KandyWandy: 2014

FIBROMYALGIA - SYMPTOMS AND PREVENTION

Fibromyalgia refers to the disease of chronic joint pain,tenderness and stiffness of the tendors, joints and

muscles. It is also known as fibrositis.One will call this disease a female disease as it affects over

Cataracts refers to a form of disease that affects the effectiveness of the eyes. It has to do with the

lens of the eyes. Cataract means the cloudiness or dullness of lens which distorts light

Premature ejaculation (PE) is explained as the early or quick discharge of the male semen (sperm)

before or during sexual intercourse. Many couple experience PE at one time or the order.

Dandruff also known as seborrhea is a type of infection that affects the skin. It is a form of psoriasis

disease. It is also described as a reddish or dry flaky skin scale on the body. It can affect both

Salmonella refers to an infection caused by salmonella bacteria and as to do with the contamination

of food (food poisoning). This infection occurs when you eat food or drink liquid that contains

Lyme disease is a disease caused by a bacterium called Borrelia burgdorferi seen in some small

animals like birds, mice. Ticks are insects which sucks blood from this small animals to survive.

Hypoglycemia also known as insulin shock is when the body has low

blood glucose (sugar), meaning the sugar level in the body is low to

support the proper functioning of the system or body.

The first way of treating or achieving healthy home or preventing any

illness is to keep the home clean and healthy.

Below is a list of ways in which the home can be kept clean;

Staphylococcus refers to a disease or infection caused by bacteria in the

skin or nose area.This type of infection can be a minor disease but can

become deadly if it enters the bloodstream, heart,

Meningitis refers to the inflammation of the meninges around the brain

and spinal cord. Meningitis

Diabetes is said to be a disease where a person has high blood sugar or

blood glucose due to an inability to metabolize or produce sufficient

insulin. If there is not enough insulin the sugar or glucose stays

Arthritis refer to a problem that as to do with the joints. It is the

inflammation of one or several joints in the human body.The causes of

arthritis could be as a person age, injury,immune disorder,

Gonorrhea refer to a bacteria infection called the gonococcus (Neisseria

gonorrhoeae) which is transmitted through having vaginal, oral and anal

sexual intercourse with a person who has gonorrhea. This disease

Driving to some people could be interesting or

could be an hobby or making a living (income).

Driving with care will save your life. Many

people died because of one slight reason or the

other when driving.

Some helpful tips for save and healthy driving

are listed below;

Vaginal yeast infection refers to an infection that as to do with the

vaginal and caused by a fungus known as candida albicans. The

infection can affect both children and adult. In every healthy

Psoriasis is a non contagious disease which affects the skin. It is a

silvery scaly patches on the skin which turn red when scratched. The

disease affects anybody but mostly age bracket of

BED-WETTING, CAUSES AND PREVENTION

Bed wetting or nocturnal enuresis is passing out urine while sleeping unconsciously. Bed wetting

is a normal process in infant,which will eventually stop as they grow older and be able to control

PNEUMONIA - CAUSES,SYMPTOMS AND PREVENTION

Pneumonia is said to be the chronic inflammation of the lungs. It is an illness caused by bacteria, chemical

irritants, viruses and affects millions of people over the world which It is also caused by other

23 KINDS OF EYE DEFECTS

The eyes is an organ that helps us to see things as they are. Without the eyes we can only imagine

how things look. There are different kind of diseases or infections that attack the eyes.

THINGS TO KNOW ABOUT APPENDICITIS

Appendicitis is said to be an illness in which the appendix is inflamed. The appendix is a small organ near

the bowel. The age bracket in which appendicitis are commonly found is between the ages of

STOP DIARRHEA IN YOUR HOME

Diarrhea is explained to be a condition in which a person has watery and frequent bowel movements,

that is, visiting the toilet frequently and occasionally. The excretion or faeces passed out is mostly

lose and watery. It happens from time

RELIEVE STOMACH ULCER

Stomach ulcer also called peptic ulcer is an infection of a kind of bacteria known as Helicobacter

pylori. It is a sore that is painful in the small intestine or could also be the break in

the lining of the stomach. Stomach ulcer does not have a particular cause but variety of factors

PROTECT YOUR EYES

The eyes is an important organ of the body that needs to be taking care off. If you close your eyes for

one second,

what can you see?, is a question which indirectly tells you that the eyes needs care and every body

that can see

CARING FOR YOUR EAR IS IMPORTANT

Caring for the ear is very important because its part of the sense organ of the body. It needs to be cared for

gently and regularly. The ear canal produces earwax that moves towards the opening of the ear. It

could either fall off or be cleaned with wash cloth. The earwax has a function that serves as protection of the

MOUTH ULCER

Mouth ulcer is known to be a painful wound, sore or opening of the skin inside the mouth. It is not a serious

disease or affliction because healing can take few days. Aphthous ulcer which needs medical attention. it is

TURN INFERTILITY TO FERTILITY IN WOMAN

Every married woman would desire to get pregnant. For one reason or the other the chances of getting

pregnant is low. No matter the fertility circumstance you find yourself in, there is always a way out.

Below are some help tips that will assist in improving your fertility chances of getting pregnant;

     1.    Eat diet rich in nutrients.

     2.    Put an end to alcohol intake.

     3.    Have positive thinking on conceiving.

     4.    Do light walk out exercises (yoga).

     5.   Stop smoking.

     6.    Introduce fruits into your diet.

     7.    Have sexual intercourse from 3 days to and during ovulation.

     8.    Take multivitamins (vitamin C, zinc, folic acid).

     9.    Fresh juice intake and not package juice.

     10. Stop drug abuse.

     11. Treat yourself of any infection.

     12. Have sexual intercourse regularly.

     13. Avoid using chemicals to wash virginal.

     14   Stop using lubricant during sexual intercouse.

     15. Try not to be overweight or underweight.

     16. Get enough sleep.

The result from doing the points listed above include;

     1.   Healthy placenta.

     2.   Reproductive system becomes healthy.

     3.   Release of healthy eggs.

     4.   The chances of miscarriage is minimized.

     5.   Hormones becomes balance.

Seek medical attention if you have serious issues with any part of your reproductive organs.

UNKNOWN FACTS ABOUT CHICKENPOX

Chickenpox is a disease that affects both children and adult. It is a disease that is highly contagious and

caused by a virus known as human herpes virus 3 (hhv-3) or varicella-zoster virus(VAV). It is a

17 CAUSES OF INFERTILITY IN WOMAN

Infertility in woman refers to a condition whereby woman find it difficult to conceive or get pregnant.

There have been different issues with broken homes due to female infertility. Infertility can be

THE BENEFITS OF LOOSING WEIGHT

There are countless benefit in Losing weight. It is far easy to gain weight than to lose weight. The more

the weight loss the healthy a person becomes. In losing weight you need to change your diet and life

Measles: Symptoms, Transmission, Complications, Treatment and Prevention

Measles is a highly contagious viral infection that can affect both children and adults.

Although many people recover, measles should not be dismissed as simply a childhood rash. It can cause serious complications including pneumonia, severe diarrhoea, brain inflammation and, in some cases, death.

Measles is also one of the most contagious infectious diseases known.

The good news is that measles is largely preventable through vaccination.

According to the World Health Organization (WHO), vaccination prevented an estimated 59 million measles deaths worldwide between 2000 and 2024.

However, measles continues to circulate in many parts of the world, particularly where vaccination coverage is insufficient.

What Causes Measles?

Measles is caused by the measles virus, which belongs to the Morbillivirus group.

The virus initially infects the respiratory tract and then spreads throughout the body.

Humans are the natural host of measles. The disease spreads from person to person.

Is Measles the Same as German Measles?

No.

Measles and rubella, sometimes called German measles, are different viral infections.

They can both cause a rash, but they are caused by different viruses and have different complications.

This distinction is especially important during pregnancy because rubella can cause severe congenital abnormalities in a developing baby.

The MMR vaccine protects against:

Measles,
Mumps,
and Rubella.

How Does Measles Spread?

Measles spreads very easily through the air.

An infected person can release the virus when they:

cough,
sneeze,
breathe,
or otherwise release respiratory particles.

Other people can become infected by breathing contaminated air.

The virus can also remain infectious in an airspace or on contaminated surfaces for up to about two hours after an infected person has left.

How Contagious Is Measles?

Extremely contagious.

WHO reports that approximately 90% of people who are not immune and come into close contact with someone who has measles may become infected.

That means a single case can spread rapidly through households, schools and communities where many people are unvaccinated or otherwise lack immunity.

When Is Someone With Measles Contagious?

A person with measles can spread the virus before the characteristic rash appears.

They are generally considered contagious from approximately:

4 days before the rash appears until 4 days after the rash appears.

This is important because someone may unknowingly spread measles before realizing that they have the disease.

How Long After Exposure Do Symptoms Begin?

Symptoms do not usually appear immediately.

According to current CDC guidance, the first symptoms commonly develop approximately 7–14 days after infection.

WHO describes initial symptoms as generally appearing around 10–14 days after exposure.

The timing can vary between individuals.

What Are the First Symptoms of Measles?

Measles commonly begins with symptoms resembling a severe respiratory infection.

Early symptoms can include:

high fever,
cough,
runny nose,
and red, watery eyes.

These symptoms usually appear before the characteristic rash.

What Are Koplik Spots?

Some people with measles develop tiny white spots inside the mouth known as Koplik spots.

They may appear approximately two to three days after the first symptoms begin.

Koplik spots can be an important clinical clue, but their absence does not necessarily exclude measles.

A healthcare professional should assess suspected cases.

What Does a Measles Rash Look Like?

The measles rash generally develops several days after the first symptoms.

It often begins as flat red spots around the face and hairline.

The rash then typically spreads downward to the:

neck,
trunk,
arms,
legs,
and feet.

Small raised bumps may sometimes appear over the flat red spots, and individual spots can merge together.

Fever can remain high when the rash develops.

Does Every Rash Mean Measles?

No.

Many conditions can cause a rash, including:

other viral infections,
allergic reactions,
medicine reactions,
chickenpox,
rubella,
and numerous skin conditions.

A rash should therefore not be diagnosed as measles based on appearance alone.

The person's symptoms, vaccination history, exposure history and appropriate laboratory testing may all be relevant.

Who Can Get Measles?

Anyone who does not have adequate immunity can potentially develop measles.

Although measles is commonly associated with childhood, adults can get measles too.

Adults who are not immune can also develop serious complications.

Who Is at Greater Risk of Serious Complications?

Measles can be serious at any age, but complications are more likely in certain groups.

These include:

babies and young children,
adults,
pregnant women,
people with weakened immune systems,
and people affected by undernutrition, particularly vitamin A deficiency.

The precise risk differs according to the person's age, immune status, nutritional status and access to medical care.

Is Vitamin A Deficiency a Cause of Measles?

No.

Vitamin A deficiency does not cause measles.

Measles is caused by infection with the measles virus.

However, vitamin A deficiency is associated with a greater risk of severe measles and complications, particularly among children in settings where deficiency and undernutrition are common.

This distinction is important.

What Complications Can Measles Cause?

Measles can cause complications ranging from relatively common problems to life-threatening illness.

Possible complications include:

ear infections,
diarrhoea,
dehydration,
pneumonia,
encephalitis,
vision problems or blindness in severe cases,
and death.

Pneumonia is an especially important cause of measles-related deaths in young children.

Measles and Pneumonia

Measles can cause serious respiratory complications.

Pneumonia may develop because of the measles virus itself or because another infection occurs while the person's immune defences are weakened.

Difficulty breathing, severe chest symptoms or a rapidly worsening condition requires urgent medical assessment.

Measles and Encephalitis

Encephalitis means inflammation of the brain.

It is an uncommon but potentially severe complication of measles.

It can cause symptoms such as:

seizures,
confusion,
loss of consciousness,
and neurological injury.

Some people who develop measles encephalitis can experience permanent disability.

Can Measles Cause Meningitis?

Neurological complications can occur with measles, including encephalitis and, less commonly, other inflammation involving the central nervous system.

However, the old article's simple statement that measles leads to “meningitis, appendicitis and lung infections” was not an appropriate description of the major complications.

Current international health guidance emphasizes complications such as pneumonia, encephalitis, severe diarrhoea, dehydration, ear infections and, in severe cases, blindness or death.

Is Appendicitis a Typical Measles Complication?

No.

Appendicitis should not be presented to readers as one of the standard major complications of measles.

It has therefore been removed from this updated article.

Can Measles Affect the Immune System?

Yes.

Measles can have effects on immune function that extend beyond the immediate illness.

Research has shown that measles can weaken previously developed immune protection against other infections, sometimes described as immune amnesia.

WHO notes that measles infection can make it more difficult for someone to fight other diseases for months or even years after the original measles illness.

This is another reason measles prevention is important.

What Is SSPE?

A rare but devastating long-term complication of measles is subacute sclerosing panencephalitis (SSPE).

SSPE is a progressive neurological disease that can occur years after the original measles infection.

It causes progressive brain damage and is usually fatal.

Although rare, SSPE demonstrates why preventing the original measles infection is preferable to relying on immunity acquired by becoming ill.

Measles During Pregnancy

Measles during pregnancy can be dangerous.

Pregnant women who develop measles may have an increased risk of serious illness.

Measles during pregnancy can also be associated with problems such as:

premature birth,
and low birth weight.

Anyone who is pregnant and thinks they have been exposed to measles should seek medical advice promptly.

Because MMR is a live vaccine, it is generally not administered during pregnancy. Vaccination status is ideally addressed before pregnancy or after delivery according to appropriate medical guidance.

Is There a Specific Medicine That Cures Measles?

There is no routine antiviral medicine that directly cures uncomplicated measles.

Treatment generally focuses on supportive care while the immune system fights the infection.

This can include:

adequate fluids,
nutrition,
management of fever and discomfort,
and treatment of complications.

People with severe disease may require hospital care.

Antibiotics do not treat the measles virus itself, although they may be prescribed when a bacterial complication such as certain ear infections or pneumonia develops.

What About Vitamin A Treatment?

Vitamin A has an important role in the management of measles in children in certain circumstances.

WHO recommends vitamin A supplementation for children with measles according to appropriate clinical guidance because it can reduce the risk of some complications and deaths, particularly where deficiency is present.

However:

Do not give high-dose vitamin A to a child without appropriate medical guidance.

Excessive vitamin A can be harmful.

Vitamin A is not a substitute for vaccination.

What Is the Best Way to Prevent Measles?

The most effective way to prevent measles is vaccination.

WHO recommends that susceptible children receive two doses of a measles-containing vaccine through national immunization programmes.

Depending on the country, this may be given as:

measles vaccine,
measles-rubella (MR),
measles-mumps-rubella (MMR),
or measles-mumps-rubella-varicella (MMRV).

Vaccination schedules differ between countries.

Follow the routine immunization schedule where you live.

How Effective Is the MMR Vaccine?

The measles-containing vaccine is highly effective.

CDC data indicate that:

one dose of MMR is about 93% effective at preventing measles,
while two doses are about 97% effective.

No vaccine provides 100% protection to every individual, but high vaccination coverage dramatically reduces measles transmission and outbreaks.

Is the Measles Vaccine Safe?

Measles-containing vaccines have been used worldwide for decades.

Most vaccine reactions are mild and temporary.

Possible reactions can include:

soreness at the injection site,
mild fever,
or a mild rash.

Serious vaccine reactions are rare.

The health risks associated with measles infection are substantially greater than the risk of serious reactions to the vaccine.

Does the MMR Vaccine Cause Autism?

No.

High-quality scientific research has found no causal relationship between MMR vaccination and autism.

The original claim suggesting such a link came from research that was subsequently discredited and retracted.

Vaccination remains the most effective way to prevent measles.

Can Vaccinated People Still Get Measles?

Rarely, yes.

No vaccine is completely effective in every individual.

However, two appropriately administered doses provide very strong protection.

When vaccinated people do develop measles, disease may sometimes be less severe.

Vaccination also reduces the number of susceptible people in the community, making outbreaks less likely.

Is Natural Measles Infection Better Than Vaccination?

No.

Recovering from measles generally produces strong immunity, but acquiring that immunity requires experiencing the actual disease and accepting its risks.

Those risks include:

pneumonia,
encephalitis,
hospitalization,
long-term neurological complications,
and death.

Vaccination provides protection without requiring someone to first experience those risks.

What Should You Do If You Think You Have Measles?

If you or your child has symptoms that could be measles, particularly after a known exposure or during an outbreak:

Contact a healthcare professional before arriving at a clinic or waiting room whenever possible.

Explain that you suspect measles.

This allows the healthcare facility to make arrangements that reduce the chance of exposing other patients.

Avoid unnecessary close contact with other people while waiting for medical advice.

What If You Have Been Exposed but Have No Symptoms?

Contact a healthcare professional or local public-health service promptly.

Depending on factors such as:

your vaccination history,
age,
immune status,
pregnancy,
and how recently the exposure occurred,

post-exposure measures may sometimes be recommended.

These can include a measles-containing vaccine for eligible people or immune globulin for certain high-risk individuals.

Timing matters, so seek advice promptly rather than waiting for symptoms.

Should Someone With Measles Go to School or Work?

No, not during the infectious period.

People with measles should follow isolation instructions from their healthcare or public-health authority.

As a general rule, a person with measles is considered infectious from approximately four days before until four days after the rash appears.

Specific instructions may differ for people with weakened immune systems or according to local public-health requirements.

Does Avoiding Shared Food Prevent Measles?

Not effectively by itself.

The old article advised readers not to share food and drinks with someone who has measles.

While normal hygiene is sensible, measles prevention cannot rely on avoiding shared food because the virus spreads very efficiently through the air.

Vaccination, appropriate isolation and rapid public-health response are far more important.

Does Good Nutrition Prevent Measles?

Good nutrition supports overall health and immune function, but a healthy diet does not make an unvaccinated susceptible person immune to measles.

The primary preventive measure is vaccination.

Nutrition becomes particularly important because undernourished children—including those deficient in vitamin A—can have a greater risk of severe disease.

Can Measles Be Eliminated?

Yes, measles can potentially be eliminated from countries and regions because:

humans are the only natural reservoir,
highly effective vaccines exist,
and there is no chronic carrier state maintaining transmission indefinitely.

However, elimination requires very high vaccination coverage.

Gaps in vaccination allow outbreaks to return.

WHO reported that by the end of 2025, approximately 84% of children worldwide had received a first measles-containing vaccine dose and 77% had received two doses.

Those global levels remain below what is needed to reliably prevent outbreaks everywhere.

Why Measles Vaccination Protects Communities

Measles spreads so easily that communities require very high levels of immunity to interrupt transmission.

High vaccination coverage protects vaccinated individuals and also reduces the likelihood that the virus reaches people who cannot receive certain vaccines for medical reasons.

This is why measles vaccination is both an individual and public-health measure.

When Should You Seek Urgent Medical Care?

Seek urgent medical assessment if someone with suspected or confirmed measles develops:

difficulty breathing,
severe dehydration,
extreme drowsiness or difficulty waking,
confusion,
seizures,
severe weakness,
bluish or unusually pale skin,
or a rapidly worsening condition.

Babies, pregnant women and people with weakened immune systems may require particularly careful assessment.

Contact your local emergency medical service if the situation appears life-threatening.

Seven Important Facts About Measles

1. Measles is caused by a virus.
Antibiotics do not cure the virus itself.

2. Measles spreads through the air.
It is one of the world's most contagious infections.

3. You can spread measles before the rash appears.
The infectious period generally begins about four days before the rash.

4. Measles is not simply a harmless childhood rash.
Pneumonia, encephalitis and other serious complications can occur.

5. Adults can get measles too.
Anyone without adequate immunity can be infected.

6. Two vaccine doses provide strong protection.

7. Suspected measles should be reported before walking into a healthcare facility.
Calling ahead helps protect other patients from exposure.

The Bottom Line

Measles is an extremely contagious viral infection that can affect children and adults.

Typical symptoms include high fever, cough, runny nose, red watery eyes and a rash that usually begins on the face before spreading downward.

Tiny white Koplik spots may also appear inside the mouth.

Although many people recover, measles can cause serious complications including pneumonia, severe diarrhoea and dehydration, encephalitis, blindness and, in rare cases, long-term neurological disease or death.

The most effective protection is vaccination.

Two doses of a measles-containing vaccine provide strong protection and are recommended through national immunization programmes around the world.

If you think you or your child has measles, contact a healthcare professional promptly and call before attending a clinic or hospital whenever possible, so measures can be taken to avoid exposing other people.

Measles is preventable. Maintaining high vaccination coverage remains one of the most effective ways to protect individuals, families and communities.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for diagnosis, vaccination advice or treatment from an appropriately qualified healthcare professional. Vaccination schedules and outbreak-control procedures differ between countries. If you think you or your child has been exposed to measles or has symptoms of measles, contact an appropriate healthcare professional or public-health service promptly. Seek urgent medical care for serious symptoms such as breathing difficulty, seizures, confusion, severe dehydration or rapidly worsening illness.

Sources and Further Reading

World Health Organization — Measles

https://www.who.int/health-topics/measles

World Health Organization — What You Need to Know About Measles

https://www.who.int/news-room/questions-and-answers/item/what-you-need-to-know-about-measles

World Health Organization — Immunization Coverage

https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

World Health Organization — Measles Vaccines

https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/measles

Centers for Disease Control and Prevention — About Measles

https://www.cdc.gov/measles/about/

Centers for Disease Control and Prevention — Measles Symptoms and Complications

https://www.cdc.gov/measles/signs-symptoms/index.html

Centers for Disease Control and Prevention — How Measles Spreads

https://www.cdc.gov/measles/causes/index.html

Tuberculosis (TB): Symptoms, Transmission, Testing, Treatment and Prevention

Tuberculosis, commonly called TB, is a serious infectious disease caused mainly by the bacterium Mycobacterium tuberculosis.

TB most commonly affects the lungs, but it can also affect other parts of the body, including the lymph nodes, kidneys, spine and brain.

Tuberculosis remains a major global health problem, but there is an important message to remember:

TB is preventable and curable.

According to the World Health Organization (WHO), an estimated 10.7 million people developed tuberculosis worldwide in 2024, including 5.8 million men, 3.7 million women and 1.2 million children.

Approximately 1.23 million people died from TB in 2024, including about 150,000 people living with HIV.

Early diagnosis, appropriate treatment and prevention can save lives and reduce transmission.

What Causes Tuberculosis?

Tuberculosis is caused by bacteria belonging to the Mycobacterium tuberculosis complex.

The bacteria most commonly infect the lungs.

When someone inhales infectious TB bacteria, the germs may reach the lungs.

From there, they may remain controlled by the immune system or, in some circumstances, multiply and cause active TB disease.

TB bacteria can also spread within the body and affect organs outside the lungs.

TB Infection and TB Disease Are Not the Same Thing

Understanding this distinction is extremely important.

Someone can have TB bacteria in their body without having active tuberculosis disease.

This is often called TB infection, latent TB infection or inactive TB.

Another person may have active TB disease.

The two conditions are different.

What Is Inactive or Latent TB Infection?

A person with inactive TB infection has TB bacteria in the body, but the bacteria are controlled and are not causing active disease.

People with inactive TB generally:

do not feel ill because of TB,
have no symptoms of active TB disease,
and cannot spread TB bacteria to other people.

However, inactive TB can later develop into active TB disease.

WHO estimates that approximately 5–10% of people infected with TB bacteria will eventually develop TB disease, although the risk is substantially higher in certain groups.

Preventive treatment can reduce the risk of inactive TB progressing to active disease.

What Is Active TB Disease?

Active TB disease occurs when TB bacteria multiply and cause illness.

A person may develop symptoms and require treatment with several antibiotics.

When active TB affects the lungs or throat, the person may be able to transmit TB bacteria to others through the air.

Active TB affecting only another part of the body is generally much less likely to be infectious through normal respiratory transmission.

Without appropriate treatment, active TB can cause serious illness and can be fatal.

How Does Tuberculosis Spread?

Tuberculosis spreads through the air.

A person with infectious TB disease involving the lungs or throat can release TB bacteria into the air when they:

cough,
speak,
sing,
sneeze,
or otherwise expel infectious respiratory particles.

Another person nearby may inhale these airborne bacteria and become infected.

The risk is generally greater when people spend prolonged or repeated periods together in enclosed or poorly ventilated spaces.

TB Is Not Usually Spread Through Surfaces

Tuberculosis should not be confused with infections that spread primarily through contaminated objects.

TB is not normally transmitted by touching surfaces or everyday objects.

It is also not generally spread by:

shaking someone's hand,
sharing plates or cutlery,
touching toilet seats,
sharing food,
or casual physical contact.

The main concern is breathing air containing infectious TB bacteria.

Does Sharing Needles Spread TB?

The original version of this KandyWandy article listed sharing or injecting illicit drugs as a method of TB transmission.

That needs correcting.

Sharing needles is not the usual mechanism by which tuberculosis itself spreads.

TB spreads primarily through the air.

However, substance use can be associated with circumstances that increase someone's vulnerability to TB, and sharing injection equipment can transmit other serious infections such as HIV and viral hepatitis.

Because HIV substantially increases the risk of developing active TB, these health issues can sometimes be connected—but they are not the same transmission route.

Can You Catch TB From Someone With Latent TB?

No.

People with inactive or latent TB infection cannot spread TB bacteria to other people.

Transmission occurs primarily from people who have infectious active TB disease involving the lungs or throat.

This distinction helps prevent unnecessary fear and stigma towards people who have tested positive for TB infection but do not have active disease.

Who Is More Likely to Be Exposed to TB?

Anyone can become infected with TB, but exposure risk is not equal everywhere.

Risk can be higher among people who:

live with or spend considerable time around someone with infectious TB,
live or work in settings where TB transmission is more common,
spend prolonged periods in crowded or poorly ventilated environments where infectious TB is present,
live in or frequently travel to countries where TB is more common,
work in healthcare or other settings where TB exposure can occur,
or live in congregate settings where transmission risk is increased.

Exposure does not automatically mean that someone will develop active TB disease.

Who Is More Likely to Develop Active TB After Infection?

Some people are more likely than others to progress from TB infection to active TB disease.

Important risk factors include:

HIV infection,
diabetes,
undernutrition,
tobacco use,
harmful alcohol use,
certain cancers,
medicines that suppress the immune system,
and other conditions that weaken immune defences.

Babies and young children who become infected also have an increased risk of developing TB disease.

TB and HIV

TB and HIV have an especially important relationship.

HIV weakens the immune system, making it more difficult for the body to keep TB bacteria under control.

As a result, people living with HIV who become infected with TB have a substantially increased risk of developing active TB disease.

WHO reports that TB remained the leading killer of people with HIV in 2024.

Testing, prevention and treatment for both conditions are therefore important.

TB and Diabetes

Diabetes is another important risk factor for developing active TB.

People with diabetes who have been exposed to TB or who live in areas where TB is common may need assessment based on local medical guidance and individual risk.

Good management of diabetes remains important for overall health.

TB and Undernutrition

Undernutrition can weaken the body's ability to fight infection and is associated with an increased risk of TB disease.

People undergoing TB treatment may also experience weight loss and poor appetite.

Nutritional assessment and support can therefore form part of comprehensive TB care where needed.

However, no particular food or supplement can cure tuberculosis.

Antibiotic treatment is essential for active TB disease.

Smoking and Tuberculosis

Tobacco use increases the risk of TB disease and can damage the lungs.

Avoiding or stopping tobacco use therefore supports respiratory health and reduces several major health risks.

Stopping smoking should complement—not replace—appropriate TB testing and treatment.

Alcohol and TB

Harmful alcohol use is associated with increased risk of TB disease.

Heavy alcohol use can also affect nutrition, immune function and a person's ability to complete a long course of treatment.

Reducing harmful alcohol consumption is therefore relevant to TB prevention and overall health.

What Are the Symptoms of Pulmonary TB?

TB symptoms depend on which part of the body is affected.

When TB affects the lungs, possible symptoms include:

a persistent or prolonged cough,
coughing up sputum or phlegm,
coughing up blood,
chest pain,
fever,
night sweats,
unexplained weight loss,
loss of appetite,
weakness,
and fatigue.

Symptoms can initially be mild.

This is one reason people may have TB for weeks or months before seeking medical attention.

How Long Can a TB Cough Last?

A persistent cough is one of the most recognizable symptoms of pulmonary TB.

Some clinical guidance describes a cough lasting three weeks or longer as a warning sign.

However, people should not wait for an exact number of weeks if they have other concerning symptoms, known TB exposure or significant risk factors.

A prolonged or unexplained cough deserves appropriate medical assessment.

Is Back Pain a Typical TB Symptom?

The old article listed back pain as a general symptom of tuberculosis.

That needs clarification.

Back pain is not one of the main symptoms of ordinary pulmonary TB.

However, tuberculosis can sometimes affect the spine.

Spinal TB can cause back pain and other symptoms related to the affected bones and nerves.

Similarly, TB affecting the brain, kidneys, lymph nodes or other organs can cause symptoms specific to those areas.

What Is Extrapulmonary TB?

Tuberculosis occurring outside the lungs is called extrapulmonary TB.

It can affect areas such as:

lymph nodes,
kidneys,
bones and joints,
spine,
brain and surrounding membranes,
abdomen,
and other organs.

Symptoms depend on the affected site.

For example:

TB of the lymph nodes may cause persistent swelling.

TB of the spine may cause back pain.

TB involving the brain or its coverings can cause severe neurological illness.

Kidney TB may cause urinary symptoms or blood in the urine.

Extrapulmonary TB requires proper medical diagnosis and treatment.

Can Someone Have Active TB Without Obvious Symptoms?

Yes.

Although active TB commonly causes symptoms, WHO notes that some people with TB disease may have few or no obvious symptoms.

This reinforces the importance of screening and testing among people at increased risk or those who have had significant exposure.

How Is Tuberculosis Diagnosed?

Symptoms alone cannot confirm TB.

Healthcare professionals may use several approaches depending on whether they are investigating TB infection or active TB disease.

Tests can include:

rapid molecular tests,
examination of sputum,
chest imaging,
TB blood tests,
TB skin tests,
and tests on samples from affected tissues or body fluids.

WHO recommends rapid diagnostic tests as the initial tests for people with signs and symptoms of TB where appropriate.

What Is a Sputum Test?

Sputum is mucus or phlegm produced from deep within the lungs.

Someone suspected of having pulmonary TB may be asked to provide a sputum sample.

Laboratory testing can look for evidence of Mycobacterium tuberculosis and may help determine whether the bacteria are resistant to important TB medicines.

Rapid molecular testing has improved the speed with which TB and some forms of drug resistance can be detected.

What Are TB Blood and Skin Tests?

Tests such as a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA) can help determine whether someone has been infected with TB bacteria.

A positive infection test does not by itself prove that someone has active TB disease.

Further assessment may be necessary to distinguish inactive infection from active disease.

How Is Tuberculosis Treated?

Tuberculosis is treated with antibiotics.

For drug-susceptible TB, treatment commonly involves combinations of medicines such as:

rifampicin,
isoniazid,
pyrazinamide,
and ethambutol.

Treatment regimens depend on the type of TB, drug susceptibility, age, pregnancy, other medical conditions and national or international guidelines.

WHO states that TB medicines generally need to be taken for 4–6 months for common drug-susceptible disease, although particular regimens may differ.

Why Are Several Antibiotics Used?

TB bacteria can develop resistance to antibiotics.

Using an appropriate combination of medicines helps:

kill TB bacteria effectively,
reduce treatment failure,
and reduce the chance that drug-resistant bacteria will emerge.

Patients should follow their prescribed regimen carefully.

Do Not Stop TB Treatment Early

This is one of the most important messages in tuberculosis care.

Someone may begin feeling better after treatment starts, but that does not mean all TB bacteria have been eliminated.

Do not stop TB medication early unless the healthcare team managing your treatment tells you to do so.

Stopping treatment prematurely or taking medicines inconsistently can contribute to:

treatment failure,
recurrence,
continued transmission,
and drug-resistant TB.

Complete the prescribed treatment.

What Is Drug-Resistant TB?

Drug-resistant tuberculosis occurs when TB bacteria no longer respond adequately to one or more important medicines.

Multidrug-resistant TB (MDR-TB) is particularly concerning because the bacteria are resistant to key first-line medicines.

Drug-resistant TB requires specialized treatment.

WHO describes MDR-TB as an ongoing global public-health and health-security threat.

Preventing resistance is one reason correct diagnosis and completion of treatment are so important.

Can Latent TB Be Treated?

Yes.

People with inactive TB infection who have a significant risk of developing active disease may be offered TB preventive treatment.

The purpose is to kill or suppress TB bacteria before they cause active disease.

Not everyone with a positive TB test receives exactly the same regimen.

The decision depends on factors such as:

age,
risk of developing active disease,
previous exposure,
medical history,
possible drug resistance,
and local clinical guidelines.

What Is the BCG Vaccine?

BCG, or Bacille Calmette-Guérin, is the currently available vaccine against tuberculosis.

It is used in many countries, particularly where TB is more common.

WHO notes that BCG vaccination can protect babies and young children against severe forms of tuberculosis and TB-related death.

However, BCG does not provide complete lifelong protection against pulmonary TB.

This means someone who received BCG can still become infected with TB and may still need testing following significant exposure.

Is BCG Given to Everyone Worldwide?

No.

BCG vaccination policies differ between countries because TB prevalence and individual risk differ.

Some countries routinely vaccinate infants.

Others use targeted vaccination for babies, children or other people considered at increased risk.

Follow the vaccination programme applicable where you live.

How Can TB Transmission Be Reduced?

Important prevention measures include:

diagnosing infectious TB promptly,
starting effective treatment,
completing treatment,
testing people who have had significant exposure,
treating inactive TB when appropriate,
improving ventilation,
avoiding prolonged exposure to untreated infectious TB in enclosed spaces,
using appropriate respiratory protection in healthcare and high-risk settings,
covering coughs appropriately,
and following public-health advice.

Why Does Ventilation Matter?

TB bacteria can remain suspended in indoor air.

The risk of transmission is therefore greater in enclosed spaces with poor air circulation.

Improving ventilation can dilute infectious particles and reduce the chance that other people will inhale them.

Healthcare and institutional settings may require additional infection-control measures.

What About Face Masks?

Masks and respirators can play a role in TB infection control, but the correct type and use depend on the situation.

A person with infectious pulmonary TB may be advised to wear an appropriate mask to reduce the release of infectious particles.

Healthcare workers and others at occupational risk may require properly fitted respirators according to infection-control procedures.

A simple instruction to “wear a face mask whenever entering a TB institution” is therefore not sufficiently precise.

Follow the infection-control guidance of the relevant healthcare or public-health authority.

Should Someone With TB Be Avoided Completely?

No.

People affected by TB should be treated with dignity and without stigma.

Someone with inactive TB cannot transmit TB.

Someone receiving treatment for active pulmonary TB may become much less infectious after effective treatment, but the exact timing varies.

The healthcare team determines when isolation or other transmission precautions can safely end.

Do not socially exclude someone indefinitely simply because they have had tuberculosis.

When Should You Get Tested for TB?

Consider medical assessment or TB testing if:

you have had close contact with someone with infectious active TB,
you have a persistent unexplained cough,
you are coughing up blood,
you have unexplained fever, night sweats or weight loss,
you have HIV or another condition that substantially weakens immunity,
you have been advised to test because of occupational exposure,
or you belong to another group considered at increased risk under local health guidance.

Testing recommendations vary between countries.

When Should You Seek Medical Attention?

Seek medical assessment if you develop symptoms that could indicate tuberculosis, particularly a persistent cough combined with:

fever,
night sweats,
unexplained weight loss,
chest pain,
fatigue,
or known exposure to someone with infectious TB.

Coughing up blood requires prompt medical assessment.

Seek urgent medical care if coughing up blood is heavy, you have severe breathing difficulty, severe chest pain, confusion, loss of consciousness or another serious deterioration.

Contact your local emergency medical service if necessary.

TB Is Curable

A diagnosis of tuberculosis can be frightening, but modern treatment can cure TB in most people when appropriate medicines are available and taken correctly.

The priorities are:

Get tested.
Start the correct treatment.
Take every medicine as prescribed.
Complete the full treatment course.
Follow infection-control advice.
Attend follow-up appointments.

Treatment protects both the individual and the wider community.

Seven Important TB Facts

1. TB is caused by bacteria.
The main cause is Mycobacterium tuberculosis.

2. TB spreads through the air.
It is not primarily spread by surfaces, handshakes or shared food.

3. Inactive TB is not contagious.
People with latent TB infection cannot spread TB to others.

4. TB most commonly affects the lungs but can affect other organs.

5. A persistent cough, fever, night sweats and unexplained weight loss are important warning symptoms.

6. TB is preventable and curable.

7. Treatment must be completed.
Stopping antibiotics too early can contribute to treatment failure and drug resistance.

The Bottom Line

Tuberculosis remains one of the world's most serious infectious diseases, but it is both preventable and curable.

TB spreads primarily through the air when someone with infectious disease of the lungs or throat releases TB bacteria.

Not everyone infected with TB becomes ill.

People with inactive TB infection usually have no symptoms and cannot transmit the bacteria, but some will later develop active TB disease.

People with HIV, diabetes, undernutrition, weakened immune systems, tobacco use and harmful alcohol use can face increased risk of developing TB disease.

Persistent cough, chest pain, fever, night sweats, fatigue and unexplained weight loss deserve medical attention, particularly when there has been possible TB exposure.

Testing can distinguish TB infection from active disease and help identify drug resistance.

Effective antibiotics can cure TB, but treatment must be taken correctly and completed.

Early diagnosis and treatment do more than protect one patient—they also help prevent tuberculosis from spreading to other people.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for professional medical diagnosis, TB testing or treatment. Tuberculosis testing, vaccination policies and treatment regimens vary according to individual circumstances, drug resistance and national guidelines. If you think you have been exposed to tuberculosis or have symptoms such as a persistent cough, coughing up blood, fever, night sweats or unexplained weight loss, seek assessment from an appropriately qualified healthcare professional.

Sources and Further Reading

World Health Organization — Tuberculosis Fact Sheet

https://www.who.int/news-room/fact-sheets/detail/tuberculosis

World Health Organization — Tuberculosis Health Topic

https://www.who.int/health-topics/tuberculosis

World Health Organization — Tuberculosis Questions and Answers

https://www.who.int/news-room/questions-and-answers/item/tuberculosis

World Health Organization — TB Vaccines

https://www.who.int/teams/immunization-vaccines-and-biologicals/tuberculosis

Centers for Disease Control and Prevention — About Tuberculosis

https://www.cdc.gov/tb/about/index.html

Centers for Disease Control and Prevention — How Tuberculosis Spreads

https://www.cdc.gov/tb/causes/index.html

Centers for Disease Control and Prevention — Signs and Symptoms of Tuberculosis

https://www.cdc.gov/tb/signs-symptoms/index.html

Centers for Disease Control and Prevention — Preventing Tuberculosis

https://www.cdc.gov/tb/prevention/index.html

High Blood Pressure (Hypertension): Numbers, Risks, Treatment and Prevention

High blood pressure, also called hypertension, is one of the world's most important preventable causes of cardiovascular disease and premature death.

It can damage the heart, brain, kidneys, blood vessels and other organs over time.

Yet there is something unusual about hypertension:

Most people who have it do not feel ill.

You can have high blood pressure for years without obvious warning signs.

The only reliable way to know your blood pressure is to measure it properly.

Fortunately, hypertension can often be successfully controlled through lifestyle changes, medicines or a combination of both.

What Is Blood Pressure?

Blood pressure is the force created as circulating blood pushes against the walls of your arteries.

A blood-pressure reading contains two numbers.

For example:

120/80 mmHg

The first number is called systolic blood pressure.

The second is called diastolic blood pressure.

What Does Systolic Blood Pressure Mean?

Systolic pressure is the pressure in your arteries when your heart contracts and pumps blood around your body.

It is the top number in a blood-pressure reading.

For example, in a reading of 120/80 mmHg, 120 is the systolic pressure.

What Does Diastolic Blood Pressure Mean?

Diastolic pressure is the pressure in your arteries while the heart relaxes between beats.

It is the bottom number.

In a reading of 120/80 mmHg, 80 is the diastolic pressure.

Both numbers matter.

What Does mmHg Mean?

Blood pressure is measured in millimetres of mercury, abbreviated as mmHg.

The unit comes from the traditional mercury instruments historically used to measure blood pressure.

Modern digital monitors generally no longer contain mercury, but the measurement unit remains the same.

What Blood Pressure Is Considered High?

This is where readers need to understand an important point:

Hypertension thresholds are not identical in every international guideline.

The World Health Organization defines hypertension in adults as:

Systolic blood pressure of 140 mmHg or higher and/or diastolic blood pressure of 90 mmHg or higher, when elevated readings are confirmed on two different days.

Some professional guidelines use lower thresholds.

For example, current American cardiovascular guidelines classify blood pressure beginning at 130/80 mmHg as hypertension.

Therefore, a reading should always be interpreted using the clinical guidelines applicable where you live and your individual cardiovascular risk.

Does One High Reading Mean You Have Hypertension?

Not necessarily.

Blood pressure naturally changes throughout the day.

It can temporarily increase because of factors such as:

physical activity,
stress or anxiety,
caffeine,
tobacco,
alcohol,
pain,
some medicines,
and incorrect measurement technique.

A diagnosis is normally based on repeated measurements rather than one isolated reading, except when extremely high blood pressure or a medical emergency requires immediate action.

Some people have higher readings in a clinic but normal readings outside the clinic. This is sometimes called white-coat hypertension.

Others can have normal clinic readings but elevated blood pressure at home, known as masked hypertension.

Home or ambulatory monitoring can therefore sometimes help confirm the diagnosis.

Hypertension Usually Has No Symptoms

This is one of the most important facts about high blood pressure.

Most people with hypertension experience no symptoms.

Someone can feel perfectly healthy while high blood pressure is gradually damaging blood vessels and organs.

This is why hypertension is sometimes described as a “silent” condition.

Do not rely on headaches, dizziness or nosebleeds to tell you whether your blood pressure is high.

Measure it.

Can Very High Blood Pressure Cause Symptoms?

Yes.

Very high blood pressure can sometimes occur with symptoms, particularly when it is causing acute organ damage.

Possible warning symptoms can include:

severe headache,
chest pain,
difficulty breathing,
weakness or numbness,
changes in vision,
difficulty speaking,
confusion,
and other sudden neurological symptoms.

These should not be treated as routine symptoms of ordinary hypertension.

They may indicate a serious medical problem requiring urgent assessment.

Why Is High Blood Pressure Dangerous?

Persistent high blood pressure places extra stress on arteries and organs.

Over time, it can increase the risk of:

heart disease,
heart attack,
stroke,
heart failure,
chronic kidney disease,
vision problems,
and other vascular complications.

Controlling blood pressure substantially reduces cardiovascular risk.

High Blood Pressure and Stroke

Hypertension is a major risk factor for stroke.

Persistently elevated pressure can damage blood vessels supplying the brain.

A stroke can occur when blood flow to part of the brain becomes blocked or when a blood vessel ruptures and bleeds.

Stroke can cause permanent disability or death.

High Blood Pressure and the Heart

The heart has to work against the pressure in the arterial system.

Over time, uncontrolled hypertension can contribute to:

coronary artery disease,
heart attack,
enlargement or thickening of the heart muscle,
and heart failure.

Managing blood pressure is therefore an important part of protecting cardiovascular health.

High Blood Pressure and the Kidneys

The kidneys contain networks of small blood vessels that filter waste and excess fluid from the blood.

High blood pressure can damage these vessels.

At the same time, kidney disease can itself cause or worsen hypertension.

This creates an important relationship:

High blood pressure can damage the kidneys, and kidney disease can raise blood pressure.

People with hypertension may therefore have blood and urine tests to assess kidney health.

High Blood Pressure and the Eyes

Very high or long-standing uncontrolled hypertension can damage blood vessels in the retina at the back of the eye.

This is known as hypertensive retinopathy.

Severe hypertension can sometimes cause visual symptoms.

However, eye examination is not the main test used to diagnose hypertension.

Blood-pressure measurement is.

What Causes High Blood Pressure?

For many adults, there is no single identifiable disease responsible for their hypertension.

This is generally called primary or essential hypertension.

It tends to develop gradually through a combination of genetics, ageing, lifestyle, environment and other biological factors.

Another form is called secondary hypertension.

What Is Secondary Hypertension?

Secondary hypertension occurs when high blood pressure is caused by another medical condition or sometimes by a medicine or substance.

Possible causes can include:

kidney disease,
certain hormonal disorders,
obstructive sleep apnoea,
narrowing of certain arteries,
some medicines,
and certain recreational or stimulant drugs.

Treating the underlying cause may improve blood pressure in some people.

What Happened to “Malignant Hypertension”?

The old version of this KandyWandy article listed:

primary hypertension,
secondary hypertension,
malignant hypertension.

That classification needs updating.

The term malignant hypertension has historically been used for severe hypertension associated with acute organ damage, particularly characteristic eye changes.

Modern clinical practice more commonly discusses hypertensive emergency when severely elevated blood pressure is accompanied by acute damage to organs such as the brain, heart, kidneys or eyes.

It is not simply a type of hypertension that “develops from an early age.”

What Increases Your Risk of Hypertension?

Risk factors include both things you can change and things you cannot.

They can include:

increasing age,
family history,
overweight or obesity,
high dietary sodium intake,
diets low in fruit and vegetables,
physical inactivity,
tobacco use,
excessive alcohol consumption,
diabetes,
kidney disease,
and other metabolic or medical conditions.

Risk does not mean certainty.

Having one or several risk factors does not guarantee that hypertension will develop.

Is Hypertension Mainly a Male Problem?

No.

The old article stated that hypertension is “common with males.”

That is too simplistic.

High blood pressure affects both men and women.

Risk patterns can differ by age, hormonal status, pregnancy and other factors, but women should not assume they are protected from hypertension.

Everyone should have their blood pressure checked appropriately.

Does Age Cause High Blood Pressure?

The risk of hypertension generally increases with age.

However, high blood pressure should not simply be dismissed as “normal ageing.”

Older adults still benefit from appropriate blood-pressure management.

Treatment decisions may take into account overall health, frailty, other medical conditions and the risk of treatment side effects.

Does Salt Affect Blood Pressure?

Yes.

High sodium consumption is associated with increased blood pressure.

Much dietary sodium comes not only from salt added at the table but also from processed and packaged foods.

Foods that can contain substantial sodium include:

processed meats,
instant noodles,
savoury snacks,
sauces and condiments,
some breads,
ready meals,
soups,
and some canned foods.

But not every canned food is automatically unhealthy.

Check the nutrition label where available and compare sodium or salt levels.

Canned vegetables, beans or fish with little added salt can still form part of a nutritious diet.

Should You Add Extra Salt After Cooking?

The old article accidentally listed “adding extra salt to food after cooking” under hypertension prevention.

That advice is incorrect.

Reducing excessive salt intake can help lower blood pressure.

Taste food before adding salt and consider herbs, spices, garlic, ginger, lemon, pepper and other flavourings where appropriate.

Can Stress Cause Hypertension?

Stress can temporarily raise blood pressure.

Long-term stress may also influence behaviours associated with cardiovascular risk, including sleep, eating, alcohol consumption, smoking and physical activity.

However, “avoid all stress” is unrealistic.

A more practical approach is to develop healthy ways to manage stress through strategies such as:

physical activity,
adequate sleep,
relaxation,
social support,
planning,
and professional mental-health support when needed.

Does Smoking Cause High Blood Pressure?

Tobacco can temporarily raise blood pressure and heart rate and causes substantial damage to blood vessels.

Smoking is also a major cardiovascular risk factor independently of hypertension.

Stopping tobacco use is therefore one of the most important actions a person can take to protect cardiovascular health.

Alcohol and Blood Pressure

Excessive alcohol consumption can increase blood pressure.

Reducing alcohol intake can help some people improve blood-pressure control while also reducing other health risks.

People who do not drink alcohol do not need to start drinking for cardiovascular health.

Weight and Blood Pressure

Excess body weight can increase the likelihood of developing hypertension.

For people who are overweight or obese, gradual and sustainable weight loss may help reduce blood pressure.

However, blood pressure is influenced by many factors.

Thin people can develop hypertension too.

Physical Activity

Regular physical activity can help lower blood pressure and reduce cardiovascular risk.

WHO generally recommends that adults accumulate 150–300 minutes of moderate-intensity aerobic physical activity per week, or an equivalent amount of vigorous activity, together with muscle-strengthening activities.

People who have medical conditions or have been inactive for a long period may benefit from discussing an appropriate activity plan with a healthcare professional.

Healthy Eating for Blood Pressure

A heart-healthy eating pattern generally emphasizes:

vegetables,
fruits,
whole grains,
legumes,
nuts and seeds where appropriate,
healthier protein sources,
and foods lower in excessive sodium, saturated fat and added sugars.

There is no single food that cures hypertension.

The overall dietary pattern matters more than a supposed “blood-pressure superfood.”

Potassium and Blood Pressure

Potassium-rich foods can form part of a healthy diet and may help counter some of sodium's effects on blood pressure.

Sources include various fruits, vegetables, beans and other foods.

However, people with kidney disease or those taking certain medicines may need to limit potassium.

Do not start potassium supplements or potassium-based salt substitutes without appropriate medical advice if you have kidney problems or take medicines that affect potassium levels.

How Is Hypertension Diagnosed?

The main diagnostic tool is simple:

accurate blood-pressure measurement.

Depending on the situation, diagnosis may involve:

repeated clinic readings,
home blood-pressure monitoring,
or 24-hour ambulatory blood-pressure monitoring.

Blood tests, urine tests, ECGs and other investigations may be used to evaluate cardiovascular risk, organ health or possible causes of secondary hypertension.

But a chest X-ray, urine test or eye examination does not by itself diagnose hypertension.

How to Measure Blood Pressure Correctly

Accurate technique matters.

Before taking a home measurement:

avoid smoking, caffeine and exercise for about 30 minutes beforehand where possible,
empty your bladder,
sit quietly for several minutes,
keep your back supported,
keep both feet flat on the floor,
do not cross your legs,
support your arm approximately at heart level,
place the cuff on bare skin,
use the correct cuff size,
and remain quiet while the measurement is being taken.

A validated automatic upper-arm monitor is generally preferable for home monitoring.

Follow the instructions supplied with your device and recommendations from your healthcare team.

Take More Than One Reading

One measurement provides only a snapshot.

When monitoring at home, healthcare professionals commonly advise taking repeated readings according to a structured schedule.

If your first reading is unexpectedly high, remain calm and repeat the measurement after resting.

Record your results.

Your healthcare professional can tell you how frequently to measure and what numbers require action based on your individual circumstances.

Don't Change Medication Based on One Home Reading

Home monitoring is extremely useful, but it does not replace professional care.

Do not stop, double or change prescribed blood-pressure medicine simply because of one reading unless your healthcare professional has specifically given you instructions to do so.

Stopping some blood-pressure medicines suddenly can be harmful.

How Is High Blood Pressure Treated?

Treatment usually involves a combination of lifestyle measures and, when necessary, medication.

The appropriate plan depends on:

blood-pressure level,
cardiovascular risk,
age,
kidney function,
diabetes,
previous heart disease or stroke,
pregnancy,
other medical conditions,
and tolerance of medicines.

There is no single medicine that is best for everyone.

Medicines for High Blood Pressure

Several groups of medicines can lower blood pressure.

Common classes include:

thiazide or thiazide-like diuretics,
ACE inhibitors,
angiotensin receptor blockers (ARBs),
and calcium-channel blockers.

Other medicines are used in particular circumstances.

Some people require more than one medicine to achieve good control.

WHO recommends several of these medicine classes as appropriate first-line options for adults requiring pharmacological treatment.

Should You Stop Medicine When Your Blood Pressure Becomes Normal?

Usually, no—not without medical advice.

If someone taking blood-pressure medication has normal readings, that may mean the medicine is working.

Stopping treatment can allow blood pressure to rise again.

Always discuss medication changes with the healthcare professional managing your treatment.

What Blood Pressure Should Treatment Aim For?

Targets depend on individual health and the guideline being followed.

WHO currently states that for most people with hypertension the goal is generally below 140/90 mmHg.

A lower target, generally below 130/80 mmHg, may be recommended for people with:

cardiovascular disease,
diabetes,
chronic kidney disease,
or high cardiovascular risk.

Targets can differ according to individual circumstances and national clinical guidelines.

Your healthcare professional should tell you the target appropriate for you.

What Is Severe Hypertension?

A blood pressure reading above 180/120 mmHg is severely elevated and requires attention.

If you obtain a reading in this range:

remain seated and calm,
wait at least one minute,
measure your blood pressure again correctly.

If it remains above 180/120 mmHg, seek prompt medical advice.

When Is High Blood Pressure an Emergency?

Blood pressure above 180/120 mmHg together with symptoms suggesting acute organ damage can represent a hypertensive emergency.

Warning symptoms may include:

chest pain,
severe shortness of breath,
weakness or numbness,
difficulty speaking,
sudden vision changes,
severe neurological symptoms,
confusion,
or loss of consciousness.

Seek emergency medical care immediately or contact your local emergency medical service.

Do not wait at home hoping the blood pressure will fall by itself.

Hypertension During Pregnancy

High blood pressure during pregnancy requires special consideration.

Pregnancy-related hypertension and pre-eclampsia can endanger both the pregnant person and baby.

Symptoms that can occur with severe pre-eclampsia include:

severe headache,
visual disturbance,
pain beneath the ribs or upper abdomen,
nausea or vomiting,
sudden swelling,
and feeling seriously unwell.

Anyone who is pregnant and has high blood pressure or concerning symptoms should seek appropriate maternity or medical assessment.

Blood-pressure targets and medication choices during pregnancy differ from those used for non-pregnant adults.

Can Hypertension Be Prevented?

Not every case can be prevented because genetics, age and medical conditions can influence risk.

However, several measures can lower the likelihood of developing hypertension and help control existing high blood pressure.

These include:

reducing excessive sodium intake,
eating plenty of nutritious plant foods,
being physically active,
maintaining an appropriate body weight,
avoiding tobacco,
limiting alcohol,
managing diabetes and other health conditions,
getting adequate sleep,
and checking blood pressure periodically.

If You Already Have Hypertension

Lifestyle changes remain valuable even when medication is required.

Good management often involves:

Know your numbers.
Take your medicine as prescribed.
Attend follow-up appointments.
Monitor at home if recommended.
Maintain healthy lifestyle habits.
Know when an unusually high reading needs medical attention.

Hypertension is often a long-term condition, but effective control can greatly reduce its risks.

The Bottom Line

High blood pressure is a common and serious condition that increases the risk of heart attack, stroke, heart failure, kidney disease and other health problems.

Most importantly:

Hypertension usually causes no symptoms.

Do not wait for a headache, dizziness or nosebleed before checking your blood pressure.

Accurate measurement is the only way to know your numbers.

Blood-pressure thresholds and treatment targets can vary somewhat between international guidelines, but persistently elevated blood pressure deserves appropriate medical assessment.

Lifestyle changes—including reducing excessive salt, exercising, maintaining metabolic health, avoiding tobacco and limiting alcohol—can help prevent and manage hypertension.

Many people also require medication.

If medicine has been prescribed, take it as directed and do not stop treatment simply because your readings improve.

Controlling blood pressure is one of the most effective ways to protect your heart, brain, kidneys and long-term health.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for individual medical diagnosis or treatment. Blood-pressure thresholds, treatment targets and medication recommendations can vary according to medical history, pregnancy, cardiovascular risk and national guidelines. Consult an appropriately qualified healthcare professional for advice about your individual blood pressure. Seek emergency medical care for severely elevated blood pressure accompanied by serious symptoms such as chest pain, breathing difficulty, neurological weakness, difficulty speaking or sudden vision changes.

Sources and Further Reading

World Health Organization — Hypertension

https://www.who.int/news-room/fact-sheets/detail/hypertension

World Health Organization — Guideline for the Pharmacological Treatment of Hypertension in Adults

https://www.who.int/publications/i/item/9789240033986

Centers for Disease Control and Prevention — Measuring Your Blood Pressure

https://www.cdc.gov/high-blood-pressure/measure/index.html

Centers for Disease Control and Prevention — High Blood Pressure Risk Factors

https://www.cdc.gov/high-blood-pressure/risk-factors/

American Heart Association — Home Blood Pressure Monitoring

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home

Breast Cancer: Symptoms, Risk Factors, Screening and Early Detection

Breast cancer is one of the most common cancers worldwide and can affect people in every country.

It develops when abnormal cells in the breast begin growing uncontrollably. These cells can form a tumour and, if the cancer becomes invasive, may spread into surrounding breast tissue, nearby lymph nodes or other parts of the body.

Breast cancer mainly affects women, but men can develop it too.

Finding breast cancer early and receiving appropriate treatment can substantially improve outcomes.

However, early detection involves more than looking for a lump. It includes knowing what is normal for your breasts, reporting unusual changes promptly and participating in appropriate screening when recommended.

How Common Is Breast Cancer?

Breast cancer represents a major global health challenge.

According to the World Health Organization, an estimated 2.4 million women were diagnosed with breast cancer worldwide in 2024, and approximately 694,000 women died from the disease.

Breast cancer occurs in women in every country and can occur at any age after puberty, although rates increase later in life.

Approximately 0.5% to 1% of breast cancers occur in men.

What Happens in Breast Cancer?

Breasts contain structures including milk-producing lobules and ducts that carry milk towards the nipple.

Breast cancer most commonly begins in cells lining these ducts or lobules.

Some abnormal cells initially remain within the structure where they developed. This is known as in situ disease.

When cancer cells grow into surrounding breast tissue, the cancer becomes invasive.

Cancer cells can eventually travel through the lymphatic system or bloodstream to other parts of the body.

When cancer spreads to distant organs, this is called metastatic breast cancer.

Can Breast Cancer Develop Without Symptoms?

Yes.

Breast cancer may cause no noticeable symptoms during its early stages.

This is one reason mammography can be valuable for people who meet screening criteria: it may identify breast cancer before a lump can be felt or other symptoms appear.

However, this does not mean that breast cancer never causes early warning signs.

Some cancers are first discovered because a person notices a change in their breast.

Both symptom awareness and appropriate screening are therefore important.

What Are the Warning Signs of Breast Cancer?

Different people can experience different symptoms.

Possible warning signs include:

a new lump or thickened area in the breast,
a new lump or swelling in the armpit,
change in the size or shape of a breast,
dimpling or puckering of the breast skin,
redness or other unusual skin changes,
changes in the appearance of a nipple,
a nipple that becomes newly pulled inward,
abnormal nipple discharge, including bloody discharge,
flaky, crusted or irritated skin around the nipple,
and persistent unusual breast or nipple pain.

Having one of these symptoms does not automatically mean you have breast cancer.

Many non-cancerous breast conditions can cause similar changes.

Nevertheless, a new or unexplained breast change should be properly assessed.

Does a Breast Cancer Lump Always Hurt?

No.

A cancerous breast lump is often painless, although pain can occur.

Do not assume that a painless lump is harmless.

Likewise, breast pain by itself is commonly caused by conditions other than cancer.

The important point is to have a new, persistent or unusual breast change evaluated rather than attempting to diagnose it yourself.

Most Breast Lumps Are Not Cancer

Finding a breast lump can be frightening, but most breast lumps are caused by conditions other than cancer.

Examples include cysts and other benign breast changes.

The way a lump feels cannot reliably establish whether it is cancerous.

A healthcare professional may recommend clinical examination and imaging to determine what the lump represents.

What Is Inflammatory Breast Cancer?

Inflammatory breast cancer is an uncommon but aggressive form of breast cancer.

Unlike many breast cancers, it may not initially produce a clearly defined lump.

Possible symptoms can include:

rapid breast swelling,
redness or discolouration,
warmth,
thickening of the skin,
skin resembling the surface of an orange,
tenderness,
and nipple changes.

These symptoms can resemble an infection such as mastitis.

A breast infection is much more common than inflammatory breast cancer, particularly during breastfeeding, but symptoms that are unexplained, severe or do not improve as expected require further assessment.

Know What Is Normal for Your Breasts

Breasts naturally differ from person to person.

They can also change because of:

menstrual cycles,
pregnancy,
breastfeeding,
ageing,
changes in body weight,
hormonal medicines,
and menopause.

There is no single appearance or texture that represents a “normal breast” for everyone.

The useful approach is breast awareness—becoming familiar with how your own breasts normally look and feel.

That makes it easier to recognise a new change.

Do You Need a Formal Monthly Breast Self-Examination?

Routine breast self-examination should not be treated as a substitute for evidence-based screening.

Research has not established formal breast self-examination alone as an adequate screening test that reduces breast-cancer mortality.

However, being familiar with your breasts remains useful.

If you notice a new lump, skin change, nipple change or another unusual symptom, report it rather than waiting for your next scheduled mammogram.

Who Is at Risk of Breast Cancer?

Anyone with breast tissue can potentially develop breast cancer.

However, certain factors increase risk.

Having a risk factor does not mean that you will definitely develop breast cancer.

Similarly, having no obvious risk factors does not guarantee that you will never develop it.

WHO reports that approximately 80% of breast cancers occur in women without a specific identifiable risk factor other than sex and age.

Age

Breast-cancer risk increases with age.

Although younger women can develop breast cancer, the disease becomes increasingly common later in life.

Age is therefore an important factor when deciding who should participate in population screening programmes.

Sex

Being female is the strongest breast-cancer risk factor.

Approximately 99% of breast cancers occur in women.

But because men have breast tissue, breast cancer can occur in men as well.

Family History

Having a close relative with breast cancer can increase risk.

This can be especially relevant when several close relatives have had breast or ovarian cancer, particularly at younger ages.

However, most women diagnosed with breast cancer do not have a known family history of the disease.

Never assume that you cannot develop breast cancer simply because nobody in your family has had it.

Inherited Genetic Changes

Some inherited genetic variants substantially increase breast-cancer risk.

The best known include changes in:

BRCA1
BRCA2
PALB2

Other genes can also influence risk.

Genetic testing is not automatically necessary for everyone.

People with strong personal or family histories may be referred for genetic counselling so their risk and the potential benefits and limitations of testing can be assessed.

Previous Breast Cancer

Someone who has previously had breast cancer may have an increased risk of developing another breast cancer.

Certain non-cancerous breast conditions can also be associated with increased future risk.

Follow-up recommendations should be individualized.

Dense Breasts

Breasts are made of different proportions of fatty, glandular and fibrous tissue.

Having dense breasts can:

increase breast-cancer risk,
and make some cancers more difficult to see on a mammogram.

Breast density is determined through mammography rather than simply by how the breasts feel.

Reproductive and Hormonal Factors

Lifetime exposure to reproductive hormones can influence breast-cancer risk.

Factors associated with risk can include:

starting menstruation at a younger age,
experiencing menopause at an older age,
reproductive history,
and certain forms of menopausal hormone therapy.

These are risk factors, not guarantees that cancer will develop.

Alcohol

Alcohol consumption increases breast-cancer risk.

Risk generally increases with greater consumption.

Reducing alcohol consumption—or not drinking alcohol—can therefore reduce one modifiable risk factor.

Body Weight

Having excess body weight, particularly after menopause, is associated with increased breast-cancer risk.

This does not mean people with obesity will necessarily develop cancer, and weight should never be used to blame someone for developing breast cancer.

Risk is influenced by many factors, including those that cannot be changed.

Physical Activity

Regular physical activity is associated with a lower risk of breast cancer.

Exercise also supports cardiovascular health, metabolic health, bone health and general wellbeing.

Choose activities appropriate for your health and physical abilities.

Tobacco

Tobacco use is associated with numerous cancers and other serious diseases.

WHO also includes tobacco use among factors associated with breast-cancer risk.

Avoiding tobacco is therefore an important part of overall cancer prevention and health protection.

Previous Radiation Exposure

Previous exposure to significant ionising radiation, particularly radiation involving the chest at a younger age, can increase later breast-cancer risk.

This is particularly relevant to some people who previously received radiation therapy for another cancer.

Medical imaging uses radiation carefully because doctors balance potential risks against expected benefits.

Do not avoid medically necessary imaging because of fear of radiation without discussing your concerns with a healthcare professional.

Breastfeeding and Breast-Cancer Risk

Breastfeeding is associated with a reduction in breast-cancer risk.

However, decisions about breastfeeding are personal and can be influenced by health, circumstances, milk supply, medicines, work and many other factors.

Someone who cannot or chooses not to breastfeed should not be made to feel responsible for future cancer risk.

Breast cancer has many causes and risk factors.

Can Breast Cancer Be Completely Prevented?

No.

There is currently no guaranteed way to prevent every breast cancer.

Some important risk factors—such as age, sex and inherited genetic changes—cannot be modified.

However, certain behaviours may help reduce risk.

These include:

maintaining regular physical activity,
avoiding tobacco,
reducing or avoiding alcohol,
maintaining metabolic health and an appropriate body weight,
breastfeeding where possible and desired,
and discussing menopausal hormone therapy with a healthcare professional when relevant.

Risk reduction is not the same as guaranteed prevention.

Someone can follow a healthy lifestyle and still develop breast cancer.

What Is Breast-Cancer Screening?

Screening means testing people who do not currently have symptoms to look for cancer before it becomes clinically apparent.

This is different from diagnostic testing.

If you already have a breast lump, abnormal nipple discharge or another concerning breast symptom, you need medical evaluation, not simply routine screening.

What Is a Mammogram?

A mammogram is a low-dose X-ray image of the breast.

It can detect some breast cancers before they are large enough to feel.

Mammography is the standard breast-cancer screening method for many women.

However, it is not perfect.

A mammogram can sometimes:

miss a cancer,
produce an abnormal result when cancer is not present,
lead to additional imaging or biopsy,
or detect a cancer that might never have caused harm during a person's lifetime.

Despite these limitations, appropriate mammography screening can reduce deaths from breast cancer.

Should Every Woman Have a Mammogram Every Year?

Not necessarily.

This is an important correction to the original KandyWandy article.

There is no single worldwide screening schedule appropriate for every woman.

Recommendations differ according to:

age,
individual breast-cancer risk,
family history,
genetic risk,
previous breast conditions,
national screening programmes,
healthcare resources,
and recommendations from local health authorities.

For example, WHO describes organized mammography screening commonly targeting women approximately 50–69 years old in settings where appropriate health systems and treatment services are available.

Other national organisations begin routine screening at younger ages.

The appropriate approach is to follow the breast-screening recommendations in your country and discuss your personal risk with an appropriate healthcare professional.

Screening Is for People Without Symptoms

This distinction is extremely important.

Do not wait until your scheduled screening appointment if you discover:

a new breast lump,
unusual nipple discharge,
skin dimpling,
nipple retraction,
unexplained breast-shape changes,
or another concerning symptom.

Screening programmes are designed primarily for people without symptoms.

A new symptom requires diagnostic assessment.

What Happens If a Mammogram Is Abnormal?

An abnormal mammogram does not automatically mean breast cancer.

Further assessment may include:

additional mammogram images,
ultrasound,
breast MRI in selected situations,
clinical examination,
and/or biopsy.

A biopsy involves taking a small tissue sample for examination.

A biopsy can determine whether suspicious cells are cancerous and provide information that helps guide treatment.

How Is Breast Cancer Diagnosed?

Diagnosis may involve a combination of:

medical history,
clinical breast examination,
mammography,
ultrasound,
MRI in selected circumstances,
and biopsy.

Imaging can identify suspicious abnormalities, but tissue examination through biopsy is often necessary to confirm a cancer diagnosis.

Are All Breast Cancers the Same?

No.

Breast cancer is not one single biological disease.

Tumours can differ according to characteristics such as:

hormone receptors,
HER2 status,
genetic features,
tumour grade,
and stage.

These differences help doctors determine which treatments are most likely to work.

For example, some breast cancers respond to hormone therapy, while HER2-positive cancers may respond to medicines specifically targeting HER2.

How Is Breast Cancer Treated?

Treatment depends on the type of cancer, its biological characteristics, its size, whether it has spread and the person's overall circumstances.

Treatment may include:

Surgery

Surgery may remove the tumour while preserving much of the breast (breast-conserving surgery or lumpectomy) or remove the entire breast (mastectomy).

The appropriate operation depends on individual circumstances.

Radiation Therapy

Radiotherapy uses high-energy radiation to destroy cancer cells.

It is commonly used after breast-conserving surgery and in some other situations to reduce the risk of cancer returning.

Chemotherapy

Chemotherapy uses medicines that kill or control rapidly dividing cancer cells.

It may be given before surgery, after surgery or as part of treatment for advanced disease.

Hormone Therapy

Some breast cancers depend on hormones such as oestrogen for growth.

Hormone-receptor-positive cancers can often be treated with medicines that block hormonal effects or reduce hormone production.

Targeted Therapy

Certain medicines target specific characteristics of cancer cells.

HER2-targeted therapies are an important example.

Other Systemic Treatments

Depending on the cancer subtype and stage, other treatments, including immunotherapy in selected situations, may be considered.

Cancer treatment is increasingly personalised according to the biological characteristics of the tumour and the individual patient.

What Does Breast-Cancer Stage Mean?

Staging describes how much cancer is present and how far it has spread.

Doctors consider factors including:

tumour size,
involvement of nearby lymph nodes,
spread to distant organs,
and biological characteristics of the cancer.

Earlier-stage breast cancers have generally not spread to distant parts of the body.

Metastatic breast cancer means cancer has spread to distant organs such as bones, lungs, liver or brain.

Treatment goals and options differ according to stage.

Does Early Detection Matter?

Yes.

Breast cancers identified and treated before they have spread widely are generally easier to treat successfully.

WHO emphasizes early diagnosis, timely evaluation and comprehensive treatment as major components of reducing deaths from breast cancer.

However, “early detection” should not be interpreted as a promise that every early cancer will be cured or that every advanced cancer could have been prevented.

Cancer biology differs between individuals.

What About Headaches and Weight Loss?

The old KandyWandy article listed headaches, reduced appetite and weight loss among the general warning signs of breast cancer.

That presentation was misleading.

These are not the main breast changes used to recognise early breast cancer.

In advanced disease that has spread elsewhere in the body, symptoms can depend on the organs involved.

For example, metastatic disease may sometimes cause:

persistent bone pain,
neurological symptoms,
breathing problems,
or other systemic symptoms.

But headaches should not be presented as though they are a typical early symptom of breast cancer.

Can Men Get Breast Cancer?

Yes.

Although uncommon, men can develop breast cancer.

WHO estimates that approximately 0.5–1% of breast cancers occur in men.

Men should seek medical assessment for symptoms such as:

a new breast or chest lump,
nipple discharge,
nipple inversion,
skin changes around the breast or nipple,
or unexplained swelling in the armpit.

Breast cancer should not be dismissed solely because the patient is male.

When Should You Seek Medical Advice?

Arrange appropriate medical assessment if you notice a new or unexplained change such as:

a breast or armpit lump,
thickening or swelling,
nipple discharge other than breast milk,
bloody nipple discharge,
new nipple inversion,
persistent unusual breast or nipple pain,
change in breast size or shape,
skin dimpling,
persistent redness or unusual skin thickening,
or another change that is not normal for you.

Do not wait for the change to become painful.

And do not wait for your next routine mammogram if you already have a concerning symptom.

A Breast Change Does Not Automatically Mean Cancer

Many breast changes are caused by benign conditions.

This is worth remembering because discovering a lump can create considerable anxiety.

But the fact that most lumps are not cancer is not a reason to ignore one.

The safest approach is:

Notice the change → get it evaluated → establish the cause.

Seven Things to Remember

1. Know what is normal for you.
Breast awareness can help you recognise changes.

2. A lump is not the only warning sign.
Look for nipple, skin, shape and underarm changes too.

3. Most breast lumps are not cancer.
But a new lump still deserves assessment.

4. Breast cancer can occur without a family history.
Most people diagnosed do not have a known family history.

5. Men can develop breast cancer.
It is uncommon but possible.

6. Screening schedules differ internationally.
Follow recommendations based on your age, risk and country.

7. Symptoms should not wait for routine screening.
A new breast change needs appropriate medical assessment.

The Bottom Line

Breast cancer develops when abnormal breast cells grow uncontrollably and can eventually invade surrounding tissue or spread elsewhere in the body.

Possible warning signs include a new breast or armpit lump, thickening, changes in breast size or shape, skin dimpling, nipple changes and abnormal nipple discharge.

Many breast changes are not cancer, but it is impossible to determine the cause reliably from appearance or touch alone.

Breast awareness can help people notice changes, while mammography can detect some cancers before symptoms develop.

Screening recommendations differ around the world, so there is no universal rule that every woman should have a mammogram every year.

The most important principles are to understand your personal risk, follow appropriate screening guidance where you live and seek medical assessment promptly when you notice an unusual breast change.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for medical diagnosis, cancer screening advice or treatment. Breast-cancer screening recommendations vary according to age, individual risk and country. Anyone with a new or concerning breast change should seek assessment from an appropriately qualified healthcare professional rather than waiting for routine screening.

Sources and Further Reading

World Health Organization — Breast cancer

https://www.who.int/news-room/fact-sheets/detail/breast-cancer

World Health Organization — Cancer

https://www.who.int/news-room/fact-sheets/detail/cancer

National Cancer Institute — Breast Cancer Screening

https://www.cancer.gov/types/breast/screening

National Cancer Institute — Mammograms

https://www.cancer.gov/types/breast/screening/mammograms

Centers for Disease Control and Prevention — Symptoms of Breast Cancer

https://www.cdc.gov/breast-cancer/symptoms/index.html

Centers for Disease Control and Prevention — Breast Cancer Risk Factors

https://www.cdc.gov/breast-cancer/risk-factors/index.html