NHS CHOICES: LIVE WELL
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HOW TO WASH YOUR HANDS
Washing your hands is one of the easiest ways to protect yourself and others from illnesses such as food poisoning and flu.
But what’s the best handwashing technique?
Washing your hands properly should take about as long as singing “Happy Birthday” twice (around 20 seconds). Use the following steps from the World Health Organization while you hum:
1. Wet your hands with water (warm or cold).
2. Apply enough soap to cover all over your hands. You can use alcohol-based handrub if you don’t have immediate access to soap and water.
3. Rub hands palm to palm.
4. Rub the back of your left hand with your right palm with interlaced fingers. Repeat with the other hand.
5. Rub your palms together with fingers interlaced.
6. Rub the backs of your fingers against your palms with fingers interlocked.
7. Clasp your left thumb with your right hand and rub in rotation. Repeat with your left hand and right thumb.
8. Rub the tips of your fingers in the other palm in a circular motion, going backwards and forwards. Repeat with the other hand.
9. Rinse hands with water (warm or cold).
10. Dry thoroughly, ideally with a disposable towel.
11. Use the disposable towel to turn off the tap.
HOW OFTEN SHOULD WE WASH OUR HANDS?
We should wash our hands:
- after using the toilet
- after handling raw foods like chicken, meat and vegetables
- before eating or handling ready to eat food
- after having contact with animals, including pets
WHY IS IT SO IMPORTANT TO WASH HANDS PROPERLY?
“Hands are easily contaminated with faecal bacteria [poo] when going to the toilet and this can be easily spread on to other things you touch, including food,” says Professor Jeremy Hawker, a consultant epidemiologist at Public Health England.
“Unfortunately, not all people consistently wash their hands after going to the toilet or before handling food.
“Washing your hands with soap and water is sufficient to remove dirt, viruses or bacteria and it can reduce the risk of diarrhoea by nearly 50%.”
WHO IS MOST AT RISK FROM THE EFFECTS OF POOR HAND HYGIENE?
Children are particularly at risk of picking up infections and spreading them to other people.
It’s especially important to make sure that hands are washed when you’re visiting someone in hospital or other healthcare setting, to help prevent the spread of infection.
BUILD ACTIVITY INTO YOUR DAY
The Government recommends doing at least 150 minutes of activity a week as well as strength exercises on two or more days a week.
But don’t worry about hitting these targets straight away: every little helps. What’s more important is choosing an activity you enjoy.
The easiest way to increase your activity levels is to build activity into the things you do every day, like going to work, shopping and seeing friends.
Tips to build activity into your day:
- walk or ride part of your journey to work or the shops
- get off a bus or tube stop before your destination
- if you drive, park further away from your office and walk or ride the rest of the way
- go for a walk or a ride with your friend rather than meeting for coffee
- exercise before or after work, or during your lunch break.
- lots of gardening can provide a good workout
- exercise in front of the TV
- try an online video workout
SEARCH ACTIVITIES AND EVENTS
Find an inclusive gym on the English Federation of Disability Sport (EFDS) website.
Use the EFDS event finder to find an activity in your area.
DISABILITY SPORTS LISTINGS
Most sports organisations actively encourage disabled people to get involved. The list of organisations below is by no means exhaustive.
The British Disabled Angling Association supports disabled people of all ages and abilities to get into fishing in the UK.
The British Wheelchair Archery Association supports archers with all impairments from grassroots to elite level with expert advice and coaching.
If you’re looking to start in athletics, Parallel Success offers great opportunities for disabled athletes.
England Badminton Players Association for Disabled aims to get more disabled people into badminton at any standard or level.
Boccia England is responsible for all aspects of the sport, from beginner to expert, providing for all levels of participation.
Disability Bowls England aims to be the first port of call for anyone with a disability looking to get into bowls.
Organisations working to boost participation in cricket include the English Cricket Board, the Cricket Federation for People with Disabilities and the England Cricket Association for the Deaf.
If you enjoy dancing for fun or to stay active, find a disability dance class near you with the Wheelchair Dance Sport Association.
Find out how to get into sledge hockey with the British Sledge Hockey Association.
Look up clubs and find out more about getting into disabled fencing with the British Disabled Fencing Association.
Visit Goalball UK to find out more about the sport and how to get involved.
If you want to give wheelchair rugby a try, find your local club on the GB Wheelchair Rugby website.
Golf organisations supporting and promoting disability golf are listed on England Golf’s disability section.
Find an accessible gymnastics club near you using the British Gymnastics website.
Find a riding group near you using the Riding for the Disabled Association.
Find a club near you using the English Karate Federation website.
Find out how to get into adaptive rowing at British Rowing.
Find an accessible sailing venue near you using the Royal Yachting Association website.
Look up accessible shooting clubs on the Disabled Shooting Project website.
Find a local ski group, book lessons and find skiing activities near you at Disability Snowsports UK.
Strength and flex
Improve your strength and flexibility with this five-week exercise plan. Not adapted for wheelchair users.
Find a swimming pool near you with disability access and local disability swimming clubs at Swimming.org.
Table Tennis England works to increase the numbers of disabled people participating in table tennis.
Find out about how to take part in tennis if you have a disability with the Tennis Foundation.
Find a sitting volleyball centre near you using the Volleyball England website.
Find a club near you and all you need to know about wheelchair basketball with British Wheelchair Basketball.
Back Up – supporting people with spinal cord injury
British Amputee & Les Autres Sports Association
British Blind Sport
Cerebral Palsy Sport
Dwarf Sports Association UK
LimbPower – supporting amputees and people with limb impairments to reach their sporting potential
Mencap Sport – supporting people with a learning difficulty
Metro – London-focused resource for blind and partially sighted people
WHAT GOES IN THE FRIDGE?
Some foods need to be kept in the fridge to help slow down germs’ growth and keep food fresh and safe for longer.
These are foods marked with a “use by” date and “keep refrigerated” on the label, such as milk, meat and ready meals.
Cool down leftovers as quickly as possible (ideally within two hours), store them in the fridge and eat them within two days.
It is safe to let food cool completely at room temperature before storing it in the fridge.
Avoid putting open tin cans in the fridge, as the food inside may develop a metallic taste.
Follow the manufacturer’s instructions or place the contents in a storage container or covered bowl before refrigerating.
Keep your fridge temperature at 5C or below.
If your fridge has a digital temperature display you may wish to check it against an internal fridge thermometer now and again to make sure it’s accurate.
Clean and inspect your fridge regularly to ensure it remains hygienic and in good working order.
“USE BY” DATES
No food lasts forever, how ever well it is stored. Most pre-packed foods carry either a “use by” or a “best before” date.
- “Use by” dates appear on foods that go off quite quickly. It can be dangerous to eat foods past this date.
- “Best before” dates are for foods with a longer life. They show how long the food will be at its best.
Food can look and smell fine even after its “use by” date but that doesn’t mean it’s safe to eat. It could still contain bugs that could make you ill.
Eating food past its “best before” date is not dangerous, but the food may not be good quality.
You can freeze pretty much everything, including:
- cheese (except soft cheese as the freezing process affects the texture)
- eggs, including boiled eggs
- bananas: peel and wrap them or place in an airtight container before freezing
- baked goods
- rice: read our safety tips
Anything with a high water content like strawberries and tomatoes will go squishy but are still fine to cook with.
Place food in an airtight container or wrap it tightly in freezer bags or similar before placing in the freezer otherwise the cold air will dry it out.
Eggs are best stored in the fridge as they are kept at a constant temperature.
Eggs can also be frozen. Two ways to freeze eggs:
- crack the egg and separate yolks and whites into separate plastic containers or food bags before freezing. This is handy for baking.
- crack the egg into a plastic tub and beat it before freezing – great for omelettes and scrambled eggs.
You can safely store a boiled egg in the fridge for a couple of days. Boiled eggs can also be frozen.
STORING MEAT AND POULTRY
It’s important to store meat safely in the fridge to stop bacteria from spreading and avoid food poisoning.
- Store raw meat and poultry in clean, sealed containers on the bottom shelf of the fridge.
- Follow any storage instructions on the label and don’t eat meat after its use by date.
- Keep cooked meat separate from raw meat and ready-to-eat foods in general.
FREEZING AND DEFROSTING MEAT AND FISH
It’s safe to freeze meat and fish as long as you:
- freeze it any time before its use by date
- defrost meat and fish thoroughly before cooking – lots of liquid will come out as meat thaws, so stand it in a bowl to stop bacteria in the juice spreading to other things
- defrost meat or fish in a microwave if you intend to cook straight away, or if not, defrost in the fridge overnight so it doesn’t get too warm
- cook food until it’s steaming hot throughout
Make sure meat is properly wrapped in the freezer or it might get freezer burn, which can make it tough and inedible.
Date and label meat in the freezer and eat it within 24 hours of defrosting.
You can freeze meat for a long time and it will still be safe to eat, but the quality will deteriorate so it’s best to eat it within three to six months.
Don’t worry if it’s frozen for longer – try marinating it before cooking to improve texture or use herbs and spices to add flavour.
RE-FREEZING MEAT AND FISH
Never re-freeze raw meat (including poultry) or fish that has been defrosted.
You can cook frozen meat and fish once defrosted, and then refreeze them.
You can re-freeze cooked meat and fish once, as long as they have been cooled before going into the freezer. If in doubt, don’t re-freeze.
Frozen raw foods can be defrosted once and stored in the fridge for up to 24 hours before they need to be cooked or thrown away.
To reduce wastage, divide the meal into portions before freezing and then just defrost what you need.
Don’t throw away leftovers: they could be tomorrow’s lunch! Follow these tips to make the most of them:
- Cool leftovers as quickly as possible, ideally within two hours.
- Divide leftovers into individual portions and refrigerate or freeze.
- Use refrigerated leftovers within two days.
- When reheating food, make sure it is heated until it reaches a temperature of 70C for two minutes, so that it is steaming hot throughout.
- Always defrost leftovers completely, either in the fridge or in the microwave.
- When defrosted, food should be reheated only once, because the more times you cool and reheat food, the higher the risk of food poisoning.
- Cooked food that has been frozen and removed from the freezer should be reheated and eaten within 24 hours of fully defrosting.
- Foods stored in the freezer, such as ice cream and frozen desserts, should not be returned to the freezer once they have thawed.
- For safety and to reduce waste, only take out of the freezer what you intend to use within the next 24 hours.
With more people re-using single-use plastic carrier bags or using a reusable bag for life, you can help prevent bacteria spreading to ready-to-eat food by:
- packing raw foods separately from ready-to-eat foods, in separate bags
- keeping one or two reusable bags just for raw foods only – don’t use the same bags for ready-to-eat foods
- checking your bags for spillages, such as raw meat juices or soil, after every use
If there has been any spillage, soiling or damage, plastic bags for life or single-use plastic carrier bags should ideally be disposed of.
Cotton and fabric-based bags for life can be put in the washing machine.
LATE OR EARLY PUBERTY
Children who begin puberty either very early (before the age of 8) or very late (after 14) should see a doctor to rule out an underlying medical condition.
Read more about puberty problems.
This page covers:
FIRST SIGNS OF PUBERTY IN GIRLS
- The first sign of puberty in girls is usually that their breasts begin to develop. It’s normal for breast buds to sometimes be very tender or for one breast to start to develop several months before the other one
- Pubic hair also starts to grow and some girls may notice more hair on their legs and arms.
LATER SIGNS OF PUBERTY IN GIRLS
After a year or so of puberty beginning, and for the next couple of years:
- Girls’ breasts continue to grow and become fuller.
- Around two years after beginning puberty, girls usually have their first period. Read more about starting periods.
- Pubic hair becomes coarser and curlier.
- Underarm hair begins to grow. Some girls also have hair in other parts of their body, such as their top lip. This is completely normal.
- Girls start to sweat more.
- Girls often get acne – a skin condition that shows up as different types of spots including whiteheads, blackheads and pus-filled spots called pustules.
- Girls have a white vaginal discharge.
- Girls go through a growth spurt. From the time their periods start, girls grow 5-7.5 cm (2-3 inches) annually over the next year or two, then reach their adult height.
- Most girls gain weight – and it’s normal for this to happen – as their body shape changes. Girls develop more body fat along their upper arms, thighs and upper back; their hips grow rounder and their waist gets narrower.
AFTER ABOUT FOUR YEARS OF PUBERTY IN GIRLS
- Breasts becomes adult-like.
- Pubic hair has spread to the inner thigh.
- Genitals should now be fully developed.
- Girls stop growing taller.
FIRST SIGNS OF PUBERTY IN BOYS
- The first sign of puberty in boys is usually that their testicles get bigger and the scrotum begins to thin and redden.
- Pubic hair also starts to appear at the base of the penis.
LATER SIGNS OF PUBERTY IN BOYS
After a year or so of puberty starting, and for the next couple of years:
- The penis and testicles grow and the scrotum gradually becomes darker. Read more about penis health.
- Pubic hair becomes thicker and curlier.
- Underarm hair starts to grow.
- Boys start to sweat more.
- Breasts can swell slightly temporarily – this is normal and is not the same as “man-boobs”.
- Boys may have “wet dreams” (involuntary ejaculations of semen as they sleep).
- Their voice “breaks” and gets permanently deeper. For a while, a boy might find his voice goes very deep one minute and very high the next.
- Boys often develop acne – a skin condition that shows up as different types of spots, including whiteheads, blackheads and pus-filled spots called pustules.
- Boys go through a growth spurt and become taller by an average of 7-8cms, or around 3 inches a year, and more muscular.
AFTER ABOUT FOUR YEARS OF PUBERTY IN BOYS
- Genitals look like an adult’s and pubic hair has spread to the inner thighs.
- Facial hair begins to grow and boys may start shaving.
- Boys get taller at a slower rate and stop growing completely at around 16 years of age (but may continue to get more muscular).
- Most boys will have reached full adult maturity by 18 years of age.
MOOD CHANGES IN PUBERTY
Puberty can be a difficult time for children. They’re coping with changes in their body, and possibly acne or body odour as well, at a time when they feel self-conscious.
Puberty can also be an exciting time, as children develop new emotions and feelings. But the “emotional rollercoaster” they’re on can have psychological and emotional effects, such as:
PUBERTY SUPPORT FOR CHILDREN
If children are worried or confused about any part of puberty, it may help them to talk to a close friend or relative.
- ChildLine’s website answers boys’ common questions about puberty and girls’ common questions about puberty. It also offers free and confidential advice on its telephone helpline, which can be reached on 0800 1111. Children can also look at its puberty message board for girls and puberty message board for boys to see what other young people are asking about.
- 4You is a leaflet for boys and girls that explains body changes at puberty, sex and how babies are made, in a down-to-earth way.
- “Periods – what you need to know” is an FPA (formerly the Family Planning Association) leaflet that is helpful for older girls who are just about to or have just started their periods.
- Contact a Family’s booklet “Growing up, sex and relationships” is for disabled children.
PUBERTY SUPPORT FOR PARENTS AND CARERS
- “Surviving Adolescence – a toolkit for parents” is a leaflet that gives parents and carers clear information on what to expect when children hit adolescence, including why they’re likely to become sulky, suddenly start dieting, have crushes on friends, and crave excitement.
- The FPA (formerly the Family Planning Association) has a range of online leaflets that give advice on talking to your children about growing up, sex and relationships.
USING E-CIGARETTES TO STOP SMOKING
Over recent years, e-cigarettes have become a very popular stop smoking aid in the UK. Evidence is still developing on how effective they are, but many people have found them helpful for quitting.
An electronic cigarette (e-cigarette) is a device that allows you to inhale nicotine without most of the harmful effects of smoking.
E-cigarettes work by heating and creating a vapour from a solution that typically contains nicotine; a thick, colourless liquid called propylene glycol and/or glycerine; and flavourings. As there is no burning involved, there is no smoke.
WILL E-CIGARETTES HELP ME STOP SMOKING?
Research shows that e-cigarettes can help you give up smoking.
If you want to use an e-cigarette to help you quit, you’ll give yourself the best chance if you get expert support from your local NHS stop smoking service. In the year up to April 2015, two out of three people who used e-cigarettes in combination with the NHS stop smoking service quit smoking successfully.
Find your nearest NHS stop smoking service on the NHS Smokefree website, or call the Smokefree National Helpline to speak to a trained adviser on 0300 123 1044.
Different things work for different people and, particularly if you’ve already tried other methods of quitting smoking without success, you might want to give e-cigarettes a go.
Read more about stopping smoking using e-cigarettes.
E-CIGARETTES ON PRESCRIPTION
Currently, there are no e-cigarettes on the market that are licensed as medicines, which means they are not available on prescription from the NHS.
Once medicinally licensed e-cigarette products come onto the market, GPs and stop smoking services will be able to prescribe them alongside other stop smoking medicines.
Read about other stop smoking treatments.
ARE E-CIGARETTES SAFE?
E-cigarettes do not produce tar and carbon monoxide – two of the main toxins in conventional cigarette smoke. The vapour from e-cigarettes has been found to contain some potentially harmful chemicals also found in cigarette smoke, but at much lower levels.
E-cigarettes are still fairly new and we won’t have a full picture on their safety until they have been in use for many years. However, according to current evidence on e-cigarettes, they carry a fraction of the risk of cigarettes.
New rules for e-cigarettes and their refill containers came into effect in the UK on May 20 2016. These rules ensure that there are minimum standards for the safety and quality of all e-cigarettes and refill containers.
POSSIBLE SAFETY CONCERNS
There are two types of safety concerns associated with e-cigarettes:
- a fault with the e-cigarette device that could make it unsafe to use
- side effects to your health caused by using your e-cigarette
It’s important that any e-cigarette safety concerns are reported and monitored, which you can do through the Yellow Card Scheme.
HOW TO GET MORE FIBRE INTO YOUR DIET
Most of us need to eat more fibre and have fewer added sugars in our diet. Eating plenty of fibre is associated with a lower risk of heart disease, stroke, type 2 diabetes and bowel cancer.
Government guidelines published in July 2015 say that our dietary fibre intake should increase to 30g a day, as part of a healthy balanced diet. As most adults are only eating an average of about 18g day, we need to find ways of increasing our intake.
Children under the age of 16 don’t need as much fibre in their diet as older teenagers and adults, but they still need more than they get currently:
- 2-5 year-olds: need about 15g of fibre a day
- 5-11 year-olds: need about 20g
- 11-16 year-olds: need about 25g
On average, children and teenagers are only getting around 15g or less of fibre a day. Encouraging them to eat plenty of fruit and vegetables and starchy foods (choosing wholegrain versions and potatoes with the skins on where possible) can help to ensure they are eating enough fibre.
WHY DO WE NEED FIBRE IN OUR DIET?
Choosing foods with fibre also makes us feel fuller, while a diet rich in fibre can help digestion and prevent constipation.
Find out more about the importance of fibre and when you may need to reduce your intake, in Why is fibre important?
TIPS TO INCREASE YOUR FIBRE INTAKE
It’s important to get fibre from a variety of sources, as eating too much of one type of food may not provide you with a healthy balanced diet.
To increase your fibre intake you could:
- Choose a higher-fibre breakfast cereal such as plain wholewheat biscuits (like Weetabix) or plain shredded whole grain (like Shredded wheat), or porridge as oats are also a good source of fibre. Find out more about healthy breakfast cereals.
- Go for wholemeal or granary breads, or higher fibre white bread, and choose wholegrains like wholewheat pasta, bulgur wheat or brown rice.
- Go for potatoes with their skins on, such as a baked potato or boiled new potatoes. Find out more about starchy foods and carbohydrates.
- Add pulses like beans, lentils or chickpeas to stews, curries and salads.
- Include plenty of vegetables with meals, either as a side dish or added to sauces, stews or curries. Find out more about how to get your 5 A DAY.
- Have some fresh or dried fruit, or fruit canned in natural juice for dessert. Because dried fruit is sticky, it can increase the risk of tooth decay, so it’s better if it is only eaten as part of a meal, rather than as a between-meal snack.
- For snacks, try fresh fruit, vegetable sticks, rye crackers, oatcakes and unsalted nuts or seeds.
FIBRE IN YOUR DAILY DIET
Listed below is the fibre content of some example meals.
FIBRE AT BREAKFAST
Two thick slices of wholemeal toasted bread (6.5g of fibre) topped with one sliced banana (1.4g) and a small glass of fruit smoothie drink (1.5g) will give you around 9.4g of fibre.
FIBRE AT LUNCH
A baked jacket potato with the skin on (2.6g) with a 200g portion of reduced-sugar and reduced-salt baked beans in tomato sauce (9.8g) followed by an apple (1.2g) will give you around 13.6g of fibre.
FIBRE AT DINNER
Mixed vegetable tomato-based curry cooked with onion and spices (3.3g) with wholegrain rice (2.8g) followed by a lower fat fruit yoghurt (0.4g) will give you around 6.5g of fibre. Bear in mind that fruit yoghurts can sometimes be high in added sugars, so check the label and try to choose lower-sugar versions.
FIBRE AS A SNACK
A small handful of nuts can have up to 3g of fibre. Make sure you choose unsalted nuts, such as plain almonds, without added sugars.
Total: Around 32.5g of fibre
FIBRE ON FOOD LABELS
The above example is only an illustration, as the amount of fibre in any food can depend on how it is made or prepared and on how much of it you eat. Most pre-packaged foods have a nutrition label on the side or back of the packaging, which often gives you a guide about how much dietary fibre the food contains.
PASSIVE SMOKING: PROTECT YOUR FAMILY AND FRIENDS
Secondhand smoke is dangerous, especially for children. The best way to protect loved ones is to quit smoking. At the very least, make sure you have a smokefree home and car.
When you smoke a cigarette (or roll-up, pipe or cigar), most of the smoke doesn’t go into your lungs, it goes into the air around you where anyone nearby can breathe it in.
Secondhand smoke is the smoke that you exhale plus the “sidestream” smoke created by the lit end of your cigarette.
When friends and family breathe in your secondhand smoke – what we call passive smoking – it isn’t just unpleasant for them, it can damage their health too.
Pregnant women exposed to passive smoke are more prone to premature birth and their baby is more at risk of low birthweight and cot death.
HOW TO PROTECT AGAINST SECONDHAND SMOKE
The only way to protect your friends and family from secondhand smoke is to keep the environment around them smoke free.
The best way to do that is to quit smoking completely. If you’re not ready to quit, make every effort to keep your cigarette smoke away from other people and never smoke indoors or in the car.
- always smoke outside
- ask your visitors to smoke outside
- don’t smoke in the car or allow anyone else to
THE RISKS OF PASSIVE SMOKING
Secondhand smoke is a lethal cocktail of more than 4,000 irritants, toxins and cancer-causing substances.
Most secondhand smoke is invisible and odourless, so no matter how careful you think you’re being, people around you still breathe in the harmful poisons.
Opening windows and doors or smoking in another room in the house doesn’t protect people. Smoke can linger in the air for two to three hours after you’ve finished a cigarette, even with a window open. And even if you limit smoking to one room, the smoke will spread to the rest of the house where people can inhale it.
CHILDREN AND PASSIVE SMOKING
Passive smoking is especially harmful for children as they have less well-developed airways, lungs and immune systems.
It’s estimated that more than one in five children in the UK live in a household where at least one person smokes and, as a result, they’re more likely to develop:
Children are particularly vulnerable in the family car where secondhand smoke can reach hazardous levels even with the windows open.
It’s estimated that smoking in cars produces concentrations of toxins up to 11 times higher than you used to find in the average smoky pub.
To protect children, there is a new ban on smoking in cars and other vehicles carrying children. From October 1 2015 it is against the law to smoke in a private vehicle if there’s a young person under-18 present.
Read about the new law on smoking in private vehicles.
HOW SAFE IS E-CIG VAPOUR?
E-cigarettes don’t produce tobacco smoke so the risks of passive smoking with conventional cigarettes don’t apply to e-cigs.
Research into this area is ongoing, but it seems that e-cigs release negligible amounts of nicotine into the atmosphere and the limited evidence available suggests that any risk from passive vaping to bystanders is small relative to tobacco cigarettes.
In England, the Government has no plans to ban vaping indoors (although some employers have banned them in the workplace) but some health professionals recommend avoiding using them around pregnant women, babies and children.
Read about the safety of e-cigarettes.
Your GP can give you advice about quitting smoking.
FAMILY ALERTS TRAVELLERS TO DEADLY FAKE ALCOHOL
The family of a British backpacker who died after drinking gin which had been mixed with methanol have launched a campaign to warn travellers of the dangers of fake alcohol.
Cheznye Emmons, 23, was fatally poisoned after drinking the counterfeit gin, which she bought from a shop in a sealed bottle sporting a familiar brand while travelling in Indonesia in 2013.
Methanol (also known as methyl alcohol) is a colourless liquid with a mild alcohol odour. When ingested, it is extremely poisonous and is known to cause blindness, kidney failure, seizures and death.
The chemical is deliberately added to strengthen or stretch illegal alcoholic drinks, especially spirits, some of which are being sold in bars, shops and hotels in popular tourist areas such as Bali, Lombok and Sumatra.
BOTTLES ‘LOOK GENUINE’
The practice is common in many parts of the world. However, Indonesia has recently been singled out following a number of deaths and cases of serious illness of locals and foreigners.
Some fake alcohol on sale in Indonesia has been found to contain concentrations of methanol 44,000 times above safe levels.
Figures suggest 280 people have died from illicit alcohol poisoning since 2011 in Indonesia. Three Brits have died from methanol poisoning in the country in the last five years.
The Foreign and Commonwealth Office (FCO) advises tourists to “take extreme care when purchasing spirit-based drinks, as bottles may appear to be genuine when they are not.”
The FCO reports that there have also been cases of methanol poisoning from drinking adulterated “arak” or “arrack” – a local rice or palm liquor.
‘SAVE A LIFE’ CAMPAIGN
The Emmons family set up the Save a Life Campaign soon after Cheznye’s death and have created a poster for GP surgeries warning people travelling to Indonesia, including Bali, of the dangers of counterfeit alcohol.
Measha Emmons, Cheznye’s sister, says: “The bottle may be sealed and it may look genuine but it may still have been contaminated with methanol. You won’t be able to taste the difference.”
Cheznye, who was travelling with her boyfriend, first showed signs of methanol poisoning when she woke up a day after drinking the fake gin unable to see. She died five days later in hospital.
SIGNS OF METHANOL POISONING
The first signs of methanol poisoning include drowsiness, feeling unsteady and loss of inhibition, but these are often confused with the effects of drinking alcohol and may not be noticed.
It can be several hours before the major symptoms of methanol poisoning appear including:
- abdominal pain
- feeling breathless
- impaired vision and, in severe cases, blindness
Without prompt treatment, the poison will continue to build up and can lead to convulsions, coma and death. Patients who survive may suffer permanent visual impairment.
Methanol poisoning can be treated by giving the patient fomepizole or ethanol through an intravenous drip to try to reduce the level of poisoning and dialysis to remove toxic substances from the kidneys.
TIPS ON STAYING SAFE
Here’s a checklist to help you reduce your risk of methanol poisoning:
- Don’t buy illegal alcoholic drinks.
- If the price of your alcoholic drink looks too good to be true, it probably is.
- Buy alcoholic drinks from a reputable vendor and check bottle seals are intact.
- Be suspicious of alcoholic drinks offered for sale in informal settings that are not licensed to sell alcohol, such as market stalls.
- Steer clear of alcoholic drinks sold in unlabelled containers .
- Check branded products for labels that are poorly printed or with errors, or bottles with broken seals. Do not buy these.
- Be aware of the signs of methanol poisoning and seek medical attention immediately if you suspect you or a companion have ingested methanol.
BREAST CHANGES IN OLDER WOMEN
As you get older, it’s natural for your breasts to lose their firmness, change shape, shrink in size and become more prone to certain abnormal lumps.
In most cases, breast lumps are harmless but, whatever your age, it’s important that you report any new lumps to your doctor.
From around the age of 40, you can expect your breasts to change in size and shape. It’s normal for breast tissue to become less glandular and more fatty as you get older, which makes them feel less firm and full.
With age, there’s also an increasing risk of abnormal growths in the breast. These are often harmless breast lumps, like cysts, but they can also be a sign of serious conditions like breast cancer.
As the years go by, you might also notice a wider space between your breasts and that your breasts shrink in size, sometimes by a cup size or more (unless you put on weight, in which case your breasts may get bigger). The area around the nipple (the areola) tends to become smaller and may nearly disappear, and the nipple may turn in slightly.
Many of the breast changes that happen as you get older are caused by hormonal changes.
Declining oestrogen levels at the menopause make breast tissue dehydrated and less elastic, so that your breasts lose their once rounded shape and begin to sag.
On the plus side, you may stop having any of the premenstrual lumps, pain or nipple discharge that you used to have.
BREAST CANCER SCREENING
Screening for breast cancer is currently offered on the NHS to women aged 50-70 in England. However, it’s in the process of being extended as a trial to some women aged 47-73.
Breast screening uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.
It’s your choice whether to have breast screening, but bear in mind that most experts believe it’s beneficial in picking up breast cancer early.
If you’re over 70, you’ll stop receiving screening invitations through the post, but you can still carry on with screening if you want to. To arrange an appointment, contact your local breast screening unit.
Read more about breast cancer screening.
Young women who have not yet gone through the menopause often have what’s known as dense breasts.
Dense breasts contain more glandular and less fat tissue than usual. It’s not the same as having firm breasts and it has nothing to do with how big or what shape your breasts are.
Having dense breasts isn’t abnormal and it’s not something that you can change, but a potential drawback is that dense breasts can make breast cancer screening more difficult, because the dense tissue can mask potential tumours on a mammogram.
Breast tissue tends to become less dense as you get older, especially after the menopause, so it becomes easier to detect breast cancers on a mammogram.
Breast lumps are common around the menopause. They’re usually cysts, which are harmless lumps filled with fluid. But if you notice a lump, don’t wait to be offered screening – see your GP, to rule out breast cancer.
Breast cancer is most common in women over 50. Other warning signs of breast cancer include:
- puckering of the skin
- nipple changes (like scaling or discharge)
- a swollen, red or “inflamed” breast
Read more about breast lumps.
WOMEN OVER 70
Women over 70 are particularly at risk of breast cancer, because a woman’s risk of getting breast cancer increases with age. Don’t assume that because you’re in your 70s or older that you’re in the clear. Always report any unusual breast symptoms to your doctor.
Find out how to spot breast lumps.
STAY GAS SAFE THIS SUMMER
Gas safety is just as important in the summer as it is in the winter. Poorly maintained appliances and boilers can cause carbon monoxide poisoning, which can be fatal. Find out how you can keep safe.
Gas central heating may be turned off in the summer, but your boiler is still being used for hot water and, perhaps, you use a gas cooker.
Remember the barbecue, too, which is often gas. More than 40% of us own a gas barbecue and 30% of us use it weekly to produce simple meals to enjoy outdoors.
HOW DO APPLIANCES CAUSE CARBON MONOXIDE POISONING?
Carbon monoxide (CO) is a poisonous gas produced when fuel such as gas (or charcoal or petrol) burns incompletely. Inadequately installed or poorly maintained appliances and boilers increase the risk of carbon monoxide being produced.
You can’t see, taste or smell carbon monoxide. The Health and Safety Executive (HSE) reported that last year 319 people were killed or injured due to carbon monoxide poisoning.
It is important to look out for the warning signs of carbon monoxide poisoning and to seek urgent medical attention from your GP or accident and emergency department.
It is not always possible to check gas appliances for signs they are not working properly, such as lazy yellow flames instead of crisp blue ones. It is better to ensure that all gas appliances are checked annually by a Gas Safe engineer.
GAS SAFETY CHECKLIST
If you are going on holiday in the UK or abroad, follow these tips to protect yourself and your family:
- All gas appliances, including gas barbecues, should be given an annual safety check by a Gas Safe registered engineer.
- By law, all gas appliances in rented properties in the UK, whether a long-term rental or short-term holiday let, must have an annual safety check. This also applies to motorhomes and caravans. Ask to see the current gas safety record.
- Never use a smouldering or lit barbecue (gas or charcoal), gas or paraffin stove, light or heater in a tent, caravan, motorhome or under an awning unless it is a permanent fixture that has been installed and maintained correctly.
- Make sure you know how to use any gas appliances, including barbecues. This is to help prevent the risk of fire and carbon monoxide poisoning.
- Fit a carbon monoxide alarm in your home, preferably one that emits an audible signal. Make sure it is approved to the latest British or European Standard (BS Kitemark or EN 50291). Take a portable one with you on holiday and, particularly when taking it abroad, make sure it will work at your destination.