Changes to the patient's diet

• A varied diet rich in proteins and fibre and low in salt is recommended, restricting fats and fried foods. Following a Mediterranean diet, which features fresh and seasonal products, is advisable.
• Patients who experience changes in their sense of smell or taste, or decreased hunger, should be monitored to avoid excess weight loss that can be caused by malnutrition.
• If they have a decreased sensitivity to heat and can not tell if the food is too hot, the temperature of the foods given should be controlled to avoid burns.

Patients with dysphagia

• The food should not have lumps and should not be too hot. To encourage swallowing, cold and hot (but not hot enough to burn) foods can be alternated.
• The patient should have their back straight and head upright. Sometimes, however, their chin can be lowered to facilitate swallowing.
• To make drinking easier, you can use small glasses, avoiding straws and small bottles.
• Food should be given frequently but in small quantities, on the patient's good side. To ensure there is no food left in their mouth, you can wait until they swallow once or twice.
• Avoid distractions while eating.
• If the patient tends to cough or choke, chemical thickeners (bought at the pharmacy) or natural thickeners (potato, flour, or bread, among others) can be used.

Using a feeding tube

• The food should be finely mashed and mixed with water.
• The patient should be in a seated or semi-seated position while being fed.
• Even when feeding is done through a tube, correct oral hygiene should be practised.
• When the feeding is interrupted, it is important to put a little water into the tube to avoid blockages and to later keep the cover of the feeding tube closed. If an obstruction occurs, you can try to unblock the tube with oil or a cola soft drink. If this does not work, you should go to the health centre.
• If it is a nasogastric tube, the nasal cavities should be cleaned daily and the place in the nose where the tube is inserted should be rotated to avoid the formation of ulcers.
• If the patient has a gastrostomy tube, the skin around the tube, the tube itself, and the connectors should be cleaned daily with soap and water. The tape securing the tube must also be changed daily, covering the area with gauze affixed with surgical tape.

If the patient has mobility problems

• Use cups with two handles.
• Serve the food in bowls or soup plates.
• The handles of the cutlery should be thick.
• Non-slip tablecloths should be used.

If the patient has problems defecating

In the case of constipation:

• Maintain a diet rich in fibre and encourage mobility whenever possible.
• Establish a set time to defecate, preferably on the toilet, avoiding faecal collection systems or nappies.
• Laxatives or enemas should only be used if a doctor prescribes them.

In the case of diarrhoea:

• Provide an astringent diet and keep the patient hydrated.
• If it continues for more than two days, consult a physician.

If urinary incontinence is an issue 

• Take note of the quantity and frequency of urine (incontinence, urine infection and retention).
• The patient must drink one and a half litres of liquid a day and reduce liquid intake from late afternoon onwards.
• If the patient has light bladder leakage, offer them the chance to go to the bathroom frequently until they have better control of their sphincter.
• In the case of incontinence, nappies or a urine collector can be used, keeping the skin clean and dry.

10 tips to avoid starting to smoke again 

1. Make a list of the benefits your have felt and read it at tricky times.

2. Reduce alcohol and caffeine consumption, increase consumption of water or natural fruit juices.

3. Increase physical activity.

4. Take up hobbies again that you stopped.

5. Keep yourself busy. Take the opportunity to do things that you have been putting off doing.

6. Get yourself a present.

7. Ask a relative, friend or healthcare professional for support.

8. When you feel like smoking, eat a piece of fruit, a sugar-free sweet or drink water.

9. Stay alert; don’t think that smoking just one cigarette won’t do any harm.

10. Focus on the present; every day without smoking is a battle won.

I have a newborn at home. What guidelines should I follow to avoid possible COVID-19 contagion in the baby?

If you have a newborn at home, you must follow the same precautionary measures that healthcare professionals recommend to the rest of the population. It is especially important to maintain good hygiene practices, especially on the hands, both for the parents and the baby, and take isolation measures in case of possible contagions.

Shall we reduce friends and family visits to welcome the baby?

In the actual epidemiological situation, and considering babies situation, hospital and home visits should be limited to those strictly necessary and avoid receiving friends or family. Complying with #Iamstayingathome is essential to contain the virus and avoid undesired infections.

If the mother is infected with SARS-CoV-2 coronavirus, will the baby be infected too?

In the case of women who are newly mothers and infected, data do not show intrauterine transmission through the placenta or perinatal transmission. This means that there’s no mother-child vertical transmission of the disease during pregnancy.

If the mother is infected, specialists will perform appropriate tests for the newborn and, if necessary, prescribe the most appropriate treatment and recommendations for both.

What risks does the newborn face in case of COVID-19?

Although the reason why infection rate in newborns is low is still unknown, according to studies so far, if the baby is infected with COVID-19, the risk of serious complications from the virus is low and the more likely you are to have a mild symptomatology.

If your baby has any symptoms associated with COVID-19, please contact your health care authorities.

What is menopause

The menopause is:

• The definitive cessation of ovarian function, i.e. a sudden oestrogen deficiency.
• A life stage for each and every woman.
• The origin of certain changes and some disorders.
• Women who have the right information and healthy habits will enjoy better quality of life during this stage of their lives.
• The menopause is not:
• A disease.
• A sign of old age or loss of femininity.
• Not all women experience the same symptoms or experience symptoms with the same degree of intensity. 15% of women do not experience any discomfort at all.

How, when and why does the menopause happen?

The menopause marks the end of the fertile stage of a woman's life. It is a consequence of the natural ageing of the ovaries and the end of their reproductive and hormonal function. During this process of losing fertility, some hormonal disorders can arise that affect the way the body works.

As well as the natural menopause we have just described, there is also induced menopause, caused by removing the ovaries, chemotherapy treatment or radiotherapy treatment, autoimmune diseases or abnormal ovary function.

The menopause is considered to be early if it happens before the age of 40 years and late if it happens after the age of 57.

Short-term Symptoms 

The lack of oestrogen in the short term can cause:

1. Hot flushes and sweats: the lack of oestrogen causes the body's temperature to increase by almost 1 degree. Generally, hot flushes or a feeling of suffocation start at the thorax and rise up to the head and across the whole body. When a hot flush has happened, the body starts the process of going back to normal and in order to do so it produces sweat, which is the mechanism for reducing body temperature. Sweats may be as bothersome as or more so than hot flushes. 60%-80% of women experience them. 
2. The frequency of hot flushes may be once a day or every half an hour. Normally, episodes occur at night. They usually last between three and six minutes. This situation can go on for six months or two to three years on average. 15%-20% of women will, however, have them for the rest of their lives. 
3. Dizziness: a feeling of sickness and a sensation of not being stable.
4. Paraesthesia: a burning or pricking sensation or a feeling of extremities having fallen to sleep.  
5. Psychological symptoms: often associated with hot flushes or suffocation. The changes that take place for women during climacteric - which incorporates pre-menopause and menopause and lasts between 5 and 15 years - are the consequence, on the one hand, of endocrine and metabolic changes and, on the other hand, of an individual's psychological characteristics and social factors. The symptoms are:

• Nervousness
• Anxiety
• Tendency towards depression
• Decreased capacity to concentrate.

Medium-term Symptoms 

These come about 5-10 years after the beginning of menopause. 

1. Urinary alterations or genitourinary syndrome of menopause 

• Urogenital atrophy: the lack of oestrogen leads to decreased lubrication of the vagina and a decrease in the number of vaginal folds due to the loss of collagen.
• Urinary incontinence: a disorder that often affects post-menopausal women, but is not always linked to oestrogen deficiency. It can be a hygiene, social and psychological issue. 

The symptoms are: 

• Urinary incontinence
• Urinary urgency 
• Mixed incontinence (a combination of the two previous symptoms)
• Urinary infections

Current treatment is based on physiotherapy to improve pelvic floor muscle strength. Treatment with oestrogen improves mucosal trophism and can help to decrease symptoms and improve the symptomatology.

2. Skin alterations

The skin may also undergo changes caused by oestrogen deficiency, as well as by other age-related or external factors, such as exposure to sunlight.
The passage of time leads to decreased collagen and skin thickness, which causes the skin to become looser, more wrinkled and to lose its elasticity and sensitivity. 

3. Sexuality during menopause

The arrival of the menopause does not mean that a women's sex life has come to an end. The opposite perception is also mistaken. It depends more on social and cultural factors than on hormones. 

The menopause brings with it certain changes and may lead to some disorders, but this does not mean a loss of femininity:

• Decreased lubrication can sometimes cause discomfort during intercourse.
• Sexual arousal may be slower or less intense.
• Taking drugs and also suffering from some chronic illnesses may lead to decreased sexual desire.
• Certain types of surgical operations and treatments associated with such illness may cause women to feel less attractive.
• The psychological conditions associated with the menopause also affect sexual response.
• Today's beauty ideals can put pressure on menopausal women. Given the increased life expectancy in today's society, menopausal women still have a third of their lives ahead of them. This is a challenge that must be tackled and a myth that needs to be broken.

Long-term Symptoms  

These begin to appear 10 years or more after the beginning of menopause.

The lack of oestrogen in the long term can cause:

Osteoporosis

• Progressive loss of calcium in the bones. Oestrogen contributes to bone regeneration. The lack of oestrogen means that the bones no longer regenerate properly and the result is that in the first few years women may lose 2-3% of bone mass each year, which means that in 10 years they may lose 25% of their total bone mass.
• This affects more than 40% of menopausal women and leads to increased risk of fractures.

Cardiovascular Diseases

During the reproductive stage of their lives, women experience a greater degree of protection against cardiovascular diseases than men thanks to the action of oestrogen on the body.

• The lack of oestrogen may lead to increased risk of suffering cardiovascular diseases.
• Oestrogen deficiency increases the likelihood of coronary thrombosis due to the change in lipid metabolism, which affects clotting and fibrinolysis.
• It also has an impact on the weight changes that women experience during this hormonal phase, as more fat accumulates in the abdominal area.

With the lack of oestrogen during the menopause, women enter the risk group for cardiovascular diseases. The cardiovascular disease risk factors identified in women are:

• Age: over 55 years
• Family history
• Obesity
• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Stress
• Hypoestrogenism

Diagnosis 

The definition of the menopause is one year without having a period. Aside from that, the diagnosis will be clinical on account of all of the symptomatology explained above and also the findings of general tests, where there will be an increase in cholesterol, but the main signs relate to hormones, with a major increase in gonadotropins and particularly more than 40 IU/l FSH (follicle-stimulating hormone) and oestrogen deficiency, with values below 18 pg/ml.

Prevention rather than cure during the menopause

Healthy habits should be maintained during the menopause.

• Good diet: varied, rich in calcium and balance in proteins, sodium and phosphorous. Limited consumption of coffee, alcohol, fats and carbohydrates.
• Being in the sun for 15 minutes a day: ultraviolet rays turn dehydrocholesterol into vitamin D, which allows calcium taken in as part of a healthy diet to be absorbed into the intestine.
• Moderate physical exercise: physical inactivity reduces bone mass formation. If women do adequate exercise for their age and their general condition, they will achieve better equilibrium between bone formation and resorption.
• Stop smoking: tobacco contributes to reduced bone mass. 

Type of treatment

The menopause DOES NOT need to be treated but THERE ARE treatments to reduce some of the symptoms and improve the quality of life of affected women.

Phytoestrogens:

• What are they? They are biologically active plant derivatives found in many foods, such as legumes, green vegetables and cereals. They include various chemical derivatives (lignans, isoflavones and coumestan).
• What benefits do they bring? They help to alleviate the symptoms of menopause, including loss of bone mass. They have major antioxidant, antiviral and anti-inflammatory effects. A person's diet does not usually contain enough phytoestrogens, which means supplements are a good idea.

Hormonal treatment:

Oestrogen deficiency leads to the changes that some women experience. Hormone replacement therapy (HRT) involves supplementing these hormones. HRT allows minimum hormonal levels to be restored, allowing some women who have severe symptoms to retain a good quality of life. 

Medical consensus also warns of some risks:

• Not all women can receive HRT.
• The dosage prescription should be as low as possible.
• The treatment duration should be as short as possible and never longer than 5 years (aside from cases of early menopause), as it can increase the risk associated with breast cancer.

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What are the main causes of back pain, or which are the most common complaints?

Most cases of back pain are caused by muscle pain due to mechanical overloading of the spine, static positions, physical exertion and bad movements that cause a muscle spasm and pain. A bio-mechanical alteration of the small posterior joints of the vertebrae that cause nerve irritation with a spasm of the surrounding paravertebral muscles. 

The most frequent types are mechanical lumbar pain, where you can find spasms of the lumbar region or the pyramidal muscles, with the pain radiating towards the gluteal region. 

You can observe phenomena such as wear, osteoarthritis of these joints, protrusion of the discs or disc herniation can make these spasms be more or less frequent. The next, in terms of frequency, is neck pain, which can cause pain towards the shoulders, or even tension-related headaches. These are more directly related to bad posture and spasms of the trapezoid and sternocleidomastoid muscles.

Do some people have a predisposition to back pain?

Yes, and most of the time it is multi-factor. People with the following issues can suffer it:

• Those with a specific anatomical spinal constitution
• Those with important lumbar or cervical lordosis
• Those with a weak muscular constitution
• Those that perform mechanical tasks with poor ergo-dynamic adaptation
• Those that do not exercise and have a sedentary lifestyle
• Those with hereditary genetic factors, etc.

As well as lower back pain and neck pain, there are other very common ailments that affect the back, such as sciatica. What is sciatica and how does it manifest?

Sciatica is an irritation of the sciatic nerve, which starts at the lower lumbar area and radiates throughout the gluteus, all the way to the posterior part of the leg. This irritation can be caused by a herniated disc, foraminal stenosis, or a pyramidal muscle spasm, which all present a similar clinical picture, pseudo-sciatica.

What is a herniated disc and what causes it? 

Hernias are caused by a rupture of the inter-vertebral disc that causes the extrusion (it moves outwards) of its contents, which can come in contact with the root of the nerve that runs alongside it and produce a painful irritation that will radiate along the nerve's whole trajectory. 

Can having muscle spasms on a regular basis be indicative of a more severe back problem?

Not necessarily. It depends on many factors. It is best to see a specialist so they can orient a proper diagnosis for muscle spasms.

If your back hurts, is it better to rest or exercise?

It is best to combine both, though it depends. You should never do any exercises that cause pain while you are doing them or afterwards. You can stretch, for example, which can help relax muscles and ease the pain. Total bed rest is not beneficial either.

Are orthopaedic elements, such as girdles, back braces, etc, really of any use for back pain?

It depends on the diagnosis. They are not recommended in general terms, though they can alleviate pain during a certain period of the day, depending on the type of activity being performed and the pathology in question. We always recommend that they only be used when prescribed by a doctor.

When should an anti-inflammatory be taken to deal with back pain? Can they have side effects that are bad for our health?

They must always be prescribed by a doctor. The best thing to do is decrease the intensity of your daily activity, rest a bit, apply gentle heat locally for 15 minutes at a time and take a conventional analgesic, and if the pain does not improve, you can take an anti-inflammatory, assuming it has been recommended by a doctor and has been effective in the past. 

How can we alleviate back pain while sleeping? Is it true that there are some postures that help, and others that hinder, back pain?

The quality of your rest at night is important for improving back pain. If pain is interfering with your sleep patterns, you’ll wake up feeling worse, with more spasms and pain. Sleeping in postures that cause pain, such as flat on your back or flat on your stomach, is not recommended. Sleeping on your side, or in a foetal position can help with the pain. You can place pillows or cushions between your legs if you are on your side, or under your stomach if you are lying face-down, to try to alleviate the pain and be able to rest. 

To what extent do our shoes influence back pain?

They can make it worse if you don't use adequate footwear. You should use comfortable shoes, with a snug fit, least a 2 cm sole, and a wedge heel. Shoes should never be totally flat.

As well as regular physical activity and good posture, are there any other things we can do to prevent back pain?

The most important things would be to keep a correct height/weight ratio, eating well and also another recommendation would be to work in an adapted environment.

Is there a specific exercise to prevent back pain?

Yes, there are specific exercises. In general, any that strengthen the abdominal area. It is best if these are prescribed by a professional in that field, since they really do need to be adapted to each person’s morphology. As a general recommendation, you can find exercises, for example, on the website for the Sociedad Española de Rehabilitación y Medicina Física (Spanish Society for Rehabilitation and Physical Medicine), under the “Exercises” header.

Personal hygiene is health

A person who fails to take care of their personal hygiene may catch various diseases and infections. For example, failure to clean our teeth can cause decay and bad breath. Cardiovascular diseases as well. Bacteria from the plaque in our gums can enter the body through the bloodstream. When such bacteria reach our heart, they increase our possibility of having a heart attack. 

Failure to wash our hands after going to the toilet can result in diseases such as the common cold, the flu, chicken pox, meningitis, gastroenteritis and ’hepatitis A.

Basic personal-hygiene rules

You can enjoy good personal hygiene by following these recommendations:

Taking a bath or shower every day

This is the best way to eliminate dirt, sweat, dead cells and bacteria. Especially take a shower after you have done some sport. If that is not possible, you can use a damp towel to clean your body at the end of the day.

Using a deodorant or antiperspirant

Wash your armpits thoroughly with soap and water every day. This is important for protecting against body odour. Use a deodorant or antiperspirant too These products help to control excess sweat and body odour.

Washing your hair

You do not need to wash your hair every day. It depends on your habits and your hair type. It is recommended to wash your hair at least once a week with an appropriate shampoo. It is also advisable to have your hair cut every three months or, at the very least, twice a year. That way it stays healthy.

Washing your hands

It is important you wash your hands frequently, to eliminate dirt and bacteria. It also helps to prevent the spreading of respiratory and diarrhoeal infections from one person to another. 

You must wash your hands and wrists with soap and water:

• When preparing a meal and handling food.
• Before eating breakfast, lunch or supper.
• When you touch an animal.
• After going to the toilet.
• After coughing, sneezing or blowing your nose.
• When you have a wound.
• If you have been in contact with someone ill, with a cold or who has diarrhoea.  

Brush your teach after every meal

Cleaning your teeth helps to protect against gum diseases such as gingivitis. And bad breath too. To eliminate the accumulation of bacteria in your mouth, your brushing should last between 4 and 5 minutes. It is advisable to start from the front of your teeth. Afterwards, continue with the inside and, finally, your molars. You should ideally brush your teeth after every meal. If not, you can brush them twice a day: in the morning and before you go to bed.

Do not forget your tongue. It has to be cleaned with your toothbrush from inside to outside. You can also use a specific cleaner for your tongue. For good oral-dental health, you should visit your dentist twice a year.

Washing your face

Our skin produces oils every day that block its pores. These can cause eruptions and acne. Which is why you need to wash your face at least twice a day.

Facial skin is more sensitive than the rest of the body’s skin. This is why we recommend you use a facial cleaner adapted to your individual skin type. Anyone with dry skin should avoid using alcohol-based cleansers. It is best to use hypo-allergenic cleansers for sensitive skin. If you use make-up, you should use a special cleanser and wash your face afterwards.

Frequently cutting your fingernails and toenails 

Fingernails and toenails need to be frequently cut to prevent dirt from accumulating underneath them. That way you can protect the skin of your feet against infections and conditions. 

Avoiding sharing personal-hygiene items

Do not share personal-hygiene items as they may contain bacteria. Electric shavers, brushes, tweezers, sponges, make-up, lipstick, deodorant balls or bars... It is better to have your own personal-hygiene items. 

Wearing clean clothes

People who wear clean clothes always look better and feel better. Moreover, dirty clothes may contain micro-organisms and cause skin infections. 

Underclothes must be changed every day. You are advised to put on clean clothes after you take a shower or bath.

Cleaning your clothes after you use them

Shirts and T-shirts are best cleaned after use. Trousers and skirts, by contrast, can be worn more before they need to be washed.

Clothes that contain vomit, fluids resulting from wounds, sweat, contaminated food or which have been in contact with animals, must be washed at 60 degrees and separately. This eliminates bacteria and the possible spread of disease.
After you wash your clothes, you need to dry them immediately. If they remain wet for too long, they may give off a dank odour and cause skin infections.

Cleaning dishes and pots after each meal

It is not advisable to leave dirty plates and cutlery in the sink for hours or your dishwasher full, after each meal. Food leftovers encourage the growth of micro-organisms that can cause infections, such as salmonella. 

Kitchen sinks can accumulate more bacteria than a bathroom or toilet bowl. They can be disinfected every day with vinegar and bicarbonate of soda or bleach.

Your cleaning cloth should also be changed every week, as it accumulates a large quantity of bacteria.

Keeping your contact lenses and glasses clean

Glasses and contact lenses must be kept clean to avoid infections, such as conjunctivitis and keratitis. They need to be cleaned with specific products.

If you do not have these products, you can clean your glasses with soap and water. You must never clean them with saliva or clothing. Contact lenses must be cleaned with a special solution after use. 

Avoiding walking barefoot

It is not advisable to walk barefoot at home, as large quantities of bacteria accumulate on the floor. Walking without shoes or sandals can cause infections, such as athlete’s foot. Bacteria cause peeling and itchiness in the lower part of the feet and the build up of fungus in the nails.

If a woman is pregnant, can she transmit the virus to her baby?

According to the data that is currently available, there is no evidence of mother-to-child vertical transmission. This means that a mother cannot transmit the virus to her unborn child, either via the placenta or during birth. Thus far, in the cases where newborns were infected, this happened post-partum, hours after they were born.

The studies carried out show that the SARS-CoV-2 coronavirus spreads via the respiratory route, when in close contact with someone who is infected. Transmission occurs through small droplets that come from the nose and mouth of an infected person when they cough or exhale. Therefore, it spreads in a similar manner to the flu and other respiratory viruses.

What measures should a pregnant woman take as regards COVID-19?

The preventative measures that a pregnant woman should take are the same as those for any other person:

• Practice good hygiene by washing your hands with soap and water or a 70% alcohol solution.
• If you need to cough or sneeze, cover your mouth and nose with the inside of your elbow or with disposable tissue paper.
• Avoid touching your eyes, nose, and mouth with your hands unless you have properly washed or sanitised them first.
• Do not share utensils like cutlery, cups, or towels, along with food or objects that haven't been correctly cleaned first.

Follow the link to find more health advice on how to avoid being infected with the SARS-CoV-2 coronavirus.

Does COVID-19 affect the birth plan?

Having COVID-19 should not affect how you plan on giving birth. The birth will be vaginal, unless there’s another cause that justifies a C-section.

What should a pregnant woman do if she suspects she has COVID-19?

Currently, there is not enough data on the relationship between the SARS-CoV-2 coronavirus and pregnancy and its possible effects. In the scientific literature, eighteen cases of pregnant women with COVID-19 have been described in China. In these cases, the women contracted the virus during the third trimester of pregnancy and the symptoms were mild, without severe pneumonia. Thus, it is recommended that there be early care and strict monitoring of the pregnancy in the case of suspected infection, to minimise any possible risk of premature birth or intrauterine growth restriction (IUGR).

What do you need to bear in mind if you have Crohn's disease or you are caring for someone who does?

People with Crohn’s diseases must eat a varied and balanced diet, contributing energy and all the nutrients appropriate to the needs of each person according to age, gender, constitution and level of physical activity.

The balanced diet should be based on three rules:

• Daily food intake should provide the energy needed for the body to work properly.
• Each meal must provide the energy and non-energy nutrients to adequately cover the nutrition function.
• Nutrition should be consumed in suitable proportions.

Based on these rules, the Generalitat de Catalunya published its revised healthy food pyramid, based on the Mediterranean diet.

The Mediterranean diet is a model that has been recognised by the international scientific community as one of the healthiest and most balanced diets in the world. Based on the trilogy of wheat, vines and olive trees, it offers a variety of very important products that allow you to combine pleasure at the dinner table with nutritional and cultural balance.

Patients at the start of an outbreak and for as long as the outbreak continues, should follow a low-calorie diet. This will stop the inflammation in the intestines from getting worse. It is, therefore, necessary to personalise diets depending on the localisation, extent and type of lesions patients present.

Symptoms

Patients with traveller’s diarrhoea present with frequent and abundant liquid stools, which may contain blood and mucus.

Additionally, patients almost always experience abdominal pain, nausea, vomiting and often a high fever.

Who is affected by the condition?

Traveller's diarrhoea can affect anyone, especially those travelling to lesser developed countries.

It is most common in young travellers (20-35 years) and during long trips, usually occurring within the first few weeks.

Diagnosis

In most cases, since traveller's diarrhoea is self-limiting, no specific diagnostic measures are taken, but the symptoms are treated, especially with oral rehydration solutions to avoid dehydration.

Diagnosis by stool cultures that look for parasites, viruses or causative bacteria, is reserved for cases in which symptoms last more than a week.

Cases of traveller's diarrhoea usually occur on trips where healthcare is poor and oral rehydration should be started as soon as possible.

Standard treatment

The treatment of traveller's diarrhoea involves maintaining an adequate degree of hydration in order to maintain the amount of water, mineral salts and glucose that the body needs, and which are altered by the presence of diarrhoea and vomiting.

Oral rehydration solutions, either in liquid form or sachets for dissolving in clean water, are ideal in these cases. Degassed carbonated drinks may be a temporary solution if oral rehydration is not available.

If symptoms persist for more than four days, or are severe, medical advice should be sought, even in an area with poor healthcare.

The use of antibiotics in these cases has not been proven advantageous and is not advised.

The use of anti-diuretics is also debatable, as they may impede the expulsion of diarrhoea necessary to start the recovery process.

They are not always recommended.

Standard tests

Specific testing is not initially indicated.

Early treatment for diarrhoea with an oral rehydration solution is fundamental as previously indicated.

Prevention

Prevention is fundamental in order to avoid traveller’s diarrhoea though complete prevention is never possible.

Drinking water and water used for tooth-brushing must be bottled or sterilised with a sterilisation tablet for such use.

Only cooked foods should be consumed, never raw.

Salads must be avoided, above all.

Fruit should be eaten only after having been washed with clean water and peeled with a clean knife.

Basic recommendations

Do not let children in the kitchen while you are cooking.

Some of the utensils most associated with domestic accidents:

In the kitchen:

• Frying pans - hot oil or flame caused by oil
• Pressure pots and pans - hot liquids
• Glasses, mugs and plates - due to spillage of liquids
• Microwaves - due to liquids or depilatory wax
• Oven door - by contact, especially in children

In the bathroom:

• Unblockers - Sulphuric acid
• And caustic soda mixed or combined with bleach are highly dangerous, whether due to inhalation of the mixture or due to contact on explosion.
• Hot tap water: regulate boilers to prevent the water from causing burns. 

Rest of the house:

Electricity, plug sockets, electrical extension lead, clothes iron by contact or steam.

Other most common injuries

• Motorbike exhaust pipe
• Special attention when handling firecrackers and sparklers, (especially in children)
• Burning alcohol or gasoline in barbecues.
• Colognes or sprays near sources of heat (candles) 

What to do when you burn yourself, using some of the methods below:

• It is very important to move away from the source of the burn: flame, hot water, electricity, hot solid, steam, etc.
• Cool the affected area, thus halting the spread of the heat in the skin and body tissue, preventing the injury from getting any worse. This also works in acid burns as you will dilute the product and its impregnation into body tissue. Use cold water for 10 or 15 minutes depending on the agent that caused the injury.
• Once the area is cool, there may be some redness to the skin, with more or less pain or discomfort (hot water, superficial flame, sun burn).
• It can be soothed with water or cold cloths, and by applying moisturisers.

And above all, if the burn is very painful, visit a health centre.

If blisters appear, there is loss of skin, or white or pearly blotches after cooling, you must keep the affected area covered with gauze, a towel, a sheet, etc.

If there is pain, cold water can be applied to this cover.

If the injuries only cover a small area, you should first go to a health centre. For more widespread injuries, go to the hospital accident and emergency department or 112 emergency services.

If the burn is on the face, neck, hands, major joints, groin or perineum (the area between the genitals and the anus), it should be assessed by a specialist.

Special care should be taken with children and the elderly as they may require special attention to their injuries.