Studying the effect of abdominal massage on the gastric residual volume in patients

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Gastric residual refers to the volume of fluid that remains in the stomach every time during an enternal nutrition feeding (direct to the stomach). Nurses can withdraw the fluid through a feeding tube by pulling back on a plugger of a large syringe (usually a 60 Ml) at intervals at intervals ranging from 4-8 hours. The nurses or someone in the team that is taking care of the critically ill patient should ensure that they replace the residual fluid into the stomach of a patient to prevent loss of electrolyte, fluid and nutrients.

Gastric abdominal massage is one of the ways to decrease gastric residual volumes. It is an external practice that aims at shifting internal organs that could have changed the location to restrict blood flow, body chi and lymphs .it help to release more than the physical tension by also one that occurs because of spiritual and mental strain. Releasing the tension opens up the energy pathways and flow of chi in the body.

Critically ill patients cannot eat sufficient quantities of food to satisfy the nutritional needs. The doctors at this time may decide that feeding should take place through a tube that is inserted into the stomach or small bowel to provide enough nutrients.

There is various tube feeding formulas in the market made by different companies with ingredients that meet 100 per cent of the nutritional needs by the patient. This feeding can go on continually for some hours at any time of the day at a specific rate. The delivery is by a pump or sometimes several times of measured amounts within the day. Adequate nutrition depends on right amount and type of formula.

Sickness or injury might cause an increase in the need for energy, protein and metabolic rate to promote healing by providing more nutrients. Muscle damage is also common at this stage because there is a limitation to mobility at this time. Many people with severe injuries such as those of the spinal cord lose a significant amount of muscle when they first get an injury. The body needs for protein and calories will decrease in a few months after the injury and care providers should adjust the tube feedings to prevent unwanted weight gains.

It is important to monitor the body weight and know the weight goals. It is essential for a doctor or registered dietician to provide the tube feeding adjustment instructions after significant weight changes which are a loss or gain of over two pounds in a week. It is also essential to seek the counsel of adjusting the tube feeding after clearance to eat by a specialist.

A healthcare provider has the responsibility to prescribe the feeding schedule, formula and the amount of water necessary for optimal hydration and nutrition.

How Widespread Is Abdominal Massage Practice

It is not many people who know about abdominal massage compared to other types of massage. It is a restorative and healing process that has shown to have many benefits for individuals in need of a holistic approach to the wellbeing.

Role of Abdominal Massage In Decreasing Gastric Residual Volumes In Critically Ill Patients

Gastrointestinal dysfunction is one of the problems that affect critically ill patients during their hospitalization in the intensive care units. Some of them even get constipation that affects their bowel movement.

The increase of bowel dysfunction among the critically ill has become common to the point of reaching up to 50%. Enternal feeding is a primary recommendation for the critically ill and mechanically ventilated patients but still can be a risk factor for aspiration.

More caregivers and health institutions are becoming aware that abdominal massage has the power to reverse such GI issues. The simple technique of massaging the stomach in a clockwise motion is proving to be very useful in helping to relieve the issues. It works better with incorporation of some reflexology point work on the abdomen, intestines and bladder.

Currently, abdominal massage is one of the non-medicinal methods that one can apply with or without therapeutic methods that have much acceptance. To prove the efficiency of abdominal massage on gastrointestinal functions, a clinical trial on 70 patients in intensive care and with an endotracheal tube.

The researchers used a convenience sampling method for random allocation to a control or an intervention group. The intervention group got 15 minutes of abdominal massage two times a day for three days, but the control group only got routine cares. The study team took records of the abdominal circumference, times of bowel movements, the frequency of constipation and gastric residual volume.

The results show that gastric residual volume had a significant decrease in the intervention group that got an abdominal massage. The control group that was receiving support care showed a significant increase in gastric residual volume. The intervention group also had more benefits in the form of an increase in defecation times and a decrease in the prevalence of constipation. The abdominal circumference in the intervention group also reduced more than those in the control group.

The findings show that the abdominal massage helps to improve gastrointestinal functions among the enternally fed patients with endotracheal tubes. The suggestion to those taking care of critically ill patients is that they should consider using abdominal massage as an adjunct therapy to improve gastrointestinal functions in intensive care patients.

Importance of Decreasing Gastric Residual Volumes with Abdominal Massage

Experts in critical patient care recommend early enternal nutrition (EN) as the first line of nutrition therapy in critically ill patients because it alters the outcome in the favor providing the nutritional and even non-nutritional benefits. However, the critically ill patients who are receiving mechanical ventilation are a high risk of pulmonary aspiration, regurgitation, and ventilator-associated pneumonia (VAP) if they stay long in this environment. EN can increase these risks when gastrointestinal dysfunction is present. It has a surrogate parameter in the Gastric residual volume (GRV) as the enternal feeding progresses in the early phase of the critical illness and even beyond. Clinicians who monitor GRV might detect patients with a delayed gastric emptying much earlier and intervene with strategies that will prevent or minimize VAP one of the most significant risks of EN.

The value of periodic GRV measurements regarding reducing VAP incidents is a frequent cause of debate in the past years. An increase of GRV threshold before interrupting the results of gastric feeding will cause marginal increases in the EN delivery.

Benefits of Abdominal Massage To Critically Ill Patients

Abdominal massage plays a significant part in reducing abdominal massage. The abdomen is a critical part of the body as it houses many vital organs including most of the digestive system. The digestive system can develop weaknesses as a result of illness. Living a sedentary lifestyle and failing to exercise enough can also contribute to weakness in the abdomen. Abdominal massage practice helps in toning and strengthening the muscles in the abdomen, and it helps to improve the digestive system tremendously. An abdominal massage helps in detoxification of the body. It is one of the recommendations for the success of a colon cleansing program.

Additionally, it also provides these other benefits.

1.The holistic and complete attention of the organs

Most people have never got an opportunity to receive abdominal or anterior chest work. Abdominal massage is an opportunity for the huge sections of the body that have not got attention to get of addressing their problems through touch. Clients who get the massage even at the commercial outlet when they are not ill say they feel lighter, calmer, more energized and with more integration. Patients get more benefits because their movement at the time is restricted.

2.Enhances intestinal functional

Some studies show that massage promotes peristalsis, helps to improve or prevent symptoms of constipation and soothes the minor intestinal discomforts. The partly mechanical effects help in moving intestinal contents for those people with various conditions including:

  • Parkinsonism
  • Neurological gut control
  • Spinal cord injury
  • High-stress level
  • Anxiety proneness

It also has neurologically and reflex-mediated effects to support simplicity and efficiency of the intestinal function.

3.Helps with other physical, mental and spiritual conditions

Abdominal massage provides benefits that go beyond the abdomen because the effect of massage reaches another region of the body to help with reducing anxiety, depression as well as eating disorders. Some of those who went for abdomen therapy due to GI issues also report that it reliefs lower back pain, post-childbirth syndromes and posture abnormalities showing that abdomen work has therapeutic qualities.

It is important to consider then contradictions and cautions of abdominal therapy. It is essential to do a study about the appropriateness of the massage therapy by examining the scope of practice and collaboration with other health practitioners as well as using the correct techniques for the practice.

More focus on the fact is essential considering the effects in the previous points which show strong indications that abdominal massage helps to manage and overcome various disorders above decreasing gastric residual volumes.

The Connection between Abdominal Massage, Gastric Residual Volumes And Wellbeing

The abdominal massage was until recently a new thing but fascination new information is now filtering through, and scientists are taking more time to learn about an enteric nervous system that is drawing a lot more interest due to connection and role. There might not much reach data massage connection with abdominal organs, but there is enough information to stimulate the thought process.

The enteric nervous system predates much development and independent features with some connection to the brain.

Limitations of Abdominal Massage Techniques

Although abdominal massage has numerous benefits for the critically ill patients who need everything that can reduce their gastric residual volumes, it is not everyone.


People with certain gastrointestinal tract disorders should not get an abdominal massage. It should also not take place in the presence of inflammatory intestinal conditions such as celiac disease, ulcerative colitis and celiac disease during the flare-ups.

Light, soothing abdominal massage helps but it should be without pressure to the abdomen if the recipient is hypersensitive. The touch should be lighter on someone who is in the first trimester of pregnancy. Some pregnancies are a no-go zone if they have elements such as placenta précis or anything that makes it high-risk pregnancy.

ii.Reproductive and high risk conditions

Some of the reproductive conditions including severe endometriosis and unstable ovarian cysts do not permit abdominal massages. It is always essential to consider if a medical condition is too risky for other procedures including the non-invasive massage.

Presence of less acute reproductive or gastrointestinal disorders such as abdominal surgeries, high –risk pregnancies or aortic complications require consultation and working in collaboration with a physician. Abdominal massage in such instances involves input by a massage practitioner who understands the medical repercussions and the necessary care but not someone who has primary massage education.

iii.Emotional and psychological factors

Some people have reservations about massage on their belly for other non-medical reasons. For instance, some people feel that it is undesirable or uncomfortable for someone to touch their abdomen because they consider it to be more of a private body part. Such arguments might seem weak in the face of the benefits that abdominal therapy can bring, but massage therapists have to respect these stances.

This list might not exhaust everything about the use of abdominal massage to decrease gastric residual volumes but with a little research and common sense will decide on the suitability of the procedure to be straightforward.

If a client who should benefit from the abdominal massage techniques or the family sets any boundary, the first step should be to provide information about the pros. The details and answers to questions might change the attitude after an increase of awareness and trust for the therapist. However, it would be unethical to pressurize the patient or family into accepting abdominal massage by portraying like it is the only way to promote healing.

Lessons about Abdominal Massage and GRV

Abdominal massage can decrease gastric residual volumes (GRVs) and abdominal circumference over time in select population in the critical care unit. Research and standardization for abdominal massage practice might provide clinicians with some additional tools to improve gastrointestinal (GI) functions and feeding among the critically ill.

It is a fair rating that many of the persons who have not got an abdominal massage during a critical illness that compels doctors to feed them via a tube is because the therapist s did not suggest the option. It could also be that their physicians were uncomfortable with the procedure due to real or overblown safety worries.

Does the new drug which treats prostate symptoms associated with risk of falls?

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Prostate is a gland within the male reproductive system located below the neck of the bladder that lets fluid to pass through. This chestnut-shaped organ surrounds the beginning of a urethra that empties urine from the bladder. In reality, it is not a single, but many glands that can be 30-50 between which are is abundant tissue that contains many bundles of a smooth muscle.

The size of the prostate is almost that of a walnut. It is placed between the bladder and base of a penis. A tube that moves urine to the urethra in the penis from the urethra runs through the center of a prostate. A prostate secretes some fluid. The secretion from a prostate is milky liquid goes into the urethra during semen ejaculation. Urethra also moves semen from sex glands to the penis.

The prostate is a name with a unique origin as it comes from a Greek word “prostates” that means to stand before. An anatomist called Herophilus gave it the name because he made an observation that it holds before both testes. Unfortunately, it also gets sick. Prostatitis is an infection that occurs when a prostate and surrounding area get an inflammation.

Causes of prostatitis

Several types of infections may affect the prostate. Some men with prostatitis do not experience any symptoms while other might report a number of them that include feeling intense pain.

The cause of prostate infection is not always clear, but researchers believe that these have something to do with its occurrence

  • The microorganism can cause chronic prostatitis
  • The immune system is reacting to nerve damage around the area
  • The immune system is responding to previous UTI

Using a catheter or having any medical procedure that involves the urethra increases the risk of prostate infection .other risk factors are:

  • Infection
  • Bladder obstruction
  • Injury or enlarged prostate that can encourage infection
  • Sexually transmitted diseases

Prostate cancer is another infection that is one of the most common among the cancers in men.

The specific risk factors of prostate cancer are unclear, but medics believe there is a contribution by a protein that this organ excretes. A prostate produces a fluid that nourishes and transports sperm on its journey to fuse with a female egg and create life. Contraction by the prostate forces the liquids to come out during an orgasm. PSA (Prostate-specific antigen) is the protein that the prostate excretes to enable the semen to retain the liquid state. An excess of PSA in blood is among the first signs of prostate cancer.

Association between Prostate Symptoms Medication and Risk of Falls

There are many types of medications that cause different side effects. Alpha-adrenergic blockers (alpha blockers) are a drug that treats prostate symptoms, but they have drugs that increase the risk of falls because they cause one of few of these effects that contribute to a risk of falling.

  • Drowsiness
  • Hypotension
  • Ataxia/gait disturbance
  • Parkinsonian effects

A drug that produces these effects is likely to the other impacts that might also increase the risk of other conditions such as osteoporosis or a reduced bone mineral density, fracture or threat of brain hemorrhage also increases.

Alpha blockers are a type of medication that many take for treatment of urinary difficulties that occur due to an overgrown prostate cause a small but dangerous risk of falling according to recent studies. It also has properties that cause a sudden drop in blood pressure. It is their ability to reduce BP that makes doctors prescribes them to manage high blood pressure but for a prostatitis patient with normal blood pressure, their prescription might cause the pressure to drop too low.

Why Do Doctors Prescribe Alpha Blockers

Alpha blockers relax some muscles and help the small blood vessels to stay open. They work by preventing norepinephrine (noradrenaline) hormone from tightening the muscles in walls of smaller veins and arteries causing vessels to relax and remain open. It improves the flow of blood and lower blood pressure. Because alpha blockers relax the other muscles of the whole body, the medications help to enhance the flow of urine among the men with prostate problems.

Examples of alpha blockers types

There are different types of alpha-blockers for treating prostate problems. Alpha-blocking agents, alpha-adrenergic antagonists, alpha-adrenergic blocking agents, and alpha-blocking agents are the other names for this medication.

They can be long or short-acting forms. Short-acting medications act fast, but their effect lasts for a few hours. Long-acting medications take a longer time for the patient to feel the effects but they continue for more extended period. The best alpha blocker for a patient with prostate symptoms depends on the health and extent of prostatitis.

Examples of alpha blockers for treating prostate symptoms but also cause the blood pressure to reduce include:

  • Prazosin (Minipress)
  • Doxazosin (Cardura)
  • Terazosin

Drug That Treats Prostate Symptoms Cause a Risk of falls

Many men who get alpha blocking agents also get a warning that they increase the risk of falls, but it is not all the studies that have come to this conclusion. Though this risk of falls can be attributed drugs is small it might be compounded by other existing factors such taking them along with other medications that could lower blood pressure or have a history of falling and mobility problems.

It is still important to start watching out for the side effects when someone starts taking any of the alpha blockers. A Canadian study identified over 147,000 to take a prescription of the different types of drugs that work a similar way. Over a three month period, 14 percent of the men in the study got effects that increased the need to visit an emergency room or a hospital admission due to a fall. The study was in comparison with a carefully matched comparison group of men who did not take the alpha-blocking agents. In absolute numbers, it shows that 17 out of 10,000 could get a higher risk of falls because of the drugs although the scope of the study was not focusing on other cause and effect relationships. Alpha blockers cause more risk of falls because they trigger these contributing factors.


Drowsiness is the feeling of excessive sleepiness without any other cause as they often cause apathy and fatigue. Excessive sleepiness even during the day is one o the significant factors contributing to falls in older adults. Problems with sleep often occur in older adults, and it is the same age when prostate symptoms arise. Since doctors must treat the issues that arise due to infection and enlarging of the prostate, they use alpha blockers that in turn cause drowsiness. Alertness is essential is essential in maintaining balance when walking requires vigilance which is not at the optimal level for patients with drowsiness.


Hypotension is a significant drop in the blood pressure that mostly affects the older patients when they are in hospital under medication. It causes the patient to feel;

  • Lightheaded
  • Dizziness
  • Visual blurring
  • Fatigue
  • General weakness
  • Leg buckling
  • Cognitive slowdown
  • Leg buckling
  • Ache in the neck and shoulders(coathannger ache)

Unsteadiness, sudden or gradual unconsciousness and falls are frequent among such patients.

It is essential for nurses taking care of patients who take medications such as alpha blockers for treating prostate symptoms to know that it can cause falls. They should be skillful in assessing, monitoring and treating a patient about the falls assessment and management. Some patients who may not experience the symptoms above while other may not remember having them thus caregivers might miss hypotension if it is not part of the assessment.

Changing from a lying position stand causes much of the blood approximately 500ml to pool at the lower parts due to gravity. A healthy body can counteract this through an autonomic nervous system that increases the increases the heart rate, vascular tone, and cardiac contractility to regulate BP and maintain adequate cerebral perfusion.

Alpha blockers cause an inadequate physiological response to postural changes especially the aged which may cause a significant drop in blood pressure resulting in symptoms that increase risk of falls. These symptoms may resolve after resuming a seating or supine position but it is essential for caregivers and physicians to determine if prostate symptoms medication could be the cause.


Dizziness or lightheadedness might not be a sign of serious but still requires checking up by doctors especially for those on medication because some of the drugs could be the cause. Understanding the reason for those with prostate medications is essential because the medicine is one of the causes of such extreme dizziness because it reduces the blood pressure.

The usual drugs for prostate cases are alpha blockers that can also cause orthostatic (postural) hypotension that causes a drop in the blood pressure when someone stands from a sitting or lying position. An assessment is necessary because it is not all the patients who get dizziness because of the medicine. Other causes such as aging, circulation, dehydration, and other medical conditions such as heart or Parkinson’s disease could be the reason someone has dizziness.

4.Ataxia/gait disturbance

Ataxia refers to a lack of coordination and might including a staggering pace, uncoordinated movement of the arms, eyes as well as speech. Ataxias are a group of neurodegenerative genetic conditions that cause balance problems. Alpha blockers increase the risk of falls because of higher variability. Gait disorders are prevalent among the older people and increases with age. The cause can be neurological or non-neurological, but they occur at the age when men are likely to have prostate symptoms that require medicine with effects which are expected to increase the risk of falls.

5.Parkinsonian effects

The parkinsonian effect is a chronic progressive neurological disease that decreases the production of dopamine which helps much in controlling the movement of the body. Parkinson’s disease usually occurs in the aged, but the medicine that treats prostate symptoms can cause similar effects. The most outstanding change relating to Parkinson like conditions is that it hinders movement including walking and increases the risk of falls and freezing. The walking (gait) suffers from impairment causing changes in movement including:

  • Slowed progress Inability to swing arms partly or completely
  • Small shuffling steps
  • A tendency to lean forward

Walking can become tiring even when the above symptoms do not occur. Changes in walking can relate to the medication cycle such as when a patient is on or off the medication. One of the ways to manage the side effects of alpha blockers is to consult a specialist to review the drugs that cause much effect. Help from a physiotherapist on how to improve walking can help in managing the side effects. Parkinsons effect because of prostate medication can also cause freezing which is a form of more advanced walking challenge. Freezing is a sudden stop when trying to move after feeling as if the feet are glued to the ground. Freezing usually occurs in particular situations such as when starting to walk, attempting to turn a corner, stepping through doorways or approaching a chair.

Should doctors and patients avoid new drug for prostate symptoms that has more association with a risk of falls. Eliminating the alpha blockers from a prescription range might not be the realistic option. They provide many benefits to the patient by train he symptoms of the prostate that at the time area massive problem for a patient. The essential thing is for doctors to continually weigh the benefits together with the drawbacks of each type of medicine that they can prescribe to impatient. If the person has a history of falls or new clinical information shows that this might occur limited options if the medication is essential for healing and critical aspects of well being. It is a situation of anticipated falls where a patient indicates he or she is at risk. They can take measures to maintain a safe environment for the patient during the time of medication.

Simple changes such as a review of medication regimes that have more association with falls are more likely to solve the issue by simultaneous solving of other possible causes such as age or environmental factors.

Maturity onset diabetes of the young. Is it in the gene?

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Infections occur due to different reasons. Some of them occur due to infections while others arise among family members in various generations due to genetically problems. There is a question as to whether Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes that occurs at adolescence or early in adulthood. MODY accounts for a low percentage of diabetes cases but is still a cause of worry. For example, up to 2% of 20 years or younger in the United States have MODY.

Researchers have found out that gene mutations are a cause of MODY thus it is in the gene. The gene mutations affect the pancreas interfering with its ability to produce insulin. It then leads to high levels of blood glucose and with time it may damage the body tissues. High blood glucose levels usually harm tissues in the blood vessels, eyes, nerves and kidneys .clinical features of MODY will depend on gene mutations affecting a person.

Genes provide instructions within the cell on how to make proteins. The protein will malfunction if a gene undergoes change or mutation. Genetic mutations that cause diabetes affect the proteins that give the body an ability to produce insulin or the ability of insulin to reduce the blood glucose. A person has two copies for most genes after inheritance of one gene for each from both the father and mother.

Young people with some types of mutations might have a slightly higher level of blood sugars that stay stable throughout the life. They can have mild symptoms of diabetes or none but might not develop any long-term complications. It is only during a routine blood test that there will be the discovery of high blood glucose levels. Nonetheless, other forms of mutation require specific treatment with a type of oral diabetes medicine called sulfonylureas or insulin.

Usually, there is a confusion between MODY and diabetes type 1 and 2.

These are the most common types of diabetes and polygenic meaning that they have a relationship to defect or a change in the multiple genes. Environmental factors such as obesity for type 2 diabetes are also a contributor to the development of polygenic types of diabetes. These are the forms of diabetes that run in the family. Doctors diagnose polygenic types of diabetes by testing the blood sugar also known as blood glucose in individuals who show symptoms or risk factors for diabetes.

In the past, most people with MODY did not become overweight or obese. They also did not have other risk factors that occur during type 2 diabetes. This can be abnormal blood fat or high blood pressure levels. However, more people with MODY are showing signs of becoming overweight not because of diabetes but the general way of life where more people, especially in developed countries, are becoming obese.

Although MODY and type2 diabetes may run in families, those with the latter will have a family history of diabetes in successive generations. It means that MODY in a child is a manifestation of a similar condition in a parent and grandparent.

Genetic Heterogeneity of MODY and causes

Heterogeneity means the diversity in character or content. Due to genetically diversity MODY are in the following types:

MODY1: Occurs due to the heterozygous mutation in hepatocyte nuclear factor -4-alpha gene (HNF4A) on chromosome 20.

MODY2: The cause is a heterozygous mutation in glucokisanegene (GCK) on chromosome 7.

MODY3: MODY 3 occur due to a heterozygous mutation in hepatocyte nuclear factor alpha gene (HNF1A) on chromosome 12q24.2.

MODY 4: The cause is a heterozygous mutation in the pancreas/duodenum homeobox protein one gene, PDX1 on chromosome 13q12.1.

MODY5: Heterozygous mutation in a gene encoding hepatic transcription factor-2, TCF2 on chromosome 17cen-q21.3. Is the cause of MODY 5?

MODY 6: Heterozygous mutation in NEUROD1 gene on chromosome 2q32

MODY7: Heterozygous mutation inKLF11gene on chromosome2q32.

MODY8: MODY 8 also called diabetes pancreatic exocrine dysfunction syndrome occurs due to heterozygous mutation I CEL gene on the chromosome 9q34.

MODY9: Happens after a heterozygous mutation on the PAX4 gene on the chromosome 7q32.

MODY10: Occurs due to a heterozygous mutation in insulin gene (INS) on chromosome 11p15.5.

MODY11: Heterozygous mutation in BLK gene 191305 on chromosome 8p23.

MODY13: Heterozygous mutation inKCNJ11 gene on chromosome11p15.

MODY14: Heterozygous mutation inAPPL1 gene on chromosome 3p14.

Common genes that cause the occurrence of MODY

Most maturity onset diabetes of the young cases occurs due to these causes.

HNF1-alpha-This gene is the cause of around 70 % of diabetes by reducing the amount insulin the pancreas should make. HNF1-alpha usually causes the development of diabetes in adolescence or the early twenties, and people it affects do not need to take insulin as part of their treatment. Group tablets in small doses called sulphonylureas can treat it in the same way it doctors use it for treatment of Type 2 diabetes.

HNF1-beta-this type of MODY makes people get variety o health problems including uterine abnormalities, gout, and renal cysts in the kidneys alongside diabetes. The renal cysts often can occur in the womb before childbirth, but diabetes develops later and receptive to insulin treatment together with eating a healthy diet and regular physical exercises. The complications of diabetes can resemble those of HNF4-beta MODY.

HNF4-Alpha: This cause of MODY does not frequently occur like others, but it is likely to occur among the people who inherited a change in this gene are likely to have been born with a birth weight of 4 or kilos (nine pounds). The patient might have a history of low blood sugar at birth or soon after and might need treatment. The people with HNF4-alpha require therapy with a tablet that might require progress to use of insulin.

Glucokinase-glucokinase is a gene that helps the body in recognizing the level of blood glucose in the body. If this gene fails to work correctly, the body allows the level of blood glucose to increase and become higher than the average level. Blood glucose levels among the people with glucokinase MODY are slightly higher than usual amount which is between 5.5 to 8mmol/l.

This type of MODY does not cause visible symptoms hence a doctor can only pick its existence through routine testing such as during pregnancy. MODY from glucokinase unlike other type does not long-term complications hence patients can manage it without any medical treatment. Physical activity and eating a healthy balanced diet helps to maintain the right levels of blood glucose and cholesterol which in turn decrease the risk of complications.

Study outcomes on Population genetics of Maturity-onset diabetes of the young

For many years, people associated onset of diabetes to age. Studies on MODY are not old as about the other types of diabetes, but there are still findings on research many years ago. The researchers were aiming to determine what it was, likely causes and the population where it was possible to occur. MODY is more prevalent in specific regions than others. Studies at various places and years by these researchers brought out these findings of MODY.

1979: Rimoin stated that it affects more people in Romania than at other places.

1987: Winter and other researchers out MODY in America was more common in the Black populations .they found a typical form in 12 out of 129 patients and in the last two generations of nine in 12 families in the probands. The study scope was on 12 probands and 14 of the diabetic relatives. There were no findings of cells in Islet cell auto antibodies, and thyroid microsomal auto antibodies were present in only one. The study did not have an increase in frequencies of insulin-dependent diabetes relating antigen HLA-DR3 and DR4 among the probands and diabetes did not co-segregate with HLA haplotypes in informative families.

1995: A study by Leadermann stated that MODY occurrence is about 5% among patients with type 2 diabetes in most populations.

2001: Fajans states that members of families with a clinical history that resembles diagnosis of MODY but did not have mutations in any of the MODY-relating genes makes up 15-20 per cent of the Europeans with clinical MODY. The percentage reaches the highest percentage in Japan where researchers say it goes up to 80%.

MODY2 and MODY3 are the two most prevalent forms of diabetes in the young. They account for more that 80% of the MODY patients in Caucasians. Mutations in the HNF4A gene are not common, and even research on the Japanese populations where MODY is highly prevalent found that it affects only one out of 57 patients.

Other subtypes are rare disorders that only a few families report. According to the outcome of findings by Yamada et al. (2000) suggested that there is an explanation by known MODY genes about the existence of diabetes in 80% of MODY patients.

Studies on 146 families in a condition that fulfils the minimum criteria for MODY 2 had at least one member diagnosed for with the disease before age 25. Thirteen of the families had MODY3 mutations while mutations for two others were MODY2. Researchers did not find any presence of MODY1. Four of the MODY3 mutations were novel that researchers could not place in any type and refer to them as un-typed cases. The conclusion is that some of the patients get MODY due to defects in the unknown genes but appear to have insulin resistance.

Causes of Autosomal Dominant And Recessive Mutations

Autosomal dominant mutations cause most forms of MODY meaning that these conditions can pass on to children even if it is just one parent who has or carries the disease gene. A parent with dominant mutations carries a gene with a 50 per cent chance of getting a child with monogenic diabetes. Some MODY cases also occur as a result of Autosomal recessive condition.

Autosomal dominant cases occur when a father or a mother are carriers MODY, and it puts the probability of passing the mutated gene to an offspring by 50%. In contrast, children can only get MODY by autosomal recessive if they inherit mutation from two parents. A child in such an instance has a 25 per cent chance of contracting monogenic diabetes.

Testing for recessive forms of monogenic diabetes can show whether parents or siblings are carriers without disease for latent genetic conditions that their children could inherit. It is possible to inherit mutations from a mother only (X linked mutations), but it is not widespread just like the occurrence of spontaneous mutations.

Genetic Testing of MODY

Doctors recommend genetic testing for MODY in the case of:

  • Diagnosis of diabetes within the first six months of age
  • Diagnosis of diabetes in children and the young adults especially those with a strong family history. These are the children who do not show regular features of diabetes type 1 or type 2 such as the presence of auto-antibodies, obesity, and the other relating metabolic features.
  • Stable mild fasting hyperglycemia especially if there is no presence of obesity

It is essential for those who think that a member of their family might be having a monogenic form of diabetes to consult a doctor. A doctor will offer advice on how to get the appropriate treatment and provide the right information about the existing type of diabetes such as stopping insulin.

Due to the high-risk chance of 50 per cent risk of passing MODY that a parent carries, it is important to discuss the risk to any children he or she plans to have and possible solutions. Genetic testing is available even for other members of the family of persons who think that they might have MODY.

MODY Testing Procedure

Testing MODY involves taking blood for pancreatic antibodies and urine or blood tested for C-peptide which is something that a personal doctor can do. Another method is to draw blood for genetic testing. The procedure starts with a doctor taking the blood from a patient but will send it to a specialist centre for testing together with the details of diagnosis and treatment.

Treatment and Management of MODY

Treatment of monogenic diabetes depends on a specific genetic mutation that causes the condition. Treatment with an oral diabetes medicine called sulfonylurea can help the body to release more insulin into the blood of people with certain forms of MODY.

Other people require insulin injections, yet others can manage the disease by lifestyle chance such as starting to eat a healthier diet and exercising. A diabetes specialist can work together with a patient’s physician to develop a beneficial plan for treating and managing diabetes based on the results of genetic testing.

MODY is a disease that a patient and doctor can manage and treat. Early detection makes a significant difference in the success of the treatment strategy. An accurate diagnosis is also essential in determining the correct pathway.

New treatment approaches on Autism Spectrum Disorder

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Autism Spectrum Disorder (ASD) has various treatment approaches, but it is essential first to determine what it means to have an ASD. It is a neurological and developmental disorder beginning early in childhood and lasts for the entire life of a person. It is called a spectrum disorder because it causes those who have the condition to experience a range of symptoms.

It affects the way a person acts and interacts with other people, leans and communicates. Pervasive developmental disorders and what was known as Asperger syndrome are components of ASD.

It can make them have problems talking to people or looking others in the eye during conversations. They might also show signs of repetitive behaviors and restricted interest in many essential issues. The time that people with ASD take to put things in the right order is longer than other people. Others might repeat sentences again and again and do things that make them spear-like they are in their world.

The origin or autism is in the brain development. The most notable signs and symptoms of autism emerge at 12-8 months of age. Some of the infants can develop until they reach the second year of life. They start losing their skills and generate a pattern called regression.

Causes of Autism Spectrum Disorder

Until recently, there was no answer about the cause of autism spectrum disorder. Research finding is now providing more precise solutions. We now know that there is no single cause of autism just like it is not in one type. Scientists over the last five years have identified various rare gene mutations or changes with an association with autism. Autism risk genes according to findings from different studies are more than a hundred,

Around 15 percent of the cases occur because of a specific gene that medics can identify. Nevertheless, complex variable genetic risks combine with environmental factors to influence the development of brain early in life. The explanation shows that some non-genetic or environmental factors together with a genetic predisposition to autism influence an increase in the risk of children to get ASD. The most apparent evidence of the environmental risk factors are the events that happen before and during birth including:

  • Advanced parental age at conception (both the father and mother)
  • Severe maternal illness during expectancy
  • Extreme prematurity and birth weight
  • Some kinds of difficulties during birth especially those involving a period of oxygen deprivation to the brain
  • Exposure of the mother to air pollution and high levels of pesticides

The above factors do not cause ASD on their own but in combination with the genetic risk factors that appear to increase risk.

Researchers are increasing their efforts to study the role of the immune system in the occurrence of autism. A small body of developing research suggest s that mothers who take prenatal vitamins that containing folic acid before they conceive and during pregnancy reduce the risk of autism in their babies.

Treatment approaches on autism spectrum disorder interchange

Treating ASD requires a multidimensional approach as there no single cure for all the signs and symptoms. A multiple approach helps to maximize the ability of a patient to function by reducing the ASD symptoms and supporting development as well learning. Early intervention during pre-school years allows children to learn critical social, functional, behavioral and communication skills. The range of treatments including the home and school-based interventions can be overwhelming making the patient change over time. The health care provider might recommend options and help to identify the most convenient resources.

Parents should make arrangements for early treatment if a diagnosis on their children shows that they have autism spectrum disorder by talking to experts about creating a treatment strategy. The procedure might involve a team of professionals with knowledge in various specialties necessary for meeting the needs of a child. The treatment options might include the following approaches that a patient receives in the combination that is most suitable for treating his or her type of ASD.


No particular type of medicine improves the core signs of ASD but the medication that healthcare providers subscribe help to manage them. For instance, children who are hyperactive due to autism might get antipsychotic drugs that doctors sometimes use to treat extreme behavioral problems. Antidepressants help to reduce anxiety. It is essential to provide up to date information on medication or supplements to health care providers that a patient is taking. The reason is that some of the medicines and supplement might interact to cause dangerous side effects.

2.Educational therapies

Children with autism spectrum disorder can benefit much from highly structured educational programs because they respond well. Some of the successful programs include a team of specialists and various other activities that improve social skills, behavior, and communication. Preschool children show good progress if they receive intensive and individualized behavioral interventions.

3.Behavioral and communication therapies

Many programs to treat ASD address a range of social, behavioral and language difficulties that occur as a result of the disorder. Some of the programs focus on reducing the problem behaviors as well as teach new skills. Other programs focus on teaching the children how they should act in social situations and communicate in a better way. Applied behavior analysis (ABA) helps children to learn new skills that they can generalize to multiple situations through a motivation system that rewards achievements.

Speech-language therapy: will help to improve the communication skills in children with ASD. For instance, they can learn the way to use a normal up and down rather than a flat tone when speaking. They also get lessons on how to maintain a two-way conversation, understand social cues such as hand gestures and make eye contact.

Cognitive behavioral therapy (CBT): Helps a child to change the way of thinking to gain better control of the emotions and the repetitive behaviors. It helps an ASD patient to learn techniques of controlling outbursts, obsessions, and meltdowns.

Social skills training: therapists teach the affected person in one-on-one sessions to impart skills on interacting with others and expressing themselves in better ways. The best approach to teach social skills is by making the patient model atypical behavior.

Applied behavior analysis

Applied behavior analysis is a technique that encourages positive social and communication skills but discourages undesirable behavior. A therapist will use praise and any other positive reinforcement’s methods that motivate the patient to change to achieve desired results.

Family therapies

Family therapies provide parent education and training. This training is a preserve of parents or those taking care of children with ASD to help them work on the social skills of the patient at home. Some families might also find a counselor to assist them in dealing with the challenges of living with someone who has autism. Parents and family members learn how to interact with ASD patients in ways that promote interaction skills, management of behavioral problems communication and teaching skills of daily living. It will also include ways to play with kids who have autism.

Other therapies for ASD.

There are many different therapies that a doctor can decide to apply after evaluating the needs of the patient with autism spectrum disorder. They can use speech therapy to improve the communication skills, physical therapy to improve mobility and balance and occupational therapy to training activities of daily living. A psychologist might recommend the right ways of addressing problem behavior.

Management of other existing conditions in autism spectrum disorder treatment

In some cases ASD, the patients will also have other medical and mental conditions that hinder living in the same manner as other people. It is essential to address the other these other conditions as part of the treatment approach.

Medical health issues

Children with ASD may have medical problems such as sleep disorders, stomach diseases, sleep disorders, and limited food preferences. It is essential for a doctor to define a way of managing any medical conditions together with autism therapy.

Mental health disorders

Teenagers and adults with ASD often have other mental health disorders such as depression and anxiety. ASD doctor, a psychiatrist, community and service organizations can help in defining the best treatment for psychiatric conditions.

Complementary and alternative therapies

Because there is no definite cure for Autism Spectrum Disorder, many parents and those who are adults with the conditions try other therapies that complement the treatment approaches. The intention is to improve the life of the patient although some the alternative treatments have little or no research to prove their efficiency. It is important to determine those that provide the patient with benefits after use together with evidence-based therapies.

Examples of beneficial therapies are:

Sensory-based therapies: These are the therapies based on an unproven theory that the people who have autism spectrum disorder will have an auditory processing disorder that is a cause of problems in processing or tolerating sensory information such as balance, touch, and hearing. Therapists use materials such as squeeze toys, brushes or trampolines to stimulate the senses. These therapies are not evidence-based, but there is a possibility that they might offer some benefits but together with other treatments.

Creative therapies: Some of the parents take an option to supplement medical and educational intervention with music or art therapy that focuses on reducing the sensitivity of a child to sound or touch. These therapies might provide some benefit when in use with other treatments.

Massage: Massage is relaxing, but there is not enough evidence to verify if it improves the symptoms of ASD.

Pet therapy:The purpose of this therapy is to get a person living with ASD a pet for companionship as well recreation, but there is a need to determine if the interaction with the animals has a way to improve the symptoms of the disorder.

Harmless but non-evidence based alternative therapies

These complementary therapies might not cause any harm, but there is no evidence of their efficiency. They might include significant financial cost making it challenging to implement. These are some of the therapies in this category.


Acupuncture is a method of complementary medicine that uses fine needles which an acupuncturist inserts into specific points that are deemed to be meridians (lines of energy) through the skin for treatment of different mental and physical conditions.

The use of acupuncture does not have research backing, but it remains one of the popular methods for improving ASD symptoms.

There is no straight way to explain the scientific functioning of acupuncture, but it helps to relieve pain and to relieve a range of other complaints. Acupuncture enthusiasts say that it works by balancing the vital energy with some believing that it has a neurological effect.The Chinese and eastern countries use it but it western medical doctors consider it a controversy.

Eating special diets

Restrictive diets might cause nutritional deficiencies to growing children. It is essential to pursue a restrictive diet will be better if it involves a consulting a registered dietician to develop an appropriate meal plan.

In the standard treatment that does not involve reliance on alternative therapies, doctors do not recommend a special diet for autism spectrum disorder, but it is essential to get proper nutrition. There is a belief that restricting gluten or casein in the diet might help to improve some of the symptoms. Gluten and casein are proteins in wheat and milk products.products.The action does not have a backing of any research and limiting dairy in daily food intake might prevent proper development of the bone. It is unnecessary and might even be dangerous because kids with autism spectrum disorder usually have thinner bones thus bone-building foods are essential.

Dangerous treatment approaches

Their treatment approaches are in use, but experts say they do not have evidence about their benefits in treating symptoms of ASD and are even potentially dangerous. The methods that autism experts do not recommend are:

Chelation therapy: removal or mercury and any other heavy metals from the body. Experts say there is no evidence of success and it is too intensive for the patient.

Hyperbaric oxygen treatment: Breathing oxygen in a pressurized chamber but the Food and Drug Administration (FDA) has not given its approval.

IVIG(Intravenous immunoglobulin) infusions: no evidence to show its efficiency and it does not have any approval by FDA.

The new treatment approaches to autism spectrum disorder require a thorough evaluation to evaluation of the patient needs and evidence of efficiency before use. The patients require much support and care from the family even when taking medication and undergoing therapy.

What is the cause of child mortality under 14 years in the UK?

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Child mortality refers to the death of children under 14 years old. It is also called child death and encompasses neonatal, under-5 and age 5-14 mortality.

It is an important aspect for the world that the fourth Millennium Development Goal (MDG4) aims at reducing the mortality rate of the under-five children in the 1990s by two thirds. Many of these children do not need to die because the most causes of child deaths occur because of preventable diseases or condition that include infection and disease. Children in developing countries are at the risk of dying from lack of clean drinking water and malnutrition.

Developed countries might not suffer from lack of resources and services to support proper nutrition, healthcare as well as living conditions that contribute to an increase in child mortality rates. The UK is one of the developed countries that can afford to invest in preventive health care based on behavioral change, cultural and social change with a long-term impact on the lives of children and mothers.

The death rates of infant and child in the UK has been on a decline and continued to fall. The challenge for authorities is that UK child mortality rates are one of the worst western Europe to the point of having close to 2,00 excess deaths annually compared to Sweden which is the best performer. There are still a high number of babies who die within a year of birth. It is a disturbing reversal of the gains by National Health Service in reducing infant mortality over several decades. Health charities, professionals and midwives are among the people who voice a serious concern at the trend of child deaths in England and Wales.

The rate of child deaths rose from 2.6 neonatal deaths per 1,000 births to 2.7 for every 1,000. The infant mortality rate survey shows that deaths within the first year of child's life rose from 3.7 -3.8 for every 1,000 live births within a year. The concerns became rife after an increase two year in a row.

Cause of Child Mortality Less Than 14 Years in the UK

However, there are variations in the mortality rates across the UK meaning that it requires much more effort to ensure that health services give the vulnerable babies a chance for survival. The key area where the UK has an extremely high rate of child mortality is infant and children deaths due to chronic conditions.

Several reports also show that health services always do not deliver optimal care for children and teenagers creating room for loss of lives.

Social inequalities are another factor contributing to death rates. Many of these causes of childhood deaths have a way of preventing them. The main causes of child mortality in the UK are:

1.Low birth weight

Premature birth and low birth weight increase the risk of child mortality mostly because of the lack of prenatal care diminish the growth of the fetus. Mothers who are pregnant without getting any prenatal care should take a step of informing the state health department about lack of medical once they access it to give extra attention in the remaining gestation period. It is essential for NHS to educate the pregnant and sexually active teens about the importance of prenatal care as they are the age group that neglects to attend antenatal care clinics.

A mother’s health status and environment during pregnancy affect the way a fetus develops and pregnancy development. Failing to take good care increases the risk of child mortality due to occurrences such as congenital disabilities, low birth weight, preterm birth and Sudden Infant Death Syndrome (SIDS). A mother should make an effort to start receiving early and regular prenatal care to promote the best outcome for both the baby and mother.

2.Preterm birth and its outcomes

There is no definitive way of preventing preterm birth the second most frequent cause of infant mortality in some developed countries. Researchers and healthcare providers keep on finding multiple fronts to solve the problem by finding trying methods of stopping preterm labor from progressing to delivery and identifying ways to improve health outcomes for infants born before their time. These infants usually have low birth weight. The cause of preterm birth can be poor nutrition or chronic health conditions. Delivery before time in the previous pregnancy is a risk factor for women in other pregnancies, and they should inform medical practitioners to receive care that will reduce the risks.

3.Congenital disabilities (birth defects)

Congenital disabilities are one of the leading causes of infant mortality in the UK another first world countries such as the United States. Different types of birth defects can even start during pregnancy. Pregnant women can do several things that contribute to reducing the risk of particular birth defects such as taking adequate folic acid before getting pregnant and during pregnancy to prevent the occurrence of neural tube defects.

4.Unsafe Infant sleep environment

The unsafe environment for children can lead to child mortality. It is much riskier for infants who are more likely to get SIDS (sudden infant death) that cause sudden death for infants younger than a year due to unexplainable reason even after thorough investigations. SIDS is a type within a broad category of the causes why infants pass on. They are called SUID sudden unexpected infant death category that includes the other causes of sleep-related deaths. These include accidental suffocation, vehicle collisions, infections, and other unexpected causes.

SIDs has been decreasing in the last few years, but the rate of other sleep-relating causes of infant deaths has been on the rise. Accidental injury, for instance, has risen to become one of the top five causes of infant mortality. There are no definite ways of preventing SIDs, but it is still possible for mothers to reduce their risk as well the causes of other sleep-related causes of death to infants. For instance, removing of toys or other objects from a baby’s sleeping cot, placing a baby on the back when sleeping and loosening the beddings are some of the ways that reduce the risk.

5.Lack of newborn screening

Failing to screen a newborn might cause failure to detect hidden conditions and eventual cause death. Tests after birth help with detection of certain conditions that midwives and doctors who participate in delivery cannot notice at the time. Some of these conditions can quickly cause severe disability and even death if no treatment takes place within a short period of birth. Infants born with some of the conditions that cause child mortality to appear to be in excellent health and may not even be from parents with a family history of the disease.

Screening after birth involves drawing a few drops of blood from the heel of an infant and applying it to a particular paper. The doctor sends the spots for analysis in a laboratory and begins treatment immediately if the test reveals the presence of a condition that causes infant mortality.

Most hospitals in the UK can screen more than 20 conditions. Infants born to parents with a history of specific illnesses that could put their lives at risk or are born with high risk will undergo an additional screening beyond the usual under observance of a health care specialist. Testing to achieve early detection and intervention helps to save the lives of children and improve the quality of their future life.

6.Smoking by the mother during pregnancy

Mothers who smoke during pregnancy are putting their fetuses and infants at the risk of adverse outcomes that could cause their death. There is a possibility that children from the lineage of a smoking grandmother will develop childhood asthma.

Cigarettes are especially dangerous for a fetus because they contain an addictive substance known as nicotine, carbon monoxide, and numerous other materials that a smoker inhales from a cigarette. The danger extends to the baby because all these substances directly go to the baby through the bloodstream. Smoking during pregnancy will lower the amount of oxygen that the baby can access and increase the following:

  • Heart rate
  • Lung and other respiratory problems
  • Birth defects
  • Sudden infant death syndrome
  • Premature birth
  • Intrauterine growth retardation
  • Low birth weight
  • Early death

In some instances, smoking mothers during pregnancy give birth to stillborn babies. Those who do not get adverse effects while young still face negative consequences during their subsequent health and development. Mothers who are at the exposure of second-hand cigarette smoke from a smoking partner or other environmental fumes are also more likely to put their unborn babies at risk and give birth to underweight infants with possible health problems. Children born of mothers who smoke during their gestation are at risk of dying from SID syndrome by three times than those whose mothers keep away from during their expectancy. Maternal smoking during pregnancy is also a risk factor for obesity in early childhood. The chances of a baby getting harm due to smoking during pregnancy increases with the number of cigarettes that a mother smokes. It does not mean that there is a there is a number which someone can term as safe.

Mothers who are at the exposure of second-hand cigarette smoke from a smoking partner or other environmental fumes are also more likely to put their unborn babies at risk and give birth to underweight infants with possible health problems.

Children born of mothers who smoke during their gestation are at risk of dying from SID syndrome by three times than those whose mothers keep away from during their expectancy. Maternal smoking during pregnancy is also a risk factor for obesity in early childhood.

The chances of a baby getting harm due to smoking during pregnancy increases with the number of cigarettes that a mother smokes. It does not mean that there is a there is a number which someone can term as safe.


Accidental deaths in children at the age of just one year up to 14 years that occur at home are a worrying cause of child mortality. Approximately 60 children under five years die as a result of an accident, and more than 76, 000 under age 14 get treatment in hospital for the same causes. The number is higher for children of fewer than five years by 40% meaning the number of mortality for this age group is also higher. Children of age 0-4 years are at a higher risk of home accidents than other generations. Boys are more likely to get injuries from accidents than girls.

Injuries are another frequent cause of death among the children after the first year of life although the most frequently occur due to unintentional injuries. The failure to reduce the deaths due to intentional injuries among the young people is another reason to cause a pressing concern. Falls account for the most number of accidents. Most severe injuries occur due to falls from a height and heat-related accidents. Other types of accidents that contribute to child mortality are:


Scalds and burns that occur due to exposure to hot items like iron boxes or open flames. Children have sensitive skins those adults which put them at more risk of scalds from hot bath water and beverages.

Glass-related cuts

Poisoning by medicines, cosmetics, and household products that children reach without knowledge of the person caring for them. Strangulation when a child reaches an item that makes a tight loop around the neck or pulls a plastic container over the head to bock inhaling.

8.Neurological and developmental disorders

A neurological disorder is any condition that causes dysfunction in part of the nervous system or brain causing psychological or physical problems. Development of the brain starts during pregnancy continuing through infancy, childhood and up to adolescence. Most of the cells from before birth but the connection between them (neurons) does not develop until infancy. A child with neurological disorders gets developmental difficulties or misses essential milestones.

They cause complications that require lifelong management that is likely to cause death in a child who does not get the right support. Complications during childbirth can cause neurological disorders because the skulls are not entirely formed at this time thus exposing the brain to physical injuries. Supply o oxygen and blood from the umbilical cord can also be affected during birth causing a deprivation to the brain and causing damage.

Exposure by the mother to toxins can also cause neurological disorders because they can reach and damage the developing system of the baby through the placenta. Other causes of neurological disorders that are likely to cause mortality death include:

  • Chromosome abnormalities
  • Infections
  • Nutritional deficiencies
  • Immune disorders
  • Traumatic brain injury
  • Spinal cord injuries
  • Premature and low birth weight
  • Postnatal infections

9.Shortage of midwives

The kind of care that a baby receives soon after birth has many contributions to the health status after that. The UK like other countries has a shortage of midwives which lowers the quality of care as the few available attend to a higher number of patients. It prevents them from giving much attention as necessary to each infant who could make them miss a crucial observation that may have revealed a presence of a condition that can put lives at risk. Midwives work for long hours which can cause a lapse in concentration which is a crucial factor in ensuring safe delivery and detection of life-threatening conditions.

There are various causes of child mortality under 14 years in the UK, but the above are the most common. Other causes of child death such as suicide due to depression, homicide and auto accidents are also contributors but too small extent.

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