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International Primary Care Association

Clinical Focus Primary Care


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.


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.


Hepatitis C is a leading cause of chronic liver disease worldwide. Its estimated global prevalence is 170 million1 and it is the commonest indication for liver transplantation in Europe. A summary of important breakthroughs in the medical management of Hepatitis C is provided in this review, and aims to be of use to primary care clinicians.


Obstructive sleep apnoea (OSA) is a highly prevalent condition but many individuals remain undiagnosed. Patients usually present to primary care with loud snoring, daytime sleepiness, unrefreshing sleep, or as a consequence of witnessed nocturnal apnoeas. Successful treatment is achievable in most patients which can be life-changing.


Allergic rhinitis is present in over 500 million people worldwide and 300 million suffer asthma. The importance of the key Type 1 sensitivity reaction is discussed in relation to both disorders. Allergen structures and allergy tests are critically appraised. The principles of managing allergic rhinitis and asthma are discussed

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



Although we still do not have a ‘perfect contraceptive’, one which is safe, effective, and free from any side effects; a great deal has changed since Casonova first advised using half a lemon with the juice removed as a cervical cap in the 18th century. The launch of new contraceptives has increased choice and new, simplified recommendations on their use have increased the acceptability of all methods.


At any time, 1% of the UK population is receiving oral glucocorticoids, and their use is increasing. Toxicity related to glucocorticoids is potentially fatal, and often missed during a clinically latent phase, during which a number of steps can be taken to minimise their risks.


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