GHA Public Health

GHA Public Health has 6 articles published.


in Health & Beauty

Osteoporosis is a condition that weakens bones, making them fragile and more prone to breaking. The condition is often diagnosed when a fall or impact causes a bone to break, with the most common injuries occurring in the wrist, hip and vertebrae. Osteoporosis is called a “silent disease” as patients do not notice any changes until a bone breaks, as the bones often lose density over a number of years. Once the bones have become weakened some of the symptoms which my present include:

  • A gradual loss of height 
  • Stooped posture (particularly in older patients)
  • Increased bone fractures
  • Back pain as a result of fractured vertebrae. 

Sometimes even the action of coughing or sneezing can cause a broken rib or partial collapse of vertebrae in people suffering from osteoporosis.

Causes of osteoporosis

Loss of bone is a natural part of the ageing process. Women are also more likely to lose bone after the menopause. This increases the risk of osteoporosis, particularly if menopause has started before the age of 45 or they have had an oophorectomy (ovaries removed). 

Other factors can also increase the risk of osteoporosis onset, including:

  • Family history of osteoporosis 
  • Had extended bed rest
  • Having a low body mass index (BMI)
  • Lack of physical activity 
  • Heavy smoking 
  • Significant alcohol consumption 
  • Having or having had an eating disorder 
  • Taking high doses of steroid tablets for prolonged periods 
  • Medical conditions such as inflammatory conditions, hormone related conditions, or malabsorption. 
  • Long-term use of medications that affect hormone levels, such as anti-oestrogen tablets that women may take after breast cancer. 


Osteopenia is the stage before osteoporosis and occurs when bone density is below average. Osteopenia does not always lead to osteoporosis and there are steps you can take to reduce your risk from developing the condition. There are bone-strengthening treatments your doctor may prescribe, depending on the severity of your condition. 

Preventing osteoporosis 

If you are at risk of developing osteoporosis, there are steps you can take to help reduce your risk and keep your bones healthy. This includes: 

  • Keeping physically active to help keep your bones as strong as possible. Healthy adults should aim for 150 minutes of moderate intensity exercise a week or 75 minutes of vigorous intensity exercise. Try to incorporate strengthening activities on at least 2 days a week. Regular weight-bearing exercise, such as light weight training, walking, climbing stairs or hiking are important. 
  • Aim to eat a balanced diet including foods which are rich in calcium and vitamin D. 
  • Taking a daily supplement containing 10 micrograms of vitamin D. 
  • If you are a smoker, consider stopping or cutting down. Appointments with the GHA free ‘Stop Smoking’ service are available on 20052441. 
  • Reduce alcohol consumption. 

living with osteoporosis 

Osteoporosis does not usually cause discomfort until a breakage occurs. However, breaks, in the spine can be a source of chronic pain. If you have suffered from a fracture there are some things which can help you in your recovery. Hot and cold treatments such as warm baths and cold packs can be used to reduce discomfort. Additionally, transcutaneous electrical nerve stimulation (TENS) can be used to stimulate the nerves and reduce pain. If your condition is affecting your day-to-day life, or you have concerns about coping with a long-term condition, speak to your healthcare provider. 

If you are diagnosed with osteoporosis, it is important to try and reduce the risk of falls. Remove hazards from around your home and ensure you have regular sight and hearing tests. 

New drug treatment for Breast Cancer

in Health & Beauty

Breast cancer is the most common type of cancer in women. In Spain, nearly 30% of cancers diagnosed originate in the breast. Although its incidence has grown in recent years, advances in treatment and early diagnosis of the disease deliver an increasingly improved prognosis. 

Tomas Arrazola, a pharmacist specialising in oncological pharmacy at HC Marbella and HC Ceuta, talks about the new drugs currently being given to treat this disease.

How have breast cancer drugs evolved? 

Fortunately, in recent years knowledge of the molecular biology of tumours has increased, allowing the development of treatments which improve on the results from classic chemotherapy. They are basically of two types, the first are treatments which target specific mutations and the second are immunotherapy drugs which bolster our immune system so it recognises and attacks the tumour.

What new drugs are there?

Before we discuss new drugs for breast cancer, we need to have some understanding of the 3 breast cancer subtypes: luminal, HER2 and triple negative. The novel approaches to treatment are based on this information. 

Luminal: this subtype of breast cancer is highly hormone dependent and is treated with drugs which block the action of these hormones. Cell cycle inhibitors such as Ribociclib, Palbociclib and Abemaciclib used in advanced disease are no longer new drugs, and there is growing evidence that they may be useful neoadjuvant and adjuvant treatments in localised disease. When these drugs are used in advanced disease, at some point they lose their effect; 50% of the time this loss of effect is due to a PIK3CA mutation for which we have a drug called Alpelisib. This drug is not yet available commercially, but we have treated 5 patients with it in our centre with encouraging results.

HER2: This subtype is characterised by its HER2 receptor amplification and is the most aggressive, however, the arrival of Trastuzumab in early 2000 resulted in a radical change in both the treatment and prognosis of the disease. Trastuzumab results have been improved further by the introduction of Pertuzumab, in combination with Trastuzumab, in both advanced and localised disease. Subsequently antibody-drug conjugates arrived, these combine a monoclonal antibody with a cytotoxic drug with the aim of targeting the cytotoxic drug at the cell that has the HER2-amplified receptor, thus destroying it. Unlike when receiving conventional chemotherapy, other healthy cells are largely prevented from being affected. These antibody-drug conjugates use Trastuzumab as a shuttle, they are Trastuzumab-Emtansine and Trastuzumab-Deruxtecan, the latter has delivered results never seen before in the heavily pre-treated patients treated in our centre. Trastuzumab-Deruxtecan has recently delivered impressive data even in those  patients who have breast cancer with weak HER2 expression.

Triple negative: the name as such lacks definition, it has no hormone receptors for oestrogen or progestogen, or amplification of the HER2 receptor, it is the most aggressive form and there are fewer drug treatments available. Fortunately, there is a ray of hope as these are highly immunogenic tumours in which immunotherapy drugs can play a key role. Both Atezolizumab and now Pembrolizumab have been approved by regulatory agencies for their use in advanced disease; data also exists on localised disease, with Pembrolizumab indicated as neoadjuvant treatment and as adjuvant treatment afterwards.

Within this subtype, not an insignificant percentage of patients have a BRCA gene mutation which contributes to an error in DNA repair. These patients are candidates for treatment with Olaparib or Talazoparib in advanced disease, or even Olaparib as adjuvant treatment in the case of localised disease. 

Triple-negative conjugated antibodies such as Sacituzumab-Govitecan are also now available, already approved in the USA, they will be available in Europe in the near future.

At HC, we are committed to innovative treatment and to providing the latest alternative drug treatments for our patients, even if they are not yet generally available. We are increasing the range of new emerging treatments through involvement in new clinical drug trials. 

Breast Cancer Screening

October marks breast cancer awareness month, and awareness of breast cancer is crucial to early detection and better health outcomes. In some cases it will be possible to notice visible changes to the breast, check out the ‘Know Your Lemons’ website and app for more details. However breast screening is the best tool we currently have to help detect cancers before there are signs of disease, when for example they are too small to feel.

In Gibraltar, women between the ages 40 and 70 are invited for screening mammograms at 2-yearly intervals.

Trans men, trans women and anyone non-binary (between 40 – 70 years) may be invited automatically or may need to talk to the local breast screening team.

Anyone can get breast cancer. 

This includes women, men, trans and non-binary people.

The chance of getting breast cancer increases as you get older. 

Most breast cancers are diagnosed in women over 50 years old.

It is important for all those who are eligible to take advantage of the screening program. Invitations are sent in the form of a slip which must be returned to the screening nurses in order to obtain an appointment.

You can have breast screening whatever size or shape your breasts are. Those with implants can also be screened safely; there are several methods mammographers (specialists who help take the breast x-rays) use.

Breast screening cannot stop someone getting breast cancer, but it is the best way to spot cancers at an early stage.

Finding cancers early can make it:

more likely that treatment will be successful

less likely you’ll need to have any surgery

• more likely you’ll be cured

If you are eligible for screening and have not been contacted, or wish to make an appointment or just find out more, contact:

GHA Breast Screening Team

Call : 200 72266 Ext.2214 


Summer Allergies

in Health & Beauty

The summer season is associated with sun and fun. However, summer also brings with it a variety of allergy offenders; and summer allergies can be just as bad as those experienced during the spring and autumn. Common allergies during the summer include:

Insect Bites and Stings

The warm weather welcomes insects such as bees, hornets, wasps…

Most of us steer away from these buzzing creatures to avoid bites/stings. Some common symptoms that come along with an insect sting allergy are pain, swelling, redness, itching and itching at the site itself. Those who suffer from a severe reaction or anaphylaxis can also experience symptoms such as tummy upsets, tongue or throat swelling, difficulty breathing, dizziness or unconsciousness. Severe allergic reactions can occur within minutes after the sting and require immediate medical attention.  Taking precautionary measures can lessen your chances of getting stung – it is best to avoid:

• walking barefoot outdoors and wearing sweet smelling colognes, perfumes, and lotions

• eating food that has been exposed food 

• exposure to open bins where insects thrive.

Seasonal Fruits & Vegetables

Melons, peaches, nectarines, kiwi fruit, tomatoes, cucumbers and carrots are just some of the fresh produce we love to enjoy during the summer months. However, for some allergy sufferers, these fruits contain similar proteins to some grass and tree pollen they are allergic to, causing the body to react the same way it would to the pollen. This condition is referred to as oral allergy syndrome (OAS). Common symptoms of OAS include itching or burning of the lips, mouth, and throat and in some cases, hives. An allergy test can help determine what a person is allergic to; it is best to seek advice from a qualified allergy specialist.

To avoid having a reaction, try opting for a cooked version of the fruit or vegetable, which will degrade the protein causing the allergy.


Outdoor mould spores make their way through the air just as pollen does. Mould spores are ubiquitous (present everywhere) and often outnumber pollen grains in the air even when the pollen count is at its highest. Mould allergy symptoms are similar to those of pollen allergy and include coughing, sneezing, runny nose, congestion and itchy eyes. To reduce your exposure to outside moulds, keep doors and windows closed and remain indoors on days with high mould counts.


Warm, dry, and windy days are often when pollen counts tend to be the highest. Grass allergy symptoms present themselves in several ways: runny nose, sneezing, congestion, itchy and watery eyes and asthma are the most common. Skin rashes such as hives and welts may be present in people with more severe allergies or when in direct contact with the offending grass. Staying indoors on high pollen count days, showering and changing clothes after outside activities as well as keeping doors and windows shut are all ways you can avoid grass pollen. 

World Breastfeeding week

in Health & Beauty

Breastfeeding Week is an annual event organised by the World Alliance for Breastfeeding Action (WABA), a global network that works alongside the World Health Organization and UNICEF to protect, promote and support breastfeeding around the world. The event raises awareness of the health and wellbeing outcomes of breastfeeding and the importance of supporting mothers to breastfeed for as long as they wish. 

Whilst support at the individual level is crucial, WABA emphasizes that breastfeeding is a public health issue that requires investment at all levels. The opportunity to create a warm chain of support for breastfeeding that includes health systems, workplaces and communities at all levels of society is vital.  

Breast milk is tailor-made for your baby, has all of the easily digested nutrients in the right proportions, and contains antibodies and properties that prevent and protect against infections. Whilst any amount of breastfeeding is beneficial, exclusively breastfeeding your baby for 6 months offers a lot more protection. 

Breast milk has many benefits for both baby and mum.


• provides protection from infection – breast milk provides natural antibodies that help your baby fight infections like tummy bugs, diarrhoea, colds; and chest and ear infections

• is rich in vitamins and nutrition – your breast milk provides the perfect combination of vitamins and nutrition, it is also much easier to digest than first infant formula

• protects long-term health – breastfed babies are less likely to develop diabetes, or become overweight when they are older

• reduces the risk of sudden infant death syndrome (SIDS) and childhood leukaemia 


• helps your uterus get back down to size 

• promotes bonding with baby 

• protects your health by lowering your risk of breast cancer, ovarian cancer, osteoporosis (weak bones), diabetes and cardiovascular disease (conditions affecting the heart or blood vessels).

Your diet whilst breastfeeding

You do not need a special diet while you are breastfeeding; just try to include a well-balanced, healthy variety of fruits, vegetables, starchy foods, dairy products and protein. For tips and advice, visit: 

How long should I breastfeed?

The World Health Organisation recommends that babies should have only breast milk for around the first 6 months of their lives and then continue to be breastfed for 2 years and beyond.

It is particularly important to give your baby only breast milk in the early days as this can affect your milk production. If you find it difficult to only breastfeed or you do not want to, try to give as much expressed breast milk as you can; your partner can help with feeding too.

When to feed your baby

If your baby is hungry or thirsty, they will show signs of hunger by:

• moving

• putting their hand to their mouth

• rooting

• becoming agitated or upset  (try calming them by cuddling, giving skin-to-skin contact, talking and stroking)

Keeping your baby close will help you recognise these signals. Responding to their needs will not spoil them, but will help them feel safe and secure.

Understanding first feeds

Your baby’s tummy is the size of a cherry on the first day; during the first 24 hours after the birth, babies usually wake and feed often to get your milk supply started. This may seem like a lot of feeding but is normal and will settle down.

Your baby’s tummy will grow from the size of a cherry on the first day to the size of an egg by the end of the first month. They will need to feed frequently (8 to 12 times in a 24-hour period) as small amounts of milk at each feed will fill them up.

As baby’s tummy grows, they will start to take a bit more at each feed. Feeding them as often as they want will help your body prepare a good supply of milk for the days, weeks and months ahead.

As your baby feeds more and grows, the gaps between some of the feeds will get longer. Responding to your baby’s feeding cues will ensure they feed frequently. 

It is not possible to overfeed a breastfed baby.

Dads and partners

Emotional support and encouragement from dads and partners are as important as practical help. Dads and partners play a key role and can help mum by:

• taking an interest and finding out about breastfeeding, so you can give help and suggestions if your partner is struggling

• understanding it takes time and practice for mum and baby to get the technique right while feeding 

• looking after mum while she’s breastfeeding and making sure she is comfortable

Getting support to breastfeed

Your midwife, health visitor or family nurse can provide information and help, and show you:

• how to hold your baby

• how to help them take your nipple and breast in the right 

It is also helpful to chat to a friend who successfully breastfed her baby or contact the local breastfeeding association:

Self Care

in Health & Beauty

‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc.),
environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’ 

(WHO 1998)

The COVID-19 global pandemic has been challenging in a plethora of ways. As we steer toward the ‘new normal’ taking responsibility for our own health and well-being is crucial. Self-care relates to taking care of yourself physically, mentally and emotionally. 

Most people are reasonably healthy as children. As we get older however, we are faced with multiple choices and risks in the form of lifestyle challenges such as food, alcohol, and tobacco. 

Unfortunately, the common result of some of these choices (e.g. obesity, physical inactivity, tobacco use, alcohol abuse and unhealthy diets) are the modern epidemics we see; heart attacks, strokes, cancers, diabetes, chronic respiratory diseases and other ‘non-communicable diseases.’

It is, however, possible to reduce our risk of these diseases by adjusting our lifestyles and focusing on self-care.

There is a growing realisation that self-care in the home and community environment is the foundation for people to manage life-long health. Initiatives in ‘community healthcare’ and ‘health promotion’ are aspects of the new approach.

There are many different entry points into self-care and one healthy behaviour can lead on to others, drawing people in to healthier lifestyles overall. For example:

a smoker who manages to quit smoking is more likely to start exercising.

brushing and flossing teeth regularly will reduce periodontal (gum) disease – this can also slow the progression of atherosclerosis, a major risk factor for heart disease and stroke.

older people can reduce the risk of Alzheimer’s by 60% by maintaining mental acuity through crossword puzzles 

Caring for yourself also calls for the creation of your own routine, one that works for you! Finding the time to relax – taking just 10 minutes of your day to switch off with a short meditation can be beneficial.

Activities/hobbies such as painting, dancing, singing, or anything that helps you focus on a particular object, thought, or activity, will steer you toward achieving a clearer state of mind. 

The International Self-Care Foundation  has developed a framework for self-care around seven ‘pillars’ or ‘domains’…

For more information on health and healthy
lifestyles visit:




Keeping Kids Healthy this summer

in Features

Complexity seems almost built into children’s lives today. As we return to some form of normality post Covid lockdown, it is apparent many children have adopted behaviours and routines that may not promote health.

Obesity is a global epidemic. Studies project that by 2025, 16% (268 million) of the world’s children will be overweight or obese, making largely preventable health conditions such as type 2 Diabetes, heart disease and stroke more prevalent.

This summer, CHAMP (Child Healthy Active Multiagency Programme) once again wish to stress the importance of creating an informative, pragmatic and supportive environment to help children and families make appropriate choices towards healthy living. Small changes to our lifestyle can reap huge benefits…

Keep Active:

Children under five years should have around three hours of activity a day.

Children aged five to 16 years need to be active for at least 60 minutes each day.

All activity helps- use the stairs instead of the lift; enjoy a walk before or after dinner, dance, play, and cycle –  whatever works for your family!

Being active is all about having fun, this helps us keep at it, helps us feel stronger, fitter, more energetic and ultimately better for doing it. 

Eat Well: 

Have at least 5 portions of various fruit and vegetables each day, add in as much colour as you can to “eat a rainbow”

Keep fizzy drinks or sugary fruit juices to a minimum, consider swapping for sugar-free squash or water

Avoid too many sweet treats, such as chocolate bars or cakes, and opt for fresh fruit; aim for 2 portions of fruit and veg  for snacks

Enjoy calcium-rich food items to encourage bone health

Encourage starchy foods that provide slow release energy e.g. rice, potatoes, bread… Around a fist sized portion is recommended

Have a daily palm sized portion of protein e.g. lean meat, fish, lentils, beans, eggs…

Remember meal sizes should be appropriate to the person eating them!

Read more on healthy living and CHAMP, see:

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