Health related information and news from around the world.

PRACTICAL MATTERS: LEGAL RIGHTS AND OBLIGATIONS-STATE LAWS THAT APPLY TO HIV INFECTION: YOUR RIGHTS TO HOUSING AND EMPLOYMENT

admin — Sat, 23 Jul 2011 11:20:03 +0000

Your rights to housing and employment-Your rights to housing and employment are the same as your right to public accommodations. In general, you have a right to whatever housing you can afford and whatever job you can carry out. In most states, refusing someone housing or employment because they have AIDS is illegal. Most states have laws forbidding discrimination on grounds of disability; and, in most states, AIDS is defined as a disability. Whether HIV infection is also defined as a disability depends on the state: ask a lawyer. Therefore, as long as you can pay your rent or mortgage and can carry out your job, you may not be refused housing or employment or be fired because of the disabling effects of AIDS. You also have a right to expect your employer to make reasonable accommodations to your disability. If your job involves heavy lifting, for instance, and you tire easily, you can ask your employer to reassign you to a less strenuous job. The general principle is that you have a right to expect your employer to modify your job in ways that do not compromise your usefulness to the job. Again, as with public accommodations, if you think you have been forced out of a job or housing because of your HIV status, file a complaint with the state human relations or civil rights commission. If the complaint involves employment discrimination, and if you win, you are entitled to back pay, attorney’s fees, and damages.*199\191\2*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: EXCESS WEIGHT – WHY IS EXCESS WEIGHT A PROBLEM? THE YO-YO SYNDROME WHY IS EXCESS WEIGHT A PROBLEM?

admin — Sat, 16 Jul 2011 11:08:11 +0000

The most ominous burden posed by being overweight is a shortening of your life span. The likelihood of dying early (compared with the average age of death of all people in the population) progressively increases the more overweight you are.Some of the increased risk of early death is a result of obesity-associated problems that produce cardiac risks of their own. For example, obese people (more than 20% overweight), especially in the younger age groups, are three times as likely to have high blood pressure or diabetes and one-and-a-half times as likely to have high cholesterol. In addition, obesity increases the risk of dying from causes not related to the heart, such as pulmonary (lung) problems.THE YO-YO SYNDROME. The risks of being overweight may not outweigh the risks of repeated weight fluctuation. Regardless of actual weight, people whose weight goes up and down because of intermittent dieting alternating with regaining the weight (the so-called yo-yo syndrome—also referred to as weight cycling) have a higher risk of coronary artery disease and death than people with more stable weights. Therefore, the best weight-loss programs look beyond a “quick fix” and help you learn a healthful way of eating throughout your lifetime.If you are not ready to make permanent changes that will keep you from ever regaining the weight, you may be better off waiting until you are more motivated. You may lose weight, but the benefit of your success may be more than undone if you simply regain it later.*264\252\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: ELEVATED CHOLESTEROL

admin — Mon, 04 Jul 2011 11:01:17 +0000

If results of a blood test show that you have an elevated cholesterol level, you have an increased risk for the development of coronary artery disease. Thus, it makes sense to do what is necessary to keep your cholesterol in an acceptable range. In fact, the American Heart Association and the National Heart, Lung, and blood Institute have concluded jointly that “the benefits of modifying serum cholesterol levels extend to men and women, young and old, those with high risk . . . and those with borderline high risk levels.”Cholesterol has become a household word in the past decade. Food advertising and labels focus on it. Cholesterol screening has become a nearly routine part of medical examinations, work-site wellness programs, and health fairs. But the bits and pieces of information you have probably heard from various sources may have failedto answer some basic questions, such as these: What is cholesterol in the first place? What constitutes an elevated cholesterol level? How much risk does an elevated cholesterol level pose, and when should you be concerned? What can you do to control your cholesterol level?*236\252\8*

HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: RELATIONSHIPS WITH DRUG USERS

admin — Wed, 29 Jun 2011 08:28:01 +0000

Resolving relationships between drug users and their caregivers is not always possible. Relationships between drug users and their parents and partners were often difficult even before an HIV diagnosis. Sometimes addiction is a family illness and everyone is participating in the addiction process: parents or partners pay bills, make excuses, solve problems, make problems bearable. Sometimes everyone in the family is a user of some sort and dependent on alcohol or drugs. Sometimes relationships cannot bear the strain of addiction, and families have already drifted apart. Sometimes, as with gayness, families have known all along. A friend of Helen’s called a hospital social worker and said, “My brother is in the hospital, probably with AIDS, probably from using drugs. He won’t tell me, and I don’t want to ask. Can you help me talk to him?” The social worker agreed to say only that the sister had expressed concerns, and set up a visit. When they got together, he told her his life was changing and he was going to need her support. “Finally,” said the sister, “we really got together. We had a wonderful time.” Some families simply accept the addiction. Helen’s family says, “This is the way Helen is. We do what we can. We just keep going.” Other families try to fight the drug problem by withholding care until the user is off drugs. When a friend of Helen’s told his mother he became infected with HIV from injecting drugs, his mother took off her shoe, hit him with it, and said she’d take care of his infection but not his drug problem, so if he wanted help he’d better get off drugs. Like Helen’s friend’s mother, caregivers often insist on detoxification as a condition for care. The decision of whether to fight the addiction or accept it is extraordinarily painful. Do you insist on detoxification and risk letting people be sick without your care and support? Or do you accept them as they are and risk letting them continue to hurt themselves? Get help with the decision from mental health professionals—psychiatrists, psychologists, social workers—or from professional drug counselors. Professional drug counselors can be found in drug rehabilitation programs and programs in psychiatric hospitals, regular hospitals, Veterans Administration hospitals, or family and children’s social service agencies. This is not to say that the relationships between drug users and their caregivers are always unstable. If the relationship was stable before HIV infection entered their lives, it will be stable afterward. Caregivers of drug users, however, often need help from mental health professionals.
*95\191\2*

COMMON COMPLICATIONS OF SPINAL CORD INJURY: BLOOD CLOTS

admin — Sat, 18 Jun 2011 08:15:38 +0000

Several types of medical complications are commonly associated with spinal cord injury, some of which we’ve already mentioned briefly. The more you know about these problems and their solutions, the better prepared you’ll be to cope with them should they arise and the more control you can exert over your health care. These complications are most common during the first few months after injury, but may arise years later.
Blood ClotsThe deep veins are the large blood vessels chiefly responsible for returning blood to the heart. A deep vein thrombosis – or blood clot – in the legs is common in the first few months after spinal cord injury. Normally, walking and otherwise moving the legs promotes circulation and prevents clots, but when the legs are immobilized, the risk of blood pooling and clotting in the legs increases.Typically, deep vein thromboses occur only in the veins of the lower leg and are not a serious problem. If they spread to the thigh, however, there is a risk of pulmonary embolism, a potentially serious complication in which a piece of a blood clot breaks off and travels through the bloodstream to the lungs. Lodged in the lung, the embolism damages lung tissue by disrupting its blood supply.The risk of deep vein thrombosis is reduced by wearing TED (thrombo-embolic deterrent) stockings, a special type of support hose that helps prevent swelling and discourages formation of blood clots in the legs. TED hose are tight fitting and maintain a constant pressure on the legs which helps to prevent blood from pooling. A sequential compression device is sometimes used only to supplement TED hose, but can be used only when lying in bed. This machine uses air bags to put intermittent pressure on the legs, another way to reduce swelling and prevent thrombosis. For some patients, elastic wrappings around the legs work better than TED hose. A low dose of a blood thinner such as heparin also prevents blood clots.
*14/156/5*

WHAT IS CANCER?

admin — Sun, 05 Jun 2011 07:49:27 +0000

Invasion means that instead of remaining contained within its own area of the body the cancer is capable of extending outside this area. A cancer of the lungs is capable of growing into other sites in the chest. A cancer in the intestine is capable of growing through the wall of the intestine and sticking to other organs. This process of invasion may carry the cancer beyond the realm of a single surgical operation and prevent a surgeon from carrying out an operation that might lead to a cure. If extensive invasion has occurred, successful curative surgery is usually not possible.The final feature of a cancer, which is the one that makes it so difficult to cure in so many cases, is its ability to spread to distant sites of the body. This process is called metastasis and metastasis occurs by the spread of cancer cells through the fluid circulations of the body, either tissue fluids called lymph or in the bloodstream. Once a cancer has spread in this way it cannot usually be cured by an operation because so many different sites within the body will be involved. In these situations the potential for cure rests upon the much less fully developed treatments with drugs of either a chemical or biological kind.Growth, invasion and spread do not occur to the same extent in all cancers. Cancers that arise in different organs of the body have very different patterns of spread and for each individual site from which a cancer can originate there will be a different chance of spread. For instance, lung cancers have a very high probability of spread. At the time of their diagnosis about three quarters of patients will have evidence of spread when they are assessed by their doctors and when tests are carried out. Therefore, only about one quarter of lung cancer patients will have any chance of cure as a result of an operation. Spread may have occurred even though it is not detected by the tests. On the other hand, cancers that arise in the brain cause damage by local growth but very rarely spread outside the brain. The chance of spread for the other commoner cancers such as breast, bowel, bladder and gynaecological cancers is intermediate between these two extremes and spread has generally occurred in between one third and two thirds of all the patients who develop the disease.These statistics allow plans to be made for assessing and treating most patients. However, even when the diagnosis is made, the doctor will be unable to tell an individual patient with certainty what the outcome of his or her cancer is going to be. If there appears to have been no spread of the cancer and it has been completely removed by an operation, cautious optimism will be due in many cases. If, however, after the tests are done and an operation has been carried out, it is discovered that some of the cancer remains, the outcome will depend upon the chance of treating the remaining cancer by means other than surgery. For some cancers, such as Hodgkin’s disease or testicular cancer in men, the chances of effecting a cure in these circumstances will remain high.Even when cures are not achieved, there remains great uncertainty about the outcome for an individual patient. The progression of a cancer varies tremendously between individual patients. Some cancers grow rapidly and others very slowly. In some cases little change may appear over a period of several years whereas in others rapid changes will occur over a few months. Although examination of the cancer in the laboratory can give important guidance, the information obtained in this way is, as yet, not very precise and there will often be a good deal of uncertainty in the information that is given to a patient.*4\194\4*

HOW A SCHOOL-AGE GIRL WITH ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER) MIGHT DIFFER IN PRESENTATION FROM A BOY?

admin — Fri, 20 May 2011 16:08:32 +0000

That is a good question, for although girls may have the same symptoms as boys, the symptoms may often look quite different. I will illustrate by telling you about Stephanie, who was first brought to see me when she was eight.
Stephanie, an eight-year-old third-graderStephanie’s mother was not aware of any possibility of ADHD, but had been persuaded by her daughter’s school to bring her in for assessment because of her tendency to daydream, fabricate stories, and not complete academic tasks. Her mother was concerned about her daughter’s emotional welfare, as she was a single parent and felt her daughter worried too much about her, frequently talking about the possibility of either her mother’s or her own death.Upon meeting Stephanie, I was struck by several things: She was very fidgety and restless and seemed unaware of herself in space, frequently bumping into furniture, knocking over a chair, or bumping into me. Neither her mother nor the school had been concerned about this, but upon careful questioning, I found that indeed, she was very physically active, always climbing on furniture, up trees, and “even walls,” her mother proudly asserted. In fact, both school and home environments were exceedingly supportive and flexible, so her activity level had never posed a problem.The next thing that struck me was Stephanie’s use of language. Like Peter, she spoke constantly. Her speech was clear, and she used an astonishing vocabulary. At times she used phrases and expressions that made her seem uncannily grown up. In many ways she came across as a small adult, very poised, articulate, and proper except for her physical activity level. Finally I was struck by a strange inauthenticity, a feeling that the true Stephanie was somehow hidden. Not only did she tell me stories about her life which I knew to be quite untrue, but her entire demeanor and affect seemed to be an act. She was charming, obviously very intelligent, and incredibly watchful. She remembered every detail of our play and sessions and would refer to them the next time I saw her. If she noticed any changes in me or my office she would speak of them or ask about them. She often tried to direct our conversations by asking me detailed questions about my life.You may wonder why I speak of Stephanie as an illustration of ADHD when she seems so vastly different from Peter, who demonstrated such an obvious and extreme case. While I do not think that ADHD describes the whole problem (in fact, it almost never does), as I began to work with Stephanie in therapy, it became clearer to me that some of her difficulties could well be the result of some of the deficits of ADHD and their impact on her early development. As the academic demands increased at school, she began to have more difficulty, fell behind in math and couldn’t focus on homework, and her impulsivity sometimes caused her social troubles. Neuropsychological testing was able to pinpoint definite attention deficits and distractibility as well as some specific visual-spatial problems that were affecting her math abilities.I soon saw that Stephanie’s superior verbal skills were masking her inability to use language to gain a clear and firm picture of herself and her emotional states. She seemed unable to use language internally to understand and process interactions with other people. The false stories and feelings she created (sometimes borrowed whole from others or from books or television) acted as a substitute for a real sense of her self and her own story. She used this “as if” world to try to impose some order on her scary and confusing mental life, with its overwhelming states of loneliness, feelings of inadequacy, and fears of abandonment and rage. Her own states frightened her, for she had no secure sense that they could be managed or understood. Her mother had suffered some significant periods of depression and traumas in her own life. Stephanie had been a challenging baby who cried a lot. Her mother had often felt overwhelmed by her and at a loss as to how to calm her. While she tried to protect Stephanie from her own despair, she feared that it must be involved in Stephanie’s sense that emotions were dangerous and had to be replaced by fiction. Stephanie experienced her emotions as overwhelming states of confusing, intense distress that could not be understood or tolerated. Instead, they had to be hidden and denied by erecting her false world. In addition, she feared that her mother was vulnerable and would be hurt or perhaps even destroyed by these emotions. I do believe these factors have been active from the beginning of Stephanie’s life and have been much compounded by the kind of problems posed by the deficits of ADHD.*22\173\2*

SKIN AND SOFT TISSUE INFECTIONS: CLOSTRIDIAL MYONECROSIS

admin — Mon, 09 May 2011 15:34:17 +0000

Pathophysiology, Microbiology, and Risk FactorsClostridial myonecrosis refers to fulminant skeletal muscle infection caused by Clostridium species. Commonly called gas gangrene, the infection has a prominent history as a complication of battlefield wounds. Prior to widespread use of antibiotics and improved surgical interventions, clostridial myonecrosis complicated as many as 5% of battlefield injuries in World War II.Clostridia are anaerobic, gram-positive rods found widely in the soil and as a colonizer of humans and animals. Following inoculation, Clostridia multiply in the anaerobic environment created by trauma, impaired blood supply, and foreign bodies. Exotoxins appear to mediate a rapidly spreading myonecrosis, and extensive gas formation is classic. Clostridium perfringens is the most common cause of clostridial myonecrosis, although other Clostridia can also cause the infection. As many as 60% to 85% of infections may additionally involve non-clostridial bacteria.Clostridial myonecrosis can be divided into three categories: posttraumatic, postoperative (non-traumatic), and spontaneous. Causes of post-traumatic clostridial myonecrosis include compound fractures, other potentially contaminated injuries, burns, injections, and decubitus ulcers. Procedures that may be complicated by postoperative clostridial myonecrosis include abdominal surgery, amputations, and other types of surgery. Diabetes, advanced age, immunosuppression, chronic edema, and chronic debilitating illnesses have also been described as risk factors for clostridial myonecrosis. Spontaneous clostridial myonecrosis is usually caused by C. septicum bacteremia, which is associated with lower gastrointestinal (particularly cecal) malignancies, diabetes, and neutropenic colitis.
Clinical PresentationFollowing the initial inoculation or traumatic event, an incubation period of 1 to 4 days is typical, but a range of 1 hour to 6 weeks has been described. Clostridial myonecrosis is classically characterized by a triad of severe pain, tachycardia out of proportion to fever, and crepitus on examination. Early signs in postoperative cases include changes in wound appearance, pain, or onset of systemic toxicity. Signs of progression include edema, bronze purplish or brown skin discoloration, mottling, and bullae with serosanguinous discharge. Hypotension, shock, severe hemolysis, and acute renal failure may occur.*122/348/5*

DISEASES OF THE SKIN: DERMATITIS

admin — Sat, 30 Apr 2011 15:04:37 +0000

This simply means inflammation of the skin and is the term so often applied when it is impossible to be more definite in diagnosis. It goes through many different forms and it is very difficult to describe it in a general way. It may differ on the various areas of the body, and no two patients seem to show precisely the same symptoms. It is just as difficult to put one’s finger on specific causes of the trouble; in some it may follow indiscretions in eating; in others it seems to be related to nervous and emotional strains. In some it may be just a redness of the skin with very little discomfort; in others it appears to cause a good deal of discomfort. It may be accompanied by swelling of the tissues of the skin, and scales may form and gradually fall away. In some people it seems to come and go without making any great change in the skin itself.Dermatitis should be regarded as a reaction of the skin to many different causes. It may be a manifestation of disorder of an internal organ, and is usually directly related to the alimentary tract. On the other hand it may be the result to some kind of drug treatment, and it is well known that contact with certain plants may produce a violent reaction of the skin. The use of X-rays and other powerful agents may cause such a reaction, and the important thing in treatment is to eliminate the irritating agent.There are some who regard chilblains as due to a localized dermatitis following the reaction of a poor circulation subjected to intense cold. Certainly measures which improve the circulation are of the greatest help in this troublesome complaint.
*27/154/5*

LEARNING MORE ABOUT CONTRACEPTIVE PILL

admin — Sat, 16 Apr 2011 12:56:12 +0000

In Great Britain over 3 million women are now using oral contraceptives, i.e. one in three women of child-bearing age. ‘The pill’ has major advantages in addition to its reliability. It has helped many heavily populated countries to achieve lowest-ever birth rates. Fewer and fewer abortions are being performed. Periods are less often painful. On the other hand women on the pill have a somewhat increased chance of migraine, depression and weight gain. And there is now rather clear evidence from the work of Drs Vessey, Mann, Oliver and Shapiro of an increased risk of diseases of the heart and circulation. Deep vein thrombosis (formation of clots in the veins of the legs) was the first to be recognized. It may lead to swelling of the leg and foot, with or without pain. If the clot is carried away in the blood stream it lodges in a lung artery; this is known as pulmonary embolism. A large clot can obstruct the circulation and may need medical treatment or an operation. Smaller clots produce symptoms like pleurisy, with sharp pain in the chest on breathing; the patient usually coughs up bloodstained phlegm.*1/202/5*