Preventing flu - anti-flu vaccination

Annual anti-flu vaccination is the main prevention measure for flu.

The vaccinations available in Spain are all inactive (they do not contain the flu virus, just part of the virus) and they are administered by intramuscular injection in a single dose. The side effects of the vaccination are not very common and generally mild (pain, hardening and redness at the injection site that do not restrict activity). 

The purpose of the anti-flu vaccination is to generate protection against the flu virus strains that circulate in the flu season. There are normally changes in these strains each year. Vaccinations must therefore be prepared each year to include the strains that are most likely to be responsible for flu cases in the coming season. Vaccinations are manufactured based on strains recommended by the World Health Organization (WHO).

The effectiveness of the anti-flu vaccination in preventing hospitalisation due to flu and pneumonia ranges from 30% to 70%. In older people living in institutions, vaccinations have proven to be between 50% and 60% effective to prevent hospitalisation or pneumonia, and 80% to prevent death by flu.

The vaccination is particularly recommended for people at high risk of suffering complications in the event of a flu infection:

• People aged 60 or above, as well as those who live in closed institutions.
• People under 60 at high risk of presenting flu complications: pregnant women, morbidly obese people and people of any age who suffer from one of the following types of illness: cardiovascular, pulmonary (including bronchopulmonary dysplasia, cystic fibrosis and asthma), neurological, neuromuscular, metabolic (including diabetes mellitus), kidney failure, immunosuppression, cancer, chronic liver diseases, asplenia and iron deficiencies. 
• Healthcare staff and other people who may transmit flu to those at high risk of complications. 

As well as vaccination, there are a series of hygiene measures that help to prevent flu:

• Cover your mouth and nose with a disposable tissue when coughing or sneezing, and then throw it away.
• It is essential to wash your hands regularly with soap and water for 15-30 seconds and dry them properly (especially after touching shared surfaces such as handrails, door handles, computer keyboards and mice, telephones, supports on public transport and after sneezing and blowing your nose), or with alcohol solutions by rubbing your hands for 15-30 seconds.
• Enclosed spaces should be kept ventilated.
• Avoid close contact with people who have flu and do not share food or utensils with them (such as cutlery, glasses, serviettes and napkins) or other objects without cleaning them properly.

If you get symptoms of flu or the doctor has diagnosed you with the illness, you should make sure not to share enclosed spaces with people for the first 3-5 days, especially people who are ill in hospital and community care workers.

Preventing falls

• Never leave the baby unattended on top of a changing table, bed, sofa or chair. If you are unable to hold or carry them, leave them in a safe place, such as their cot.
• Make sure that the changing table is stable, especially when the baby can crawl or walk. If you need to step away, always hold onto them with one hand.
• Before they start crawling, install gates on stairs, windows and doors.
• Always place the baby’s rocker on the floor. When the baby is bigger, hold the rocker’s legs so that it cannot fall forward.

Bath time

• At bath time, hold onto the baby tight. Do it gently, but firmly and do not get distracted.
• Never leave a baby unattended near to a bathtub, pool, the sea or a vessel containing water. An infant can drown in less than 5 cm of water.
• Make sure that the water in the tub is not more than 37ºC. When you fill it up, if there is no mixer tap, first fill it with cold water and then add warm water.

To avoid burns

• Do not carry hot drinks when you are holding the baby.
• Make sure that the baby stays in the shade and protect their skin.
• Cover plug sockets, especially when they start crawling.
• Be very careful with stoves, both with regard to burns and the emission of polluting gases.

Car journeys

• Always use car seats and boosters appropriate to the age of the child and vehicle characteristics. Follow the manufacturer’s assembly instructions.
• Always make sure that the child and their seat are well secured.
• Put the baby in the appropriate basket or chair with the approved safety fittings, in accordance with current regulations.
• Never leave them in the car unattended!
• It is a good idea for young babies to travel facing backwards and in the back of the car, as this reduces the risk of injury. If the chair is in the front seat for some reason, turn the air bag off.
• Check that there are no loose objects in the car, as they may be thrown around and distract the drive.

Ear protection

• Avoiding having the music volume too high or loud and repetitive noises.
• Check that the volume on toys is not too loud or acute. Better yet, check toys before buying them.

Other accidents

• Check that the car’s brakes function correctly.
• Check that the teats on dummies and bottles are not cracked.
• Make sure that hanging towels or cables, if pulled, do not cause objects to fall.
• Do not leave small objects within reach nor give them hard foods such as apple, carrot, popcorn or crisps,
• Be careful with bags or plastic wrap, balloons or other objects that may lead to suffocation.
• Do not leave the baby alone with pets, as their reactions are unpredictable.
• Medicines and cleaning products and toxins should be kept well out of reach.
• Do not put anything around your neck, wear large earrings or rings and do not use needles.

Passive smoking

Passive smoking harms the baby’s health. Tobacco smoke in the air, also known as second-hand smoke, is a mixture of the smoke that smokers exhale and smoke from the passive combustion of the cigarette. Both are toxic and contain respiratory irritants and carcinogens. Tobacco smoke behaves like vapour: it hangs in the atmosphere and impregnates clothes, hair, furniture, curtains, etc. Despite having snubbed out the cigarette, the toxic elements remain in the air, which you should bear in mind when protecting your baby’s health. Therefore:

• Do not smoke at home, by the window or in any rooms, as there is no device that eliminates tobacco smoke from the environment.
• Ask visitors not to smoke in the house.
• If you smoke on the balcony or terrace, close the door into the house.
• Do not smoke in the car, even if the baby is not there.
• When you go out with the baby, avoid enclosed spaces where people are allowed to smoke.
• Do not smoke in front of the baby, even in open spaces.

Three stages of postpartum

From a clinical point of view, three stages can be distinguished. 

First stage: immediate postpartum 

The immediate postpartum period includes the first 24 hours, of which the first two represent a period of close surveillance, due to the increased risk of postpartum haemorrhage. 

Regular monitoring of vital signs, such as temperature, blood pressure, and heart rate, will be carried out in the delivery room. Vaginal bleeding and the size of the uterus will be assessed, which after delivery must gradually recover to its size before pregnancy.

It must be verified that there is no wound or laceration in the vagina that is actively bleeding and, in the event that the woman has requested anaesthesia, the recovery of mobility of her legs must be checked. 

Immediate skin-to-skin contact of the baby with the mother will be initiated, under the appropriate supervision of health professionals, as well as the early start of breastfeeding if the mother wishes. The pertinent care of the newborn will also be carried out without altering the mother-child relationship, whenever circumstances allow. 

During the hospital stay, checks and care must be aimed at promoting the bond between mother and baby, together with the establishment of breastfeeding. During this process, it is important to instruct the mother and her family with regards identifying the warning signs to detect possible complications early. 

It is necessary to offer the mother truthful and simple information so that at the time of discharge she has maximum autonomy regarding the care of her baby. During the hospital stay, active participation of the couple in parenting will also be encouraged.

Second stage: early postpartum

The "early", "mediate" or "clinical" postpartum covers from 24 hours to the tenth day of postpartum and is considered the most important involuntary period. During this period, attention should be paid to the following possible complications: Infection of the endometrium, the surgical wound, the episiotomy, urine or the breasts; circulatory problems such as varicose veins, haemorrhoids and difficulties related to breastfeeding: pain, cracks, inflammation and problems with the baby's latch.

The hospital stay can be extended by 2 to 3 days depending on the type of delivery and as long as the evolution of the mother and baby is within normal limits. Once hospital discharge occurs, the midwife of the primary care centre will be in charge of the continuity of care for both the woman and her baby. 

Third stage: late postpartum 

Finally, the third phase, which corresponds to the late postpartum period, is between the 11th and the 42nd day after delivery (6 weeks). In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding. 

In this period, the physical changes that occurred during pregnancy in the mother have disappeared, breastfeeding is usually in place and the first menstruation appears in mothers who are not breastfeeding. We should also provide information on postpartum support groups and breastfeeding groups.

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.