Cluster Headache Awareness Day (March 21)

The 21st of March is the “Cluster Headache Awareness Day”, a prominent event to promote CH on scientific and public levels. The spring equinox represents the perfect choice for a disease with such a great circadian and circannual  rhythmicity. Indeed, a vast majority of CH subjects experienced a CH reactivation during the seasonal shift in spring and autumn; in some cases, the circannual timing becomes so scheduled that patients do not plan activities and slowly slide toward social withdrawal just for the fear of a novel cluster period. The 21st of March is well remembered by CH patients, because starting from this date when the daylight increases there are positive effects for patients with night attacks.

With a prevalence of 0.12%, Cluster Headache (CH) is the most frequent trigeminal autonomic cephalalgia. CH is characterised by a typical clinical picture, namely a strictly unilateral, very severe, headache lasting 15 to 180 minutes associated with prominent cranial autonomic features, which are lateralized and ipsilateral to the headache.

In its episodic subtype (85% of CH subjects), CH attacks are present only in limited period of the years, lasting weeks to months (the so-called cluster periods), alternating with remission phases of at least 3 months of duration. By contrast, in the chronic CH subtype the remissions are shorter or not present at all, and the burden on the individual becomes not imaginable.

During the day, CH subjects may experience several attacks during day, often distributed during the night and with a typical circadian rhythm.

People suffering from CH consistently report severe limitations in activities of daily living and social-activity participation. Nonetheless, their working activity and career may be hindered.

CH has historically been considered as “rare”. If it is true that its prevalence falls far below migraine, it is also true that CH does not represent a rare disease. All in all, the direct and indirect (work absenteeism, sick leave, and so on) costs make CH a burden not only for the individual but for the society globally.

Therapeutic options are still limited, with most of the preventive medications being non-CH specific and borrowed from other medical conditions. Subcutaneous sumatriptan and high-flow oxygen represent the first-line choices for the acute management of CH pain. A novel anti-CGRP monoclonal antibody, which proved effective in migraine, has been approved for the preventive treatment of episodic CH, but not for the most severe chronic CH subtype. Long-term observation is needed to confirm the real-life impact of these novel drugs, hoping for a novel and specific alternative to treat CH.

Finally, CH is still little known outside the headache centres leading to diagnostic delay, low quality of counselling to the patients and sub-optimal therapeutic management.

Credit : International Headache Society 

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Are all fats bad?

Did you know that a balanced diet includes fat? Why should it be included?

Not all fats are unhealthy. A balanced diet must include fat as it is a source of energy and helps our body to absorb other nutrients.

Healthy fats such as monounsaturated fats, polyunsaturated fats and omega-3 fatty acids help to lower cholesterol. The richest sources of unsaturated fats are cooking oils such as olive, soybean and peanut oils, nuts and tofu.

Omega-3 fatty acids are found in oily fish, nuts, seeds and leafy green vegetables. They are essential nutrients not produced by our body, but vital for normal growth in young children.

Limit intake

Bad fats like saturated fats raise our cholesterol levels, clog our arteries and increase our risk of heart disease in addition to making us obese. We get saturated fats from animal products: red meat and whole milk dairy products such as cheese, ice cream and butter. However, they are also an important source of vitamins and minerals. Hence, we should limit, not eliminate, our consumption of saturated fats.

Avoid processed foods

Trans fats, also known as hydrogenated fats, are found in processed foods such as French fries and cookies. They raise bad cholesterol and lower good cholesterol. Next time you buy snacks, check for the term "partially hydrogenated oil" in the list of ingredients - those are the

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WHO releases new recommendations on human genome editing

While research on gene editing has been happening for a while, the idea of performing it on humans on a large scale has been a subject of debate. The World Health Organisation (WHO) published a slew of recommendations in July 2021, on how to ensure gene editing research is used for the public good. It called on countries to stop any research that might lead to the birth of genetically edited human beings. The WHO established a committee in 2018 to develop standards for human genome editing. The committee produced a series of nine key, recommendations in its report. Among other things, it stressed the need for regulation and the creation of a database to track all forms of gene manipulation, providing a full overview, including pre-clinical research.’

The reports deliver recommendations on the governance and oversight of human genome editing in nine areas, including human genome editing registries; international research and medical travel; illegal, unregistered, unethical or unsafe research; intellectual property; and education, engagement and empowerment. The recommendations focus on systems-level improvements that WHO believes are needed to build capacity in all countries to ensure that human genome editing is used safely, effectively and ethically. In addition, the reports provide a new governance framework that identifies specific tools, institutions and scenarios to illustrate practical challenges in implementing, regulating and overseeing research into the human genome. 

Moving forward, the organization will convene a small expert committee to consider next steps for a human genome editing registry. WHO will also convene multisector stakeholders to develop an accessible mechanism for confidential reporting of concerns about possibly illegal, unregistered, unethical and unsafe human genome editing research.

Credit : AABB 

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Exercise vigorously for 4 seconds. Repeat. Your muscles will thank you

A mere four seconds of all-out exercise, repeated two or three dozen times, could be all you need to build strength and maintain physical power, according to a new study of the potency of super-quick workouts.

The magic number

Edward Coyle, a professor of kinesiology and health education at the University of Texas, US, and his colleagues studied fit, professional athletes who generated titanic speed and power while pedalling specialised stationary bicycles that feature a heavy flywheel and no resistance.

The athletes reached a maxi- mum level of aerobic effort and power output within two seconds. This effort could be maintained briefly, but repeatedly, with a few seconds of recovery time in between When Coyle and his colleagues tested this with regular, out-of-shape volunteers, they found that those who were asked to complete five repetitions of four-second intervals on these bikes every hour for eight hours, metabolised fat much better the next day than if they sat sedentarily.

With people who are already in good shape, researchers found that, after eight weeks, they had added 17 per cent to their muscular power.

But, Coyle cautioned, if you rip through multiple four-second intervals in the morning and then sit unmoving for the rest of the day, you may still wind up with metabolic problems related to being sedentary.

Credit : Hindustan Times

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Do you really need to drink 8 glasses of water a day?

You are often bombarded with encouragements to drink more water. The purported benefits of excess water consumption are seemingly endless, from improved memory and mental health to increased energy to better complexion. "Stay hydrated" has become a new version of the old salutation "Stay well".

But what, exactly, does "stay hydrated" mean?"When lay people discuss dehydration, they mean loss of any fluids," said Dr Joel Topf, a nephrologist and assistant clinical professor of medicine at Oakland University, US.

But that interpretation "has been completely blown out of proportion", said Kelly Anne Hyndman, a kidney function researcher at the University of Alabama, U.S.

From a medical standpoint, Topf said, the most important measure of hydration is the balance between electrolytes such as sodium and water in the body. And you don't need to chug glass after glass of water throughout the day to maintain it.

How much do I really need to drink?

We've all been taught that eight glasses of water per day is the magic number, but that notion is a myth, said Tamara Hew-Butler, an exercise and sports scientist at Wayne State University, US.

Unique factors such as body size, outdoor temperature, and how hard you're breathing and sweating will determine how much water you actually need, she said. A 200-pound person who just hiked 10 miles in the heat will obviously need to drink more water than a 120-pound office manager who spent the day in a temperature controlled building.

The amount of water you need in a day will also depend on your health. For most young, healthy people, the best way to stay hydrated is simply to drink when you're thirsty Topf said. Those who are older, in their 70s and 80s, may need to pay more attention to getting sufficient fluids because the thirst sensation can decrease with age.

Do I have to drink water to stay hydrated?

Not necessarily. From a purely nutritional standpoint, water is a better choice than less healthy options such as sugary sodas or fruit juices. But when it comes to hydration, any beverage can add water to your system, Hew-Butler said.

One popular notion is that drinking beverages with caffeine or alcohol will dehydrate you, but if that's true, the impact is negligible, Topf said. A 2016 randomised controlled trial of 72 men, for instance, concluded that the hydrating impacts of water, lager, coffee and tea were nearly identical.

You can also get water from what you eat. Fluid-rich foods and meals such as fruits, vegetables, soups and sauces all contribute to water intake.

But drinking more water, even when I'm not thirsty, will improve my health, right?

No. Of course, people with certain conditions, such as kidney stones or the more rare autosomal dominant polycystic kidney disease, may benefit from making an effort to drink a little more water than their thirst would tell them to, Topf said.

In the most extreme case, drinking too much water in a short period of time could lead to a condition called hyponatremia, or "water intoxication". "This is very scary and bad," Hyndman said. If the sodium levels in your blood get too low, it can cause brain swelling and neurological issues such as seizures, coma or even death.

Credit : Hindustan Times

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What are the smart tips to reduce the risk of cancer?

The World Cancer Research Fund (WCRF) has provided a list of recommendations that may help prevent up to 40 per cent of all cancer cases. Here are some of the top tips you can follow:

  • Watch your weight and exercise regularly. Ensure you include at least 75 minutes of vigorous exercise every week.
  • Follow a healthy diet and eat at least five portions of fruit and vegetables a day, particularly green leafy vegetables like spinach and broccoli.
  • Avoid processed foods high in fat, starches or sugars, such as readymade dishes, snacks, cakes, biscuits and sweets.
  • Don't take unnecessary dietary supplements; if you eat a healthy diet, you don't need supplements.
  • Instead of drinking fizzy drinks and sweetened fruit juices, try to drink more water and unsweetened drinks. Cut down on alcohol.

Credit : Hindustan Times

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What diseases can you catch from pets?

For many people, pets are more than just pets, they are a part of the family. But just like other members of your family, pets can also infect us with germs.

Yes, we should all love our pet dog, cat, parrot, rabbit or whatever, but we also need to remember that our pets can also make us sick. We need to be enlightened to this fact, so that we can take the right precautions and ensure that our pets as well ourselves stay healthy.

Rabies: The WHO tells us that out of 59,000 rabies deaths worldwide, approximately 50% are from India. Rabies is a killer disease that has no cure.

If you have a pet dog, ensure that it gets its anti-rabies vaccine shots on time, and keep it away from stray animals. Rabies is also called 'hydrophobia' because the affected animal develops a fear of water.

Prevention: If your dog bites you, ensure that you wash the bitten area with soap under running water, and apply a disinfectant. Then immediately consult your doctor. Similarly, if your pet is bitten by a stray, consult your vet immediately.

Leptospirosis: Pet owners should also vaccinate their dogs against leptospirosis. This highly infectious disease is spread through the urine of infected animals and can survive in water or soil for a long time. These bacteria can enter your body through broken skin, an open cut or wound, or through your eyes, nose or mouth. Symptoms include chills, sore throat, cough and redness of the eyes.

Prevention: Always wash your hands and feet, and your pet's paws thoroughly after taking them for a walk. Since this disease spreads more during the monsoon, it would be wise to invest in gumboots for your pet.

Toxoplasmosis: You can be infected by this disease simply by cleaning your cat's litter box or by touching soil where your cat may have defecated.

Symptoms are similar to the common flu, where you feel tired, feverish and your body aches. Pregnant women need to take extreme care as this disease can also infect the foetus and cause a miscarriage.

Prevention: Always use gloves while cleaning your cat's litter box. Also always wash your hands thoroughly with soap after handling a cat's litter box/or after doing any gardening.

Capnocytophaga or 'Cat Scratch Disease': The bacteria called Capnocytophaga are found in the nails of cats. People who become infected normally experience diarrhoea, fever, vomiting, headache, and muscle pain.

People can become infected if they are scratched or bitten by a cat, or if a cat licks an open wound on their body. Symptoms include infection at the wound site, fever, headache, poor appetite, exhaustion and swollen lymph nodes.

Prevention: Wash the cat bite or scratch under running water with soap and then apply a disinfectant. Also, do not let a cat lick an open wound or cut.

Ringworm: Contact with the fungus that causes ringworm will cause it to take root in your skin. It is called ringworm because it can cause an itchy, red, circular rash. This fungus can live and thrive on bedding or towels used for your pets. Apart from adult pets, puppies and kittens are more likely to develop and transmit ringworm. The rash that it causes isn't serious, although it may cause you severe itchiness.

Prevention: A simple antifungal cream should help you get rid of it. But if it persists, then please see your doctor.

Psittacosis: Also known as 'parrot fever', this is a zoonotic infectious disease caused by a bacterium, contracted by inhaling the dried secretions from infected birds such as parrots or other pet birds. It can also be contacted through pigeons, sparrows, ducks or hens. Symptoms include headache, breathlessness, fever and a cough.

Prevention: Always use a mask and gloves while cleaning out your bird cages. Any pet bird showing signs of illness should be taken to the vet immediately.

If your symptoms do not go away in a few days always consult your doctor.

Love your pet... but take care they don't make you sick!

Credit : Noel Keymer (The Teenager Today)

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What organ in your body is 60% fat?

The brain is the fattiest organ in our body it is composed of nearly 60% fat. The largest part of the central nervous system, the brain controls our thoughts, speech, movements and memory. It is composed of billions of neurons, or nerve cells, and glial cells.

Each day humans must consume a certain amount of water to survive. Of course, this varies according to age and gender, and also by where someone lives. Generally, an adult male needs about 3 liters (3.2 quarts) per day while an adult female needs about 2.2 liters (2.3 quarts) per day. All of the water a person needs does not have to come from drinking liquids, as some of this water is contained in the food we eat.

According to Dr. Jeffrey Utz, Neuroscience, pediatrics, Allegheny University, different people have different percentages of their bodies made up of water. Babies have the most, being born at about 78%. By one year of age, that amount drops to about 65%. In adult men, about 60% of their bodies are water. However, fat tissue does not have as much water as lean tissue. In adult women, fat makes up more of the body than men, so they have about 55% of their bodies made of water. 

Credit : USGS

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What is dengue and what are its causes?

Hospitals in Haryana, Kerala, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, Uttarakhand, Delhi, and Jammu and Kashmir are witnessing a surge in dengue cases with the number of cases reported exceeding one lakh. The Union health ministry has sent teams of experts to the nine States and Union Territories to support them in public health measures for control and management of the disease. What is dengue, what causes it, what are the symptoms to look out for, and how is it treated? Let's find out.

A mosquito-borne infection Dengue is a mosquito-borne viral infection that is transmitted to people through the bite of an infected Aedes aegypti mosquito. When a mosquito bites us, it not only sucks blood but also secretes saliva that enters our bloodstream. This is how an infected mosquito passes on the infection. Dengue is a seasonal disease which witnesses a surge in cases post-rain. Dengue virus causes fever and haemorrhagic symptoms.

Dengue infections are caused by four related viruses namely DEN-1, DEN-2, DEN-3, and DEN-4 belonging to the genus Flavivirus. These four viruses are called serotypes because each has different interactions with the antibodies in our blood serum. The four dengue virus serotypes mean it is possible to be infected more than once. In other words, being infected from one dengue virus does not guarantee protection from the other three. Once a person gets infected, he becomes the main carrier of the virus and passes it to uninfected mosquitoes. After recovery, he becomes immune to that particular serotype for lifetime.

Flying killers

Mosquitoes thrive in tropical regions. Dengue mosquitoes breed only in clear water. They lay eggs on the surface of the water which hatch in eight days (or even less in extremely warm weather).

Mosquitoes take refuge in dark spaces indoors and use puddles, tree holes, discarded vehicle tyres, and plant pots around homes to breed. If water is not allowed to stagnate, mosquitoes cannot multiply. Did you know that only female mosquitoes are capable of biting us? They feed on our blood to source protein for their eggs.

According to the World Health Organization, mosquito-borne diseases kill several million people worldwide, every year.

Dengue symptoms

Dengue causes a severe flu-like illness that may last up to a week. In some cases, the fever could be life-threatening, resulting in bleeding, a fall platelet count, and sometimes extremely low blood pressure. Dengue symptoms include high fever, severe headache, pain behind the eyes, nausea, vomiting, acute stomach ache, muscle and joint pain, and skin rash. They begin to manifest three to 14 days after the bite. The severity of the symptoms increases if the infection is not treated properly and in time. Seek medical advice immediately if you have a fever or develop any of the dengue symptoms.

At present, there are no vaccines for dengue or specific medications to treat it. Pain killers are prescribed for relief from symptoms. Drinking plenty of fluids and taking ample rest are also advised. So the best way to protect ourselves from dengue is to avoid mosquito bites by sleeping under the net using mosquito repellent, etc.

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What is Y-Break?

The Union Ayush Ministry launched a mobile app called "Y-Break" on September 1, 2021. What is this app for?

"Y-Break" is nothing but a Yoga-Break app, a five-minute yoga protocol designed to help working professionals remain fit and healthy, and thereby increase their productivity. The aim of the app is to help them de-stress, refresh, and refocus through simple yoga asanas that can be done in five minutes.

Ever since the pandemic broke out in 2019, it has had a great impact on people, especially office-goers. We often hear of people experiencing stress and anxiety besides physical problems on account of their sedentary occupation. It is said that the Y-Break app has been developed keeping in view the working population as it is expected to give them some relief at the workplace.

How is it beneficial?

The Y-Break app intends to introduce people at the workplace to yoga. It promotes the idea of a five-minute break from work to practise yoga and feel refreshed. The Yoga-Break protocol consists of asanas, pranayama, and dhyana, and can integrate seamlessly with people's work routine.

Simple stretching exercises such as Tadasana, Urdhva Hastottanasana, Uttana Mandukasana, Kati Chakrasana. Ardha Chakrasana, and Bhramari Pranayama among others make up the protocol. Besides enabling people to perform stretching exercises and meditation with ease anywhere in just five minutes, the app will help create awareness about different yogic practices.

The mobile app was launched by Ayush Minister Sarbananda Sonowal as part of the 'Azadi Ka Amrit Mahotsav celebrations organised by the Government to commemorate the 75th year of India's Independence. The launch of the app has been termed as one of the significant initiatives of the Ministry of AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy).

Who developed the app?

The Morarji Desai National Institute of Yoga (MDNY), an autonomous body under the Ayush Ministry, has developed the Y-Break app, which is available on both iOS and Android platforms.

A pilot study to find the efficacy of the yoga protocol was undertaken in six major metro cities on a sample size of 717 participants aged 18 and above. Fifteen-day trials involving participants from private and government bodies were conducted by the MDNIY in collaboration with six leading yoga institutes of the country.

The participants were selected taking into consideration the various problems they were suffering from such as lower back pain, headache, anger, and stress. The study showed positive outcomes. It was also recognised that yoga break at the workplace enables one to relax completely.

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What are the benefits of s plant-centred diet?

The results of a study published in August in the Journal of the American Heart Association states that eating nutritious, plant-based foods is beneficial to the heart at any age. The study showed that those who ate more healthy plant foods had fewer heart attacks and were also less likely to develop cardiovascular diseases.

Observational study

For this study, the researchers looked at long-term consumption of plant-based foods and the impact of switching to a plant-centred diet in young adulthood. The researchers examined diet and prevalence of heart disease among those enrolled in the Coronary Artery Risk Development in Young Adults.

The participants numbering close to 5,000, belonged to the 18-30 age group at the time of enrolment in 1985-86 and were free of cardiovascular diseases at that time. Between 1987 and 2016, these adults took eight follow-up exams that included lab tests, physical measurements, lifestyle assessments, and medical histories.

Unbiased data

As the results of these tests were not revealed to the participants and they weren't instructed to eat in any particular way either, the researchers had unbiased data that reflected habitual long-term diets. The food groups were classified into beneficial foods (including fruits and vegetables), adverse foods (think junk foods and soft drinks) and neutral foods (refined grains, lean meats).

After considering several factors such as age, sex educational background, and calorie consumption, it was found that people who ate the most nutritionally rich plant foods and very little adverse foods were 52% less likely to develop cardiovascular diseases.

The research also pointed out that even switching to a plant-centred diet led to lesser risk in terms of cardiovascular diseases.

As this study is observational, it cannot be used to prove a cause-and-effect relationship between the diet and heart disease. The research, however, does suggest that a nutritionally rich plant-centred disease is definitely good for the heart. And since it also shows that including more plant-based foods has its benefits, it might be a good idea to start taking more vegetables and fruits whenever you can.

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What are the health benefits of swimming?

Hobbies are our best friends. We pursue them when we have either nothing to do or are tired from the day's work. While some hobbies merely help us to kill time, there are other hobbies that improve the quality of our life. Swimming is one such hobby.

There are more benefits to swimming than simply cooling off on a hot day. Swimming is one of the best exercises that benefit our entire body. The more we learn about swimming the more we will want to add it to our list of favourite hobbies. It is a great, year-round hobby and takes very little gear to get started.

Swimming not only burns calories, but is easy on the joints, supports our weight, builds our muscular strength and endurance. The other health benefits of swimming are that it keeps our heart rate up and takes some of the stress off our body. The most beautiful aspect of swimming is that we can set our own pace fast as we like go as otherwise just take slow laps in the pool. Swimming uses all the muscles in the body - SO whether it is a gentle breaststroke or hammer butterfly, we get a full body workout.

Swimming is perfect for our mental health as well. According to the Centre for Disease Control and Prevention, swimming for just 2.5 hours per week decreases the risk of chronic illness. By toning and developing a wide range of muscles, swimming helps prevent the injuries that can occur in youth who specialize in a sport from a younger age.

But swimming for beginners can be challenging if you don't know what to do in the pool. Hence, it's extremely important to start swimming by using a beginners' guide and including all the safety measures. It is essential to find the right pool and take proper swimming lessons and not try out anything on your own. The best way to pursue swimming as a hobby is to join a swimming club. To get started, one can begin with just the swim workouts.

Swimming was one of the eight sports practised at the first Paralympic Games in 1960, and has now become most popular. Swimming has been part of the Olympic schedule since the very first modern Olympic Games held in 1896. New additions to the Games programme for Olympics 2020 in Japan are men's 800m freestyle, women's 1,500m freestyle, and the exciting mixed 4x100m medley relay. The competition (excluding marathon swimming) will take place from 24 July to 1 August 2021. Swimming world champion Ariarne Titmus will be in one of the most-anticipated races of the Tokyo Olympics.

Credit : Jubliee cradozo (The Teenager Today)

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Why is it important to keep your body clean?

You might think that looking clean is just something that adults worry about. But you should think about it too. Keeping yourself clean helps you stay free of harmful germs.

Whether you play, work, shop or visit a friend, your hands pick up germs all day. If the germs get into your food, or if you lick your fingers or bite your nails, it is easy to see how the germs can get inside your body. But you do not have to let this happen.

You can get rid of the germs you collect. After going to the toilet, wash your hands with soap and water-and don’t forget the backs of your hands. Wash your hands before meals so germs don’t get into your food-and inside you. Also wash your hands after sneezing and coughing, especially if you are sick.

The skin on other parts of your body picks up germs too. These germs may even cause an unpleasant smell. That is because they feed on the oil in sweat. Then they multiply and die-that’s where the bad smells comes from. So take a bath or wash the places where you sweat most.

Keeping clean not only makes you feel good, it also helps you to stay healthy.

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Why do you need sleep?

Think about how you feel when you don’t get enough sleep. You feel tired, you can’t think very well, and you may get angry easily.

Sleep helps keep you healthy. When you sleep, your muscles rest. So does your brain.

People who get enough sleep each night are able to think more clearly. They do not make as many mistakes as people who do not get a good night’s sleep. And they may react more quickly.

People who get enough sleep night after night also are better able to fight off diseases. They do not get as many colds and other illnesses as people who are always tired.

The best way to get a good night’s sleep is to go to bed at the same time each night and wake up at the same time each morning. While you may want to sleep late on weekends, try not to. Oversleeping can keep you awake the next night.

The next time it’s bedtime, give your brain a treat. Go to bed on time, and give it the rest it deserves.

If you have trouble falling asleep– or simply do not want to go to bed– try these ideas to make bedtime a good time:

  • Listen to a book or soft music on a CD.
  • Imagine yourself in your favourite place.
  • Think about what you did today, and what you will do tomorrow.
  • Imagine sheep jumping over a fence one by one. Count each sheep as it jumps.

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Why should we look after your teeth?

There is a war going on inside your mouth. The enemy is plaque, sticky white coating that grows on teeth. Plaque destroys the outside of teeth by sending out an army of acids. It sends poisons into the gums.

How can you fight back? The handiest weapon you have is your toothbrush. Brush with small, round movements to clean the outside of your teeth. Then move the toothbrush up and down to clear away the plaque between your teeth. To hold back plaque, your dentist may also tell you to floss your teeth at least once a day.

You also can help your teeth by choosing healthy foods. The more often you eat sugary things, the worse it is for your teeth. As soon as something sugary is around, plaque sends out a new army of acids. The more often you eat sweets, the more acid you have to fight. That’s why dentists suggest that you eat snacks such as fruit and vegetables.

If you do eat sugary things, eat them at mealtimes and brush your teeth soon afterwards. Try to avoid sweet foods that stick your teeth, such as sugary cereals and mints.

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