Medspillsnews. The Health Blog
Welcome to our look into the world health
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Parents will often have different concerns about a child’s sleeping patterns at different ages. In infancy these will usually be about the unpredictable nature of sleep. Many babies take a very long time to settle into any sort of predictable rhythm of sleeping, feeding and playing. This makes life very difficult for the rest of the family, of course, as it is impossible to schedule other activities, such as paying attention to other children, shopping, cleaning and most importantly, the parents’ (usually the mother’s) own relaxation or sleep. There is always the possibility that the baby will wake up, demanding a feed or attention.
Babies who continue to wake through the night cause similar problems. Parents get very tired and become exasperated at having their sleep interrupted regularly, sometimes several times a night. This is always a source of considerable tension in the whole family. Nothing seems worse than having to get up in the morning to face the day tired and grumpy.
Many children seem never to get into a predictable routine. Those who have a difficult temperament seem to go right through infancy and the toddler periods without sleeping through the night. Parents will report that ‘Johnny didn’t sleep through the night until he was 4 years of age’. While this may be true and it may also be true that some children do have an intrinsic predisposition to be irregular sleepers, the problem is often contributed to by the parents’ inadvertent reinforcement of the very sleep patterns that they complain of. There is no doubt that all children, no matter what their temperament, can be taught to sleep through the night.
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Your loved one may continue to lose weight in spite of your combined best efforts. If they do this, try not to take it personally. Their weight loss doesn’t mean that you are not caring for them properly, nor does it mean that they are not grateful for your efforts and eating as much as they comfortably can of what you prepare. It is no more possible to stop some people with cancer from losing weight than it is possible to stop some people with cancer from dying of it.
So try to aim for what is possible. If you refuse to settle for anything less than stopping a person who has extensive cancer or is having very intensive chemotherapy from losing weight, you are likely to succeed only in making both of your lives miserable. Both of you have enough to deal with without getting into battles over food. Why not simply aim for pleasant meal times, free of nagging or feelings of guilt? Perhaps there are even times when both of you would benefit more from a chat and a cuddle than more food!
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It is important for everyone to know how to do artificial respiration.
The easiest and most effective is mouth-to-mouth resuscitation — or the “Kiss-of-Life.” This is simple to learn — and simple to forget. So you will need to refresh your knowledge from time to time.
Cardiac massage is harder to learn. You may do harm if you try this when a person’s heart has not stopped. But if it has, then that person will die unless CPR, a combination of external massage and mouth-to-mouth resuscitation is begun at once.
The brain cells are very sensitive to lack of oxygen. If breathing stops, then oxygen is not taken in and various organs of the body will suffer from the lack of oxygen. The heart itself may also stop.
If the brain cells are deprived of oxygen for longer than 3-4 minutes, irreversible damage may occur. However, this should not be considered a reason for not trying artificial respiration or heart massage. It is possible that breathing may stop but the heart may continue beating for some time, pushing around an ever diminishing amount of oxygen in the blood, but still supplying the brain with enough oxygen so that permanent damage has not occurred.
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Chronic glaucoma comes on slowly and insidiously. It is a common cause of blindness and has often progressed to a stage where the vision is markedly impaired before it is noticed by the sufferer.
It becomes increasingly common after 40 and most eye specialists recommend that all those over 50 should have the pressure in their eyes checked each two years, even if the vision seems satisfactory. Three per cent of people over 50 can suffer from glaucoma.
Sometimes, service clubs organise a drive in their suburb where all those over 40 can present themselves for a check on the pressure of their eyes. The condition is so uncommon under this age that there is little point in the routine screening of younger people.
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About 100 hairs are shed each day from the average scalp. The normal pattern of cyclical growth of hair may be disturbed by general health factors, either physical or mental. Most women notice their hair becomes thinner and loses its lustre after childbirth and may take a year or two to recover.
Alopecia areata is a condition where the hair is lost in patches. It may spread to involve the whole scalp or even the eyebrows or all the body hair. The cause is uncertain and there are several theories. Some believe it is one of the auto-immune diseases where the body, as it were, develops an allergy to its own tissues and produces antibodies which tend to destroy those tissues.
Women whose male relatives suffer from male pattern baldness may also suffer a more diffuse hair loss. This is more usual after the menopause and is due to the action of androgens or male hormones on the predisposed hair follicles. This may respond to the use of oestrogens.
Diffuse hair loss may also be due to metabolic illnesses such as myxoedema or thyroid insufficiency.
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There is no symptom that automatically means you have to go into hospital. However, you may choose to go into hospital for
tests or to have some form of treatment that cannot be done at home. The need for hospitalisation is one of the costs you should
take into account when deciding what tests and treatment to have.
The decision as to whether to stay at home or go into hospital in the final stages should largely be yours. However, a decision to stay at home is practical only if you can rely on a lot of support and cooperation from family and friends. I suggest that, if you do want to be at home, you make some preparations towards this while you are still relatively well. Talk with your family and friends about what you want and find out how much help and support they are prepared and able to give you. Get to know a doctor who will make home visits. Find out whether there is a special palliative care/terminal care/hospice team in your town and ask to be referred to them when the time seems right for that. Keep in mind that, at least throughout Australia, there is a government-subsidised home-nursing service. It is easy and inexpensive to arrange for nurses to visit your home for a particular purpose such as to do dressings, supervise pressure care, help you with bowel or bladder problems or just for a friendly check on how you are managing. Special aids that you might need such as wheelchairs, bedpans, commodes, special bedding, oxygen masks, etc, are often available on loan or hire from public hospitals or through the home-nursing services, so the fact that you can’t afford to buy such things shouldn’t mean that you have to go into hospital.
You may also be able to get financial assistance from your local cancer society, for example, to cover the cost of a nurse or companion to stay with you at times when friends and family cannot manage this.
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If you are trying to reduce your kilojoule intake there is still a minimum amount of certain foods that you should be eating each day. These are:
• Breads/cereals/and grain foods—5 servings or more. 1 serving means - 1 bowl breakfast cereal (30 grams), 1/2 cup cooked pasta or rice, ? cup cooked grain such as barley or wheat, 1 slice bread, ? bread roll or muffin.
• Vegetables—4 servings. 1 serving means - 1 medium potato (about 150 grams), cooked vegetables such as broccoli or carrot—eat freely. Raw leafy vegetables, such as lettuce—eat freely.
• Fruit—3 servings. 1 serving means: 1 medium orange (200 grams), 1 medium apple (150 grams), ? punnet strawberries (100 grams).
• Dairy foods—2 servings.1 serving means: 300 ml milk, 40 grams cheese, 200 grams of low-fat yoghurt or other low-fat dairy foods.
• Meat and alternatives—1 serving. 1 serving means - 60 to 80 grams cooked lean beef, veal, lamb or pork 120 grams lean chicken (cooked weight, excluding bone), skin removed 120 grams fish (cooked weight, excluding bone), 2 eggs, 1 cup cooked lentils or dried peas or beans. In our experience, looking at the diets of hundreds of people who want to lose weight, the change required is often to eat more!
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The socio-cultural macro environment represents the values, expectations and attitudes of the wider social environment. Community attitudes to convenience foods and leisure saving technologies are examples. A hedonistic and materialistic atmosphere where moderation is considered unfashionable is common in many sectors of Western societies. Where this is coupled with easy access to palatable, high-fat foods and reduced necessity for energy expenditure, obesity levels are likely to increase. In Australia, an advertising expenditure of $1 million per day on food stuffs, confectionery and soft drinks is combatted by an equivalent amount per year spent on public health education, some of which is presumably aimed at eating for reduced body fatness.
With increased affluence there is also an increased opportunity for over-indulgence through the social processes of dining out, business lunches, social festivities and celebrations. There are also cultural and ethnic differences in food preferences and exercise availability: European-style food is usually higher in fat, for example, than Asian foods; some foods, such as pork, have traditionally held a higher social status than vegetables or fruit in different cultures; opportunities for exercise are reduced for some ethnic and religious groups such as Middle Eastern and Muslim women.
Male attitudes to health are known to differ from those of females. Men have typically been less responsive to health messages, attend doctors less often, but suffer more from most forms of illness than women. This has been attributed to social and attitudinal differences between the sexes—men feel more isolated and vulnerable if they admit any concern about their health. Overcoming these attitudes is a major obstacle to providing acceptable fat loss programs for men. Cultural attitudes in some ethnic groups also mean that partner support for fat loss practices, particularly by males for females, is low or non-existent.
Social attitudes to physical activity can influence participation. Increased interest in jogging in the 1970s for example, followed by aerobics and then weight training in the 1980s, formed the pattern of a social ‘trend’. It is doubtful, however, if these have compensated for the decreases in physical activity that have occurred at the workplace or the decreases in other ‘incidental’ activity in day-to-day life. Multi-event sports like triathlons have become popular, but this is usually only amongst the very fit. Fun runs and community activities, however, have the potential to attract large numbers of people who may otherwise remain inactive. Socially acceptable forms of activity differ according to ethnic group, nationality, age and gender. Being fat carries a negative status, but more so for women, and being inactive also carries a negative status, but more so for men.
The influence of the socio-cultural macro environment has been particularly noticeable in countries like the UK and the Netherlands. The overall nutrient intake in the food in both countries is similar, but the obesity rate in Britain is increasing at a much greater rate than in Holland. According to Dr Wim Saris, from the University of Limburg, this might be put down simply to the fact that only 3 per cent of British transport involves the bicycle, whereas the equivalent figure is over 30 per cent in the Netherlands.
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Although fat moves continuously through the fat cycle, at times lipogenesis dominates and at other times lipolysis dominates. The overwhelming factor influencing the balance is the state of feeding, with fasting favouring lipolysis and feeding favouring lipogenesis, as already discussed. These directly correspond to the demand for fat as fuel.
Another condition which favours lipolysis is stress, either physical or psychological, such as exercise or a fearful situation. Adrenalin causes an increase in lipolysis with FFAs being released into the bloodstream anticipating a demand for fat as fuel. If the situation passes without the need to use the extra energy, such as with exercise, the fat returns from the fat cycle back to the fat cell In other words, an increase in lipolysis does not always correspond to an increase in fat utilisation for energy.
A number of other factors can influence the balance of lipolysis and lipogenesis. A large fat mass tends to increase the amount of lipolysis and thus the amount of FFAs available for energy needs. Insulin, catecholamines, Cortisol and sex hormone levels can also alter the balance. Fat cells in the hips, buttocks and breast are more responsive to female hormones than the fat cells on the abdomen, which are more prolific in men.
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Foreign bodies seem to have an amazing attraction for children, and it is incredible the number and range of items that are swallowed. The incidence is highest in infants in the 1-3 year age group. Coins, screws, nails, washers, bits from toys, plastic gadgets such as doll’s eyes, wheels from toy cars, and pins, safety pins and otherwise, have all gone down the red lane. Sheer good luck, and the body’s ability to deal with these onslaughts, make the risks happily fairly small.
Most foreign bodies simply pass through the full length of the bowel, and in the majority of cases are passed at the far end with little discomfort within four to five days. In fact, a parent may be totally unaware of what has occurred. Occasionally symptoms may develop, but overall this is uncommon. Usually, the doctor’s assistance is needed if there is pain, a fever or vomiting resulting from the incident.
Sometimes a foreign body may be held up at certain critical points in the bowel. A sharp object, such as a pin or a needle, may penetrate the bowel lining and fail to move or it may actually perforate the wall.
Treatment
Most cases do not require any treatment. However, if the foreign body is known and especially if it is a sharp, potentially dangerous one, treatment may become necessary. If symptoms (as noted) occur, it will require medical attention.
The doctor may ask for a bowel X-ray if the foreign body has not been passed within a few days. However, only about 2-4 per cent of cases require active surgical intervention. These days, with the use of a long, flexible device called the endoscope, it is possible to locate foreign bodies and remove them fairly simply under an anaesthetic.
There is probably one major exception to the suggestion of waiting for the child to pass the object. That is in the case of the miniature mercury batteries that are now widely used in hearing aids, cameras and calculators; it is becoming more common for these to be in homes, often in ready access to infants. Their shiny silver metal coat is attractive to some children, who suck them, and several cases of their being swallowed have been reported. The incidence will inevitably increase over the next few years.
The acid of the child’s stomach may rapidly destroy the thin metal lining of the battery, so releasing very toxic quantities of mercury which may be lethal to small children. If this occurs, immediate treatment either from the doctor or at the emergency ward of the nearest big hospital is essential. The battery must be removed as urgently as possible before it disintegrates and allows the toxic substances to be absorbed by the body. Never forget this danger.
Do not give cathartics for foreign bodies. Do not give cottonwool sandwiches or follow other antiquated old wives’ tales. These all belong to a bygone era. Castor oil is definitely out, and so is cascara and similar products. They could stimulate the bowel violently and with sharp objects increase the risk of perforation. Do not get hysterical—death is not imminent. Ring the doctor for advice or take the child immediately to the nearest large hospital.
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