HEALTH BLOG: Cholera: Causes, Symptoms, and Treatment

HEALTH BLOG: Cholera: Causes, Symptoms, and Treatment: Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and sever...

Cholera: Causes, Symptoms, and Treatment

Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and severe dehydration. It can be fatal.

It is caused by the bacterium Vibrio cholera (V. Cholera).

Despite being easy to treat, cholera is estimated to affect between 3 and 5 million people each year, and it causes over 100,000 deaths worldwide.

Due to severe dehydration, fatality rates are high when untreated, especially among children and infants. Death can occur in otherwise healthy adults within hours. Those who recover usually have long-term immunity against re-infection.

Cholera was prevalent in the United States in the 1800s, but now it is rare, because there are well-developed sanitary systems and living conditions.

When traveling to Asia, Africa and some parts of Latin America, however, people need to protect themselves against cholera by having the appropriate vaccinations beforehand, drinking only water that is boiled or from a sealed bottle, and following good handwashing practices.

Contents of this article:

1. What is cholera?
2. Symptoms and causes
3. Diagnosis and treatment
4. Preventing cholera and reducing the risk

What is cholera?

Diarrhea is the key symptom of cholera.

The cause of cholera is infection by the V. cholera bacteria. These bacteria were discovered in 1883.

The German bacteriologist, Robert Koch (1843-1910), studied the disease during an epidemic in Egypt. He found a bacterium in the intestines of those who had died of cholera but could neither isolate the organism nor infect animals with it.

Later that year, Koch went to India, where he succeeded in isolating the bacteria. He discovered that they thrived in damp, dirty linen and moist earth, and in the stools of patients with the disease.

V. cholera bacteria live in shallow, salty water on microscopic crustaceans. They can also exist as colonies of biofilms that coat the surface of the water, plants, stones, shells, and similar items, and they can live among the eggs of midges, which serve as a reservoir for cholera bacteria.

Toxic strains of cholera bacteria produce a poison that triggers violent diarrhea in humans.

When the bacteria enter areas where humans live, they can quickly cause severe epidemics. Weather changes, population loss, and improved sanitation can all end an outbreak.

Symptoms and causes

Only around 1 in 20 cholera infections are severe, and a high percentage of infected people show no symptoms.

If symptoms appear, they will do so between 12 hours and 5 days after exposure. They range from mild or asymptomatic to severe.

They typically include:

• Large volumes of explosive watery diarrhea, sometimes called "rice water stools" because it can look like water that has been used to wash rice
• Vomiting
• Leg cramps

A person with cholera can quickly lose fluids, up to 20 liters a day, so severe dehydration and shock can occur.

Signs of dehydration include:

• Loose skin
• Sunken eyes
• Dry mouth
• Decreased secretion, for example, less sweating
• Fast heart beat
• Low blood pressure
• Dizziness or lightheadedness
• Rapid weight loss

Shock can lead to collapse of the circulatory system. It is a life-threatening condition and a medical emergency.

Causes

Cholera is more common where there is overcrowding and poor sanitation.

Cholera bacteria enter the body through the mouth, often in food or water that has been contaminated with human waste, due to poor sanitation and hygiene.

They can also enter by eating seafood that is raw or not completely cooked, in particular shellfish native to estuary environments, such as oysters or crabs.

Poorly cleaned vegetables irrigated by contaminated water sources are another common source of infection.

In situations where sanitation is severely challenged, such as in refugee camps or communities with highly limited water resources, a single affected victim can contaminate all the water for an entire population.

Diagnosis and treatment

A doctor may suspect cholera if a patient has severe watery diarrhea, vomiting, and rapid dehydration, especially if they have recently traveled to a place that has a recent history of cholera, or poor sanitation, or if they have recently consumed shellfish.

A stool sample will be sent to a laboratory for testing, but if cholera is suspected, the patient must begin treatment even before the results come back.

It is normally dehydration that leads to death from cholera, so the most important treatment is to give oral hydration solution (ORS), also known as oral rehydration therapy (ORT).

The treatment consists of large volumes of water mixed with a blend of sugar and salts.

Prepackaged mixtures are commercially available, but widespread distribution in developing countries is limited by cost, so homemade ORS recipes are often used, with common household ingredients.

Severe cases of cholera require intravenous fluid replacement. An adult weighing 70 kilograms will need at least 7 liters of intravenous fluids.

Antibiotics can shorten the duration of the illness, but the WHO does not recommend mass use of antibiotics for cholera, because of the growing risk of bacterial resistance.

Anti-diarrheal medicines are not used because they prevent the bacteria from being flushed out of the body.

With proper care and treatment, the fatality rate should be around 1 percent.

Preventing cholera and reducing risk

Cholera is often spread through food and because of poor hygiene. Some simple measures can reduce the risk of contracting cholera.

Handwashing is important to prevent the spread of disease.

When traveling in areas where the disease is endemic, it is important to:

• Eat only fruit you have peeled
• Avoid salads, raw fish, and uncooked vegetables
• Ensure that food is thoroughly cooked
• Make sure water is bottled or boiled and safe to consume
• Avoid street food, as this can carry cholera and other diseases

Travelers should learn about cholera before visiting a country where it is prevalent.

Individuals should seek medical attention immediately if they experience symptoms such as leg cramps, vomiting, and diarrhea while in a community where the disease exists.

Cholera vaccine

There are currently three cholera vaccines recommended by the World Health Organization (WHO). These are Dukoral, Shanchol, and Euvichol.

All three require two doses to give full protection.

Dukoral needs to be taken with clean water, and it provides roughly 65 percent protection for 2 years. Shanchol and Euvichol do not need to be taken with water, and they provide 65 percent protection for 5 years. All the vaccines offer higher protection nearer to the time they are given

Tuberculosis: Causes, Symptoms, and Treatments

Tuberculosis is an infectious disease that usually affects the lungs. Compared with other diseases caused by a single infectious agent, tuberculosis is the second biggest killer, globally.

In 2015, 1.8 million people died from the disease, with 10.4 million falling ill.

In the 18th and 19th centuries, a tuberculosis epidemic rampaged throughout Europe and North America, before the German microbiologist Robert Koch discovered the microbial causes of tuberculosis in 1882.

Following Koch's discovery, the development of vaccines and effective drug treatment led to the belief that the disease was almost defeated. Indeed, at one point, the United Nations, predicted that tuberculosis (TB) would be eliminated worldwide by 2025.

However, in the mid-80s, TB cases began to rise worldwide, so much so, that in 1993, the World Health Organization (WHO) declared that TB was a global emergency; the first time that a disease had been labeled as such.

Fortunately, with proper treatment, the vast majority of cases of tuberculosis are curable. Cases of TB have decreased in the United States since 1993, but the disease remains a concern. Without proper treatment, up to two-thirds of people ill with tuberculosis will die.

Contents of this article:

1. Causes
2. Symptoms
3. Diagnosis
4. Treatment
5. Prevention

Fast facts on tuberculosis

Here are some key points about tuberculosis. More detail and supporting information is in the main article.

• The World Health Organization estimates that 9 million people a year get sick with TB, with 3 million of these "missed" by health systems
• TB is among the top 3 causes of death for women aged 15 to 44
• TB symptoms (cough, fever, night sweats, weight loss, etc.) may be mild for many months, and people ill with TB can infect up to 10-15 other people through close contact over the course of a year
• TB is an airborne pathogen, meaning that the bacteria that cause TB can spread through the air from person to person

What is tuberculosis?

TB usually affects the lungs, although it can spread to other organs around the body.

Doctors make a distinction between two kinds of tuberculosis infection: latent and active.

Latent TB - the bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active.

Active TB - the bacteria do cause symptoms and can be transmitted to others.

About one-third of the world's population is believed to have latent TB. There is a 10 percent chance of latent TB becoming active, but this risk is much higher in people who have compromised immune systems i.e., people living with HIVor malnutrition, or people who smoke.

TB affects all age groups and all parts of the world. However, the disease mostly affects young adults and people living in developing countries. In 2012, 80 percent of reported TB cases occurred in just 22 countries.

What causes tuberculosis?

The Mycobacterium tuberculosis bacterium causes TB. It is spread through the air when a person with TB (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.

TB is contagious, but it is not easy to catch. The chances of catching TB from someone you live or work with are much higher than from a stranger. Most people with active TB who have received appropriate treatment for at least 2 weeks are no longer contagious.

Since antibiotics began to be used to fight TB, some strains have become resistant to drugs. Multidrug-resistant TB (MDR-TB) arises when an antibiotic fails to kill all of the bacteria, with the surviving bacteria developing resistance to that antibiotic and often others at the same time.

MDR-TB is treatable and curable only with the use of very specific anti-TB drugs, which are often limited or not readily available. In 2012, around 450,000 people developed MDR-TB.

Who is at risk?

People with compromised immune systems are most at risk of developing active tuberculosis. HIV suppresses the immune system, making it harder for the body to control TB bacteria. People who are infected with both HIV and TB are around 20-30 percent more likely to develop active TB than those who do not have HIV.

Tobacco use has also been found to increase the risk of developing active TB. Over 20 percent of TB cases worldwide are related to smoking.

Symptoms of tuberculosis

While latent TB is symptomless, the symptoms of active TB include the following:

• Coughing, sometimes with mucus or blood
• Chills
• Fatigue
• Fever
• Loss of weight
• Loss of appetite
• Night sweats

Tuberculosis usually affects the lungs, but can also affect other parts of the body. When TB occurs outside of the lungs, the symptoms vary accordingly. Without treatment, TB can spread to other parts of the body through the bloodstream:

• TB infecting the bones can lead to spinal pain and joint destruction
• TB infecting the brain can cause meningitis
• TB infecting the liver and kidneys can impair their waste filtration functions and lead to blood in the urine
• TB infecting the heart can impair the heart's ability to pump blood, resulting in a condition called cardiac tamponade that can be fatal

• Diagnosis of tuberculosis

  
  TB is most commonly diagnosed via a skin test involving an injection in the forearm.
  To check for TB, a doctor will use a stethoscope to listen to the lungs and check for swelling in the lymph nodes. They will also ask about symptoms and medical history as well as assessing the individual's risk of exposure to TB.
  The most common diagnostic test for TB is a skin test where a small injection of PPD tuberculin, an extract of the TB bacterium, is made just below the inside forearm.
  The injection site should be checked after 2-3 days, and, if a hard, red bump has swollen up to a specific size, then it is likely that TB is present.
  Unfortunately, the skin test is not 100 percent accurate and has been known to give incorrect positive and negative readings.
  However, there are other tests that are available to diagnose TB. Blood tests, chest X-rays, and sputum tests can all be used to test for the presence of TB bacteria and may be used alongside a skin test.
  MDR-TB is more difficult to diagnose than regular TB. It is also difficult to diagnose regular TB in children.

  Treatments for tuberculosis

  The majority of TB cases can be cured when the right medication is available and administered correctly. The precise type and length of antibiotic treatment depends on a person's age, overall health, potential resistance to drugs, whether the TB is latent or active, and the location of infection (i.e. the lungs, brain, kidneys).
  People with latent TB may need just one kind of TB antibiotics, whereas people with active TB (particularly MDR-TB) will often require a prescription of multiple drugs.
  Antibiotics are usually required to be taken for a relatively long time. The standard length of time for a course of TB antibiotics is about 6 months.
  TB medication can be toxic to the liver, and although side effects are uncommon, when they do occur, they can be quite serious. Potential side effects should be reported to a doctor and include:
  • Dark urine
  • Fever
  • Jaundice
  • Loss of appetite
  • Nausea and vomiting
  It is important for any course of treatment to be completed fully, even if the TB symptoms have gone away. Any bacteria that have survived the treatment could become resistant to the medication that has been prescribed and could lead to developing MDR-TB in the future.
  Directly observed therapy (DOT) may be recommended. This involves a healthcare worker administering the TB medication to ensure that the course of treatment is completed.

  Prevention of tuberculosis

  
  If you have active TB, a face mask can help lower the risk of the disease spreading to other people.

  A few general measures can be taken to prevent the spread of active TB.

  Avoiding other people by not going to school or work, or sleeping in the same room as someone, will help to minimize the risk of germs from reaching anyone else. Wearing a mask, covering the mouth, and ventilating rooms can also limit the spread of bacteria.

  TB vaccination

  In some countries, BCG injections are given to children in order to vaccinate them against tuberculosis. It is not recommended for general use in the U.S. because it is not effective in adults, and it can adversely influence the results of skin testing diagnoses.

  The most important thing to do is to finish entire courses of medication when they are prescribed. MDR-TB bacteria are far deadlier than regular TB bacteria. Some cases of MDR-TB require extensive courses of chemotherapy, which can be expensive and cause severe adverse drug reactions in patients.

  Countries with higher tuberculosis rates

  The following countries have the highest TB rates, globally:

  • Africa - particularly West African and sub-Saharan Africa
  • Afghanistan
  • Southeast Asia - including Pakistan, India, Bangladesh, and Indonesia
  • China
  • Russia
  • South America
  • Western Pacific region - including the Philippines, Cambodia, and Vietnam

Senior Technical Adviser, Epidemiology at KNCV Tuberculosis Foundation

KNCV is the lead partner in Challenge TB (CTB), the USAID-funded 5-year global program to decrease TB mortality and morbidity in high-burdened countries. We lead an international consortium with eight partner organizations: American Thoracic Society (ATS), FHI 360, Interactive Research & Development (IRD), Japan Anti-Tuberculosis Foundation (JATA), Management Sciences for Health (MSH), PATH, The International Union Against Tuberculosis and Lung Disease (The Union), and the World Health Organization (WHO).

Senior Technical Adviser, Epidemiology

• Job TypeFull Time
• QualificationMBA/MSc/MA   PhD/Fellowship  
• Experience7 years
• LocationAbuja
• Job FieldMedical / Health   NGO/Non-Profit  

 

Purpose of the Position

• In the position of senior technical advisor epidemiology you will provide epidemiological support to complex projects in order to enhance evidence-based decision-making, conduct intervention studies, surveys, support analysis of epidemiological data, and carry out operational research.

Profile
As Senior Technical Adviser Epidemiology you will:

• Work with relevant stakeholders including the NTP, donors and project staff to ensure a data driven process is used in programming;
• Be responsible for leading the design and implementation of the activity M&E framework and information system to track delivery against targets, outcomes and impact;
• Lead the analysis of data collected for assessment of progress, areas of improvement, and identification of successful interventions that could/should be replicated or scaled-up;
• Guide reporting processes amongst technical staff and consolidate program reports, promote learning and knowledge sharing of best practices and lessons learned;
• Support all technical staff in M&E functions and supervise any M&E related staff in the program;
• Carry out and support epidemiological TB research;
• Develop and evaluate project plans for CTB research projects;
• Maintain research contacts with national and international organizations and with various local and external organizations such as universities or medical research institutes;
• Give formal and on the job training on M&E, and operational research related to TB control;
• Advise and support government authorities and local institutions in setting up and conducting M&E activities;
• Formulate recommendations for the implementation of TB control interventions to national TB control programs and other institutions or organizations on the basis of research results and lessons learned;
• Promote the expertise of KNCV colleagues by presenting research results and their relevance for policy making;
• Publish scientific articles on the basis of the research conducted and lessons learned;
• Give presentations at conferences and scientific meetings.

Requirements
Education:

• MSc or corresponding degree in epidemiology, statistics or in public health
• Holding a doctorate degree (PhD) in epidemiology, public health and/or statistics.

Knowledge/experience:

• At least seven years of experience designing and implementing monitoring and evaluating activities for complex programs in developing countries
• A firm command of the M&E issues with respect to improvements in quality integrated service and support programs
• Demonstrated experience in setting up and managing M&E systems that track performance as per the objectives of this project (e.g., activity implementation against results and funding)
• Demonstrated analytical skills to measure the outcomes of the project’s activities and support project supervision
• Strong writing and organizational skills for monitoring and reporting on program and program outcomes and impacts
• In-depth knowledge of and experience with epidemiological and statistical analysis
• At least 4 years relevant post-qualification professional experience in research
• In-depth knowledge of and experience with quantitative and qualitative epidemiological research techniques; specifically implementation research
• Demonstrated skills in applying statistical software for research data analysis
• Knowledge of and experience in training and capacity building
• Ability to work both as member of a team and independently
• Ability to cope with stress and to organize and prioritize workload
• Ability to work in an international team
• Excellent verbal and written communication skills in English.

Assets:

• Experience with working in resource-challenged countries
• Familiarity with infectious diseases such as HIV AIDS and TB.

What does KNCV Tuberculosis Foundation Offer

• A full-time (40 hours per week) fixed-term contract for a year, with the intention to extend the contract, depending on performance and availability of funding;
• An informal work atmosphere in an international environment where initiative is appreciated;
• A highly-motivated team of experienced, self-driven colleagues;
• The salary is dependent upon education and relevant working experience;
• KNCV Tuberculosis Foundation has its own Employment Conditions Scheme.

Method of Application

You can apply for this position by submitting your CV, including a motivation letter and 3 professional references

Interested and qualified? Go to KNCV Tuberculosis Foundation career website on www.kncvtbc.org to apply

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Brain response to unfairness 'predicts depression'

New research finds that brain responses to unfair treatment in a computer game involving money rewards can predict whether healthy people will develop symptoms of depression.

The researchers, from the National Institute of Information and Communications Technology in Osaka and Tamagawa University in Tokyo, both in Japan, have published their findings in the journal Nature Human Behaviour.

Experts suggest that the imaging study offers new insights into how mechanisms in the brain might explain the link between economic inequity and depression.

Depression is a global public health problem that affects more than 300 million people, and it is the "leading cause of disability worldwide." In the United States alone, depression affects around 7.6 percent of people aged 12 and older and cost the nation $210.5 billion in 2010.

People living below the poverty line in the U.S. are more than twice as likely to have depression than people living at or above it.

Economic inequity and depression

In their study report, the researchers write that economic inequity has become "an increasing concern for society," and they cite previous studies that have linked it to depression and other psychiatric diseases.

They refer to large studies, such as Whitehall II, that have found links between "economic gaps and major depression, where economic and material disadvantage are crucial in explaining depressive symptoms."

However, because the brain mechanism underlying the link is less well understood, they decided to investigate it further.

The team used functional MRI to scan brain activity of healthy individuals as they played a computer game wherein they were asked to accept or reject offers to split a pot of money between themselves and a "virtual partner."

There were three types of offer: one in which the two players received equal shares of the money ("equity"); another in which the participant got more ("advantageous inequity"); and another in which the virtual partner got more ("disadvantageous inequity").

Individualists and prosocials

At the time of playing the game, the participants were also asked to complete two other tests: the Beck Depression Inventory (BDI) and a test that measures their "social value orientation." They also completed the BDI a year later.

The team found that the participants with "individualist" social orientation tended to be more selfish and keep the money in unfair advantageous offers.

In contrast, the "prosocial" participants tended to be more self-sacrificing and rejected offers wherein the money was not split equally.

The researchers then analyzed measures of brain activity in the amygdala and hippocampus in response to types of offer and depression scores.

It was found that for the disadvantageous offers, the response in the amygdala and hippocampus predicted current depression scores and changes in symptoms 1 year later. This was true of both prosocials and individualists.

But when the team analyzed the results for advantageous offers, they found that the amygdala and hippocampus responses only predicted depression in prosocials.

'Critical effect on mood'

The researchers note that these various predictions "were not possible using participants' behavioral and socioeconomic status measures."

They suggest that the findings show that even healthy people's response to inequity may have "far-reaching implications for their mood."

They call for further studies to build on the results to find ways to better identify and protect people from mental illness.

In an accompanying commentary, Megan Speer and Mauricio Delgado - both of Rutgers University in Newark, NJ - describe the research as "thought-provoking" and suggest that it "highlights potential risk factors that can precipitate or exacerbate the debilitating nature of depression."

"These findings suggest that sensitivity to economic inequity has a critical effect on human mood states, and the amygdala and hippocampus play a key role in individual differences in the effect."

Coping with panic disorder

Do you experience sudden attacks of anxiety, fear, and panic? Perhaps your heart races, you feel unable to breathe or think properly, and you sweat. Do these attacks have no obvious trigger? Here are some of the best ways to cope with panic disorder to improve your quality of life.

Panic disorder affects 2 to 3 percent of people in the United States per year, and it is twice as likely to occur in women than in men. Individuals with panic disorder tend to have spontaneous panic attacks, and they therefore become preoccupied with the fear that they may happen again, at any time.

The condition can interfere with many aspects of the person's life, causing them to avoid work or school and avoid situations wherein they fear a panic attack may occur.

Many people with panic disorder are embarrassed or afraid to tell anyone about what they experience, instead distancing themselves from family and friends who could be supportive.

Panic disorder is highly responsive to treatment. Building a toolbox of self-help strategies can be effective in helping you to manage your symptoms without living in fear. Here are Medical News Today's tips for coping with panic disorder.

1. Gain knowledge of panic disorder

The first step in overcoming your panic disorder symptoms is to understand what is happening in your body when you experience an attack. Gathering knowledge about the disorder and working out your underlying triggers can be a starting point for dealing with the condition.

Learning about anxiety and panic disorder can help you to take control of your condition.

Anxiety is likely to cause the worries and physical feelings you feel as a part of panic disorder. Anxiety is a normal part of the body's "fight-or-flight" response to uncertainty, feeling unprepared, or trouble, which prepares us to act quickly in the face of danger.

Panic disorder results from misinterpreting sensations linked with the fight-or-flight response as dangerous, which triggers an uncomfortable and often frightening barrage of symptoms - also known as a panic attack.

Living in fear of having a panic attack and therefore avoiding situations that may cause them can often create more situations and more avoidance in a never-ending cycle of fear and anxiety.

Although scary, panic attacks are harmless; they are the body's alarm system kicking in and are not designed to harm you in any way.

While the response may make you feel as though you are going crazy or dying, you are not. Your body would have the same reaction if you were facing a physical threat, such as coming face to face with a bear.

Once you understand what panic disorder is and why you are experiencing the symptoms, you can begin to learn to cope with them. The goal is not to eliminate the attacks, but to find a way to manage them without fear.

Do you experience sudden attacks of anxiety, fear, and panic? Perhaps your heart races, you feel unable to breathe or think properly, and you sweat. Do these attacks have no obvious trigger? Here are some of the best ways to cope with panic disorder to improve your quality of life.

Panic disorder affects 2 to 3 percent of people in the United States per year, and it is twice as likely to occur in women than in men. Individuals with panic disorder tend to have spontaneous panic attacks, and they therefore become preoccupied with the fear that they may happen again, at any time.

The condition can interfere with many aspects of the person's life, causing them to avoid work or school and avoid situations wherein they fear a panic attack may occur.

Many people with panic disorder are embarrassed or afraid to tell anyone about what they experience, instead distancing themselves from family and friends who could be supportive.

Panic disorder is highly responsive to treatment. Building a toolbox of self-help strategies can be effective in helping you to manage your symptoms without living in fear. Here are Medical News Today's tips for coping with panic disorder.

1. Gain knowledge of panic disorder

The first step in overcoming your panic disorder symptoms is to understand what is happening in your body when you experience an attack. Gathering knowledge about the disorder and working out your underlying triggers can be a starting point for dealing with the condition.

Learning about anxiety and panic disorder can help you to take control of your condition.

Anxiety is likely to cause the worries and physical feelings you feel as a part of panic disorder. Anxiety is a normal part of the body's "fight-or-flight" response to uncertainty, feeling unprepared, or trouble, which prepares us to act quickly in the face of danger.

Panic disorder results from misinterpreting sensations linked with the fight-or-flight response as dangerous, which triggers an uncomfortable and often frightening barrage of symptoms - also known as a panic attack.

Living in fear of having a panic attack and therefore avoiding situations that may cause them can often create more situations and more avoidance in a never-ending cycle of fear and anxiety.

Although scary, panic attacks are harmless; they are the body's alarm system kicking in and are not designed to harm you in any way.

While the response may make you feel as though you are going crazy or dying, you are not. Your body would have the same reaction if you were facing a physical threat, such as coming face to face with a bear.

Once you understand what panic disorder is and why you are experiencing the symptoms, you can begin to learn to cope with them. The goal is not to eliminate the attacks, but to find a way to manage them without fear.

4. Make coping cards

However, it can be tough to challenge unhelpful or scary thoughts in times of severe anxiety, so it might be useful to make coping cards.

Coping cards can feature realistic thoughts about panic attacks to challenge your thinking. You can use an index card or piece of paper, write down some realistic thoughts, and carry them around with you throughout the day.

4. Make coping cards

However, it can be tough to challenge unhelpful or scary thoughts in times of severe anxiety, so it might be useful to make coping cards.

Coping cards can feature realistic thoughts about panic attacks to challenge your thinking. You can use an index card or piece of paper, write down some realistic thoughts, and carry them around with you throughout the day.

4. Make coping cards

However, it can be tough to challenge unhelpful or scary thoughts in times of severe anxiety, so it might be useful to make coping cards.

Coping cards can feature realistic thoughts about panic attacks to challenge your thinking. You can use an index card or piece of paper, write down some realistic thoughts, and carry them around with you throughout the day.

Atherosclerosis: Skipping breakfast may double risk

A study led by researchers in Spain has suggested that skipping breakfast doubles the risk of "subclinical atherosclerosis."

Atherosclerosis occurs when fatty deposits, along with cholesterol and other forms of cellular waste, build up inside the arteries. This reduces arterial elasticity, and, over time, it can lead to coronary heart disease, angina, or peripheral artery disease, among other conditions.

Subclinical atherosclerosis is a latent form of the condition, which does not produce symptoms straight away.

Popular wisdom has it that breakfast is the most important meal of the day - and the first set of findings from the Progression and Early Detection of Atherosclerosis study (PESA) suggests that the meal may be even more important than traditionally believed.

The results of the research show that those who consume less than 5 percent of their daily calorie intake for breakfast may have double the risk of subclinical atherosclerosis compared with people who have a high-energy breakfast.

A high-energy breakfast might comprise a good source of protein - such as yogurt or eggs - whole grains, and fruit.

The first author of the new study is Dr. Irina Uzhova, of the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, Spain, and the findings were published in the Journal of American College of Cardiology.