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International Primary Care Association

Clinical Focus Primary Care

Editor Admin

Editor Admin


Isolated headache is rarely the harbinger of serious pathology. The prevalence of primary headaches greatly outweighs that of secondary headaches. This article addresses the most consistent indicators for secondary headache.


Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder which can be lifelong with a risk of negative long term outcomes. Symptoms affect academic, occupational and social functioning. Co-morbidity is common and the frequency of symptoms such as mood instability alongside core ADHD symptoms in adults can lead to it being mistaken for personality disorder or an affective disorder. It is highly heritable and treatable.

More crises in the NHS. General Practice is being overwhelmed and recruitment has slowed and so we have returned to enticing doctors from abroad. It is astonishing that with all the resources allocated to “Workforce Planning”, both financial and human resource, we continue to lurch from feast to famine in medical manpower! I recall the tiered lecture rooms in the Middlesex Hospital Medical School, London there was a row of chairs with easels to accommodate the extra places for Medical students as the planners had grossly underestimated UK’s requirements. The politicians closed the Medical School and where the Middlesex Hospital once proudly served the populace, is a building of apartments that only foreign investors can afford.

The winter rains, hurricanes and floods will hopefully have subsided by the time this issue reaches you. Spring was edging out the winter blues as I write this editorial. This will be an exciting year as it is the lead up to the general election and no doubt the politicians will pick up the NHS football to garner votes.


The Health and Social Care legislation has slowly become embedded, warts and all. Many CCGs have started some semblance of commissioning, the main focus of the restructuring, but are hampered by a very wieldy and bureaucratic tendering system. It is difficult to understand the need for such a process for services that have no more than one supplier or are innovations, which means divulging intellectual property to third parties. Furthermore, the bigger private sector organisations have an army of “Tendering Experts”, whose sole tasks are to get through the bidding process, which they do very successfully. Little surprise then that the assurances given to the SMEs, including CIC and Social Enterprises that this would be a level playing field ring a resounding hollow. They just do not have the resources of the larger companies. Whatever the hue of the next government the tendering process needs to be overhauled.


With obesity levels, in adults and children, rising and rising (we are following the USA trend of course), the awareness of the role of nutrition to our health is vital. Katey Halliday busts some of the myths (p.30). UK has one of the highest incidence of unwanted pregnancies in Europe. I find this hard to square given the myriad of methods of contraception available as neatly detailed by Anusha Dias (p.8).


Mackenzie brings us right up to date by addressing problems such as fractures, adrenal suppression, hyperglycaemia……. (p.19).


Enjoy this issue. Please let me have your suggestions and comments. By the time of the next issue the Football World Cup tournament will have concluded. As a football fan I shall be rooting for England, in the hope rather than the expectation that my gut feeling of their level of performance is wrong.


Professor Ram Dhillon



Theories abound and a constant deluge of articles continue in an attempt to give people advice to better health. Many are based on fads. This article provides a summary of the scientifically proven evidence around nutrition, health and exercise for better health, based in fact not in myth.


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