Breastfeeding

Breastfeeding is one of the best ways to ensure your baby's health and development. It's a convenient, cost-effective, natural way to feed your baby.Breastfeeding is widely recommended as the best way of feeding infants by leading health organizations, including, among others, the:* American Academy of Pediatrics* American Academy of Family Physicians* American College of Obstetricians and Gynecologists* American Dietetic Association* American College of Nurse-Midwives* U.S. Department of Health and Human Services, Office on Women's HealthHealthy mothers should consider breastfeeding exclusively (no formula) for the first six months of life and ideally continue until the baby is one year old or beyond. Ideally, solid foods should only be introduced after six months of age.While most new mothers breastfeed in the weeks following delivery (called the early postpartum period), only one in three continues to nurse when her baby reaches six months of age. The likelihood of breastfeeding is even lower among African-American women, as well as women with lower levels of education.Initiatives to educate new mothers and their partners, health care professionals and employers about the clear, long-lasting health benefits of breastfeeding for both mom and baby are ongoing. Changes to routine maternity unit practices, including "rooming in" policies, which allow mom and baby to stay together in the hospital, are increasingly common and help support mothers who wish to breastfeed. Healthy People 2010, a national prevention initiative to improve the health of all Americans, set forth goals to increase breastfeeding rates.Healthy People 2010 Goals2010 TargetIn early postpartum 75%At six months 50%At one year 25%Health Benefits for Mom and BabyThere are compelling reasons to breastfeed—and both you and your baby benefit.For Your Baby...* Breast milk provides just the right balance of nutrients for optimal growth and development.* Breast milk has antibodies that help protect your baby from common childhood illnesses and infections, such as bacterial meningitis, diarrhea, painful ear infections and certain lung infections. This natural immunity—or ability to fight off infection—means breast-fed babies have fewer:o Illnesses (less severe and shorter)o Visits to the pediatriciano Hospitalizations* Research shows that breastfeeding also reduces newborns' and infants' risk for developing chronic diseases, such as celiac disease, inflammatory bowel disease, allergies, asthma and some childhood cancers.* Breastfed babies are at lower risk for sudden infant death syndrome (SIDS), the leading cause of death among infants one month to one year old.* Breast milk may offer protection against overweight/obesity years later in childhood and possibly adulthood, too. At one year of age, breastfed babies have significantly less fat than those who are fed formula.For You...* Breastfeeding releases a hormone called oxytocin that helps the uterus return to its normal size and reduces post-delivery bleeding.* It also burns extra calories (up to 500 calories per day), making it easier for you to shed those pregnancy pounds.* Breastfeeding can deepen the emotional bond between you and your baby. Such physical contact helps your baby feel secure and warm and eases his/her transition from the womb.* Breastfeeding may guard against postpartum depression.* Nursing can delay the return of regular periods, although you still need to use birth control.* There is growing evidence that certain cancers (breast, uterine and ovarian cancer) occur less often in women who breastfed. A recent study found that breastfeeding may protect women at increased risk of breast cancer due to delayed childbirth.* Breastfeeding may also reduce the risk of osteoporosis.* Breastfeeding saves time and money. There are no bottles to sterilize or formula to mix or warm. In fact, families save an estimated $1,000 on health care costs in the first year because breastfed babies are healthier and tend not to need as many visits to the pediatrician.How the Breast Produces MilkMilk production is a normal physiologic response to the childbearing experience. New studies shed light on milk delivery, the composition of milk and the anatomy of the lactating breast. This information can help new moms better understand their bodies and how they respond to breastfeeding.After pregnancy, your breasts produce colostrum—a thick, yellowish fluid—that helps your newborn's digestive system grow and function. Colostrum, often called "first milk" or "supermilk," is rich in nutrients and infection fighting antibodies. While you may wonder whether you're producing enough colostrum or milk for your baby in these first few days, keep in mind your baby's stomach is only the size of a marble. Your mature milk supply typically "comes in" two to four days after giving birth.When you put your baby to your breast, your milk doesn't automatically start to flow. Your body responds to your baby's suckling patterns, which occur in two phases.* Non-nutritive phase: when the baby is first put to breast and starts suckling in a fast, light rhythm to stimulate the milk-ejection reflex. This reflex is also known as the let-down reflex. It is the "trigger" that starts your milk flowing and often doesn't occur for a minute or so after the baby starts suckling (timing varies with each mom). This can be stimulated by your baby's cry or if you are overdue for a feeding. When your milk lets down, you may feel a tingling or tightening sensation as it fills your breast.* Nutritive phase: after let-down occurs and your baby switches to a slower, deeper suck. This nutritive phase is when the baby actually drinks your breast milk.Anatomy of the Lactating BreastAnatomy of Lactating BreastUsed with permission by Medela, Inc.New research using ultrasound imaging reveals a number of key differences from the previously held understanding of the anatomy of the breast. These findings can help mothers understand how their infants obtain milk and provide insights for physicians and women considering breast augmentation or reduction surgery.Key findings include:1. The average number of milk ducts (4-18) per breast is less then previously believed (15-20).2. An absence of lactiferous sinuses, which were previously believed to contain a significant amount of milk3. Fat and glandular tissue overlap more than originally believed.The absence of lactiferous sinuses changes our understanding of the way in which the breast produces and delivers milk. For example, it's thought that the lack of lactiferous sinuses is a reason why little milk is able to be expressed prior to milk ejection. Much more study needs to be done to further understand milk delivery.The number of milk ducts also has implications for breast augmentation surgeons, since the loss of only a few ducts could seriously compromise a woman's ability to breastfeed. The overlapping of fat and glandular tissue also suggests that it is very difficult to remove only fatty tissue from the breast. For more information about the anatomy of the breast, visit www.medela.com.Overcoming Breastfeeding ChallengesBreastfeeding is a natural and rewarding process; however, some women have trouble during the early stages of nursing. In fact, more than one in three moms report one or more complications within the first few weeks. The good news is that most of these problems can be resolved with patience, practice or treatment, so don't be discouraged.Don't be discouraged if you experience sore nipples, engorged breasts, mastitis or thrush. The severity of these symptoms can vary, but they all are treatable and often avoidable.* Sore nipples may develop as you start to breastfeed. Mild nipple tenderness is common. Seek the advice of a lactation professional if your nipples are cracked or bleeding as these are often signs that your infant may not be latching properly onto your breast.* Engorgement happens when your breasts are overly full due to missed feedings or poor or inadequate feeding by your baby. There are some simple steps you can take to ease engorgement. If your baby is not latching on well, use a pump to reduce engorgement and help your milk flow. Use cool compresses in between feedings to reduce swelling.* Plugged milk ducts can reduce the flow of milk from one or more sections of the breast. If untreated, this often leads to infection. To help alleviate the situation take a warm shower and massage the breast. If it continues, seek the advice of a lactation consultant.* Mastitis, or breast infection, is not a common occurrence, but typically happens when bacteria from your baby's body or from your body invade your milk duct through a crack in the skin. If you have an infection, your breast will feel tender, and you may also have flu-like symptoms, including chills, high fever or fatigue. Your health care professional may need to prescribe an antibiotic.* Yeast infection, or thrush, is suspected if you experience deep, shooting breast pain after you've been successfully breastfeeding for a while. This condition is relatively rare. Consult your health care professional if you experience these symptoms. Both mom and baby will need treatment with antifungal medication, if this condition develops.Breastfeeding shouldn't hurt. Contact your health care professional if your breasts remain tender or sore, or if you have flu-like symptoms that may indicate an infection. In most cases, you can continue breastfeeding. Emptying your breasts frequently by breastfeeding or pumping can often reduce inflammation and relieve the problem.Finding Extra SupportYour health care professional may suggest that you work with a lactation consultant (also called a lactation counselor) who can review breastfeeding techniques and help you address any problems that you may have while nursing. Many hospitals and health centers have lactation consultants on staff, so make sure to ask your obstetrician or primary care provider if you think you need extra support. New mother support groups and encouragement from your partner, family, friends and your employer are also important.When Not to BreastfeedDespite the clear benefits of breastfeeding, there are circumstances when breastfeeding is not in the best interest of the baby. A woman should not breastfeed if her infant is diagnosed with galactosemia (a rare metabolic disorder) or if she has certain health conditions that can be passed to her baby through breast milk, including:* Human immunodeficiency virus (HIV)* T-cell leukemia virus type 1* Active, untreated tuberculosisMothers who use illicit drugs, drink excessive amounts of alcohol or are taking prescribed chemotherapy or radiation therapies for cancer also should not breastfeed their babies. If you have a herpes lesion (sore) on your breast, you should not breastfeed.Women who have had breast reduction surgery or breast implants may not be able to breastfeed because of the impact these surgeries can have on milk production. However, each woman's breast anatomy and breast surgery is unique. Discuss any concerns you may have about your ability to breastfeed or complications you may experience breastfeeding with a lactation consultant.10 Hints for Ensuring Success1. Start early. Learn as much as you can about breastfeeding before your baby is born so you'll feel prepared. Try to breastfeed your baby soon after giving birth (within the first hour). Newborns sleep a lot, so you'll have to wake him/her every couple of hours for a feeding. Ask to keep your baby in your hospital room (called "rooming in"). Mother-infant rooming in is becoming more accepted as hospitals try to support early breastfeeding.2. Review nursing techniques with a lactation consultant or nurse. Learn how to position your baby so he/she is properly latched on to your breast. This will improve your confidence when you return home.3. Nurse frequently (8-12 times in 24 hours) and anytime your baby seems hungry. Your milk supply responds to your baby's demand—the more the baby suckles, the more milk will be produced. Many health care providers recommend breastfeeding on demand rather than according to a predetermined schedule. Watch for early signs of hunger, which include:* Increased alertness or activity* Mouthing or putting hands to mouth* Rooting (moving his/her head in search of your nipple)Be aware that crying is a late sign of hunger. Try to feed your baby before he/she becomes overly hungry and starts to cry. Offer both breasts during feedings. Usually breastfeeding takes 10 to 20 minutes for each breast. However, from time to time your baby may become full after feeding on just one breast. If this is the case, remember to pump the breast that remains full to avoid engorgement or discomfort.4. Know how much milk is enough. Many nursing mothers worry about whether their baby is getting enough nourishment. An easy way to gauge whether your baby is getting enough milk is to pay attention to the number of wet, dirty diapers (six to eight wet diapers and three to four yellow, seedy bowel movements by day five are good signs). Keep in mind it's normal for babies to lose some weight (7 to 10 percent of birth weight) within the first week.If you are still concerned about whether your baby is getting enough milk, seek the advice of a health care professional or lactation consultant.5. Choose a comfortable position. Breastfeeding is very personal. There are a number of ways to hold your baby while breastfeeding. See what feels most comfortable for you and your baby. (See the American Academy of Family Physicians (AAFP) Web site for more information.)* Cradle position: Place your baby's head in the crook of your arm. Support his/her back and bottom with your arm and hand.* Cross cradle position: Hold your baby with the opposite arm from the breast you are using. Support baby's head with the palm of your hand at the base of his/her neck.* Clutch/football position: Tuck your baby under your arm like a football with his or her head resting on your hand. Support your baby's body with your forearm.* Side-lying: Lie on your side with your baby facing you. Use pillows to prop up your head and shoulders.No matter which feeding position you use, make sure your baby's whole body is turned toward your breast, not just his/her head. Your baby should have your entire nipple and most of the areola (dark skin around the nipple) well into his/her mouth.6. Breastfeeding shouldn't hurt. If you feel pain or discomfort, your baby is probably not latched on properly. Gently place your finger into your baby's mouth to break the suction and try again. You may want to position a pillow just below your breasts or under your arm to support yourself and ensure the baby is at the same level as your nipple. Contact your health care professional if the pain continues or if you notice flu-like symptoms.7. Take care of yourself. Get plenty of rest and eat well-balanced meals to regain energy.8. Ask about medications. Talk with your health care providers about any prescription medications or over-the-counter drugs you are taking just in case these may be harmful to your baby.9. Refrain from giving your baby other liquids or formula during his/her first six months.10. Delay introducing bottle nipples or pacifiers to let your baby develop a good sucking pattern and become familiar with feeding from your breast. If you plan to return to work, try introducing a bottle filled with your breast milk during week four to six, after breastfeeding is well established.Returning to Work: Breastfeeding Tips for Working MomsThe transition back to work after maternity leave can be emotional. You're probably asking yourself lots of questions: Can I overcome the guilt of leaving my baby? Will I be able to juggle motherhood and work? How can I continue breastfeeding? Like any transition, some of these issues may take some time to work through. But, fortunately, where continuing to provide your baby with breast milk is concerned, breast pumps offer working mothers the flexibility to maintain their milk supply and continue nursing, which helps you stay connected to your baby even when you're away.A 2007 survey of working mothers conducted by the National Women's Health Resource Center and Medela about breastfeeding in the workplace found:*The top three reasons why working mothers decide to continue breastfeeding include:oThe health benefits for the babyo The emotional bond between mom and babyo It is the most natural way to feed the baby*Although one in three women stopped breastfeeding less than seven weeks after returning to work, many more continued to breastfeed and stopped between six and 12 months.* Older moms were more likely to take longer maternity leaves.* Working moms find it difficult to continue breastfeeding upon returning to work if their employer does not provide a supportive environment.oYounger moms and African-American moms said they were not able to pump as often as they would have liked.o Women surveyed reported that the top three things employers could do to make pumping at work easier, include:+ Providing a physical environment (private office with lockable door, clean environment, fridge/freezer)+ Having or establishing a corporate policy on breastfeeding (written policy supportive of breastfeeding in the workplace)+ Offering flexible scheduling to accommodate pumping breaksHere are some tips to help ensure success for your goal to continue breastfeeding when you return to work:* Take as much time away from the workplace as possible. Studies show that women who take longer maternity leaves are more likely to continue breastfeeding once back at work. And the longer babies are breastfed, the greater the health benefits for mom and baby.* The Family Medical Leave Act provides 12 weeks of unpaid time for the birth and care of a newborn for certain employees. Visit the U.S. Department of Labor for more information, www.dol.gov.* Plan in advance. Before returning to work, talk with your employer or human resources department about your needs and plans to continue breastfeeding.* Ask if there is a private, clean room set aside for mothers to pump. If not, suggest an office or conference room. Your employer should create a supportive environment for you to continue breastfeeding.* Discuss how pumping breaks (20 minutes every three to four hours) will fit into your schedule.* Educate your employer about the benefits of breastfeeding. This includes fewer missed work days and shorter absences because breast-fed babies are better able to fight off infection and are sick less often.* Breastfeed your baby as soon as you get home. This is a special time to bond and helps you maintain your milk supply. Ask your caregiver not to feed your baby during the last hour of the workday, so your baby will take your breast when you return home.What You'll Need* A breast pump (double electric pumps, which allow you to empty both breasts at the same time, are more effective than hand pumps for expressing milk.) Also, look for a pump that fits your work environment. Most leading electric pumps offer a battery option which may give you greater flexibility.)* An insulated bag with cold packs or access to a refrigerator (most pumps come with a cooler pack)* Bottles or bags to collect and store your milk* Labels to mark the date* Breast pads to protect your clothes and conceal leakage (you may want to keep an extra shirt at work just in case)* Picture of your baby* A support system. Don't try to do everything yourself. Let your partner, family and friends help out. Seek out other working mothers who can offer you support.It's important to continue breastfeeding for as long as you can and ideally until your baby is one year old and beyond.Using a breast pumpBreast pumps are designed to help:1. Provide your baby with the health and nutritional advantages of breast milk while you're away.2. Empty the milk in your breast, which can guard against engorgement, blocked milk ducts and infection.3. Stimulate your milk production.If possible, you should pump every three hours that you are away from your baby. Make sure to clean the breast pump parts between uses.Both hand and battery-operated pumps are available. Electric pumps simulate your baby's sucking more effectively and are faster than hand pumps. Many pumps come with discreet carrying cases. The cost ranges from $35 to $350. Not all pumps are created equal. Be sure to research which brands and models provide the best performance, reliability and comfort. Also take into consideration the demands of your daily schedule. Many hospitals and clinics rent breast pumps, so you may want to ask your health care provider or a lactation counselor about these and which models would best fit your needs.A word about milk storage* After pumping, refrigerate, freeze or store your milk in a cooler.* Any container used to store milk should be clean and sterile. Glass containers, polypropylene plastic bottles (slightly cloudier, flexible plastic indicated with recycling #5) and storage bags are all good choices.* Always label and note the date on the storage bag or container. Always use oldest dated milk first.* The following are some guidelines for freshly expressed breast milk storage:o At room temperature (66-72°F) for up to four hourso In a refrigerator (32-39°F) for five to seven dayso In a cooler with freezer ice packs (59°F) for 24 hourso In a self-contained freezer unit for three to four monthso In a deep-freezer (0°F) for six to 12 months* Breast milk should be thawed slowly under warm running water and not in the microwave, which can reduce its nutrition.* Once the milk has been thawed it should not be refrozen.

Cervical Cancer

Cancer of the cervix is the second most common type of cancer found in women after breast cancer in the world. In the United States, cervical cancer is the twelfth most common cancer in women, affecting an estimated 500,000 women worldwide each year. The American Cancer Society estimates that about 9,710 cases of invasive cervical cancer will be diagnosed in the United States in 2006, and about 3,700 women will die from the disease.Cervical cancer is a disease in which cancer cells are found in the tissues of the cervix. The cervix, the lower part of the uterus, connects the body of the uterus to the vagina. Nearly all cases of cervical cancer can be linked to the human papillomavirus, or HPV, a sexually transmitted virus.The normal cervix is a healthy pink color and is covered with scale-like cells called squamous cells. The cervical canal is lined with another kind of cell called columnar cells. But the area where the two cells meet—called the squamocolumnar junction and transformation zone (T-zone)—is the most likely area for abnormal cells to develop. The T-zone is more exposed on the cervix of young women (teens through 20s), making them more susceptible to cervical infections.Health care professionals use the Pap test to find cellular abnormalities in cervical tissue that has already or may become cancerous. The earlier cervical cancer is diagnosed, the better the chance for a cure. The American Cancer Society reports that both incidence and deaths from cervical cancer have declined markedly over the last several decades, due to more frequent detection of preinvasive and cancerous lesions of the cervix from increased Pap screening. There is a direct relationship between the use of the Pap smear as a screening tool for cervical cancer and the reduction of the incidence of cervical cancer, according to the American Society for Clinical Pathologists.In its earliest stages, cervical cancer usually causes no symptoms. Irregular bleeding, bleeding or pain during sex, or vaginal discharge may be symptoms of more advanced disease. These symptoms should always be discussed with a health care professional.All women are at risk for developing the disease, but several factors can increase a woman's risk of developing cervical cancer, according to the American Cancer Society:*Infection with human papillomavirus (HPV), a common sexually transmitted disease in the U.S. (Most women and men who have been sexually active have been exposed to the HPV virus, which is spread through skin-to-skin contact with an HPV-infected area. However, certain types of sexual behavior increase a woman's risk of getting an HPV infection, such as having sex at an early age, having many sexual partners and having unprotected sex at any age.)Recent studies find that using condoms cannot completely protect against HPV because the virus is passed by way of skin-to-skin contact, including the skin in the genital area that may not be covered by a condom. Correct and consistent condom use is still important, however, to protect against AIDS and other sexually transmitted diseases.*Smoking cigarettes, which exposes the body to cancer-causing chemicals absorbed initially by the lungs but then carried in the bloodstream throughout the body. The chemicals produced by tobacco smoke may damage the DNA in cells of the cervix and make cancer more likely to occur there.*Infection with chlamydia bacteria, which is spread by sexual contact and may or may not cause symptoms. Researchers don't know exactly why chlamydia infection increases cervical cancer risk, but they think it might be because active immune system cells at the site of a chlamydia infection might damage normal cells and cause them to turn cancerous.*A diet low in fruits and vegetables. Women who don't eat many fruits and vegetables miss out on the protective antioxidants and phytochemicals such as vitamins A, C, E and beta-carotene, which have all been shown to help prevent cervical cancer and other forms of cancer.*A compromised immune system related to certain illnesses such as human immunodeficiency virus (HIV) infection. Being HIV positive makes a woman's immune system less able to fight cancers such as cervical cancer.*A family history of cervical cancer—your mother or sister had cervical cancer—may mean you have a genetic tendency for the disease. This could be because such women are genetically less able to fight off HPV infection than other women.*Exposure in utero to diethylstilbestrol (DES), a synthetic hormone that was prescribed to pregnant women between 1940 and 1971 to prevent miscarriages. For every 1,000 women whose mother took DES when she was pregnant, about one develops clear-cell adenocarcinoma (cancer) of the vagina or cervix. For more information on DES exposure, contact the U.S. Centers for Disease Control and Prevention (CDC), toll-free: 1-888-232-6789, or online at www.cdc.gov.*Long-term oral contraceptive (OC) use (five or more years) may very slightly increase a woman's risk of cancer of the cervix, according to some statistical evidence. The American Cancer Society advises women to discuss the benefits of OC use versus this very slight potential risk with their health care professionals.More than twice as many African-American women die from cervical cancer as Caucasian women. Additionally, Hispanic women and Native-American women have higher rates of cervical cancer than Caucasian women. Rates of cervical cancer are also increasing among Vietnamese women. Lack of access to health services (and therefore, less screening), cultural influences and diagnosis of cancer at more advanced stages are all possible reasons for these differences.Women of all ages are at risk of cervical cancer, but half of those diagnosed are between ages 35 and 55, with the average age of diagnosis of 47 years. Regardless, it is important that even postmenopausal women continue having regular Pap tests if they still have a cervix. Even if a woman's cervix was removed during a hysterectomy (as 90 percent are), if she had a suspicious Pap before her surgery, she should continue Pap tests.The benefits of the Pap test are clear: The overall death rate in the United States from the disease has declined by 74 percent since the introduction of the Pap test in the 1950s.Although both the incidence and death rates of cervical cancer are going down, it is still the 12th most common cancer in women, which may be related to the epidemic of infection with HPV. According to the CDC, approximately 20 million people are currently infected with HPV. As many as 75 percent of the reproductive-age population has been infected with one or more types of HPV, and up to 5.5 million new infections occur each year.There are more than 100 different strains of HPV, and approximately 15 types have been linked to cancer of the cervix. While most women who develop cervical cancer have HPV, not all women with the virus will develop cervical cancer. In fact, only a small proportion of women infected with HPV develop cervical cancer. Some types of HPV cause vaginal and vulvar warts; other strains cause the warts that sometimes develop on the hands or feet.New Vaccine Offers Protection Against HPVNow there is something women can use to protect themselves against human papillomavirus (HPV)/cervical cancer in addition to regular Pap tests and safe sex: An HPV vaccine. The FDA recently approved the vaccine—called Gardasil—for women ages 13 to 26 after clinical trials showed the vaccine is safe and 100 percent effective in preventing HPV strains 16 and 18, which cause 70 percent of cervical cancers. Gardasil, given in three injections over six months, is also 99 percent effective in preventing HPV strains 6 and 11, which cause about 90 percent of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn't protect against all of them, so the FDA recommends it as a complement to Pap tests. Furthermore, the vaccine does not work if a woman is already infected with one of these HPV types. It has to be given before infection.

Chiropractic

The term "chiropractic" is derived from the Greek language and means "done by hand." Chiropractic therapy involves manual manipulation (primarily of the spine but can and often does include other manipulation of the musculoskeletal system (MSS) such as ankles, knees, hips, wrists, elbows, shoulders and ribs) to correct musculoskeletal disorders and improve overall health.

Chiropractic therapy is based on the theory that illness stems from blockages within spinal nerve roots, which exit the spine at regular intervals along its length. Chiropractors do not treat your illness unless the problem is directly musculoskeletally related. Instead, they seek to correct the MSS-related cause. If that problem is fixed, chiropractors say, the human body often has the ability to heal itself. So, chiropractors stress the importance of the relationship between the musculoskeletal system and the nervous system in regaining and sustaining health. They use adjustments, joint manipulation and other techniques to normalize spinal function, relieve various disorders and promote your body's natural healing process.

Chiropractors take a holistic approach to health, meaning they treat you and your body as a complete system. When one part or system is disabled, chiropractors believe it affects the entire system. They pay particular attention to preventive treatments to keep you well, such as changes in nutrition and exercise. The practice involves neither drugs nor surgery, but most chiropractors will advise you to consult with another health care professional if your condition requires a different type of treatment.

Chiropractic is the most popular form of alternative health care in the U.S., according to a survey reported by the American Medical Association (AMA). The percentage of the population seeking chiropractic care ranges from 3.3 percent to 16 percent. Up to 100 million Americans have used chiropractic care, including 27 million in 1999 alone. The practice is licensed in every state and the District of Columbia, and there are at least 55,000 chiropractors in the U.S.

Spinal manipulation has been practiced for thousands of years, and modern chiropractic care is more than a century old. Modern chiropractic was initially established by Daniel David Palmer, who was seeking a way to cure disease without using drugs. Palmer concluded that most disease results from spinal misalignment (a concept that has since been discarded in the light of new evidence) and that many ailments are caused by the vertebrae impinging on spinal nerves. This impingement or blockage, he said at the turn of the 19th century, interferes with natural nerve transmission. He termed this condition "subluxation." Subluxation, he said, should be treated with manipulations or adjustments to properly align the spine and eliminate the blockage, restoring nerve transmission and allowing the body to heal itself. Dr. Palmer, however, was open to new scientific findings, something that was unusual at the turn of the 19th century.Different Approaches

Today, there are several types of chiropractors, but most can be grouped into one of two basic schools. "Straight" chiropractors are purists, adhering to the philosophy that subluxations are responsible for most diseases. An element of this group spurns diagnosis and works to adhere to the early teachings of chiropractic. The much larger group -- historically called "mixers"-uses various approaches and isn't limited to manipulation and adjustments. They perform diagnosis to the level of the general medical practitioner in order to work more closely with physicians. Like straight chiropractors, many mixers believe that certain disease processes are attributable to subluxations: others disagree. These differences of opinion are fading, and according to a report by the U.S. Agency for Health Care Policy and Research, more than two-thirds of chiropractors use techniques other than manipulation (such as exercise, nutritional counseling and physiotherapy), but 93 percent of the conditions treated by chiropractors are musculoskeletal in nature.

The larger group generally promote chiropractors as primary health care providers and are members of the American Chiropractic Association (ACA), the largest professional association for chiropractors.

There's a third, much smaller group of practitioners-many represented by the National Association for Chiropractic Medicine (NACM). It doesn't publish either its numbers or the names of its members, preferring to remain secretive while it cooperates with individuals and groups that are hostile to the chiropractic profession. This group focuses only on musculoskeletal back disorders. They do not treat other conditions, limiting their practice to spinal manipulative therapy. NACM membership requirements state that a Doctor of Chiropractic Medicine must renounce the chiropractic hypothesis and/or philosophy: that is, that subluxation is the cause of disease. The chasm between the American Chiropractic Association-the largest and more progressive of the chiropractic groups-and the other groups is wide and contentious.Applications

Some chiropractors limit their practices to back pain, headache and similar musculoskeletal complaints, but some contend that chiropractic manipulation is the appropriate treatment for a wide-range of conditions, including those that aren't related to the musculoskeletal system. Most also focus on preventive care, which may include regular adjustments of returning musculoskeletal imbalances for health maintenance.

Many health care professionals (including many chiropractors) contend that chiropractic treatment should focus only on musculoskeletal conditions. And, in fact, studies show that chiropractic manipulation seems to have the best results for acute back pain, particularly lower-back pain. It may also be an effective therapy for muscle spasms, nerve inflammation, headache, joint pain and various other musculoskeletal problems. According to a RAND study, more than 94 percent of all spinal manipulations are administered by chiropractors.

Many chiropractors also address problems unique to women, suggesting chiropractic care for pregnant and postpartum women, as well as those suffering from premenstrual syndrome and menstrual cramps. According to a study performed through the National University of Health Sciences, 88 percent of women receiving chiropractic treatment said it reduced menstrual pain. The Journal of Manipulative and Physiological Therapeutics reported that spinal manipulation might provide short-term relief of menstrual pain.

Chiropractic neurologists are a growing specialty, treating patients with a variety of conditions, including hyperactivity, attention deficit disorder and autism.

Sciatica (pain in the lower back and hip that spreads down the back of the thigh into the leg), asthma, high blood pressure, tension headaches, carpal tunnel syndrome, osteoporosis, severe temporomandibular joint dysfunction (TMD) and neurological pain are among the disorders treated by chiropractors, certain of them directly such as tension headaches, and others indirectly, such as osteoporosis, by addressing the symptoms. However conditions of the blood, heart, lungs and other organs, as well as infectious diseases or injuries, require treatment by medical health care professionals. If you are under the care of a specialist, discuss your interest in chiropractic treatment with your health care team: don't ignore your regular course of treatment: many conditions today are more effectively co-managed by a variety of health care professionals.

Medical and chiropractic physicians have been in the process for many years now of building professional bridges. You should have no difficulty attaining cooperation between a medical and a chiropractic doctor.Increasing Acceptance

Chiropractic care has been the object of skepticism and even scorn by certain conventional health care professionals. But the practice has gained much respect in recent years, and many health care professionals will refer patients to chiropractors on occasion. A recent report from Washington state points out that fully 57 percent of medical doctors refer their patients with back pain to chiropractors and that two-thirds of them would like to learn more about exactly what it is chiropractors do. Your health plan may even cover chiropractic treatment. Ninety-two percent of preferred provider organizations (PPOs) and 57 percent of health maintenance organizations (HMOs) include chiropractic benefits.

Active duty personnel in the U.S. armed forces now have guaranteed access to a permanent chiropractic benefit. On October 30, 2000, President Bill Clinton signed into law the National Defense Authorization Act for Fiscal Year 2001, requiring access to chiropractic services which includes, at a minimum, care for neuromusculoskeletal conditions typical among military personnel on active duty. The law requires that full implementation of the benefit be phased in over a five-year period, throughout all three service branches of the military. When completed, all active duty personnel stationed in the U.S. and overseas are to have access to chiropractic care.

A similar bill was signed into law in 2002, providing chiropractic care for United States Armed Forces veterans. It should be noted that 20 percent of all medical military discharges are for low back pain.

Respect for chiropractic has increased because of the therapy's track record as an appropriate treatment, particularly for early-stage lower-back pain, which is the second most costly medical problem in America. The Journal of the American Medical Association reported that chiropractic manipulation has been shown to have a "reasonably good degree of efficacy in relieving back pain, headaches and similar musculoskeletal problems."

Several studies indicate that chiropractic patients are more satisfied with their treatment than are those who receive traditional medical care and that they are less likely to seek care elsewhere for the same problem. Chiropractic patients also have the perception that chiropractors spend more face-to-face time with them than do their other health care professionals.

Hepatitis B

Hepatitis B

Hepatitis B is the most common serious liver infection in the world. It is thought to be the leading cause of liver cancer.
The World Health Organization estimates that hepatitis B infections lead to more than one million deaths every year.
What causes hepatitis B?
The disease is caused by the hepatitis B virus (HBV) that attacks the liver.
The virus is transmitted through blood and bodily fluids that contain blood.
This can occur through direct blood-to-blood contact, unprotected sex, and illicit drug use.
It can also be passed from an infected woman to her new-born during the delivery process.
Does the virus always pose a health threat?
It is thought that about one in three of the world's population is infected by HBV.
However, about 50% of those who carry the virus never develop any symptoms.
About nine out of ten people infected with HBV will eventually clear the virus from their bodies. But about 5-10% of infected adults will become chronic hepatitis B carriers, often without even knowing it.
What are the symptoms?
The virus can cause a range of problems, including fever, fatigue, muscle or joint pain, loss of appetite, nausea and vomiting.
Chronic carriers have an increased risk of developing liver disease such as cirrhosis or liver cancer, because the hepatitis B virus steadily attacks the liver.
Chronic carriers will usually have on going inflammation of the liver and may eventually develop cirrhosis and liver cancer.
About 1% of people who are infected develop an extreme form of disease called acute fulminant hepatitis.
This condition can be fatal if not treated quickly. Sufferers may collapse with fatigue, have yellowing of the skin and eyes (jaundice) and develop swelling in their abdomen.
How is it treated?
There are several drug treatments available to treat hepatitis B.
Patients may be put on a four month course of injections of the drug interferon.
An alternative treatment is a drug called lamivudine which is taken orally once a day. Treatment is usually for one year. Sometimes lamivudine is combined with interferon.
Chronic patients may require a liver transplant.
Can it be prevented?
Yes, by the use of a safe and effective vaccine.
However, for the 400 million people world-wide who are already carriers of HBV, the vaccine is of no use.

Hepatitis C

Hepatitis C

The virus is carried in the bloodHepatitis C is a virus which can cause fatal liver problems.
Although some modern treatments can control it in some patients, on the whole it remains an infection which is very hard to treat.
The virus is carried in the blood, and people with the infection can pass it on if their blood gets under the skin or into the bloodstream of another person.
Examples of how this might happen include intravenous drug users sharing syringes, or a surgeon with the infection who is cut while carrying out an operation, with the blood getting into the patient's wound.
It can also be passed on through sexual contact but that is very rare. Hepatitis C is not transmitted through normal social contact such as touching, hugging or kissing.
The word hepatitis in general refers to an inflammation of the liver - which can be caused either by the C virus, or by other viruses, drinking too much or even by a condition in which the body's own immune system attacks liver cells.
Symptomless

Sharing needles increases infection risksSome patients - some 20% - manage to get rid of the hepatitis C virus within six months without ever suffering the symptoms of the disease.
In the remainder, the virus can remain in the body, again perhaps not causing any symptoms, for even a period of decades.
However, if the liver inflammation begins to get worse, then symptoms can appear.
These include jaundice, a condition which tells doctors that the liver may not be working properly.
In this the skin turns yellowish, as do the whites of the eyes. It is associated with fatigue.
Other symptoms of hepatitis C include weight loss, alcohol intolerance, vomiting and flu like symptoms.
If severe liver inflammation persists, serious damage may occur.
Tests for hepatitis C
Blood tests may be able to tell doctors if hepatitis C is present. However, as the test is looking for signs that the body's immune system is trying to fight the virus, it may not be positive for a few months after infection.
A doctor may also want to carry out "liver function tests" to see how well the liver is working, or even take a sample of liver tissue - a liver "biopsy" to check for serious damage.
Treatments
Currently, hepatitis C is treated with a combination of two drugs, interferon alpha and ribavirin.
About 40% of patients respond to this "combination" therapy.
In some cases, however, doctors who know a patient has hepatitis C may opt to simply keep an eye on them to check that liver damage is not occurring.
If liver damage is severe, then a transplant may be the only option. The shortage of organs for transplantation is a severe problem - patients may have to wait some time before one becomes available.
Even when the liver is replaced, this does not cure the virus - the virus infects the new liver and will eventually start to damage it in the same way.
The operation simply buys some time and improves the general health of the patient.

Hypothermia

Exposure to cold is estimated to cause 30,000 deaths a year in the UK.
The causes vary, and include increased susceptibility to flu and other viruses.
However, hypothermia is one of the most deadly cold-induced conditions and, if not caught and treated early on, can lead to a rapid decline in the body's ability to function normally.
What is it?
Hypothermia occurs when the body's core temperature is lowered due to exposure to cold.
It can occur even at mild temperatures if exposure is prolonged.
The body's natural defences against the cold consist of restricting the flow of blood to the skin so as to prevent heat loss, along with shivering and releasing hormones to generate heat.
These measures are limited and are usually inadequate to maintain body temperature in cold environments.
What are the symptoms?
Symptoms take effect in three stages.
The first stage - mild hypothermia - is characterised by:
Bouts of shivering;
Grogginess and muddled thinking.
Indicators of moderate hypothermia are:
Violent shivering or shivering which suddenly stops;
Inability to think and pay attention;
Slow, shallow breathing;
Slow, weak pulse.
Severe hypothermia has set in when:
Shivering stops;
The patient loses consciousness;
There is little or no breathing;
Pulse is weak, irregular or non-existent.
Who is at risk?
The elderly and babies under one year old are most at risk among people with no other complaints.
Age Concern estimates that every time the temperature drops one degree Celsius below average, 8,000 more elderly people will die.
However, people who already have something wrong with them are also at a higher risk, as they may not be aware of how severely they are exposing themselves to the cold.
The main risk groups are:
People who have been involved in accidents;
Mentally ill patients;
People with heart problems;
Hypothyroid patients;
Patients on sedatives;
Alcoholics.
Due to their sleeping arrangements, the homeless are also particularly at risk.
People who expose themselves to extreme weather conditions, such as mountain climbers, are at risk, but will usually travel prepared for emergencies.
They should also have some understanding of how to recognise and treat hypothermia before they set off.
What is the treatment?
The first step is to contact the emergency services as extreme hypothermia requires urgent professional attention.
All cold, wet clothing should be replaced with warm, dry clothing to prevent further heat loss immediately.
If breathing has stopped or there is no pulse, cardiopulmonary resuscitation (CPR) should be attempted until the emergency services arrive.
Rapid rewarming with hot water or massaging cold extremities should be avoided as, if done improperly, it could lead to serious tissue damage.
Do not give alcohol or nicotine products to someone suffering from hypothermia.
How can it be prevented?
The key rules are to wear many layers of clothing, drink plenty of fluids and hot drinks (but not alcohol) and keep well nourished.
Maintaining movement to keep circulation up is also advised.
Age Concern advises keeping at least one room well-heated during the winter months.
Is help available?
Age Concern runs a Be a Good Neighbour scheme during winter.
The scheme calls on people to be aware of elderly people living nearby and to help out with routine tasks.
Dr Simon Fradd, of the Doctor Patient Partnership, said: "Helping collect prescriptions, getting prescriptions or just making time for a chat are a few simple ways we can help."
More details can be obtained from Age Concern's freephone line on 0800 00 99 66.
This page contains basic information. If you are concerned about your health, you should consult a doctor.

Depression

Sir Winston Churchill suffered from depressionDepression is a common mental illness which is estimated to affect up to one in five Britons at some point in their lifetime and to cost the UK about £8bn a year in medication, benefits and lost working days.
It can strike at any age and the feelings of hopelessness and helplessness attached to it can make it difficult for people to carry out their normal activities.
It can be more or less severe and
symptoms are often varied, making it often hard to diagnose.
It is thought that some individuals may be more prone to depression, whether because of life experiences, their body chemistry or genetically inherited conditions.
Those who have suffered from depression include Sir Winston Churchill and Florence Nightingale.
What is depression?
Anyone can suffer from depression. The most common symptoms include:
Feelings of helplessness and hopelessness
Feeling useless, inadequate, bad
A sense of self hatred, constant questioning of thoughts and actions and a constant need for reassurance
Feeling vulnerable and being oversensitive to criticism
Sense of guilt
Loss of energy and the ability to concentrate and be motivated to do even the simplest tasks
Harming oneself
Sudden loss or gain in weight
Sleep disruption or a need to sleep very long hours
Agitation and restlessness
Loss of libido
Physical aches and pains
Most people only suffer two or three of these symptoms at any one time.
People with severe depression may also experience suicidal feelings, stop eating or drinking and suffer from delusions or hallucinations.
Many people who need treatment for depression suffer further bouts later in life.
Women are twice as likely to suffer from depression, but three times as many men commit suicide.
Experts say this could be because women are more likely to admit to depression because of the stigma attached to mental illness.
Different types of depression
There are many different types of depression, including clinically diagnosed depression, manic depression and post-natal depression.
Manic depression is marked by extreme mood swings, between highs when a person experiences excessive energy and optimism and lows when they may feel total despair and lack of energy.
It is often treated with lithium or, in extreme cases, electro-convulsive therapy.
Post-natal depression can occur from about two weeks after the birth of a child to two years after and differs from the mood swings suffered by many in the first few days after the child is born.
Other forms of depression include Seasonal Affective Disorder which is thought to be associated with the approach of winter and may be linked to lack of sunlight.
Causes of depression
Depression can be caused by a combination of factors.
It often runs in families, suggesting a genetic component, but it may be triggered by stressful events.
Major depressive illness is usually linked to some form of chemical imbalance in the brain.
It is also thought that people with low self-esteem, a pessimistic outloook on life and difficulty coping with stress are more prone to depression.
Life events which may trigger depression include bereavement, chronic illness, relationship problems and financial difficulties.
Treatment
In recent years, the market has been saturated by a range of new drugs called anti-depressants.
These include Prozac which is thought to stimulate the growth of brain cells in an area of the brain called the dentate gyrus.
Other types of drugs may also be used to treat depression.
Many positive claims have been made for anti-depressants, but some patients experience bad side effects.
Other ways of treating depression include psychotherapy, which aims to uncover the reasons for depression and help the patient to find ways of overcoming them.
Self help groups may also offer people a forum for talking about their condition and sharing it with others so that they do not feel isolated and alone.
In extreme cases, a person with depression may need to be treated in hospital, for example, if they are threatening or have attempted to commit suicide.
If the person is deemed a risk to himself or others, he may have to be committed to hospital.
Besides psychotherapy and a course of anti-psychotic drugs, people in hospital may be offered or forced to undergo electro-convulsive therapy.
This involves applying electric currents to the brain. The treatment is controversial, but safety procedures have been improved in recent years.
Some psychiatrists are against its use, particularly without the patient's consent, but others believe it can be effective in dealing with life-threatening depression.

Cholera

Medical notes: Cholera

Cholera-causing bacteriaCholera is an intestinal infection caused by a bacteria - and is often linked to contaminated supplies of drinking water.
By the start of the 20th Century, six major cholera "pandemics" had affected countries across the world.
The world is now fighting the seventh, caused by a new strain of the Vibrio cholerae bacterium.
Epidemics involving this strain started in 1961 in Indonesia, spreading rapidly elsewhere in eastern Asia, and from there to India and Bangladesh, the USSR, Iran and Iraq.
The bacterium is part of the flora of brackish water and estuaries - it is when this water gets into the drinking supply that an outbreak can start.
It causes severe diarrhoea and vomiting, and patients, particularly children and the elderly, are vulnerable to dangerous dehydration as a result.
Treating the condition - or rather alleviating these severe effects, requires only simple measures.
However, the clean water and rehydration salts required are often in short supply in areas where they are needed most.
An outbreak of cholera can spread quickly in areas where there is poor sanitation and where water supplies can be tainted.
It is only rarely spread by person-to-person contact.
Carriers
Most people infected with cholera don't actually get ill.
Despite this, they are contributing to the problem because the bacteria remain in their faeces for up to a fortnight.
Most symptomatic cases are hard to distinguish from other illnesses that cause diarrhoea - it is only in one in 10 that severe symptoms such as dehydration occur.
A well-organised response to cholera, says the World Health Organization, can reduce death rates to 1%.
An unprepared community, however, will experience many times this death rate, it says.
Normally, rehydration salts are the only treatment given, although severely dehydrated patients may need intravenous fluids.
Antibiotics can reduce the amount of diarrhoea.
Vaccines
There are two oral cholera vaccines - but these are mainly aimed at travellers rather than wider use in a community stricken by the illness.
Control of an epidemic is difficult in a community unless clean water supplies can be restored.
Systems for hygienic disposal of human wastes also need to be brought in.
Cooking practices need to be made as safe as possible - where practicable, food needs to be cooked thoroughly and eaten while hot, and raw fruit and vegetables avoided unless they are peeled first.
Handwashing after going to the toilet is a vital measure to prevent the spread of the disease.

Female sexual dysfunction

Inadequate sexual function in women is a complex problem that can have many different causes.
It is estimated that up to 40% of women suffer from sexual dysfunction. This might be caused by physical illness, but is often linked to psychological factors.
The symptoms of sexual dysfunction can include lack of sexual desire, an inability to enjoy sex, insufficient vaginal lubrication, or, even if sexually aroused, a failure to achieve an orgasm.
The female equivalent of impotence is known as Female Sexual Arousal Disorder (FSAD).
When men and women become sexually aroused, their genitals become engorged with blood.
In women this normally results in:
Enlargement of the clitoris and surrounding tissues (comparable to a male erection)
Secretion of vaginal lubrication
Relaxation and widening of the vaginal opening to permit intercourse.
FSAD patients have the desire to have sex but their genital area fails to respond in the normal way, making sex painful or impossible.
Underlying medical condition

Vaigra may successfully treat some womenFSAD can result from an underlying medical condition, such as high blood pressure or diabetes.
It can also be caused by irritations, infections and growths in the vaginal area, or reactions to contraceptive devices.
Medications used to treat high blood pressure, peptic ulcers, depression or anxiety and cancer may also cause problems.
Another factor is the physical, hormonal and emotional changes that occur during or after pregnancy or while breast feeding.
However, FSAD is usually linked to psychological causes. These can include:
Inadequate or ineffective foreplay
Depression
Poor self-esteem
Sexual abuse or incest
Feelings of shame or guilt about sex
Fear of pregnancy
Stress and fatigue
Orgasm problems
Women who suffer from Female Orgasmic Disorder (FOD) are unable to achieve orgasm despite being sufficiently aroused to have sex.
Women differ from men in that orgasm is a learned, not automatic, response. About five to ten percent of women never have an orgasm through any type of sexual activity - a condition called anorgasmia.
Anorgasmia is most often the result of sexual inexperience, performance anxiety, or past experiences, such as sexual trauma or a strict upbringing, that have led to an inhibition of sexual response.
Some women are able to enjoy sexual activity in spite of reaching orgasm only some or even none of the time. FOD is a problem only if it has a negative effect on the satisfaction of a woman or her partner.
Treatment
On-going research suggests that Viagra, the anti-impotence drug for men, may help to treat sexual disorders in women by increasing blood flow to the sexual organs and thereby increasing physical stimulation in the area.
However, the scientific community is still waiting for firm evidence to be published that the drug that the drug can work on women. A small study published earlier this year found no positive impact on postmenopausal women.
For the moment, doctors concentrate, where possible, on eliminating medications that might have a negative effect on sexual performance.
They also review contraceptive methods to ascertain whether this is a factor.
Women who suffer from vaginal dryness may also be recommended to use lubricants during intercourse.
Some doctors recommend that women use Kegel exercises, which help to develop the muscles around the outer portion of the vagina that are involved in pleasurable sensations.
Psychological counselling can also play an important part in treating women with sexual problems, as can coaching in sexual foreplay and stimulation techniques.

Female genital mutilation

Female circumcision, officially known as female genital mutilation, is one of the most political areas of women's health. Worldwide it is estimated that well over 100 million women have been subjected to it.
Supporters of the practice say it is done for cultural and religious reasons, but opponents say that not only is it potentially life-threatening - it is also an extreme form of oppression of women.
Those who persist in the practice in Senegal will now face a prison term of between one and five years.
Female circumcision is mainly carried out in western and southern Asia, the Middle East and large areas of Africa.
It is also known to take place among immigrant communities in the USA, Canada, France, Australia and Britain, where it is illegal.
In total it is estimated that two million a year are subjected to genital mutilation.
There are three main types of circumcision:
The removal of the tip of the clitoris;
Total removal of the clitoris and surrounding labia;
The removal of the clitoris and labia and the sewing up of the vagina, leaving only a small opening for urine and menstrual blood - a process known as infibulation.
So drastic is the mutilation involved in the latter operation that young brides have to be cut open to allow penetration on their wedding night and are customarily sewn up afterwards.
The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls ineligible for marriage if they have not been circumcised.
Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.
Health workers say that the operation is often carried out in unsanitary conditions.
Razor blades, scissors, kitchen knives and even pieces of glass are used, often on more than one girl, which increases the risk of infection.
Anaesthesia is rarely used.
Some girls die as a result of haemorraging, septicemia and shock.
It can also lead to long-term urinary and reproductive problems.
However, girls who have not been circumcised are considered "unclean" in many cultures, and can be treated as harlots by other women. Many men believe the folklore which says they will die if their penis touches a clitoris.
Campaigns are working

Female circumcision is part of the fabric of many African societiesDue to health campaigns, female circumcision has been falling in some countries in the last decade. In Kenya, a 1991 survey found that 78% of teenagers had been circumcised, compared to 100% of women over 50. In Sudan, the practice dropped by 10% between 1981 and 1990.
Several governments have introduced legislation to ensure the process is only carried out in hospitals by trained doctors.
Other countries such as Egypt have banned the operation altogether, but there is significant opposition to change because of the traditional nature of the process and health workers think a less confrontational approach, such as Ntanira Na Mugambo, could be more successful.
Ntanira Na Mugambo, also known as 'circumcision by words', has been developed in rural areas of Kenya by local and international women's health organisations.
It involves a week-long programme of community education about the negative effects of female genital mutilation, culminating in a coming of age ceremony for young women.
The young women are secluded for a week and undergo classes in reproduction, anatomy, hygiene, respect for adults, developing self-esteem and dealing with peer pressure.
Family members also undergo health education sessions and men in the community are taught about the negative effects of female circumcision.
Health workers believe the programme works because it does not exert a blunt prohibition on female genital mutilation, but offers an attractive alternative.

Eczema

Serious skin conditions affect around seven million of people in the UK alone.
They can cause significant emotional distress as well as physical discomfort.

What is it?
Eczema or dermatitis is a group of inflammatory skin disorders that make the skin dry, itchy, flaky, red and sore. In more severe forms the skin can become broken and weep or bleed.
The different types of eczema have very different causes and treatments, making their correct diagnosis important. None are contagious.
The commonest is atopic or allergic eczema, which tends to run in families and is linked with asthma and hayfever. Many children grow out of this type of eczema, but adults can have it too.
Other types include:
Contact dermatitis - caused by irritants to the skin such as nickel or detergents
Seborrhoeic eczema - cradle cap in babies and a severe form of dandruff in adults
Varicose eczema - typically found on the legs and is caused by poor blood circulation
Discoid eczema - circular patches of eczema on the body
Who gets it?
Eczema is common in childhood - up to a fifth of children of school age have eczema. It also affects one in 12 adults.
What are the symptoms?
The main symptom is itch. This can be so severe that it keeps the individual awake at night. Itching will make the condition worse. Lesions can be sore, hot, red, dry and flaky. They may weep or bleed and can become infected. Scaly areas of skin may form in places that are scratched regularly.
Eczema can appear anywhere on the body but is often found in the skin creases of the elbows and wrists and behind the knees. In babies, lesions typically appear on the cheeks.
What is the outlook?
Eczema is never cured but it can be managed. Sometimes it is possible to prevent flare-ups of eczema by avoiding the things that make it worse. For example, this might be avoiding contact with certain detergents or skin irritants like nickel.
Wearing clothing made of cotton rather than synthetic fibres and avoiding itching the skin can also help.
Factors such as stress and changes in hormone levels (during a woman's menstrual cycle) may also contribute to flare-ups.
Mild eczema may resolve itself or only require minimal treatment. Severe eczema, however, can cause extreme discomfort and distress and may even need to be treated in hospital. Treatment will help but the eczema may persist.
How can it be treated?
Emollient creams, lotions and soap substitutes, help avoid flare-ups by preventing the skin from becoming too dry. They can also help lessen the itch and discomfort.
Steroid creams and ointments can be used to reduce the inflammation by dampening down the body's natural immune response. If these do not work more potent steroids can be given as creams or oral tablet on prescription. Other immunosuppressant creams and tablets, such as tacrolimus, are available with a prescription as an alternative to steroids.
Antibiotics may also be required if the skin has become infected.
For some people with eczema, ultra violet light treatment is useful.

Cataracts

One in three people over the age of 65 has a cataract. Left untreated cataracts can significantly impair vision. However, a simple, routine operation that can be done as a day case will usually restore the sight.
What are cataracts?
Cataracts are cloudy or opaque areas that develop in the normally clear or transparent lens of the eye.
The lens sits inside the eye, behind the coloured iris. The job of the lens is to focus the light entering the eye. The lens must be transparent for us to see clearly and sharply.
What causes them?
Most forms of cataract develop in adult life. With normal ageing, the lens hardens and becomes cloudy.
Cataracts can also result from conditions such as diabetes, trauma to the eye and certain medications.
Some babies are born with cataracts, known as congenital cataracts.
Cataracts are not caused by overuse of the eyes. Also, using the eyes when cataracts start to develop will not worsen the condition.
What are the symptoms?
The sight becomes blurred or misty. Those who wear glasses may report that they seem dirty or scratched.
Bright sunshine and lights might dazzle - some see haloes around lights. This can be a particular problem when driving at night because of the glare from on-coming headlights.
In addition, colour vision may become faded or washed out.
How can it be treated?
The most effective treatment is to remove the damaged lens. The operation is usually done once the cataract has begun to interfere with the person's quality of life. For example, when the person finds it hard to read, get out and about and drive because of their deteriorating eyesight.
Typically, the surgery is carried out under local anaesthetic, meaning the patient will be awake during the operation but will feel no pain.
The eye is not taken out of the socket. The lens can be removed and replaced with a clear plastic lens by making a small cut in the eye that does not usually require stitching afterwards. This new lens will remain in the eye for good and should correct the eyesight.
The surgery generally takes about 20 minutes to complete and most patients can return home that same day.
After the surgery, the eye that has been operated on will be covered with a protective patch, which should generally be worn for the whole of the next day and then every night for the next month.
Eye drops should also be used for two months after the operation to protect against infection. Some people may also be sensitive to bright lights for a while and might find wearing a pair of dark glasses helpful.
Generally, normal activities, including going back to work, can be resumed a week after the surgery.
Some people notice an immediate improvement in their vision, but it will take the eye a few weeks to settle and for the vision to return to normal. Those who needed glasses before the operation may still need them afterwards because the surgery only corrects the cataract.
Are there any side effects?
Cataract surgery is extremely safe. Fewer than 2% of patients have serious complications.
There is a risk of infection. An accumulation of fluid in the back of the eye can also occur, causing blurring of the central vision.
One of the most common complications is thickening of the membrane behind the new lens in the months following the surgery, which is known as capsular opacity. This can be treated with lasers.

Epilepsy

Epilepsy is a common neurological disorder which causes seizures. One in 133 people in the UK has epilepsy, and at any one time 300,000 have an active form of the condition.

An epileptic seizure is caused by over-activity of the brain cells, which produces a surge of electricity.
This may be due to a variety of factors, such as brain damage from birth injuries, head injury, stroke, brain tumours and alcoholism.
There is some evidence to suggest the condition sometimes has a genetic basis - although it is rare for it to run in families.
In many instances, the cause of the condition is a mystery.
Are there different types of seizure?
Yes. Essentially, there are two types.
A partial seizure begins in one specific part of the brain, and may spread to other areas.
A generalised seizure can start in both sides of the brain at once.
Partial seizures:
Simple partial seizure - Confined to one particular area of the brain. The person retains consciousness, but may be fearful, and experience a strong sense of deja vu. Symptoms include jerking of an arm and an unpleasant taste in the mouth.
Complex partial seizure - The electrical disturbance spreads, disrupting consciousness. The person may interact with the surroundings, but be unaware of what they are doing and have no recollection of the event.
Symptoms may include repeatedly chewing, swallowing or scratching. Afterwards the person is likely to be confused for some minutes.
Generalised seizures:
Tonic clonic seizure - This leads to 'grand mal' convulsions in which the person loses consciousness, falls to the ground, becomes stiff and shakes.
In some instances a tonic clonic seizure may occur after an initial partial seizure - in which case the person may have some warning of what is about to occur.
Absence attack - A blank spell lasting a matter of seconds from which recovery is almost immediate.
Myoclonic seizures - Jerks caused by a sudden contraction of the muscles. Can affect the whole body usually restricted to one or both arms and sometimes the head.
Tonic seizures - All the muscles contract. The body stiffens and the person will fall over if unsupported.
Atonic seizures - All muscle tone is lost and the person simply drops to the ground.
How is epilepsy treated?
There are a wide range of anti-epileptic drugs to prevent seizures.
Which drug is prescribed will depend on the individual patient, and their particular form of epilepsy.
The drugs are effective, but can have side effects, including drowsiness and dizziness.
Some drugs may produce longer term side effects, such as acne and weight gain.
Anti-epileptic drugs should not be taken in tandem with some other medications. They may also slightly increase the risk of malformations if taken during pregnancy.
Is surgery an option?
Yes, for people who do not respond to drug treatment.
The most common form of surgical treatment is to remove the hippocampus - a part of the brain involved in memory which is particularly vulnerable to damage.
Other forms of surgery which may be considered include:
Temporal lobectomy - a larger part of the temporal lobe is removed.
Sub-pial resection - fine cuts are made in the motor areas of the brain.
Hemispherectomy - the removal of the whole of one side of the brain
Corpus callosotomy - cutting the fibres that connect the two halves of the brain.
An alternative to neurosurgery is a treatment called vagal nerve stimulation in which a pacemaker device is placed under the skin to stimulate the vagus nerve in the neck.
This form of treatment does not usually cure the epilepsy, but can reduce seizure frequency and severity.

Nosebleeds

Nosebleeds are more often annoying than a serious health threat, although they can indicate the presence of other underlying illnesses. Most nosebleeds can be treated at home. They are messy and can be embarrassing, but most do not need professional medical attention.

What are they?
Most nosebleeds start in the lower part of the septum, the semi-rigid wall that separates the two channels of the nose.
It contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail.
With these nosebleeds - known as anterior nosebleeds - bleeding can occur from one side of the nose (epistaxis) or both (epistaxis bilateral).
They can usually be treated easily at home and do not require medical attention.
More rarely, posterior nosebleeds start when bleeding begins high and deep within the nose.
Blood flows down the back of the mouth and throat even when the patient is sitting up or standing.
This more severe type of nosebleed needs immediate medical attention.
What causes them?
Nosebleeds are caused by the rupture of a small blood vessel called a capilliary in the nose.
The most common cause of this is injury - a good bash to the nose will result in bleeding.
The other main cause is dryness of the inside of the nose. A dry climate or heated indoor air irritates and dries out nasal membranes, causing crusts that may itch and then bleed when picked.
Other causes of nosebleeds are colds, high altitude, allergies and medications.
Nosebleeds can also result from a calcium deficiency.
Occasionally, nosebleeds may indicate other disorders such as bleeding disorders, cancer, high blood pressure or disease of the arteries.
They can also indicate hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu syndrome.
This is a disorder involving a vascular growth similar to a birthmark in the back of the nose.
What is the treatment?
Doctors advise people with lower-septum nosebleeds to sit up straight and pinch the nostrils together firmly for 10 minutes.
An ice pack can also be applied to the nose and cheeks.
The pressure should then be relieved to see if the nose is still bleeding.
If it is, patients are advised to pinch the nostrils for another 10 minutes.
If the nosebleed was caused by atmospheric dryness, the patient should breathe steamy air. After bleeding stops, petroleum jelly can be applied just inside the nose to prevent further bleeding.
Once bleeding has stopped, the sufferer should avoid any strenuous activity for 12 hours. Nor should they blow their nose, as this may dislodge blood clots and cause bleeding to start again.
If bleeding does not stop after 30 minutes of direct pressure, patients should see a doctor.
If blood runs down the back of the throat when pressure is applied to the nose, it could be a higher-septum nosebleed and require a visit to the doctor.
Patients should also seek professional help if nosebleeds occur more than once a week.
What is the treatment for serious nosebleeds?
Cauterisation is the minor surgical procedure used to stop heavy nosebleeds.
It involves destroying tissue with an electric current, a hot iron, or caustic chemicals.
This seals the ruptured blood vessel and prevents further bleeding.
This page contains basic information. If you are concerned about your health, you should consult a doctor.

Vibration White Finger

British miners have been awarded compensation after they developed Vibration White Finger, a condition caused by working with vibrating machinery such as chain saws and drills. The condition is one form of Raynaud's Disease which affects one in 10 women, usually with mild symptoms. Women are nine times more likely to suffer from the disease as men. What is Raynaud's Disease?

Raynaud's is caused by a restriction in the blood supply to the extremities, usually the fingers and toes.

It can also affect the ears and nose. The parts initially turn white and dead-looking and then become inflamed. An attack may be accompanied by significant pain, numbness or a tingling sensation.

With Vibration White Finger (VWF), the fingers may go into spasm.

This is due to an intermittent lack of blood supply to the fingers.

The condition is usually not severe and attacks only cause minor discomfort. But it can lead to skin ulcers and even gangrene.

And it can be progressive over a period of several years.

VWF is triggered by continuous use of vibrating hand machinery, but some forms of primary Raynaud's have no trigger.

The disease can also be genetically inherited.

However, in these cases, the attacks are usually mild.

Secondary Raynaud's is less common and more severe. It is linked to underlying diseases such as rheumatoid arthritis.

What triggers attacks?

Prolonged exposure to the cold is a major trigger for the disease.

Smoking and stress are also thought to be factors and the disease can be caused by a reaction to beta blocker drugs.

People who work with vibrating machinery are more likely to develop VWF, which can become irreversible.

Vibration White finger (VWF) causes the fingers to become numb and begin turning white.

Symptoms include:

Tingling and numbness in the fingers which often continues after the machinery has been switched off;One fingertip temporarily turns white and may start to ache;The finger turns white with increasing frequency;Other fingers begin turning white, but the thumb is not usually affected. After several fingers turn white, the disease is probably irreversible;The person suffers increasingly frequent painful attacks at any time.Eventually, the person may lose their fingers. This only happens in extreme cases, for example, when people are working with vibrating machinery in very cold conditions, but it is more common in the forestry industry among people working with chainsaws.

Vitamin B6

More than one million people take vitamin B6 it to fight stress and increase energy. B6 is also used in conjunction with magnesium to treat autism.
However, scientists have found that long term use of high doses may affect the sensory nervous system leading to loss of sensation in the hands and feet and permanent nerve damage.
What is Vitamin B6?
Vitamin B6, also known as pyridoxine hydrochloride, is essential for the metabolism of protein by the body, and the proper functioning of the nervous system and the immune system. It is also involved in the synthesis of hormones and red blood cells.
Where is it found?
Vitamin B6 occurs naturally in poultry, fish, pork, cereals, eggs, vegetables and fruit. It is also widely available as a dietary supplement.
What is the recommended daily intake?
Men should ingest 2mg daily and women 1.6mg. People on a high protein diet, and those who drink heavily need more B6. Women on the Pill also tend to have a low level of B6.
How much is too much?
Scientific studies have shown that B6 can be dangerous in very high doses. One study suggested that long term use of doses of 500 times the recommended daily level may cause damage to the nervous system. A second study found adverse effects in humans from ingesting a dose as low as 50mg a day, although there are question marks over the methods used in this investigation. The government plans to limit the sale of over-the-counter B6 to 10mg doses, with a doctor's prescription needed for larger amounts.
Who opposes the government plan?
A group of 218 scientists and doctors have sent a letter to all MPs claiming that B6 is safe at daily doses of up to 200mg, and that no significant health problems have emerged despite several decades of widespread use. More than 100,000 letters have also been sent to MPs by consumers complaining about the government decision, and a lobby group called Consumers for Health Choice has spearheaded a campaign of opposition.
What happens now?
The government launched a three month consultation period in April, but ministers are said to be determined that the controls will eventually be introduced.

Anaesthesia

Asthma is a controllable but not curable disease. The World Health Organisation (WHO) says 100 to 150 million people around the world are asthmatic and the number is growing by 50% every decade. It causes 180,000 deaths a year. What is asthma?
Asthma is a chronic, inflammatory lung disease characterised by recurrent breathing problems. People with the disease suffer "attacks", or acute episodes, when the air passages in their lungs narrow and breathing becomes difficult.
Attacks are caused by the airways over-reacting to certain environmental factors. They then become inflamed and clogged.
They are described as feeling similar to taking deep breaths of very cold air in winter. Breathing becomes harder and may hurt, and there may be coughing. The air may make a wheezing or whistling sound.
What causes it?
A definitive cause for the lung abnormality at the root of asthma has so far eluded doctors.
However, Professor Duncan Geddes of the National Asthma Campaign says there are plenty of reasons why prevalence of the disease is increasing.
"There are simple ones - women who smoke during pregnancy are much more likely to have asthmatic children.
"It's also something to do with the way we're living in modern housing - little ventilation, damp housing, more carpets and more dust make asthma more common."
Exposure to illness in childhood could also play a role, he says.
"There are some curious things like the pattern of early childhood infections. It may be that in the past when all children had a lot of viral infections their bodies were defending themselves against infection.
"Now with fewer of them, their bodies are turning over to asthma instead."
Some scientists have linked the increase in asthma with an increase in air pollution. However, this theory is hotly disputed.
The most likely culprit are PM10s, microscopically small particles given off by diesel engines, coal burning, mining, construction and quarrying.
These particles can penetrate deep into the lung and are known to worsen existing heart or respiratory problems.
What triggers an asthma attack?
There are plenty of known triggers for asthma attacks. They include:
Allergens (substances to which some people are allergic) such as pollens, foods, dust, mould, feathers, or animal dander (small scales from animal hair or feathers);
Irritants in the air such as dirt, cigarette smoke, gases, and odours;
Respiratory infections such as colds, flu, sore throats, and bronchitis;
Too much exertion such as running upstairs too fast or carrying heavy loads (although people with asthma can benefit from a moderate amount of exercise);
Emotional stress such as excessive fear or excitement;
Weather such as very cold air, windy weather, or sudden changes in weather;
Medication such as aspirin or related drugs and some drugs used to treat glaucoma and high blood pressure. Each person with asthma reacts to a different set of triggers. Identifying which triggers apply is important if asthma attacks are to be prevented.
What are the symptoms?
The condition varies a great deal from one person to another. Symptoms range from mild to moderate to severe and can be life-threatening.
Attacks can be only occasional or frequent. The symptoms of asthma are a major cause of time lost from school and work and sleep disturbances.
However, with proper treatment these symptoms can almost always be controlled.
Sometimes the only symptom is a chronic cough which may occur only at night or during exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.
The condition can be diagnosed using:
Spirometry, which uses an instrument that measures the air taken into and out of the lungs;
Peak flow monitoring, which also measures the performance of the lungs;
Chest x-rays;
(Occasionally) blood and allergy tests.
There are certain warning signs of an impending attack. These can occur hours or days before audible wheezing begins.
They vary from person to person, but include:
Light wheezing;
Coughing pain;
A tight feeling in the chest;
Shortness of breath;
Restlessness. Once a patient learns what their signs are they can become better at recognising an attack before it gets out of control.
How can attacks be prevented?
To prevent attacks, people with asthma should avoid their asthma triggers and take medicine appropriately.
What is the treatment?
Treatment consists of two main factors - environmental control and medication.
Environmental control means simply keeping away from factors - like tobacco smoke or allergens - likely to trigger an attack.
Medication is the mainstay of asthma treatment. Because patterns of asthma are different for different people, the specific type of drug treatment varies a lot depending on the frequency, severity, and particular triggers of each patient's episodes.
For people with mild asthma, medication may only be needed before exposure to triggers or when they detect the onset of an attack.
Those with more frequent symptoms may take daily medicine as well as using medicine for specific symptoms. In the case of severe, persistent asthma patients may need two or more doses of medicine each day.
The major types of anti-asthma medicine are:
Corticosteroids, which reduce the inflammation of the airways. They can be taken as pills or as an aerosol. Inhaled steroids have fewer side-effects, so oral steroids are usually reserved for those with severe asthma;
Anti-allergy drugs, which can be used to prevent an attack, but are of no use after an attack has begun;
Bronchodilators, of which there are several types. These provide temporary relief from asthma symptoms but do not tackle the underlying inflammation. They can be taken in liquid, inhaled or tablet form.
Immunotherapy - where the patient is desensitised to their allergens - can be useful in cases where environmental control and medication have failed.
Professor Geddes says: "A cure is always just around the corner."
The National Asthma Campaign is one of many bodies sponsoring research into the causes of asthma, and scientists hope to produce a vaccine for the disease in the near future.

Alzheimer's disease

Alzheimer's disease is a progressive, degenerative and irreversible brain disorder that causes intellectual impairment, disorientation and eventually death. There is no cure. It is estimated that 2-5% of people over 65 years of age and up to 20% of those over 85 years of age suffer from the disease. What causes Alzheimer's?
The causes of Alzheimer's disease are not yet fully understood.
There are some very rare inherited cases caused by genetic mutations, but these account for around 1% of people with Alzheimer's.
For most cases, there is a complex interaction of many genetic, environmental and life-style risk factors, with age and genetics playing the largest part.
Some factors, such as a well-balanced diet and regular physical and mental exercise can reduce the risk of developing Alzheimer's.
Protein deposits, known as amyloid plaques and tau tangles, appear and spread in the brain, particularly in the cortex and the hippocampus.
The levels of important chemical transmitters, such as acetylcholine, are reduced. Many of the blood vessels of the brain are also damaged.
These processes are made worse by chronic inflammation in the brain and by an excess of highly reactive molecules known as free radicals, which damage brain tissue.
Gradually the connections between brain cells are lost and eventually many of the cells themselves die.
It is particularly the loss of connections between brain cells that is thought to cause the devastating symptoms of the disease.
What are the symptoms?
Alzheimer's disease has a gradual onset.
Well established features of the disease include:
Problems with memory
Poor or decreased judgement
Difficulty in performing everyday tasks
Problems with language
Disorientation in time and place
Problems with abstract thinking
Change in mood and behaviour
Change in personality
Loss of initiative
The disease is often associated with depression, anxiety and sleep disturbance.
The rate of decline varies from patient to patient. The disease course runs anywhere from three to twenty years, with eight years being the average life span after diagnosis.
How is the disease diagnosed?
There is no single diagnostic test for Alzheimer's disease.
Patients require a thorough physical, psychiatric and neurological examination by a doctor when symptoms are noticed.
Doctors are able to diagnose the disease with 90% accuracy, even though proof can only be obtained by examining the brain after death.
Many other disease processes can mimic Alzheimer's such as thyroid imbalances, vitamin B12 deficiency, brain injuries, tumours, and severe depression.
Are there other types of dementia?
Yes. These include Dementia with Lewy bodies, which gets its name from tiny structures that develop inside nerve cells, and which trigger the degeneration of brain tissue.
Other rarer causes of dementia include progressive supranuclear palsy, Korsakoff's syndrome, Binswanger's disease, HIV and Creutzfeldt-Jakob disease (CJD).
People with multiple sclerosis, motor neurone disease, Parkinson's disease and Huntington's disease can also be at an increased risk.
What treatment is available?
Various types of therapy are used to try to stimulate Alzheimer's patients.
These include: psychological methods, art therapy, music therapy, playing with toys.
Some health professionals try to encourage patients to reminisce about past memories as a way to reduce depression without the use of drugs.
A variety of drug treatments have been shown to benefit patients. None are a cure, but they can temporarily relieve some of the symptoms in some patients:
Cholinesterase inhibitors including donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon)
NMDA receptor antagonist, namely memantine (Ebixa)
Neuroleptics, also known as anti-psychotics or major tranquillisers - although these drugs are only used as a last resort when other methods have failed
Antidepressants and anti-anxiety drugs
Is there controversy over availability of drugs?
Most certainly. The National Institute for Health and Clinical Excellence (NICE) has ruled that donepezil, rivastigmine and galantamine should only be used to treat Alzheimer's once it has progressed to its moderate stages.
Campaigners argue patients in the early stages of Alzheimer's should also have access to the drugs.
But NICE said studies showed the drugs "did not make enough of a difference".
Eisai and Pfizer, which produce donepezil, are seeking a judicial review of the decision after NICE rejected an appeal.
NICE has also ruled that memantine should be used only in clinical studies of people with moderately severe to severe Alzheimer's disease.

Acne

Serious skin conditions affect around seven million of people in the UK alone.
They can cause significant emotional distress as well as physical discomfort.
What is it?
Acne is an inflammatory skin condition that causes spots.
Spots result from the build up of dead skin cells and grease that block the pores or hair follicles, typically on the face, upper arms, upper back and chest.
It is not contagious and is nothing to do with not being clean.
Hormonal changes, such as those related to puberty, menstruation and pregnancy, can contribute to acne.
Some medicines will also make it worse, including some contraceptive pills and steroids.
Who gets it?
Most people experience acne at some time in their lives, typically as young adults. Girls tend to develop it slightly earlier than boys - around the ages of 14-17 compared to 16-19 years, respectively.
Acne can occur later in life. Around five per cent of women and one per cent of men aged 25-40 continue to have acne after adolescence.
What are the symptoms?
As the pores of the skin become blocked, blackheads develop and small, tender, red spots appear. These can turn into pimples or whiteheads filled with pus.
What is the outlook?
Usually it is a mild condition, most commonly during young adulthood, and will resolve by itself. But for 15% of people it is severe.
The spots can become infected and cause significant scarring, particularly if they are scratched or squeezed.
How can it be treated?
Mild acne does not need treating as each inflamed spot will eventually heal. Eating a healthy diet and drinking plenty of water will help keep the skin healthy.
Keeping spot-prone areas clean by washing the affected area twice daily with an unperfumed cleanser can help. However, excessive washing and scrubbing of the skin will not help and may make the inflammation worse.
More severe acne may need treatment. The aim is to clear the spots and prevent scarring.
Treatments work by either unblocking blocked pores, reducing the amount of grease or sebum made by the skin, reducing the inflammation or fighting the bacterium that infects the lesions.
Creams, gels and lotions that can be applied to the skin are available to buy at pharmacies without a prescription. These usually contain antibacterial agents such as benzoyl peroxide, which also works by drying out the skin and encouraging it to shed the surface layer of dead skin.
There are several more potent oral tablets that can be prescribed by a doctor if the acne persists.
Make-up can be used to cover blemishes but heavy use of concealer may make acne worse.
Any scarring will improve with time. Laser therapy, chemical peels, dermabrasion and other treatments have been suggested for acne scarring.
Acne can be extremely distressing and it is important to seek help if you are anxious or depressed about it.

Labels 'key to tackling obesity

Ministers have told the food industry a "single, simple" product labelling system is the key to tackling obesity. Major retailers and food producers use a combination of systems from traffic light codes to guideline daily amounts.

But the government has said it wants them to agree to abide by the findings of an independent expert panel which is currently looking into the issue.

It comes as ministers prepare to unveil a range of measures making up their anti-obesity strategy for England.

The cross-government strategy for England will make it clear that a uniform approach is needed to food labelling.
The Food Standards Agency favours a traffic light system which uses red, amber and green labels to signify whether the food is good for you.

What do the traffic light symbols mean?
But the watchdog has failed to get the agreement of industry, which has used a mix of different methods.
Many favour guideline daily amounts, which are percentages of sugar, salt and fat per serving.
Consumer groups have complained that such systems are too complicated.
Major retail groups, including Tesco and Asda, have told the BBC they are not yet prepared to abide by the findings of the independent group examining the issue, despite the government's call.
Consensus needed
Health Secretary Alan Johnson said: "In this country we are probably ahead of the world in food labelling.
"Our retailers and our food manufacturers have looked at this in a very clear way and said 'Our consumers do want information'.
"The problem is there are three systems. We are saying we want to work with the industry and have an independent review by experts to see which of these three systems is the most effective. Then we hope that we can convince the industry to go for one system."
Shadow Health Secretary Andrew Lansley said the traffic light system was too simplistic.
"If we are going to achieve a consensus in this country which we can then try to drive through on a Europe-wide basis, the thing we are going to need is combined traffic light and guideline daily amounts to help people construct their diets."
Mr Johnson will unveil government's obesity strategy in parliament on Wednesday afternoon.
He told the BBC that obesity was "probably the biggest public health threat that we face."
Increases
In the UK, nearly a quarter of adults and over a tenth of children are obese after sharp increases in the last decade.
The strategy is likely to include measures to encourage cookery lessons in schools and allocate £30m to help create a series of healthy towns with comprehensive cycle routes and pedestrian areas.
Ministers also want to see councils use their planning powers to prevent fast-food outlets setting up near schools.
It comes as the NHS advisory body, the National Institute for Health and Clinical Excellence, has made recommendations about how planners, designers and architects can help create an environment that promotes physical activity.
The advisers said more priority should be given to cyclists and pedestrians when it comes to street design, including narrower roads, more cycle networks and wider pavements.
The advisers also pointed out simple measures such as signposting where stairs are rather than just highlighting lifts could make a difference.
NICE official Professor Mike Kelly said society had now reached a "watershed".
"We are a super-tanker heading in the wrong direction and it will take time to turn that around."
But public health experts questioned the government's track-record on tackling obesity.
The topic was a central plank of the government's 2004 public health White Paper, but the Faculty of Public Health said less than half of the promised £300m extra funding materialised.
Professor Alan Maryon-Davis, president of the Faculty of Public Health, which represents public health specialists, said: "We have had a lot of rhetoric on tackling obesity.
"But what we need now is good local schemes in place. That requires both financial and strategic support."