Baldness drug Wayne Rooney took 'could cause permanent impotence and shrink genitals in some men'

A hair-loss medication reportedly tried by Wayne Rooney may cause prolonged and possibly irreversible impotence, scientists have claimed.

The recent findings come after one patient bravely stepped forward to reveal the drug left him with no sex drive and even shrank his genitals.

Kevin Malley, 30, was prescribed with the drug Propecia after he worried he could be losing his hair. He said he only planned to take the pill for a year.

However, just five months after he started taking it in May 2011 he found he was completely impotent and his testes also became smaller.

Worried, he consulted his doctor and was told the symptoms would disappear after he stopped taking the drug. But he says a year on and nothing has

changed.

It will come as no surprise to Dr Michael Irwig from the University of Washington.

He recently published a study in the Journal of Sexual Medicine, that found the ingredient finasteride, which is found in Propecia, can cause persistent

sexual dysfunction, including low sexual desire, erectile dysfunction and problems with orgasms.

The male pattern baldness drug is manufactured by Merck and was approved by the FDA in 1997.

While labeling on the medication in the U.S. currently warns about possible reversible sexual side effects, there is no reference to the effects being

persistent, Dr Irwig said.

However, other countries including the UK and Sweden do require medical companies to include the 'persistent risk' warning on the labeling.

It was reported that Wayne Rooney started taking the medication in 2009 after he became sick of other footballer's jibes about his receding hairline. He has

since had a hair transplant.

Dr Irwig first became aware of the problems caused by finasteride several years ago when he encountered several men who reported they had developed

sexual dysfunction while taking the medication.

'It’s been very frustrating for a lot of these men because they’ve sought care from medical professionals who have looked at the literature and have not

seen a risk of persistent sexual dysfunction,' says Dr Irwig.

'So a lot of these patients have been told to see psychiatrists and psychologists and that it’s all in their head.'

Dr Irwig then noticed that men had reported sexual dysfunction for months even after they stopped taking the medication.

'I came across a website called propeciahelp.com with more than 1,400 registered users - many young healthy men who developed the same sexual side

effects from finasteride - and I discovered that nobody had published a series looking at these men - who they are, how long the sexual side effects lasted,

what types.'

Dr Irwig’s study included results from interviews with 71 men aged 21 to 46 years old to assess how long they took finasteride, the type and duration of

sexual side effects and their sexual frequency before and after the medication.

Dr Irwig discovered that 94 per cent developed low libido, 92 per cent developed erectile dysfunction and decreased arousal, and 69 per cent developed

problems with orgasm.

On average, the men used finasteride for approximately 28 months but experienced persistent sexual side effects for an average of 40 months, from the

time they ceased taking the medication to the time of the interview.

Dr Irwig also found that the average number of sexual episodes per month dropped after finasteride use.

'It turns out that almost all the men had multiple sexual function problems,' says Dr Irwig.

'Before finasteride use, the men experienced average sexual activity of approximately 26 episodes per month, but after use, it came down to

approximately eight per month - an almost two-thirds reduction.

'Twenty per cent of patients I interviewed experienced persistent sexual dysfunction for more than five years, which makes me wonder if their persistent

sexual dysfunction is permanent,' he adds.

This was certainly Mr Malley's experience. He told Good Morning America: 'I kept expecting the side effects to go away, but they did not, they only got

worse.'

Mr Malley said before he took the drug he was engaged and worked as a public health researcher at a university in Las Vegas.

After he developed symptoms his fiancee broke off the engagement and he said he had to resign from his job because of cognitive problems. He said he is

angry no one warned him the drug could have such lasting effects.

'Even if the side effects are rare, that doesn't mean that I should not have been warned. I did have a life before this,' he told Good Morning America.

Dr Irwig said roughly 5 per cent of men who take medicine will experience sexual dysfunction, and of those 'it’s hard to tell how many will experience

persistent symptoms'.

'We know that this is a potential problem, but we can’t quantify what the exact risk is. I can’t tell a man if he has a 1-in-100 chance, or a 1-in-1000 chance of

developing persistent sexual dysfunction, but it’s pretty clear there’s a relationship here,' he says.

Topical Rogaine can be used as an alternative to Propecia - applied directly on the skin, it does not get absorbed by body and thus does not cause sexual

side effects - but Dr. Irwig says Propecia is very effective in treating hair loss and thus is commonly prescribed.

So Dr Irwig says it is crucial physicians treating male pattern hair loss discuss the possibility of persistent sexual side effects associated with finasteride with

their patients.

'I think it’s very important that doctors who are prescribing this medicine talk about potential risks, so men can make an informed decision,' he said.

In a statement, Merck said no evidence has proved a causal relationship between Propecia and long-lasting sexual dysfunction.

A spokesman said: 'Merck believes that PROPECIA (finasteride) has demonstrated safety and efficacy profiles and that the product labeling appropriately

describes the benefits and risks of the drug to help inform prescribing.

'A causal relationship between the use of PROPECIA and continued sexual dysfunction after discontinuation of treatment has not been established.   We

encourage patients to talk with their doctor if they have any questions or concerns about their health, or about PROPECIA.'

10 best foods for your Hair

Having a balanced diet, while putting a little extra emphasis on things like protein and iron, gives your hair a boost, the pursuit of shiny looks starts with a healthy balanced

diet such as fish, bananas, beans and some vegetables which is good for the 150,000 hair follicles on your head as it is for your body.

Protein, for example is the building block of hair. If you don’t get enough, you hair will grow more slowly, and strands will be weaker.

• Eggs:- it contains vitamin B that promotes hair growth and overall scalp health. A deficiency can cause brittle hair. Other high-biotin foods include peanuts, almonds, wheat

bran, salmon, low-fat cheese, and avocados.

• Bananas:- This contains minerals Silica which is good for the thickness of the hair, also helps in making hair stronger and durable.

• Green Vegetables:- it contains vitamins A and C which help to produce Sebum, a scalp oil that works as a natural hair conditioner.

• Sweet Potatoes:- These are packed with beta-carotene, which your body converts to vitamin A, a nourishing agent for your hair and skin. Vitamin A protects against dull hair and

dry skin, a leading cause of dandruff.

• Kidney Beans:- These are Iron rich Protein which play a major role in hair maintenance and support.

• Fruits:- This contains vitamin C which helps your body to absorb Iron. Lack of vitamin C may lead to dry and weak hair.

• Fatty Acid:- They support scalp health; a deficiency can lead to dry scalp and dull hair. Good sources include salmon, sardines, herring, mackerel, flaxseeds, and walnuts.

• Healthy Oil:- No one wants dry, lackluster hair. But if your diet is too low in fat, that’s what could happen. Healthy oils like olive, peanut, safflower, and sunflower can

restore the shine. About a teaspoon a day will do the trick.

• Oysters:-This contains Zinc, a mineral that helps regulate the production of androgens. These are hormones that, in low levels, are associated with hair loss. People with low

levels of androgens can also suffer from slow hair growth and dandruff.

• Lean Red Meat:- This contains Iron and lack of Iron can lead to baldness, . “People who have problems with hair loss or hair growth tend to be iron deficient.

Rogaine For Men 5% Foam

- Hair Regrowth Treatment Review

There’s not a man alive who doesn’t worry about losing his hair – going bald isn’t something that any man wants to experience but the reality is that well over 80% of

guys are going to have to deal with some amount of hair loss and baldness during their lives; it’s just in our genes and can’t really be escaped. That’s simply been the

case for the last few thousand years of human existence – when your hair started falling out and you developed a bald patch you just had to deal with it.

But things have changed and an accident during a medical trial (that sounds like somebody created the Hulk doesn’t it?) has led to the development of a very real and

every effective treatment for hair loss in the form of Minoxidil, which you’ll also recognize by the name Rogaine. As a hair loss treatment Rogaine has been available

for a long time now so why even mention it anymore? Well at first Rogaine was available as a topical lotion but a lot of people found that it was difficult to apply and

now Upjohn have released Rogaine as a foam and not only that but they’ve made the formulation of their Rogaine stronger than ever.

The biggest problem most people had with using the original Rogaine was that it was in an alcohol solution and sometimes if the Rogaine changed temperature it could get

quite sticky. So even though you’d squirt it onto your scalp and try to massage it in most of the solution would wind up getting stuck to your hair or fingers instead.

Then there was the issue that because the human scalp produces oil it’s very difficult to mix alcohol and oil together, which meant that only about 50% of the actual

Rogaine was getting down to your hair follicles in the first place.

So the company behind Rogaine, Upjohn, have created a 5% Rogaine foam product which eliminates the problem of this hair loss treatment being sticky or not being

absorbed properly into your scalp. So now there’s less mess and you stand a better chance of growing more of your hair back because your follicles are being stimulated

by 5% Minoxidil instead of the standard 2%. Just using 2% Rogaine instead of 5% Rogaine is enough to encourage more growth on its own but the foam means even more

penetration so more hair growth. Simple as that folks.

Why Rogaine?
You’ve probably seen dozens of different hair loss products advertized online and offline and they all seem to claim the same thing – to be able to regrow any of your

hair that’s fallen out. So what makes any one of these treatments better or worse than Rogaine? Well Rogaine is the only FDA approved hair loss treatment of its kind on

the market right now. In fact over the last little while the FDA have forced many companies to take their Minoxidil based products off the market because they didn’t

contain enough real Minoxidil to encourage hair growth. With Rogaine foam you’re getting the proven Upjohn formulation you need to get the best possible results. In

fact 85% of men reported results after using this product twice daily.

Can It Regrow All Your Hair
The most important thing to remember about Rogaine is that it’s not a miracle cure for hair loss but that it can and does regrow a cosmetically significant amount of

hair and slow down any further hair loss. Rogaine 5% foam is going to be most effective when combined with a DHT inhibitor like Propecia or a natural alternative like

HairOmega 3-in-1 DHT-blocker. The combination of a DHT blocker or inhibitor and a growth “agent” like Rogaine will give you the best possible results because not only

are you blocking the DHT that causes your hair follicles to shrink and stop producing hair but you’re also encourage fresh hair growth with Minoxidil 5%.

Minoxidil 5% foam is designed to work most effectively on your vertex (the crown of your head) but people who are using it have reported that it can also regrow hair

elsewhere on your head too. Using the foam is very easy – you just need to use half a capful twice per day and rub it gently into your scalp with your fingertips.

There’s always the temptation to use any product like this more often to get better results but

Packaging
This extra strength Rogaine product comes in a pack of 3 so you have 3-month supply so there won’t be any breaks in your treatment, which is very important. You need to

apply Rogaine 5% foam on a consistent daily basis to get the best possible results.

Pros
* Easy to use foam

* 5% extra strength Rogaine formula

* Better absorption of Minoxidil into your scalp

Cons

* Not a cure for hair loss but is an effective treatment

* Not available in higher strengths like 7.5% or 10%

How Popular Is This Treatment?
Over 170 customers have given Rogaine 5% foam 4 or more stars on Amazon so it obviously does work for the vast majority of people. You need to allow a full 90-days

before you measure your results and in many cases it will take 6-months to see the kind of results that your friends will notice.

Pricing
This triple pack of Rogaine 5% foam costs a little over $40 at the time of writing.

When it comes to slowing down your hair loss and growing back some or all of your lost hair the sooner you start treatment the better so ordering your Rogaine 5% foam

triple pack today is a good idea.

A Confession of a Hair Loss Victim

People look at hair loss in negative ways. This I knew even before I started losing my hair a year ago.

As a young child until my early twenties, I was blessed with thick long hair. However, I did a lot of things that caused my body to react in an unexpected way.  Because I was too conscious of my weight and body, I began to skip meals and avoid eating proper nutritious foods. Other than that, I have bad habits like smoking and drinking. With this unhealthy lifestyle, it was imminent that my body would eventually succumb to problems.

I started noticing the changes in my hair when I saw a mass of hair tangled along my hairbrush. I was literally shocked, because it was the first time that I’ve experienced that kind of hair loss. My excessive hair loss really caught me off guard, though I still ignored this at first. However, for at least 2 weeks I continued to lose masses of hair, that was the wake-up call for me, and so I started to panic.

The only person whom I share my feelings with is my best friend. I told her about the excessive hair loss that I was experiencing. She suggested that I should use hair loss treatment products which can help me stop and prevent my hair loss from getting worse. She told me to try the Leimo 30-day Free Hair Loss Treatment Trial she saw in a television advertisement. Since it was free, it would be very convenient on my part because I can test its effectiveness without spending a single cent.

With her prodding, I signed up for a 30-day free hair loss treatment promotion from Leimo International. Throughout my 30-day hair treatment program, I observed that my hair was becoming healthier. To my amazement, my hair loss has ceased and I feel that my hair is shinier and smoother.

At present, I am still using the Leimo Hair Treatment Pack as part of my daily hair care routine. I am indeed very thankful to Leimo because without it, I would have no way of stopping my hair loss problems. Without it, I probably would have had a worse case of excessive hair loss or major hair thinning.

Visit http://www.leimo-hairloss.co.uk for more information

Treating Hair Loss The Advanced Procedure

To create a treatment for hair loss efficient, it’s extremely essential to initially address its cause. There are lots of factors that can be affecting your health, and this might be the cause of the hair loss issue. Fortunately, there are contemporary methods to “cure” this condition and reverse hair loss, giving you a complete head of hair and a boosted-up self-confidence. Read more information about Follicular Unit Extraction.

FUE – What’s This?

FUE or Follicular Unit Extraction is among the latest techniques of hair transplant. The distinction of FUE from other transplant operation is that it’s much less invasive. It involves using precision tools, which are utilized to harvest 1 follicle of hair at a time.

FUE, like any other surgical hair transplant techniques, has its pros and cons. Nevertheless, in comparison with other surgical hair transplant methods, this 1 has more advantages than disadvantages. It’s less-invasive and leaves fewer and relatively smaller scars, unlike other hair transplant procedures that leave you with patches of scars around your head.

Among the disadvantages of FUE is it is a much less effectual technique in comparison with Follicular Unit Transplantation or FUT. In FUE, there is a greater danger that the follicles die throughout the extraction. An additional hitch is you’ll be needed to completely shave your head, that is a hindrance to numerous, but not to others.

Nevertheless, despite some advantages, lots of people still opt to go below FUE technique instead of other available transplantation methods. Since it’s less-invasive, most patients can resume their normal way of life shortly after the procedure. Simply because the physician creates only tiny slits, recovery is faster, which means they are able to resume their everyday activities sooner.

Laser Therapy Can Save Your Hair

In addition to FUE, an additional contemporary technique used in fighting hair loss is laser treatment. Laser treatment for hair loss is among the most efficient non-invasive methods to keep your hair thick and healthy. Many people swear to the efficiency of laser treatment against hair loss.

You can use hair growth goods to elevate the effectiveness of laser treatment. The effects of oral supplements, topical applications as well as other hair loss remedies are positively enhanced with the use of laser therapy. 9 out of 10 patients swear to see visible results in as early as 6 weeks after their laser therapy began, making laser treatment amongst probably the most efficient and simplest methods to stop hair loss.

Technically, laser remedies function by stimulating the hair follicles and providing them with the necessary nutrients. Furthermore, laser treatment helps improve blood flow, therefore enhancing the effects of other hair growth medicines and hastening their capability to promote hair growth.

Although deemed efficient for many people, not everyone may be a candidate for laser treatment. Your physician is still the 1 to understand which process is correct for you. You must also know that laser hair loss remedies may be really pricey, but I guess this statement goes with FUE, also.

If you are suffering from hair loss and wish to experience the beauty of thick locks once more, then try using among the available hair loss remedies. IF the oral and topical remedies do not function for you, maybe it’s time to ask your physician about using a more complicated technique like FUE or laser treatment.

Avoid being At A Loss When It Comes To Hair Loss Therapy

You’ll find several Forza T5 Super Strength problems that can strike any guy along at any offered occasion, however when you happen to be to ask the normal guy what they ended up being the majority of worried about in the event it located his or her actual being, you’d most likely notice curly hair decline as the long list of most bothersome. Many men and ladies might wish to rapidly run into the best curly hair decrease solution. There are various males that sense which a overall, beneficial curly hair can be an crucial aspect with their self-assurance as well as benefits. Every time a person or perhaps young lady as an example, Very first realises their locks are starting out slender, it may be an exceptionally strenuous period, nevertheless they may take some peace during the truth they have possibilities in relation to thinning hair.

Almost all of these kind of people will certainly tend to recognize in regards to the best locks reduction cure, but it really could possibly fundamentally have one thing to accomplish with the type associated with life style that they direct. A person that features a little bit ago recently been spot on a whole new treatments, or possibly encountering a very good offer involving pressure may possibly extremely properly be subjected to head of hair lowering. The identical tips use when they make use of a lot of option in their hair, as well as have it often colored. These kind of are common items that can contribute to male pattern baldness or getting thinner, and it is actually a good thought to find out in case among individuals could possibly end up being the matter ahead of aiming from the search for the superior locks decrease treatments.

Precisely what men and women will surely have to understand is always that in relation to improving the particular strength of your curly hair along with aiming to turn back the thinning technique, it can be a lengthy, from time to time pricey fight in advance of the very best therapy will be found. You’ll find a number of goods round the marketplace which may have validated being useful with supporting using baldness or thinning hair, however you will find also a lot of that not simply in no way complete the job, Acne Scars Treatment nevertheless can also become harmful. Ahead of starting up upon any design involving curly hair treatment routine it truly is extremely crucial an individual check with your own medical doctor or perhaps a hair skilled at first. They can level you from the route from the object, this type of because Provillus, that could be both the valuable and also risk-free to use.

It is actually also critical to learn if the locks is merely thinning hair, because virtually every person’s will as we grow older, or maybe it really is actually woman or man male pattern baldness. In case it can be rogues, after that right now there is just not just one item, regardless of how exceptional it really is, which may cease that tactic. The patient typically wants a new procedure that will eliminate the main will cause around the obstacle, and inside the the exact same period nurture as well as induce fresh locks improvement. In that scenario you will find however few choices, including hair pieces, laser beam cure, and also medical procedure.

Most people want a extra normal seem to be though, as well as which might be attained by way of hair transplant, curly hair alternative, as well as scalp micro-pigmentation (SMP). There are plenty involving firms offering these kind of options, as well as it can be very best to obtain a session together with above One particular, in order that you are able to evaluate positive aspects and in addition expenses.

Hair pieces came a lengthy method in recent years, along with plenty of turn out really really challenging in order to find. Hairpieces are available pertaining to folks along with women. For ladies, you will find hands linked hairpieces which can be specifically developed regarding locks lowering victims. These kinds of palm tied hair pieces are really safe along with basic to place on. For a number of consumers curly hair decline isn’t any joking make any difference, nevertheless by using a modest little bit of help along with preparation, you might fairly effectively have the option to search out that best hair reduction treatment that can help reinstate your look.

Mira is incredibly enthusiastic about head of hair decrease complications and also treatments. She commenced losing your ex head of hair with 45 as well as do a good amount of analysis pertaining to fellas and female curly hair decrease. The girl stays loads of time for my child internet site composing concerning hair reduction, the simplest way to find the top curly hair decrease therapy, and the way Provillus Reviews to hold your hair that has grown back.

Chemo Means Going Bald? Not Necessarily

When I wrote my last post about hair, I wasn’t completely clear about my hair situation because it would have made the post too long: When I said my hair post chemo was growing back wavy instead of straight, I should have said about 20 percent of my hair is growing back that way.

I didn’t lose all of my hair during chemo.

That’s not because of luck. It’s not because the drugs I was given don’t cause hair loss. It’s because I was fortunate enough to be part of a feasibility study at University of California-San Francisco (UCSF) that aims to help breast cancer patients keep their hair.

Each time I went in for a chemo infusion, they hooked me up to a high-tech machine from Sweden that pumped coolant into a neoprene cap, cooling my scalp to approximately 40 degrees Fahrenheit.

Called the DigniCap machine, it made me feel like I was sticking my head in an Alpine lake for several hours. It made me look like a Russian cosmonaut, as you can see by the pictures that accompany this post on my personal blog.

When I was going through it, the comment threads could be critical: Some people said it was vain to want to keep your hair during chemo. Some asked, why focus on something trivial like hair when you’re fighting cancer? Some said it wouldn’t work, and that I was risking getting cancer in my scalp.

Medicine can be a very conservative field—new treatments are experimenting with people’s lives after all—and many doctors remain skeptical of scalp cooling because studies done a few decades ago failed. Some doctors won’t consider anything that’s not been approved by the Food and Drug Administration.

Yet the national health services in Britain and France cover scalp cooling to prevent chemo-related hair loss. Various scalp cooling systems are being distributed in Europe, the Middle East, and many other countries.

Another system, Paxman scalp cooling, developed by a company that originally made beer coolers, has become widely available in Britain. Paxman has recently expanded into Canada, Turkey, and the Middle East.

My UCSF doctor, Dr. Hope Rugo is a world-renowned oncologist. She said that scalp cooling systems have improved. Dr. Rugo also told me she and her colleagues did a review of 83 scalp-cooling studies around the world, and they found that scalp metastasis after scalp cooling is incredibly rare. It occurs in less than 1 percent of patients.

Scalp cooling works by cutting off blood flow to hair follicles during chemotherapy infusions. The drugs go into your system and circulate throughout your body, throwing monkey wrenches into the systems that help cells divide. If cells can’t divide, they die. It may take a week for these monkey-wrenches to result in cancer cell death. But the drugs quickly shunt to your bladder, usually within an hour or two. If you can keep the chemo away from your hair follicles for that short time, you can avoid losing your hair.

Unfortunately, saving your hair during chemo remains rare in America. I was one of only 20 American patients who tried the DigniCap ™ machine last year. The official results haven’t been released yet, but I know many of the other patients in the trial and most of us kept our hair.  The team plans a Phase I clinical trial with about 100 patients.

“Great,” you’re probably thinking. “What good does this do me now, if I don’t have breast cancer and I’m not part of this tiny clinical trial?”

You—in fact any patient who’s undergoing a treatment that causes hair loss—can use a system called Penguin Cold Caps right now. Approximately 50,000 cancer patients worldwide have used the Penguin Cold Caps to save their hair. At least two dozen U.S. medical centers have installed freezers for the caps, including leading cancer centers like UCSF and Weill Cornell Medical Center in Manhattan.

The Penguin Cold Cap system uses patented gel-filled caps instead of a fancy computerized refrigerating machine. The caps must be changed every 30 minutes.

Penguin Caps demand logistical effort: You need dry ice and a couple of coolers to hold the caps. You need to invest about $100 in a fancy infrared thermometer to check temperatures. You need a friend or two to help you get the caps on and off quickly. It costs $1,500 for three months, and $75 a month after that. But it works. I saw it work on other patients at UCSF.

Obviously, you need to get your oncologist’s OK before using the Penguin Cap system. Penguin Caps aren’t right for everyone: The shape of your head and the thickness of your hair seem to play a role in success. Cooling does not prevent hair loss with all chemo drugs—anthracylines and taxanes seem resistant to cold therapy. Cold caps cannot be used in patients suffering from leukemia or lymphoma because of the fear of mestastasis in those non-solid cancers.

Hair loss isn’t trivial. What are the first things other people notice? They notice your face and your hair. The prospect of going bald was the first thing that reduced me to tears after my diagnosis.

Hold onto your hats. You won’t necessarily need them.

Hair salon teams up with cancer charity

A BEAUTY salon has teamed up with a cancer charity to give specialist advice for people dealing with hair loss.

People affected by cancer can get expert support and advice on hair and wig care at Toni & Guy in South Street, Dorchester in partnership with Macmillan Cancer Support.

Steve Clark, manager at Toni & Guy, said: “Recently we have had more and more clients coming in who have been affected by cancer so we decided to offer this extra service so they can come here and get away from their problems.

“Going for a haircut is such a normal thing for most people and a lot of people lose their confidence when they lose their hair.

“We’ve found that people don’t know what route to take because nothing like this has been done in salons before.”

The salon is one of 102 across the country to take part in the new Strength in Style scheme, last month staff from the Dorchester salon went on a training course to help them deal with the emotional and practical issues surrounding the sensitive nature of hair loss and hair thinning due to cancer treatment.

Mr Clark said: “The training went into the different types of cancer and chemotherapy and the stages people go through.

“It’s important to pick up on things like that because people often don’t want to talk about it because they think it’s awkward.

“We also learnt about wig cutting, temporary hair loss and hair thinning and personalisation of wigs to make them more trendy.

“Some people find if they are in a busy salon it can be quite intimidating having a lot of other people around so we have a smaller, more private room available if they want to keep it personal.”

Staff in the Dorchester salon will also be fundraising throughout the year to raise money to help Macmillan.

Caroline Peppin, spokesman for Macmillan, said: “This a fantastic scheme aimed at tackling an important issue associated with cancer treatment, while helping to improve the individual’s confidence.”

Macmillan provides essential information, expert medical care, financial help and emotional support for people diagnosed with cancer, as well as their family and carers.