What is irritable bowel syndrome (IBS)? IBS is a condition that involves recurrent abdominal pain as well as abnormal bowel motility, which can include diarrhea and/or constipation.

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Risk factors are things that increase the chance that a person will develop a certain disease. Lots of these are lifestyle choices that we make everyday. Learn the links you need to know, and how disease can affect society at large.

Read the full research online:http://www.bmj.com/content/347/bmj.f6398

Lucy Chappell and colleagues identify certain lifestyle factors that make it more likely for a woman to have a normal pregnancy.

They include increasing fruit intake before pregnancy, being a healthy weight, reducing blood pressure, stopping drug and alcohol misuse, and being in paid employment during pregnancy.

Although further work is needed to determine whether these associations have causal importance, this study implies that targeted interventions that encourage women to make healthy choices before and during pregnancy “may increase the likelihood of normal pregnancy outcomes,” write the authors.

Previous research has focused on the association between risk factors and subsequent adverse pregnancy outcomes, but little is known about factors associated with subsequent healthy pregnancies.

Researchers from the UK, Ireland and New Zealand therefore carried out a study to identify factors at 15-20 weeks’ gestation associated with a subsequent uncomplicated pregnancy. Their aim was to highlight those factors amenable to change before pregnancy, thereby informing decisions about interventions that could increase the likelihood of a normal outcome.

A total of 5,628 healthy women with singleton births (and no previous pregnancies) were recruited to the Screening for Pregnancy Endpoints study between November 2004 and August 2008 (3196 from Australia and New Zealand and 2432 from the UK and Ireland).

The primary outcome was uncomplicated pregnancy defined as a “normotensive pregnancy, delivered at more than 37 weeks resulting in a live born baby who was not small for gestational age and did not have any other significant pregnancy complications”.

Of the 5,628 women, 3,452 (61%) had an uncomplicated pregnancy. A lower proportion of women in the UK and Ireland had an uncomplicated pregnancy (58%) compared with women in Australasia (63%).

The most common reasons for a complicated pregnancy in the mother were gestational hypertension (8%) and pre-eclampsia (5%) and in babies was being small for gestational age (11%) and spontaneous preterm birth (4%).

Factors amenable to improvement that reduced the likelihood of an uncomplicated pregnancy (that is, were detrimental) were increasing body mass index and blood pressure and misuse of drugs (including binge drinking) in the first trimester.

Factors amenable to improvement that increased the likelihood of an uncomplicated pregnancy (that is, were beneficial) were high fruit intake in the month before pregnancy and being in paid employment 15 weeks into pregnancy.

Detrimental factors that could not be altered were being in a lower socio-economic group, high blood pressure before pregnancy while taking oral contraceptive pills, family history of high blood pressure in pregnancy and bleeding during pregnancy.

Lifestyle recommendations already exist for non-hypertensive people to optimise their blood pressure through physical exercise, weight reduction, limiting salt intake and alcohol consumption, and consuming a healthy diet, explain the authors. “Our study suggests that adoption of these choices seems to be beneficial in determining uncomplicated pregnancy.”

For example, a 5 mm Hg reduction of maternal systolic blood pressure would increase the proportion of uncomplicated pregnancies by 3% equating to 24,674 more UK women having an uncomplicated pregnancy. They say, however, that this requires demonstration in a randomised controlled trial.

They point to a “growing interest” in promotion of health and normality, rather than a focus on adverse outcomes and say that, if confirmed, “this study should inform development of interventions to increase normal pregnancy outcomes.”

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(USMLE topics) Crohn disease: pathophysiology, symptoms, causes, risk factors, complications, diagnosis and treatments. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/digestive-diseases/-/medias/47f8d399-6671-487c-909c-2ed1eb5b6a77-crohn-s-disease-narrated-animation
Voice by: Ashley Fleming
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All images/videos by Alila Medical Media are for information purposes ONLY and are NOT intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition.
Crohn’s disease is one of the 2 major forms of inflammatory bowel disease. Inflammation caused by Crohn’s disease may affect any parts of the gastrointestinal tract, but it most commonly involves the end of the small bowel, the ileum, and the beginning of the colon. The inflammation is not continuous, inflamed segments are usually interrupted by normal healthy tissues.
Most people experience recurrent flares, when the disease is active, followed by symptom-free periods of remission.
Symptoms may differ depending on the parts of the digestive tract that are affected. Most common signs include diarrhea, abdominal pain and tenderness, loss of appetite, weight loss, fatigue and fever. Blood in stools occurs when the colon is involved; nausea and vomiting are usually the signs that the stomach or the first part of the small intestine is affected. About one third of patients present with perianal disease, including abscess, fistulas and ulcers. The disease also often manifests outside the intestine, especially in the joints, skin, and eyes.
Inflammation in Crohn’s disease extends to the entire thickness of the intestinal wall. Deep lesions in the mucosa often alternate with areas of mucosal swelling, creating a characteristic cobblestoned appearance. Extensive inflammation may cause thickening of the bowel wall and hypertrophy of the mesenteric fat that wraps around the intestine (creeping fat). Intestinal wall thickening, together with scar formation, may block the flow of digestive content, leading to bowel obstruction. Ulcers can extend through the bowel wall and form tunnels, called fistulas, which may connect to other loops of the intestine, to abdominal organs, muscles and even skin. A fistula may become infected and form abscesses, which can be life-threatening if not treated. In the long-term, Crohn’s disease may increase risks for colon cancers.
The disease has a major peak of onset between the age of 20 and 30, and a smaller peak later in life. White individuals, people with family history, and smokers are at higher risks.
The exact mechanism of Crohn’s disease is not fully understood, but it likely involves both genetic and environmental factors. Multiple genes are identified, most of which act in the immune system, or in maintaining the gastrointestinal epithelial barrier. This barrier separates the gut content from the underlying immune system, preventing the body from reacting to dietary antigens and resident bacteria of the gut. A crack in the barrier may increase the chance that the immune system overreacts to non-pathogenic antigens from the gut content.
Involvement of environmental factors is evidenced by higher disease incidence in developed countries, especially urban areas.
Diagnosis is made based on a combination of tests and imaging procedures.
Treatments start with dietary management to maintain good nutrition but avoid foods that may exacerbate symptoms. Some patients may benefit from nutrition therapy, a special diet given via a feeding tube or injected into a vein. The therapy provides nutrition while allowing the bowel to rest, reducing inflammation.
A number of medications can be prescribed depending on disease severity and the patient’s response to different drugs. These may include: antidiarrheals, anti-inflammatories, antibiotics, corticosteroids, immunomodulators and biologics.
Abscesses and fistulas are drained and treated with antibiotics.
Nearly half of patients require at least one surgery to manage recurrent intestinal obstructions or complicated fistulas or abscesses. Surgical removal of the diseased parts of the bowel may improve symptoms temporarily, but is not a cure, because the disease is likely to recur, usually near the reconnected tissue.
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Crohn’s disease is difficult to diagnose, because the symptoms overlap with other diseases. Physicals, x-rays, colonoscopies and biopsies aid in diagnosis.
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This training resource is now available for FREE UK delivery:
https://www.bvs.co.uk/risk-assessment-for-health-safety-in-the-care-home
Risk assessments are a legal requirement under the Management of Health and Safety at Work Regulations. This video will show managers and staff how to carry out effective health and safety risk assessments in the care home. Learn how to identify the hazards and risks; evaluate the risks; record existing control measures; evaluate the adequacy of control measures; implement additional controls; review the risk assessments and control measures. Staff, residents and general building assessments are all examined.

Subjects covered include:

Identify the Hazards
Observation
Consultation
Hazard Reporting
Identify Who is at Risk
Evaluate the Risks
Evaluate the Severity of the Hazard
Record your Findings
Review and Revise the Assessments
Generic Assessments
Staff Assessments
Resident Assessments
Case Study and Results
Summary

Video Format:
DVD or Download

Duration:
24 minute video in 16 sections to be used in a suggested 3 hour training session

Supporting Materials:
Contains a Lesson plan, Handouts, Question and Answer sheets, Care Certificate Workbook and a CPD Accredited Certificate

Consultant:
Andy Furness, CFIOSH GIFireE MIIRSM MRSH

Peer Review:
Salvus Consulting – Safety Management Training

Standards:

Care Certificate Standard 13

Social Care Induction Framework for Wales (SCIF) (2012) 3.1, 2.2.6

NOS: CHS2, CHS 6, SCDHSC0022, SCDHSC0223, SCDHSC0032

QCF: Unit ref: R/601/8922, F/601/8138, J601/8027, T/502/7585, K/502/7583, A/601/9420
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Most people are aware that health and safety is important, but for whatever reasons, precautions are regularly ignored. This video shows how very simple changes to workplace activity can avoid life changing harm or injury and the importance of health and safety at work.

00:00 A real life example of injury caused by poor measures
00:43 Workers’ rights
00:54 Personal responsibilities
01:26 Risk assessment in our personal lives
02:19 Example of injury over a period of time
02:56 Managing risk in a work environment
04:37 Keeping the workplace as safe as possible

It also shows how we all do our own risk assessments in our personal lives, so carrying them out at work is just a continuation of these. Although responsibility for health and safety primarily lies with the management, everyone has their role to play in looking after themselves and others.

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