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ADHD has had many different names. Hyperactive child syndrome, hyperkinetic impulse disorder, even organic brain disease - these were terms used to explain the symptoms of what we now call attention deficit hyperactivity disorder. It is usually diagnosed by the age of 6 and has two main presentations, the first of which is inattentiveness and the second is hyperactivity and impulsiveness. 
 
According to the NHS, the symptoms of inattentiveness are:
  • having a short attention span and being easily distracted
  • making careless mistakes – for example, in schoolwork
  • appearing forgetful or losing things
  • being unable to stick to tasks that are tedious or time-consuming
  • appearing to be unable to listen to or carry out instructions
  • constantly changing activity or task
  • having difficulty organising tasks
 
The symptoms of hyperactivity and impulsiveness are:
  • being unable to sit still, especially in calm or quiet surroundings
  • constantly fidgeting
  • being unable to concentrate on tasks
  • excessive physical movement
  • excessive talking
  • being unable to wait their turn
  • acting without thinking
  • interrupting conversations
  • little or no sense of danger
 
As with many medical conditions that have an effect on behaviour, early cases were often diagnosed as having to do with good and evil rather than physical health. In fact, some of the earliest descriptions of children with ADHD-like symptoms (made in 1902 by Sir George Frederick Still) claimed they had a “defect of moral control”. 
 
In terms of treatment, the first breakthrough happened in 1937. Dr Charles Bradley, learned about the benefits of administering Benzedrine accidentally, when prescribing it to children with severe headaches. He was amazed to find that instead of pain relief, it improved their behaviour and school performance. 
 
However, it wasn’t until 1957 that the term “hyperkinetic impulse disorder” was coined, leading to a study on the effects of Ritalin (methylphenidate) in “emotionally disturbed children”. In the ensuing decades the use of the drug to treat ADHD became more widespread, eventually causing controversy and prompting some to accuse the pharmaceutical companies of inventing the condition to make money. Instead, parents attributed symptoms to things like food additives and allergies.
 
By the eighties, ADHD was widely accepted as a diagnosis, although treatment with stimulants was beginning to also be tempered with other treatments including tricyclic antidepressants. As with depression and other forms of mental illness, the combination of medication and a certain amount of management of external factors like school and home life became more common. 
 
So, what do things look like for those suffering from ADHD in 2019? Things haven’t really changed much since the advent of Ritalin. The five licensed medications in the UK are methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine and the first three of those are all stimulants as well as being the most common.
 
There is still an element of contention surrounding giving children stimulants. Most medical professionals tend to stress that such a course of treatment, would only be advised, after a comprehensive clinical evaluation with collateral information before a diagnosis of ADHD was reached. Then and only then would psychostimulants be recommended.
 
What has changed, is the perception of ADHD. Therapy is often recommended alongside medication, and the NHS lists psychoeducation, behaviour therapy, CBT and social skills training as useful tools. Teacher now know how to recognise the signs of ADHD and instead of isolating the children or labelling them as “difficult” can now help them. Most importantly, we recognise it as a medical condition that can be treated, not a personality flaw to be dismissed or mocked.
Over the years, certain medical and mental health terms that have somewhat lost their meaning. “I’m so OCD”, “He was a total psycho” or “I think I’m getting a migraine” are all common phrases that often aren’t meant to be taken literally. However, the danger is that this kind of loosely accurate usage can erase the seriousness of the real condition.
 
There are several differences between a migraine and a simple headache, although there can be crossover in terms of symptoms. There are different kinds of headaches ranging in severity, from mild pain in the forehead, temples, or back of the neck (which are often classed as tension headaches) to potentially incredibly painful and chronic cluster headaches.  
 
With migraines, head pain is often only one of the symptoms. Others include:
  • Nausea and vomiting
  • Pain behind one eye or ear
  • Pain in the temples
  • Seeing spots or flashing lights
  • Sensitivity to light and/or sound
  • Temporary vision loss
 
There is a lot of variation within migraines in terms of duration and severity of pain. Some can be so intense that the sufferer seeks medical help, but even milder cases can often result in an inability to concentrate on tasks or get through one’s day.
 
For the most part, migraines fall into two different categories: migraine with aura and migraine without aura. An aura refers to feelings and sensations a person experiences before the migraine comes on. They can happen 10 to 30 minutes before an attack, and can include:
  • Feeling less mentally alert or having trouble thinking
  • Seeing flashing lights or unusual lines
  • Feeling tingling or numbness in the face or hands
  • Having an unusual sense of smell, taste, or touch
 
The symptoms can sometimes begin as long as a day before the actual migraine hits. This is known as the prodrome phase and may include constipation, depression, yawning, irritability, neck pain or unusual food cravings. There are also several known triggers for those who suffer from migraines such as anxiety, alcohol, hormonal changes (for instance, from a change in contraception or menopause), and food. 
 
Another important difference between migraines and headaches is the treatment options. Most headaches respond to over-the-counter medication like aspirin, paracetamol or ibuprofen. However, with migraines, prevention is often the best form of treatment. Eliminating alcohol and caffeine from your diet, prescription medications like antidepressants, blood pressure-lowering medicines, antiepileptic medications, or CGRP antagonists and trying to reduce stress levels may all help.
Once a migraine has taken hold, it can be much harder to get rid of. Normal painkillers can occasionally improve symptoms as well as anti-nausea medicines or tripans, but may not get rid of them entirely. However, there can be a danger of rebound headaches if these treatments are used more than 10 times in a month. If you suspect you may be having migraines rather than more normal tension-type headaches, you should consult your doctor for more help and advice.
 
If you’d like to have a chat about our current medical roles, then get in touch with one of our experienced recruitment consultants. Call 020 8505 6600 or email info@medicspro.co.uk.     
A cancer diagnosis at any age is a devastating, life-altering event and one that’s different for each individual. For a young person the diagnosis can be even more traumatic; for very young children it may be totally incomprehensible, while teenagers my feel a keen sense of injustice or hopelessness. Parents, too, share the burden and may not know how to best to comfort and support their children through treatment and everything that comes after that.
 
According to Children With Cancer UK, “4,500 children and young people are diagnosed with cancer every year in the UK.” Different cancers affect different age groups, with children, teenagers, young adults and over 25s all suffering from varying types. Leukemias of one sort or another are the most common but luckily, the past few decades have seen dramatic improvements in the outlook for children diagnosed with cancer. Fifty years ago, three-quarters of children diagnosed with cancer died; today more than three-quarters survive. Despite this, the treatment can be gruelling and take its toll both physically and mentally.
 
The Children’s Cancer and Leukemia Group (CCLG) has done extensive research on the subject. They have found that “96% of parents or carers felt lonely or isolated following their child's diagnosis, while 79% said they felt left out of normal life.” In addition to this, over half claimed they were given “no information or help on how to cope with emotional distress and shock at diagnosis.” Parents are likely to be the primary support system for child cancer sufferers, meaning the lack of support offered to them can seriously affect how well the family (and child in particular) copes.
 
The same research suggested that nearly half of parents found their child had grown apart from their friends as a result of their cancer diagnosis. They link this to the fact that it is often “difficult for children with cancer to continue with social activities with their family and friends, particularly when time is spent away from home. This can lead to poorly developed interpersonal skills, feeling isolated, and can be a cause of low self-esteem.” Cancer treatment can cause hair loss and weight gain, further compounding these feelings
 
It seems clear from all this, therefore, that mental health support is one of the most important aspects of a cancer diagnosis early on in life. Luckily, there are charities that specialise in just that such as the aforementioned CCLG, as well as the Youth Cancer Trust and the Teenage Cancer Trust. Most of these focus on creating a community, for teenagers especially, who may not want to talk to adults about what they’re going through. Instead they are brought together with people sharing their experience. The Youth Cancer Trust sends young people with cancer on free holidays and activities to keep them active and socialised. These are the type of things that will make all the difference.
 
So, the answer to the initial question, “How important is mental health support for childhood cancer sufferers?” can only be answered with a resounding “very”. 
 
If you’d like to have a chat about our current medical roles, then get in touch with one of our experienced recruitment consultants. Call 020 8505 6600 or email info@medicspro.co.uk.      
According to the NHS, roughly 2% of the population have psoriasis. It is defined there as “a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales”. It is most commonly found on elbows, knees, scalp and lower back, but can appear anywhere on the body. The severity also varies from person to person and it is a chronic condition, which means that symptoms can fluctuate but it can never be fully cured.
 
Psoriasis is caused by the overproduction of skin cells. These are normally made and replaced every 3 to 4 weeks, but for people with psoriasis this process only takes about 3 to 7 days. It remains a condition that is not wholly understood, although medicine now agrees it is involved with the immune system, which attacks healthy skin cells by mistake in people with psoriasis.   
 
When the immune system’s involvement was discovered in the 1960s and 70s, treatments that used corticosteroids, cyclosporine, and methotrexate became mainstays for managing the disease. For the next couple of decades, that remained the same with very few advances in treatment due to lack of interest and funding.
 
That has changed recently, with one relatively new drug named Taltz generating $606m over the first half of the year. This belongs to a family of drugs known as biologics that were discovered as research into other autoimmune diseases brought new insights about the immune system. The conclusion was that some of the issues that arose in those conditions were also active in psoriasis.
 
Instead of the usual topical creams or steroids, biologics target specific areas of the immune system and consist of lab-made proteins or antibodies. These are injected, blocking the part of the immune system that causes psoriasis symptoms. 
 
According to PsoriasisFoundation.org, “the biologics used to treat psoriatic disease block the action of a specific type of immune cell called a T-cell, or block protein, in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A or interleukins-12 and -23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.”
 
There are risks that come with biologics, such as an increased risk of infection. However, they are effective, with clinical trials showing that psoriatic activity was lowered by at least 75% in many patients. They offer real hope to many suffering from the disease which can not only cause depression and huge issues with self-image and confidence, but also develop into psoriatic arthritis, an incredibly painful chronic condition.
 
If you’d like to have a chat about our current medical roles, then get in touch with one of our experienced recruitment consultants. Call 020 8505 6600 or email info@medicspro.co.uk.      

Everyone seems to have an opinion on breastfeeding. Doing it in public or posting it on Instagram has become a political statementSocial media influencers like Chrissy Teigen tackle this stigma by promoting visibility online. But what about women who find it hard to breastfeed? Or same-sex couples who have adopted? Or who those who have surrogates that can’t provide milk? When it comes down to it, is breastfeeding really the be all and end all of early development?    

 

The official party line from the NHS on the subject is that “breastfeeding has long-term benefits for your baby, lasting right into adulthood.” It is said to reduce: 

  • infections, with fewer visits to hospital as a result 

  • diarrhoea and vomiting, with fewer visits to hospital as a result 

  • sudden infant death syndrome (SIDS) 

  • childhood leukaemia 

  • obesity 

  • cardiovascular disease in adulthood 

The website also emphasises the many benefits to both mother and baby, including building “a strong emotional bond between you and your baby.”  

 

On a page from the article that highlights the many positives that come from breastfeeding, there is only one mention of women who may struggle with this revered bonding and feeding process - and it’s in the myth-busting section. The so-called ‘myth’ is that “some women do not produce enough breast milk”, in answer to which the NHS provides the ‘fact’ that “almost all women are physically able to breastfeed. Early, frequent feeding and responding to your baby's cues give you the best start to establishing your supply.”  

 

This kind of attitude, especially when found on the NHS’s own website, perpetuates the notion that mothers who choose the bottle over the breast are committing a sin that in many cases is equated to child endangerment. Questions of selfishness and negligence creep into the rhetoric. This Telegraph article gives those pointing the finger the moniker the ‘Breastapo’ and only partly in jest. It also details the stories of several mothers who were unable to produce enough milk for their babies, who started to lose weight and become listless. Their appeals for help were met with the medical equivalent of “try harder.” 

 

Recently, the endlessly touted health benefits of breast milk have been called into doubt by one American study, as much of the evidence fails to take into account the fact that “mothers who breastfeed tend to be richer and better-educated than mothers who formula-feed. The authors further argue that a mother’s socio-economic advantage, measured through her intention to breastfeed, is associated with the same health benefits for her baby as actually breastfeeding.” As with every study of this kind, there is opposition and (perfectly fair) criticism. There is medical evidence on the side of breastfeeding, both for mother and baby that most researchers agree on - what the study is asking is, is there a chance these pros have been inflated? 

 

It seems the definitive question should actually be, is it worth new mothers putting themselves through the enormous stress of trying to support their babies on breast milk alone for the first six months of their life when they aren’t producing it no matter how hard they try? Surely the baby will benefit more from a mother who is happy, calm and relaxed, not to mention the risk of malnutrition if they aren’t getting what they need in terms of food from breastfeeding? Often successful lactation is a matter of education and technique that mothers are not taught properly, especially with most being discharged from the hospital the next day.  

 

There are strong voices on the other side of the debate, from those who believe that formula lobbyists are seeking to debunk “decades of research” on the natural benefits of breast milk in particular. All of this, however, seems to be a culmination of both the politicising of motherhood and the ever-soaring pressures on mothers to meet every exacting social standard foisted on them, often by their own community. Breastfeeding is almost certainly an incredibly beneficial process for both baby and mother, but if someone is struggling to the point of anxiety or even postpartum depression, formula exists as a good supplement or even alternative that will, in most cases, give a baby the nutrition it needs.    

 

If you’d like to have a chat about our current medical roles, then get in touch with one of our experienced recruitment consultants. Call 020 8505 6600 or email info@medicspro.co.uk.      

Brexit. The topic of every circular dinner party debate in every household for the past three years and banned in most offices. Whether you voted leave or remain, the one thing everyone can agree on is that nothing seems to have gone to plan since the results of the controversial referendum were revealed. Since then the outcome of Brexit has remained uncertain, but we can hypothesise about how certain sectors may be affected, such as medicine.  

 

The medical supply chain is, of course, integral to keeping our hospitals and pharmacies stocked with live-saving drugs and some of the companies that supply them are European. Equally, some are based in the UK. And although according to the Financial Times, “The British government agreed last August that medicines and devices approved in one of the remaining member states could continue to be sold in the UK once it leaves the EU... the decision has yet to be reciprocated.” 

 

European pharma leaders are understandably unhappy with this state of affairs, calling on EU member states to do more to safeguard the supply of medicines post-Brexit. They are frustrated that industries like fishing and finance seem to have taken precedence in discussions with Britain. The same article states that “every pharma company has made changes to product supply chains as the industry has prepared for all Brexit eventualities.” No one wants to get caught off guard. 

 

The transfer of supplies with short shelf lives has been planned for in what Stefan Oschmann, president of the federation and chief executive of Germany-based Merck, classifies as “one of the biggest supply-chain logistics challenges our industry and our health service partners have ever faced”. And therein lies the problem. Brexit has already been postponed twice, missing both its March and April deadlines. The new date of the 31st of October feels no more certain – will it be a no-deal Brexit or will they wrangle a mutually disappointing agreement out of Juncker?  

 

Minister Stephen Hammond MP has weighed in on the no-deal contingency plan publishing a statement as well as communications for patients and healthcare professionals. The gist being that the “Department of Health and Social Care (DHSC) has been working closely with industry stakeholders to undertake considerable contingency planning for any UK exit from the EU with no ratified deal (a no-deal Brexit). The contingency plans are being made to ensure the continuity of the supply of medicines to patients in the UK.” Effectively, provisions are being made, so don’t panic. 

 

So, to answer our initial question, how will Brexit affect the medical supply chain? We won’t know until we know the terms of Brexit itself. However, the government is going to great pains to assure the public and members of the medical profession that the supply of medicines and medical products should be uninterrupted even in the event of exiting the EU without a deal. Whether things will run this smoothly in reality, time will tell - however, considering how well Brexit has gone so far, there could be a slightly bumpier road ahead.   

The Resurgence of Hepatitis A: Why is it happening?

Hepatitis A is a preventable illness that can be guarded against with vaccines. It is an infection affecting the liver caused by a virus that is spread through the faeces of an infected person. Symptoms can include fatigue, joint pain, high temperature, nausea as well as jaundice, itchy skin, dark urine and liver pain. So, why write about a preventable disease that is, by the 
NHS’s own admission, “uncommon in the UK”? 

 

Well, in the US, this preventable illness has increased by nearly 300% in just two years. The virus itself is highly contagious and can be transmitted through contaminated food, close or sexual contact or through drug use. Although it is curable and most people make a full recovery, rare cases can suffer from liver failure and even death. This resurgence is particularly worrying considering hepatitis A declined by 95% in the states between 1996 (when the vaccine was made available) and 2011.  

 

According to one doctor, one of the culprits is lack of vaccination. Most children are given the vaccination at age one and lasts for roughly 11 years - however, most of the outbreaks being recorded are occurring in adults. Some of these adults were not vaccinated as children or instead had the virus in their youth and as a consequence remain vulnerable to it from contaminated food or, more commonly, drug use. Increasing vaccination among groups at risk for hepatitis A infection could be what is needed to stop these outbreaks. 

 

Although hepatitis A is, as we mentioned previously, something that is far more commonly found among adults (though not exclusively), other preventable diseases that seemed to die out years ago in the developing world have started to crop up again. Measles is one of these and, according to the World Health Organisation, “reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.”  

 

Again, the US has proved to be the area where this alarming trend has taken route most aggressively. This is mostly due to the anti-vaxxer movement that has gained traction in the past few years, bolstered by false claims that vaccinating babies can cause autism - claims that have been completely debunked by scientists but nonetheless spread much like these preventable viruses through first-time parents who either believe them or hope nature will protect their children. As ever, with both hepatitis A and measles, education is key and empowering susceptible groups to take action will help everyone in the long term.   

Men’s Health Week, which usually falls at the beginning of the month, runs from 10th to 16th of June this year. In addition to this, every November men attempt to grow moustaches to raise awareness for men’s health - for the whole Movember, hashtags appear all over social media underneath photos of hairy top lips. But why do men need so much encouragement to seek medical help? Well, according to a study by the National Pharmacy Association (NPA) “men visit their GP four times a year compared to six times for women. On average they visit a pharmacy four times a year compared with 18 for women.”  

 

Taking into account the fact that women tend to have more routine medical appointments, such as cervical smears or visits for contraception, this disparity is still alarming. The same study also found that “nearly nine in ten men do not like to trouble a doctor or pharmacist unless they have a serious problem. As a result, men are less likely to access disease screening or seek professional support for healthy-living initiatives such as stop smoking schemes.” The overall impression given by this data is that men generally don’t take as much care of themselves as women, which could explain their lower life expectancy, too.  

 

MedicsPro’s own research backs this up, with 79% of our medical professionals saying they agreed that they see more women than men on average. So, the next question has to be why? Again, some of our doctors and nurses had their own opinions. One claimed it’s because “men don’t like to hear bad news” and another that its purely “pride”. This was a running theme throughout the replies with most answers falling into the category of either fear or illness as a threat to their masculinity. However, 20% of professionals asked, disagree with the statement and would happily go to the doctors if they had any concerns for their health. Moreover, modern discourse on gender focuses on the many ways the patriarchy is damaging to women - but the sword cuts both ways. If a man misses catching a preventable disease early because of perceived weakness, the results are not only sad but actively dangerous.  

 

Opening up, even to a doctor, can sometimes feel unnatural for boys or men and this can become life-threatening. From physical ailments to psychological issues, very often early detection and prompt treatment is the key to stopping anything serious from developing. Prostate cancer, testicular cancer and mental health issues are the three greatest concerns in men’s health, and this applies to all three. For instance, in the UK, men are three times more likely to take their own lives as women and the highest suicide rate is for men aged 45-49. Seeking out help can prevent the worst-case scenario, even if it goes against the grain for some men, and that is why these awareness weeks and months are so important. To show that no one is alone and it’s never weak to look for guidance and support if you are struggling. 

 

There are various charities dedicated to men’s mental health as well as resources that can help you check for abnormalities and you can find some of them here: 

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