Have you ever wondered how home visits came about? Or what a GP in the 50’s took along with them on a home visit? Let’s talk a short walk down memory lane. In the olden days, home visits were a given. Hospitals (and doctors) were few and far between and it wasn’t always easy for patients to travel to their doctors, due to poor health, poverty, age, or emergencies. So doctors (more GPs than specialists in those days) made home visits all the time. And we’re talking the 50’s and 60’s with no intermediary emergent services, which meant the GP had to be ready for anything short of an organ transplant on each home visit. Granted they had some help.

Take the doctor’s bag for example – the iconic Gladstone Bag (created right here in Westminster by J G Beard’s leather shop and named after British PM William Evart Gladstone) was built for utility with an easy-to-open hatch (that stayed open) to allow
the GP to reach his tools quickly and easily. Considering a GP might be treating a high fever or a concussion or even childbirth, they had to be carrying everything from thermometers to amputation kits to chloroform! Can you imagine a GP visiting your
home today with all of these tools?

Modern medicine has come a long way and thankfully so. It has changed how we view, seek and administer care, but home visits remain a huge part of that process, at least here in the UK. Things may be changing though, if we are to go by a recent article in the BBC (Nov 2019) that talked about GPs voting to reduce home visits, citing capacity issues. There may be lobbying efforts with the NHS to revamp home visit requirements altogether and there are divided camps on the issue.

But the power of a holistic healthcare continuum, one that includes telemedicine and home visits, cannot be denied. In fact, in a fast-paced world like today, not only do home visits help the elderly and the very sick and serve as the medical frontline, but they also provide a level of convenience in the face of longer working hours, long wait times and travel restrictions. Sometimes, the doctor has to come to you, which is why, at Gogodoc, our GPs are a click away.

To book a home visit in today’s world, all you have to do is download the GogoDoc app, and schedule an appointment for the SAME DAY (£75 for a home visit and £20 for tele or video conferencing). With average wait times at ONE HOUR, we beat the 2-week national average by well, about two weeks!

As the saying goes, the doctor will see you NOW, not in a fortnight.
Book your appointment today, and if you have, tell us about your experience in the comments below.

[pexcirclecta pex_attr_title=”Book your home visit today.” pex_attr_button_text=”Book Now” pex_attr_button_link=”https://gogodoc.com/consultation/” pex_attr_button_link_open=”same” pex_attr_button_color=”39b8b8″][/pexcirclecta]

I intended to write this article on the first day of summer. But as I sat on my sun-kissed desk in California, a place known for its warm, dry summers, opal sky and scantily-clad liberals, I figured I better check the weather in London before continuing. With a few weeks of drizzle and clouds, it seems that summer in London is finally on the horizon.

The following are some of the health benefits that exposure to sunlight can bring, including tips to stay safe.

Whereas exposure to excessive levels of sunlight is detrimental to our health, moderate exposure can boost our physical and mental state. The aim is to enjoy the sun sensibly, to make enough vitamin D, while not increasing the risk of skin cancer.

 

HEALTH BENEFITS

 

1) Improves the quality of sleep

Waking up in sync with the sun’s natural light switches off melatonin, a hormone made in your pineal gland, associated with sleep onset. This is the reason why you feel alert during your waking hours and tired at bedtime – and discombobulated when you cross time zones after a long-haul flight. It is, therefore, a good idea to open the curtains in the morning and avoid artificial light once the sun goes down.

People with irregular sleeping schedules often have trouble sleeping or feel tired during waking hours. Several studies have shown that chronic disruption of circadian rhythms can lead to weight gain, slower thinking, and other physiological and behavioural changes – analogous to the changes observed in people who experience shift work or jet lag.

 

2) Reduces risk of some cancers

Prolonged sun exposure increases the risk of skin cancer, but vitamin D is also known to be protective against several cancers, including of the colon, kidney and breast. In a study conducted by the US National Cancer Institute, it was found that high levels of sunlight were significantly associated with reduced mortality from breast and colon cancer. Similar effects were seen in the bladder, womb, oesophagus and stomach cancer.

 

3) Improves mood

Sunlight triggers the release of serotonin, a neurotransmitter that helps to regulate mood. It’s no surprise that spending time outdoors improves mood and relieves stress. Lack of sunlight exposure in some people can even trigger a type of depression known as a seasonal affective disorder, which is treated with light therapy.

 

4) Lowers blood pressure

Rates of hypertension tend to be higher in the winter and in countries farther from the equator. A possible explanation is that exposure to sunlight causes nitric oxide in the skin to be absorbed into the bloodstream, which can help widen blood vessels and lower the pressure inside them.

 

5) Can help with some skin disorders

Sunlight can improve several skin complaints, such as psoriasis, eczema and acne. Indeed, eczema and psoriasis are sometimes treated with UV light (phototherapy). However, sunlight can aggravate other skin conditions, particularly rosacea.

 

6) Improves the musculoskeletal system

It is common knowledge that vitamin D is important for healthy bones by helping the body absorb calcium. In a 2013 large Danish study, researchers found that having a history of skin cancer was linked to a lower risk of hip fractures. This may be because those who developed skin cancer also had prolonged sun exposure.

Vitamin D is also important to muscle health, and people with low levels are more likely to experience muscle cramps and joint pain.

 

TIPS TO STAY SAFE

 

There are of course risks associated with sunlight. Prolonged exposure causes damage to the epidermis and to other parts of the skin such as the supporting elastic tissue in the dermis. This damage is known as actinic (solar) elastosis, and gives the skin a baggy, wrinkled appearance. A significant risk factor for malignant melanoma is sunburn, especially during childhood.

 

1) Duration

One of the major benefits of basking in the sun is to make vitamin D, which is useful because there is very little found in typical dietary sources. To prevent deficiency of vitamin D, it is recommended to have 2-3 sun exposures per week. Each exposure should last 20-30 minutes and be to bare skin.

 

2) Stay hydrated

Aim to drink more than the standard eight glasses a day. And get creative: put some frozen berries in your water or even some mint leaves and lime slices. Opt for snacks with high-water content such as watermelon, cantaloupe, tomatoes and cucumbers.

 

3) Wear sunscreen

Look for at least an SPF 30 and wear it when you know you’ll be out and about during the day. Wear sunscreens with both UVA and UVB protection. Blocking UVB may prevent burning (which is what the SPF number indicates), but UVA still delivers skin-damaging radiation (and isn’t rated).

 

CONCLUSION

To summarise, try to have 2-3 sun exposures per week, but avoid the sun when it is strong; and when you think you’re exceeding the recommended limit, cover up, or use high-factor sunscreen.

According to the World Health Organisation (WHO), there are nearly 10 million new cases of dementia worldwide every year, with the figure set to triple by 2050.

The WHO evaluated 12 modifiable risk factors and offered advice on how to tackle them. It provides evidence-based recommendations on lifestyle behaviours and interventions to delay or prevent cognitive decline and dementia.

 

What is dementia?

Dementia is not a single disease, but rather an umbrella term that describes a group disorders. It’s a term used to describe a progressive deterioration of intellect and social functioning as a consequence of brain disease. Dementia is usually progressive and eventually severe.

There are over 100 different types of dementia, and any progressive brain disease (including e.g. multiple sclerosis) can include dementia later.

Alzheimer’s accounts for 70% of all dementias, affecting 20% of individuals over 85.

In practice, the term dementia is usually used for patients presenting with symptoms such as problems with memory, speech and understanding, where a general medical cause such as infection or a metabolic disturbance can’t be identified.

 

Who’s at risk?

Dementia can develop at any age from adolescence onwards, but is strongly age related, rare under the age of 60, and very rare under the age of 45.

The incidence increases from 6.7 per 1,000 persons, years 65–69, to 68.5 per 1,000 persons at age 85 years and above. About 5% of the population over 65 has dementia at any one time, and around 163,000 new cases of dementia occur in England and Wales each year.

Thus, as people get older and live longer, it is increasingly common and not unusual for patients to know others who have suffered, or have a family history of the condition. Although there are some genetic types of dementia, these usually present at a younger age.

 

Reducing risk

The WHO has launched its first ever guidelines on how people can reduce their risk of getting dementia.

The main takeaways in the guidelines are to exercise more and maintain a healthy diet, with an emphasis on the benefits of the Mediterranean diet – simple plant-based cooking, little or no meat and a healthy dose of olive oil.

Interestingly, supplementation with vitamins B and E, polyunsaturated fats and multi-complex supplements did not make a difference.

People should be looking for these nutrients through food; not through supplements.

 

Other notable factors

There is now ‘extensive evidence’ that smoking and alcohol are risk factors for dementia and cognitive decline.

In terms of other risk factors, the guidelines note the following may be offered to help reduce cognitive decline or dementia:

• Cognitive training to older adults with normal cognition and mild cognitive impairment.
• Weight management with interventions for overweight and/or obesity at mid-life
• Management of dyslipidaemia at mid-life
• Management of hypertension and diabetes for adults with these conditions

The WHO did not endorse games and other activities aimed at boosting thinking skills. These can be considered for people with normal capacities or mild impairment, but there’s little evidence of benefit.

 

Conclusion

While there is no cure for dementia, there is hope that having better overall health could help prevent it.

In summary, the WHO recommends staying away from tobacco, limiting your alcohol consumption, and maintaining a healthy blood pressure through a good diet and exercise.

It seems that what’s good for your heart is probably good for your brain too.

HIV is a virus that attacks the immune system, the body’s defence against infectious organisms and other invaders. If HIV is left untreated, a person’s immune system will get progressively weaker until it can no longer fight off life-threatening infections and diseases. However, the rate at which HIV progresses varies depending on age, general health and background. Testing regularly for HIV means you can get antiretroviral treatment if you need it and stay healthy.

The ‘give HIV the finger’ pun refers to the free postal finger-prick test that people can receive for testing without attending a clinic.

 

HIV in the United Kingdom

The United Kingdom (UK) has a relatively small HIV epidemic, with an estimated 101,200 people living with HIV in 2015. Just over 5,000 people were diagnosed with HIV in 2016, according to the data from Public Health England. This is an 18% decline from 2015.

The epidemic is largely concentrated among certain key populations, including men who have sex with men and black African populations. 54% of diagnoses were among gay and bisexual men; 19% and 22% among heterosexual men and women, respectively.

Late diagnosis is an important predictor of morbidity and premature death in people with HIV. In 2016, 42% diagnoses were made at a late stage of infection when treatment is less effective.

 

Current Screening Tests

HIV postal test kits allow people to take a finger-prick blood sample themselves. The samples are sent to a local laboratory for HIV testing. The test is highly accurate and can detect HIV within four weeks after infection.

These tests give a result of ‘reactive’ (positive) or ‘non-reactive’ (negative); reactive results are further classified into ‘high’ and ‘low’ reactive tests. A highly reactive result is suggestive of a HIV infection.

Patients providing a specimen reactive in the screening assay, but not confirmed to be consistent with HIV infection, should be retested using a fresh blood specimen collected at least two weeks later.

Ideally, a HIV antibody test should be performed on venous blood. Most laboratories in the UK use ‘fourth generation’ HIV screening tests. They detect anti-HIV (nearly all can detect the three main Ig classes: IgM, IgG and IgA) and p24 antigen. All patients whose first specimen indicates evidence of HIV infection must have their HIV status confirmed by tests on a second sample collected at another time.

HIV home sampling could potentially improve our ability to identify cases of HIV by targeting people at risk who do not use traditional testing venues such as sexual health clinics. The results data collected between 2015 and 2016 showed that 1.1% of tests submitted via the national postal testing scheme were ‘reactive’ and 0.7% were ‘high reactive’, compared to just 0.3% of tests finding HIV positive results from specialist sexual health clinics.

 

What is the difference between HIV and AIDS?

The definition of AIDS (acquired immune deficiency syndrome) is based on a potentially life-threatening infection or cancer seen in the immunosuppressed. Patients who have been diagnosed with AIDS have a greater risk of opportunistic infections. The most common AIDS-defining illnesses include:

1. Tuberculosis
2. Recurrent bacterial pneumonia
3. Pneumocystis jiroveci pneumonia
4. Kaposi’s sarcoma
5. Lymphoma
6. Cerebral toxoplasmosis
7. Cryptococcal meningitis
8. Intestinal cryptosporidiosis

Patients diagnosed late during HIV infection are at an increased risk of developing AIDS and are more likely to transmit HIV to others. This is one of the key challenges facing the UK, despite rates of late diagnosis being on the decline. In 2017, 428 people died from AIDS-related illnesses due to being diagnosed late. Nevertheless, the number of people diagnosed with AIDS-defining illnesses is declining and fell by 25% from 2015 to 2016.

 

Counselling

Patients identified as being at high-risk for HIV or those with concerns should be offered more in-depth discussion or counselling, in addition to a test. A brief pre-test discussion, explaining that routine HIV testing is recommended, is appropriate, with the aim of obtaining informed verbal consent.

 

Other methods to increase the uptake of testing

The Department of Health recommendation is that patients who come from countries where prevalence of HIV infection is high (>0.5%), all adults presenting to the emergency department in the UK should be tested (with consent). Also, all new patients registering at a GP should be tested. Testing in other outpatient departments, e.g. colposcopy and dermatology should also be carried out.

All patients attending sexual health clinics should be offered a HIV test on an ‘opt-out’ basis, and an information leaflet should be used to increase uptake of HIV antibody testing.

 

The future

Not too long ago, a diagnosis of HIV and AIDS was considered to be a death sentence. This has fortunately changed over the past decade, owing to significant progress made in the provision of antiretroviral treatment and gradual upliftment of the stigma that is attached to the condition.

Progress is still to be made, however, as late diagnosis rates continue to be high. People living with an undiagnosed infection have worse health outcomes and pose a public health risk as they are more likely to pass the virus on to others. Homosexual men and black Africans are still at a heightened risk of HIV. Further, the younger generation has lost some fear of HIV because of the success of treatment, causing them to engage in risky behaviours. These issues can be rectified by narrowing the gaps in HIV prevention and education schemes.

If you have any concerns or questions, you can get help from sexual health clinics, charities, or your GP.

Obesity is a very important public health problem. The rates are now very high, with over 25% of the UK population and 33% of the US population classified as obese.

Want firmer, smoother skin and a brighter complexion? Try these top 10 anti-ageing foods.

Charcoal? Either I’m missing something or the world’s losing the plot. Because it’s usually the latter, I decided to write this article to rectify the issue.

Cardiovascular diseases are the leading cause of death worldwide. According to the World Health Organisation (WHO), an estimated 17.7 million people died from cardiovascular diseases in 2015, representing a third of all global deaths.

Most of us think that if we do not smoke, do not carry extra baggage around the waist, we’ll keep our heart in good health. In a way, we are right, since smoking is a major cause of heart disease (estimated to account for about 20% of all cardiovascular death), and obesity is linked to several factors that increase the risk of coronary artery disease and stroke.

However, there are many other habits that can damage the heart – habits that are so mundane, they are often overlooked. Some habits are plainly obvious, such as eating too much fat, sugar and salt, not exercising, and neglecting regular health check-ups.

It is worth reviewing your everyday habits and learning how you can reduce your risks to prevent heart disease.

 

 

Get more sleep

A study showed that people who slept less than 6 hours each night were 79% more likely to develop coronary heart disease than those who slept up to 8 hours. Sleeping reduces blood pressure, and those who do not sleep enough are more likely to have hypertension. Experts also point out that the quality of sleep also matters. People who snore loudly are more likely to have sleep apnoea, a disorder in which breathing stops and starts repeatedly during sleep, and often without knowing it.

 

 

 

 

 

 

 

Laugh more

When we are stressed, our body secretes adrenaline and cortisol. This increases the rate and force of cardiac contractions and narrows the arteries – a dangerous combination for heart health. In addition to stress, anger and depression can also negatively affect the cardiovascular system. The antidote? Laughter. Interestingly, laughing relaxes and enlarges the arteries, thus promoting cardiovascular health. There is truth in the old saying ‘laughter is the best medicine’ after all.

 

 

 

 

 

 

 

Brush your teeth (please)

Research has shown that there is a link between gum disease and heart problems. There are two main types of gum disease: gingivitis, which causes red, painful, tender gums; and periodontitis, which leads to infected pockets of germy pus. Scientists believe that bacteria collected in the gums can cause inflammation in other parts of the body. Thus, poor oral hygiene can increase the likelihood of arteriosclerosis (stiffened arteries) and thrombosis (blood clot). So, brush your teeth at least twice a day and use a mouthwash. Your family and friends may even thank you for it.

 

 

 

 

 

 

Take a break from city life

It doesn’t require a stretch of the imagination to know that the pressing and fast living conditions in a big city can overwhelm your poor heart. But stress is not the only factor. In a study published in The Lancet, researchers looked at the long-term effects of air pollution on the heart’s arteries. Poor air quality leads to accelerated plaque build-up in arteries, leading to heart disease, stroke and high blood pressure. If living in a city is unavoidable, make sure to retreat into the countryside from time to time, even if it’s only for a day or two.

 

 

 

 

 

 

Exercise flexibility

Research in Japan involving more than 500 adults has shown that people who are flexible tend to have more flexible arteries and therefore better regulation of their blood pressure. Flexibility is one of the main components of physical fitness, including cardiovascular fitness, muscular strength and endurance.

So perhaps it is not a bad idea to include yoga or Pilates in your exercise routine. This will have the added benefit of preventing exercise-induced injuries, back pain, and balance problems.

 

 

 

 

 

 

Break a sweat

While many chemical elements are essential for life, some such as arsenic, cadmium, lead, and mercury have no known beneficial effect in humans. These elements are confirmed or probable carcinogens, and they exhibit wide-ranging toxic effects on many bodily systems, including the cardiovascular system.

All people have some level of toxic metals in their bodies, circulating and accumulating with acute and chronic lifetime exposures. Research shows that sweating with heat or exercise may help to eliminate these toxic substances.

 

 

 

 

 

 

 

Sit less, move more

It can be argued that chairs are detrimental to our health. Indeed, ‘sitting is the new smoking’. According to the WHO, 60 to 85 per cent of people globally lead sedentary lifestyles (i.e. remaining seated for much of the day), making it one of the more serious yet inadequately addressed public health problems of our time. A sedentary lifestyle, along with smoking and poor diet and nutrition, is increasingly being adopted as the norm, which is resulting in the rapid rise of cardiovascular diseases, diabetes, obesity and cancer. For every 30 minutes of sitting still, be sure to walk, stretch or jog on spot for 1 to 2 minutes.

 

 

 

 

Eating meat

In a previous article, it was stated that the WHO have classified processed meats as a Class I carcinogen. It turns out that these meats, which include bacon, sausages and pepperoni, also increase the chance of having cardiovascular problems. Processed meats not only have a lot of salt, which elevates our blood pressure but large amounts of saturated fat, which contribute to chronic inflammatory diseases.

Migraines are common in both children and adults and are estimated to affect up to 10% of the population in the UK.

NHS figures show alcohol-related problems are at a record high

Alcohol is a problem – there are no two ways about it. The number of people being admitted to hospital due to problems with alcohol has hit a record high in England, new NHS figures show. It has been suggested that the swingeing budget cuts to addiction and prevention services over the recent years are the culprit.

As revealed by The Independent in August last year, spending on drug and alcohol support services across England fell by 16 per cent in the four years to 2017. According to recent figures released by Public Health England, there has been a concurrent 13 per cent rise in alcohol-related hospital admissions over the same period.

Moreover, the number of people being admitted to hospital with drink-related brain damage in Scotland is the highest it has been in ten years, according to Scottish NHS figures.

Scotland has the worst record on alcohol-related illnesses and death in the UK with hundreds of people a week – an average of twenty-two a day – being treated in hospitals.

Last year there were 661 cases of brain damage caused by excessive alcohol consumption; a regular drinking habit can cause problems with memory, learning and thinking.

 

UK guidelines

The NHS recommends that men and women drink no more than 14 units of alcohol per week. The general rule of thumb is that a pint of standard strength beer is 2 units, a pint of cider or extra strength beer is 3 units, a single shot of spirit is 1 unit, and 125 ml of wine is 1 unit. However, home measures are usually more ‘generous’.

This simple rule does not apply to stronger beers and lagers, and many wines nowadays contain 12-14% alcohol by volume and are served in glasses holding 175 ml, rather than 125 ml. The unit content of a drink can be calculated easily by realising that the percentage of alcohol by volume of any drink equals the number of units in 1 L of that drink. For example, a half-litre (500 ml) can of strong lager (8% alcohol by volume) contains 4 units, and an eighth of a litre (125 ml) glass of wine (12% alcohol by volume) contains 1.5 units. However, few people know the strengths of what they drink and the Government is being urged to introduce mandatory, bold, unit labelling on all alcoholic drink containers.

Alcohol Concern UK and Drink Wise have a handy alcoholic unit calculator to help you calculate the number of units that you consume in a week:

https://www.alcoholconcern.org.uk/unit-calculator

 

The biology of booze

Alcohol is a small molecule and thus interacts with many neurotransmitter systems in the brain. This makes its mechanism of action very different from and much more complex than other drugs such as heroin and cannabis, which influence dedicated systems of the brain.

Alcohol affects both excitatory and inhibitory neurotransmitters, rendering it both a stimulant and depressant.

Its stimulant quality comes from the release of dopamine in the ventral striatum – the region in the brain involved in reward processing. The reward centre is affected by all pleasurable activity, including everything from meeting old friends, going on holiday, winning the lottery, and drinking alcohol.

This artificially-raised dopamine gives you a false sense of satisfaction, a kind of euphoria. This encourages you to keep on drinking to release more dopamine. But of course, all counterfeit happiness come at a price: for every high, there’s an equal and opposite low. The alcohol-induced euphoria is off-set by other neurotransmitters that simultaneously enhance the feelings of depression.

Alcohol acts as a depressant by binding to GABA receptors – the major inhibitory neurotransmitter receptors in the mammalian brain. It also suppresses the release of glutamate, which would normally increase brain activity and energy levels. This is partly why we get foggy thinking, slowed reaction times, and slurred speech when under the influence.

The pathophysiology of alcoholism has come into sharper focus over the past decade. It is now well-known that alcohol consumption can increase blood pressure, damage the immune system, overtax the liver, increase the risk of several cancers, and most insidiously, impair the brain.

 

Thresholds for safer alcohol use might need lowering

The consensus now is that the risks from alcohol start from any level of regular drinking. The purported benefits of alcohol are tenuous at best. Hence, the new Department of Health and Social Care guidelines state, ‘There is no justification for recommending drinking on health grounds – nor for starting drinking for health reasons’.

A recent large study published this year in The Lancet analysed individual-participant data for alcohol use in 599,912 current drinkers in 83 prospective studies in 19 countries. The researchers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank less than this amount. The results applied equally to women and men.

Drinking more alcohol was linked to higher chances of all cardiovascular conditions except heart attacks, where it was linked to a decreased risk of 6%. However, greater risks from other causes of death outweighed any advantage that might bring.

Men who drank above the 14 units a week limit lost an average of 1.6 years. This is comparable to women who lost an average of 1.3 years.

The researchers concluded: ‘These data support adoption of lower limits of alcohol consumption that are recommended in most current guidelines’. It wouldn’t be surprising if the drinking levels recommended in this study are described as implausible and unfeasible by opponents of public health warnings on alcohol – most notably, the alcohol industry.

 

Conclusion

Things that are good in moderation can be dangerous in excess. But it is questionable that alcohol is even good in moderation. It is helpful to note that the guidelines are not purporting ‘safe’ drinking, but rather aimed at minimising the risk of illness. All alcohol consumption carries some risk.

We have all played psychological tricks to undermine conscience, self-restraint and deferred gratification. Drinking modest amounts of alcohol is fine, but let’s not fool ourselves into calling it ‘safe’.

Indeed, lower amounts are safer, and a recent study suggests minimising consumption to no more than 12.5 units per week. But our bodily cells perceive any amount of alcohol as poison – and we should too.