What do we mean by a heat wave (Ola de Calor)?

A heatwave is a situation of intense, often with high humidity levels, covering a wide geographical area and lasting for several consecutive days.

Who are most in danger?

• Children under 5 years old
• Elderly people over 65 years old
• People suffering with obesity
• People who carry out activities that require physical effort and in places with heat sources
• Ill people and people taking certain medication

What should we do on very hot days?

• Drink plenty of liquid, especially if you are carrying out physical activity. Bear in mind that alcoholic drinks or drinks with caffeine increase the loss of liquids and they are therefor not recommended. Neither is it recommended to drink excessively cold drinks or highly sugared drinks.
• Provide your body with mineral salts, through drinks in order to replace those that are lost through sweat. Energy drinks for sportspeople are particulary suitable. If you drink these type of drinks or eat salty food and your consumption of salt is restricted by your doctor, check with your doctor before taking them.
• Eat small amounts of food, more often and preferably plenty of fruit and vegetables, and reduce proteine rich foods such as meat.
• Wear suitable clothing. The most suitable clothing is thin, loose fitting items that cover as much of your body as possible and which should be light in colour.
• Use protection against sunlight. Do not expose yourself to the sun during periods of highest sun radiation and always using factor 15 or more as a sun cream protection which should be applied to exposed areas 30 minutes before going into the sun, before leaving home if necessary. Protect your head from the sun.
• Avoid unnecessary physical effort, during hot weather. Start exercising gradually and increase slowly. If you feel very tired, dizzy, confused or if you feel you are going to faint, stop wathever you are doing and rest in a cooler place in the shadow.
• Use air conditioning if it is available, without excessively reducing the ambient temperature.
• Plan your daily activities for mornings or evenings when temperatures are not at their highest.
• Keep a close check on children and elderly people. People over 65 years old start to loose their ability to react to changes in temperature and their feeling of thirst is altered. Check their condition and make sure they take in liquids.
• Never leave children, elderly people or pets in a parked car during periods of intense heat. Bear in mind that areas of sun and shade can change in a very short time.

What problems can occur during a heat wave and how should we deal with them?

When the body can no longer regulate its own temperature because of the heat, our temperature rises very quickly and give a situation known as heat stroke.
The symptoms are:
• High temperature
• Red, hot and dry skin
• Strong, fast pulse rate
• Throbbing headaches
• Dizziness, nausea and confusion
• It is possible to loose consciousness

Treatment:
• Try to obtain medical attention
• Reduce the body temperature taking the affected person to a cooler place and rub them with damp cloths or shower them
• If the person is unconsious and vomitting turn their head to one side and keep their airway free from obstructions

Heat exhaustion
The symptoms are:
• Cool, moist skin
• Fast, weak pulse rate
• Fast shallow breathing
• Without treatment a heartattack can arise, particulary if the affected person suffers from a heartcondition.

Treatment:
• Treatment is the same as for a heat stroke, although the affected person may also be able to drink liquids.

Other common problems are heat cramps, that are treated by rest and by drinking diluted fruitjuices or sportdrinks. Sunburn is also common- these burn should be cooled and medical attention sought.
Remember that all the adive given above is of a very general nature; the specific recommendations for each person can be obtained from your doctor.
(Information provided by the Generalitat Valenciana)

What is cystitis?

The bladder is the storage room for urine and is located low in the abdomen. Through the urethra the urine can be evacuated to the outside. With cystitis the inner lining of the bladder is infected. Sometimes the urethra can also be infected.

Cystitis usually gives pain and discomfort while peeing. It can be that you have to go to the toilet frequently and that you urinate small amounts. Some people constantly have the feeling that they have to go to the toilet. Cystitis can cause a pressure or painfull feeling in your lower abdomen or back. Sometimes the urine has an unpleasant smell or is not clear. Sometimes there might be blood in the urine. In small children crying and fever might be the only symptoms of cystitis.

What causes it?

Cystitis is usually caused by bacteria. Women tend to have cystitis more often then men, because women have a shorter urethra. Therefore bacteria from outside can easily access the bladder. People who can't empty their bladder completly, for example men with an enlarged prostate or women with a prolaps, have more chance in developing an infection. With them there's alsways a small amount of urine left in the bladder, where bacteria can multiply.

Does it do any harm?

Cystitis is an annoying and painfull problem. Normally cystitis is well treatable. In children the infection can be caused by abnormalities in the urinary tract. In men cystitis is usually combined with an infection of the prostate.

What can you do yourself?

• To prevent cystitis it is important to drink plenty. Try to drink 2 liters a day.
• By going to the toilet frequently, you wash out the bacteria. Try to empty your bladder completly.
• Some women tend to have less cystitis when they urinate after having sex.
• Drinking cranberry juice can sometimes prevent cystitis.

When to see your doctor?

Men who have symptoms of cystitis always should see their doctor.
Women who think they have cystitis do not always have to seek medical attention. Sometimes it can be curable with drinking plenty of water. Women should see their doctor when they are very uncomfortable or the complaints last more then a week. Women have to see a doctor when they are pregnant, develop a fever or pain in the side or back or when they think they might have a STD.

Children with fever of unknown origen, can have cystitis and have to see a doctor.

When you go and see your doctor you have to bring some urine with you. Urine has to be checked in 2 hours, if you can't make it in 2 hours you can keep the urine in the fridge. If refridgerated urine can be examined for 24 hours.

Source: translated from patientinfo Nederlands Huisartsengenootschap

Tanning And The Sun

The sun gives 3 different kinds of light. Infrared is invisable and gives warmth. Visable light is the light that makes us see the world around us. Ultraviolet is invisable, just like infrared.

Ultraviolet radiation

Ultraviolet radiation (UV-radiation) is devided into 3 different types: UV-A, UV-B and UV-C. Normaly the atmosphere around the world holds back most of the radiation. Mainly the ozonlayer plays a big part in this. The atmosphere works as some kind of UV- shield which is beneficiary for us, since UV radiation can cause severe damage to our skin.
• UV-C is the most powerfull form of UV-radiation, but it doesn't reach the surface of the earth.
• UV-B is blocked by the atmosphere for a big part, but when there's a cloudfree sky an considerate amount reaches the surface of the earth. UV-B is the biggest cause of sunburn and skincancer.
• UV-A reaches the surface of the earth quite easily and is the least harmfull of all 3, but in high amounts still can cause sunburn and skincancer.

But UV-radiation also has advantages. It is essential for producing vitamine D in our body. A shortage of vitamine D in children causes developmental disorders of the bones. During the industrial revolution in Europe there were many children working in factories and they didn't get out in the sun much. The consequence was that their bones didn't develop properly. They also call it the "English disease" since it was seen a lot in the UK (early industrial revolution and not a lot of sun). The medical therm is "rachitis". With normal sunexposure the body produces more then enough vitamine D. Nowadays there are cases of vitamine D shortage described in women who are inside a lot and wear a burka or a veil when they step outside.

UV-radiation works, when dosed well, also as an anti inflammatory on the skin. With eczema or psoriasis the dermatologist can even prescribe UV-lighttherapy.

How too much UV damages the skin

UV can do damage when the energy of the UV radiation is taken in by the DNA of the skin. DNA is the genetic material that regulates things like cellgrowth and celldivision. By absorption of the energy the protein in the DNA can change.
If there's a small change in the structure of the DNA, this fault can be repared again by other special proteins of the cell.
When there's a lot of damage, the DNA of the cell eventually will die.
If the DNA gets damaged and this isn't noticed by the cell or is fixed wrong, the change in the DNA can be permanent. In some cases the damage can be of such nature that the cells start to divide in an uncontrolled way. This is the way skincancer or melanoma is formed. You can recognize a melanoma by the asymmetry of the mold, the undefined border, the colourdifferences and the size.
UV-radiation breaks down the elastic fibers. Elastic fibers provide the skin with felxibility and resistance. The breaking down of these fibers you can compare with what happens to an elastic band which is in the sun: after a few days the elastic fibers are broken and the elastic band crumbles away. The skin always makes new elastic fibers but this process decreases when getting older. When the destruction is bigger then the construction the skin looses its flexibility and wrinkles appear. This is also called photoageing.
UV-radiation can also cause pigmentdisorders in the skin.

Tanning

The skin tries to protect itself against the UV radiation. This it does by making pigment which is being put in the cells of the epidermis. That way a 'parasol' is formed of pigment (melanine) which protects the cells of the epidermis against the UV radiation. The tanning proces reduces the chance of damage to the DNA. People who don't produce a lot of pigment - very blond persons and persons with red hair- hardly can make this protective pigmentparasol and therefor have a higher risk in getting skincancer then the people who tan easily or who have already a darker skin by nature.

The amount of UV radiation depends on:
• The season: in summer the amount of sunlight is a lot higher then in winter.
• The time of the day: in the middle of the day the sun is right above the surface of the earth which means that the radiation only has to travel a relative small distance.
• Degree of latitude: closer to the equator there's more UV radiation.
• Height: high in the mountains there's less UV filtered then on sealevel.
• Reflection: there's more UV radiation when it is reflected by snow, water or sand.
• Extra filters: on a very cloudy day, only little UV radiation reaches the surface of the earth.

Protection

Because of the the risk of sunburn, skincancer and premature aging of the skin it is better not to expose the skin to the sun too much. If you are planning to stay in the sun for a longer time, it's recommended to wear a shirt, cap or a hat. The disadvantage of a cap is that it only gives shade on one side, while a hat with a wide rim gives shade over the face and the neck. People who are getting bold or have problems with hairloss a cap or hat are really necessary.
The strength of the sun is around noon always the strongest. Try to avoid the sun in these times as much as possible. In northern Europe this is between 12pm and 3pm in summer. In (sub) tropical places this period can be a lot longer. Be aware that because of the reflection in water or sand there is also UV radiation reaching you when you are under a tree or a parasol. Therefore always use a suncream with sunny weather even if you are sitting in the shadow.
Also the eyes can be damaged by the sunlight. Always wear sunglasses with a good UV filter. Cheaper glasses without a good UV filter are worse then wearing no sunglasses at all. They put your eyes in the dark which makes that the pupils are wide open and therefor the UV radiation can cause more damage.
Suncream is an efficient way to protect your skin against UV radiation. Every suncream has a certain degree of protection, de sun protection factor (SPF). For example: someone with skintype 2, burns after aprox. 20 minutes in the midday sun. When this person would use a suncream with SPF 12 the sunburn will occur after 12x20 minutes, so after 4 hours.

This table gives you an overview what SPF to use for which skintype:
• Skintype 1: very light skintype, burns quickly, never tans factor 30
• Skintype 2: light skintype, burns fairly quick, tans slowly factor 15-20
• Skintype 3: fairly light skintype, doesn't burn so quickly, tans quite fast factor 10-15
• Skintype 4: tanned skintype, hardly ever burns, tans fast factor 5-10
• Under the age of 16 factor 30

The get the protection that the suncream offers, you have to apply it in quite a thick layer. A handfull for creaming the whole body isn't over the top.

The quality of suncreams improved a lot over the last years. Nevertheless the layer of suncream wears off in a couple of hours. This is increased by wearing clothes, laying in the sand and swimming. The waterproof creams stay better on the skin after contact with the water, but it is still recommended to cream regulary. Keep in mind also that the cream only starts to work after 30 minutes.

House Dust Mite Allergy

House dust mites are about a quarter of a millimeter long. They live off human skin scales and thrive in humid climates. Mites are found in bedding, carpets, soft furnishings and clothing. Dust mites often cause allergies because humans react to various proteins (allergens) contained in their droppings. Each mite produces about 20 of these waste droppings every day and the droppings continue to cause allergic symptoms even after the mite has died.

House dust mite allergy is very common and is associated with asthma, eczema and allergic rhinitis. A major site of exposure to house dust mite allergen is the bed however it is important to remember that dust mite allergen is found in all rooms of the house, on the floor and in soft furnishings, not just in the bedroom. House dust mite avoidance measures may lower but do not totally remove dust mite allergens.

Managing mites

What may or may not help to reduce mite allergen:
• Mattress, doona and pillow covers may reduce allergen exposure in the bed. Make sure they are removable and machine washable. The protector should entirely encase the mattress. Mattress protectors which do not completely encase the mattress are not effective and should not be used.
• Washing of bedding, soft toys and soft furnishings at usual washing temperatures removes more than 95% of allergens but does not kill dust mites, thus washing should be repeated about every 8 weeks. Attempts to kill dust mites are not very successful in practice and are currently not recommended by experts.
• Regular vacuuming may help reduce mite allergens in your carpets or rugs but this is not very efficient and many vacuum cleaners also increase the amount of allergen in the air. It is important to understand that vacuuming alone without undertaking other measures will not reduce the dust mite level significantly.
• Having non-carpeted flooring and reducing soft furnishings such as curtains, soft toys and sheepskins reduces the amount of house dust mite allergen.

Other methods are of very little help, including chemical sprays, air filtration, negative ion generators and "allergen-free" products.
Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for you.

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Identification:
Dr. An Croonenborghs
C/La Mar 121
03590 Altea
Spain

Title and Council:
General Practitioner
Graduation KU Leuven 2006
Member of the Medical Council of Alicante
Number COMA 03.03.10.499
VAT Number: ES-X-7076501-E

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