|When will you suspect one to have anorexia
When the person has the followings:
- Self-induced starvation and weight loss, usually 15 percent or more
below ideal body weight or BMI (body mass index) <17.5 (BMI can be
calculated by dividing the BW in Kg by the square of height in
- A strong desire to be thinner with marked fear of weight gain
- A distorted body image (eg feeling fat when already very thin to
- Obsession with food, occasionally accompanied by binging and
- Ammenorrhoea, either primary or secondary
- Increased physical activity
|Features of person with anorexia nervosa
- Prolonged self-imposed starvation
- Self imposed extreme and rigid dieting
- Dieting begins following a chance remark about size/shape or as a
group behaviour with other adolescent girls
- Derives satisfaction from weight loss
- Marked interest in exercise and participating in vigorous athletic
- Use excessive laxative
- Distorted body image: despite an increasing thin physique, refuses
to accept her emaciated status, believing and perceiving herself to be
fat or overweight
|What would an anorexia nervosa patient look
- Despite of very thin, can be bright and alert
- Prominent cheekbone and sunken eye
- Bones protruding through the skin
- Dry skin/hair with blue cold hands/feet
- Lanugo hair on face/limbs/trunk
- Slow pulse rate
- Low BP and hypothermia
|What is the underlying causes
- Remains unknown
- Mass/Medium: thin is beauty
- Environment: psychosomatic family (enmeshment, overprotective,
rigidity and inability to resolve conflicts or display feelings)
- Before the onset of illness, usually the person is conformist,
conscientious, compliant and high achieving
- After the onset of illness, control over food intake becomes the
only available means to preserve self-identity and independence
|How to treat person with anorexia nervosa
- Multimodal approach: individual, family and cognitive therapy
- Multidisciplinary approach: primary care physician, psychiatrist,
nutritionist, and skilled nursing
- Person with the following features need to be admitted and treated
- Family in crisis
- Suicidal ideation
- Cardiovascular complications (arrythmias, postural hypotension
or systolic BP <70mmHg, bradycardia <40-50/min)
- Hypothermia <36°C
- Significant dehydration or electrolyte disturbances
- When the weight loss is mild or moderate (10-20% below ideal body
weight), outpatient management can be tried if the social situation is
- The nature and seriousness of the condition must be explored
thoroughly in order to establish a therapeutic alliance with the
adolescent and the family
- Eating habit must be altered in order to restore weight and to
correct nutritional deficiencies
- A target weight (around the average for the age/height) should
be agreed upon along with the appropriate daily caloric intake to
ensure its attainment.
|How it works?
- Oestrogen stops the egg from maturing and being released from the
- Progesterone thickened the mucus at the cervix, which makes it hard
for sperms to pass through. It also makes the lining of uterus less
likely to accept a fertilized egg.
- Effective method of contraception
- Does not interfere with intercourse
- Helps to reduce heavy or painful period and makes periods more
- May prevent pre-menstrual syndrome
- Reduces the risk of ovarian and uterine cancer and ovarian
- Progestogen-only pill (mini-pill) is intended for older women or
others who cannot use the combine pills (chronic smokers/ those with
history of cardiovascular disease)
- Progestogen can also be used while breast-feeding
- Common: breast tenderness, mild headache, bloated feeling or mid
- Severe: deep vein thrombosis, high blood pressure, migraine, liver
problem, gall bladder disease, depression
- Cannot be used by those with history of breast cancer, deep vein
thrombosis, liver disease, kidney disease, unexplained uterine
- Should not be used by those with high blood pressure, diabetes,
migraine or depression
|How to use it?
- A hormone pill is taken at the same time daily for 21 days, and
then no pills or sugar pill is taken for 7 days to complete a 28-day
cycle. Refer to the individual drug insert
|Call a doctor
- If you experience any of the followings e.g. shortness of breath,
severe chest pain, fainting or collapse, unusual headache, numbness or
weakness of a limb, pain or swelling of legs
|Types of injections
- Progesterone containing injection given once every 3 months
- Combination injection (estrogen + progesterone) given once every
|Who is suitable for it?
- women who find daily pill taking hard to remember
- those who must avoid pregnancy
- those unable to use other methods
|How is it used?
- Hormone is injected to muscle of the shoulder, front of thigh or
- First injection is given within 5 days of the beginning of a normal
menstrual period, after an early abortion or 6 weeks after giving
- Highly effective
- Does not interfere with intercourse
- Changes in monthly bleeding patterns during the first 3 to 6
- Breast tenderness, weight gain, nausea and others as in OC
|Stopping the drug
- Hormone leaves the body within 60 to 90 days
- Will not affect future pregnancy
|What is it?
- It is a small T-shaped plastic device coated with copper, which is
inserted in the uterus.
- New product can release progestogen
|How does it work?
- To stop sperm from reaching the egg to fertilize it.
- To delay egg from coming down from fallopian tube as well as
preventing the egg settling in the uterus
|Who is suitable for it?
- Women who had children and older women who may be advised to stop
|How is it fitted?
- It must be fitted and removed by a specially trained doctor,
usually during a period or 6-8 weeks after delivery
- For long term use up to 10 years
- Effective and cheap
- Easy to use
- No systemic side effect
- Increased menstrual flow and cramps
- Accidental expulsion of device
- May have increased risk of pelvic inflammatory infection especially
in young users who has multiple sexual partners
- Within 2-3 months of fitting and then at least once yearly
- IUCD usually replaced at least every 4 years, depending on
- Consult doctor if you think the device has come out, experience
pain with intercourse or abdominal pain, have unusual vaginal discharge
|What is it?
- It is a dome-shaped soft rubber cup with a flexible ring.
- When fitted and inserted correctly, it covers the cervix and is
held in place behind the pubic bone
|How dose it work?
- It stops sperm from entering the cervical canal.
- It is usually accompanied by the use of spermicide
- Reduces sexually transmitted disease
- Allow women to control use
- Safe and no prescription needed
- Should have checked by doctor for the correct size of
- Should learn how to properly insert the device
- Woman may be allergic to latex
- May increase chance of cystitis -
|How to use it?
- Put device into vagina prior to intercourse
- Do not remove it for at least 6 hours after intercourse to allow
spermicide to work
- Do not leave it for more than 24 hours
- At least every 12 months for a check if the diaphragm fits
- New size may be needed if put on weight, after delivery,
miscarriage or abortion
|Prevalence of obesity in school children
- 10-13% of children aged 6-18 is obese by Hong Kong Growth Survey in
|Cause of obesity
- Excessive dietary caloric intake
- Sedentary lifestyle
- little exercise
- more time spent on watching TV / playing games
|Sequelae of childhood obesity
- Adult obesity
|Prevention is the most effective way to tackle
Promote physical activity in school setting
- Encourage children to go to school on foot instead of traveling by
bus if possible
- Promote basic exercise eg walking and cycling
- Encourage using of stairs instead of elevators
- Encourage regular physical activity to cultivate students' interest
in certain kind of sports
- Encourage joining active extra-curricular activities like boy/girl
|Toxic substances released by cigarette
- Nicotine: leads to addiction
- Carbon monoxide: causes tireness, accelerate 'aging' process
- Tar: carcinogenic substances, stains fingers and teeth
|Quitting smoking is one of the wisest things to
- You will live longer and live better, as quitting can lower the
chance of having a heart attack, stroke, or cancer.
- If you are pregnant, quitting smoking will improve your chances of
having a healthy baby.
- The people you live with, will not suffer from the harm of
- You can save a lot of money previously spent on buying
- Your sence of smell and taste will improve
- Your skin will look more beautiful and you need not worry about the
stain on your teeth and fingers
|Five keys for quitting
- Get Ready
- Set a quit date.
- Change your environment - get rid of ALL cigarettes and
ashtrays at home, car, and workplace
- Don't let people smoke in your home.
- Get Support and Encouragement
- Tell your family, friends, and colleagues you are going to quit
and ask for their support
- Get individual, group, or telephone counseling. Call your local
health department for information about anti-smoking programs.
- Learn New Skills and Behaviours
- Try to distract yourself from urges to smoke.
- When you first try to quit, change your routine.
- Do something enjoyable to reduce your stress, like exercising,
- Get Medication and Use It Correctly
- The U.S. Food and Drug Administration (FDA) has approved using
Nicotine gum, Nicotine inhaler, Nicotine nasal spray and Nicotine
patch to help the quitting process. Ask your health care provider
for advice for the usage.
- Be Prepared for Relapse or Difficult Situations
- Most relapses occur within the first 3 months after quitting.
Don't be discouraged if you start smoking again. When encounter
difficult situations like having other smokers around, having
weight gain after quitting, suffer a low mood or even depression,
do talk to your doctor or other health care provider for help and
After you quit, become a role model. Be a quit buddy for your friend
as you know what it was like to be addicted. Become a women's health
advocate to prevent young people from ever becoming addicted
|Check these out
|There are supports all around
|Pamela Youde Nethersole Eastern Hospital
|Aberdeen Jocky Club Clinic
||2555 0381 Ext.: 13
|Ngau Tau Kok Jockey Club Clinic
|Ma On Shan Health Centre
|Ha Kwai Chung Polyclinic
|Hospital Authority Quitline
|Hong Kong Council on Smoking and Health Hotline
|Hong Kong Smoking Cessation Health Centre
|The University of Hong Kong Quitline
Substance abuse has been a serious problem in Hong Kong, and in recent
years there is a tendency to involve increasing younger teenagers and
even school children. The pattern of abused substance has also changed
over the past few years.
|Pattern of substance abuse
- In spite of the fact that heroin remained the most common drug of
abuse in Hong Kong (70% of the reported abusers), the trend of
increased psychotropic substance abusers has been sharp. Amongst which
51% were aged 21 or under, and 12% were still in school.
- The most common psychotropic drugs abused included MDMA ("ecstasy")
(abused by 40.1% of abusers), cannabis (26.7%), ketamine (22.3%) and
methylamphetamine ("ice") (17.5%).
- The common reasons given for the abuse of psychotropic substances
were under peer influence (54.3%), to seek euphoria or sensory
satisfaction (43.2%), and for curiosity (40.5%). The usual daily
expenditure on drugs of most individuals was below $300.
- Other substance abuse, for example glue sniffing and cough mixture
abuse is still significant and likely being under-reported.
|Effects of Substance abuse
The range of detrimental effects from substance abuse is enormous,
which, in most situation is augmented by simultaneous alcohol intake,
- Withdrawal syndrome: watery eyes, runny nose, yawning
- Disoriented behaviour and impaired judgement, memory and
- Psychosis, insomnia and depression
- Some also has long-term effect on heart, lung, kidneys and
|Combat against substance abuse
The HKSAR government and various community-based organizations provide
up-to-date information on substance abuse, its prevention and abstinence
program. Some useful links are as follows:
|Check these out