Public Health

SPECIAL SUPPLEMENT WEDNESDAY 25 JANUARY 2017

PHCC recruits 290 Qataris

Screen For Life: A year of achievements

SPONSORS

MAIN SPONSOR

Fazeena Saleem The Peninsula

Organ donation and transplant pro-gramme of Hamad Medical Corporation (HMC) saw a huge

leap recently with the success-ful first ever liver transplant from a living donor in Qatar. It has been added to the other achieve-ments including the launch of Doha International Academy for Organ Donation (DIAOD) and the number of organ donations in Qatar has gone up significantly since 2009, helping reduce the waiting time for patients need-ing transplants.

A team of surgeons at HMC performed the first liver trans-plant from a living donor since the commencement of the liver transplant in 2011.

The donor was Usama Taher Zaid, 26 years old, and he is the son of the recipient - 58-year-old Ashraf Zaid. Implanting the donated portion of the liver in the recipient’s body who suffered from liver cirrhosis took 12 hours to complete.

The donor has recovered and was discharged from hospital one week after the procedure. The recipient remained under

the care of HMC for two weeks and was then discharged.

Since the commencement of the liver transplant programme at HMC, all transplants were per-formed from deceased donors. The latest transplant takes the total number of liver transplants in Qatar to 17. Each year, between 20 and 25 patients are added to the waiting list for organ transplantation in the country.

Dr Yousef Al Maslamani, Medical Director of Hamad Gen-eral Hospital and Head of the Organ Transplant Committee at HMC, said, “The transplant was planned and performed by HMC’s highly qualified team of liver transplant surgeons, anes-thetists, nurses and technicians. The procedure consisted the par-tial resection of the donor’s liver, which took eight hours to com-plete, and the removal of the recipient’s liver.”

Over the past six years, the number of ‘deceased’ organ donations has increased eight times and ‘living’ donations 20 times as a result of continued awareness programmes.

Among the living donors, 75 percent are Qataris, said Dr Riadh Fadhil, Director, Qatar Organ Donation Center (Hiba)

during a organ donation aware-ness campaign.

Deceased donors are those who have pledged during their life to give organs to someone in need. They include cases in which the family agrees on organ donation after the person’s death. Living donors donate a kidney or part of the liver while they are alive.

“Living and deceased dona-tions are increasing. The waiting list has started to fall, which is something admirable. We have seen about a 10 percent drop every year in the waiting list for kidney and liver transplants since 2009,” Dr Fadhil said.

In 2009, about 2,000 poten-tial donors registered with the Organ Donor Registry and the number increased to 100,000 in 2015. More than 44,000 new donors signed up to Organ Donor Registry during Ramadan last year. It was more than double of the total number of donors registered in 2015.

With this, the number of peo-ple on the register, which is unique in the region, has crossed 148,000.

A donor registry is a national confidential list of people who are willing to become organ donors after their death. It can be quickly accessed in the event of a death to see whether an indi-vidual has registered their willingness to be an organ donor. This list literally saves the lives of people waiting for a viable organ.

People have the donor reg-istry are issued with a ‘donor card that they carry with them. This indicates they have

expressed a wish to be an organ donor, in the event of their death.

If someone decides to sign up to be a donor it is very important to tell the family of the wishes. They will be asked, in the event of your death, to confirm that you had not changed your mind before any donation is carried out. Losing a loved one is incred-ibly hard but donation may also help the remaining family mem-bers to cope with the loss of their loved ones.

At present, HMC conducts k i d n e y a n d l i v e r

transplant surgery. All donation and transplant surgeries are done so under the Doha Dona-tion Accord. This Accord has received endorsement from the International Society for Organ Transplantation as well as by the Istanbul Declaration Custodian Group (international experts in professional and ethical organ donation and transplantation). The aim of the Accord is to pro-tect patients and ensure the safest, most effective and truly ethical care for all.

All procedures, related to o r g a n d o n a t i o n a n d transplantation in Qatar are free of charge for all patients; both Qatari and non-Qatari citizens. There is one waiting list for organ transplantation for Qatari and non-Qatari citizens. This feature is distinct to Qatar and differentiates the program from that of other neighboring countries.

If someone is sick or injured, the number one priority of the medical team is to save the life. Organ and tissue donation can be pursued only after all efforts to save life have failed, after a person is declared dead and after the family has been consulted.

The organs to be donated are removed from the donor’s body through surgery that is done

carefully and precisely and will not disfigure the body. A traditional burial or funeral service, in accordance with the donor’s faith, is still possible.

Living donor surgery for kidney and liver transplantation is carried out through laparoscopy, which is an advanced surgical technique involving only a small incision.

No organ retrieval from a living donor will be carried out before making sure the donor’s health will not be adversely affected and there is no risk of serious consequences.

The Doha International Academy for Organ Donation (DIAOD) launched in 2016 with the aim of promoting education and research in organ donation in Qatar and internationally.

DIAOD is the world’s first international academy on organ donation.

The Academy will function under the umbrella of HMC as an additional activity of the Qatar Organ Donation Centre (Hiba) and will also support Qatar to achieve self-sufficiency in organ donation and transplant.

The new academy aims eventually to become a hub for resources and training required to assist other countries to establish their own programmes.

Huge leap in organ donation and transplant

Dr Riadh Fadhil, Director, Qatar Organ Donation Center (Hiba), with HMC staff during an organ donation campaign.

Organ donation is an invaluable gift to those in pain and suffering from organ failure.

The number of organ donations in Qatar has gone up significantly since 2009, helping reduce the waiting time for patients needing transplants. Each year, between 20 and 25 patients are added to the waiting list for organ transplantation in the country.

If someone decides to sign up to be a donor it is very important to tell the family of the wishes. They will be asked, in the event of your death, to confirm that you had not changed your mind before any donation is carried out.

ACTING MANAGING EDITORMohammed Salim Mohamed

SUPPLEMENT EDITORHussain Ahmad

CHAIRMANSheikh Thani bin Abdullah Al Thani

EDITOR-IN-CHIEFDr. Khalid Mubarak Al-Shafi

IMAGE PROCESSINGMohd Sajad Sahir

SUPPLEMENT COORDINATORAhmed Eltigani Idris

DESIGNAbraham Augusthy

PRODUCTIONViswanath Sarma

PAGE | 2 PAGE | 6

خط حيـــــاك المبـــاشر لتوفيـــر المعلومات وتقديم المساعدة Primary Health Care Corporation Hayyak Helpline

خط واحد لجميع مراكزنا One line for all PHCC Centers

خمس لغـات لخدمتكـمFive Languages at your service

سبــع أيــــام با�سـبـــوععـلـــى مــدار الســاعــــة

7 days, 24 hours

ثالث خدمات المـواعيد, المعلومات, المساعدة

Three ServicesAppointments, Information &

Assistance

Public Health

WEDNESDAY 25 JANUARY 2017

2

PHCC recruits 290 QatarisP

HCC announced the employ-ment of 290 Qataris for different positions in the cor-poration as part of the job nationalisation programme of

the government. Musallam Al Nabit, Managing Direc-

tor Assistant for Administrative and Financial Affairs in PHCC, welcomed the new employees during an induction meeting at the Ministry of Public Health, he commented “the recruitment of Qatari’s is a key provision in the local nationalization program designed to develop our local working force to ensure delivery of excellent healthcare across PHCC. We are delighted to attract such a high number of skilled locals with the determination to drive forward health-care development in the country”

Al Nabit added, “Primary Healthcare has developed various professional ini-tiative to attract and recruit a knowledgeable workforce with a vision of providing promising career opportu-nities and further inspiring Qatari leadership in the health and medical sector.”

Joint working initiatives between the Minister of Administrative Development, Labor and Social Affairs and PHCC are focused on advancing Qatar’s local work-force to achieve sustainable development in support of the Qatar National Vision

2030. Mrs. Al Anoud Al Neami- Manager of

Personnel Affairs Department at PHCC highlighted that PHCC is committed to providing the necessary professional support to all Qatari employees by pre-senting them with relevant opportunities in the health sector in which they can excel and offering professional develop-ment support through training, mentoring and educational programs.

One of the new PHCC employees Khaled Jaber Al Qashouti commented, “I have chosen to work for PHCC in order

to support the efforts to improve access to healthcare for the citizens of Qatar and to contribute to PHCC becoming a source of excellent healthcare for all”

Amal Yahya Ali, one of the new employees, also expressed her delight in

joining the PHCC fam-ily and her eagerness to play an active role in ensuring that Qatar’s cit izens receive the best in pri-mary care.

Dr Samya Al Abdulla, Execu-tive Director of Operation Department in PHCC,

revealed the launch of the pilot operation SMART, a preventive medicine and screening service that was showcased at The World Innovation Summit for Health back in November 2016. SMART health checks proactively invite the com-munity to attend screening and health maintenance appointments to ensure targeted support is pro-vided to individuals to prevent and manage risks for long-term health conditions such as diabetes, hyper-tension, endocrine or cancer.

SMART will be operating as a pilot service in Leabaib and Raw-dat Al Khaial Health Centres. The primary objective of the SMART Checkup is to act as a gateway into the full range of primary health care services on offer at PHCC and support the popula-tion of Qatar to take steps to maintain or improve their health.

The Checkup includes a range of preventative screening for com-mon diseases in the country such as diabetes and hypertension and is designed to help with early diag-nosis and treatment. It focuses on identifying common risk factors for ill health so that patient can be sup-ported to adopt a healthier lifestyle to avoid becoming ill in the future by accessing PHCC’s preventative care services, such as wellness services.

During the pilot period, tar-geted patients will be those that are believed to be at risk of

developing common diseases. The patients will be invited to attend the 20 minute appointment to establish patients medical and fam-ily history, they will be referred to complete the SMART health check which includes a series of medical tests before being transferred to a specialists should this be required to encourage early treatment.

Currently this service will only be available to Qatari nation-als, aged 18 and above and registered at either Leabaib or Rawdat Al Khail health centers. In the longer term, PHCC plans to open the service up to all reg-istered clients across Health Centers in Qatar.

Dr Samya said, “SMART serv-ice is in line with PHCC’s pledge to drive forward the national vision for healthcare develop-ment in Qatar by providing excellence in health care services to its citizens. SMART will sup-port the national public health strategy, which incorporates dis-ease prevention, early detection and surveillance and promotion of healthy behaviours. We are delighted to launch the SMART service pilot operation at Leabaib and Rawdat Al Khaial Health Centers, a comprehensive health check that will play a vital role in encouraging citizens to adopt a healthy lifestyle and aim at tack-ling preventative diseases through early diagnosis. We look forward to expanding access to this service to all our health centers.”

SMART: Preventative medicine & screening service launched

Recruitment of Qataris is a key provision in the local nationalisation programme designed to develop our local working force to ensure delivery of excellent healthcare across PHCC. We are delighted to attract such a high number of skilled locals with the determination to drive forward healthcare development in the country” Musallam Al Nabit

Public Health

WEDNESDAY 25 JANUARY 2017

3

Saudi delegation visits Umm Salal Health Centre E

ngineer Abdul Aziz bin Saleh Al Saloum, Direc-tor of Business Environment Develop-ment at the Ministry of

Health Saudi and several high ranking healthcare officials from Saudi visited primary healthcare’s Umm Salal Health Centre.

Dr Mariam Abdulmalik, Man-aging Director of Primary Healthcare, welcomed the dele-gation, accompanying them on a tour of the center. The visit fol-lows collaborations between Qatar and Saudi to discuss and share ways to enhance coopera-tion in the field and facilitate exchange of know-how, man-power and expertise, specifically with regards to health and

wellness services in which Qatar is the first country in the region to offer these services in accord-ance with international health standards.

Dr Mariam provided an over-view of the service at Um Salal health center, highlighting the center’s medical facilities with a guided tour of the health and wellness center, radiology, phar-macy, laboratory, dental and specialist clinics. The delegation were also briefed on the work place mechanisms and electronic systems in place used to improve patient experience.

Abdul Aziz bin Saleh-Direc-tor of Business Environment Development Department in the Saudi Ministry of Health praised

the country's excellent quality in medical facilities and highlighted that this visit follows the drive of the Health Ministry in Saudi to create effective communication channels with the Health Minis-try in Qatar, enabling both countries to successfully share industry knowledge. Emphasiz-ing that Qatar’s development experience will be of great value to primary Care in Saudi.

Abdul Aziz bin Saleh extended his appreciation to the Ministry of Public Health and to the Man-aging Director of PHCC for the warm reception and hospitality.

The visit comes as part of the Health Centers Development Project framework in the King-dom of Saudi Arabia

Public Health

WEDNESDAY 25 JANUARY 2017

6

The Primary Health Care Corporation (PHCC), the main provider of primary healthcare services across the

State of Qatar, has pledged to continue its drive in educating the local population about early can-cer screening as it marks its first anniversary.

Celebrating 12 months after being appointed to implement the national Breast and Bowel Screening Program, ‘Screen for Life’, initiated by the Ministry of Public Health under Qatar’s National Cancer Program in accordance with the country’s National Health Strategy 2011-2016, PHCC has declared that it will drive further over the course of 2017.

“During our first year, the ‘Screen for Life’ Program has achieved some significant mile-stones as part of our drive and effort to encourage a great number of people to undertake screening. I am proud of what we have accomplished so far in our mission,” Dr. Mariam Ali Abdul-malik, Managing Director of Primary Health Care Corporation, said.

“We started planning a

wealth of engagement activities and initiatives to build on for year 2017 and I look forward to greater milestones being met in this new year.”

In recent months PHCC marked the inauguration of its third screening facility, marking the expansion of its reach to Qatar’s wider community. The screening suite in Rawdat Al Khail Health Center follows that of the Leabaib Health Centre and Al Wakra Health Center, which both opened earlier in 2016.

Among the key achievements marked by the program was the launch of Qatar’s first Mobile Screening Unit. Designed to offer breast screening services, the traveling suite has been utilized during various events and pro-motional activities to enhance outreach work and offer screen-ing and guidance to a multitude of communities across the country.

Facilitating enquiries and appointments, PHCC set up the 'Screen for Life' Call Center, designed to not only receive calls, but also to proactively reach out to individuals to make a screen-ing. From its start of operations in February 2016 to December

Screen For Life: A year of achievementsScreen For Life marks its first anniversary with a pledge to continue its cancer screening awareness efforts into 2017.

2016, the call center made breast and bowel screening 66,209 outgoing calls, with 38,431 invited for screening. These numbers con-tinue to grow through the dedicated efforts of our team.

Throughout the course of the year, PHCC’s ‘Screen for Life’ program has par-ticipated in a number of lectures, conferences, and seminars through strate-gic partnerships with education institutes,

corporate entities and government bodies. Public activation booths were also a key part of its marketing efforts with a presence within leading shopping malls and public walks or charity events.

Exercise in almost any form can act as a stress reliever. Being active can boost your feel-good endorphins and distract you from daily

worries.You know that exercise does your

body good, but you're too busy and stressed to fit it into your routine. Hold on a second — there's good news when it comes to exercise and stress.

Virtually any form of exercise, from aerobics to yoga, can act as a stress reliever. If you're not an athlete or even if you're out of shape, you can still make a little exercise go a long way toward stress management. Dis-cover the connection between exercise and stress relief — and why exercise should be part of your stress management plan.

Exercise and stress reliefExercise increases your overall

health and your sense of well-being, which puts more pep in your step every day. But exercise also has some direct stress-busting benefits.

It pumps up your endorphins: Physical activity helps bump up the production of your brain's feel-good neurotransmitters, called endorphins. Although this function is often referred to as a runner's high, a rousing game of tennis or a nature hike also can contribute to this same feeling.

It's meditation in motion: After a fast-paced game of racquetball or sev-eral laps in the pool, you'll often find that you've forgotten the day's irrita-tions and concentrated only on your body's movements.

As you begin to regularly shed your daily tensions through move-ment and physical activity, you may find that this focus on a single task, and the resulting energy and opti-mism, can help you remain calm and clear in everything you do.

It improves your mood: Regular exercise can increase self-confidence, it can relax you, and it can lower the symptoms associated with mild depression and anxiety. Exercise can also improve your sleep, which is often disrupted by stress, depression and anxiety. All of these exercise ben-efits can ease your stress levels and give you a sense of command over your body and your life.

A successful exercise program begins with a few simple steps.

Consult with your doctor: If you haven't exercised for some time and you have health concerns, you may want to talk to your doctor before starting a new exercise routine.

Walk before you run: Build up your fitness level gradually. Excite-ment about a new program can lead to overdoing it and possibly even injury.

For most healthy adults, the Department of Health and Human Services recommends getting at least 150 minutes a week of moderate aer-obic activity (such as brisk walking or

swimming) or 75 minutes a week of vigorous aerobic activity (such as run-ning). You also can do a combination of moderate and vigorous activity.

Also, incorporate strength train-ing exercises at least twice a week.

Do what you love: Virtually any form of exercise or movement can increase your fitness level while decreasing your stress. The most important thing is to pick an activity that you enjoy. Examples include walking, stair climbing, jogging, bicy-cling, yoga, tai chi, gardening, weightlifting and swimming.

Pencil it in: Although your sched-ule may necessitate a morning workout one day and an evening activity the next, carving out some time to move every day helps you make your exercise program an ongo-ing priority.

Stick with itStarting an exercise program is

just the first step. Here are some tips for sticking with a new routine or reinvigorating a tired workout:

Set SMART goals: Write down SMART goals — specific, measurable, attainable, relevant and time-limited goals.

If your primary goal is to reduce stress in your life and recharge your batteries, your specific goals might include committing to walking dur-ing your lunch hour three times a week or, if needed, finding a baby sit-ter to watch your children so that you can slip away to attend a cycling class.

Find a friend: Knowing that someone is waiting for you to show up at the gym or the park can be a powerful incentive. Working out with a friend, co-worker or family mem-ber often brings a new level of motivation and commitment to your workouts.

Change up your routine: If you've always been a competitive runner, take a look at other less competitive options that may help with stress reduction, such as Pilates or yoga classes. As an added bonus, these

kinder, gentler workouts may enhance your running while also decreasing your stress.

Exercise in increments: Even brief bouts of activity offer benefits. For instance, if you can't fit in one 30-minute walk, try three 10-minute walks instead. Interval training, which entails brief (60 to 90 seconds) bursts of intense activity at almost full effort, is being shown to be a safe, effective and efficient way of gain-ing many of the benefits of longer duration exercise. What's most important is making regular physi-cal activity part of your lifestyle.

Whatever you do, don't think of exercise as just one more thing on your to-do list. Find an activity you enjoy — whether it's an active tennis match or a meditative meander down to a local park and back — and make it part of your regular routine. Any form of physical activity can help you unwind and become an important part of your approach to easing stress.

How exercise reduces stress As you begin to regularly shed your daily tensions through movement and physical activity, you may find that this focus on a single task, and the resulting energy and optimism, can help you remain calm and clear in everything you do.

Public Health

WEDNESDAY 25 JANUARY 2017

7

Living with someone with depression?

Living with someone with depression can be difficult. Here are some tips on what you can do to help someone you live with who is

depressed, while taking care of yourself at the same time.

What you should knowP Depression is an illness and not a character

weakness.P Depression can be treated. What treatment is best

and how long the depression lasts depend on the severity of the depression.

P The support of carers, friends and family facili-tates recovery from depression. Patience and perseverance is needed, as recovery can take time.

P Stress can make depression worse.

What you can do for peoplewho are depressedP Make it clear that you want to help, listen with-

out judgement, and offer support.P Find out more about depression.P Encourage them to seek professional help when

available. Offer to accompany them to appointments.

P If medication is prescribed, help them to take it as prescribed. Be patient; it usually takes a few weeks to feel better.

P Help them with everyday tasks and to have reg-ular eating and sleeping patterns.

P Encourage regular exercise and social activities.

P Encourage them to focus on the positive, rather than the negative.

P If they are thinking about self-harm, or have already intentionally harmed themselves, do not leave them alone. Seek further help from the emergency services or a health-care professional. In the meantime, remove items such as medica-tions, sharp objects and firearms.

P Take care of yourself too. Try to find ways to relax and continue doing things you enjoy.

Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different

from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.

Types and symptomsDepending on the number and

severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.

A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.

Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Diagnosis andtreatment

There are effective treatments for moderate and severe depression. Health care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

WHO responseDepression is one of the

priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. The Programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives – even where resources are scarce.

Coping with andovercoming depression

Depression: What you should know

If you think you, or someone you know, might be suf-fering from depression, read on.

What is depression?Depression is an illness characterized by persistent

sadness and a loss of interest in activities that you nor-mally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.

In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concen-tration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.

Something that can happen to anybody.Not a sign or weakness.Treatable, with talking therapies or antidepressant med-

ication or a combination of these.

What you can do if you think you are depressed

P Talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.

P Seek professional help. Your local health-care worker or doctor is a good place to start.

P Remember that with the right help, you can get better.

P Keep up with activities that you used to enjoy when you were well.

P Stay connected. Keep in contact with family and friends.P Exercise regularly, even if it’s just a short walk.P Stick to regular eating and sleeping habits.P Accept that you might have depression and adjust your

expectations. You may not be able to accomplish as much as you do usually.

P Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.

P If you feel suicidal, contact someone for help immediately.

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression.

Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition.

Public Health

WEDNESDAY 25 JANUARY 2017

8

A fever -- also known as a high fever or a high temperature -- is not by itself an illness. It's usually a

symptom of an underlying con-dition, most often an infection.

Fever is usually associated with physical discomfort, and most people feel better when a fever is treated. But depending on your age, physical condition, and the underlying cause of your fever, you may or may not require medical treatment for the fever alone. Many experts believe that fever is a natural bodily defense against infection. There are also many non-infectious causes of fever.

Fever is generally not con-sidered dangerous, but hyperthermia can cause danger-ous rises in body temperature. This can be due to an extreme temperature associated with heat injury such as heat stroke, side effects of certain medications or illicit drugs, and stroke. With hyperthermia, the body is no longer able to control body temperature.

In children with fever, accompanying symptoms such as lethargy, fussiness, poor appe-tite, sore throat, cough, ear pain, vomiting, and diarrhea are important to relay to your

doctor.According to the American

Academy of Paediatrics, if you have an infant younger than 4 months old with a rectal temper-ature of 100.4 F or above, you should immediately call your doctor or go to an emergency room, because it could be a sign of a potentially life-threatening infection. Also call your doctor

or go to the emergency room if any child has a fever above 104 F. High fever can cause seizures in young children.

Call your doctor right away if your child has a fever and:

P Looks very sickP Is drowsy or very fussyP Has a weakened immune sys-

tem or other medical

problemsP Has a seizureP Has other symptoms such as

rash, sore throat, headache, stiff neck, or earache

Call the doctor if the fever lasts more than 1 day in a child less than 2 years old or lasts more than 3 days in a child age 2 or older.

Causes of FeverA part of the brain called the

hypothalamus controls body temperature, which usually var-ies throughout the day from the normal temperature of 98.6 F.

In response to an infection, illness, or some other cause, the hypothalamus may reset the body to a higher temperature.

Although the most common causes of fever are common infections such as colds and gas-troenteritis, other causes include:

P Infections of the ear, lung, skin, throat, bladder, or kidney

P Conditions that cause inflammation

P Side effects of drugsP CancerP Vaccines

Other causes of fever include:

P Blood clotsP Autoimmune diseases such as

lupus, rheumatoid arthritis, and inflammatory bowel disease

P Hormone disorders such as hyperthyroidism

P Illegal drugs such as amphet-amines and cocaine

Diagnosis of FeverAlthough a fever is easy to

measure, determining its cause can be hard. Besides a physical exam, your doctor will ask about symptoms and conditions, med-ications, and if you've recently traveled to areas with infections or have other infection risks. A malaria infection, for example, may be have a fever that typi-cally recurs. Some areas of the US are hotspots for infections such as Lyme disease and Rocky Mountain spotted fever.

Sometimes, you may have a "fever of unknown origin." In such cases, the cause could be an unusual or not obvious con-dition such as a chronic infection, a connective tissue disorder, can-cer, or another problem.

Treatments for FeverTreatments vary depending

on the cause of the fever. For example, antibiotics would be used for a bacterial infection such as strep throat.

The most common treat-ments for fever include over-the-counter drugs such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs such ibuprofen (Advil, Mot-rin) and naproxen (Aleve). Children and teens should not take aspirin because it's linked to condition called Reye’s syndrome.

Fever is not an illness, but a symptom

Many parents have false beliefs (myths) about fever. They think fever will hurt their child. They worry and lose

sleep when their child has a fever. This is called fever phobia. In fact, fevers are harm-less and often helpful. Let these facts help you better understand fever.

MYTH: My child feels warm, so she has a fever.

FACT: Children can feel warm for a many reasons. Examples are playing hard, crying, getting out of a warm bed or hot weather. They are "giving off heat". Their skin tem-perature should return to normal in 10 to 20 minutes. About 80% of children who act sick and feel warm do have a fever. If you want to be sure, take the temperature. These are the cutoffs for fever using different types of thermometers:

Rectal, ear or forehead temperature: 100.4° F (38.0° C) or higher

Oral (mouth) temperature: 100° F (37.8° C) or higher

Under the arm (Armpit) temperature: 99° F (37.2° C) or higher

MYTH: All fevers are bad for children.FACT: Fevers turn on the body's immune

system. They help the body fight infection. Normal fevers between 100° and 104° F (37.8° - 40° C) are good for sick children.

MYTH: Fevers above 104° F (40° C) are dangerous. They can cause brain damage.

FACT: Fevers with infections don't cause brain damage. Only temperatures above 108° F (42° C) can cause brain damage. It's very rare for the body temperature to climb this high. It only happens if the air temperature is very high. An example is a child left in a closed car during hot weather.

MYTH: Anyone can have a seizure trig-gered by fever.

FACT: Only 4% of children can have a seizure with fever.

MYTH: Seizures with fever are harmful.

FACT: These seizures are scary to watch, but they stop within 5 minutes. They don't cause any permanent harm. They don't increase the risk for speech delays, learning problems, or seizures without fever.

MYTH: All fevers need to be treated with fever medicine.

FACT: Fevers only need to be treated if they cause discomfort. Most fevers don't

cause discomfort until they go above 102° or 103° F (39° or 39.5° C).

MYTH: Without treatment, fevers will keep going higher.

FACT: Wrong, because the brain has a thermostat. Most fevers from infection don't go above 103° or 104° F (39.5°- 40° C). They rarely go to 105° or 106° F (40.6° or 41.1° C). While these are "high" fevers, they also are harmless ones.

MYTH: With treatment, fevers should come down to normal.

FACT: With treatment, most fevers come down 2° or 3° F (1° or 1.5° C).

MYTH: If you can't "break the fever", the cause is serious.

FACT:. Fevers that don't come down to normal can be caused by viruses or bacte-ria. The response to fever medicines tells us nothing about the cause of the infection.

MYTH: Once the fever comes down with medicines, it should stay down.

FACT: It's normal for fevers with most viral infections to last for 2 or 3 days. When the fever medicine wears off, the fever will come back. It may need to be treated again. The fever will go away and not return once the body overpowers the virus. Most often, this is day 3 or 4.

MYTH: If the fever is high, the cause is serious.

FACT: If the fever is high, the cause may or may not be serious. If your child looks very sick, the cause is more likely to be serious.

MYTH: The exact number of the temper-ature is very important.

FACT: How your child looks is what's important. The exact temperature number is not.

MYTH: Oral temperatures between 98.7° and 100° F (37.1° to 37.8° C) are low-grade fevers.

FACT: These temperatures are normal. The body's normal temperature changes throughout the day. It peaks in the late afternoon and evening. A true low-grade fever is 100° F to 102° F (37.8° - 39° C) .

SUMMARY. Keep in mind that fever is fighting off your child's infection. Fever is one of the good guys.

Fever is an elevated temper-ature of the human body that is substantially beyond

the normal range. Normal body temperature fluctuates daily from about one degree below 98.6 degrees Fahrenheit to one degree above that number. Lower body temperatures usu-ally occur before dawn; higher temperatures in the afternoon.

Body temperature also var-ies slightly depending on where on the human body it is meas-ured. Rectal (internal) temperature tends normally to be higher than skin (surface) temperature. Oral and armpit temperatures can approximate actual body temperature and are more convenient to measure.

The presence of a fever is usually related to stimulation of the body's immune response. Fever can support the immune system's attempt to gain advan-tage over infectious agents, such as viruses and bacteria, and it makes the body less favorable as a host for replicating viruses and bacteria, which are temper-ature sensitive. Infectious agents are not the only causes of fever, however. Amphetamine abuse and alcohol withdrawal can both elicit high temperatures,

for example. And environmen-tal fevers--such as those associated with heat stroke and related illnesses--can also occur.

The hypothalamus, which sits at the base of the brain, acts as the body's thermostat. It is triggered by floating biochem-ical substances called pyrogens, which flow from sites where the immune system has identified potential trouble to the hypoth-alamus via the bloodstream. Some pyrogens are produced by body tissue; many pathogens also produce pyrogens. When the hypothalamus detects them, it tells the body to generate and retain more heat, thus produc-ing a fever. Children typically get higher and quicker fevers, reflecting the effects of the pyro-gens upon an inexperienced immune system.

Should one eat little or noth-ing while feverish, as the saying "Feed a cold, starve a fever" sug-gests? Yes. The reasons for this are threefold. First, during fever, all the body's functions are occurring amidst increased physiologic stress. Provoking digestion during physiologic stress over stimulates the para-sympathetic nervous system

when the sympathetic nervous system is already active. Second, it is possible that the body could misinterpret some substances absorbed from the gut as aller-gens during a fever. Finally, excessive fever can, on rare occasions, cause seizures, col-lapse and delirium--all of which may be further complicated by recent eating.

Fever can help fight infec-tion, but sometimes it can climb too high for the body's own good. Internal body tempera-tures in excess of 105 degrees F, for instance, expose proteins and body fats to direct temper-ature stressors. This form of heat distress can threaten the integ-rity and function of proteins accustomed to the body's usual temperature variations and the occasional less excessive fevers. Cellular stress, infarctions, necrosis, seizures and delirium are among the potential conse-quences of prolonged, severe fevers. The receptor environ-ment at the hypothalamus maintains limitations on high fevers. In the rare instances in which the hypothalamus itself malfunctions, the result is typ-ically low body temperature, not elevated body temperature.

If you have an infant younger than 4 months old with a rectal temperature of 100.4 F or above, you should immediately call your doctor or go to an emergency room, because it could be a sign of a potentially life-threatening infection.

Fever: Myths versus facts

What causes a fever?