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.

On a physical level, postpartum is characterised by an involuntary and regression process of the body areas and organs that have undergone changes, with the exception of the mammary gland, which at this time is of greater importance for feeding the baby. In addition to physiological changes, there are also changes in mothers on a psychological level, in the family structure and in their social role.

A period in which so many changes appear can translate into a complex or difficult adaptation, so it is important that the care provided by health professionals is carried out from a biopsychosocial and holistic approach, and it is recommended that they be coordinated by a midwife.

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?

Menopause is a natural stage in a woman’s life that marks the end of reproductive life. It is confirmed after twelve consecutive months without menstruation and occurs because the ovaries gradually stop functioning and hormone production decreases, particularly oestrogens.

This hormonal change can cause physical and emotional changes, with an intensity that varies widely between women.

Menopause is:

• Is part of the natural course of life
• May be accompanied by symptoms such as hot flushes, night sweats, fatigue, sleep disturbances, mood changes, or vaginal and urinary discomfort
• Is experienced differently by each woman; every experience is unique

With good information, healthy lifestyle habits and, when necessary, medical follow-up, most women can maintain a good quality of life during this stage.

Menopause is not:

• A disease
• A stage that should be faced without information or support
• A limit to personal, professional or sexual life

Some women hardly notice any changes, while others experience more intense symptoms. Approximately 15% of women do not have significant discomfort.

How, when and why does menopause occur?

Menopause occurs when the ovaries progressively stop producing hormones, especially oestrogens, leading to the permanent cessation of menstruation.

It usually appears between the ages of 45 and 55, although the age may vary from one woman to another. This variability is related to the fact that women are born with a finite number of eggs, which gradually decreases throughout life. Genetic and environmental factors, as well as certain medical conditions or treatments, influence this process and determine when menopause is reached.

The way menopause begins also varies. In many women, changes occur gradually, while in others symptoms may appear more intensely from the outset, or may be mild or absent.

In some cases, menopause does not occur naturally but is induced, when certain medical treatments or procedures cause the ovaries to stop functioning abruptly, as can happen after some gynaecological surgeries or treatments such as chemotherapy or radiotherapy.

Short-term symptoms

The decrease and fluctuation in oestrogen levels during perimenopause and the first years after menopause can cause a range of short-term symptoms. These hormonal changes may affect different organs and systems in the body, as oestrogen receptors are distributed throughout the organism.

1. Vasomotor symptoms: hot flushes and night sweats

Hot flushes are sudden episodes of intense heat caused by changes in the system that regulates body temperature. They are often accompanied by skin flushing and, in some cases, palpitations. When a hot flush ends, the body attempts to restore normal temperature by producing sweat, which is the natural cooling mechanism. Sweating can be as bothersome as, or even more bothersome than, the hot flush itself.

When these episodes occur at night, they can disrupt sleep and make rest more difficult. Hot flushes and night sweats are the most common symptoms of menopause and affect approximately three out of four women at some point.

Their frequency varies widely: some women experience them occasionally, while others may have several episodes during the day or night. Each episode usually lasts a few minutes. In most women, these symptoms tend to improve over time, although their course may differ from one woman to another.

2. Sleep disturbances

Difficulty falling asleep, nighttime awakenings or non-restorative sleep are common. These disturbances may be related to night sweats, but also to the hormonal changes typical of this stage. Lack of rest can lead to daytime fatigue and a sense of reduced physical and mental performance.

3. Emotional and cognitive changes

During this stage, mood changes such as nervousness, irritability, anxiety or low mood may occur. Difficulties with concentration, a sensation of “brain fog” or mild memory problems are also common. These changes are mainly related to hormonal fluctuations, although they may also be influenced by personal, family, work and social factors that often coincide with this period of life.

These symptoms may appear gradually, fluctuate over time or change in intensity. Not all women experience them, nor with the same severity. When they interfere with quality of life, it is advisable to seek advice to receive information and consider appropriate support and treatment options.

Medium-term symptoms

Years after menopause, reduced oestrogen levels may lead to gradual changes in different parts of the body.

Changes in the genital and urinary area

Oestrogens play an important role in maintaining the health of the vagina, vulva and urinary tract. When oestrogen levels fall, these tissues may become drier, more delicate and more sensitive.

This may cause:

• Vaginal dryness and irritation
• Pain or discomfort during sexual intercourse
• Increased urinary frequency or urgency
• More recurrent urinary tract infections
• Urinary leakage, especially during activities such as coughing, laughing or lifting

Unlike other menopausal symptoms, these changes do not usually resolve on their own over time, but they can be treated. Pelvic floor physiotherapy helps improve urinary control, and the use of vaginal moisturisers and lubricants, as well as local oestrogen treatments, can relieve dryness and discomfort.

Skin changes

With decreasing oestrogen levels, the skin may lose some of its hydration, elasticity and firmness, becoming drier, thinner or more sensitive. In addition to hormonal changes, other factors such as ageing, sun exposure and lifestyle habits also play a role.

Sexuality during menopause

Menopause does not mean the end of sexuality. However, some women may notice changes. Reduced vaginal lubrication may make intercourse less comfortable, and arousal may take longer. Changes in sexual desire may also occur.

Sexual experience during this stage does not depend solely on hormones, but also on overall health, self-image, previous experiences and life circumstances. With appropriate information and treatment when needed, many women maintain a satisfying sex life.

Long-term symptoms

In the long term, reduced oestrogen levels may affect bone and cardiovascular health. These changes are not immediately noticeable but are important for future health.

Bone health

Oestrogens help keep bones strong. After menopause, reduced oestrogen levels may promote a progressive loss of bone mass, increasing the risk of osteoporosis and fractures. Osteoporosis often causes no symptoms until a fracture occurs, which is why prevention and medical follow-up are essential.
To protect bone health, regular physical activity is particularly important, especially strength and weight-bearing exercises, which help maintain bone density and muscle strength. Ensuring adequate calcium and vitamin D intake, through diet or supplements when necessary, is also key, as these nutrients are essential for bone health.

The combination of healthy lifestyle habits, physical activity and appropriate medical follow-up helps reduce fracture risk and preserve long-term bone health.

Cardiovascular health

Before menopause, women have a certain degree of protection against cardiovascular disease. As oestrogen levels decline, this protection decreases and cardiovascular risk increases with age.

Hormonal changes may contribute to increased cholesterol levels, abdominal fat and other risk factors. Maintaining healthy habits, such as a balanced diet, regular physical activity and avoiding tobacco, is particularly important at this stage.

Diagnosis

Menopause is considered confirmed after twelve consecutive months without menstruation, provided there is no other explanation. This is the criterion generally used.

In most women, diagnosis is based on clinical history and symptoms. Age, changes in the menstrual cycle and the presence of symptoms such as hot flushes, sleep disturbances or mood changes are usually sufficient to identify this stage. In these cases, routine hormonal blood tests are not required. Hormonal testing is only necessary in specific situations.

Key points about menopause

• Menopause is a natural stage of life, not a disease.
• It is confirmed after 12 consecutive months without menstruation.
• Symptoms and their intensity vary widely between women.
• Hot flushes and night sweats are the most common symptoms, but their duration varies.
• Vaginal and urinary changes do not usually resolve on their own, but they are treatable.
• Menopause does not mean the end of sexuality or quality of life.
• Strength training, a balanced diet, calcium and vitamin D are essential for bone health.
• Both hormonal and non-hormonal treatment options are available; treatment should be tailored to each woman.
• Seeking advice when symptoms affect daily life helps improve wellbeing and prevent health problems.

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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 essential for protection against microbes and bacteria. People who shower every day and clean their hands frequently are protecting themselves against many diseases. It is important to take care of our hands, mouth, feet and genitals. These are the parts of the body that have greater contact with bacteria and which need special attention.

Be careful when you sneeze or cough. Throw away used tissues and clean any items you have touched. These are small actions that improve everyone’s quality of life. By taking care of ourselves, we are taking care of others.

If you have a pet, it is important to maintain basic rules of hygiene relating to the animal and to the spaces in the house it lives in.

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.

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.

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.

Warning signs

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.