Health related information and news from around the world.

Symptoms: runny nose, red eyes, cough, fever, rash.

Home care:

Give aspirin for fever and a cough medication for severe cough.

Give the child extra liquids.

Bright light bothers (but does not injure) the eyes; keep the child out of brightly lit areas.

Precautions:

-    A vaccine is available to prevent measles. Be sure that your child receives the proper vaccination.

-    If your child has not been vaccinated, is under the age of three, and has been exposed to the measles virus, call the doctor.

-    When a child has measles, the fever and cough should subside as the rash peaks. If they do not, watch for signs of complications.

-    Earache during measles may indicate a middle ear infection. Consult the doctor.

Measles, which is also known as rubeola, is a highly contagious disease caused by a specific virus. It affects mainly the respiratory system, the eyes, and the skin, and is spread from person to person in airborne droplets of moisture from an infected person’s respiratory system. The incubation period-the time it takes for symptoms to develop once the child has been exposed to the virus – is ten to 12 days. Measles can be passed to other people between the fifth day of the incubation period and the sixth day after the appearance of the rash that is characteristic of this disease.

Measles used to be one of the more dangerous of the childhood diseases, but it is relatively uncommon today because a vaccine is now available to protect against it. Most children are now vaccinated against measles by an injection given at around the age of 15 months. If a mother is immune to measles (because she has either had it or been vaccinated against it), her baby before birth will receive temporary protection against the disease. This protection lasts only three to six months after birth. The reason that vaccination is delayed until the baby is 15 months old (and not given as soon as the temporary immunity acquired from the mother wears off) is that the vaccination is not fully effective in a baby under 15 months. It’s also fairly unlikely that a child under that age will be exposed to measles. It’s important to note, however, that measles is dangerous in a child under three years old, and if an unvaccinated young child is exposed to the virus you should consult the doctor at once. Measles is also likely to be serious in children who have chronic (long-term) diseases.

Measles is considered dangerous mainly because of the complications it can cause, among them pneumonia (infection of the lungs), middle ear infection, and encephalitis (inflammation of the brain). Encephalitis occurs in only one or two out of every 1,000 cases of measles, and today death from measles or its complications is very rare.

*146/84/5*

What are they?

A heart attack occurs when the muscle of the heart cannot get sufficient oxygen-containing blood for it to function. Angina pectoris (a tight chest pain that comes on exertion am goes) is often the earliest sign that something is wrong. In this condition there is insufficient blood getting to the heart muscles, especially on exertion, and the person complains of tightness in the chest as the heart muscle goes into cramp.

A heart attack is like a very severe bout of angina. Sometimes the loss of blood supply is sufficiently severe to kill off a part of the heart’s muscle, and less commonly the damage from a shortage of blood is so severe that it causes almost instant death.

The heart finds itself in this lethal condition as a result of a lifetime’s abuse which causes a progressive narrowing of the arteries (atherosclerosis) that supply the heart with oxygen. Blood clots may obstruct the arteries further.

Heart disease is now the prime killer in the western world; although in the US death rates have fallen by a quarter over the last fifteen years. Given that much of this improvement is caused by lifestyle changes it makes sense to look at heart attacks as substantially preventable. Historic evidence and evidence from populations who migrate from one country to another also strongly suggest that mankind doesn’t have to suffer from coronary artery disease and heart attacks.

There are compelling reasons for rejecting a fatalistic view that heart attacks cannot be prevented. We still have a lot to learn about heart disease, but it does seem clear that it is affected by lifestyle. We have seen that the coronary-artery death rates in the US and Australia have fallen dramatically over the last fifteen years. This improvement pre-dates the widespread use of coronary care units and coronary bypass surgery and even the widespread use of drugs for combating high blood pressure. The fall in heart disease has, however, coincided with a considerable reduction in both cigarette consumption and consumption of saturated fats. However, things are not quite as simple as this suggests, because heart-attack rates are still high in Sweden despite their wealth of medical technology and falling cigarette and fat consumption, and rates in American women are falling despite their rise in cigarette consumption.

What causes them?

No one knows exactly what ultimately causes heart attacks but several fairly clear-cut ‘risk factors’ have been established after vast and complicated studies worldwide.

• Smoking. Several studies have shown the link between smoking and heart disease. A study of particular interest looked at British doctors who stopped smoking between 34 and 55 years of age. It found that their coronary death rate fell by half over five years compared with doctors who continued to smoke. Stopping after 55 appeared to make much less difference. The degree of risk with smoking is related to the number of cigarettes smoked. Filter cigarettes are probably not protective. Cigarettes act along with the contraceptive pill to increase the risk of heart disease in young women twenty fold.

• High blood pressure. Many studies have found that reducing raised blood pressure, provided the treatment is begun in middle age, reduces mortality from strokes, heart failure and kidney failure. There is some evidence that anti-hypertensive drugs reduce mortality from heart attacks.

• High blood fats. The fats in the blood are many and take different forms. They all come originally from the digestion of dietary fat. The fractions of fats that seem to be of greatest significance in heart disease are the lipoproteins. High density lipoproteins (HDLs) appear to protect against heart disease, whereas low density lipoproteins (LDLs) seem to be harmful in this respect. The balance of these two types of lipoproteins can be altered by what we eat.

• Exercise. Studies show that those who take regular, vigorous exercise tend to have fewer heart attacks, though the evidence is not so clear-cut as is that on smoking, high blood pressure and dietary fats.

*164/72/5*

In the summer television season in Britain in 1995, a series of weekly programs about women’s health was shown. Called The Ladykillers, it concentrated on the diseases that the producers felt were killing women in the last decade of the twentieth century. It highlighted cervical, ovarian, and breast cancer, post-partum depression, rheumatoid arthritis, ectopic pregnancy, and pregnancy toxemia. These are all very worthwhile disorders to show, but they fade into insignificance when compared with the deaths in women as a result of heart disease.

Coronary artery disease is now the most common cause of death in women in most developed countries, including the United States and Britain. This is mainly because the coronary death rate rises steeply after menopause: by the age of sixty-five, as many women as men are dying from heart attacks, and over the age of eighty, heart attacks are much more common in women, proportionately, than in men.

However, heart attacks do occur in younger women. Of the deaths caused by heart attacks in women aged under sixty-five, one in four is in a woman aged under forty-five. Therefore it is clear that women and their doctors must know the risks and try to avoid them.

*103\86\8*

If you have diabetes as well as angina, then keeping your blood pressure under excellent control is even more important. Diabetes and hypertension go hand in hand; more people with diabetes than without it have hypertension. In people with both diseases, many have angina, and they are at much higher risk of a heart attack than everyone else. Treatment to lower their blood pressures is very much more effective at reducing their risks of heart attack and kidney failure than even the most rigorous control of their diabetes itself.

Your Blood Pressure Target

One of the first large studies of the results of blood-pressure lowering, the United Kingdom Medical Research Council Trial, concluded that in high-risk subjects (defined as those with mildly raised diastolic and a high systolic blood pressure, male, smokers, and people with a high blood cholesterol), treating the blood pressure would prevent one stroke per four patients over five years. In a low-risk person, with only a mildly raised diastolic pressure and no other risk factors, the saving would be one stroke per 242 patients in the same time period.

That trial used a combination of antihypertensive drugs that is now outdated, and has been superseded by newer drugs, so that treatment for hypertension is even more effective now, and with better chances of saving lives.

How far do you need to bring your blood pressure down? Studies show that lowering the average blood pressure by 6 to 8 mm Hg could reduce the incidence of coronary heart disease in the U.S. by 25 percent. This is true whether the initial blood pressure is extremely high or just moderately raised.

This finding was surprising to the researchers, who expected the benefit to be less in patients with less severe hypertension. It has meant that the target figures for a satisfactory blood pressure have been changed. The old target was a diastolic pressure of 90 mm Hg. Then it became 85 mm Hg. The current blood pressure target is 80 mm Hg or less, and the savings in illness and deaths continue to increase. It appears, for diastolic pressure, that the lower it is, the better.

You can lower your blood pressure to some extent by changing to the healthier lifestyle of good eating and exercise described earlier, but this is not enough for many people with angina and hypertension. These people also need blood pressure-lowering (antihypertensive) drugs.

*83\86\8*

Exercise won’t kill you, but choose it wisely. Don’t opt for explosive exercise, such as weightlifting. The action of lifting weights or straining muscles while holding your breath, known as the Valsalva maneuver, is harmful, not beneficial. If you are not a fully trained weightlifter, it can cause a sudden drop in the blood returning from the lower body to the heart. At best it can make you dizzy; at worst it can make you unconscious. If you already have a poor flow of blood through a coronary artery, the Valsalva maneuver can be the final insult, bringing on a heart attack. The same may occur in explosive sports like squash. Golf is more leisurely, and probably better for you.

If you are thinking of taking up a sport, take a few lessons from a professional first. It will give you an idea of how you will like it, and make it much easier to enjoy.

*59\86\8*

Norwegians, like Scots, feature highly in studies of heart disease. The Oslo Study Group screened 16,202 men aged forty to forty-nine years for Coronary risk factors. They then selected 1,232 healthy men at high risk (because of smoking and high cholesterol levels) to see whether lowering serum cholesterol and stopping smoking would reduce their heart attack rate. The men had initial blood cholesterol levels of 290-380mg/dl and 80 percent of them smoked cigarettes. Half were given health advice (the treatment group), and half (the control group) were not.

After five years, the cholesterol levels were 13 percent lower, and the number of cigarettes smoked each day 45 percent lower in the treatment group than in the control group. These were linked with a 47 percent reduction in fatal and nonfatal heart attacks in the treatment group. The statistics were clear: There were twenty-two nonfatal heart attacks per one thousand men over the five years in the treatment group, and thirty-five in the controls. The corresponding figures for deaths were twenty-six and thirty-eight.

Detailed analysis of the Oslo study suggested that the improvement in the rate for heart attacks and deaths were mainly due to cholesterol lowering, and less linked with smoking cessation.

*39\86\8*

So far I have listed elements within the circulating blood that can heighten your risk of angina, but changes in the blood vessel walls also play a part. If your blood vessels remain wide open and their lining is smooth, blood flow within them remains fast and adequate. If they become narrowed, then the flow through them slows down. The change can be dramatic. Halve the diameter of a blood vessel and the flow of blood through it decreases by nine-tenths! That may still provide enough oxygen and glucose for a heart at rest, but not when you are running or even walking briskly or climbing stairs.

I have already mentioned one cause of narrowing of these blood vessels—atheroma. However, an artery’s diameter is also governed by the tone in the muscles in its walls. Every artery has in its walls muscles that encircle it. When they contract, the artery narrows, and blood flow through it slows; when they relax, the artery opens up, and the flow increases. If your arteries are in a state of contraction, so that they are narrower than they should be, the blood flow through them is either less, or the pressure to keep the flow normal must rise. In the first instance, the supply of oxygen from that artery is diminished, and in the second, the demand on the heart is increased. Often, both occur together. Obviously, this is yet another set of circumstances that can promote angina.

The combination of a high level of fibrinogen, stiffened red cells, high cholesterol, high blood pressure, hyperactive aggregated platelets, and increased arterial muscle tone, all on top of atheroma in the coronary arteries, is a lethal one. Each element of that combination contributes either to lowering the supply of oxygen and glucose to the heart muscle or to increasing the demand of the heart for oxygen, and therefore to the onset of angina.

*18\86\8*