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AUTUMN 2019 | ISSUE 3 VOLUME 13

Head lice prevention & treatment

GUT FEELING Listening to your gut Healthy skin

2019/ADV/HED/074H

for all the family

BLITZ THOSE NITS!

Treat & Protect

For external use only. Observe normal safety precautions and always keep hair away from naked flames. Always read the label.


If it’s out there... we can source it for you

For more information please contact: Free Phone 1800 440 440 I PharmaSource@uniphar.ie I www.uniphar.ie


OTC UPDATE EDITOR Maura Henderson maura@greenx.ie SALES Graham Cooke graham@greenx.ie DESIGN Antoinette Sinclair antoinette@greenx.ie ADMIN Daiva Maciunaite daiva@greenx.ie

Contents Hot Topics

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GreenCross Publishing Ltd, Top floor 111 Rathmines Road Lower, Dublin 6 014410024 OTC UPDATE is produced by GreenCross Publishing Ltd. as a supplement to Irish Pharmacist. GreenCross Publishing was established in 2007 and is jointly owned by Graham Cooke and Maura Henderson. Graham can be contacted at graham@greenx.ie Maura at maura@greenx.ie © Copyright GreenCross Publishing Ltd. 2019

FOOD SUPPLEMENTS Winter on the way, Brexit on the horizon, recession around the corner — time to boost our defences

13 LISTENING TO YOUR GUT

Be good to your gut and it will be good to you

18 HEALTHY SKIN FOR ALL THE FAMILY The three lessons written on Mother Teresa’s face — moisturise, moisturise, moisturise.

The contents of OTC UPDATE are protected by copyright. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical or photocopy recording or otherwise – whole or in part, in any form whatsoever for advertising or promotional purposes without the prior written permission of the editor or publishers.

24 HEAD LICE

Mums must muster their ammo in the perennial battle against the mighty mites

DISCLAIMER The views expressed in OTC UPDATE are not necessarily those of the publishers, editor or editorial advisory board. While the publishers, editor and editorial advisory board have taken every care with regard to accuracy of editorial and advertisement contributions, they cannot be held responsible for any errors or omissions contained.

Regulars

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NEWS

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PRODUCT NEWS

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CROSSWORD

AUTUMN 2019 | ISSUE 3 VOLUME 13 | OTCUPDATE | 1


NEWS IN BRIEF

Keeping active linked to longer life

Lark or night owl?

KEEPING ACTIVE OR BECOMING MORE ACTIVE IN MIDDLE AND OLDER AGE LINKED TO LONGER LIFE

BEING A “MORNING PERSON” LINKED TO LOWER RISK OF BREAST CANCER

Keeping physically active or becoming more active during middle and older age is associated with a lower risk of death, regardless of past activity levels or existing health conditions, suggests a large UK study published by The BMJ recently. At the population level, meeting and maintaining at least the minimum public health recommendations (150 minutes per week of moderate-intensity physical activity) would potentially prevent 46% of deaths associated with physical inactivity, say the researchers. Previous studies have linked physical activity to lower risk of death, cardiovascular disease, and certain cancers. But few studies have looked at how changes in physical activity over time are associated with subsequent risk of death. So to address this knowledge gap, researchers from the MRC Epidemiology Unit at the University of Cambridge analysed how long term changes in physical activity are associated with risk of all-cause, cardiovascular and cancer deaths. They used data for 14,599 men and women aged 40-79 from the European Prospective Investigation into Cancer and NutritionNorfolk (EPIC-Norfolk) study, who were recruited between 1993-1997. Participants were assessed at the start of the study and then a further three times over an average of 7.6 years, along with other risk factors up to 2004. From this point in time, mortality was assessed up to 2016, for an

average of 12.5 years of follow-up. Overall physical activity included activity at work (e.g. sedentary office work, standing work, physical and heavy manual work) and leisure-time activity, such as cycling, sports and recreational activities. During the study period, there were 3,148 deaths, including 950 deaths from cardiovascular disease and 1,091 deaths from cancer. After controlling for existing physical activity and other risk factors such as diet, bodyweight, medical history, blood pressure and cholesterol levels, higher physical activity levels and increases in physical activity over time were associated with a lower risk of death. For each 1kJ/kg/day per year increase in PAEE (equivalent to being inactive at the start of the study and gradually, over five years, meeting minimum physical activity guidelines), the researchers found a 24% lower risk of death from any cause, a 29% lower risk of cardiovascular death, and an 11% lower risk of cancer death. Results were similar in those with and without a history of cardiovascular disease and cancer. What’s more, compared with consistently inactive people, those who became more active over time had a lower risk of death from all causes, regardless of past activity levels. But the benefits were greatest for those with existing high levels of physical activity who became even more active over time, with a 42% lower risk of mortality.

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Being a morning person (popularly known as larks) is associated with a lower risk of developing breast cancer than being an evening person (popularly known as owls), according to a study published by The BMJ recently. Sleeping longer than the recommended 7-8 hours a night may also carry an increased risk, the results suggest.  One in seven women will develop breast cancer at some stage in their lives. Previous studies have shown a link between night shift work and risk of breast cancer, thought to be due to disrupted sleep patterns, light exposure at night, and other lifestyle factors. But there has been much less research into the potential effects of sleep habits on breast cancer risk. So an international research team set out to examine whether certain sleep traits could have a direct (causal) effect on risk of developing breast cancer. In observational analysis of UK Biobank data, morning preference was associated with a slightly lower risk of breast cancer (one less woman per 100) than evening preference, whereas there was little evidence for an association with sleep duration and insomnia symptoms. However, the authors stress that this represents differences at the extreme ends of the scale, and that the extent of effect is likely to be smaller than that of other known risk factors for breast cancer, such as BMI and alcohol intake. The researchers say their findings “provide strong evidence for a causal effect of chronotype on breast cancer risk.” Further work to uncover possible reasons for the associations between sleep disruption and breast cancer is required, they add. Nonetheless, these findings “have potential implications for influencing sleep habits of the general population in order to improve health.” In a linked editorial, Professor Eva Schernhammer from the University of Vienna says these findings “identify a need for future research exploring how the stresses on our biological clock can be reduced.”


IN BRIEF NEWS

Study shows increased risk of breast cancer in transgender women TRANSGENDER WOMEN (MALE SEX ASSIGNED AT BIRTH, FEMALE GENDER IDENTITY) USING HORMONE TREATMENT SHOW AN INCREASED RISK OF BREAST CANCER COMPARED WITH THE GENERAL MALE POPULATION, FINDS A LARGE DUTCH STUDY PUBLISHED IN THE BMJ

The findings also show that transgender men (female sex assigned at birth, male gender identity) had a lower risk compared with the general female population Although the risk in transgender women increased during a relatively short duration of hormone treatment, it is still lower than the general female population. As such, the researchers say the absolute risk of breast cancer in transgender people remains low, and therefore current breast cancer screening is sufficient for transgender people using hormone treatment. Transgender people experience an incongruence between the sex assigned to them at birth and their experienced or expressed gender, and can receive hormone treatment to induce desired physical changes. Previous studies have shown that hormone replacement therapy (HRT) increases the risk of breast cancer in postmenopausal women, which could suggest a similarly increased risk in trans women receiving hormone treatment. But information about the risk of breast cancer in transgender people is currently limited.

So a research team, led by Professor Martin den Heijer at the University Medical Centre in Amsterdam, investigated the incidence and characteristics of breast cancer in transgender people receiving hormone treatment, compared with the general Dutch population. The study included 2,260 trans women and 1,229 trans men receiving gender affirming hormone treatment at a specialist clinic in Amsterdam between 1972 and 2016. National medical records were used to identify breast cancer cases. Average age at the start of hormone treatment was 31 years for trans women and 23 for trans men. Average treatment time was 13 years for trans women and 8 years for trans men. Of the 22,60 trans women, 15 cases of invasive breast cancer were diagnosed at an average age of 50 years and after an average 18 years of hormone treatment. This was higher than the general male population whose gender identity matches the sex they were assigned at birth (cisgender men), but lower than the general female population (cisgender women).

In 1,229 trans men, four cases of invasive breast cancer were identified at an average age of 47 years and after an average 15 years of hormone treatment. This was lower than expected compared with cisgender women. Despite the large sample size, this is an observational study, and as such, can’t establish cause, and the researchers point to some limitations, including missing or incomplete data about type of hormone use, family history, genetic mutations, tobacco and alcohol use, and body mass index. Based on this study, the authors conclude that “the absolute overall risk of breast cancer in transgender people remains low and therefore it seems sufficient for transgender people using hormone treatment to follow screening guidelines as for cisgender people.” As the risk of breast cancer in trans women increased during a relatively short duration of hormone treatment, they suggest “it would be worthwhile for future studies to investigate in more detail the cause of breast cancer in transgender people receiving hormone treatment.”

Second-trimester miscarriage SECOND-TRIMESTER MISCARRIAGE SHOULD BE HIGHLIGHTED AS A RISK FACTOR FOR ADVERSE PREGNANCY OUTCOMES, A NEW STUDY HAS WARNED

The study conducted by researchers in Cork found that “women experiencing secondtrimester miscarriage are at increased risk in subsequent pregnancies of recurrence”. Published in the European Journal of Obstetrics and Gynaecology, the study recommends further research into its pathophysiology in order to advance preventative measures. The research aimed to determine the rates of recurrence, preterm birth and live births in a cohort of 185 women who experienced second-trimester miscarriage. Conducted at Cork University Maternity Hospital (CUMH), the study followed-up 175 women who had confirmed secondtrimester miscarriage between June 2009 and June 2013 and subsequently had a pregnancy

between July 2009 and January 2016. Some 55 women did not become pregnant during the study. The results revealed that between July 2009 and January 2016, some 110 women became pregnant following a previous second-trimester miscarriage. Including those who experienced first- or second trimester-miscarriage, 47 per cent (78/155) of those who were followed-up did not go on to have a live infant. In total, 81 babies were born to 77 mothers. The recurrence rate of secondtrimester miscarriage was 6.3 per cent and the preterm birth rate was also 6.3 per cent. The caesarean section rate was high at 45 per cent.

“The reassuring message is that most women have a successful pregnancy following a second-trimester miscarriage,” according to the researchers. “The rate of recurrence and preterm birth is lower than previously quoted. There is a notable risk compared to the general population however, meriting close observation during pregnancy, particularly women with a history of periviable loss.” The article ‘Subsequent pregnancy outcomes following second trimester miscarriage – a prospective cohort study’ was undertaken by researchers at CUMH; the National Perinatal Epidemiology Centre, University College Cork; and the INFANT centre, Cork.

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NEWS IN BRIEF

Red meat risk INCREASING RED MEAT INTAKE LINKED WITH HEIGHTENED RISK OF DEATH

Increasing red meat intake, particularly processed red meat, is associated with a heightened risk of death, suggests a large study conducted in the US. However, reducing red meat intake while increasing healthy protein sources, such as eggs and fish, whole grains and vegetables over time may lower the risk, the researchers say. High intake of red meat, such as beef, pork and lamb, has been previously linked with a higher risk of type 2 diabetes, cardiovascular disease, certain types of cancers, and premature death. But little is known about how changes in red meat intake may influence risk of death. So to explore this further, a team of researchers based in the US and China looked at the link between changes in red meat consumption over an eight year period with mortality during the next eight years, starting from 1986 to the end of follow-up in 2010. They used data for 53,553 US registered female nurses, aged 30 to 55, from the Nurses’ Health Study (NHS) and 27,916 US male health professionals, aged 40 to 75, from the Health Professionals Follow-up Study (HPFS), who were free of cardiovascular disease and cancer at the start

of the study. Every four years the participants completed a food frequency questionnaire (FFQ) where they were asked how often, on average, they ate each food of a standard portion size in the past year, ranging from “never or less than once per month” to “6 or more times a day”. They were then divided into five categories based on their changes in red meat intake. During the study period, the total number of deaths from any cause (known as “all cause mortality”) reached 14,019 (8,426 women and 5,593 men). The leading causes were cardiovascular disease, cancer, respiratory disease and neurodegenerative disease. After adjusting for age and other potentially influential factors, increasing total red meat intake (both processed and unprocessed) by 3.5 servings a week or more over an eight year period was associated with a 10% higher risk of death in the next eight years. Similarly, increasing processed red meat intake, such as bacon, hot dogs, sausages and salami, by 3.5 servings a week or more was associated with a 13% higher risk of death,

whereas increasing intake of unprocessed red meat was associated with a 9% higher risk. These associations were largely consistent across different age groups, levels of physical activity, dietary quality, smoking and alcohol consumption habits. Overall, reducing red meat intake while eating more whole grains, vegetables, or other protein foods such as poultry without skin, eggs and fish, was associated with a lower risk of death among both men and women. For example, swapping out one serving per day of red meat for one serving of fish per day over eight years was linked to a 17% lower risk of death in the subsequent eight years. Similar findings were seen in the shorterterm (four years) and longer-term (12 years) for the link between changes in red meat intake and mortality, and for replacing red meat with healthier food alternatives. This is an observational study, and as such, can’t establish cause. And the authors point out some limitations, including that they did not look at the reasons for changes in red meat consumption which could have influenced the results.

Opioid analgesics increase the risk of pneumonia among persons with Alzheimer’s OPIOID ANALGESICS WERE ASSOCIATED WITH A 30% INCREASE IN THE RISK OF PNEUMONIA IN PERSONS WITH ALZHEIMER’S DISEASE, A RECENT STUDY FROM THE UNIVERSITY OF EASTERN FINLAND SHOWS

The risk was most pronounced in the first two months of use. This is the first study to investigate the association between opioids and pneumonia in this population. The results were published in the Journal of Alzheimer’s Disease. The risk of pneumonia was highest among those using strong opioids, such as oxycodone or fentanyl, but the risk was also increased among those using buprenorphine, tramadol or codeine. Persons with active cancer were excluded from the study, and other diseases and drug

use were accounted for in the analyses. Opioids impair the cough reflex and respiratory functions and cause sedation, possibly underlying the increased risk for pneumonia. Pneumonia is a severe but relatively common complication among persons with Alzheimer’s disease, and often leads to hospitalisation and even death. Opioids are important in the treatment of severe acute pain, but treatment should be initiated at a low dose and regularly assessed for both benefit and harm. The diagnosis and

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assessment of pain is challenging among persons with Alzheimer’s disease due to problems in communication. The study is part of the MEDALZ cohort, which included 5,623 persons with Alzheimer’s disease diagnosed in Finland during 2010-2011. Each person initiating opioid use was matched with a comparison person with Alzheimer’s disease who did not initiate opioid use but had the same age, gender and year of Alzheimer’s diagnosis. Data for the study were derived from Finnish nationwide registers.


IN BRIEF NEWS

One in two swingers uses recreational drugs to intensify sex NEARLY ONE-IN-TWO SWINGERS USES RECREATIONAL DRUGS TO INTENSIFY THE EXPERIENCE, WITH WOMEN MORE LIKELY TO DO SO THAN EITHER STRAIGHT OR BISEXUAL MEN, SUGGEST THE RESULTS OF A DUTCH SURVEY, PUBLISHED ONLINE IN THE JOURNAL SEXUALLY TRANSMITTED INFECTIONS

But the practice is associated with a significantly heightened risk of unprotected sex, the responses show. Swingers are couples who have sex with others and singles who have sex with them. Although they identify as straight, they also engage in same sex behaviour. The available evidence suggests that drug use among swingers is relatively common, but little is known about their beliefs and intentions around this activity. To explore this further, the researchers analysed the responses of swingers who completed an online survey on the perceived pros and cons of recreational drug use, and its possible consequences.  The survey, which was advertised through Dutch swinger websites during May and August 2018, was completed by 1005 swingers (response rate 68%). Over half of respondents (58%) said they

engaged in swinging at least monthly; for around a third (30%) the frequency was once every 3 months. And for around one-in-10 (12%) it was once or twice a year. The average age of the respondents was 47. More than four out of 10 respondents (44%; 443) said they used drugs during sex. Among women, this proportion rose to 51% compared with 44% in bisexual men and 39% in straight men. Among the general public, men are more likely to use drugs than women, prompting the researchers to suggest that women might use to enable them to take part in esoteric sex acts with multiple partners. For around two-thirds of respondents, the reasons for using were to prolong sex (68%), increase arousal (66%), release inhibitions (64%), and intensify sensations (61%). Most described drug use as pleasurable (94%), acceptable (84%), or exciting (66%).

Unprotected sex was more common among those who were using drugs than it was among those who weren’t: 46% vs 34% for vaginal sex; 22% vs 13% for anal sex. Condoms were rarely used for oral sex, irrespective of drug use. Three-quarters of the drug users had been tested for a sexually transmitted infection compared with just over half (56%) of those who didn’t use during sex. Half the respondents (47%) thought drug use during sex was “unhealthy,” yet very few thought it was either “unwise” (14%) or “dangerous” (15%). Nevertheless, one-in-four said that using drugs during sex had an adverse effect on their health and around one in 15 (7%) thought they might become addicted or felt uncomfortable having sex without drugs. One-in-five said they felt depressed in the days following drug fuelled sex. But only 4% planned to stop using altogether.

Migraine - misunderstood and under-managed The recently-published results of a survey on Irish people with frequent and severe migraine attacks reveal the condition is having a significant negative impact on their lives, including damaging their career progression and earnings. Migraine is Ireland’s fifth-leading cause of disability, affecting almost one-in-eight people. While it affects people of all ages and genders, it is three times more common in women than men. Despite its high prevalence, migraine remains a misunderstood and under-managed condition. The survey, which focuses on the small section of the population who have at least four migraines per month, was part of a global patient study undertaken by Novartis in partnership with the European Migraine and Health Alliance in 36 countries, to establish how frequent and severe migraine affects daily life. The Irish results are contained in a new report, My Migraine Voice, which was launched in Cork recently. Most (84 per cent) of the respondents in

the Irish arm of the survey who are in full or part-time employment or self-employed said that their migraine has negatively impacted their professional life. Some 15 per cent said it has caused them to change jobs, while 13 per cent changed their profession or career path due to their condition, while more than onein-10 (12 per cent) said they actually lost their job because of their condition. Furthermore, many sufferers are not in receipt of sick pay for their migraine, creating financial repercussions beyond the patient and their family in terms of lost productivity and absenteeism. Unsurprisingly, 89 per cent said they fear their next migraine attack. While most (75 per cent) said their employers were aware of their condition, recognition of their condition is often poor, with less than one-in-three saying their employer offered them any support. Issues emerge with colleagues too. Over a third (36 per cent) felt judged for taking days off work, with a quarter of respondents in employment

saying their colleagues do not understand their migraine. A small but significant minority (8 per cent) confessed to being bullied at work due to their condition. Dr Eddie O’Sullivan, General Practitioner and Director of the Migraine Clinic at Cork University Hospital, who presented the survey results, said he believes that the severity of migraine and its wider impact is often misunderstood and frequently dismissed. He highlighted the high level of medical resources that are used to support and treat people with frequent and severe migraine. “While GPs like myself are most frequently visited, this group saw a neurologist an average of four times a year. Moreover, nearly a third (31 per cent) had to attend emergency departments, while almost a quarter (23 per cent) needed to be hospitalised due to a migraine attack. With new developments in migraine, I would hope that this will change and migraine can be better managed in the community, at primary care level.”

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NEWS IN BRIEF

House move during early pregnancy linked to heightened premature birth risk MOVING HOUSE DURING THE FIRST THREE MONTHS OF PREGNANCY IS LINKED TO A HEIGHTENED RISK OF PREMATURE BIRTH AND LOW BIRTHWEIGHT AS WELL AS A SLIGHTLY HIGHER RISK OF A SMALLER THAN EXPECTED SIZE BABY, FINDS US RESEARCH PUBLISHED ONLINE IN THE JOURNAL OF EPIDEMIOLOGY & COMMUNITY HEALTH

Moving house during childhood is associated with poorer health in children, but despite being a frequent occurrence, little is known about the potential health impact of a house move during pregnancy. To try and rectify this, the researchers analysed birth certificate data for babies born in Washington state, USA, between 2007 and 2014 to mothers aged at least 18. They randomly selected 30,000 women who had moved during the first three months of pregnancy - known as the first trimester and matched them with 120,000 randomly selected women of the same birth year, but who hadn’t moved house during early pregnancy. The first trimester was chosen because previous research has suggested that major stressors during early pregnancy have a greater impact on the health of the baby than those experienced later on in the pregnancy. The final analysis included 28,011 women who had moved early in pregnancy and 112,451 who hadn’t. Women who moved early in pregnancy were likely to be younger, to be less well educated, to live in areas with lower average levels of household income and to have had other children than women who hadn’t moved. They were also more likely to be unmarried and to have smoked during their pregnancy. These are all potential risk factors for the outcomes the researchers were looking at: low birthweight; premature birth; and smaller than expected size babies. But after taking account of these potentially influential factors, a house move during the first three months of pregnancy was associated with a 37% heightened risk of low birthweight (6.4% vs 4.5%) and a 42% heightened risk of premature birth (9.1% vs 6.4%) compared with those who didn’t move during this period.

A house move in the first trimester was also associated with a slightly increased (9%) risk of giving birth to a smaller than expected size baby (9.8% vs 8.7%). These differences were seen across women in all social and economic strata. The researchers weren’t able to explore the potential reasons behind their findings, but interruptions to healthcare, the physical strain of moving, disruptions to social support, and a biological stress reaction may all be possible triggers, the researchers suggest. This is an observational study, and as such, can’t establish cause. Although the study included a large number of women,

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the researchers weren’t able to establish the reasons for the move or whether the women moved into more or less desirable areas, all of which may have influenced the results. “Despite these limitations, our results yield important insights regarding moving during pregnancy,” write the researchers. “Regardless of whether the negative impact of moving is driven by the stress from the move itself, stressful situations leading to a move, or disruption of care because of the move, asking patients about plans to move and using that as an opportunity to counsel patients on stress mitigating techniques and care continuity may be beneficial,” they conclude.


IN BRIEF NEWS

Experts question advice to reduce saturated fat ADVICE TO REDUCE INTAKE OF TOTAL SATURATED FAT AND REPLACE IT WITH UNSATURATED FAT TO CURB LEVELS OF CHRONIC DISEASE AND PREVENT DEATHS, SET OUT IN DRAFT WORLD HEALTH ORGANIZATION (WHO) GUIDANCE, IS CALLED INTO QUESTION BY EXPERTS IN THE BMJ

Arne Astrup at the University of Copenhagen and colleagues look at the evidence linking saturated fat intake and cardiovascular risk and say the recommendations “fail to take into account considerable evidence that the health effects of saturated fat varies depending on the specific fatty acid and on the specific food source.” And they warn that these recommendations might cause a reduction in the intake of nutrient dense foods that are important for preventing disease and improving health. The WHO draft guidelines were published for consultation in May 2018. They recommend reducing intake of saturated fatty acids (found in foods such as hard cheese, whole milk and butter) and replacing it with polyunsaturated and monounsaturated fatty acids (found in oily fish, vegetable oils, nuts and seeds) to reduce rates of chronic disease and related deaths. Many governments consider WHO dietary guidelines to be state of the art scientific evidence, translating them into regional and national dietary

recommendations. So the consistency of the science behind such recommendations and the validity of the conclusions are crucial, write the authors. But while consensus exists on the health benefits of eliminating industrially produced trans fatty acids, the evidence linking saturated fat to cardiovascular disease and death is less clear, they say. They point out that the draft guidance relies heavily on a meta-analysis of 84 randomised controlled trials (RCTs) that tested the effect of altering saturated fat intake on blood cholesterol levels. But this approach - which focuses on total saturated fatty acids, ignores food sources, and uses indirect (‘surrogate’) measures - is problematic for several reasons, they say. For example, not all saturated fatty acids are equal and cannot be viewed as one homogeneous group with regard to effects of diet on disease risk. What’s more, the food matrix (compounds like fibre and minerals in whole foods) in which the fatty acids exist might be more important for

the effect on cardiovascular disease risk than the saturated fat content, they add. And they point to other studies that show why a broader view of biomarkers of cardiovascular disease is needed to inform guidelines. “We think that recommendations to reduce intake of total saturated fat without considering specific fatty acids and food sources are not based on evidence and will distract from other, more effective, food based recommendations,” they argue. “We’re concerned that, based on several decades of experience, a focus on total saturated fat might have the unintended consequence of misleading governments, consumers, and industry towards promoting foods low in saturated fat but rich in refined starch and sugar,” they add. “We strongly recommend a more food based translation of how to achieve a healthy diet and reconsideration of the draft guidelines on reduction in total saturated fatty acids,” they conclude.

Music may help to reduce pre-operative anxiety MUSIC MAY OFFER AN ALTERNATIVE TO THE USE OF A DRUG ROUTINELY USED TO CALM THE NERVES BEFORE THE USE OF REGIONAL ANAESTHESIA (PERIPHERAL NERVE BLOCK), SUGGEST THE RESULTS OF A CLINICAL TRIAL, PUBLISHED ONLINE IN THE JOURNAL REGIONAL ANESTHESIA & PAIN MEDICINE

It seems to have similar effects as the sedative midazolam in reducing anxiety before a peripheral nerve block–a type of anaesthetic procedure done under ultrasound guidance, and designed to numb a specific region of the body. Preoperative anxiety is common, and it can raise levels of stress hormones in the body, which in turn can affect recovery after surgery. It is usually treated with benzodiazepines, such as midazolam. But these drugs have side effects, including affecting breathing, disturbing blood flow, and paradoxically increasing levels of agitation and hostility. Use of these drugs also requires continuous monitoring by a skilled clinician. Music medicine has been used to lower preoperative anxiety before, but it has not been directly compared with intravenous midazolam. The researchers wanted to find out if it might offer a suitable alternative to midazolam to calm the nerves before carrying out a peripheral

(regional) nerve block. They randomly assigned 157 adults to receive either 1-2 mg of midazolam (80), injected 3 minutes before the use of a peripheral nerve block, or to listen to Marconi Union’s Weightless series of music via noise cancelling headphones (77) for the same period. This track is considered to be one of the world’s most relaxing songs: https://www. youtube.com/watch?v=UfcAVejslrU. Levels of anxiety were scored using a validated measure (State Trait Anxiety Inventory-6, or STAI-6 for short) before and after the use of each anxiety calming method. Satisfaction among patients and doctors were scored on a 10-point scale, with 0 reflecting the lowest level of satisfaction. Changes in the levels of preoperative anxiety were similar in both groups, although patients in the music group were less satisfied than those given midazolam, possibly because patients were not allowed to choose the music they listened to, suggest the researchers. But there was no

difference in satisfaction levels among doctors. Both patients and doctors thought it was harder to communicate when music was used to calm nerves, possibly because of the use of noise cancelling headphones, and not standardising the volume of the music, suggest the researchers. They accept that a comparison lasting just 3 minutes may have been too short, but this period was chosen because that is how long it takes for midazolam to reach peak effectiveness. And they acknowledge that the measure used to assess satisfaction wasn’t a validated scale. Nevertheless, their findings prompt them to conclude that music may be offered as an alternative to midazolam before carrying out a regional nerve block. “However,” they caution, “further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.”

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nts COVER STORY FOOD SUPPLEMENTS

I

n today’s busy world, many of us feel run down and stressed, simply running to stand still, particularly when it comes to eating right and ensuring that your family gets the right vitamins and minerals needed for a healthy, active life. Fortunately, the local pharmacy is a great source of both advice and supplements to help patients be at their best. Vitamins and minerals are essential nutrients that the body needs in small amounts to function properly. Minerals are necessary for building strong bones and teeth, healthy cells, and turning the food you eat into energy. They are found

in varying amounts in foods such as meat, cereals including cereal products like bread, fish, milk and dairy foods, vegetables, fruit, especially dried fruit, and nuts.

VITAMINS A, C AND D Vitamins can be found in fatty foods such as animal fats, including butter and lard, vegetable oils, dairy foods, liver and oily fish. One of these, vitamin A, has several important functions, such as strengthening immunity against infections, helping vision in dim light, and keeping skin and the linings of some parts of the body, such as the nose, healthy. Good sources of vitamin

A include cheese, eggs, oily fish, such as mackerel, and milk. However, it is important to note that having large amounts of vitamin A can harm an unborn baby. Therefore, if you are pregnant or thinking of having a baby, do not eat liver or liver products, such as pâté, because these are very high in vitamin A. Other vitamins are not stored in the body, so a person needs to consume them more frequently. These watersoluble vitamins are found in fruit, vegetables and grains. Vitamin C, one of these types, has several important functions. It helps protect cells and keeps them healthy, and is necessary for

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Av


FOOD SUPPLEMENTS COVER STORY the maintenance of healthy connective tissue. A lack of vitamin C can also lead to scurvy. Vitamin C is found in a wide variety of fruit and vegetables, such as peppers, oranges, and potatoes.

SUNSHINE VITAMIN While the body needs these vitamins every day, a person may not eat the foods containing them every day, and this is where supplements can be of help. One of the best-known vitamins, vitamin D, is essential for strong, healthy bones and teeth and is especially important in early childhood when growing bones are developing. It can be obtained from sunlight on the skin and through diet and it aids the absorption of calcium. However, Ireland’s location in the northern hemisphere means that there is inadequate sunlight to allow sufficient vitamin D production in our skin, especially between the months of October through to March. Again here supplements are especially important. While generally, people do not need to take food supplements if they are healthy and eat a normal balanced diet, lots of people need to do so for various reasons, ranging from convenience to medical need. Food supplements are concentrated sources of nutrients taken as a dietary top-up. They

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include fish oils, which have been shown to benefit heart health, minerals like iron to help prevent anaemia, and a whole list of vitamins, from A to K. Supplements also contain higher amounts of nutrients than are found in most foods.

Vitamin A, has several important functions, such as strengthening immunity against infections, helping vision in dim light, and keeping skin and the linings of some parts of the body, such as the nose, healthy It is recommended that all sexually active women of childbearing age should take a 400Îźg folic acid supplement daily to prevent birth defects, such as spina bifida. In certain circumstances, a doctor may advise a patient to take a food supplement. For example, they may be needed for fragile bones and sometimes older people may have difficulty absorbing the nutrients they require from food and need to take extra in supplement form.

FOOD SUPPLEMENTS Centrum is a very well-known brand and provides a quick and convenient way to get the micronutrients our cells need. It provides


HOT TOPIC FOOD SUPPLEMENTS a range of products, one of which is Centrum Multi + Omega-3 Men 50+. This delivers wholebody benefits for men, helping to feed cells and help support the heart, brain, and eyes all in one easy-to-swallow softgel. Vitamin D is essential for strong, healthy bones and teeth. It can be obtained from sunlight on the skin and diet, and it works to support bones by aiding the absorption of calcium. The density of bones decreases after 30 which impacts balance and muscle strength. This is why older people are at increased risk of bone fractures following falls. While it is well known that sufficient calcium and vitamin D are an essential part of a healthy diet and may reduce the risk of osteoporosis, it may be less well known that calcium plays a role in nerves, hormones, and muscles. Sona is the oldest established producer of nutritional supplements and herbal remedies in Ireland, and has almost 30 years’ experience in formulating quality vitamins, nutritional supplements and other health aids. All of their 150 products are produced in a state-of-the-art facility in Dublin using the highest quality natural ingredients. Given its importance it is not surprising that there are a number of over the counter vitamin D products. Sona has an innovative product for infants, Sona Infant D3 supplement drops for babies from 0-12 months supporting their healthy development of bones, teeth and immune system. It comes with a rubber, calibrated dosing pipette

Vitamin D, is essential for strong, healthy bones and teeth and is especially important in early childhood when growing bones are developing instead of the usual glass, ensuring safety and accurate dosing. Each dose provides 100% of the HSE recommended daily dosage for babies. Free from artificial colours, preservatives and sweeteners. Each bottle contains a 4 months’ supply.

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HOT TOPIC FOOD SUPPLEMENTS their 150-plus products are produced in a state-of-the-art facility in Dublin using the highest quality natural ingredients Another over-the-counter product is Caltrate 500mg/1000iu, which offers a high level of vitamin D3 to help maximise calcium absorption and support healthy bones, joints and muscles. The advanced levels of vitamin D3 in Caltrate help maximise calcium absorption and maintain healthy bones. With a 30 year experience in providing quality bone health supplements, Caltrate provides the most clinically studied and trusted calcium supplement brands in the world. Caltrate 500mg/1000iu and Plus Minerals formulation contains the most vitamin D3 per tablet among leading brands. The Caltrate brand comes in an easy to chewable easy to swallow options. Omega 3 is vital for health and one of the best-known brands in this area is Seven Seas. Seven Seas Simply Timeless contains a natural source of Omega-3 fish oil with cod liver oil, rich in vitamin D that helps to maintain good health. Simply Timeless is suitable for adults and children 15 years and over. For those that wish to take fish oils yet don’t like the taste or aftertaste of fish, Sona has recently launched a range of innovative Omega 3 fish oils called Zomega 3 Smoothie which are deliciously fruity in flavour with added vitamins including your full daily dose of Vitamin D. With no fishy smell or aftertaste, each spoonful contains the essential Omega 3 Fatty Acids EPA and

DHA that contribute to the development and maintenance of normal brain and heart function and vision. Zomega 3 is available for adults and children from 12 months onwards.

PROBIOTICS Probiotics are live micro-organisms which when administered in adequate amounts improve the intestinal microflora balance, inhibit the growth of harmful bacteria and promote good digestion (and utilisation of nutrients from food), boost immune function and increase resistance to infection. Sona has a broad range of probiotics for all ages from newborn babies when gut microbiota is established in early infancy to help reduce diarrhoea, colic and infections; and for adults who want to maintain an ongoing good gut health. There are various strengths available from 1 billion to 25 billion, depending on your overall digestive & immune health. Sona Extra Strength Pro25Biotic, contains 25 billion friendly microbiotics per capsule and it promotes a healthy digestive and immune system and is ideal for use after completing a course of antibiotics and if run down and prone to regular infections.

JOINT CARE Sona Jointplan is a unique formulation which helps maintain supple, flexible joints and reduces inflammation. Unlike traditional analgesic/pain relievers, JointPlan helps to restore and reduce the degradation of joint cartilage rather than simply masking pain, it

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GASTRO HOT TOPIC

F

rom diarrhoea to constipation, we have learned to recognise a ‘gut feeling’ when we experience one. However, gut health is much more than just the prevention and relief of these common problems. The old phrase of ‘listening to your gut’ holds more truth than people might believe. Science is increasingly looking to the gut and the body’s good bacteria for answers to health problems

around the body. And with good reason. Forming what is called the microbiota, there are 10 “good bacteria” for every cell in our body and its importance cannot be overstated. The number of bacteria in the body is almost unfathomable. The intestine is home to between 10-100 trillion microbes in 400 different types of micro-organisms, making up what is commonly known as intestinal flora. The microbiota in the different parts of the body play a fundamental role in our

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HOT TOPIC GASTRO immunity, nutrition, and general health. Our first exposure is experienced at birth, when we inherit some good, and bad, bacteria from our mother. In addition, the intestinal tract is colonised by the mother’s microbiota through her milk and other environmental sources. This intestinal microflora is essential for the digestion and for the assimilation of nutrients. It is no surprise then that changes to our gut microbiota during this critical early childhood period may be linked to the development of various intestinal discomforts such as colic, abdominal pain, cramps, excess gas, bloating, change in bowel habits and inflammatory conditions. Furthermore, it has been noted that a troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. This means that a person’s stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression. Alterations in the gut bacteria are also increasingly being linked to variations in health including obesity, and inflammatory conditions. Maintaining gut bacteria, for example by watching what we consume, could help improve health, especially in elderly people.

CONSTIPATION Constipation is a very common condition that affects people of all ages. It can occur in babies, children and adults, and women are twice as likely to be affected as men. Older people are also five times more likely than younger adults to experience constipation, usually because of dietary factors, lack of exercise, use of certain medication and poor bowel habits. Often characterised as not passing stools as often as you would normally, constipation also sees straining more than usual or being unable to completely empty your bowels. It can also cause stools to be unusually hard, lumpy, large or small. The severity of constipation can vary greatly, but many people only experience constipation for a short period of time with no lasting effects on their health. For others, though constipation can be a chronic condition that causes significant pain and discomfort. Chronic constipation can also lead to complications, such as faecal impaction, where dry, hard stools collect in the rectum, or faecal incontinence. For most people most of the time, constipation can be prevented by making simple lifestyle changes and healthcare professionals and staff can make a number

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of recommendations. For example, it is advised that people eat on average 18 to 30 grams of fibre per day as it adds bulk and roughage to the stool. Hydration is also very important with people advised to drink 6-8 cups of water daily. Limiting the amount of caffeine and alcohol consumed should also be advised, as such beverages can dehydrate the body.

The intestine is home to between 10-100 trillion microbes in 400 different types of micro-organisms, making up what is commonly known as intestinal flora.

Approximately half an hour of daily exercise can help keep constipation away while also decreasing stress levels. For pregnant women constipation can be a significant issue as approximately 40% will experience it during their pregnancy. Their first port of call is their GP who may advise a change of diet by increasing fibre and fluid intake. They could also be advised to do gentle exercise. And if dietary and lifestyle changes do not work, they may be prescribed a laxative to help stools pass more regularly. There are also numerous trusted and effective over the counter laxatives on the market, one of which is Dulcolax. Dulcolax Liquid brings gentle and fast relief to occasional constipation in as little as 30 minutes. It contains magnesium hydroxide, which works by drawing water into the colon to help stool to pass. It works naturally with the body and is stimulant and gluten-free. Dulcolax has a range of solutions to help you get back to yourself, such as a treatment that provides overnight relief for occasional constipation and irregularity. Another, Dulcolax Pink Laxative Tablets, is specifically


For all that matters in medicine available in print and digital


HOT TOPIC GASTRO designed for women. Dulcolax Stool Softener is a stimulant-free laxative that softens dry, hard stools. Dulcolax Medicated Laxative Suppositories can start to work within 15 to 60 minutes of use, while Dulcolax Liquid gives fast relief of occasional constipation.

DIARRHOEA Diarrhoea is the frequent passing of loose or watery stools and can have numerous causes, such as the norovirus. It may be accompanied by stomach cramps, an elevated temperature, flu-like symptoms, vomiting and dehydration. Unpleasant and embarrassing, it can affect babies, children and adults at any time. Similarly to constipation, there are a number of trusted over the counter products to treat diarrhoea. Imodium Multi-Symptom Relief relieves diarrhoea along with the symptoms of gas, bloating, cramps and pressure, while OTC paracetamol or ibuprofen products relieve pain.

Dioralyte is suitable for adults and children of all ages but patients should seek medical advice before using Dioralyte for children two years and younger. It is also effective in relieving other causes of dehydration such as sport and exercise. Drinking too much alcohol can also cause dehydration.

IRRITABLE BOWEL SYNDROME Irritable bowel syndrome (IBS) is a common problem in Ireland and is thought to affect about 1 in 5 people. Its symptoms include abdominal pain or discomfort. Other symptoms include discomfort and pain relieved by going to the toilet, muscle pain, backache, and needing to pass urine more frequently or urgently. Anxiety and depression are also signs. Buscopan, an antispasmodic, is also available over the counter. It works in the abdomen directly targeting and relieving the cause of abdominal pain. It is well tolerated and starts to work within 15 minutes of taking the first dose of tablets.

PROBIOTICS

There is also evidence that certain probiotic strains may reduce the severity of eczema in children and infants People experiencing diarrhoea can also become dehydrated. If someone becomes dehydrated, their sweat levels can decrease, body temperature rises and they can experience muscle cramps and dizziness. However, Dioralyte targets dehydration following diarrhoea, helping the body restore and maintain lost fluids and replace essential body salts. It is recommended that a person should use a Dioralyte product after each episode of diarrhoea. Easy to use, Dioralyte helps replace the vital fluids and body salts lost through diarrhoea. In a range of flavours, Dioralyte products contain the right balance of body salts to aid rehydration.

The intestinal microflora is very important for good health because it is able to help the body fight off illness-causing bacteria, as well as aid nourishment. It also produces vitamins which play an important role in different metabolic reactions. However, there are many different factors which can influence the balance of intestinal microflora. These include diet, lifestyle, stress, age, use of antibiotics or chemotherapy agents, renal or hepatic illnesses, and inflammatory bowel diseases. The alteration of the balance of intestinal microflora causes symptoms such as abdominal pain, cramps, excess gas, bloating, and change in bowel habits such as harder, looser or more urgent stools than normal. In terms of maintaining and promoting this vital aspect of health, probiotics are also available. Live microorganisms that promote a healthy balance of gut bacteria, they can be consumed through fermented foods or supplements. They have been linked to a wide range of health benefits such as weight loss, digestive health, immune function and

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more. Probiotics are widely known for their ability to prevent diarrhoea or reduce its severity. There is also evidence that certain probiotic strains may reduce the severity of eczema in children and infants. One study found that eczema symptoms improved for infants fed probiotic-supplemented milk, compared to infants fed milk without probiotics. Another, which followed the children of women who took probiotics during pregnancy, found that those children had an 83% lower risk of developing eczema in the first two years of life. Here too there is a range of probiotics available over the counter. For example, OptiBac Probiotics Bifidobacteria & Fibre may help relieve symptoms of constipation and IBS. This product is suitable for vegetarian and vegan diets, it is also free from gluten, yeast, soya and artificial flavours. Another, Vivomixx is a safe, gluten-free food supplement that can be taken daily to help achieve a balanced digestive system. It does not contain preservatives, colouring agents or synthetic sweeteners. In terms of efficacy, 180 publications worldwide support its use and it is available in both sachets and capsules. ■


Swings & roundabouts

Fintan Moore on the Irish ‘claims culture’ following the Maria Bailey debacle and its relevance for pharmacists

GRAND

Clinical

AGE

EXCLUSIVE COVER

ROUNDS

Oncology, Crohn’s Disease and Ulcerative Colitis, and Mental Health

FROM THE IPU ANNUAL IN GALWAY CONFERENCE 2019

FROM THE HOSPITAL PHARMACISTS

Features

Irish researchers have identified a promising treatment for multiple myeloma, plus a report on medicines in developing countries

OPINION

ASSOCIATION OF IRELAND NAL ANNUAL EDUCATIO CONFERENCE 2019

PECKING ORDER

THE ULTAN MOLLOY ON HIERARCHY THAT EXISTS IN PRIMARY CARE

IN FOCUS PROFESSIONAL DEVELOPMENT

OPINION

CLINICAL CONTENT ON CARDIAC HEALTH, NUTRITION, AND DIABETES 1

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TERRY MAGUIRE ON BEING CORNERED AS THE PHARMACY PROFESSION’S ‘BREXIT SPOKESPERSON’

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HOT TOPIC HEALTHY SKIN

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HEALTHY SKIN HOT TOPIC

ealthy skin is an essential part of overall health and it is something to protect at each stage of life. From nappy rash, to cradle cap to dry skin, looking after a newborn baby’s skin is one of the most important things a parent can do. Babies’ skin is thinner than adults’, meaning it is more vulnerable to irritants. In fact, until three months old a baby’s skin has a higher pH than adults’. Furthermore, as their internal temperature changes, they also sweat a lot and this sweat can irritate the skin. In terms of bathing, the HSE says most experts recommend using plain water when washing a baby for the first 4 weeks or so. It also recommends parents to not use shampoo in most young babies’ hair. Instead, a baby comb can be used to gently remove flakes of skin from the hair. Nonbiological detergent should also be used when washing baby’s clothes, as non-bio detergents contain no enzymes, reducing the risk of irritating a baby’s skin. Once the baby is 4 weeks old, an emollient cream can be used on any dry skin patches, however, parents and guardians should be advised to read labels on lotions carefully. They are also advised to look for hypoallergenic products that are dye-free and fragrance-free and to avoid any products containing colours, perfumes and alcohol. Parents should also be aware that newborn babies may be born with a white coating known as vernix. This protects a newborn’s skin and will be absorbed naturally during the first week after birth.

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HOT TOPIC HEALTHY SKIN NAPPY RASH Nappy rash is one of the most common skin conditions of a baby’s early life. Occurring right up to two years of age, it can be caused when a baby’s skin becomes inflamed after contact with the chemicals in urine or faeces. Sometimes friction caused by the nappy rubbing against a baby’s skin or washing detergents not thoroughly rinsed from reusable nappies can also cause nappy rash to develop. While the irritation can be very uncomfortable for a baby, it is rarely serious. In addition, some babies naturally have more sensitive skin and may be more prone to the condition. But there are certain times when babies are especially susceptible to nappy rash, such as during teething, and when the baby is unwell. It may also occur when babies are changing from breast to bottle feeding and starting on solid foods, and after a course of antibiotics. There are a number of things a parent can do to prevent nappy rash such as changing wet or dirty nappies as soon as possible. A baby’s bottom should also be cleaned thoroughly using plain water or baby wipes, wiping front to back. While changing, the nappy can be left off for as long and as often as possible, and while this can be messy it is beneficial for the skin to be exposed to fresh air. As well as these preventative tips, there is a range of established and trusted brands which can help soothe and ease the pain of nappy rash, such as Sudocrem Care and Protect. Gentle yet effective, it can be used daily even on newborn babies. The hypoallergenic triple-care ointment is so light that it can be applied on to delicate skin easily. As Sudocrem Care and Protect has been developed specifically for

babies, all the ingredients are designed to protect against the causes of nappy rash. The triple-action formula creates a protective barrier, conditions the skin and guards against infection. By sealing in the skin’s natural moisture, Sudocrem Care & Protect helps to keep the skin in the nappy area smooth and supple. Furthermore, if a baby does get nappy rash this can be treated with Sudocrem Antiseptic Healing Cream. This cream is clinically proven to ease the discomfort of nappy rash such as sore or inflamed skin. The anaesthetic reduces the pain and irritation while the water-resistant components create a barrier to prevent any further irritation. If after using a nappy rash cream, the rash remains or the baby develops a persistent bright red, moist rash with white or red pimples, which spreads to the folds of the skin, they may have a thrush infection. This can be treated with an

also works by helping to seal in the skin’s natural moisture, providing optimal conditions to allow gentle skin recovery without drying out a baby’s delicate skin. Clinically proven, it also protects delicate skin from irritants and friction. The waterin-oil formulation keeps the skin healthy and hydrated, which is essential to maintain

Once the baby is 4 weeks old, an emollient cream can be used on any dry skin patches, however, parents should be advised to read labels on lotions carefully anti-fungal cream, available either from the pharmacist or on prescription from a doctor. Occasionally nappy rash can become persistent or can be related to other skin conditions like eczema. Another product, Bepanthen Nappy Care Ointment, is an easy to apply and breathable barrier cream that helps keep baby’s bottom happy and protected from the causes of nappy rash. Bepanthen Nappy Care Ointment is so gentle that it can be used at every nappy change to help even the most delicate skin, as it is free from fragrance, preservatives, colourants or antiseptics. Bepanthen Nappy Care Ointment works to care for baby’s skin and protect it from the causes of nappy rash. As it contains Pro Vitamin B5, it works gently to aid natural recovery of sensitive skin while keeping it soft, smooth and moisturised. Bepanthen

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its natural protective barrier. A thin layer of Bepanthen Nappy Care Ointment should be applied to a baby’s clean, dry bottom after each nappy change, especially at bedtime when the nappy is usually on for the longest period. In addition, non-rinse solutions, such as ABCDerm H2O, can be used to gently remove dirt, impurities and anything that is on the skin. Non-rinse water solutions are formulated with gentle active ingredients to ensure maximum efficacy and the safest application for healthy skin. Those solutions leave the skin moisturised, soothed and fresh. They also make parents’ lives easier, as non-rinse solutions do not need any rinsing afterwards and can be used on any part of a baby’s body. ABCDerm H2O is the first and only dermatological micellar water entirely compatible with the skin.


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HOT TOPIC HEALTHY SKIN

Cicabio Crème also relieves nappy rash discomfort, helps repair skin damage and eases irritation, redness, overheating, and scaly areas. It restores the epidermis and moisturises it while relieving discomfort and reducing the urge to scratch.

DRY SKIN AND CRADLE CAP A yellow crusty appearance on a baby’s scalp, cradle cap is a common feature of caring for a newborn. It is caused by a build-up of dry skin and natural oils on their scalp, but once the baby is around 6 weeks, a mild, tear-free baby shampoo can be used. This, together with soft brushing, should remove the scaly skin. Small amounts of natural baby oil rubbed on the scaly parts can help soften them and make them easier to remove. It is very important to moisturise a baby’s dry skin due to its delicate nature. An effective yet gentle option to try is Vaseline Jelly, which seals in moisture deep down to help heal dry skin. It is made from triple-purified petroleum jelly and is

hypoallergenic, therefore suitable for sensitive skin. It will also not clog pores. Vaseline Jelly can also be used to ease baby’s chapped lips.

LIFELONG CARE Of course skincare is a life-long concern and there are numerous products available for adults. Recently to the market, Relife Skincare is a unique range of Italian emollients and cleansers, that includes products developed for eczema, dermatitis, baby care, dry and sensitive skin. These are available in pharmacies over the counter. The range has a number of products, all dermatologically tested, including Relizema hydrating cleansing bath oil. This cleans, hydrates, protects and calms dry and sensitive skin. It is a gentle face and body cleanser without soap. Its oil formulation is also suitable for removing makeup, leaving the skin pleasantly hydrated. To use, apply Relizema hydrating cleansing bath oil on wet skin and gently massage until a light and delicate foam is

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formed. Then rinse with water and dry without rubbing. Relizema lipid-replenishing cleanser is recommended for sensitive and dry skin as a face and body cleanser. Due to its formulation based on an innovative combination of three different types of ceramides, it helps to restore the natural skin barrier. Relizema cream is available for the treatment of itching and redness associated with different types of dermatitis, including atopic eczema and contact dermatitis. Due to its dermaprotective action, it helps maintain and restore the physiological skin barrier. Its formulation also protects and moisturises the skin with a soothing effect. Another product, Relizema ultra-hydrating lotion, is a daily care treatment for dry and sensitive skin. This lotion has been formulated without fragrances, parabens, silicones or paraffins to minimise the risk of sensitisation. It also helps to restore the natural skin barrier. ■


HOT TOPIC HEAD LICE

PREVENTION, DETECTION & TREATMENT

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HEAD LICE HOT TOPIC

T

he return to school often means that pharmacies see an influx of anxious parents looking for help in eradicating these troublesome pests. While the lice themselves are fairly harmless, they are quite upsetting and prompt treatment prevents the spread of the lice in the family and the wider community. Head lice are grey or brown insects that live close to the scalp on human heads. They are 1mm to 3mm long. The main symptom is itching, but only about 1 in 3 children with head lice have an itch. Contrary to popular myth, nits cannot swim, jump or fly. They are passed on by climbing from the hair of one person to someone else in close proximity. The female head louse lays her eggs on the hair, usually quite close to the root, where they become almost cemented in place thanks to a glue-like substance. Seven to ten days later the baby lice will hatch, leaving their empty white eggshells, or nits, close to the scalp. Once they hatch they will start feeding by biting the scalp and sucking blood through it. Sometime after a week, they are considered fully mature and start the breeding cycle again. At this stage, they can also start looking to greener pastures such as the hair of the person sitting closest to the infected child or adult.

SYMPTOMS While many people may associate itching with head lice, it does not come hand in hand with an infestation. Itching is usually caused by an allergy, but if a person is not allergic to head lice, the chances are they won’t be itchy even if an infestation is present. Others report having a rash at the back of the neck, which is usually caused, by a reaction to lice waste. Even finding visible nits on the hair shaft as the hair grows out, does not indicate a current infestation. This can actually only be confirmed by the presence of a louse, which can be found through detection combing.

DETECTION COMBING Detection combing is the most reliable way of confirming a head lice infestation. It can be carried out on wet or dry hair, but as the lice will remain motionless when wet, many people prefer the wet combing method.

head of hair is combed through. • Rinse out the conditioner and repeat the combing procedure in the wet hair.

Dry detection combing Dry detection combing requires the following steps: • Straighten and untangle the hair using an ordinary comb. • Once the comb moves freely through the hair without dragging, switch to the louse detection comb. Comb the hair from the scalp to the end of the hair, combing each section of hair three to four times before moving on to the next section. • Look out for lice as the comb is drawn through the hair. If you see a louse, trap it against the face of the comb with your thumb. This helps to avoid the louse being repelled by static electricity as the comb is removed from the hair. • Continue combing the hair, section by section, until the whole head of hair has been combed through. NOTE: Lice that fall from the head are usually dying and harmless. However, lice caught on combs can re-establish if they are combed back on within 48 hours.

Wet detection combing Wet detection combing requires the following steps: • Wash the hair using ordinary shampoo and apply ample conditioner, before using a wide-toothed comb to straighten and untangle the hair. • Once the comb moves freely through the hair without dragging, switch to the louse detection comb. Make sure that the teeth of the comb slot into the hair at the roots with the bevel-edge of the teeth lightly touching the scalp. • Draw the comb down to the ends of the hair with each stroke, and check the comb for lice. • Remove lice by wiping or rinsing the comb. • Work methodically through the hair, section by section, so that the whole

TREATMENTS Medicated lotions A number of different medicated lotions and sprays are available on the market. Some of these products focus on prevention. One such, Hedrin Protect & Go Spray, protects the hair from head lice whilst leaving the hair tangle-free and conditioned at the same time. As regards an active infestation Lyclear Treatment Spray is a clinically tested and effective way to treat head lice treatment. The dual action formula suffocates and dehydrates both the head lice and eggs. Another popular treatment is Full Marks Solution. Unlike traditional treatments that poison the lice, Full Marks Solution kills head lice and their eggs by causing the lice to dehydrate and die. It is clinically proven

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HOT TOPIC HEAD LICE

to kill head lice and eliminate eggs when applied to dry hair and combed through with the comb provided. Pharmacy teams should talk their customers through the instructions for the products available and ensure they have enough product to treat everyone in their home who has a live infestation. Depending on the product being used, some need to be applied to wet hair while others should be applied to dry hair. Furthermore, some will need to be left on the hair for up to eight hours. A small number of treatments will kill both the lice and eggs, whilst others will not. Advise patients using the latter style of treatment to treat the person affected immediately and repeat again after seven days to kill the hatchlings. Special care should be taken in treating young children, pregnant women and those with allergies.

New products and old techniques In recent years, a number of new products have been added to the arsenal of weapons

against head lice including UV combs which cause lice and nits to glow and can help make combing methods more effective. Many parents are also resorting back to more old fashioned ways of eradicating lice which are not harmful to their children such as covering the child’s hair in olive oil, hair gel or even mayonnaise in the evening and getting the child to wear a shower cap on their head overnight. It’s thought the method starves the lice of oxygen.

A note about bedding Head lice will generally die within 48 hours if they do not have a human host to feed from so recent advice is that there is no real advantage in fumigating bedding or clothes which comes in contact with lice.

After treatment The hair should be checked again 2 days after the treatment, to make sure it has worked. If nits are found, but you don’t find lice, don’t treat again. Nits may be left behind on the hairs but this does not mean

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Contrary to popular myth, nits cannot swim, jump or fly the treatment has failed. Only treat if if living, moving lice are found. Finding lice after the treatment could be because • the child has been re-infected with lice • the treatment wasn’t carried out correctly The whole family should be checked again and those with lice need to be treated. A child might still scratch after the treatment but this doesn’t mean they have lice. However the child’s head should be checked to be sure. Do not treat again unless live lice are found. Overusing the treatment can make the scalp flaky and itchy. ■


HIGHLIGHTS PRODUCT NEWS CLONMEL HEALTHCARE SMOKING CESSATION

Clonmel Healthcare has announced the launch of an additional pack size of Nicochew Mint 2mg and 4mg Medicated Chewing Gum; 204 pack. This is an additional pack size to our currently marketed 36 pack size. Nicochew Mint is indicated for the treatment of tobacco dependence. A copy of the summary of product characteristics is available upon request or alternatively, please go to www.clonmel-health.ie. Medicinal product not subject to medical prescription. Please contact Clonmel Healthcare on 01 620 4000 if you require any additional information. Contains Nicotine. PA 126/263/3-4. PA Holder: Clonmel Healthcare Ltd, Clonmel, Co Tipperary. Date prepared: June 2019. 2019/ADV/NIC/084H

CLONMEL HEALTHCARE 4SURE

SUDOCREM

Clonmel Healthcare has announced the launch of its new 4SURE Smart blood glucose meter and Smart Duo Blood Glucose and ß-ketone meter.

LIFE’S LITTLE TRAVEL EMERGENCIES

New research commissioned by Sudocrem reveals that Irish people have lost €11.7 million in confiscated items whilst travelling with carry-on bags in the past year. The research, launched as part of Sudocrem’s ‘Life’s Little Travel Emergencies’ campaign, found that deodorants were the most confiscated item at airport security (36 per cent), followed by body lotions and shampoos (30 per cent), hand, face and eye cream (23 per cent), and perfume (22 per cent).

• • • • • • • • • • •

Whether planning a fun city break or a lush retreat this Summer, packing a bag for the trip can be a stressful experience and as Sudocrem’s research demonstrates, Irish people are getting caught out last minute at airport security. Sudocrem wants to help the Irish nation pack smarter and lighter this summer, with the ideal travel companion — a smaller, more convenient 15g pot for Life’s Little Emergencies — which is the perfect size to fit in to travel bags to soothe and protect skin, on the go. Speaking about the launch of Sudocrem’s ‘Life’s Little Travel Emergencies’ campaign, Ms Yvonne Neeson, Senior Product Manager at Teva, said: “Sudocrem, the antiseptic healing cream, has been soothing Irish families since 1931 and we’re always looking for new ways to take care of Irish families’ skin. Our portable, little 15g Sudocrem pot makes it easy to carry around, making it the perfect travel companion for the whole family, tackling any little emergencies when on the go.” As part of the ‘Life’s Little Travel Emergencies’ campaign, Sudocrem have compiled some helpful tips and a travel checklist, which aims to make planning your next trip a much more enjoyable experience. Developed by Dublin pharmacist Mr Thomas Smith, the award-winning Sudocrem formula is available from independent pharmacies, major pharmacy chains, supermarkets and selected department stores nationwide. Always read the label. For further information visit sudocrem.com/ie-en/ Follow Sudocrem on Instragram @SudocremIreland Like Sudocrem on Facebook at facebook.com/SudocremIreland Follow Sudocrem on Twitter twitter.com/SudocremIreland

Features include: Bluetooth connectivity. Diasend compatibility. Wide haematocrit range. Suitable for drivers. Suitable for gestational patients. Pre- and post-meal markers. Large, easy to read display. Small sample size. Rapid reaction time. Long open shelf life on blood glucose test strips. • Cost-effective blood glucose and ß-ketone strips. • Cost effective and extra fine (33g) lancets. Please see GMS codes below: If you require any additional information on the 4SURE range, please contact Clonmel on 01 620 4000. Always read the instructions before use. Date of preparation: April 2019. 2019/ADV/4SU/066H. GMS Code

Description

94170

4SURE Blood Glucose Test Strips (50)

97605

4SURE ß -Ketone Test Strips (10)

97606

4SURE Lancets Sterile (100)

AUTUMN 2019 | ISSUE 3 VOLUME 13 | OTCUPDATE | 27


CROSSWORD

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Across TO WINof Pierce Brosnan (5) 1HOW - Nationality Send your completed crossword with your name and address by November 730th - Original; new (5)2019, to: The Editor, OTC UPDATE, 8 - Approximate (8) 111 Rathmines Rd Lower, Dublin 6 4 - Variant of a thing (7)

9 - Water vapour (5)

11 - Very capable (8) 15 - Particular event (8)

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E T R A I N 17 - Produce as a fruit (5)

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(anag) (5) G20 - Aimed I S R

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21 - Graceful in form (7)

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DOWN 1 List of wares (9) 2 Put in position ready for use (7) 3 Accord (7) 4 Moral excellence (6) 5 Not rough (6) 6 Dramatic musical work (5) 10 At the same time (9) 12 Not in a hurry (7) 13 Having a resemblance to another item (7) 14 Travelling by air (6) 16 Customer (6) 18 Model; perfect (5)

NAME: 1 - ____________________________________________________ List of wares (9) ADDRESS: 2 - Put _________________________________________________ in position ready for use (7) __________________________________________________________ 3 - Accord (7)

__________________________________________________________ 4 - Moral excellence (6)

EMAIL: ____________________________________________________ 5 - Not rough (6)

6 - Dramatic musical work (5)

SUMMER 2019 SOLUTION V

Down

ACROSS 1 Nationality of Pierce Brosnan (5) 4 Variant of a thing (7) 7 Original; new (5) 8 Approximate (8) 9 Water vapour (5) 11 Very capable (8) 15 Particular event (8) 17 Produce as a fruit (5) 19 Lessen (8) 20 Aimed (anag) (5) 21 Graceful in form (7) 22 Number in a trilogy (5)

V

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10 - At the same time (9) 12 - Not in a hurry (7)

The first correct entry will win

13 - Having a resemblance to another item (7) 14 - Travelling by air (6)

Congratulations to Joanne Donohue, 16 - Customer (6) Craughwell Pharmacy, Co. Galway 18 - Model; perfect (5) Winner of our summer 2019 crossword!

â‚Ź50

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OTC Autumn 2019  

OTC Autumn 2019