Tuberculosis.jpgTuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.
TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.
However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease.
People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.
Popularity: 1% [?]
Monday, July 30, 2007
Sunday, July 29, 2007
is there treatment for HIV/AIDS
All the currently licensed anti-retroviral drugs, namely AZT, dd1 and ddC, have effects which last only for a limited duration. In addition, these drugs are very expensive and have severe adverse reactions while the virus tends to develop resistance rather quickly with single-drug therapy. The emphasis is now on giving a combination of drugs including newer drugs called protease inhibitors; but this makes treatment even more expensive. WHO’s present policy does not recommend antiviral drugs but instead advocates strengthening of clinical management for HIV-associated opportunistic infections such as tuberculosis and diarrhoea. Better care programmes have been shown to prolong survival and improve the quality of life of people living with HIV/AIDS.
What is HIV
HIV stands for human immunodeficiency virus. HIV destroys certain white blood cells called CD4+ T cells. These cells are critical to the normal function of the human immune system, which defends the body against illness. When HIV weakens the immune system, a person is more susceptible to developing a variety of cancers and becoming infected with viruses, bacteria and parasites.
How do u get infectd by HIV?
HIV is passed on in the sexual fluids or blood of an infected person, so if infected blood or sexual fluid gets into your body, you can become infected. This usually happens by either having sexual intercourse with an infected person or by sharing needles used to inject drugs with an infected person. People can also become infected by being born to a mother who has HIV and a very small number of people become infected by having medical treatment using infected blood transfusions.
HIV can’t be caught by kissing, hugging or shaking hands with an infected person, and it can’t be transmitted by sneezes, door handles or dirty glasses.
Symptoms of HIV/AIDS
You can be HIV-positive and not realize it. Many people who are infected with HIV do not have symptoms for many years. You cannot rely on symptoms to know your HIV status.
The following may be warning signs of HIV infection:
* Severe weight loss
* Fevers
* Headaches
* Drenching night sweats
* Fatigue
* Severe diarrhea
* Shortness of breath
* Difficulty swallowing
The symptoms can last for weeks or months at a time and do not go away without treatment. Since these symptoms are commonly seen in other diseases, don’t assume these are HIV/AIDS-related until you get tested. If you are experiencing these symptoms and think you might be at risk, don’t wait! See a doctor or visit your student health center and get tested!!
A positive HIV test does not mean a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria. As with other diseases, early detection offers more options for preventative care and treatment.
How do u get infectd by HIV?
HIV is passed on in the sexual fluids or blood of an infected person, so if infected blood or sexual fluid gets into your body, you can become infected. This usually happens by either having sexual intercourse with an infected person or by sharing needles used to inject drugs with an infected person. People can also become infected by being born to a mother who has HIV and a very small number of people become infected by having medical treatment using infected blood transfusions.
HIV can’t be caught by kissing, hugging or shaking hands with an infected person, and it can’t be transmitted by sneezes, door handles or dirty glasses.
Symptoms of HIV/AIDS
You can be HIV-positive and not realize it. Many people who are infected with HIV do not have symptoms for many years. You cannot rely on symptoms to know your HIV status.
The following may be warning signs of HIV infection:
* Severe weight loss
* Fevers
* Headaches
* Drenching night sweats
* Fatigue
* Severe diarrhea
* Shortness of breath
* Difficulty swallowing
The symptoms can last for weeks or months at a time and do not go away without treatment. Since these symptoms are commonly seen in other diseases, don’t assume these are HIV/AIDS-related until you get tested. If you are experiencing these symptoms and think you might be at risk, don’t wait! See a doctor or visit your student health center and get tested!!
A positive HIV test does not mean a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria. As with other diseases, early detection offers more options for preventative care and treatment.
What is AIDS
AIDS stands for Acquired Immunodeficiency Syndrome.
Acquired - means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV).
Immunodeficiency - means that the disease is characterized by a weakening of the immune system.
Syndrome - refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system.
A diagnosis of AIDS is made by a physician using specific clinical or laboratory standards.
Acquired - means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV).
Immunodeficiency - means that the disease is characterized by a weakening of the immune system.
Syndrome - refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system.
A diagnosis of AIDS is made by a physician using specific clinical or laboratory standards.
What is Acidity?
The stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking down the food during digestion. When there is excess production of acid in the stomach, it results in the condition known as acidity or APD.
Normally, there are some protective mechanisms against the acid, in the stomach and proximal intestine. But an imbalance between the protective mechanisms and the level of acid secretion can cause acidity.
Normally, there are some protective mechanisms against the acid, in the stomach and proximal intestine. But an imbalance between the protective mechanisms and the level of acid secretion can cause acidity.
Friday, July 27, 2007
For Teenagers with Depressions
Introduction
Been there, done that, bought the t-shirt. Of course, it was over twenty years ago, but I still remember with painful clarity what it was like to be a teenager with depression. The sadness, the feeling of helplessness, the belief that it was part of my personality and the conviction that something was wrong. I just didn't know what it was. At that time, in the late '70s, no one really did. The medical community didn't believe children, including teenagers, could suffer from depression. Fortunately, now things are different, to some extent. There still is a lot of misunderstanding about what clinical depression is, so many teens don't get help, either because they don't realize they have depression, or because it's hard for them to get help.
Symptoms of Depression
How Does It Feel?
You're sad all the time, and/or you feel anxious or numb.
You feel hopeless about everything.
You feel guilty.
You feel worthless.
You have a lot of physical problems (stomachaches, headaches, chest pain) that don't seem to have any cause.
You feel irritable (everything and everyone annoys you).
You have very little energy and you're tired all the time.
You feel restless and fidgety.
You have difficulty concentrating on anything.
You're thinking about suicide or death a lot.
How It May Be Affecting Your Life
Your grades have dropped.
You're sleeping a lot or having trouble sleeping.
You've gained or lost weight.
You don't want to spend time with your friends anymore.
You have no interest in things you used to like doing.
You cry a lot for no particular reason.
How Do I Tell My Parents?
This is a tough one, and a question I get fairly often. First of all, let's assume that your parents are loving, stable and have your best interests at heart. They may still unknowingly make it difficult for you to get help. They may say, "What do you have to be depressed about?" or tell you that your feelings will pass and are a normal part of being a teenager. There are two factors at work in this case. One is denial. No parent wants to think something is wrong with their child, especially something like mental illness which has so much stigma attached to it. They may feel guilty or deny what is happening because they feel helpless to take care of you, the way they used to be able to put a bandaid over a scraped knee. The second factor is lack of knowledge on their part. They are not alone in this - over 70% of adults surveyed believed that a depressed person just needed to pull himself/herself together. In this case, it's not their fault that they don't know enough about depression, and probably just need to be educated. Once you present them with some information, they will probably be eager to get help for you.
I know that you may not have parents like that. Let's assume that your parents are self-involved or have their own problems like addiction or are abusive. In this case you'll have to be strong and get help on your own. It's hard that your parents can't be there for you when you need them, but chances are that you're used to taking care of yourself. If you have depression it's very difficult to do anything positive, but you have to get help. You can't let it ruin your life.
Been there, done that, bought the t-shirt. Of course, it was over twenty years ago, but I still remember with painful clarity what it was like to be a teenager with depression. The sadness, the feeling of helplessness, the belief that it was part of my personality and the conviction that something was wrong. I just didn't know what it was. At that time, in the late '70s, no one really did. The medical community didn't believe children, including teenagers, could suffer from depression. Fortunately, now things are different, to some extent. There still is a lot of misunderstanding about what clinical depression is, so many teens don't get help, either because they don't realize they have depression, or because it's hard for them to get help.
Symptoms of Depression
How Does It Feel?
You're sad all the time, and/or you feel anxious or numb.
You feel hopeless about everything.
You feel guilty.
You feel worthless.
You have a lot of physical problems (stomachaches, headaches, chest pain) that don't seem to have any cause.
You feel irritable (everything and everyone annoys you).
You have very little energy and you're tired all the time.
You feel restless and fidgety.
You have difficulty concentrating on anything.
You're thinking about suicide or death a lot.
How It May Be Affecting Your Life
Your grades have dropped.
You're sleeping a lot or having trouble sleeping.
You've gained or lost weight.
You don't want to spend time with your friends anymore.
You have no interest in things you used to like doing.
You cry a lot for no particular reason.
How Do I Tell My Parents?
This is a tough one, and a question I get fairly often. First of all, let's assume that your parents are loving, stable and have your best interests at heart. They may still unknowingly make it difficult for you to get help. They may say, "What do you have to be depressed about?" or tell you that your feelings will pass and are a normal part of being a teenager. There are two factors at work in this case. One is denial. No parent wants to think something is wrong with their child, especially something like mental illness which has so much stigma attached to it. They may feel guilty or deny what is happening because they feel helpless to take care of you, the way they used to be able to put a bandaid over a scraped knee. The second factor is lack of knowledge on their part. They are not alone in this - over 70% of adults surveyed believed that a depressed person just needed to pull himself/herself together. In this case, it's not their fault that they don't know enough about depression, and probably just need to be educated. Once you present them with some information, they will probably be eager to get help for you.
I know that you may not have parents like that. Let's assume that your parents are self-involved or have their own problems like addiction or are abusive. In this case you'll have to be strong and get help on your own. It's hard that your parents can't be there for you when you need them, but chances are that you're used to taking care of yourself. If you have depression it's very difficult to do anything positive, but you have to get help. You can't let it ruin your life.
Wednesday, July 25, 2007
How to prevent acne
Natural treatments for acne are the only treatments that are completely harmless in your battle against acne. The only way that you can prevent acne is either through very harsh prescribed antibiotics or through safe and effective natural treatments. I am going to share some things with you that you can do to treat and prevent acne.
One thing that you can do to treat and prevent acne is to use toothpaste on swelling and red pimples. Toothpaste will actually help reduce the swelling and redness a whole lot in a little amount of time. Take some regular toothpaste and put it on the affected areas right before you go to bed. Leave in on your face overnight and in the morning you should see a big difference in the swelling and redness.
Another thing that will help prevent and treat acne is to drink a lot of water each day. Make sure that you drink 10-12 full glasses of water each day. Water will flush out the toxins that are causing acne and will help your skin a whole lot. It doesn’t get much easier than water as a natural treatment for acne.
You also want to make sure that you eat plenty of fruits and vegetables each day. They will help with water intake and provide your body with a lot of great vitamins and minerals that will help fight off acne.
Another great thing to use to treat acne is a lemon face wash. With the skin of a lemon and warm water, wash your face gently. Let the water and lemon juice stand on your face for around thirty minutes to do its magic. You will be amazed at the results within a week or two.
Acne can be hard to treat and prevent if you don’t know what to do to treat it. There is a lot of guess work when you go to the doctor and get on harsh medicines. They will try one thing, and if it doesn’t work, will go to another. This can lead to a lot of harm to your body. The great thing about natural treatment is that there will never be any harm and you will be able to get rid of acne a lot faster and keep it off.
Another tip to help treat and prevent acne is to stay out of the kitchen. When foods are frying grease becomes airborne and settles on your face and skin. This will clog your pores and will cause your acne to get worse than it already is. So, if there is food frying, go the other way.
The most important thing I want you to remember is that you need to stop popping pimples. Popping pimples spreads that bacteria causing more acne, and can also push the pus further down into the skin causing cystic acne. So, the next time you find yourself picking and popping, try to stop. I know it is hard looking at that ugly pimple, but try to hold back so that your skin can heal.
One thing that you can do to treat and prevent acne is to use toothpaste on swelling and red pimples. Toothpaste will actually help reduce the swelling and redness a whole lot in a little amount of time. Take some regular toothpaste and put it on the affected areas right before you go to bed. Leave in on your face overnight and in the morning you should see a big difference in the swelling and redness.
Another thing that will help prevent and treat acne is to drink a lot of water each day. Make sure that you drink 10-12 full glasses of water each day. Water will flush out the toxins that are causing acne and will help your skin a whole lot. It doesn’t get much easier than water as a natural treatment for acne.
You also want to make sure that you eat plenty of fruits and vegetables each day. They will help with water intake and provide your body with a lot of great vitamins and minerals that will help fight off acne.
Another great thing to use to treat acne is a lemon face wash. With the skin of a lemon and warm water, wash your face gently. Let the water and lemon juice stand on your face for around thirty minutes to do its magic. You will be amazed at the results within a week or two.
Acne can be hard to treat and prevent if you don’t know what to do to treat it. There is a lot of guess work when you go to the doctor and get on harsh medicines. They will try one thing, and if it doesn’t work, will go to another. This can lead to a lot of harm to your body. The great thing about natural treatment is that there will never be any harm and you will be able to get rid of acne a lot faster and keep it off.
Another tip to help treat and prevent acne is to stay out of the kitchen. When foods are frying grease becomes airborne and settles on your face and skin. This will clog your pores and will cause your acne to get worse than it already is. So, if there is food frying, go the other way.
The most important thing I want you to remember is that you need to stop popping pimples. Popping pimples spreads that bacteria causing more acne, and can also push the pus further down into the skin causing cystic acne. So, the next time you find yourself picking and popping, try to stop. I know it is hard looking at that ugly pimple, but try to hold back so that your skin can heal.
Sunday, July 15, 2007
Overweight and Obesity
The number of overweight and obese children in the United States is growing at a phenomenal rate. On the whole, kids are spending less time exercising and more time in front of the TV, computer, or video game console. And today's busy families have fewer free moments to prepare wholesome, home-cooked meals, day in and day out. From fast food to electronics, quick and easy seems to be the mindset of many people, young and old, in the new millennium.
Since the 1960s, the number of overweight kids and adolescents in the United States has nearly doubled. Today, 10% of 2- to 5-year-olds and more than 15% of children between the ages of 6 and 19 are overweight. And a whopping 31% of adults are also obese. Studies indicate that overweight and obese adolescents have up to an 80% chance of becoming overweight and obese adults, especially if one or more parent has the same condition.
Overcoming overweight and obesity in your own children means adapting the way you and your family eat and exercise and the way you spend time together. Ensuring that your children lead a healthy lifestyle begins with you, the parent, and leading by example.
Is Your Child Overweight or Obese?
Although you may think that your child is overweight or even obese, only a doctor should make that determination (calculating your child's body mass index, or BMI, can be a good indicator).
To determine BMI, the doctor divides the child's weight by his or her height squared, or wt/ht2. (Important: To use this formula for BMI, the child's weight and height measurements must be in kilograms and meters, respectively. If you use pounds and inches, multiply the result by the conversion factor 703.) This calculation helps the doctor determine whether the child's weight is appropriate for height.
Children ranking higher than the 97th percentile for age are considered obese. Kids with a BMI score between the 85th and 97th percentile are considered overweight or at risk for becoming obese (or extremely overweight). And children who fall between the 5th and 85th percentile are considered normal weight.
For example, a 13-year-old boy who's an average 5 feet, 3 inches tall would rank as follows:
* Above 141 pounds = obese
* 124 -141 pounds = overweight
* 88 - 123 pounds = normal weight
* Below 88 pounds = underweight
There are exceptions, of course, like for those who are very muscular (because extra muscle adds to a person's body weight - but not fatness). It's important to remember that BMI is usually a good indicator - but is not a direct measurement - of body fat.
If you're worried that your child or teen may be overweight, make an appointment with your family doctor to find out for sure. Your doctor will need to evaluate your child not only for obesity, but for the medical conditions that can be associated with obesity (see below).
Before adopting any kind of diet or weight-loss plan, talk to your child's doctor, who may refer you to a registered dietitian or a weight management program. Depending on the child's weight and age, the doctor or specialist may not emphasize immediate weight loss but may focus, instead, on decreasing the rate of weight gain as the child grows.
The Effects of Overweight and Obesity
Not only are overweight and obese children at risk for serious health conditions like type 2 diabetes, high blood pressure, and high cholesterol - all once considered exclusively adult issues - they're also prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Overweight children are often the last to be chosen as playmates, even as early as preschool. They may also be more likely than average-weight children to develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia, and they may be more prone to depression, as well as substance abuse.
Being overweight or obese can be associated with medical conditions that affect a child's present and future health and have direct impact on quality of life:
* trouble with bones and joints
* shortness of breath that makes exercise, sports, or any physical activity more difficult and may
* aggravate the symptoms or increase the chances of developing asthma
* restless or disordered sleep patterns
* tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers; overweight girls may enter puberty earlier, have irregular menstrual cycles, excessive body hair growth, and may experience potential fertility problems in adulthood)
* the presence of risk factors such as hypertension, lipid problems, insulin resistance, and type 2
* diabetes, which can lead to the early development of cardiovascular disease
* liver problems
* depression
Serious adult medical conditions like heart disease, heart failure, stroke, and certain cancers can have their roots in childhood. Preventing or treating obesity in children may reduce the risk of developing these conditions as they get older.
What Causes Obesity?
There are a number of factors that can cause obesity, either alone or together. If someone becomes overweight or obese, genetic factors, lifestyle habits, or both may be involved.
Much of what we eat is quick and easy - from fat-laden fast food to microwave and prepackaged meals. Daily schedules are so jam-packed that there's little time to prepare healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, have drastically increased.
Plus, now, more than ever, life is sedentary - children spend more time playing with electronic devices, from computers to home video game systems, than actively playing outside. Television is a major culprit.
"We should be turning off the TV for every age," says Dr. Dorothy Anne Richmond, director of the Eating, Assessment and Treatment Clinic at Georgetown University Hospital in Washington, D.C. "More TV viewing is associated with being overweight."
In fact, kids younger than 8 spend an average of 2.5 hours watching TV or playing video games, and kids 8 and up spend 4.5 hours plopped in front of the TV or wriggling a joystick. In other words, once many kids get home from school, virtually all of their free time before dinner, doing homework, and getting ready for bed is spent in front of one screen or another!
And although physical education (PE) in schools can help kids get up and moving, more and more schools are cutting PE programs altogether or cutting down on the amount of time spent actually doing fitness-building physical activities. One study showed that gym classes offered third graders just 25 minutes of vigorous activity each week.
A greater reliance on "food fixes" to deal with emotions can also contribute to weight gain. Some people tend to eat more when they're feeling sad, stressed, or bored. Children will often pick up negative eating patterns from their parents. Certain endocrine problems, genetic syndromes, and medications can also be associated with excessive weight gain.
Genetics also plays a role - genes help determine how your body stores and burns fat just like they help determine other body traits. Because both genes and habits can be passed down from one generation to the next, multiple members of a family may struggle with weight.
People in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight. Studies have shown that a child's risk of obesity greatly increases if one or more parent is overweight or obese.
Overcoming Overweight and Obesity in Your Child
The key to keeping kids of all ages at a healthy weight is taking a whole-family approach. It's the "practice what you preach" mentality. Make eating and exercise a family affair. Have your children help you plan healthy meals and go grocery shopping, so they can learn how to make good food choices.
Lead by example. Watch less television and go for a walk with your children. Help them feel good about themselves and build their confidence. "Some activities are more prone to building self-esteem, like tae kwon do or other martial arts," Dr. Richardson suggests.
Avoid falling into some common food/eating behavior traps:
* Don't reward children for good behavior or try to stop bad behavior with sweets or treats. Come up with other solutions to modify their behavior.
* Don't maintain a clean-plate policy. Be aware of kids' hunger cues. Even babies who turn away from the bottle or breast send signals that they're full. If kids are satisfied, don't force them to continue eating. Reinforce the idea that they should only eat when they're hungry.
* Don't talk about "bad foods" or completely eliminate all sweets and favorite snacks from overweight children's diets. Children may rebel and overeat these forbidden foods outside the home or sneak them in on their own.
Here are some additional recommendations for children of all ages:
* Birth to age 1: Some doctors feel that breastfeeding instead of using formula may help prevent excessive weight gain because breastfed babies are more able to control their own intake and follow their own internal hunger cues. Also, limit the amount of extra sugar infants get, particularly in what they drink; instead of lots of juice, offer water when they're thirsty.
* Ages 2 to 6: Start good habits early. Limit children's TV time (better yet, leave the tube off) and increase their physical activity. Encourage children to eat healthy foods and only to eat when they're hungry. "Don't use food as a reward system," Dr. Richmond says. Make good foods fun and try to eat meals together as often as possible.
* Ages 7 to 12: Encourage children to be physically active every day, whether it's a pick-up game of soccer or playing in a community sports league. Keep your kids active at home, too, through everyday activities like walking and or playing in the yard. Even basic household chores like vacuuming, washing the car, and raking leaves burn calories.
* Ages 13 to 17: Teens like fast-food joints, but try to steer them toward healthier choices like grilled chicken sandwiches, salads, and smaller sizes. Encourage them to join a school sports team. If they don't feel very athletic, suggest a less competitive community program or alternative sport like skateboarding, inline skating, or mountain biking. Don't force any one sport or activity - help your children find what they enjoy and then support them in their efforts.
* All ages: Cut down on TV, computer, and video game time, and discourage eating while watching the tube. Try to include 5 servings of fruits and vegetables a day in their diet, plan healthy snacks, and encourage kids to eat a nutritionally balanced breakfast every day.
Most of all, let your children know you love them - no matter what their weight - and that you want to help them be happy and healthy. If you, as a parent, eat well and exercise often and incorporate healthy habits into your family's daily life, you're modeling a healthy lifestyle for your children that could last into adulthood. Instead of constantly harping on kids to eat well and be active, make it a family affair that will become second nature for both you and your children.
Since the 1960s, the number of overweight kids and adolescents in the United States has nearly doubled. Today, 10% of 2- to 5-year-olds and more than 15% of children between the ages of 6 and 19 are overweight. And a whopping 31% of adults are also obese. Studies indicate that overweight and obese adolescents have up to an 80% chance of becoming overweight and obese adults, especially if one or more parent has the same condition.
Overcoming overweight and obesity in your own children means adapting the way you and your family eat and exercise and the way you spend time together. Ensuring that your children lead a healthy lifestyle begins with you, the parent, and leading by example.
Is Your Child Overweight or Obese?
Although you may think that your child is overweight or even obese, only a doctor should make that determination (calculating your child's body mass index, or BMI, can be a good indicator).
To determine BMI, the doctor divides the child's weight by his or her height squared, or wt/ht2. (Important: To use this formula for BMI, the child's weight and height measurements must be in kilograms and meters, respectively. If you use pounds and inches, multiply the result by the conversion factor 703.) This calculation helps the doctor determine whether the child's weight is appropriate for height.
Children ranking higher than the 97th percentile for age are considered obese. Kids with a BMI score between the 85th and 97th percentile are considered overweight or at risk for becoming obese (or extremely overweight). And children who fall between the 5th and 85th percentile are considered normal weight.
For example, a 13-year-old boy who's an average 5 feet, 3 inches tall would rank as follows:
* Above 141 pounds = obese
* 124 -141 pounds = overweight
* 88 - 123 pounds = normal weight
* Below 88 pounds = underweight
There are exceptions, of course, like for those who are very muscular (because extra muscle adds to a person's body weight - but not fatness). It's important to remember that BMI is usually a good indicator - but is not a direct measurement - of body fat.
If you're worried that your child or teen may be overweight, make an appointment with your family doctor to find out for sure. Your doctor will need to evaluate your child not only for obesity, but for the medical conditions that can be associated with obesity (see below).
Before adopting any kind of diet or weight-loss plan, talk to your child's doctor, who may refer you to a registered dietitian or a weight management program. Depending on the child's weight and age, the doctor or specialist may not emphasize immediate weight loss but may focus, instead, on decreasing the rate of weight gain as the child grows.
The Effects of Overweight and Obesity
Not only are overweight and obese children at risk for serious health conditions like type 2 diabetes, high blood pressure, and high cholesterol - all once considered exclusively adult issues - they're also prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Overweight children are often the last to be chosen as playmates, even as early as preschool. They may also be more likely than average-weight children to develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia, and they may be more prone to depression, as well as substance abuse.
Being overweight or obese can be associated with medical conditions that affect a child's present and future health and have direct impact on quality of life:
* trouble with bones and joints
* shortness of breath that makes exercise, sports, or any physical activity more difficult and may
* aggravate the symptoms or increase the chances of developing asthma
* restless or disordered sleep patterns
* tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers; overweight girls may enter puberty earlier, have irregular menstrual cycles, excessive body hair growth, and may experience potential fertility problems in adulthood)
* the presence of risk factors such as hypertension, lipid problems, insulin resistance, and type 2
* diabetes, which can lead to the early development of cardiovascular disease
* liver problems
* depression
Serious adult medical conditions like heart disease, heart failure, stroke, and certain cancers can have their roots in childhood. Preventing or treating obesity in children may reduce the risk of developing these conditions as they get older.
What Causes Obesity?
There are a number of factors that can cause obesity, either alone or together. If someone becomes overweight or obese, genetic factors, lifestyle habits, or both may be involved.
Much of what we eat is quick and easy - from fat-laden fast food to microwave and prepackaged meals. Daily schedules are so jam-packed that there's little time to prepare healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, have drastically increased.
Plus, now, more than ever, life is sedentary - children spend more time playing with electronic devices, from computers to home video game systems, than actively playing outside. Television is a major culprit.
"We should be turning off the TV for every age," says Dr. Dorothy Anne Richmond, director of the Eating, Assessment and Treatment Clinic at Georgetown University Hospital in Washington, D.C. "More TV viewing is associated with being overweight."
In fact, kids younger than 8 spend an average of 2.5 hours watching TV or playing video games, and kids 8 and up spend 4.5 hours plopped in front of the TV or wriggling a joystick. In other words, once many kids get home from school, virtually all of their free time before dinner, doing homework, and getting ready for bed is spent in front of one screen or another!
And although physical education (PE) in schools can help kids get up and moving, more and more schools are cutting PE programs altogether or cutting down on the amount of time spent actually doing fitness-building physical activities. One study showed that gym classes offered third graders just 25 minutes of vigorous activity each week.
A greater reliance on "food fixes" to deal with emotions can also contribute to weight gain. Some people tend to eat more when they're feeling sad, stressed, or bored. Children will often pick up negative eating patterns from their parents. Certain endocrine problems, genetic syndromes, and medications can also be associated with excessive weight gain.
Genetics also plays a role - genes help determine how your body stores and burns fat just like they help determine other body traits. Because both genes and habits can be passed down from one generation to the next, multiple members of a family may struggle with weight.
People in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight. Studies have shown that a child's risk of obesity greatly increases if one or more parent is overweight or obese.
Overcoming Overweight and Obesity in Your Child
The key to keeping kids of all ages at a healthy weight is taking a whole-family approach. It's the "practice what you preach" mentality. Make eating and exercise a family affair. Have your children help you plan healthy meals and go grocery shopping, so they can learn how to make good food choices.
Lead by example. Watch less television and go for a walk with your children. Help them feel good about themselves and build their confidence. "Some activities are more prone to building self-esteem, like tae kwon do or other martial arts," Dr. Richardson suggests.
Avoid falling into some common food/eating behavior traps:
* Don't reward children for good behavior or try to stop bad behavior with sweets or treats. Come up with other solutions to modify their behavior.
* Don't maintain a clean-plate policy. Be aware of kids' hunger cues. Even babies who turn away from the bottle or breast send signals that they're full. If kids are satisfied, don't force them to continue eating. Reinforce the idea that they should only eat when they're hungry.
* Don't talk about "bad foods" or completely eliminate all sweets and favorite snacks from overweight children's diets. Children may rebel and overeat these forbidden foods outside the home or sneak them in on their own.
Here are some additional recommendations for children of all ages:
* Birth to age 1: Some doctors feel that breastfeeding instead of using formula may help prevent excessive weight gain because breastfed babies are more able to control their own intake and follow their own internal hunger cues. Also, limit the amount of extra sugar infants get, particularly in what they drink; instead of lots of juice, offer water when they're thirsty.
* Ages 2 to 6: Start good habits early. Limit children's TV time (better yet, leave the tube off) and increase their physical activity. Encourage children to eat healthy foods and only to eat when they're hungry. "Don't use food as a reward system," Dr. Richmond says. Make good foods fun and try to eat meals together as often as possible.
* Ages 7 to 12: Encourage children to be physically active every day, whether it's a pick-up game of soccer or playing in a community sports league. Keep your kids active at home, too, through everyday activities like walking and or playing in the yard. Even basic household chores like vacuuming, washing the car, and raking leaves burn calories.
* Ages 13 to 17: Teens like fast-food joints, but try to steer them toward healthier choices like grilled chicken sandwiches, salads, and smaller sizes. Encourage them to join a school sports team. If they don't feel very athletic, suggest a less competitive community program or alternative sport like skateboarding, inline skating, or mountain biking. Don't force any one sport or activity - help your children find what they enjoy and then support them in their efforts.
* All ages: Cut down on TV, computer, and video game time, and discourage eating while watching the tube. Try to include 5 servings of fruits and vegetables a day in their diet, plan healthy snacks, and encourage kids to eat a nutritionally balanced breakfast every day.
Most of all, let your children know you love them - no matter what their weight - and that you want to help them be happy and healthy. If you, as a parent, eat well and exercise often and incorporate healthy habits into your family's daily life, you're modeling a healthy lifestyle for your children that could last into adulthood. Instead of constantly harping on kids to eat well and be active, make it a family affair that will become second nature for both you and your children.
Saturday, July 7, 2007
travel by air -- health considerations
The volume of air traffic has risen steeply in recent years and the number of long distance flights has greatly increased. With modern long range aircraft the need for “stop-overs” has been reduced so the duration of flights has also increased. The passenger capacity of long distance aircraft is also increasing, so larger numbers of people travel aboard a single aircraft. “Frequent flyers” now form a
substantial proportion of the travelling public. According to the International Civil Aviation Organization, the annual number of flight passengers exceeded 1647 million in 2000 and although the numbers dropped the following years because of security concerns and the outbreak of severe acute respiratory syndrome (SARS), numbers are again rising and are forecasted to grow by 4.4 per cent annually until 2015.
Air travel, in particular over long distances, exposes passengers to a number of factors that may have an effect on their health and well-being. Passengers with pre-existing health problems are more likely to be affected and should consult their doctor or a travel medicine clinic in good time before travelling. Those receiving medical care and intending to travel by air in the near future should tell their medical adviser.
Health risks associated with air travel can be minimized if the traveller plans carefully and takes some simple precautions before, during, and after the flight. An explanation of the various factors that may affect the health and well-being of air travellers follows.
Cabin air pressure
Although aircraft cabins are pressurized, cabin air pressure at cruising altitude is lower than air pressure at sea level. At typical cruising altitudes in the range 11 000–12 200 metres (36 000–40 000 feet) air pressure in the cabin is equivalent to the outside air pressure at 1800–2400 metres (6000–8000 feet) above sea level. As a consequence, less oxygen is taken up by the blood (hypoxia) and gases within the body expand. The effects of reduced cabin air pressure are usually well tolerated by healthy passengers.
Oxygen and hypoxia
Cabin air contains ample oxygen for healthy passengers and crew. However, because cabin air pressure is relatively low, the amount of oxygen carried in the blood is reduced compared to sea level. Passengers with certain medical conditions, in particular heart and lung disease, and blood disorders such as anaemia, may not tolerate this reduced oxygen level (hypoxia) very well. Such passengers are usually able to travel safely if arrangements are made with the airline for the provision of an additional oxygen supply during flight.
Gas expansion
As the aircraft climbs, the decreasing cabin air pressure causes gases to expand. Similarly, as the aircraft descends, the increasing pressure in the cabin causes gases to contract. These changes may have effects where gas is trapped in the body.
Gas expansion during the climb causes air to escape from the middle ear and the sinuses, usually without causing problems. This airflow can sometimes be perceived as a “popping” sensation in the ears. As the aircraft descends, air must flow back into the middle ear and sinuses in order to equalize pressure differences. If this does not take place, the ears or sinuses may feel as if they were blocked and, if the pressure is not relieved, pain can result. Swallowing, chewing, or yawning (‘clearing the ears’) will usually relieve any discomfort. If the problem persists, a short forceful expiration against a pinched nose and closed mouth (Valsalva manoeuvre) will usually help. For infants, feeding or giving a pacifier (dummy) to stimulate swallowing may reduce the symptoms.
Individuals with ear, nose, and sinus infections should avoid flying because pain and injury may result from the inability to equalize pressure differences. If travel cannot be avoided, the use of decongestant nasal drops shortly before the flight and again before descent may be helpful.
As the aircraft climbs, expansion of gas in the abdomen can cause discomfort, although this is usually mild.
Some forms of surgery, other medical treatments, or diagnostic tests, may introduce air or other gas into a body cavity. Examples include abdominal surgery or eye treatment for a detached retina. Passengers who have recently undergone such a procedure should ask a travel medicine physician or their treating physicianhow long they should wait before undertaking air travel.
Cabin humidity and dehydration
The humidity in aircraft cabins is low, usually less than 20% (humidity in the home is normally over 30%). Low humidity may cause skin dryness and discomfort of the eyes, mouth, nose and exposed skin but presents no risk to health. Using a skin moisturizing lotion, saline nasal spray to moisturize the nasal passages, and wearing spectacles rather than contact lenses can relieve or prevent discomfort. The low humidity does not cause dehydration and there is no need to drink extra water.
Ozone
Ozone is a form of oxygen (with three, rather than two, atoms to the molecule) that occurs in the upper atmosphere and may enter the aircraft cabin together with the fresh air supply. In older aircraft, it was found that the levels of ozone in cabin air could sometimes lead to irritation of the lungs, eyes and nasal tissues. Ozone is broken down by heat and most ozone is removed by the compressors (in the aircraft engines) that provide pressurized air for the cabin. In addition, most modern long-haul jet aircraft are fitted with equipment (catalytic converters) that breaks down any remaining ozone.
Cosmic radiation
Cosmic radiation is made up of radiation that comes from the sun and from outer space. The earth’s atmosphere and magnetic field are natural shields and therefore cosmic radiation levels are lower at lower altitudes. Cosmic radiation is more intense over polar regions than over the equator because of the shape of the earth’s magnetic field and the “flattening” of the atmosphere over the poles. The population is continually exposed to natural background radiation from soil, rock and building materials as well as from cosmic radiation that reaches the earth’s surface. Although cosmic radiation levels are higher at aircraft cruising altitudes than at sea level, research so far has not shown any significant health effects for either passengers or crew.
Motion sickness
Except in the case of severe turbulence, travellers by air rarely suffer from motion (travel) sickness. Those who do suffer should request a seat in the mid-section of the cabin where movements are less pronounced, and keep the motion sickness bag, provided at each seat, readily accessible. They should also consult their doctor or travel medicine physician about medication that can be taken before
flight to help prevent problems.
Immobility, circulatory problems and Deep Vein Thrombosis (DVT)
Contraction of muscles is an important factor in helping to keep blood flowing through the veins, particularly in the legs. Prolonged immobility, especially when seated, can lead to pooling of blood in the legs, which in turn may cause swelling, stiffness, and discomfort.
It is known that immobility is one of the factors that may lead to the development of a blood clot in a deep vein, so-called “deep vein thrombosis”, or DVT. Research has shown that DVT can occur as a result of prolonged immobility, for instance during long distance travel, whether by car, bus, train or air. The World Health Organization (WHO) has set up a major research study to find out if there are any factors that might lead to the risk of DVT being higher for air travel than for other causes of immobility.
In most cases of DVT, the clots are small and do not cause any symptoms. The body is able to gradually break down the clot and there are no long-term effects. Larger clots may cause symptoms such as swelling of the leg, tenderness, soreness and pain. Occasionally a piece of the clot may break off and travel with the bloodstream to become lodged in the lungs. This is known as pulmonary
embolism and may cause chest pain, shortness of breath and, in severe cases, sudden death. This can occur many hours or even days after the formation of the clot.
The risk of developing DVT when travelling is very small unless one or more other risk factors are present. These include:
* Previous DVT or pulmonary embolism
* History of DVT or pulmonary embolism in a close family member
* Use of oestrogen therapy–oral contraceptives (“the Pill”) or hormone replacement therapy (HRT)
* Pregnancy
* Recent surgery or trauma, particularly to the abdomen, pelvic region or legs
* Cancer
* Some inherited blood-clotting abnormalities.
It is advisable for people with one or more of these risk factors to seek specific medical advice from their doctor or a travel medicine clinic in good time before embarking on a flight of three or more hours.
DVT occurs more commonly in older people. Some researchers have suggested that there may be a risk from smoking, obesity and varicose veins.
Precautions
The risk of a passenger who does not have any of the risk factors above developing DVT as a consequence of flying is small and the benefits of most precautionary measures in such passengers are unproven and some might even result in harm. Some common-sense advice for such passengers is given below.
Moving around the cabin during long flights will help to reduce any period of prolonged immobility. However, this may not always be possible and any potential health benefits must be balanced against the risk of injury that could occur if the aircraft encounters sudden and unexpected turbulence. A sensible compromise is to walk around in the cabin, e.g. go to the bathroom, once every 2–3 hours. Many airlines also provide helpful advice on exercises that can be carried out in the seat during flight. It is thought that exercise of the calf muscles can stimulate the circulation, reduce discomfort, fatigue and stiffness, and it may reduce the risk of developing DVT. Hand luggage should not be placed where it restricts movement of the legs and feet, and clothing should be loose and comfortable.
Wearing properly fitted graduated compression stockings may be helpful. These compress the calf muscles and improve the flow of blood in the deep veins. They may also help prevent the swollen ankles that are quite common on long flights. However, they need to be the correct size to be effective and passengers should therefore ask their doctor or a travel medicine clinic which type would be
appropriate for them.
In view of the clear risk of significant side effects and absence of clear evidence of benefit, passengers are advised not to use aspirin just for the prevention of travel-related DVT.
Those travellers who are at most risk of developing DVT may be prescribed specific treatments, such as injections of heparin. Cabin crew are not trained to give injections and travellers who have been prescribed these must either be taught to give the injections themselves or make other arrangements to have them given by a qualified person.
Diving
Divers should not fly too soon after diving because of the risk that the reduced cabin pressure may lead to decompression sickness (the bends). It is recommended that they do not fly until at least 12 hours after their last dive and this period should be extended to 24 hours after multiple dives or after diving that requires decompression stops during ascent to the surface. Passengers undertaking
recreational diving before flying should seek specialist advice from diving schools.
Jet lag
Jet lag is the term used for the symptoms caused by the disruption of the body’s internal clock and the approximate 24-hour (circadian) rhythms it controls. Disruption occurs when crossing multiple time zones i.e. when flying east to west or west to east. Jet lag may lead to indigestion and disturbance of bowel function, general malaise, daytime sleepiness, difficulty in sleeping at night, and reduced physical and mental performance. Its effects are often combined with tiredness due to the journey itself. Jet lag symptoms gradually wear off as the body adapts to the new time zone.
Jet lag cannot be prevented but there are some ways to reduce its effects (see below). Travellers who take medication according to a strict timetable (e.g. insulin, oral contraceptives) should seek medical advice from their doctor or a travel medicine clinic before their journey.
General measures to reduce the effects of jet lag
* Be as well rested as possible before departure, and rest during the flight. Short naps can be helpful.
* Eat light meals and limit consumption of alcohol. Alcohol increases urine output which can result in disturbed sleep by causing awakenings in order to urinate. Whilst it can accelerate sleep onset, it reduces sleep quality, making sleep less recuperative. The after effects of alcohol (hangover) can exacerbate the effects of jet lag and travel fatigue. Alcohol should therefore be consumed in moderation, if at all, before and during flight. Caffeine should be limited to normal amounts and avoided within a few hours of an anticipated period of sleep.
* Try to create the right conditions when preparing for sleep. When taking a nap during the day, eyeshades and earplugs may help. Regular exercise during the day may help to promote sleep, but avoid strenuous exercise immediately before sleep.
* At the destination, try to get as much sleep in every 24 hours as normal. A minimum block of 4 hours sleep during the local night – known as “anchor sleep” – is thought to be necessary to allow the body’s internal clock to adapt to the new time zone. If possible, make up the total sleep time by taking naps at times when feeling sleepy during the day.
* The cycle of light and dark is one of the most important factors in setting the body’s internal clock. Exposure to daylight at the destination will usually help adaptation.
* Short-acting sleeping pills may be helpful. They should be used only in accordance with medical advice and should not normally be taken during the flight, as they may increase immobility and therefore the risk of developing DVT.
* Melatonin is available in some countries and can be used to help resynchronize the body’s internal clock. It is normally sold as a food supplement and therefore is not subject to the same strict control as medications (for example, it has not been approved for use as a medication in the United States, but can be sold as a food supplement). The timing and effective dosage of melatonin have not been fully evaluated and its side effects, particularly if used long term, are unknown. In addition, manufacturing methods are not standardised and therefore the dose in each tablet can be very variable and some harmful compounds may be present. For these reasons, melatonin cannot be recommended.
* It is not always appropriate to adjust to local time for short trips of 2–3 days or less. If in doubt, seek specialist travel medicine advice.
* Individuals react in different ways to time zone changes. Frequent flyers should learn how their own body responds and adopt habits accordingly. Advice from a travel medicine clinic may be beneficial in determining an effective coping strategy.
Psychological aspects
Travel by air is not a natural activity for humans and many people experience some degree of psychological difficulty when flying. The main problems encountered are stress and fear of flying. These may occur together or separately at different times before and during the period of travel.
Stress
All forms of travel generate stress. Flying can be particularly stressful because it often involves a long journey to the airport, curtailed sleep and the need to walk long distances in the terminal building. Most passengers find their own ways of coping, but passengers who find air travel particularly stressful should seek medical advice in good time. Good planning (passports, tickets, medication, etc) and allowing plenty of time to get to the airport helps relieve stress.
Flight phobia (fear of flying)
Fear of flying may range from feeling slightly anxious to being unable to travel by air at all. It can lead to problems at work and leisure.
Travellers who want to travel by air but are unable to do so because of their fear of flying should seek medical advice before the journey. Medication may be useful in some cases but the use of alcohol “to steady the nerves” is not helpful and may be dangerous if combined with some medicines. For a longer-term solution, travellers should seek specialized treatment to reduce the psychological difficulties associated with air travel. There are many courses available that aim to reduce or cure, fear of flying. These typically include advice on how to cope with the symptoms of fear, information about how an aircraft flies, how controls are operated during a flight and, in most cases, a short flight.
Air rage
In recent years, air rage has been recognized as a form of disruptive behaviour associated with air travel. It appears to be linked to high levels of general stress but not specifically to flight phobia. It is frequently preceded by excessive consumption of alcohol.
Travellers with medical conditions or special needs
Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. Airlines may require medical clearance from their medical department/adviser if there is an indication that a passenger could be suffering from any disease or physical or mental condition that:
* May be considered a potential hazard to the safety of the aircraft
* Adversely affects the welfare and comfort of the other passengers and/or crew members
* Requires medical attention and/or special equipment during the flight
* May be aggravated by the flight.
If cabin crew suspect before departure that a passenger may be ill, the aircraft’s captain will be informed and a decision taken as to whether the passenger is fit to travel, needs medical attention, or presents a danger to other passengers and crew or to the safety of the aircraft.
Although this chapter provides some general guidelines on conditions that may require medical clearance in advance, airline policies do vary and the requirements should always be checked at the time of, or prior to, booking the flight. A good place to find information is often the airline’s own web site.
Infants
Air travel is not recommended for infants less than seven days old. If travel is absolutely necessary for babies who are over seven days, but were born prematurely, medical advice should be sought in each case. Changes in cabin air pressure may upset infants; this can be helped by feeding or giving a pacifier to stimulate swallowing.
Pregnant women
Pregnant women can normally travel safely by air, but most airlines restrict travel in late pregnancy. Typical guidelines for those who have an uncomplicated pregnancy are:
* after the 28th week of pregnancy a letter from a doctor or midwife should be carried, confirming the expected date of delivery and that the pregnancy is normal
* for single pregnancies, flying is permitted up to the end of the 36th week
* for multiple pregnancies, flying is permitted up to the end of the 32nd week.
Pre-existing illness
Most people with medical conditions are able to travel safely by air, provided that necessary precautions, such as the need for additional oxygen supply, are considered in advance.
Those who have underlying health problems such as cancer, heart or lung disease, anaemia, diabetes, are on any form of regular medication or treatment, have recently had surgery or have been in hospital, or who are concerned about their fitness to travel for any other reason, should consult their doctor or a travel medicine clinic before deciding to travel by air.
Medication that may be required during the journey, or soon after arrival, should be carried in the hand luggage. It is also advisable to carry a copy of the prescription in case the medication is lost, additional supplies are needed or security checks require proof of purpose.
Frequent travellers with medical conditions
Frequent travellers who have a permanent and stable underlying health problem may obtain a frequent traveller’s medical card from the medical or reservation department of many airlines. This card is accepted, under specified conditions, as proof of medical clearance and for identification of the holder’s medical condition.
Security Issues
Security checks can cause concerns for travellers who have been fitted with metal devices such as artificial joints, pacemakers or internal automatic defibrillators. Some pacemakers may be affected by modern security screening equipment and travellers with these should carry a letter from their doctor. Travellers who need to carry other medical equipment in their hand luggage, particularly sharp items
such as hypodermic needles, should also carry a letter from their doctor.
Smokers
Almost all airlines now ban smoking on board. Some smokers may find this stressful, particularly during long flights, and should discuss this with their doctor before travelling. Nicotine replacement patches or chewing gum containing nicotine may be helpful during the flight and the use of other medication or techniques may also be considered.
Travellers with disabilities
A physical disability is not usually a contraindication for travel. Passengers who are unable to look after their own needs during the flight (including use of the toilet and transfer from wheelchair to seat and vice versa) will need to be accompanied by an escort able to provide all necessary assistance.
The cabin crew are generally not permitted to provide such assistance and a traveller who requires it and does not have a suitable escort may not be permitted to travel. Travellers confined to wheelchairs should be advised against deliberately restricting their fluid intake before or during travel as a means of avoiding use of toilets during flights as this might detrimentally affect their general health.
Airlines have regulations on conditions of travel for passengers with disabilities. Disabled passengers should contact the airline in advance of their travel for guidance (the airline’s own web site often gives useful information).
Communicable diseases
Research has shown that there is very little risk of any infectious disease being transmitted on board the aircraft.
The quality of aircraft cabin air is carefully controlled. Ventilation rates provide a total change of air 20–30 times per hour. Most modern aircraft have recirculation systems, which recycle up to 50% of cabin air. The recirculated air is usually passed through HEPA (high-efficiency particulate air) filters, of the type used in hospital operating theatres and intensive care units, which trap particles, bacteria, fungi and viruses.
Transmission of infection may occur between passengers who are seated in the same area of an aircraft, usually as a result of the infected person coughing or sneezing or by touch (direct contact or contact with the same parts of the aircraft cabin and furnishings that other passengers touch). This is no different from any other situation where people are close to each other, such as on a train, bus or at
a theatre. Highly infectious conditions, such as influenza, are more likely to be spread to other passengers in situations when the aircraft ventilation system is not operating. A small auxiliary power unit is normally used to provide ventilation when the aircraft is on the ground, before the main engines are started, but occasionally this is not operated for environmental (noise) or technical reasons.
In such cases, when associated with a prolonged delay, passengers may be temporarily disembarked.
In order to minimise the risk of passing on infections, passengers who are unwell, particularly if they have a fever, should delay their journey until they have recovered. Airlines may deny boarding to passengers who appear to be infected with a communicable disease.
Aircraft disinsection
Many countries require disinsection of aircraft (to kill insects) arriving from countries where diseases that are spread by insects, such as malaria and yellow fever, occur. There have been a number of cases of malaria affecting individuals who live or work in the vicinity of airports in countries where malaria is not present, thought to be due to the escape of malaria-carrying mosquitoes transported on aircraft. Some countries, e.g. Australia and New Zealand, routinely require disinsection be carried out in order to prevent inadvertent introduction of species that may harm their agriculture.
Disinsection is a public health measure that is mandated by the current International Health Regulations (see Annex 3). It involves treatment of the interior of the aircraft with insecticides specified by WHO. The different procedures currently in use are as follows:
* treatment of the interior of the aircraft using a quick-acting insecticide spray immediately before take-off, with the passengers on board;
* treatment of the interior of the aircraft on the ground before passengers come on board, using a residual insecticide aerosol, plus additional inflight treatment with a quick-acting spray shortly before landing;
* regular application of a residual insecticide to all internal surfaces of the aircraft, except those in food preparation areas.
Travellers are sometimes concerned about their exposure to insecticide sprays while travelling by air. Some people have reported that they feel unwell after spraying of aircraft for disinsection. However, WHO has found no evidence that the specified insecticide sprays are harmful to human health when used as prescribed.
Medical assistance on board
Airlines are required to provide minimum levels of medical equipment on aircraft and to train all cabin crew in first aid. The equipment carried varies, with many airlines carrying more than the minimum level of equipment required by the regulations. Equipment carried on a typical international flight would include:
* one or more first-aid kits, to be used by the crew;
* a medical kit, normally to be used by a doctor or other qualified person, to treat in-flight medical emergencies;
* an automated external defibrillator (AED) to be used by the crew in case of cardiac arrest.
Cabin crew are trained in the use of first-aid equipment and in carrying out first-aid and resuscitation procedures. They are usually also trained to recognize a range of medical conditions that may cause emergencies on board and to act appropriately to manage these.
In addition, many airlines have facilities to enable crew to contact a medical expert at a ground-based response centre for advice on how to manage in-flight medical emergencies.
Contraindications to air travel
Travel by air is normally contraindicated in the following cases:
* Infants less than 7 days old;
* Women after the 36th week of pregnancy (after 32nd week for multiple pregnancies) and until seven days after delivery;
* Those suffering from:
o angina pectoris or chest pain at rest
o any serious or acute infectious disease
o decompression sickness after diving
o increased intracranial pressure due to haemorrhage, trauma or infection
o infections of the sinuses or infections of the ear and nose, particularly if the Eustachian tube is blocked
o recent myocardial infarction and stroke (time period depending on severity of illness and duration of travel)
o recent surgery or injury where trapped air or gas may be present, especially abdominal trauma and gastrointestinal surgery, cranio-facial and ocular injuries, brain operations, and eye operations involving penetration of the eyeball
o severe chronic respiratory disease, breathlessness at rest, or unresolved pneumothorax
o sickle-cell disease
o psychotic illness, except when fully controlled.
substantial proportion of the travelling public. According to the International Civil Aviation Organization, the annual number of flight passengers exceeded 1647 million in 2000 and although the numbers dropped the following years because of security concerns and the outbreak of severe acute respiratory syndrome (SARS), numbers are again rising and are forecasted to grow by 4.4 per cent annually until 2015.
Air travel, in particular over long distances, exposes passengers to a number of factors that may have an effect on their health and well-being. Passengers with pre-existing health problems are more likely to be affected and should consult their doctor or a travel medicine clinic in good time before travelling. Those receiving medical care and intending to travel by air in the near future should tell their medical adviser.
Health risks associated with air travel can be minimized if the traveller plans carefully and takes some simple precautions before, during, and after the flight. An explanation of the various factors that may affect the health and well-being of air travellers follows.
Cabin air pressure
Although aircraft cabins are pressurized, cabin air pressure at cruising altitude is lower than air pressure at sea level. At typical cruising altitudes in the range 11 000–12 200 metres (36 000–40 000 feet) air pressure in the cabin is equivalent to the outside air pressure at 1800–2400 metres (6000–8000 feet) above sea level. As a consequence, less oxygen is taken up by the blood (hypoxia) and gases within the body expand. The effects of reduced cabin air pressure are usually well tolerated by healthy passengers.
Oxygen and hypoxia
Cabin air contains ample oxygen for healthy passengers and crew. However, because cabin air pressure is relatively low, the amount of oxygen carried in the blood is reduced compared to sea level. Passengers with certain medical conditions, in particular heart and lung disease, and blood disorders such as anaemia, may not tolerate this reduced oxygen level (hypoxia) very well. Such passengers are usually able to travel safely if arrangements are made with the airline for the provision of an additional oxygen supply during flight.
Gas expansion
As the aircraft climbs, the decreasing cabin air pressure causes gases to expand. Similarly, as the aircraft descends, the increasing pressure in the cabin causes gases to contract. These changes may have effects where gas is trapped in the body.
Gas expansion during the climb causes air to escape from the middle ear and the sinuses, usually without causing problems. This airflow can sometimes be perceived as a “popping” sensation in the ears. As the aircraft descends, air must flow back into the middle ear and sinuses in order to equalize pressure differences. If this does not take place, the ears or sinuses may feel as if they were blocked and, if the pressure is not relieved, pain can result. Swallowing, chewing, or yawning (‘clearing the ears’) will usually relieve any discomfort. If the problem persists, a short forceful expiration against a pinched nose and closed mouth (Valsalva manoeuvre) will usually help. For infants, feeding or giving a pacifier (dummy) to stimulate swallowing may reduce the symptoms.
Individuals with ear, nose, and sinus infections should avoid flying because pain and injury may result from the inability to equalize pressure differences. If travel cannot be avoided, the use of decongestant nasal drops shortly before the flight and again before descent may be helpful.
As the aircraft climbs, expansion of gas in the abdomen can cause discomfort, although this is usually mild.
Some forms of surgery, other medical treatments, or diagnostic tests, may introduce air or other gas into a body cavity. Examples include abdominal surgery or eye treatment for a detached retina. Passengers who have recently undergone such a procedure should ask a travel medicine physician or their treating physicianhow long they should wait before undertaking air travel.
Cabin humidity and dehydration
The humidity in aircraft cabins is low, usually less than 20% (humidity in the home is normally over 30%). Low humidity may cause skin dryness and discomfort of the eyes, mouth, nose and exposed skin but presents no risk to health. Using a skin moisturizing lotion, saline nasal spray to moisturize the nasal passages, and wearing spectacles rather than contact lenses can relieve or prevent discomfort. The low humidity does not cause dehydration and there is no need to drink extra water.
Ozone
Ozone is a form of oxygen (with three, rather than two, atoms to the molecule) that occurs in the upper atmosphere and may enter the aircraft cabin together with the fresh air supply. In older aircraft, it was found that the levels of ozone in cabin air could sometimes lead to irritation of the lungs, eyes and nasal tissues. Ozone is broken down by heat and most ozone is removed by the compressors (in the aircraft engines) that provide pressurized air for the cabin. In addition, most modern long-haul jet aircraft are fitted with equipment (catalytic converters) that breaks down any remaining ozone.
Cosmic radiation
Cosmic radiation is made up of radiation that comes from the sun and from outer space. The earth’s atmosphere and magnetic field are natural shields and therefore cosmic radiation levels are lower at lower altitudes. Cosmic radiation is more intense over polar regions than over the equator because of the shape of the earth’s magnetic field and the “flattening” of the atmosphere over the poles. The population is continually exposed to natural background radiation from soil, rock and building materials as well as from cosmic radiation that reaches the earth’s surface. Although cosmic radiation levels are higher at aircraft cruising altitudes than at sea level, research so far has not shown any significant health effects for either passengers or crew.
Motion sickness
Except in the case of severe turbulence, travellers by air rarely suffer from motion (travel) sickness. Those who do suffer should request a seat in the mid-section of the cabin where movements are less pronounced, and keep the motion sickness bag, provided at each seat, readily accessible. They should also consult their doctor or travel medicine physician about medication that can be taken before
flight to help prevent problems.
Immobility, circulatory problems and Deep Vein Thrombosis (DVT)
Contraction of muscles is an important factor in helping to keep blood flowing through the veins, particularly in the legs. Prolonged immobility, especially when seated, can lead to pooling of blood in the legs, which in turn may cause swelling, stiffness, and discomfort.
It is known that immobility is one of the factors that may lead to the development of a blood clot in a deep vein, so-called “deep vein thrombosis”, or DVT. Research has shown that DVT can occur as a result of prolonged immobility, for instance during long distance travel, whether by car, bus, train or air. The World Health Organization (WHO) has set up a major research study to find out if there are any factors that might lead to the risk of DVT being higher for air travel than for other causes of immobility.
In most cases of DVT, the clots are small and do not cause any symptoms. The body is able to gradually break down the clot and there are no long-term effects. Larger clots may cause symptoms such as swelling of the leg, tenderness, soreness and pain. Occasionally a piece of the clot may break off and travel with the bloodstream to become lodged in the lungs. This is known as pulmonary
embolism and may cause chest pain, shortness of breath and, in severe cases, sudden death. This can occur many hours or even days after the formation of the clot.
The risk of developing DVT when travelling is very small unless one or more other risk factors are present. These include:
* Previous DVT or pulmonary embolism
* History of DVT or pulmonary embolism in a close family member
* Use of oestrogen therapy–oral contraceptives (“the Pill”) or hormone replacement therapy (HRT)
* Pregnancy
* Recent surgery or trauma, particularly to the abdomen, pelvic region or legs
* Cancer
* Some inherited blood-clotting abnormalities.
It is advisable for people with one or more of these risk factors to seek specific medical advice from their doctor or a travel medicine clinic in good time before embarking on a flight of three or more hours.
DVT occurs more commonly in older people. Some researchers have suggested that there may be a risk from smoking, obesity and varicose veins.
Precautions
The risk of a passenger who does not have any of the risk factors above developing DVT as a consequence of flying is small and the benefits of most precautionary measures in such passengers are unproven and some might even result in harm. Some common-sense advice for such passengers is given below.
Moving around the cabin during long flights will help to reduce any period of prolonged immobility. However, this may not always be possible and any potential health benefits must be balanced against the risk of injury that could occur if the aircraft encounters sudden and unexpected turbulence. A sensible compromise is to walk around in the cabin, e.g. go to the bathroom, once every 2–3 hours. Many airlines also provide helpful advice on exercises that can be carried out in the seat during flight. It is thought that exercise of the calf muscles can stimulate the circulation, reduce discomfort, fatigue and stiffness, and it may reduce the risk of developing DVT. Hand luggage should not be placed where it restricts movement of the legs and feet, and clothing should be loose and comfortable.
Wearing properly fitted graduated compression stockings may be helpful. These compress the calf muscles and improve the flow of blood in the deep veins. They may also help prevent the swollen ankles that are quite common on long flights. However, they need to be the correct size to be effective and passengers should therefore ask their doctor or a travel medicine clinic which type would be
appropriate for them.
In view of the clear risk of significant side effects and absence of clear evidence of benefit, passengers are advised not to use aspirin just for the prevention of travel-related DVT.
Those travellers who are at most risk of developing DVT may be prescribed specific treatments, such as injections of heparin. Cabin crew are not trained to give injections and travellers who have been prescribed these must either be taught to give the injections themselves or make other arrangements to have them given by a qualified person.
Diving
Divers should not fly too soon after diving because of the risk that the reduced cabin pressure may lead to decompression sickness (the bends). It is recommended that they do not fly until at least 12 hours after their last dive and this period should be extended to 24 hours after multiple dives or after diving that requires decompression stops during ascent to the surface. Passengers undertaking
recreational diving before flying should seek specialist advice from diving schools.
Jet lag
Jet lag is the term used for the symptoms caused by the disruption of the body’s internal clock and the approximate 24-hour (circadian) rhythms it controls. Disruption occurs when crossing multiple time zones i.e. when flying east to west or west to east. Jet lag may lead to indigestion and disturbance of bowel function, general malaise, daytime sleepiness, difficulty in sleeping at night, and reduced physical and mental performance. Its effects are often combined with tiredness due to the journey itself. Jet lag symptoms gradually wear off as the body adapts to the new time zone.
Jet lag cannot be prevented but there are some ways to reduce its effects (see below). Travellers who take medication according to a strict timetable (e.g. insulin, oral contraceptives) should seek medical advice from their doctor or a travel medicine clinic before their journey.
General measures to reduce the effects of jet lag
* Be as well rested as possible before departure, and rest during the flight. Short naps can be helpful.
* Eat light meals and limit consumption of alcohol. Alcohol increases urine output which can result in disturbed sleep by causing awakenings in order to urinate. Whilst it can accelerate sleep onset, it reduces sleep quality, making sleep less recuperative. The after effects of alcohol (hangover) can exacerbate the effects of jet lag and travel fatigue. Alcohol should therefore be consumed in moderation, if at all, before and during flight. Caffeine should be limited to normal amounts and avoided within a few hours of an anticipated period of sleep.
* Try to create the right conditions when preparing for sleep. When taking a nap during the day, eyeshades and earplugs may help. Regular exercise during the day may help to promote sleep, but avoid strenuous exercise immediately before sleep.
* At the destination, try to get as much sleep in every 24 hours as normal. A minimum block of 4 hours sleep during the local night – known as “anchor sleep” – is thought to be necessary to allow the body’s internal clock to adapt to the new time zone. If possible, make up the total sleep time by taking naps at times when feeling sleepy during the day.
* The cycle of light and dark is one of the most important factors in setting the body’s internal clock. Exposure to daylight at the destination will usually help adaptation.
* Short-acting sleeping pills may be helpful. They should be used only in accordance with medical advice and should not normally be taken during the flight, as they may increase immobility and therefore the risk of developing DVT.
* Melatonin is available in some countries and can be used to help resynchronize the body’s internal clock. It is normally sold as a food supplement and therefore is not subject to the same strict control as medications (for example, it has not been approved for use as a medication in the United States, but can be sold as a food supplement). The timing and effective dosage of melatonin have not been fully evaluated and its side effects, particularly if used long term, are unknown. In addition, manufacturing methods are not standardised and therefore the dose in each tablet can be very variable and some harmful compounds may be present. For these reasons, melatonin cannot be recommended.
* It is not always appropriate to adjust to local time for short trips of 2–3 days or less. If in doubt, seek specialist travel medicine advice.
* Individuals react in different ways to time zone changes. Frequent flyers should learn how their own body responds and adopt habits accordingly. Advice from a travel medicine clinic may be beneficial in determining an effective coping strategy.
Psychological aspects
Travel by air is not a natural activity for humans and many people experience some degree of psychological difficulty when flying. The main problems encountered are stress and fear of flying. These may occur together or separately at different times before and during the period of travel.
Stress
All forms of travel generate stress. Flying can be particularly stressful because it often involves a long journey to the airport, curtailed sleep and the need to walk long distances in the terminal building. Most passengers find their own ways of coping, but passengers who find air travel particularly stressful should seek medical advice in good time. Good planning (passports, tickets, medication, etc) and allowing plenty of time to get to the airport helps relieve stress.
Flight phobia (fear of flying)
Fear of flying may range from feeling slightly anxious to being unable to travel by air at all. It can lead to problems at work and leisure.
Travellers who want to travel by air but are unable to do so because of their fear of flying should seek medical advice before the journey. Medication may be useful in some cases but the use of alcohol “to steady the nerves” is not helpful and may be dangerous if combined with some medicines. For a longer-term solution, travellers should seek specialized treatment to reduce the psychological difficulties associated with air travel. There are many courses available that aim to reduce or cure, fear of flying. These typically include advice on how to cope with the symptoms of fear, information about how an aircraft flies, how controls are operated during a flight and, in most cases, a short flight.
Air rage
In recent years, air rage has been recognized as a form of disruptive behaviour associated with air travel. It appears to be linked to high levels of general stress but not specifically to flight phobia. It is frequently preceded by excessive consumption of alcohol.
Travellers with medical conditions or special needs
Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. Airlines may require medical clearance from their medical department/adviser if there is an indication that a passenger could be suffering from any disease or physical or mental condition that:
* May be considered a potential hazard to the safety of the aircraft
* Adversely affects the welfare and comfort of the other passengers and/or crew members
* Requires medical attention and/or special equipment during the flight
* May be aggravated by the flight.
If cabin crew suspect before departure that a passenger may be ill, the aircraft’s captain will be informed and a decision taken as to whether the passenger is fit to travel, needs medical attention, or presents a danger to other passengers and crew or to the safety of the aircraft.
Although this chapter provides some general guidelines on conditions that may require medical clearance in advance, airline policies do vary and the requirements should always be checked at the time of, or prior to, booking the flight. A good place to find information is often the airline’s own web site.
Infants
Air travel is not recommended for infants less than seven days old. If travel is absolutely necessary for babies who are over seven days, but were born prematurely, medical advice should be sought in each case. Changes in cabin air pressure may upset infants; this can be helped by feeding or giving a pacifier to stimulate swallowing.
Pregnant women
Pregnant women can normally travel safely by air, but most airlines restrict travel in late pregnancy. Typical guidelines for those who have an uncomplicated pregnancy are:
* after the 28th week of pregnancy a letter from a doctor or midwife should be carried, confirming the expected date of delivery and that the pregnancy is normal
* for single pregnancies, flying is permitted up to the end of the 36th week
* for multiple pregnancies, flying is permitted up to the end of the 32nd week.
Pre-existing illness
Most people with medical conditions are able to travel safely by air, provided that necessary precautions, such as the need for additional oxygen supply, are considered in advance.
Those who have underlying health problems such as cancer, heart or lung disease, anaemia, diabetes, are on any form of regular medication or treatment, have recently had surgery or have been in hospital, or who are concerned about their fitness to travel for any other reason, should consult their doctor or a travel medicine clinic before deciding to travel by air.
Medication that may be required during the journey, or soon after arrival, should be carried in the hand luggage. It is also advisable to carry a copy of the prescription in case the medication is lost, additional supplies are needed or security checks require proof of purpose.
Frequent travellers with medical conditions
Frequent travellers who have a permanent and stable underlying health problem may obtain a frequent traveller’s medical card from the medical or reservation department of many airlines. This card is accepted, under specified conditions, as proof of medical clearance and for identification of the holder’s medical condition.
Security Issues
Security checks can cause concerns for travellers who have been fitted with metal devices such as artificial joints, pacemakers or internal automatic defibrillators. Some pacemakers may be affected by modern security screening equipment and travellers with these should carry a letter from their doctor. Travellers who need to carry other medical equipment in their hand luggage, particularly sharp items
such as hypodermic needles, should also carry a letter from their doctor.
Smokers
Almost all airlines now ban smoking on board. Some smokers may find this stressful, particularly during long flights, and should discuss this with their doctor before travelling. Nicotine replacement patches or chewing gum containing nicotine may be helpful during the flight and the use of other medication or techniques may also be considered.
Travellers with disabilities
A physical disability is not usually a contraindication for travel. Passengers who are unable to look after their own needs during the flight (including use of the toilet and transfer from wheelchair to seat and vice versa) will need to be accompanied by an escort able to provide all necessary assistance.
The cabin crew are generally not permitted to provide such assistance and a traveller who requires it and does not have a suitable escort may not be permitted to travel. Travellers confined to wheelchairs should be advised against deliberately restricting their fluid intake before or during travel as a means of avoiding use of toilets during flights as this might detrimentally affect their general health.
Airlines have regulations on conditions of travel for passengers with disabilities. Disabled passengers should contact the airline in advance of their travel for guidance (the airline’s own web site often gives useful information).
Communicable diseases
Research has shown that there is very little risk of any infectious disease being transmitted on board the aircraft.
The quality of aircraft cabin air is carefully controlled. Ventilation rates provide a total change of air 20–30 times per hour. Most modern aircraft have recirculation systems, which recycle up to 50% of cabin air. The recirculated air is usually passed through HEPA (high-efficiency particulate air) filters, of the type used in hospital operating theatres and intensive care units, which trap particles, bacteria, fungi and viruses.
Transmission of infection may occur between passengers who are seated in the same area of an aircraft, usually as a result of the infected person coughing or sneezing or by touch (direct contact or contact with the same parts of the aircraft cabin and furnishings that other passengers touch). This is no different from any other situation where people are close to each other, such as on a train, bus or at
a theatre. Highly infectious conditions, such as influenza, are more likely to be spread to other passengers in situations when the aircraft ventilation system is not operating. A small auxiliary power unit is normally used to provide ventilation when the aircraft is on the ground, before the main engines are started, but occasionally this is not operated for environmental (noise) or technical reasons.
In such cases, when associated with a prolonged delay, passengers may be temporarily disembarked.
In order to minimise the risk of passing on infections, passengers who are unwell, particularly if they have a fever, should delay their journey until they have recovered. Airlines may deny boarding to passengers who appear to be infected with a communicable disease.
Aircraft disinsection
Many countries require disinsection of aircraft (to kill insects) arriving from countries where diseases that are spread by insects, such as malaria and yellow fever, occur. There have been a number of cases of malaria affecting individuals who live or work in the vicinity of airports in countries where malaria is not present, thought to be due to the escape of malaria-carrying mosquitoes transported on aircraft. Some countries, e.g. Australia and New Zealand, routinely require disinsection be carried out in order to prevent inadvertent introduction of species that may harm their agriculture.
Disinsection is a public health measure that is mandated by the current International Health Regulations (see Annex 3). It involves treatment of the interior of the aircraft with insecticides specified by WHO. The different procedures currently in use are as follows:
* treatment of the interior of the aircraft using a quick-acting insecticide spray immediately before take-off, with the passengers on board;
* treatment of the interior of the aircraft on the ground before passengers come on board, using a residual insecticide aerosol, plus additional inflight treatment with a quick-acting spray shortly before landing;
* regular application of a residual insecticide to all internal surfaces of the aircraft, except those in food preparation areas.
Travellers are sometimes concerned about their exposure to insecticide sprays while travelling by air. Some people have reported that they feel unwell after spraying of aircraft for disinsection. However, WHO has found no evidence that the specified insecticide sprays are harmful to human health when used as prescribed.
Medical assistance on board
Airlines are required to provide minimum levels of medical equipment on aircraft and to train all cabin crew in first aid. The equipment carried varies, with many airlines carrying more than the minimum level of equipment required by the regulations. Equipment carried on a typical international flight would include:
* one or more first-aid kits, to be used by the crew;
* a medical kit, normally to be used by a doctor or other qualified person, to treat in-flight medical emergencies;
* an automated external defibrillator (AED) to be used by the crew in case of cardiac arrest.
Cabin crew are trained in the use of first-aid equipment and in carrying out first-aid and resuscitation procedures. They are usually also trained to recognize a range of medical conditions that may cause emergencies on board and to act appropriately to manage these.
In addition, many airlines have facilities to enable crew to contact a medical expert at a ground-based response centre for advice on how to manage in-flight medical emergencies.
Contraindications to air travel
Travel by air is normally contraindicated in the following cases:
* Infants less than 7 days old;
* Women after the 36th week of pregnancy (after 32nd week for multiple pregnancies) and until seven days after delivery;
* Those suffering from:
o angina pectoris or chest pain at rest
o any serious or acute infectious disease
o decompression sickness after diving
o increased intracranial pressure due to haemorrhage, trauma or infection
o infections of the sinuses or infections of the ear and nose, particularly if the Eustachian tube is blocked
o recent myocardial infarction and stroke (time period depending on severity of illness and duration of travel)
o recent surgery or injury where trapped air or gas may be present, especially abdominal trauma and gastrointestinal surgery, cranio-facial and ocular injuries, brain operations, and eye operations involving penetration of the eyeball
o severe chronic respiratory disease, breathlessness at rest, or unresolved pneumothorax
o sickle-cell disease
o psychotic illness, except when fully controlled.
Travel tips for Seniors
The free time that comes with retirement gives seniors ample opportunity to explore the globe. Seniors, in fact, make up a large proportion of the tourist market both domestically and internationally. But being a little older can make these travelers a bit more susceptible to certain travel-related health problems.
For a safe trip, heed these tips:
* Make sure your itinerary is not too demanding for you or your companions.
* Visit your doctor and dentist before an extended trip; schedule appointments enough in advance to take care of any health problems well before your departure date.
* When traveling to areas in which infectious diseases are a threat, consult your doctor several months in advance to assure time for immunizations. Many large university hospitals have travel clinics, which have the latest information on necessary immunizations, and precautions for travel to remote (and not so remote) areas. The U.S. Centers for Disease Control also maintains a web site with this information.
* If you are being treated for an ongoing medical condition, carry copies of your medical records.
* Carry a good supply of your prescription medications and keep them with you, not packed in your suitcase. Take along non-prescription pain relievers, such as aspirin or ibuprofen and over-the-counter antacids and antidiarrheal medications.
* Take along a spare pair of eyeglasses.
* When traveling to areas with poor sanitation or disease-control measures, avoid drinking unbottled water (including ice cubes and tap water for brushing your teeth). Also avoid raw and undercooked seafood as well as unpeeled fruits and vegetables. The food you eat should be fully cooked and served HOT.
* For additional protection against traveler's diarrhea, the Centers for Disease Control and Prevention recommends using Pepto Bismol or an antidiarrheal. You can take these safely, several times daily with meals, for up to three weeks --EXCEPT if you are already taking salicylate products (for example, aspirin for arthritis). If diarrhea becomes severe, or contains traces of blood, seek medical attention immediately.
* When traveling in mosquito-infested regions, use insect repellent containing the compound DEET. Mosquitoes are responsible for spreading yellow fever, dengue fever, encephalitis, and malaria.
* Check your health insurance policy. If it doesn't cover you for treatment outside the U.S.A. -- including emergency evacuation by air ambulance to a major medical center -- consider purchasing travel health insurance (ask your travel agent).
* If you need medical care while abroad, go to the largest university hospital or consult the hotel concierge.
For a safe trip, heed these tips:
* Make sure your itinerary is not too demanding for you or your companions.
* Visit your doctor and dentist before an extended trip; schedule appointments enough in advance to take care of any health problems well before your departure date.
* When traveling to areas in which infectious diseases are a threat, consult your doctor several months in advance to assure time for immunizations. Many large university hospitals have travel clinics, which have the latest information on necessary immunizations, and precautions for travel to remote (and not so remote) areas. The U.S. Centers for Disease Control also maintains a web site with this information.
* If you are being treated for an ongoing medical condition, carry copies of your medical records.
* Carry a good supply of your prescription medications and keep them with you, not packed in your suitcase. Take along non-prescription pain relievers, such as aspirin or ibuprofen and over-the-counter antacids and antidiarrheal medications.
* Take along a spare pair of eyeglasses.
* When traveling to areas with poor sanitation or disease-control measures, avoid drinking unbottled water (including ice cubes and tap water for brushing your teeth). Also avoid raw and undercooked seafood as well as unpeeled fruits and vegetables. The food you eat should be fully cooked and served HOT.
* For additional protection against traveler's diarrhea, the Centers for Disease Control and Prevention recommends using Pepto Bismol or an antidiarrheal. You can take these safely, several times daily with meals, for up to three weeks --EXCEPT if you are already taking salicylate products (for example, aspirin for arthritis). If diarrhea becomes severe, or contains traces of blood, seek medical attention immediately.
* When traveling in mosquito-infested regions, use insect repellent containing the compound DEET. Mosquitoes are responsible for spreading yellow fever, dengue fever, encephalitis, and malaria.
* Check your health insurance policy. If it doesn't cover you for treatment outside the U.S.A. -- including emergency evacuation by air ambulance to a major medical center -- consider purchasing travel health insurance (ask your travel agent).
* If you need medical care while abroad, go to the largest university hospital or consult the hotel concierge.
Chocolate reduces Bllod Pressure
Here's some good and bad news for chocoholics: Dark chocolate seems to lower blood pressure, but it requires an amount less than two Hershey's Kisses to do it, a small study suggests. The new research from Germany adds to mounting evidence linking dark chocolate with health benefits, but it's the first to suggest that just a tiny amount may suffice.
Volunteers for the study ate just over 6 grams of dark chocolate daily for almost five months - one square from a German chocolate bar called Ritter Sport, equal to about 1 1/2 Hershey's Kisses. People who ate that amount ended up with lower blood pressure readings than those who ate white chocolate.
University of Cologne researcher Dr. Dirk Taubert, the study's lead author, said the blood pressure reductions with dark chocolate were small but still substantial enough to potentially reduce cardiovascular disease risks, although study volunteers weren't followed long enough to measure that effect.
The research involved just 44 people aged 56 through 73, but the results echo other small studies of cocoa-containing foods. Cocoa contains flavanols, plant-based compounds that also are credited with giving red wine its heart-healthy benefits.
One problem is chocolate bars containing cocoa tend to have lots of calories, so Taubert and his colleagues tested small amounts containing just 30 calories each.
The study appears in Wednesday's Journal of the American Medical Association. It was funded by University Hospital in Cologne.
The results are interesting but need to be duplicated in larger, more ethnically diverse populations, said Dr. Laura Svetkey, director of Duke University's Hypertension Center.
She stressed that the study results should not be viewed as license to gorge on chocolate.
"I would be as happy as the next person if I got to eat more chocolate," she said, but cautioned that weight gain from eating large amounts of dark chocolate would counteract any benefits on blood pressure.
Study participants were otherwise healthy and mostly normal-weight German adults with mild high blood pressure or pre-hypertension, which includes readings between 120 over 80 and 139 over 89.
Average blood pressure at the start was about 147 over 86.
Every day for 18 weeks, the volunteers were instructed to eat one-square portions of a 16-square Ritter Sport bar, or a similar portion of white chocolate. White chocolate doesn't contain cocoa.
Systolic blood pressure, the top number, fell an average of nearly three points and diastolic dropped almost two points in the dark chocolate group, compared with no change in blood pressure readings in the white chocolate group.
Tests suggested that steady exposure to dark chocolate prompted chemical changes that helped dilate blood vessels and regulate blood pressure, the researchers said.
Participants were told not to eat other cocoa-containing products and to continue regular eating habits and activity levels. They also kept food diaries so researchers could see if other foods might have influenced the results.
But, said Taubert, "It is very unlikely that other factors may explain the blood pressure reduction".
Dr. Lawrence Appel of Johns Hopkins School of Medicine said the most proven non-drug methods for lowering blood pressure are losing weight and eating less salt. Eating dark chocolate might help if combined with those two, he said.
For most people, "the lower your blood pressure, the better you are. So if you can get it lower from different strategies that's good for the long term".
Volunteers for the study ate just over 6 grams of dark chocolate daily for almost five months - one square from a German chocolate bar called Ritter Sport, equal to about 1 1/2 Hershey's Kisses. People who ate that amount ended up with lower blood pressure readings than those who ate white chocolate.
University of Cologne researcher Dr. Dirk Taubert, the study's lead author, said the blood pressure reductions with dark chocolate were small but still substantial enough to potentially reduce cardiovascular disease risks, although study volunteers weren't followed long enough to measure that effect.
The research involved just 44 people aged 56 through 73, but the results echo other small studies of cocoa-containing foods. Cocoa contains flavanols, plant-based compounds that also are credited with giving red wine its heart-healthy benefits.
One problem is chocolate bars containing cocoa tend to have lots of calories, so Taubert and his colleagues tested small amounts containing just 30 calories each.
The study appears in Wednesday's Journal of the American Medical Association. It was funded by University Hospital in Cologne.
The results are interesting but need to be duplicated in larger, more ethnically diverse populations, said Dr. Laura Svetkey, director of Duke University's Hypertension Center.
She stressed that the study results should not be viewed as license to gorge on chocolate.
"I would be as happy as the next person if I got to eat more chocolate," she said, but cautioned that weight gain from eating large amounts of dark chocolate would counteract any benefits on blood pressure.
Study participants were otherwise healthy and mostly normal-weight German adults with mild high blood pressure or pre-hypertension, which includes readings between 120 over 80 and 139 over 89.
Average blood pressure at the start was about 147 over 86.
Every day for 18 weeks, the volunteers were instructed to eat one-square portions of a 16-square Ritter Sport bar, or a similar portion of white chocolate. White chocolate doesn't contain cocoa.
Systolic blood pressure, the top number, fell an average of nearly three points and diastolic dropped almost two points in the dark chocolate group, compared with no change in blood pressure readings in the white chocolate group.
Tests suggested that steady exposure to dark chocolate prompted chemical changes that helped dilate blood vessels and regulate blood pressure, the researchers said.
Participants were told not to eat other cocoa-containing products and to continue regular eating habits and activity levels. They also kept food diaries so researchers could see if other foods might have influenced the results.
But, said Taubert, "It is very unlikely that other factors may explain the blood pressure reduction".
Dr. Lawrence Appel of Johns Hopkins School of Medicine said the most proven non-drug methods for lowering blood pressure are losing weight and eating less salt. Eating dark chocolate might help if combined with those two, he said.
For most people, "the lower your blood pressure, the better you are. So if you can get it lower from different strategies that's good for the long term".
Health Care for Women
Women have been synonymous with multi tasking-juggling careers, motherhood, and household chores. This hectic lifestyle forces, health issues to take a back seat. To ensure a healthy lifestyle, it is imperative that women acquire health related literacy. Research has shown that 90% women are not concerned about their health due to lack of health care literacy, which has it’s consequences for the entire family.
Obesity in women is responsible for triggering off, a series of other health related problems. Most women would feel more positive about themselves if they could maintain an ideal body weight. Obesity however, can become a catalyst for heart disease , high blood pressure, diabetes , arthritis, back pain, some cancers, and infertility .Specific diet plans are popular but difficult to follow instead adopting healthy habits can go a long way in achieving physical and mental fitness.
Breast and ovarian Cancer : Women have been susceptible to these cancers which can turn fatal, unless detected at an early stage. Routine mammography and any changes in the breast should be evaluated by a physician. It has been proven that women over 40 years of age and in younger women with a family history of breast cancer have improved the survival rate of breast cancer patients by 2% per year over the last ten years.
Unfortunately, ovarian cancer remains more difficult to detect at the early and most curable stages. The symptoms of ovarian cancer are fairly nonspecific and often go undiagnosed. Change in urine production, bowl movements, gas production, indigestion, or weight in addition to pelvic pain, painful intercourse, or feeling of fullness should be discussed with a physician and an exam should be scheduled.
Women HealthMenopause is part of the normal life cycle of women. The average age for women to reach menopause is about 51 years. Many women welcome this new phase which life brings- liberty from pregnancy and child-raising responsibilities. However, it is important for women to seek medical advice in case menopause occurs on account of poor health or other reasons. Also post-menopausal women are at a greater risk (as much as double the risk of younger women or men) of heart attacks, cholesterol levels , which increase more rapidly in women over 50 from diet or other factors including smoking, increase the risk of heart disease.
Information and awareness can empower women to enjoy better health and lifestyle. Research and advances are continually being made in women's disease prevention, diagnosis and treatment. Women’s health and fitness requires constant attention. So why wait…Start your journey, to attain a healthy lifestyle-NOW!!
Obesity in women is responsible for triggering off, a series of other health related problems. Most women would feel more positive about themselves if they could maintain an ideal body weight. Obesity however, can become a catalyst for heart disease , high blood pressure, diabetes , arthritis, back pain, some cancers, and infertility .Specific diet plans are popular but difficult to follow instead adopting healthy habits can go a long way in achieving physical and mental fitness.
Breast and ovarian Cancer : Women have been susceptible to these cancers which can turn fatal, unless detected at an early stage. Routine mammography and any changes in the breast should be evaluated by a physician. It has been proven that women over 40 years of age and in younger women with a family history of breast cancer have improved the survival rate of breast cancer patients by 2% per year over the last ten years.
Unfortunately, ovarian cancer remains more difficult to detect at the early and most curable stages. The symptoms of ovarian cancer are fairly nonspecific and often go undiagnosed. Change in urine production, bowl movements, gas production, indigestion, or weight in addition to pelvic pain, painful intercourse, or feeling of fullness should be discussed with a physician and an exam should be scheduled.
Women HealthMenopause is part of the normal life cycle of women. The average age for women to reach menopause is about 51 years. Many women welcome this new phase which life brings- liberty from pregnancy and child-raising responsibilities. However, it is important for women to seek medical advice in case menopause occurs on account of poor health or other reasons. Also post-menopausal women are at a greater risk (as much as double the risk of younger women or men) of heart attacks, cholesterol levels , which increase more rapidly in women over 50 from diet or other factors including smoking, increase the risk of heart disease.
Information and awareness can empower women to enjoy better health and lifestyle. Research and advances are continually being made in women's disease prevention, diagnosis and treatment. Women’s health and fitness requires constant attention. So why wait…Start your journey, to attain a healthy lifestyle-NOW!!
Eyestrain and your computer screen: Tips for getting relief
Although not associated with long-term consequences, eyestrain resulting from computer use can be bothersome and uncomfortable — and may cut your work short. Minimize computer-related eyestrain by following these tips.
Your eyes hurt. Your head aches. And there you sit, peering at your computer monitor. If you're one of the many people who use computers every day — either for work or personal use — you may experience eyestrain as a result.
Eyestrain: Signs and symptoms
Common signs and symptoms include:
* Sore, tired, burning or itching eyes
* Watery eyes
* Dry eyes
* Blurred or double vision
* Headache and sore neck
* Difficulty shifting focus between monitor and paper documents in your work area
* Color fringes or afterimages when you look away from the monitor
* Increased sensitivity to light
Eyestrain associated with computer use isn't thought to have serious or long-term consequences, but it's disruptive and unpleasant. Though you may not be able to change the nature of your job or all the factors that can cause eyestrain, you can take steps to reduce the strain.
New habits can help relieve eyestrain
A few simple adjustments in how you work or surf the Internet can give your eyes a much-needed rest.
Follow these simple tips to reduce eyestrain:
* Take eye breaks. Throughout the day, give your eyes a break by forcing them to focus on something other than on your screen. Try the following exercise: Hold a finger a few inches in front of your face; focus on the finger as you slowly move it away; focus on something far in the distance and then back to the finger; slowly bring the finger back toward your face. Next, shift your focus to something farther than eight feet away and hold your eyes there for a few seconds. Repeat this exercise three times, several times a day.
* Change the pace. Try to stand up and move around at least once every hour or so. If possible, lean back and close your eyes for a few moments. At the very least, try to give yourself a five-minute rest every hour. Do other work, such as phone calls or filing, during this time.
* Blink often to refresh your eyes. Because many people blink less than normal when working at a computer, dry eyes can result from prolonged computer use. Blinking produces tears that can help moisten and lubricate your eyes. Make a conscious effort to blink more often.
Your eyes hurt. Your head aches. And there you sit, peering at your computer monitor. If you're one of the many people who use computers every day — either for work or personal use — you may experience eyestrain as a result.
Eyestrain: Signs and symptoms
Common signs and symptoms include:
* Sore, tired, burning or itching eyes
* Watery eyes
* Dry eyes
* Blurred or double vision
* Headache and sore neck
* Difficulty shifting focus between monitor and paper documents in your work area
* Color fringes or afterimages when you look away from the monitor
* Increased sensitivity to light
Eyestrain associated with computer use isn't thought to have serious or long-term consequences, but it's disruptive and unpleasant. Though you may not be able to change the nature of your job or all the factors that can cause eyestrain, you can take steps to reduce the strain.
New habits can help relieve eyestrain
A few simple adjustments in how you work or surf the Internet can give your eyes a much-needed rest.
Follow these simple tips to reduce eyestrain:
* Take eye breaks. Throughout the day, give your eyes a break by forcing them to focus on something other than on your screen. Try the following exercise: Hold a finger a few inches in front of your face; focus on the finger as you slowly move it away; focus on something far in the distance and then back to the finger; slowly bring the finger back toward your face. Next, shift your focus to something farther than eight feet away and hold your eyes there for a few seconds. Repeat this exercise three times, several times a day.
* Change the pace. Try to stand up and move around at least once every hour or so. If possible, lean back and close your eyes for a few moments. At the very least, try to give yourself a five-minute rest every hour. Do other work, such as phone calls or filing, during this time.
* Blink often to refresh your eyes. Because many people blink less than normal when working at a computer, dry eyes can result from prolonged computer use. Blinking produces tears that can help moisten and lubricate your eyes. Make a conscious effort to blink more often.
Monday, July 2, 2007
What is Psychotherapy?
Psychotherapy is the process by which feelings, issues, problems, stresses, symptoms, disorders, etc. are discussed openly, addressed and resolved appropriately. What form this process takes, whether or not it is successful and how it turns out depends a lot, in my opinion, on the dynamic between the therapist and client or clients, the willingness of the client to be an active partner in the helping and healing process and do his/her/their part towards working on and resolving issues (even if his/her/their part is just being open and honest in discussion and in giving and receiving feedback). I believe that the therapist and client are equally responsible for working out issues and problems. My role is to help you gain insight and awareness as well as to facilitate your healing and problem solving so that you can assume more control in your life with the issues that present themselves and in general. This is not to say that you are to blame for the problems that have occurred in your life, but for true healing, you need to assume responsibility for working on the problems and resolving them appropriately. Psychotherapy can assist in this process.
Subscribe to:
Posts (Atom)
