Heart surgery: Leicester and London hospitals can continue services

Two hospitals in Leicester and London are being allowed to continue to provide congenital heart surgery.

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Health24.com | SA health facilities fail rape survivors

Three-quarters of public health facilities in South Africa, designated to provide medical or forensic care, are unable to provide all the components of comprehensive care to survivors of sexual violence.

In addition, there are only 61 forensic nurses in the entire country and forensic nursing is still not recognised as a specialised skill by the SA Nursing Council or the health department.

Facilities unreachable

This is according to Doctors Without Borders (MSF), which released a report yesterday (29 Nov), exposing critical gaps in medical and forensic care for survivors of sexual violence.

In preparation for the report “Untreated Violence: Critical gaps in medical and clinical forensic care for survivors of sexual violence in South Africa”, MSF called all 265 facilities designated to provide care for survivors of sexual assault. A quarter of facilities were unreachable.

In total, 167 (63%) participated in the survey and the main findings include:

  • Only 43 facilities (26,7%) provide the full medical component of the comprehensive package of care.
  • Only 68 facilities (42%) reported all medical examination and treatments were available.
  • 12 facilities (7%) reported they did not provide any services for survivors of sexual violence.

Where clinical forensic services are available, they are provided exclusively by doctors in 74 of these facilities. Counselling and social assistance was not widely reportedly available. Only 27% of facilities provide access to a psychologist, while 28% are unable to provide access to a social worker.

20% do not provide the clinical forensic services that enable survivors to pursue a legal case against their attacker.

Longer-term support for survivors

MSF called on the Department of Health to “urgently address issues of access to health care for hundreds of thousands of people who each year experience sexual violence in South Africa”.

“National findings and MSF experience in North West suggest a need for more healthcare workers to be trained in caring for survivors of sexual violence,” says Cecilia Lamola, MSF forensic nurse and nurse mentor in Rustenburg. “Nurses should be trained to conduct forensic examinations with standard clinical care, and lay counsellors can be given skills to offer longer-term support for survivors,” she adds. – Health-e News.

Image credit: iStock

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Health24.com | Troubleshooting your common cycling pains

With all those moving pieces, deciphering just what’s gone awry can be tricky. So we turned to physical therapist and bike fit specialist Kevin Schmidt, owner of Pedal PT in Portland, Oregon to help us troubleshoot cycling’s most common aches and pains.

These fixes are obviously not a substitute for a professional bike fit, but they will get you off on the right foot and may help you pedal pain free.

Neck pain

Common culprit: You’re too stretched out.

Try this: If you’re experiencing neck pain, first establish what a neutral head position on the bike should feel like.

“The goal is for your shoulders to be able to make an angle of 90 degrees or slightly less between your upper arms and torso with your hands on the hoods,” says Schmidt. Anything above that, and your more forward positioned head puts stress on the upper trap muscles that support your head.

With your hands on the bars, tuck your chin in, engaging the muscles in the front of your neck and then look up.

“That motion distributes the pressure through more vertebrae, versus hinging on only one or two segments, lessening stress on the upper cervical spine,” says Schmidt.

Adjust your cockpit accordingly to maintain it. Try a shorter stem; raise your bars or lower your saddle if you tend to run it on the high side.

“People are very quick to go to the stem first, but lowering the saddle a bit narrows the cockpit and brings you closer to the bars, lessening the reach,” he says.

Hand pain

Common culprits: Too much weight on your hands and/or too much (or too little) bend in your wrists.

Try this: Level your saddle.

“The first thing I look at is the saddle tilt,” says Schmidt. “If it’s even a little nose down, you’re dumping too much body weight onto your hands. Make sure it’s level.”

Handlebars that are too low also can cause hand pain. Try a higher rise stem. Then check your wrists. They should have a slight, 10 to 15 degree back-bend, on the bars. Too little or too much can be stressful.

You can do a sight check by looking at the skin on the top of your wrists. Cock them up until you see creases or folds (that’s too far); then straighten just until the folds disappear.

Low back pain

Common culprits: Saddle too high or too low; poor core strength; mashing gears and/or too much differential between your saddle and bar height.

Try this: First check your position. If your hips are rocking side to side as you pedal, your low back is taking a beating – lower the saddle until they’re stable. If it’s too low, your knee has to come up above hip level at the top of the pedal stroke, which also can flex and stress the low back.

Next check your posture. You should aim to have a flat back with normal low-back curvature. If your spine is rounded, you’re stressing your back. Roll your pelvis forward to create a neutral spine. Adjust the cockpit of your bike to maintain that position. Often that means bringing your handlebars and saddle closer to level with each other.

“Everyone wants to look like Peter Sagan with a super high saddle and slammed stem, but they’re rounding their spines and stretching out the paraspinal muscles, which support the spine and control movement between the vertebrae,” says Schmidt. “Those muscles are like Velcro, when you stretch them too far, they can barely hold on to support you and absorb the force from your pedalling legs.”

Speaking of force from your legs, mashing a super hard gear is like doing leg presses with zero back support. Shift down and raise your cadence to take some stress off your back.

Then check your core strength. You should be able to take your hands off the bars (not while riding please) and comfortably maintain that neutral spine flexed position. If you can’t, it’s time for some bridges and deadlifts to strengthen your supporting muscles.

Groin pain

Common culprits: Saddle shape and/or saddle position.

Try this: A saddle that doesn’t fit your anatomy will be uncomfortable no matter where you sit on it. So the first check is that your saddle supports your weight on your ischial tuberosities (the hard bones you feel when you sit down) or the pubic rami (the pelvic bones further forward) not your soft tissue.

However, even the right saddle will cause pain if you’re in the wrong position, says Schmidt. “The saddle needs to be level. Nose down or nose up can shift weight and cause problems.”

A saddle position that is too high will force pressure on the perineal area, as well. Finally, too much reach to the bars can cause you to roll your pelvis forward and place weight on your sensitive tissues. Tighten your cockpit with a shorter and/or more high-rise stem.

Knee pain

Common culprits: Saddle height and/or cleat position.

Try this: Follow the old adage: If you have pain in the front of your knee, your saddle may be too low.

If you have pain in the back of your knee, it may be too high.

IT band pain in the knee (stabbing pain in the side of the knee) may also be from a saddle that’s too high.

However, a really common and often overlooked source of knee pain is cleat position, says Schmidt.

“Cleats too far forward or too far back can stress the knee joint,” he says. “We try to line up the first big toe knuckle in front of the pedal axel.”

Also check that you’re not pedalling toe down, but rather with a proper heel drop, so you use your calves as stabilisers and generate more power from your glutes and hamstrings, all of which remove stress from your knees.

Foot pain

Common culprits: Cleat position and/or shoe fit.

Try this: Check your cleats. If they’re too far forward, you’re pedalling too much with your toes, says Schmidt.

“The toe joint flexor muscles are not meant to generate force and that can lead to cramping,” says Schmidt.

Then check your shoe fit. Cycling shoes should be snug, but many riders go overboard here. “Pull the insole out of your shoe and stand on it. If your foot is spilling out all over the place, your shoes are too small and you’ll end up with compression, tingling and numbness,” he says.

Also adjust shoe closure so it is slightly snug, but not tight over the top of your foot. If your feet still hurt, you may need custom foot beds or orthotics.

This article was originally published on www.bicycling.co.za

Image credit: iStock

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Health24.com | 5 rules for weight training nutrition

Weight training is vital to build muscle mass, strengthen your bones and decrease your body fat percentage. But you should also be mindful of what you eat to reap the benefits of weight training. Make sure you are following these five nutrition tips to get the most out of your weight training.

1.       Do not skip breakfast

A healthy breakfast is important to fire up your metabolism and prevent cravings later during the day. You will also have more energy during the day and for your workout. Don’t expect your body to perform if you are not giving it the proper nutrients. Be sure to include protein in your breakfast to keep you satisfied for longer. Good examples are omelettes, cottage cheese, or plain yogurt. 

2.       Eat every three hours…

When trying to build muscle, it’s important to keep your metabolism going and not get to the point of starvation. The faster your metabolic rate, the easier you will be able to burn fat and make way for lean muscle. Regular snacking also helps with muscle repair and will give you enough energy for your weight lifting workout. Include protein with every meal, as studies have shown that it can increase your metabolism.

3.       …but be mindful of when you eat what

A balanced diet is key for any workout plan to be effective, but it’s also important to get the timing right to make your workout as beneficial as possible. Know when to eat what, and it can benefit the quality of your workout, as well as the repair and building of your muscles afterwards. Carbohydrates serve as a great source of fuel before a workout, while protein after a workout helps speed up muscle recovery and is essential for tissue growth and repair.

4.       Incorporate fresh fruits and vegetables in your meals

Fruit such as berries and leafy green vegetables like spinach are especially rich in antioxidants. Without these nutrients, your immune system is compromised and your energy levels are low. Antioxidants are chemicals important for fighting free radicals, which cause the decaying of cells. Without these antioxidants, your cells can’t rejuvenate and therefore your muscles can’t repair and build as efficiently. Another reason why fruit and vegetables are so important in a weight training diet is because they are filled with fibre that keeps you fuller and energised for longer without adding additional calories.

5.       Eat healthy fats

Not all fats are good for the body, but unsaturated fats are vital for healthy cholesterol levels and heart health. To build muscle and lose fat, it’s also important to incorporate sources of healthy fats in your diet, since eating fats keeps the body’s overall functions working and can ultimately help with fat loss. Healthy fats are also important for overall muscle build and repair, since fats assist important bodily functions that aid repair. Incorporate good fats such as nuts, seeds, olive oil, avocado and oily fish in your diet.

This article is provided through a sponsorship from Pfizer in the interests of continuous medical education. Notwithstanding Pfizer’s sponsorship of this publication, neither Pfizer nor its subsidiary or affiliated companies shall be liable for any damages, claims, liabilities, costs or obligations arising from the misuse of the information provided in this publication. Readers are advised to consult their health care practitioner for specific information on personal health matters as this is not the intention or purpose of the publication. Specific medical advice or recommendations on the clinical management of patients will not be provided by Pfizer. In this regard Pfizer does not support the use of products for off label indications, nor dosing which falls outside the approved label recommendations and readers must refer to the Package Insert of any product for full prescribing guidelines.

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