary care physicians vs call centre) and 0.377 (95% CI 0.279 to 0.480) (hospital vs primary care physicians). Seven of 153 cases (4.57%; 95% CI 1.85% to 9.20%) were classified as a potentially AHS. A risk to health or life was adjudged in one case (0.65%; 95% CI 0.02% to 3.58%).

Conclusion

Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions.

Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest

2012-01-11T15:30:57-08:00 - Objective

Animal studies describe cardiovascular collapse (CVC; hypotension or reoccurrence of cardiac arrest) after return of spontaneous circulation (ROSC) from cardiopulmonary arrest. Few studies describe CVC in humans. This study aimed to determine the occurrence of CVC in human out-of-hospital cardiopulmonary arrest (OHCA).

Methods

Using observational data from a site of the Resuscitation Outcomes Consortium, the study analysed treated, non-traumatic OHCA achieving initial ROSC. CVC was defined as post-ROSC hypotension (systolic blood pressure ≤80 mm Hg), post-ROSC administration of epinephrine, vasopressin or dopamine, or post-ROSC recurrent cardiac arrest. The time period from initial ROSC to emergency department (ED) arrival was measured. The prevalence of and elapsed time to post-ROSC CVC was determined, censoring cases at the point of ED arrival and comparing clinical characteristics between CVC and non-CVC cases.

Results

Of 1081 treated OHCA, ROSC occurred in 58 (5%; 95% CI 4% to 7%). CVC occurred in three cases of 58 ROSC (5%; 95% CI 1% to 14%), all due to recurrent cardiac arrest. The median ROSC to ED arrival time was 6 min (IQR 3–13 min). ROSC to CVC times were 1, 2 and 8 min. Patient sex, age, initial ECG rhythm, endotracheal intubation, bystander cardiopulmonary resuscitation and bystander automated external defibrillation were similar between CVC and non-CVC cases (p=0.11–1.00).

Conclusions

In this series of treated OHCA, only a small fraction of patients experienced CVC after ROSC.

Effect of an onboard event recorder and a formal review process on ambulance driving behaviour

2012-01-11T15:30:57-08:00 - Background

Onboard event recorders in vehicles record external and internal video before and after when preset g-force limits are exceeded. The use of these recorders in a fleet of ambulances, along with formal review, may decrease the number of unsafe driving events. The aim of this study was to evaluate the number of driving events since the inception of DriveCam technology in a fleet.

Methods

54 vehicles were outfitted with DriveCam event recorders in 2003. Events were captured and assigned a categorical severity score of 1–4 (1 being the lowest severity) when the vehicle exceeded preset g-force limits. An event was assigned a score of ‘good’ if the review determined that the driver demonstrated good judgement. A review and feedback process was implemented in August 2006 and analysed through June 2008.

Results

During the study period, 2 979 891 miles were driven for 115 019 ambulance responses, with 6009 events captured. Events were categorised as follows: 2008 (33.4%) level 1; 3726 (62.0%) level 2; 175 (2.9%) level 3; 3 (0.05%) level 4; and 97 (1.6%) good events. The proportion of all events per mile and all events per response decreased over time with use of the recorder and review and feedback.

Conclusions

The institution of video event recorder technology along with formal review and feedback resulted in a change in driving behaviour. Given that call volumes increased and driving events decreased, these measures may serve as surrogates for improvements in safety and maintenance costs. Economic analysis is necessary for conclusions on fiscal impact.

Prehospital anaesthesia: a survey of current practice in the UK

2012-01-11T15:30:57-08:00 - Aim

To establish the national picture of prehospital anaesthesia in the UK and to reference practice against the Association of prior to Anaesthetists of Great Britain and Ireland safety guideline on prehospital anaesthesia.

Methods

Lead clinicians were identified for all prehospital services in the UK that could potentially be performing prehospital anaesthesia and invited to complete a detailed online survey. The survey requested details on team structure, the process for prehospital anaesthesia, drugs and equipment used and training and governance arrangements.

Results

55 responses were received from 63 invitations sent (87.3%) yielding usable data for 47 services. 31 of the 47 services (70%) responded that they performed prehospital anaesthesia. All services performing prehospital anaesthesia utilised a doctor but only 18 services (58%) always utilised a trained assistant. 28 services (90%) maintained a database and over half of services (55%) performed less than 20 prehospital anaesthetics annually. 23 services (74%) had a designated lead clinician for prehospital anaesthesia and 25 (81%) had a written difficult airway plan. 19 services (61%) had mandatory continual training requirements.

Conclusions

The majority of services are currently complying with the recommendations in the Association of prior to Anaesthetists of Great Britain and Ireland safety guideline. There are still areas of concern, particularly with regard to ongoing training and the high numbers of services that do not use a trained assistant for the process of prehospital anaesthesia.

Inappropriate 999 calls: an online pilot survey

2012-01-11T15:30:57-08:00 - Background

Abuse of ambulance services is high, and there is concern among healthcare professionals that misuse of ambulances places stress on services, which may jeopardise patient care. This study aims to determine the proportion of people who correctly identify appropriate situations to call for an ambulance, and determine the characteristics of those most likely to call inappropriately.

Methods

An online questionnaire presented 12 common scenarios that may require medical attention and required participants to identify when they would request an ambulance. Proportions correctly responding to each scenario were calculated and each respondent was given a total score. t-Tests compared mean scores between groups (with and without first aid (FA) training), and ² tests compared between-group proportions of correct answers for scenarios. Backwards stepwise logistic regression analyses determined the characteristics of those most likely to call inappropriately.

Results

150 respondents completed the questionnaire. 5.2–47.8% responded with an inappropriate answer, depending on the scenario. Almost all participants identified the need for an ambulance in 3/5 scenarios when it was required; however, fewer (74.8%) respondents identified the need for an ambulance to a suspected stroke. The majority correctly identified an ambulance was not required in only 2/7 scenarios. Those with FA training were less likely to call inappropriately in all scenarios (significant in three situations). However, no participant characteristics were predictive of calling an ambulance inappropriately once confounders were taken into account.

Conclusions

The majority would call for an ambulance appropriately when a real emergency occurred, and most inappropriate classification occurs when an ambulance is not required.

Management of acute allergic reactions by dispatching physicians in a Medical Emergency Dispatch Centre

2012-01-11T15:30:57-08:00 - Background

Acute allergic reactions often occur in out-of-hospital settings, and some of these reactions may cause death in the short term. However, initial diagnosis, management and processing of acute allergic reactions by Medical Emergency Dispatch Centres are not documented. The aim of the present study was to describe acute allergic reactions and their management by a Medical Emergency Dispatch Centre.

Methods

A prospective study was conducted from 20 August 2006 to 5 November 2006 on incoming calls for acute allergic reactions to the Medical Emergency Dispatch Centre for the Hauts de Seine (Paris West suburb, France). The agreement between initial diagnosis (made by dispatching physician) and final diagnosis (made by the physician who later examined the patient), and between initial and final severity, were evaluated using Cohen's weighted coefficient.

Results

210 calls were included. The diagnoses made by the dispatching physician were: in 58.1% of cases urticaria, in 23.8% angioedema, in 13.3% laryngeal oedema, and in 1.9% anaphylactic shock. The agreement between initial and final diagnoses was evaluated by a coefficient at 0.44 (95% CI 0.26 to 0.61) and the agreement between initial and final severity was evaluated using a coefficient at 0.37 (95% CI 0.24 to 0.50).

Conclusions

Only moderate agreement is highlighted between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres.

Paramedics and the effects of shift work on sleep: a literature review

2012-01-11T15:30:57-08:00 - Introduction

This paper investigates the literature regarding the impact of shift work on prehospital emergency providers. While the issue of shift work has been thoroughly investigated in other health disciplines, this is not the case for the paramedic discipline, particularly in the Australian context.

Objective

To identify the literature available on prehospital providers regarding the effects of shift work on sleep.

Method

Electronic databases used were the Cochrane Database of Systematic Reviews, Ovid MEDLINE, Proquest, AMED and CINAHL. The following MeSH terms and keywords with truncation were used in the search strategy: ‘shift work’; ‘sleep disorder’; ‘sleep deprivation’; ‘circadian rhythm’; ‘fatigue’; ‘occupational stress’.

Results

The electronic databases cited 226 articles, of which nine met the inclusion criteria with another three articles sourced from references in the retrieved papers. There is a lack of literature describing the effect of shift work on sleep in the prehospital arena, with only one paper exploring paramedics in the Australian setting. These findings suggest that further work is required to examine shift hours and workforce health and safety in the prehospital setting.

Conclusions

Shift work can affect health and well-being on a variety of levels, both physiologically and psychologically, affecting aspects of work and personal life. Further research is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work.

Is direct transport to a trauma centre best for patients with severe traumatic brain injury? A study in south-central Taiwan

2012-01-11T15:30:57-08:00 - Objective

This study attempted to identify any differences between the outcomes of patients with severe traumatic brain injury (TBI) who were directly transported to Chang Gung Memorial Hospital and those who were stabilised initially at other hospitals in south-central Taiwan.

Methods

A retrospective review of the records of 254 patients with isolated severe TBI who visited this hospital's emergency department from July 2003 to June 2008, of whom 167 were referred from other hospitals. Logistic regression was used to assess the effects of transfer and its components on mortality.

Results

Transfer from another hospital was not significantly correlated with mortality in this study (OR 0.513, 95% CI 0.240 to 1.097). Moreover, neither intubation (OR 1.356, 95% CI 0.445 to 4.133) nor transfer time over 4 h (OR 0.549, 95% CI 0.119 to 1.744) had a significant effect on mortality.

Conclusion

No differences in outcome were found between patients with isolated severe TBI who were directly transported and those transferred to this hospital's emergency room.

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster

2012-01-11T15:30:57-08:00 -

This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment.

Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

2012-01-11T15:30:57-08:00 -

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again.

The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary¹ or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.² The BETs shown here together with those published previously and those currently under construction can be...

BET 1: Does the 'Seatbelt Sign' predict intra-abdominal injury after motor vehicle trauma in children?

2012-01-11T15:30:57-08:00 -

A short cut review was carried out to establish whether the seat belt sign was a significant predictor of intra-abdominal injury in children involved in motor vehicle collisions. 51 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that seatbelt sign appears to be associated with an increased risk of intra-abdominal injuries, especially gastrointestinal and pancreatic injuries.

BET 2: Should capnography be routinely used during procedural sedation in the Emergency Department?

2012-01-11T15:30:57-08:00 -

A short cut review was carried out to establish whether capnography should be routinely used during procedural sedation in Emergency Departments. 206 papers were found using the reported searches, of which nine presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is that capnography may provide early warning of ventilatory changes that could result in hypoxia.

BET 3: Can pregabalin effectively diminish acute herpetic pain and reduce the incidence of post-herpetic neuralgia?

2012-01-11T15:30:57-08:00 -

A short cut review was carried out to establish whether pregabalin can reduce acute herpetic pain and reduce post herpetic neuralgia. 48 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. It is concluded that pregabalin does not seem to decrease the intensity of pain related to acute herpes zoster. Moreover, it does not decrease the incidence of post herpetic neuralgia. More research is.

Massive transfusion: a complex issue

2012-01-11T15:30:57-08:00 -

I must comment on the article by Milligan et al regarding massive transfusion in trauma.1 The authors state that ‘standardizing blood transfusion in major trauma to include automatic delivery of appropriate blood products at particular points in resuscitation may be of benefit’. They base this on their survey of 32 emergency medicine doctors to whom they asked questions apparently relating to the definition of massive transfusion (MT), ‘target’ laboratory values and blood product components. The definition of MT is a retrospective one and therefore not of value to the emergency physician faced with a bleeding patient. The ‘target’ laboratory values may be of academic interest but are not the primary relevant point we should be interested in—the authors quite rightly allude to the delay associated with treatment reactionary to laboratory values. A recent data analysis by Brown et al2 noted that, in patients who had...

Short answer question case series: diagnosis and management of glaucoma

2012-01-11T15:30:57-08:00 - Case vignette

A 40-year-old woman with history of hypertension and migraines presents with a complaint of headache. Two days prior to presentation she began to experience a left-sided, throbbing headache that radiated to the right and was accompanied by blurring of left eye vision and nausea. The blurred vision and headache were exacerbated by bright light, consistent with prior migraine attacks. She took her usual dose of naproxen with resolution of her nausea but still had a mild headache and blurred left eye vision. Two hours prior to presentation she walked outside and experienced worsening of her headache upon exposure to the sunlight, but without concomitant change in her vision or nausea. Aleve did not improve her symptoms, so she decided to present to the emergency department. Her vital signs were normal.

Key questions

Which features are consistent with migraine in this patient?

What other important...

Highlights from the literature

2012-01-11T15:30:57-08:00 - Prehospital intraosseous access

Intraosseous (IO) needles are commonly used to obtain vascular access in children rapidly. Recent studies have shown that IO needles can also be used as a rapid method for obtaining vascular access in adults. A randomised controlled trial attempted to establish whether there was a difference in the frequency of first attempt success between humeral IO, tibial IO and peripheral intravenous access in adult patients experiencing non-traumatic out-of-hospital cardiac arrest. The study found that tibial IO needles had the highest first attempt success and the most rapid time to vascular access. Perhaps IO access should be adopted more widely in the adult population (Annals of Emerg Med 2011;58:509–16).

Pigtails for chest trauma

There is an increasing trend towards using pigtail catheters (rather than traditional large bore drains) in patients who are found to have a traumatic pneumothorax. A retrospective study from the USA found that...