Health related information and news from around the world.

Sweat glands are a specialized group of cells lying in the dermis which produces sweat. These glands are found over the whole skin surface, with considerable regional variation in density of distribution. They are most numerous on the palms, soles, forehead and armpits. The duct of the sweat gland opens on to the skin surface independently of hair and sebaceous gland openings. On the forehead or armpits there are frequently 200-300 sweat glands per square centimetre, and under extreme climatic provocation an individual may produce two litres of sweat an hour. In this way sweat glands are able to flood the skin surface with water, which has a cooling effect, and hence they are very important as part of a heat exchange mechanism. The closely associated blood vessels dilate or constrict to either dissipate or conserve body heat. This is therefore a very effective thermoregulatory system, one which maintains a constant internal environment, enabling man to escape the rigid climatic limitations imposed upon cold-blooded animals.

Hair follicles are finger-shaped folds of epidermis dipping into the dermis, which are responsible for hair formation. Hair then is a derivative of epidermis, arising from deep within the dermis, and composed of the protein keratin. The most superficial part of the follicle forms a duct, in which the hair stands free. Since the sebaceous duct also opens into the follicular duct, the hair shaft emerges through the same pore which secretes the sebum, ensuring its direct lubrication. In the deepest part of the follicle the follicular wall and the hair are fused. This section constitutes its root, the lowest part of which is known as the bulb.

Hair is an extremely complex structure which broadly speaking consists of a central cortex surrounded by several protective layers. Hair contains neither nerves nor blood vessels and is therefore a ‘dead’ structure. There are many different types of hair, which in one form or another cover the entire surface of the skin, with the exception of the palms and soles. In most areas the hair is short and fine, like that found on a child or on the cheeks of a woman, and is known as vellus hair. The longer, broader, and usually coloured hair, such as that on the scalp, is known as terminal hair. There is no clear distinction between these types. In fact, the same follicle may produce either type under different conditions. For example, vellus may change to terminal hair on the chin of an adolescent, or terminal may change to vellus on the scalp of a balding man. The protein-synthesizing capacity of this tissue is enormous. When one considers that scalp hair grows at the rate of 0-35 millimetre daily, and that the average number of scalp hairs is about 100000, this means that about 30 metres of hair is produced every day.

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Some snack foods with a very low G.I. factor (such as peanuts with a G.I. factor of 14) have a very high fat content and are not recommended for people with a weight problem. As an occasional snack they are fine (especially as their fat is monounsaturated), but not every day. Peanuts are also very moreish and it is hard to stop at just one handful!

Mary, 65 years old, was found to have diabetes two years ago. She was overweight and was told that she had to lose several kilos. Although she had been trying to do this before she developed diabetes, she had been unsuccessful. Now she felt that the extra burden of diabetes would make life impossible for her and that she could not do any more than she was already doing with her diet. Because her blood sugar levels were too high she was presented diabetic tablets.

When we looked at what Mary ate, we could see that indeed she really was trying hard and was not overeating. However, almost all of her carbohydrate foods had a high G.I. factor. For example, she was having Weet-Bix or cornflakes for breakfast morning coffee biscuits for mid-meal snacks, lots of rice with her lunch and evening meals and watermelon was a favourite fruit All these foods have a high G.I. factor. By changing to All-Bran™ or untoasted muesli for breakfast, having oatmeal biscuits or an apple, pear or orange for snacks and by adjusting the type and amount of rice the was eating, Mary was able to eat more, lose weight and improve her blood sugar levels. Eventually she stopped her diabetes tablets too.

Sometimes, despite your best efforts with diet, tablets will still be needed to obtain good blood sugar control. This is eventually the case for most people with type 2 diabetes.

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The advantage of weight is that it is a simple, accurate and reliable measurement. For individuals, significant changes in weight over the long term usually reflect significant changes in body composition.

Over the years, several attempts have been made to establish a series of ‘ideal weight’ measures as a goal for people to aim for. One of the first of these, the ‘Broce Index’, was estimated in kilograms by taking 100 away from height (in cm). In other words, a person 180cm tall might be expected to have an ‘ideal weight’ of 180-100=80kg. Ideal weights for height have also been developed over the years (beginning in the late 19th century in the US) based on actuarial, or death statistics. More recently, ideal measures of body mass index, skinfolds and fat distribution have been used (see below). However, scientists have yet to agree on a measure of ‘ideal’, and now generally accept that a variety of the measures discussed below have to be combined.

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‘Jimmy suddenly ran this very high fever,’ Jane said on the phone. ‘I’m awfully worried. He is hot and clammy and looks pale and listless. What’s more, he wants to pass his urine every few minutes. When he does, he squeals as if it’s hurting him. Jimmy hardly ever complains… He is always a happy little chap,’ Jane went on. ‘I think he must have some sort of infection in his bladder…’

Soon afterwards I visited young Jimmy. Certainly, he rarely complained and was usually a bright happy lad. But today he was pale and obviously unwell. He had been off his food for about 24 hours, and his temperature had suddenly shot up, leaving him feeling very miserable. He was sweating profusely, and just before I arrived he had been vomiting slightly—also unusual for Jimmy. Passing his urine was definitely painful, and this immediately suggested an infection in the bladder or kidney region. When I gently prodded below his navel, in the so-called supra-pubic region, he winced. ‘Hurts,’ was all he would say, then he quietly shed a few tears. Similarly, pressure in the lower part of his back, just over his kidneys, was also quite uncomfortable.

‘We shall have a specime of urine checked out,’ I said to Jane. ‘This will tell us exactly the nature of the germ causing the trouble. It will also indicate the best treatment to give. Antibiotics are usually very satisfactory, but a sensitivity test will give us the exact result and indicate the most suitable treatment.’

Treatment

To begin with, doctors often prescribe one, of the ‘broad spectrum’ antibiotics, even before the results of investigation are received. This may start the patient quickly on the path to recovery. Many excellent varieties are now available and the urinary system is very receptive to them.

Also, keeping the patient in bed for a few days, until he feels and looks better and his temperature has come back to normal, is a good idea.

Plenty of fluids are advisable, for this flushes out the dead germs and general toxins, not only from the system but from the urinary tract in particular. It also replaces the fluids lost from perspiring and sweating.

Powders and granules given in fluid to ‘alkalinize’ the urine are often used, and this is claimed to help. Paracetamol will often reduce fevers and make the patient feel more comfortable and it reduces aches and pains which commonly accompany urinary infections. However, if there is vomiting, the more that is introduced into the stomach the worse the patient feels, so the less the better. Sucking chipped ice or cold drinks are often acceptable, and frequently retained.

Most infections in children affect the bladder region, but they are usually brought under control rapidly. Sometimes, especially if there are recurrences, it may indicate that the kidneys and upper parts of the urinary system (the ureters) may also be infected. It may be necessary to have further and more complete investigations carried out after the child has settled down and the acute bouts are brought under control.

Tests on thousands of children, especially those of school age, shows that many individuals carry around small numbers of germs in their bladders, even though symptoms are not present. Sometimes these can suddenly get out of control and an acute attack supervene. Some doctors believe that all urinary infections, however mild, should be treated.

It is a very important system, and disorders here can lead to more serious ones in later life. It is worth keeping a close check for symptoms and reporting any abnormality promptly to the doctor, for treatment or further investigation.

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Childhood hyperactivity is currently a controversial and emotive topic. Rather than a symptom (as many suppose), it is a syndrome embracing a number of symptoms.

The symptoms include hyperactivity (excessive movements), a short attention span, being impulsive and being easily distracted. Sometimes learning difficulties and other nervous system signs are also present. From the point of view of the teacher or parent, hyperactivity is most likely to be the main symptom which leads to a visit to the doctor.

However, increasing evidence is accumulating which suggests that, from the child’s point of view, it is the disorder of attention which is the most important. The two do not necessarily go hand in hand, for the level of physical activity often bears little relationship to the child’s difficulty in learning or with his nervous system disabilities.

The frequency with which the disorder occurs is variable. In school-aged children in primary school, estimates have varied from 4-10 per cent. However, behavioural patterns of children which caused parents and teachers to seek medical help are far more frequently encountered. In one survey reported in the Medical Journal of Australia, restlessness occurred in 50 per cent of boys and 28 per cent of girls.

These sorts of figures are causing considerable concern in countries like the United States, where medication of supposedly hyperactive children is getting out of hand.

It is well-established that boys are affected more commonly than girls, and the ratio of nine to one is frequently reported.

Many other terms are used to describe these children, for the complexity of the disorder is being realized by doctors and psychologists. The terms ‘learning disability’ and ‘minimal brain dysfunction’ (MBD) and ‘hyperactivity’ are now commonly used. Doctors tend to use the term ‘MBD’ in the medical literature (particularly in American medical literature, although ‘hyperactivity’ seems more common in Australia). ‘Learning disability’ and ‘hyperactivity’ are used widely by educators and psychologists.

Symptoms

A great deal of controversy exists over what constitutes a hyperactive child. The dividing line between normal and abnormal is difficult to establish, as the range of figures of complaints indicates.

Although physical hyperactivity may be a symptom of certain disorders which can be clearly distinguished, it may be a symptom of some other disorder. Because of the implications of treatment, correct diagnosis is necessary, although it may be difficult. It may require special investigation and psychometric tests. For instance, there may be mental retardation (anywhere from borderline to severe); perceptual disorders (relating to the ability to hear and see); psychological disorders (anxiety states, psychoses); neurological disorders (such as lead poisoning or the use of certain drugs); and acute medical disorders (for example, chorea or thyroid excesses). Finally, there may be cultural differences: what is socially acceptable in one society may be attributed to some pathological disorder in another.

Many of these causes may be totally unrecognised by parents or teachers. For example, a child with borderline retardation may react with restlessness and lack of co-operation when his parents indicate excessive expectations of him.

Cause

There are many theories on the cause of the syndrome. Some claim it is a genetically determined developmental abnormality resulting from a low nervous system arousal. It tends to run in families. Parents producing hyperactive children can describe similar problems in their own childhood.

Others believe the condition is ‘psychogenic’. There may have been a poor social relationship between mother and child early in life. This may have resulted from early separations, or more commonly from emotional distancing resulting from maternal disturbances. This can commonly occur in the time immediately following birth, and is manifest as a depression, which may persist undiagnosed. The child reacts to this with an increasing aggression and a diminished capacity to develop internal controls on aggression and impulsiveness.

Another group claims hyperactivity is due to ‘minimal brain damage’. Damage is slight for general intelligence to be noticeably impaired or for there to be gross nervous system signs of impairment. This damage might occur prenatally or in the postnatal period. Giving weight to this are abnormal brain tracings (EEGs) that are found in up to 50 per cent of these children.

Treatment

Diagnosis of hyperactivity is no simple matter. If a parent or teacher suspects that a child may be suffering from the syndrome and can identify some of the suspect symptoms (some are quite obvious, others are not), then take the child to the doctor. In turn, your family doctor may refer the child to a doctor who specialised in this particular field. Further tests are necessary to clearly establish the correct diagnosis, as has been explained.

If the child is diagnosed as hyperactive, then specialised therapy may be indicated. As an ongoing process, this must be under the general supervision and guidance of persons with the necessary knowledge and expertise in the field, usually child psychiatrists.

The Feingold Diet: A theory which has gained wide credence and support is the one put forth by Dr. Ben Feingold, an allergist who claims certain ‘small sized molecules’ occurring in some natural foods and in some artificial colours and flavours have an adverse effect on brain cells of children afflicted with the syndrome.

He has put forth proposals that limitation of these foods (simply by dietetic restriction) yields positive benefits to the children.

The Feingold method has attracted considerable criticism, but its following is enormous. Doctors themselves are in disagreement, and medical journals regularly print fiery articles either supporting or denouncing the system.

It seems relevant that many parents with hyperactive children frequently follow the system on their own account, and often report favourable results. Probably they all cannot be right; neither can they all be wrong. The truth of the matter is still unknown. More clinical trials under strict, closely supervised conditions are necessary before the final word is given.

‘From my private practice, of 72 families I have instructed and supervised to date, 62 found sufficient change to continue adherence to the diet to date, from 4 to 20 months. A difficult diet is less difficult to manage than a difficult child, and it is surely preferable that a child be “set apart” because of his diet than because of his behaviour,’ is typical of the reports appearing in medical magazines in support of the routine. This excerpt came from the Medical Journal of Australia from a doctor in Queensland.

But others are just as convincing in the opposite direction. ‘The diet costs averages $120 per week per family,’ an MJA editorial states. ‘The results suggest that on objective tests, no changes of any kind were observed—physical, behavioural or cognitive—and in school children neither were there any parental or teacher reports of behavioural change.’

‘The diet was not designed for use in normal households,’ another correspondent says. ‘To place this treatment in perspective, the Feingold diet is no more difficult than many other dietary regimes commonly used in medical therapy, for example, diabetic, or gluten free diets.’

The book by Dr. B.F. Feingold which started the controversy on the diet is entitled Why Your Child is Hyperactive, (Random House, New York, 1975). No doubt many parents are already trying out his suggestions on their own.

In 1980 another detailed book which examined the Feingold system in detail came off the press. It is entitled Food Additives and Hyperactive Children by Dr. C.K. Connors (Plenum Press, New York, 1980).

Parents who would like more information are coming together to pool their knowledge and ideas. The National Association of Hyperactivity’s address is P.O. Box 100, Narrabeen, Sydney, NSW, 2101. But whatever routine is considered, medical supervision by a medical practitioner specially versed in this difficult field is recommended.

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