Health related information and news from around the world.

Fibre probably has an important effect on satiety. In one study researchers showed that a high-fibre breakfast, including 20g of soluble and insoluble fibre, significantly suppressed ad libitum lunch energy intake 4 hours later when compared with a low fibre breakfast. There was, however, no significant effect on total energy intake for the day.

Other studies have found increased feelings of fullness for 3-4 hours after eating high-fibre breakfast cereals. The highest scores always corresponded to the highest fibre content. Because fibre does not seem to limit consumption at the test meal it seems that the appetite benefits of eating fibre emerge at the next meal rather than the current meal. That is, fibre has a bigger effect on satiety than satiation. However, simply adding fibre supplements to a high-fat diet is not likely to have the same effect as eating a selection of high-fibre foods. This is because the fibre in supplements is not ‘bound’ to the nutrients in the food consumed.

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Most women with endometriosis have felt anger at some stage. It may happen after you overcome the initial confusion and feelings of isolation because then you start asking yourself: ‘Why me?’, ‘Why am I infertile?’, ‘Why didn’t doctors pick this up sooner?’, ‘Why isn’t there a cure?’, ‘What research is being undertaken?’, ‘Why isn’t more information available about this disease?’.

With all these questions racing through your mind it is difficult to realise that you have not been singled out to suffer. You will feel angry that at some stage this disease may interrupt your life or that it may prevent you from having children, or attaining other goals in your life or pursuing some sporting interest or hobby.

You may also feel angry because endometriosis is a chronic disease for which there is no ‘cure’. You may be angry because a diagnosis has taken so long, because doctors do not have all the answers and it seems that no-one understands your turmoil.

Your partner too may be confused and frustrated by the disruption the disease has caused to your lives. He may feel angry that there is no cure, or may find it difficult because you may need his constant support.

How do you cope with this anger and frustration that you both may feel?

Try to include your partner in talks about the disease. Encourage him to accompany you on visits to the doctor or to meetings of support groups.

Let your partner talk about his fears and concerns and include him in any decision making.

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For the majority of women with endometriosis the initial decision regarding treatment is whether to have hormonal or surgical treatment. Ideally, you should make this decision yourself in consultation with your gynaecologist.

The reasons for selecting a particular treatment vary widely and will depend on a number of factors including:

Extent and severity of the endometriosis

Size and location of the endometrial implants

Extent and location of any adhesions

Nature and severity of symptoms

Duration of any infertility

Desire for future childbearing

Age

Whether or not related problems exist

Success of previous treatments

Your preferences

The preferences and practices of your gynaecologist.

If you have minimal to moderate endometriosis, hormonal treatment is usually recommended. In contrast, if you have severe endometriosis you are more likely to have surgical treatment although hormonal treatment may still be appropriate if you do not have any large cysts.

If you have any adhesions or endometriomas greater than two centimetres in diameter, these can only be removed surgically as hormonal treatment has no effect on adhesions or large endometriomas.

Some women choose hormonal treatment rather than surgery because they do not want to have their lives totally disrupted for several weeks while they recover from an operation. Others choose hormonal treatment because they feel that it is a less drastic form of treatment or because they do not like the idea of having surgery. Some women do not want surgery because they do not want to take the risk of developing adhesions which surgery can cause.

Some women choose surgery because they do not want to delay trying to conceive for another six to nine months while they are having hormonal treatment. Others may have already experienced intolerable side effects from previous hormonal treatment and would rather try surgery. Others simply do not wish to use drugs or are concerned about the possible long-term effects of hormonal treatment.

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There are essentially two main ways of reducing stress:

To identify the sources of your stress and where possible seek either to reduce or eliminate these; and/or

To find ways to enable you to cope better with those sources of stress you can neither reduce nor avoid.

The most effective way to get your stress level down is usually by working towards both of these aims simultaneously. These tips from the experts will help you do just that:

Much stress is linked to always being in a rush, to constantly fighting the clock to get everything you need to do completed in time. Plan your day more carefully, allow yourself enough time for what you must do and so meet deadlines more gracefully, and you’ll find this cuts out a great deal of stress.

Directly linked to the above is the recommendation that you should be careful not to set yourself unrealistic targets, especially those that you know beforehand you will probably be incapable of meeting or where you will only manage to do so by rushing like mad or cutting corners, this being a sure-fire recipe to push up your stress level.

Always think things through carefully before you act or commit yourself to a course of action. Impulsive and less than well-thought-out actions are frequently the source of subsequent regrets, and the latter can be extremely stressful.

Set aside time to relax both physically and mentally for at least a part of every day, no matter how busy your schedule may be.

Retain control of your own life by learning to say ‘no’ if saying ‘yes’ would commit you to what is likely to become a stressful situation.

Whenever possible, take a break now and then, as a change of routine can recharge your mental and emotional batteries and improve your resistance to stress, thereby effectively reducing your level of it.

Learn to accept sensible limitations. If something is beyond your control, accept it as gracefully as possible until the time comes when you can do something to change it for the better. Agonising and worrying about things that can’t be helped is a major cause of stress and can also be a precursor to chronic anxiety.

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There are many ways of tackling or managing stress, and mastering these techniques inevitably pays off by promoting an antidepressant lifestyle. Improving interpersonal skills, for example, is one way of reducing the feeling that others are a constant source of unavoidable and uncontrollable stress. When I first began to supervise research assistants, I would observe that they often seemed harried and anxious. On one occasion, as a result of a shuffling of government personnel, a senior manager was temporarily assigned to me as a research assistant. I delegated several tasks to him and, after the first week of working under my direction, he asked to meet with me. He explained that the number of tasks I had assigned him were more than he was able to manage competently in the course of his working hours. Would I be good enough, he asked, to indicate to him my priorities so that if he was unable to complete all the tasks by the week’s end, only the least important task would remain undone. This research assistant taught me two invaluable lessons: Not only did I learn to become a better manager, to set priorities and be more realistic about what could be accomplished in the time available, but I learned how someone who is subordinate in an organization can politely set limits and manage his or her level of daily stress. If you are feeling under pressure at work, take some time to analyse the situation. Make a list of all the sources of stress and then try to figure out solutions to each of them. It is in the interest of the other parties involved to have these stresses resolved as well. Consider ways of presenting the problem to your boss, co-workers or even those working for you in such a way as to point out how it would be mutually beneficial if the stresses could be alleviated. For example, the final product might be superior, production might be more efficient, or the working environment more conducive to creativity or productivity. All of these goals can be legitimately presented as being in the interests of both workers and management.

Exactly the same principles apply in a marriage or other type of relationship, only more so. In these situations all parties involved usually have major investments at multiple, different levels. For example, in a marriage or relationship it is in both parties’ interests to get along, not only because it is more pleasant to do so, but also for the sake of mutual investments in the form of children and other common goals. Once again sources of stress can be identified and communicated to your partner, and if this is done in the right way the outcome can diminish levels of stress, relieve the tension in the relationship and promote an anti-depressant lifestyle. The key is always to present the situation as a shared issue which it would benefit both individuals to solve together. Let us say, for example, that a husband comes home from work and goes straight to the fridge for a can of lager, ignoring his wife in the process. She is bound to feel neglected, angry and perhaps depressed. At this point she has a choice. She can attack her husband for his callous and brutish behaviour or she can take a more collaborative approach. Attacking him may make her feel better in the short run but is bound to make the problem worse. A collaborative approach may have a better chance of working in the long run. This could involve: (1) empathy – ‘I understand that you are stressed and tired at the end of a hard day’; (2) communication of her feelings – T feel the same way after running after the kids all day’; (3) involving him in solving the problem – ‘Can you think of some way that we can unwind together?’; and (4) demonstration of what’s in it for him to do so – ‘so that we can support each other at difficult times and maybe even figure out a way of having some fun in the process.’ Obviously the way in which she chooses to handle the communication is likely to influence the outcome of the evening and either exacerbate or ameliorate her depression.

Part of the skill involved in such communications is picking the right time. A perceptive husband might recognize, for example, that the three days before his wife’s period are not the best time to discuss the large charges they have run up on the credit card. Conversely, an insightful wife learns to discern her husband’s moods and bides her time before discussing with him how she could use more help from him around the house or with the children.

It is also important to recognize that depression frequently causes stress in a relationship. This is of course an additional reason to treat the depression biologically. The partner of the depressed person often feels neglected. Feelings of depression can be contagious and there is a natural tendency to want to avoid a depressed person, which can isolate the person further and deepen the depression. There are some important pointers for the partner or family member of a depressed person to bear in mind. First, don’t take the depression personally. It is not your fault. Frequently the family member feels responsible for the depressed person’s mood, which makes him or her angry since at times nothing seems to cheer the depressed person up and there is a tendency for friends and family members to give up on the depressed person and withdraw. Second, it is not your responsibility to turn the depressed person’s mood around. You can and should be supportive. It is particularly worth trying to help your friend or loved one get appropriate assistance. But you cannot expect to have a direct effect on the other person’s mood. It is too much of a burden to place on yourself and is bound to leave you feeling resentful. Finally, don’t ignore the depressed person and enhance his or her sense of isolation. Do what you can to include the person in activities in a non-demanding way. For example, a husband might suggest going out to a restaurant for dinner with his wife, who may feel cheered up by the food, the setting and the friendly attention. On the other hand, suggesting that it might cheer her up to have guests over is unlikely to have its intended beneficial effect because of the demands this will place on her to perform and be sociable, which might be the last things in the world that she feels like doing.

There is a great deal that a depressed person can do to keep his or her loved one involved even while in a depressed state. Simply acknowledging the depression and its impact can be helpful. For example, a wife is likely to respond favourably to her depressed husband if he says T know I have been down and not much fun lately, but I am trying to turn things around as best I can. Thanks for hanging in there with me.’ The partner of a depressed person becomes starved for any positive feedback and comments such as this are generally greatly appreciated. Even if you are feeling sad and detached, as is often the case when one is depressed, it pays to make a point of expressing appreciation to your friend or loved one for gestures of kindness. It can be also useful to pinpoint specific things that your loved one can do that would make you feel better. This helps him or her to feel useful and counteracts the powerlessness typically experienced by those who surround and care about a depressed person.

So important are interpersonal skills in helping people overcome and avoid depression that an entire type of psychotherapy for depression, called Interpersonal Therapy, has been developed around these principles.

There are many types of stress other than interpersonal difficulties which may confront a depressed person and make matters worse. These include physical illness, financial difficulties and loss of a loved one. For all these different types of situations, help can be obtained from different types of experts, for example a sympathetic and competent doctor, a financial advisor or a religious or spiritual leader. A good doctor should not only provide specific help for symptoms but also comfort and reassurance. I have seen people in serious financial difficulty who have been greatly relieved after turning their affairs over to a debt counsellor or obtaining help and guidance from a financial planner. And innumerable people have been comforted and supported over the centuries by their priests, ministers or rabbis. Of course, caveat emptor applies whenever one turns to any guide or authority figure for help. Ultimately you have to be the judge as to whether a so-called expert is helping you or not. As always, stay tuned to your mood barometer to judge the quality of assistance you are receiving.

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The incidence of a disease means the number of new cases in a defined population (usually

100 000) in a defined period of time (usually one year).

Good figures for the incidence of new cases of epilepsy come from the population of Olmstead County in Minnesota. People in this rural part of the USA do not move around very much, and have the good fortune to be cared for by doctors at the famous Mayo Clinic. Research workers there have long had an interest in identifying all patients with epilepsy.

The incidence of new cases is highest in infancy and in old age, but new cases can occur at any age. Throughout middle life the incidence is about 40 cases per 100 000 per year. As the years go by, the risk of having had epilepsy at some time in one’s life increases in a cumulative fashion. The cumulative incidence in a population of children studied in the UK was 410 per 100 000 by the age of eleven, 600 by the age of 16, and 1000 per 100 000 by the age of 23. From the United States study cited above, the cumulative risk by age 75 was 3400 per 100 000 (3.4 per cent) for males and 2800 per 100 000 (2.8 per cent) for females. Epilepsy is thus not a rare or unusual disorder; seizures may impinge upon the lives of any one of us.

Another word used in counting cases of disease is prevalence. Here it is best to consider first another common illness which has a prolonged and steady course such as Parkinson’s disease. It is quite easy (though expensive) to do a door to door survey and count the people found to have Parkinson’s disease, as the signs of it will always be apparent. Prevalence is usually expressed per 1000. The prevalence of cases per 1000 population means that this number of people have the disease on the day of the survey. This technique is more difficult for epilepsy because of its episodic nature. Clearly, common sense dictates that if someone had a seizure during a day on which a survey day was done, they should be included, but what about someone who had many seizures in the past, but none for three years? One has to judge where to draw the line. In practice, most surveys of prevalence include people who have had more than one non-febrile seizure in the past, and are on continuing anti-epileptic drugs and/or who have had at least one seizure in the last two years. After early childhood, the prevalence is more or less constant throughout life at about seven per 1000 in developed countries, and considerably higher in developing countries.

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An itching rash covered in tiny blisters may occur at points of contact with watch bands, ear rings, and costume jewelry, and then spread widely over the surrounding skin in people who have become sensitive to nickel. This is much more likely to occur when there is excessive perspiration, so that the skin is moist at the point of contact with the metal. In some cases, furthermore, the dermatitis becomes so widespread that it is mistaken for scabies.

The latest news about nickel, Cutis (35#5:424) reports, is the mysterious appearance of dermatitis on the abdomen just below the umbilicus. Eventually, its cause was found to be contact with nickel buttons on blue jeans. In many cases, the dermatitis had also spread to other parts of the body. More often than not, treatment of this condition involves nothing more than replacing the button, watch band, etc., with an item made of another material. If the rash is severe and widespread, however, a visit to the dermatologist for special medication is required.

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Symptoms: pain in hip or knee; limp; limited movement of hip joint; slight fever (in case of acute synovitis).

Home care

Keep the child off his or her feet for three or four days.

Consult the doctor if the condition does not improve.

Precautions

-    Pain in the knee may be a sign of a hip problem.

-    A severe form of arthritis may be signaled by hip pain and a limp accompanied by high fever. If the child appears to have a hip problem and also has a high fever, call the doctor.

-    Some hip problems can cause permanent deformity if left untreated.

Children are susceptible to joint pains, most of which come and go and are not serious – for example, sprains and growing pains. Occasionally children get arthritis, which may affect the hips. Dislocated hips sometimes occur in infants and toddlers. There are also three specific causes of hip pain that occur commonly in children.

Acute synovitis of the hip can be described as a bruise of the inside of the hip joint. It is usually associated with a viral illness and is nearly always a harmless condition that disappears by itself. It can occur at any age, but most frequently happens between ages two and six.

Legg-Calve-Perthes disease is a serious condition in which the upper end of the thigh bone (femoral head) softens and becomes deformed. No one knows why it happens, but it usually begins between ages four and ten years and affects boys more often than girls. If it is not treated, Legg-Calve-Perthes disease results in a severe and permanent deformity of the hip.

Slipped femoral epiphysis is another condition of unknown origin, but it is possible that it happens as a delayed result of an injury. It occurs most often in the teen years, usually in overweight (obese or muscular) children. It results in severe deformity if it is not treated.

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The key is to buy food in its most natural state. As a general rule, avoid foods that have had chemicals added (either to replace something natural, as with artificial sweeteners) or to prolong shelf-life.

Remember that you are aiming to avoid chemicals that could compromise your fertility. You also want to optimize your health by eating as naturally as possible, in order to increase your chances of getting pregnant.

The first step is to get into the habit of reading labels carefully.

Reading Labels

Although most of us lead busy lives, and tend to do our shopping as quickly as possible, it’s worth investing some time in looking at labels on foods and drinks before you buy them. Once you are familiar with the best brands to buy, shopping for the healthiest foods becomes relatively easy.

Firstly, it is best to avoid ingredients which sound like something from a chemistry lesson, especially products containing E numbers. Some are fine to eat, as they are naturally derived, but the vast majority are not and have known side-effects. Without carrying a reference book with us all the time we cannot know which ones are which. Usually food manufacturers make it clear if the additive in question is a natural one because it is a good selling point. However, if in doubt, avoid it altogether.

Also check the label for artificial sweeteners (such as saccharin and aspartame) and, where possible, avoid them. They are chemicals too and the safety of many of them is in doubt.

Generally, the longer the ingredients list, the more suspicious you should be about the product.

Manufacturers argue that additives, preservatives and flavourings are used in such small quantities that they have no adverse effect. However, if you take into account the cumulative effect of these additives in all the different products you eat each day, the quantities soon mount up. Nobody knows what the combined effect of this chemical cocktail might be or how it could affect fertility and a developing baby.

These days it’s more or less impossible for most people to make sure that every single thing they eat is chemical-free, especially if their lifestyle means they need to eat snacks or meals away from home. But, without getting unduly anxious about it, you need to eat as naturally and healthily as possible. For example, as you will undoubtedly need to buy convenience or packaged food from time to time, try to find the best brand you can by going for the shortest, most chemical-free ingredients list.

Healthy cooking tips

• With organic carrots and potatoes, you only need to scrub the skins. Do not peel them, as many of the nutrients are concentrated just under the skin.

• To avoid nutrient loss, lightly cook vegetables in a little water or steam them.

• Avoid frying where possible. Try grilling or baking instead.

• Choose cookware with care. Avoid all aluminum cookware, as this is a heavy toxic metal that can enter food through the cooking process. The same applies to aluminum foil and cases. Avoid any coated cookware, such as non-stick, which is thought to be carcinogenic. The best cookware materials are cast iron, enamel, glass and stainless steel.

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What is it?

The death of an apparently healthy, normal baby in its cot or pram for no known reason. The baby has sometimes had a snuffle nose or other minor symptoms.

In Britain one in every 500 babies dies suddenly and unexpectedly like this. In many parts of the world it is the commonest cause of death under the age of 1 year. It is slightly more common in boys than girls and occurs more frequently in the winter months.

What causes it?

The vast majority of such deaths have to be labeled ’cause unknown’. Occasionally, post-mortem examination shows there is an unrecognized serious condition such as pneumonia or meningitis. Evidence of a minor infection is found in some children.

Prevention

Although the cause of sudden infant deaths (cot death) is not usually known there are certain precautions that can be taken, especially if you have already had one such death in the family.

• Breastfeed exclusively from birth until at least 6 months. Whilst breast-fed babies do die from cot deaths the condition is less common in totally breast-feds.

• Don’t give a child under 1 year a pillow unless it is a special non-suffocating type. Most babies who die in this way certainly have not suffocated but it will put your mind at rest and will prevent suffocation in itself.

• Try to protect your baby from coming unnecessarily into contact with people who have coughs, colds and ‘flu. Of course, all babies will get these illnesses from time to time but once again, it will put your mind at rest if you have taken such simple precautions.

• Those who have lost one child by cot death, and even some who have not, will probably want to think about the following precautions, which are at least sensible, for a subsequent baby:

1. Tell your doctor if you think your baby is at all ill.

2. Always take seriously fits, blue or grey turns, difficult breathing, and exceptional drowsiness. Tell the doctor urgently.

3. Tell the doctor as soon as possible if your baby has any of the following: croup; can’t breathe through nose; cries in an unusual way or for a long time; repeatedly refuses food; vomits repeatedly; has watery diarrhea; or is unusually cold, hot or floppy. Even if you have told your doctor, health visitor or nurse, if things don’t improve tell, your doctor again the same day.

• If your baby stops breathing, perform artificial respiration, blowing only the amount of air you can hold in your cheeks into his or her nose and mouth by covering both with your mouth.

• If your baby has a fit lay him or her face down with the head turned to one side, clear the mouth of sick or froth and cool him or her by removing clothes or sponging with tepid water.

• If your baby swallows pills or poisons get expert help at once.

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