Community immunity protects those members of the community who cannot or have not already been vaccinated – like the immunocompromised with serious other illness like cancer or dialysis, old age debility , those undergoing chemotherapy and new borns not yet vaccinated. To achieve community immunity at least 92% of the community need to be vaccinated.
Potentially life threatening diseases that are vaccinated against in Australia are: Diptheria , Whooping cough , Tetanus , Poliomyelitis, Measles, gastroeneteritis from Rotavirus.and chickenpox
Additionally significant diseases like cancer of the cervix, meningococcal infection, hepatitis B pnemococcal disease are also vaccinated through school and retired age group programs .
“ use it or lose it “ is a useful adage to remember for osteoarthritis especially of weight bearing joints.
Weight reduction of 5% in 20 weeks is a worthwhile goal to aspire to with real benefits remembering that for every 1 kgm weight loss there is a 4kgm reduction in pressure on the major weight bearing joints of the leg like the knee.
Regular Exercise reduces pain and maintains or improves joint function. Balance training reduces the likelihood of falls and enhances joint movement.
Active aerobic exercise should be done for 30 mins / day – most days at a level that makes you breathe hard but still able to speak about 7 words at a time. Walking is very easy especially if done as part of a lunch break or part of the daily commuting walking to transport or the car park. 3 x 10 min burst of intense exercise have also been found to be of similar benefit
Strengthening exercises should be done at least 3 x /week involving core strength exercise , quadriceps hamstrings hip abductors and calf muscles. Therabands or light weights are useful. Exercises to consider – standing leg side raises; sit to stand from chair ( no hands); calf raises ( tip toes ); one or two step up and down – facing stairs , side steps – face left and face right, have support rail or bannister next to the step for safety. Straight leg raises and knee straightening when seated.
Flexibility exercises at least 3 x/week for at least the knee and hip as well as the back involving stretches and rotations for 15-30 seconds repeated 3-4 times at least 3 x/week. Quadriceps , hamstrings , hip flexors and abductor stretches
Water based exercise 2 x /week for 30 mins is a valuable addition because of constant resistance, the soothing effect on joints, the improvement Water aerobic or exercise classes are a useful adjunct. Consider walking in above waist height water , swimming , bicycling action , star jumps and lunges also the use of resistance equipment like noodles paddles and kickboards.
Ask your doctor , physiotherapist or trainer for advice.
Lifestyle modification is the mainstay of treatment of type 2 Diabetes Mellitus and generally achieves around 5% weight loss and should be maintained for at least 2 years preferably 3 years to be considered sustained and permanent. It is best if this weight loss is apparent in a reduction in waist circumference – less than 94 cm for men and 80 cm for women or waist / hip ratio that is sustained. These measurements reflect the fat load on central blood vessels.
Three forms of bariatric weight reduction surgery are available in Australia.
Laparascopic gastric band, gastric sleeve and gastric bypass.
Strengthening exercises should be done at least 3 x /week involving core strength exercise , quadriceps, hamstrings hip abductors and calf muscles. Therabands or light weights are useful. Exercises to consider – standing leg side raises; sit to stand from chair ; calf raises; step up and down , side steps both directions; straight leg raises lying /seated and knee straightening when seated.
Falls risk can be reduced by doing flexibility balance exercises at least 3 x/week for at least the knee and hip as well as the back involving stretches and rotations for 15-30 seconds repeated 3-4 times at least 3 x/week. Quadriceps , hamstrings , hip flexors and abductor stretches
Water based exercise 2 x /week for 30 mins is a valuable addition because of constant resistance, the soothing effect on joints, the improvement Water aerobic or exercise classes are a useful adjunct. Consider walking in above waist height water , swimming , bicycling action , star jumps and lunges.
Ask your doctor , physiotherapist or trainer for advice.
Previous pap smear testing which was based on looking for abnormal cervical cells derived by smear test taken intravaginally has been replaced with routine HPV ( human papilloma virus ) screening combined with liquid based screening of cervical cells derived by intravaginal brush sampling where indicated.
Routine testing is recommended from age 25-74 at 5 yearly intervals if there is no indication for more frequent testing such as a previous abnormality or recall.
The screening is now based on testing for the presence of high risk HPV viral types which has been researched to be a more sensitive test. If the virus is detected cytology screening is then done on the cells from the cervix that have been obtained at the same time from the same sample- looking for abnormal cells.
Results are in 3 categories
Low risk – HPV test is negative repeat in 5 years
Intermediate risk -HPV test is positive repeat test in 12 months
High Risk – HPV test is +ve for high risk oncogene HPV types and/or cytology is abnormal suggesting the presence of high grade cervical changes – follow up cytology by a gynaecologist is recommended
Testing can now be more focused by requesting the cervical screening test .
In the format of
Cervical screening Routine
Cervical screening – co test symptomatic
Cervical screening – follow up of previous abnormality
Cervical screening – co test Test of cure ( after previous treatment)
Cervical screening – previous AIS ( previous carcinoma in situ )
A 2017 UK study showed that with high levels of continuity of care resulted in 12.49% fewer hospital admissions and in Holland low levels of continuity of care was associated with increased mortality. Traditionally high levels of continuity of care have usually been with a particular GP but similar benefits at lesser level seem to be associated with the same group of practitioners in the same practice possibly due to shared long term records.