Obesity is, quite literally, the big health problem of the 21st century, with rapidly increasing rates in both adults and children. In this article we explore why obesity is such a challenge and the role of primary healthcare professionals in addressing the problem. We try to unravel the wide range of factors that cause obesity before focusing on why people eat what they do and how we can help patients to review their eating habits, introduce changes to eat more healthily and then sustain those changes.
Swollen ankles: preventing, detecting and managing oedema
It is Friday afternoon and, checking your screen, you see your last free appointment has been given to a patient you have seen in the past for routine blood tests. This time when she enters the room you observe that her legs are covered with what looks like kitchen roll, and she is wearing supermarket carrier bags over her feet to protect her shoes. For many of us, this is a ‘heart sink’ patient – with heavy, wet and oedematous legs that are difficult to manage. To be able to manage this type of condition we first need to understand the possible causes of oedema, to identify patients who may be at risk for developing the problem, and to be aware when early intervention could be of benefit.
What is the evidence for statins in the secondary prevention of stroke?
The Stroke Association estimates that about 150,000 people suffer a stroke in the UK each year. Stroke is the third commonest cause of death in developed countries and the leading cause of disability. So can we reduce this burden? In this article, we look at the evidence for statins in the secondary prevention of stroke.
Back to Basics: Urine tests for renal function
Urine tests for renal function: What tests detect different levels of damage?
Venous thrombosis and thromboembolism
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major public health problem affecting around 100 per 100,000 population per year and causing thousands of deaths annually. Large population-based studies have shown that factors associated with hospitalisation account for half of the attributable risk of VTE.
When to use aspirin in CVD prevention: acting on the latest evidence
Back to Basics: Mechanisms of allergy
Useful techniques to manage breathlessness
Although breathlessness is a complex symptom, appropriate management in primary
care can be very rewarding, and does not have to rely on complex, hi-tech
interventions. This article discusses the rationale behind the practical interventions
that practitioners in primary care can consider.
Sexual relationships, breathlessness and the respiratory patient
The rising incidence of a range of respiratory disorders means an increasing emphasis
on treatment, management and care. Although some respiratory diseases are acute,
many are chronic, bringing with them a burden of morbidity affecting patients in many
areas of everyday life. One area of concern for patients may be sexual functioning so
somewhere in the process of management and care the practice nurse may need to address the
issues of sexuality (Petty 1986, Kaptein et al. 2008).
Occupational asthma: how to help the wheezy workers
Approximately one in every ten cases of adult-onset asthma is attributable to
occupational exposure. Unless occupation is considered, a diagnosis of occupational
asthma will be missed so it is likely to be underdiagnosed. An average practice with
around 6,000 patients will typically have approximately 600 adult patients with asthma,
of whom 60 may have occupational asthma if we assume 10% of cases are related to
occupational exposure. Can you think of 60 patients with occupational asthma in your practice?
Getting it Right: Asthma Devices in Children
Asthma medications should routinely be delivered by a pressurised metered dose inhaler
(pMDI) and spacer system, with a facemask where necessary, in children under five,
according to the National Institute for Health and Clinical Excellence (NICE).1
For older children, aged 5-15 years, NICE has advised that a child’s therapeutic needs,
the ability to develop and maintain an effective technique, the suitability of a device for the
child’s and carer’s lifestyles (ie portability and convenience) and the likelihood of good
compliance are the factors that should govern the choice of device.2 Only once these factors
have been taken into account, should choice be made on the basis of cost minimisation.
Cough as a Presenting Symptom in General Practice
Cough is a common presenting symptom in primary care. It has a prevalence of 30% in
the general European population, and in a US National Medical Case Survey in 1991
cough was the commonest presenting complaint. Between 10% and 38% of all new
patient referrals to UK hospital chest clinics are for chronic cough. This article covers
the physiological nature of cough and its role as an essential protective reflex, focuses on the
differential diagnosis of cough in general practice in both adults and children, and discusses the
use of treatment as a diagnostic tool.
