For Parents : If your child is disabled

You may find out that your child has a health condition or impairment at a scan during your pregnancy, or at the birth itself. Alternatively you may notice something in your child’s behaviour early on. Here is what you can expect to happen if your child has a disability.
If your child’s condition is found at a pregnancy scan

If the sonographer (the professional doing the scan) finds anything unusual, they should refer you to a doctor within 24 hours. If it is necessary, you should be referred to a specialist within 72 hours. These doctors will be able to tell you more about the condition and possible treatments.
If your child’s condition is found at birth

The paediatrician (the doctor specialising in care for children) at the hospital will be able to tell you about your child’s condition and possible treatment. If it’s a rare condition the paediatrician may refer you to a specialist. The paediatrician will be able to answer most of your questions. They will then write a report and send it to your family doctor (GP).

You should be given contact details of someone who can answer any questions that you have after your first discussion with the paediatrician. This could be a meeting with another doctor or specialist at the hospital, your family doctor or a health visitor. A follow-up meeting should also be arranged.
When your child's condition is found

You should always be given:

* written information about your child’s condition
* information about services available to you
* practical and emotional support (eg how to feed your baby if you have difficulty, and the opportunity to talk about your feelings)

You can also ask for a second opinion if you wish.

Acne - Causes & How Is it Treated

What Is Acne?

Acne is a disorder resulting from the action of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring.

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.


The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin – sebum, shed skin cells, and bacteria – leading to lesions or pimples.

People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin's surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.













Other troublesome acne lesions can develop, including the following:

* Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
* Pustules (pimples) – papules topped by white or yellow pus-filled lesions that may be red at the base
* Nodules – large, painful, solid lesions that are lodged deep within the skin
* Cysts – deep, painful, pus-filled lesions that can cause scarring.

What Causes Acne?

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.
Factors That Can Make Acne Worse

Factors that can cause an acne flare include:

* Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
* Oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats)
* Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms
* Environmental irritants, such as pollution and high humidity
* Squeezing or picking at blemishes
* Hard scrubbing of the skin
* Stress.

Myths About the Causes of Acne

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn't cause acne, but research suggests that for people who have acne, stress can make it worse.
Who Gets Acne?

People of all races and ages get acne. It is most common in adolescents and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.
How Is Acne Treated?

Acne is often treated by dermatologists (doctors who specialize in skin problems). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The goals of treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment1 is aimed at reducing several problems that play a part in causing acne:

* abnormal clumping of cells in the follicles
* increased oil production
* bacteria
* inflammation.

All medicines can have side effects. Some medicines and side effects are mentioned in this booklet. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.

Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Asthma

Asthma causes the airways of the lungs (the bronchi) to become inflamed and swollen.

The bronchi are small tubes that carry air in and out of your lungs. If you have asthma, the bronchi are more sensitive than normal and certain substances or triggers can irritate them.

Common triggers include house dust mites, animal fur, pollen, tobacco smoke, cold air and chest infections.

When the bronchi are irritated, they become narrow and the muscles around them tighten, which can increase the production of sticky mucus, or phlegm. This makes it difficult to breathe and causes wheezing and coughing, and it may make your chest feel tight.

The severity of the symptoms of asthma differs from person to person, from mild to severe. The narrowing of the airways is usually reversible – occurring naturally, or through the use of medicines. However, for some people with chronic (long-lasting) asthma, the inflammation may lead to an irreversible obstruction of the airways.

A severe onset of symptoms is known as an asthma attack, or 'acute asthma exacerbation'. Asthma attacks can be life-threatening and may require hospital treatment.
Triggers

In 2005 in the UK, 1318 deaths were caused by asthma. Over 5m people in the UK have asthma. Asthma in adults is more common among women than men.

The cause of asthma is not fully understood, but it is thought to be a combination of genetic (inherited) and environmental factors. Asthma often runs in families, and you can inherit the susceptibility to asthma, which is then triggered by certain factors in the environment.

Factors include exposure to air pollutants, such as cigarette smoke, or certain substances that can cause allergic reactions (allergens), such as pollen or animal fur.

There is no cure for asthma, but there are a number of treatments that can normally manage the condition. Treatment is based on two important goals:

* Relief of symptoms.
* Preventing future symptoms from developing.

Successful prevention can be achieved through a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.

There are also different types of pre-existing asthma that can be made worse by certain activities:

Work-aggravated asthma is a pre-existing asthma that is made worse by dust and fumes at work.

Occupational asthma is due to exposure to specific substances at work. Often these substances are specific to certain occupations. For example, some nurses develop occupational asthma as a response to prolonged exposure to latex, and some workers in the food-processing industry develop occupational asthma as a response to prolonged exposure to flour.

Exercise-induced asthma is a pre-existing asthma brought on by physical exercise. However, for most people it is an indication of poorly controlled asthma.

How Flu Spreads

Person to Person

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. (This is called "droplet spread.") This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water immediately after handling dirty laundry. If soap and water are not available, they should use an alcohol-based hand rub* to clean their hands. Eating utensils should be washed either in a dishwasher or by hand with water and soap.

The Flu Is Contagious

Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5-7 days after becoming sick. Children may pass the virus for longer than seven days. Symptoms start one to four days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some persons can be infected with the flu virus but have no symptoms. During this time, those persons may still spread the virus to others.

Smoking and Influenza

If you are thinking about quitting smoking – today is the time to take the appropriate steps to do so

• Some research studies show an increase in influenza infections among smokers compared to nonsmokers.
• There is a higher mortality rate for smokers than nonsmokers from influenza.

Additional respiratory health consequences

• Smoking is related to chronic coughing and wheezing among adults and children and chronic bronchitis and emphysema among adults.
• Smokers are more likely than nonsmokers to have upper and lower respiratory tract infections, perhaps because smoking suppresses immune function.

Within 20 minutes after you smoke that last cigarette, your body begins a series of positive changes that continue for years.

Smoking Cessation

• Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers. Quitting smoking has immediate, as well as long-term health benefits.
• Individual, group, or telephone counseling by trained health professionals increases the chances of successful quitting. Nicotine replacement products and certain other medications also increase the chance that people can successfully quit.

To successfully quit smoking, you should take the following steps

• See your doctor, call a telephone quitline, or join a group program to learn new skills and behaviors to deal with situations when you want to smoke.
• Get ready and set a quit date.
• Get support and encouragement from family and friends.
• Get medication and use it correctly.

Carbohydrates Pose Heart Risk for Women

A diet rich in carbohydrates that are quickly transformed into sugar in the blood raises the risk of heart disease for women, a new Italian study finds.

The same effect, however, is not seen in men, according to the report, published April 12 in the Archives of Internal Medicine.

The study, by researchers at Italy's National Cancer Institute, looked not only at total carbohydrate intake but also at what is known as the glycemic index of those carbohydrates -- a measure of how quickly and to what extent blood sugar rises after intake of specific carbohydrates.

Carbohydrate foods with similar calorie content can show widely different scores on the glycemic index. Carbohydrates with a high glycemic index include corn flakes, white bread and white rice. Those with lower scores include whole wheat products and sweet potatoes.

"A high glycemic index is known to increase the concentration of triglycerides and lower the concentration of HDL cholesterol, the good kind," explained Victoria J. Drake, director of the Micronutrient Information Center at the Linus Pauling Institute of Oregon State University, who has studied the subject. "Those adverse effects make it a stronger risk factor for heart disease."

The Italian researchers got their information on dietary intake from questionnaires filled out by 15,171 men and 32,578 women. Following them for nearly eight years, the researchers found that women who consumed the most carbohydrates overall had about twice the incidence of heart disease as those who consumed the least. Closer analysis showed that the risk was associated with higher intake of high-glycemic foods.

"Thus, a high consumption of carbohydrates from high-glycemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the influence of developing coronary heart disease," the researchers wrote.

Previous studies have seen the same effect in other groups of women, Drake said. They include the Nurses Health Study, done in the United States, and studies of women in the Netherlands.

No effect from total carbohydrate consumption or consumption of foods with a high-glycemic index was seen in men in the Italian study, a pattern also seen in other studies, Drake added.

"There is definitely a gender difference," she noted.

The difference might be due to the action of sex hormones, the researchers speculate. Male hormones, androgens, appear to slow the transformation of carbohydrates into blood sugar, whereas the female hormone estrogen speeds the process, she said.

Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City, said the study shows the need for women to be more aware of the nature of the carbohydrates in their diet.

"An emphasis needs to be placed on a diet that is not simply low in carbohydrates but rather low in simple sugars, as measured by the glycemic index," Steinbaum said.

There's a simple way to determine the glycemic index of a food, she said.

"Look at the label," Steinbaum said. "It says 'carbohydrates.' Under that, it says 'sugars.' When you have a high number for sugars, that's a way to know what the glycemic index is."

That index can differ widely in foods that don't appear to be different, she said. One breakfast cereal may have a sugar content of 16 grams, but another may have just 3 grams to 6 grams.

"If you see a high level of sugar, that's the one to stay away from," Steinbaum said.

Simple Test May Detect Early Lung Cancer

Researchers may have found an easy way to detect lung cancer in its early or even pre-cancerous stages, as well as a way to reverse the start of the deadly disease with a readily available, over-the-counter drug.

"It's incredibly, incredibly exciting," said Dr. Patrick Nana-Sinkam, a lung cancer expert with the Ohio State University Comprehensive Cancer Center, who was not involved with the new study. "This definitely has potential."

The minimally invasive procedure involves using a small brush to collect a smattering of cells from the windpipe (a bronchoscopy), explained study co-author Andrea Bild, an assistant professor of pharmacology and toxicology at the University of Utah in Salt Lake City.

Maybe one day, screening could be done using an even simpler nasal or sputum test, the researchers said.

Currently, there is no good way to detect lung cancer -- the number one cancer killer -- in its early stages when it's most treatable. By the time most lung cancers are diagnosed -- which usually involves an invasive examination of the lungs -- patients already have advanced malignancies. Only 15 percent of patients are still alive at five years, said Nana-Sinkam.

Cigarette smoking is responsible for 90 percent of all lung cancer cases in the United States.

Still, only 10 to 20 percent of smokers actually develop lung cancer, begging the question: Why do some smokers succumb to the disease and others don't.

Now genomics may have provided an answer.

Working on the theory that cigarettes harm not only the lungs but a "field of injury" extending to other areas of the respiratory tract, the study authors surmised that evidence of existing or soon-to-develop lung cancer might be available further up in the airway.

The researchers used so-called microarray genetic analysis to measure gene expression levels in the epithelial cells -- those cells lining the respiratory tract -- that they had captured with the bronchoscopy.

"We were looking at the activity of genes in the cells that we obtained from the windpipe or airways of smokers at risk for lung cancer," said study senior author Dr. Avrum Spira, a critical care physician at Boston Medical Center and associate professor of medicine, pathology and bioinformatics at Boston University School of Medicine.

It turned out that gene activity in the PI3K pathway was "off the chart" in smokers with lung cancer versus those without the disease.

"Obviously that's very exciting," Spira said. "We have identified a marker for an early risk of developing lung cancer."

And when treated with the compound myo-inositol, the gene pathway activity declined along with improvement in the troublesome lesions, the researcher noted.

"This drug inhibits the pathway that's activated in smokers. The drug is a natural compound. You can get it in health-food stores," Spira said.

"We're now in the midst of a large study to look at whether or not activity of this pathway can be used to pick those who could benefit from this as a treatment as opposed to just prevention," said Spira, who is a co-founder of Allegro Diagnostics Inc., a company that plans to market this biomarker.

The researchers also need to explore whether or not the PI3K pathway is active in non-smokers, as well as what other pathways might also trigger lung cancer.