452_Health

Prostate cancer symptoms

2007-02-22T06:46:00.001-08:00

Author: Valerian D

Do you want to know what are the prostate cancer symptoms for sure ?
I hope I will not disappoint you, but basically, none.

However, the good news is more males die from heart, lung, liver, kidney, Alzheimer or accidents, other diseases than from prostate cancer, which is often detected only during an autopsy.

If you like more, put the problem another way: many more men die with
undetected prostate cancer than from it.

However it is recommended that all males have a PSA blood test every year after the age of 50, and a biopsy if any PSA test is high - some doctors say if it's over 40, others say over 50 or 60.

If the biopsy is positive and you're under 60, you may want to follow your doctor's suggestions.

Between 60 and 70, follow your heart and mind. How's your overall health else wise? How long do you expect to live (not how long do you want to live)? Would intervention improve the quality of live during your remaining years?

Over 70, it's really up in the air whether any treatment/surgery would be beneficial and add to the quality of life.

Valerian D. is a freelance writer interested in items such as prostate cancer

This article is free for republishing
Source: http://www.articlealley.com

Food and prostate cancer prevention

2007-02-22T06:45:00.002-08:00

Author: Valerian D

A family member has just died from prostate cancer. The doctor stated that this cancer is more common in high fat/low fiber diets and rather rare in high fiber/low fat diets like the traditional Japanese and vegetarian diets.

Many studies have concluded that a vegan diet lower the risk of developing prostate cancer. There are two groups - lycopene and cruciferous vegetables. As there is a weak relationship between prostate cancer prevention and tomatoes, the cruciferous vegetables consumption has an important influence in helping prostate cancer patients.

Related to lycopene vegetables, researchers have found that eating tomatoes only reduces the risk by 16% and eating the more concentrate tomato paste does increase that amount to 23%.

On the contrary, cruciferous vegetables definitely showed a greater correlation between the food and prostate cancer prevention. It can reduce your chances by as much as 40%. Of course, there was some differences in the different cruciferous vegetables, but they all are helpful. The basic action these vegetables is protect the DNA from breaking down.

One major problem regarding vegetables is their natural consumption, because the cooked food is not as good for the body in getting the needed nutriment. Researches related to nutrition process have revealed the existence of an enzyme that help plant's cell structure to release the nutriment. When the food is cooked, high temperature destroys this enzyme and the nutriment remains in the food, except for the little bit that our body can process it. The conclusion is that natural food is about 7 times stronger than if it is cooked.

The problem is how strict a diet does it take to get the benefit? Does one have to be a strict vegetarian?. My personal opinion is that a little of everything cannot harm our body. Avoid red meat as much as you can, especially organs, but eating a little bit from time to time wont be a tragedy. If you like meat very much, fish is preferable. Is also a fact, your body need calcium. You can have it from veggies, but 1-2 glasses of milk will provide the necessary intake.

Valerian D. is a freelance writer interested in items such as cancer prostate treatment

This article is free for republishing
Source: http://www.articlealley.com

Go Proactive To Treat Your Acne

2007-02-22T06:45:00.001-08:00

Author: Kanishk manchanda

Much ado about nothing! That's what you feel at times, when you read thousands of pages about treating acne. You get totally confused by having a look at the multitude of over the counter products for acne treatment. Each supposed to be better than the other! Among all this confusion, votaries of the proactive acne treatments are gaining in number.

There is another reason for support for proactive skin care products. When you recall the suffering you underwent, in treating acne, that too without adequate benefits, you feel encouraged to support the alternative method. They waited in the wings to take over.
The vast number of satisfied customers boost the market for proactive skin care products.

A medicine that works on the acne problem of one individual, will not work on the other. But proactive acne solution gets the nod from a large number of acne sufferers and they tell you about marked improvements in skin quality. For any product to find genuine acceptance in the market, it needs to have the real merit. It must address to the problem sincerely.

Proactive acne treatment is based on basic skin care products- toner, cleanser and repairing lotion. With these products, a good combination therapy is developed. The collective might of these three products confronts acne successfully in majority of the cases. The top quality of Proactive products is that they are neither harsh nor astringent. Therefore, they don't dry out your skin.

With Proactive acne treatment you get soft and healthy skin. This indeed is the bonus and helps to increase the popularity of the natural ways of curing acne.

All in all, what matters most in the realm of acne treatment, is your proper understanding of acne condition. You can get a firm view about this, only after consulting your dermatologist.

The expensive treatment need not be the best. Excessive medication may also result in complications. Some types of mild attacks of acne may not require any treatment as such at all. Just take care of your face, and don't wash it with hard and astringent soaps unnecessarily. Many natural treatments go well in case you have sensitive skin. The fear of side effects is not there as far as natural skin products are concerned.

To get more information on acne, acne medication and acne types visit http://www.acnetalks.com/pimple/magazine/edition/Acne-Treatment.htm

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Source: http://www.articlealley.com

Some Remedies for Gout

2007-02-22T06:44:00.001-08:00

Author: Arturo Ronzon

Gout attacks are sudden and often occur at night. The excruciating pain may last for days, leaving the joints inflamed and making movements painful. Gout is the result of over-production or under-excretion of uric acid. Middle-aged, over-weight males, having a family history of gout are specific victims in most cases.

Unfortunately, there exists no absolute or definite cure for gout. A sufferer may undertake some measures to alleviate the pain and leave with this affliction.

At the time of the gout attack, the affected joint should be rested at an elevation to ease the pain. The pain stems from the inflammation surrounding the joint. So it is a better option to resort to painkillers that are anti-inflammatory as well, like ibuprofen. However, is the dosage mentioned on the package fails to give relief; a doctor must be consulted before increasing the intake. Also, all painkiller medicines are not beneficial for gout attacks. Aspirin should be avoided, because it hinders the excretion of uric acid from the body and worsens the gout attack. A pack of crushed ice also has a soothing effect.

Many sufferers claim that charcoal poultice help a lot. This may occur because charcoal has the capacity to drag out toxic accumulations from the body. A mixture of powdered activated charcoal and ground flaxseed should be made into a paste with warm water. This should be applied to the affected joint, and covered with a piece of cloth or plastic sheet to hold the poultice in place. This needs to be renewed from time to time. Prevention should be taken to avoid charcoal stains on bed linen or the clothes.

Activated charcoal may also be taken orally to diminish the levels of uric acid in blood. One half to one teaspoon full amounts need to be consumed at least four times a day for effective relief.

If the entire foot is affected, a charcoal bath can be an effectual remedy. Half a cup of charcoal powder can be mixed with water to form a paste and taken in a basin large enough to hold the feet. Hot water should then be added in sufficient quantity to submerge the feet. Then the feet can be soaked in the bath for thirty minutes or one hour.

For more information about Gout?, feel free to visit us at: http://www.about-goat.info/Articles/Gout_Home_Remedy.php

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The Psychology of Acne - Coping Exercises

2007-01-30T19:17:00.000-08:00

By gcleanth

Acne can be a debilitating condition even with mild attacks. You feel as though you don’t fit in and that everyone is going to notice the blemishes straight away. You become so self-conscious of them that you cover up what you can with clothes or makeup and anything that is still showing you cover with your hand or by looking away from whoever you are speaking to.

I studied psychology for over two years and neuro-linguistic programming (NLP) for another year. NLP, to simplify, is the language of the brain. This has allowed me to understand how the human mind experiences the outside world.

The first thing that all acne sufferers need to realize is that blemishes do not attract attention. Yes, they are visible, but in actuality people are seen as packages. That is, the human brain views the world in groups. What this means is that when any person sees or thinks of anything, it is as a collaboration of many smaller things.

For example, if I say to you to think of a tree, you will most likely visualize the entire image of tree. You do not think of each individual leaf and strain of bark. You do not think of all the branches that come out. You do not think of all the dead leaves still hanging that are about to fall off or of the roots that are underground. You think of the tree as a whole. That is how you see a tree unless you stop and analyze it. And even then if you think of a leaf, you do not think of each individual vein or the slight spots of brown on it.

The same applies to people. If I were to show you a picture of your friend’s ear, unless you have spent hours staring at it you will not know whose ear it is. Why? Because memories are made of millions of individual sensory inputs. When you see a person, you see all of them at once: eyes, ears, nose, mouth, hair, body, skin colour, etc. These objects are combined together by the mind to create a ‘big picture’.

What does this mean for acne sufferers? This means that when any person sees you, unless you both sit down and they analyze your entire appearance, the acne blemishes are entirely secondary to your overall appearance.

The only reason they stand out to you is because you stand in front of the mirror and look for them, or you can feel them with your hand or you can feel the pain of the infection. Yes, I too have done this. And by doing this you focus your attention on them.

If there were a tiny red dot on a white cashmere jumper, you would only find it if you went over every square inch, bit by bit. But once you know where it is, you know exactly where to look the next time. This is the psychology of acne.

It only appears to stand out to you because you know exactly where to look - and you focus on it. And by focusing on it, you attract attention to it, even if it is subconsciously. Covering it with your hands only attracts more attention to it. Just like when flirting people touch their most attractive feature to draw attention to it, putting your hand in the exact place your acne is only DRAWS attention TO it.

Here are two quick experiments you can try to demonstrate my point. Next time you look in a mirror, focus on your eyes and get so close to the mirror that the rest of you is a blur. I guarantee you that if you stay focused on your eyes, the blemishes will be almost impossible to see. Because outside of your eyes, your face is one big object. If you don’t like that one then try standing at least five meters (about twenty feet will do) from the mirror. Again you have to see yourself as a whole.

That is the closest you can get to understanding how others see you - and even then it isn’t even close. So the next time you find yourself thinking that you don’t want to go out because you think your acne defines you, think of this experiment (however stupid it may seem) and what it has shown you.

Author Info:

George Cleanthous suffered from acne for over ten years. He now provides free information on acne, including articles on acne causes, acne treatments, acne medicine, acne 'cures', and how to deal with acne. To view George's articles, visit his online website, My Acne Review, at http://www.myacnereview.com.

Article Source: 1st Rate Articles - http://1stRateArticles.com

Man lives to 112 despite junk-food diet

2006-09-02T00:24:00.000-07:00

George Johnson, considered California's oldest living person at 112 and the state's last surviving World War I veteran, had experts shaking their heads over his junk food diet.

"He had terrible bad habits. He had a diet largely of sausages and waffles," Dr. L. Stephen Coles, founder of the Gerontology Research Group at the University of California, Los Angeles, said Friday.

The 5-foot-7, 140-pound Johnson died of pneumonia Wednesday at his Richmond home in Northern California.

"A lot of people think or imagine that your good habits and bad habits contribute to your longevity," Coles said. "But we often find it is in the genes rather than lifestyle."

Johnson, who was blind and living alone until his 110th birthday when a caregiver began helping him, built the Richmond house by hand in 1935. He got around using a walker in recent years.

Johnson was the only living Californian considered a "supercentenarian," a designation for those ages 110 or older, Coles said. His group is now in the process of validating a Los Angeles candidate who claims to be 112 years old.

Coles participated in an autopsy Thursday that was designed to study Johnson's health.

"All of his organs were extremely youthful. They could have been the organs of someone who was 50 or 60, not 112. Clearly his genes had some secrets," Coles said.

"Everything in his body that we looked at was clean as a whistle, except for his lungs with the pneumonia," Coles said. "He had no heart disease, he had no cancer, no diabetes and no Alzheimer's.

"This is a mysterious case that someone could be so healthy from a pathology point of view and that there is no obvious cause of death."

The family was in favor of an autopsy. Relatives said Johnson wanted them to allow it if it would help science.

Born May 1, 1894, Johnson's father managed the Baltimore and Ohio Railway station in Philadelphia.

Johnson was working in 1917 as a mail sorter for the U.S. Post Office when he was drafted into the Army. The war ended a year later, and he never served in combat.

Two years later, he and his wife moved to Northern California.

"It was a great adventure in those days. We were young and wanted the experience," Johnson said in a March interview with the Contra Costa Times.

The couple settled in Fresno and remained there until 1935, when they bought property in Richmond. They used lumber salvaged from dismantled buildings to build their house.

During World War II, Johnson worked at the Kaiser shipyard in Richmond and later managed the heating plant at Oak Knoll Naval Hospital in Oakland.

He remained in good health and continued driving until he was 102, when his vision began to fail.

Johnson's wife died in 1992 at the age of 92. The couple had no children.

Mass. boy dies from mosquito-borne virus

2006-09-02T00:21:00.000-07:00

A 9-year-old boy from Middleborough died Thursday from eastern equine encephalitis, the first fatality from the mosquito-borne virus in the state this year.

John Fontaine developed a fever Aug. 18 and was hospitalized two days later. He died Thursday afternoon, said Christine Powers-Perry, a spokeswoman for Children's Hospital in Boston.

The grade school student played youth football and was "like every other 9-year-old. Happy to be there. A joy to be around. Fun to watch grow," said Jim Muirhead, the program director for Mitchell Memorial Club Youth Football and Cheerleading program.

Middleborough was among the communities in southeastern Massachusetts that have undergone two rounds of aerial spraying to kill the mosquitoes that carry the virus. The first round of spraying Aug. 8 reduced the mosquito population by at least 60 percent, officials said.

The boy could have contracted the virus as early as Aug. 8, but probably got the virus the following week, according to state health officials.

John's former teammates joined more than 100 people at the Sacred Heart Church in Middleborough to mourn his death.

"It's a terrible tragedy," the boy's coach, Bill Fuller, told WLVI-TV, "this kid was 9 years old."

Two other people — a 52-year-old woman from Lakeville and a 23-year-old man from Acushnet — have contracted the virus this year.

Four people have died in the state from the virus in the last four years. There were four human cases last year, all in Plymouth County.

The virus is transmitted to humans through mosquito bites. Symptoms range from mild flu-like illness to encephalitis — inflammation of the brain — coma and death. According to state health officials, about three of every 10 human cases is fatal.

Study finds mercury fillings not harmful

2006-09-02T00:19:00.000-07:00

Silver fillings used to patch cavities aren't dangerous even though they expose dental patients to the toxic metal mercury, federal health researchers said Friday.

The
Food and Drug Administration reviewed 34 recent research studies and found "no significant new information" that would change its determination that mercury-based fillings don't harm patients, except in rare cases where they have allergic reactions.

The FDA released a draft of its review ahead of a two-day meeting next week to discuss the safety of mercury used in dentistry.

Consumer groups opposed to its use disputed the FDA's conclusions. The groups plan to petition the agency for an immediate ban on use of the cavity-filler in pregnant women.

"The science is over. There is no safe level of exposure," said Charles Brown, a lawyer for one of the groups, Consumers for Dental Choice. "The only thing standing between this and a ban is politics. They are still pretending it is a scientific question, but it isn't."

Amalgam fillings, also called silver fillings, by weight are about 50 percent mercury, joined with silver, copper and tin. Dentists have used amalgam to fill cavities since the 1800s. Today, tens of millions of Americans receive mercury fillings each year. Amalgam use has begun to decline, however, with many doctors switching to resin composite fillings, considered more appealing since they blend better with the natural coloring of teeth.

With amalgam fillings, mercury vapor is released through tooth-brushing and chewing. In general, significant levels of mercury exposure can permanently damage the brain and kidneys. Fetuses and children are especially sensitive to its harmful effects.

Scientists have found that mercury levels in the blood, urine and body tissues rise the more mercury fillings a person has. However, even among people with numerous fillings, exposure levels are well below those known to be harmful, the report said.

"If substantial scientific evidence showed that dental amalgam posed a threat to the health of dental patients, we would advise dentists to stop using it. But the best and latest available scientific evidence indicates that dental amalgam is safe," Dr. Ronald Zentz, senior director of the American Dental Association's council on scientific affairs, said in prepared remarks to be delivered Wednesday to the joint meeting of FDA experts on dental products and neurology.

Among those expected to address the joint panel is Rep. Diane Watson (news, bio, voting record), D-Calif., who has introduced legislation that would effectively ban the use of mercury in dental fillings by 2008. Watson will press the FDA for a ban and call on the agency to study the environmental impact of dental mercury, spokesman Bert Hammond said.

Also on the legislative front, Sen. Mike Enzi, R-Wyo., and other Senate colleagues have asked
President Bush's nominee to head the FDA about the safety of mercury fillings. An Enzi spokesman said the lawmaker has yet to receive Dr. Andrew von Eschenbach's answers to those questions.

Meanwhile, representatives of the National Multiple Sclerosis Society and Alzheimer's Association are expected to testify that there is no known scientific evidence to connect mercury fillings and the two diseases that are the focus of their respective groups. And Swedish and Canadian experts are to discuss how their countries regulate amalgam fillings.

The meeting likely won't be the last word in the drawn-out fight over mercury fillings. As early as the 1840s, dentists were squabbling over whether gold or mercury-silver fillings were better — a feud that led to the disbanding of the first national dental society in the United States, according to a March article in the Journal of the California Dental Association.

Some "night owl" teens may have sleep disorder

2006-09-02T00:00:00.000-07:00

As school doors open across the country, teenagers should be sure to adjust their summer sleep schedule to their new school schedule, experts advise. In other words, they should start hitting the sack earlier so that they will be able to awake earlier and be alert in morning classes.

But for teens with a sleep disorder known as delayed sleep phase syndrome, this solution may not be so simple.

"A lot of teens have a tendency to want to go to bed later; despite this, they still need eight to nine hours of sleep," Dr. Grace Pien, of the University of Pennsylvania's Division of Sleep Medicine, told Reuters Health. She noted that "recent research shows they don't perceive their need to sleep quite as acutely as younger or older adults may."

"For teens who really have a lot of trouble getting to sleep until 2, 3 in the morning," she added, "these are the kids who need to be evaluated by a sleep specialist."

Delayed sleep phase syndrome, which, Pien noted, "is a disorder where people may think they have insomnia," affects between 7 percent and 16 percent of adolescents and young adults. It is less common among older adults.

Among those affected by the disorder, the body's circadian rhythm allows them to stay awake long past what may be considered a normal bedtime. The condition can be diagnosed through an interview with a trained professional and his or her evaluation of the patient's sleep log.

There is no cure for this sleep disorder, but it can be treated by behavioral modification, such as restricting the consumption of caffeinated beverages, not exercising during or near bedtime hours and limiting light exposure from computer screens and television screens at night, the researcher said.

In some cases, Pien added, teens may need to undergo bright light therapy, to help realign their body's clock to regular sleep hours, or receive medication.

Teenagers without the disorder may also need to perform some behavioral modification to get themselves back on a normal sleep schedule after summer, "by moving their bedtime back a little each day until they get back in the right cycle, and sticking to it," Pien said.

Is Chocolate Healthy?

2006-06-25T18:46:00.000-07:00

Recent studies have shown that eating chocolate may actually be good for you. Researchers have found that raw and / or minimally processed cocoa - as is found in Yachana Jungle Chocolate - contains flavonoids similar to those found in green tea. According to preliminary studies, these antioxidants have been linked to help accomplish the following:

Decrease blood pressure
Improve circulation
Lower death rate from heart disease
Improve function of endothelial cells that line the blood vessels
Defend against destructive molecules called free radicals, which trigger cancer, heart disease and stroke
Improve Digestion and stimulate kidneys
Has been used to help treat patients with anemia, kidney stones and poor appetite

There are two different kinds of flavonoids called catechin and epicatechins. Catechins, which have recently been found to be abundant in cocoa and minimally processed chocolates such as Yachana Jungle Chocolate, could also help prevent heart disease and possibly cancer, as well as boosting the immune system, according to recent studies. Dark chocolate has also recently been found to contain more than 3 times the amount of catechins as that found in tea. Chocolate is also a good source of copper and magnesium, which helps to regulate heartbeat and blood pressure.

Of course eating large amounts of chocolate is still bad for you and could cause weight gain. But, taken in smaller quantities, it could prove to be very beneficial to your health. It all depends on the quantity and the type of chocolate that you are eating. There have been many different studies showing the possible effects of chocolate consumption on groups of participants.

One such study by the associated press entitled 'Study: Dark chocolate lowers blood pressure' printed on August 27, 2003 which appears in the Journal of the American Medical Association included 13 adults with untreated mild hypertension. Each of them ate 3-ounce chocolate bars every day for two weeks. Half of them received white chocolate while the other half got dark chocolate. Blood pressure was shown to be relatively unchanged for those who ate the white chocolate, but the dark chocolate eaters' blood pressure showed changes. Their systolic blood pressure dropped an average of 5 points and their diastolic reading dropped an average of nearly two points.

In another study conducted at Pennsylvania State University by study leader Penny Kris-Etherton, a group of participants, split into two groups, ate the same low fat diet except for one of the groups got a chocolate bar and the other group received a high-carb snack. The groups later switched snacks. Total blood cholesterol and LDL ("bad") cholesterol levels didn't vary with either snack. But, increases in HDL ("good") cholesterol and reductions in triglycerides (a heart-risky type of blood fat) were found in the people eating chocolate.

3 Easy Ways to Treat Body Acne!

2006-06-17T00:08:00.000-07:00

Are you suffering from Body acne? or Zits below the neckline? Don't worry. You are not alone! Lot's of teen get body acne. It is common in the winter months, when you are wearing piles of heavy clothing.

Sweat can clog skin pores and lead to breakouts all over. Other things that can cause body acne are tight fitting clothing ( It traps sweat against the skin, leading to clogged pores and blemishes) stress and hormones. Body acne commonly pops up on the chest and back.

Ø To zap body acne and prevent it from coming back, you can wash your body daily with a salicylic acid based cleanser. Look for this ingredient on product labels.

Ø Shower daily and be sure to shower as soon as possible anytime you have been sweating ? such as after playing sports, working outside or just being in the sun. After your shower, you can follow up by a body moisturizer that contains Alfa Hydroxy acid. This will exfoliate skin and help prevent breakouts, without drying skin out.

Ø At Nighttime you can treat body acne just like facial acne, by applying an acne zapping gel or cream at the effected parts.

Ø If your body acne is particularly bad and wont respond to this treatment after about a month, you will probably need to see a dermatologist.

Here?s The One Thing You Can Start Doing Today That Can Help Prevent Acne

2006-06-17T00:03:00.000-07:00

You probably don't know this yet but product wastes and toxic build up in your system is one of the main reasons why you have acne or why your skin breaks out.

You see, your body has 4 channels of elimination...your bowels, kidneys, lungs, and your skin. Your bowels and kidneys are the primary channels that your body expels product wastes and toxics through.

The only time that your body expels product wastes through your lungs and skin is when your bowels and kidneys are overloaded with product wastes and toxics or when your bowels becomes sluggish.

When this happens, your body will take some of the product waste and expel it through your lungs and skin (your secondary channels of elimination). Resulting in acne breakout.

However, you can prevent this from happening by increasing "fiber" intake. Fiber will absorb these toxins and product waste, and help your bowels sweep them out of your system fast.

So by taking enough fiber, you'll be able to speed up your bowels transit time thus, preventing your body from expelling toxics through your skin and preventing acne.

So your next step is to start eating the type of foods that contains the highest amount of fiber.

What types of food contains the highest amount of fiber? Fruits and non-starchy vegetables.

Fruits such as apples, bananas, oranges, raspberries, and strawberries. And vegetables such as broccoli, Brussels sprouts, spinach, parsnips, and potatoes. These contains the highest amount of fiber.

But this does not mean that you go out and eat as much of these high fiber foods as you can.

You should only consume enough so that your bowel transit time is between 12 to 18 hours. In other words, try not to consume too much fiber in day or else your transit time may be too fast causing nutrients to pass through your system without being absorbed. So if your transit time is under 12 hours, you may want to reduce the amount of fibers consume each day.

However, if your transit time is more than 24 hours then you really need to consume more fiber intake or else your body will start expelling these product wastes and toxins through your skin (resulting in acne breakout).

For me it's about 32 grams of fiber a day but it may be different for you, so you should really test it out for yourself and see how much grams of fiber you should be consuming each day. It's probably best to start out with 30 grams of fiber a day and go on from there.

How much grams of fiber does each fruit and vegetable contain? For the fruits I've listed above it's about 3 grams each and the vegetables are about 2 grams each. However, I do recommend you consume more vegetables than fruits because fruits are high in natural sugar.

While consuming more fiber alone will not stop acne it can help in preventing acne. And that's one portion of the pie in fighting acne.

Why Drinking Enough Water Can Help Keep Acne Away

2006-06-17T00:01:00.000-07:00

You probably don't know this yet but product wastes and toxic build up in your system is one of the main reasons why you have acne or why your skin breaks out.

The only time that your body expels product wastes through your lungs and skin is when your bowels and kidneys are overloaded with product wastes and toxics.

This can happen when you're not drinking enough water. You see, water is the main carrier of nutrients throughout your body and is quite possibly the single most important contributor to healing and preventing acne flare-ups.

Drinking enough water will dissolve waste products in your system so it can be easily remove and flush out. Without enough water, there won't be much to dissolve these product wastes and toxics...causing it to build up in your system and causing your body to expel these product wastes and toxics through your lungs and skin.

And this can and will result in acne breakout.

How much water should you be drinking each day to dissolve product waste and flush out toxins from your body?

Although some would say you drink at least 8 glasses of water a day and some would say 3 liters a day or half of your bodyweight in ounces a day.

I say, you should drink only enough to see that your urine is mostly clear, which is probably much more than what you're drinking now.

But I wouldn't recommend you going overboard because drinking too much water will also flush out electrolyte minerals out of your system (which is not good).

So how do you know how much water you should be drinking each day?

Test!

Start by drinking 7 glasses of water a day for the next 2 to 3 days. If you see that your urine is clear then 7 glasses of water a day is what you should be drinking.

But remember, you don't want to go overboard so you may want to try drinking 6 glasses of water a day. If you see that your urine is kind of yellow drinking 6 glasses of water a day then you should stick to 7 glasses of water a day. If not then you should stick with 6 glasses of water a day.

But if you find that 7 glasses of water a day is not enough. Then you should try drinking more glasses of water a day and see the results.

What you're trying to do here is make sure you're drinking enough water each day. Not too much or too little. Another important thing you should know...

You can't just drink any type of water. There are certain types of water that's full of toxins (such as tap water). The 2 types of water I recommend you drink is distilled water and purified water. Distilled water has no minerals, which means if you drink it, it will leach out any unwanted non-organic minerals from your system.

But since distilled water has no minerals (it's just dead water), you will need to drink some purified water to oxygenate your system. However, you do need to drink them separately and drink it on an empty stomach for it to be effective.

While water alone will not eliminate your acne it will greatly assist your skin in remaining healthy and that will be one portion of the pie in fighting acne.

Why You Will Never Achieve Long-Lasting Acne Free Skin With The ?External? Acne Treatments Today

2006-06-16T23:59:00.000-07:00

Most of the acne treatments out there just don't have what it takes to get rid of acne.

This is simply because most (or shall I say all) of the acne treatments out there are doing, is just masking the symptoms of acne. And doing absolutely nothing to stop the real cause of acne. Therefore, once you stop using acne treatment, acne will come back again and again every time you stop using it.

This is why acne sufferers continue buy acne treatments month after month (year after year).

And in some cases, most acne treatments will make your acne conditions worse. This is because some acne treatments contains harsh chemical that's not good for your skin, causing it to irritate, itch, peel, and skin dryness.

If you really want to get rid of your acne and achieve a long-term acne free skin. You have to correct the very root problem that is causing acne. You need an internal acne treatment and not the external acne treatments you see today.

You should know that acne is just an external feedback to a much larger problem happening on the inside of your body, and not your skin itself.

So you really need to stop looking at your skin as the problem because acne has nothing to do with your skin and everything to do with what's happening on the inside of your internal system.

Are You Sure Your Diet Doesnt Affect Your Acne?

2006-06-16T23:58:00.000-07:00

For those of you who have met me, you know I am often mistaken for being an 18 year old when in actuality I'm 27. I'm currently teaching after-school cooking classes in Brooklyn to middle school kids and I was mistaken for one of the students by an employee. I almost got in trouble for being in the hallway!

All I can say is that the organic food and vegetables must be working!

...and I use Oil of Olay (with SPF) everyday although I am searching for a more natural product that I will like.

Developing Acne

Around the age of 18 I started developing a mild case of adult acne. It actually wasn't too bad, but I noticed it because my face had always been very clear. I was stumped as to why this was happening.

I solved the problem, and I thought it would be great to share my discovery with you. Not only to show how food does affect our skin, but also because maybe it will work for you too!

Caffeine

Around the same time I developed the acne I was also becoming a social coffee drinker. It took me awhile to put two and two together, but I eventually experimented with eliminating the coffee. Guess what! The pimples went away.

Hmmm... So what could it have been? I then figured out that my skin would break out if I had soda, chocolate, or tea. The common factor was caffeine. In fact, I was so sensitive that even decaf caused me to have blemishes. (Decaf still contains a small amount of caffeine leftover from the process.) I also later discovered that alcohol would have the same effect.

I'm not a dermatologist, and many of them will tell you that what you eat does not affect whether you have acne or not, but I will tell you from first hand experience that it does. What seemed to be happening was that caffeine or alcohol would stimulate oil production in my skin (probably because of increased hormone levels). The oil was probably being produced at a faster rate than my skin was able to naturally slough off dead skin cells, therefore my pores would get clogged.

This is my non-technical version of what I think must've been happening

My Skin Is CLEAR!

I've eliminated all forms of caffeine and alcohol and my skin is clear. Of course I get the occasional zit, but not often. I also find that I need to wash my face with a washcloth or exfoliater in the evening and that will keep the occasional pimple to a minimum.

Teenage Acne Revisited

2006-06-16T23:57:00.000-07:00

- A lot has been written about the causes of teenage acne and still there does not appear to be consensus on this topic. However, it is becoming clear that it is a problem that needs to be treated from the inside as well as on the outside It is therefore necessary for the teenager to find products that treat the condition both internally and externally,

- Rooibos tea has received a lot of attention from scientists over the last 15 years and Japanese scientists in particular have done a lot of research on the Tea and its beneficial properties. Thanks to Rooibos Tea's natural age fighting properties it is excellent for use in skin and healthcare products. Rooibos Extract, derived from the Rooibos plant Aspalathus linearis is not only full of antioxidants, it is also has anti-bacterial, anti-inflammatory and anti-allergic properties. Aspalathin the anti-allergic property occurs only in the Rooibos plant.

- Products containing Rooibos extract are well suited for the particular needs of the teenage years. Rooibos skincare products will clean the skin without disturbing the pH-balance of the skin or dehydrating the skin. It will cleanse the pores, get rid of impurities, and help to keep the pores from blocking up again. The advantage of the antibacterial property is that it promotes the healing of problem skin in a natural way. It helps to reduce the incidence and spreading of bacterial infections.

- It is even helpful to add cooled Rooibos tea to the rinsing water when washing the face. Applied topically it has a soothing effect on the skin.

- Modern foods are often over-refined and full of additives and teenagers frequently choose to snack on poor quality food. This can lead to nutritional deficiencies, which could have a major impact on the physical condition of the skin. It is therefore important that teenagers take a balanced supplement of vitamins, minerals, and essential fatty acids geared to their specific needs.

 A new train of thought is that it is essential for teenagers to use a health supplement that contains Vitamin B5. Vitamin B5 is one of the new Buzzwords in the fight against acne. Vitamin B5 supplementation strengthens the immune system, helps the body to deal with stress, and increases stamina.

- Green Rooibos tea is The New drink for the New Generation.

- Green Rooibos tea is unfermented Rooibos tea and it contains 100 times more anti-oxidants than normal Rooibos tea and 10 times more aspalathin ? the anti-allergic flavonoid.

- The Annique GRAB Teenage range promotes a healthy, clear complexion by also tackling the problem at its source.

An Acne Fetish is No Laughing Matter

2006-06-16T23:56:00.000-07:00

While it may be easy to scoff off an acne fetish with remarks like, "I don't have that problem," this condition is more common than properly acknowledged. A fetish is an object of unreasonably obsessive attention or regard. Thus, extreme attention given to zits and pimples characterize an acne fetish. Two clinical forms of an acne fetish include excoriated acne and imagined acne.

Excoriated acne occurs when an acne patient continues to pick at or squeeze acne formations on their face, never allowing the skin to heal. This constant picking aggravates the acne condition and often times leaves severe scarring. Imagined acne happens when a patient is convinced she has acne but in reality does not. This person may have one small pimple and blow the existence of the pimple out of proportion and view it as a severe case of acne.

Underlying both of these acne fetishes is the fear of being ugly, or dysmorphophobia. It's an easy psychological state to acquire in a society that increasingly places more value on superficial looks than personal traits.

Steps to combating an acne fetish include: Spending less time self-critiquing in front of the mirror; and Embellishing your talents.

Even a hiatus from mirror visits may help an acne fetish. If you do look in the mirror, focus on elements of your face besides the zits. For instance, look at the color of your eyes or the size of your lips, without criticizing of course. You may have lovely eyelashes or the perfect eyebrows. Whenever you look in the mirror stop making negative judgments about yourself. If you do find yourself ridiculing yourself and wanting to burst a zit in a rushed desire for clear skin, just remind yourself that every zit that you prematurely pop may encourage the formation of 3 completely new zits.

Focus on your greatest assets as a person, or cultivate new skills. You may be an awesome guitar player or fabulous singer, give yourself recognition for your strengths. Do something that you've always wanted to do, but did not do because you felt having acne precludes you from this activity.

In the final analysis, healing an acne fetish starts with recognizing that this condition has serious medical repercussions. An acne fetish can debilitate one's self-esteem while encouraging needless facial scarring. If you think you have an acne fetish, you can get help from a qualified dermatologist, psychologists or just talk it over with some really cool and understanding friends.

The Kill the Bacterial and Cure the Acne Myth

2006-06-16T23:55:00.000-07:00

All life forms strategize to survive and procreate. Weeds, worms, birds, fungi and bacteria all work to sustain their own lives on this planet. In fact, we humans survive because of the biological games constantly unfolding in our mist.

Propionibacterium acnes, or p acne bacteria, are no different. They want and need to survive. Skin bacteria perform an important function. Bacteria use the secretions of our sweat and sebaceous glands (sebum is the oil that makes our skin look shiny) as nutrients. P acnes that are in balance with your body prevent colonization by more harmful bacteria.

P acne bacteria only encourage acne formations if the production of oil on the face is excessive. This surplus of oil of prompted by hormonal, nutritional, environmental and/or psychological changes in the body. So to prevent acne, you do not what to kill bacteria per se, but keep the amount of bacteria on your skin at an optimal balance. You optimize your oil secretion by understanding and controlling your response to hormonal, nutritional, environmental and/or psychological changes.

If we upset the balance of bacteria in our bodies by taking antibiotics, our resident flora is upset and this enables harmful bacteria (such as Staphylococcus aureus and Acinetobacter baumannii) to colonize our skin. What's more, antibiotics can destroy the balance of intestinal flora and cause constipation.

In short, using antibiotics on bacteria is a battle amongst intelligent parties involving the bacteria, the body, and the human mind. If we fail to appreciate the bacteria as bodily maintenance workers and continue dousing them with antibiotics, the bacteria just become more resistant to our antibiotics. The bacteria are practiced at playing dead as a tactic for survival. Even people who have used the strongest acne drug on the market, Accutane, have witnessed the cunning behavior of bacteria as zits reappear some months after using this course of acne treatment. These people have discovered that bacteria do not die; they silently and strategically multiply. If you do not want your bacteria out of balance, do not provide them an environment conducive to acne

Shopping for Sensitive Skin: A Guide for the Acne and Rosacea Conscious

2006-06-16T23:54:00.000-07:00

Acne and rosacea patients take note- you must know about proper skin-care and cosmetic usage to successfully manage your sensitive skin. This is the counsel of Dr. Diane Berson, who runs a dermatology practice in New York City.

A critical step in reducing skin sensitivity is understanding the importance of the stratum corneum. The stratum corneum is the outermost layer of the skin and is composed of dead, flat skin cells held together by the protein keratin. This skin barrier prevents molecules from passing into and out of the skin and thereby protects the lower layers of skin while reducing skin sensitivity.

Healthy, uninjured skin is more effective at preventing skin irritations that may result from using cosmetics and skin care products. Individuals with altered nerve endings or more neurotransmitters under their skin are more susceptible to minor skin irritants in cosmetics and skin care products. When the skin is excessively dry or damaged, it cannot adequately protect these nerve endings. Sound moisturizing and a strong immune system help minimize possible skin irritants.

Some of Dr. Berson's recommendations for caring for sensitive skin include:

Selecting mild cleansers. Use mild cleansing agents that have synthetic detergents or lipid-free cleansers. Resist using abrasive cleansers since they can cause microscopic tears in the skin and damage the protective layers of the skin.

Rosacea patients should not use alcohol-based products such as toners or astringents.

Acne patients will benefit from toners that contain salicylic acid or alpha hydroxy acid. However, when starting a retinoid treatment, temporarily discontinue using a toner or astringent since the combination may make the retinoid more irritating. Acne patients must also limit or abstain from excessively rough cleansing and washing. Julie Harper, M.D., who directs a clinic to treat acne at the University of Alabama at Birmingham laments, "Teenagers think they have acne because they do not wash enough, but usually they are washing too often with harsh scrubs that make their symptoms worse."

Using moisturizers. Tracy L. Grosick, a key skin care product researcher with Procter & Gamble, Cincinnati says that when the skin's moisture barrier is intact, it helps the skin to combat environmental attacks that are encountered on a daily basis. When acne and rosacea patients are using treatments that dry the skin, moisturizers may improve the skin's barrier function. Dr. Benson recommends using moisturizers with the least amount of ingredients.

Rosacea patients should choose a moisturizer with only glycerin, petrolatum, or aloe vera, which might be anti-inflammatory.

Acne patients should also stick with products containing the least amount of ingredients.

Using noncomedogenic sunscreens. Rosacea patients need to use a physical-blocking products containing zinc oxide or titanium dioxide because these ingredients will not irritate red, inflamed skin and will provide optimal protection.

Acne patients with oily skin should use noncomedogenic, non-pore clogging, products. Select an alcohol-based or gel-based sunscreen.

Preservatives. The best preservatives for sensitive skin are those containing parabens like methyl paraben and butyl paraben.

The key to keeping sensitive skin less susceptible to irritation is ensuring the integrity of your stratum corneum, the skin's primary defensive barrier. You can start by using a minimalist moisturizer, and noncomedogenic sunscreen.

About Acne, itsTypes & Symptoms

2006-06-16T23:53:00.000-07:00

What is Acne?

Acne is a chronic disorder of the hair follicles and sebaceous glands. Some of the characteristics of acne include black heads, pimples, cysts, infected abscesses, and rarely scarring. Acne usually occurs during adolescence in both men and women. To be more specific, acne starts during puberty and tends to get worse for people with oily skin. Acne badly affects teenage boys. Only mild to moderate forms of acne occur in middle-aged women. Acne can be seen most commonly on the face. The other places where it can occur include the neck, chest, back, shoulders, scalp, and upper arms and legs. Most forms of acne are the result of heredity and hormonal problems and has nothing to do with a harmful diet or poor hygiene.

Types of acne

Acne starts in a similar way for all but can take different forms and can react in a unique way according to the body conditions of the individual. A basic lesion called the comedo is the begining of acne. The comedo is an enlarged hair follicle plugged with oil and bacteria residing under the surface of your skin, that waits for the right conditions to grow into an inflamed lesion. Whenever the skin produces more oil, the bacteria grows within the swollen follicle. The surrounding skin becomes increasingly inflamed as your white blood cells fight against the intruders. Two main types of acne include non-inflammatory acne and inflammatory acne.

Non-inflammatory acne

Closed comedo:

If the plugged follicle stays below the surface of the skin, the lesion is called a closed comedo. This usually appears on the skin as small, whitish bumps. This condition is otherwise called as whitehead.

Open comedo :

If the plug enlarges and pushes through the surface of the skin, the lesion is called an open comedo. The dark appearance of the plug is not due to dirt, but due to the buildup of melanin, the pigmentation element of the skin. This condition is otherwise called as blackhead.

Inflammatory acne

Papule:

This appears on the skin as a small, firm pink bump. The papules are tender in nature and are often considered an intermediary step between non-inflammatory and clearly inflammatory lesions.

Pustule:

These are small round lesions that are inflamed and contain visible pus, which appear red at the base with a yellowish or whitish center. Pustules do not contain a large amount of bacteria. The inflammation is caused by chemical irritation from sebum components such as fatty free acids.

Cyst:

These are large pus-filled lesions that are usually present deep within the skin. The cysts are very painful lesions, as they are inflamed. Cysts form as a result of the contents of a comedo spilling over the surrounding skin and due to the response of the local immune system in producing pus. The cysts often leave deep scars.

Acne conglobata:

This is a rare but serious form of inflammatory acne that develops primarily on the back, buttocks, and chest. In addition, to the presence of pustules and cysts, there may be severe bacterial infection.

Symptoms

The common symptoms of acne include persistent, recurrent red spots or swellings on the skin known as pimples. The pimples become inflamed and get filled with pus. The pimples usually occur on the face, chest, shoulders, neck, or upper portion of the back. Some of the other symptoms include dark spots with open pores at the center, which are known as blackheads, bulged spots under the skin without openings, which are known as whiteheads, and red swellings or lumps filled with pus, which are known as pustules. The pustules can develop from blackheads or whiteheads. Inflamed fluid-filled lumps under the skin known as cysts are also a symptom of acne. These cysts can become as large as an inch across.

Acne Home Remedy

2006-06-16T23:52:00.000-07:00

Acne or pimples are caused by hormonal changes, wrong food habits and improper skin care. Acne remedies given below are based on herbs and natural ingredients that treat your acne like magic and help improve the skin disorders.

Grind nutmeg with unboiled milk and apply on affected area. This works as a magic. Pimples should disappear without leaving a mark.

Make a paste by mixing 3 tablespoons of honey and 1 teaspoon of cinnamon powder. Apply this paste on the pimples before sleeping and wash it next morning with warm water. Repeat for two weeks, pimples will disappear forever.

Apply a mixture of 1 teaspoon lemon juice and 1 teaspoon cinnamon powder.

Make orange peel paste by grinding it in some water. Apply on and around pimples.

Rub fresh garlic on and around pimples. Pimples will disappear without a mark with regular applications.

Mix 1 tablespoon groundnut oil with 1 tablespoon fresh lime juice to prevent formation of blackheads and pimples .

Apply fresh mint juice over the face every night for the treatment of pimples, insect stings, eczema, scabies, & other skin infections.

Apply a paste of fresh fenugreek leaves over the face every night for 10-15 minutes and washed with warm water. This will prevent pimples, blackheads, and wrinkles.

Apply juice of raw papaya (including the skin and seed) on swelling pimples.

Apply fresh lime juice mixed to a glass of boiled milk as a face wash for pimples.

Mix lime juice and rose water in equal portions. Apply on affected area. Wash it off after 20-30 minutes with lukewarm water.

Apply ripe tomatoes pulp on pimples and kept up to 1 hour, then wash.

Herbal Acne Treatments That Work

2006-06-16T23:51:00.000-07:00

In the United States alone, there are over 40 Million people who struggle with acne. Many of these people treat acne using chemicals such as antibiotics, prescription drugs, benzoyl peroxide, and salicylic acid.

However, there is a growing number of people who choose herbal acne treatments over traditional medications. Usually, herbal medications have far fewer side effects, and are not as dangerous as some of the prescription drugs.

The problem however, is that the United States does very little to regulate the herbal supplement industry. Unlike traditional chemical medications, herbal medications are not required to be clinically proven to work, or even to be safe. An example of this lack of regulation recently came to light with ephedra related deaths, and ephedras subsequent ban.

This lack of regulation results in many different acne products on the market. All of which claim to heal, prevent, or even cure acne with few, if any, side effects.

The truth is, there are very few herbal acne treatments that are scientifically proven to work. Traditional chemical treatments are still the most effective in stopping acne.

There are only 2 herbal treatments that have been clinically proven to help stop acne, tea tree oil and green tea cream.

Tea tree oil is a natural oil, derived from the Melaleuca alternifolia, a particular type of tea tree found exclusively in Australia. While it has been used from hundreds of years by the native aboriginals as a treatment for just about anything, it has only recently been accepted by modern medicine as being a viable anti-bacterial agent.

Even though tea tree oil has been suspected as an anti-bacterial agent for some time, A groundbreakings study was conducted in 1990 by I.B. Bassett, which compared tea tree oil to benzoyl peroxide in the treatment of acne. It was found that tea tree oil is as effective as a 5% benzoyl peroxide solution. It takes longer (6 weeks) for the tea tree oil to be as effective, but participants in the study reported none of the side effects associated with benzoyl peroxide, such as redness, skin irritation, or dry skin.

This study has helped tea tree oil become a recognized and legitimate herbal acne treatment. However, there is no need to purchase an expensive cream that contains tea tree oil. Just applying several drops of the oil directly on the acne has shown to be the most effective way to apply tea tree oil.

This was the only herbal acne treatment that had been proven to work until recently, when Dr. Jennifer Gan-Wong conducted a study that shows green tea can also effectively fight acne.

Dr. Gan-Wong compared a green tea cream with 3% green tea, to a 4% benzoyl peroxide solution, and found that the results in treating acne where the same for both the tea and the peroxide. These results were recently presented at the 2003 annual meeting of the American Academy of Dermatology.

These findings are relatively recent, and are not yet corroborated by additional independent studies. However, this evidence does demonstrate that the natural anti-bacterial properties of green tea can be effective to treat acne.

For those of you who are confused by the plethora of herbal acne treatments available, there really are only 2 that have been proven to be effective in fighting acne. Green tea cream, and tea tree oil. While many other herbal acne treatments may be good to moisturize the skin, or reduce oils, these are the only two that should be considered truly effective acne treatments.

How to Choose an Over The Counter Acne Medication

2006-06-16T23:50:00.000-07:00

There are literally hundreds of various treatments available to reduce acne. There is everything from all natural herbal remedies, to powerful chemical pharmaceuticals such as Accutane.

However, the most commonly used acne treatments in the United States are over the counter acne medications. They are generally inexpensive when compared to prescription medications, and some work very well.

Benzoyl peroxide is the most commonly used over the counter acne medication, and for good reason; Benzoyl peroxide is one of the most effective acne treatments available.

A 5% solution is usually all that is needed to treat acne, and it has almost no side effects for most people who use it. Unlike antibiotics and other prescription medications, Benzoyl peroxide can be used for months, even years at a time, and there are really no long term side effects (including a tolerance) that can be associated with it.

Furthermore, benzoyl peroxide has been compared to some of the prescription medications for acne, and it is nearly as effective as many acne antibiotics. Over all, benzoyl peroxide is the most successful over the counter acne medication.

However, there are others that can be very beneficial as well, including salicylic acid. Salicylic acid is a beta hydroxy acid, and it works as an astringent to remove dead skin cells. By removing the dead cells, this helps eliminate clogged pores, as well as help the skin renew itself faster.

Since acne is caused by p.bacteria that builds up in sebum in the pores of the skin, it is very important for the sebum to have a way of draining out of the pores before it becomes infected. Once salicylic acid is used to eliminate the dead skin cells, then the sebum is much less likely to become trapped under the skin and infected.

Salicylic acid is often sold as a makeup remover, but it is most commonly used in acne treatment via stridex pads or oxy pads.

Sulfur is also used in some over the counter acne medications. Sulfur is one of the oldest acne treatments, and reacts with the skin in such a way that it makes it dry, and peel. This works on acne by drying out the Sebum, and therefore, stopping the bacterial growth.

Many soaps and facial cleansers have sulfur in them. Sulfur is effective in getting rid of whiteheads and blackheads. It doesn't work well against the more inflamed cystic acne. One of the drawbacks is that it can increase skin cell adhesion to the skin, and therefore help cause more pimples in the future. It is best to use a gentle exfoliator when using sulfur to treat acne.

Sulfur also has a strong odor, and some people have skin that reacts harshly to sulfur, causing excessive redness and peeling.

Resorcinol is another over-the-counter chemical that is used to treat a variety of skin conditions, including acne. It works by breaking down hard skin. For acne, this means less clogged pores, and faster skin growth. Resorcinol is commonly used with sulfur to treat acne. It is also good for eczema and dandruff.

Because it is a strong chemical, don't use resorcinol with other astringents or cleansers unless advised by a dermatologist to do so.

These are the most commonly used over the counter acne treatments. For anyone who is suffering from acne, these 4 over-the-counter treatments have a good chance of helping to reduce or eliminate acne.

Proven Acne Medications

2006-06-16T23:49:00.000-07:00

There are a plethora of acne medications currently on the market. Some of these are prescription medications, such as accutane. Others are over the counter chemical compounds, such as benzoyl peroxide. There are even herbal based acne medications, such as tea tree oil. However, many of them are not as effective as advertised.

Part of the problem with finding the right acne medication is that there is no "one size fits all" when it comes to acne. Different people respond differently to the various medications and treatments. However, there are several acne medications that have been clinically proven to be effective in treating acne, and these are the medications that will stop acne for most people.

Prescription Acne Treatments

Of the prescription medications, Accutane is one of the best. It is a chemical derivative of vitamin A, and is often referred to as the "miracle drug" for acne. Accutane is most effective in the treatment of severe cystic acne, and not to be taken lightly. For some people, the many side effects can be worse than the acne itself. However, this is one treatment that works.

Retin A and Renova are also prescription medications. These are topical derivatives of vitamin A, and are also good at clearing up fine lines, wrinkles, and slight skin discolorations. One of the biggest downsides is sunlight and other topical acne treatments must be avoided while using either of them. However, they are proven to reduce acne.

Birth control pills and antibiotics round out the acne medications most commonly prescribed. Birth control pills are used exclusively by women to help regulate hormones, and therefore lessen the hormonally related acne that many women experience. Antibiotics work by attacking the acne causing p.bateria as it grows deep in skin pores.

Over the Counter Acne Treatments

There are some over the counter acne treatments that work well. The two best are benzoyl peroxide, and salicylic acid.

Benzoyl peroxide works by penetrating the skin pores, and eliminating the acne causing bacteria that grows deep in the skin. Benzoyl peroxide is the most commonly used acne treatment because it is affordable, easily available, and nearly as effective as most prescription medication.

Salicylic acid works by removing the top layers of dead skin cells. This helps the skin renew itself faster, and decreases the chance for pore blockage and a subsequent acne breakout.

Herbal Acne Treatments

The vast majority of acne treatments fall under the heading of "herbal" acne treatments. The reason is because of the lack or regulation for herbal products. This can be very frustrating to the general consumer, because it is impossible to tell which herbal treatment will work to stop acne, and which ones will do very little at all.

Of every herbal treatment available, there are only 2 that are currently proven to stop acne. Tea tree oil will help get rid of acne, and so will green tea cream.

Tea tree oil is an oil derived from one tea tree plant that is unique to Australia. For several hundred years it was touted as a cure all, until penicillin was introduced to fight bacteria. However, tea tree oil has seen a recent revival due in part to study conducted in 1990 that proved it is as effective in treating acne as 5% benzoyl peroxide. Furthermore, it had none of the side effects that benzoyl peroxide does.

Green tea cream has been validated more recently, at the 2003 American Academy of Dermatology conference. It was proven that green tea is as effective in treating acne as a 4% benzoyl peroxide solution. Though the study has not been corroborated yet, it demonstrated that there is another herbal treatment besides tea tree oil.

These are some of the acne medications proven to work. For those who are experiencing acne, any of the aforementioned treatments would be well worth trying.

Acne Solution

2006-06-16T23:48:00.000-07:00

Million of people suffer from acne breakouts young and old. If your doctor has you on topical or oral treatment and it is not working try other ways to cure the breakouts.

For example: Topical retinoids (Retin-A, Differin and Tazorac, for example)are helpful for mild to severe acne especially when they are used early on combining with hormonal antibiotics,or benzoyl peroxide treatments. When you discontinue the antibiotics you can maintain clear skin with retinoids. Another way to treat your acne is with laser light. The doctor applies a chemical called aminole-v-vulinic acid and then exposed to a sunlump called Clearlight. You need two to four treatments to kill bacteria and keep skin clear for 5 months or up to 2 years.

Over the counter products aren't strong enough to treat severe acne. Try using a product with 10% benzoyl peroxide plus another product with 2% percent salicylic acid. Keep a daily routine faithfully and if your skin doesn't improve see your dermatologist.

Acne And Wrinkles At My Age

2006-06-16T23:46:00.000-07:00

Puberty brought bouts of acne. In your 20s, finding Mr. or Mrs. Right was of chief consequence. When the 30s hit, you worked to raise little Johnnie or Suzie to be a model kid. Now that your hitting the fabulous 40s, you should be coasting through life, right. Well, why are you suddenly dealing with the cosmetic double whammy of acne and wrinkles? Even your insurance company figures that you should have gotten rid of acne by the age of 25.

The number people over 30 needing acne treatments has climbed to the extent that a report published in Journal of the American Academy of Dermatology recommends raising the age for insurance coverage of the acne drug tretinoin to at least 40. The authors of the report, Drs. Steven Feldman and Alan Fleischer, add that many insurance companies refuse to pay for tretinoin prescriptions for patients older than 25.

Cosmetic Catch 22 Even if your insurance company leaves you to fend for yourself, you still have options for freeing yourself from acne and wrinkles. At first, coping with acne and wrinkles may seem like a cosmetic catch 22. Do you dry your skin with acne cleansers containing benzoyl peroxide and salicylic acid, and worsen your wrinkles? Or, do you smear on the moisturizer to smooth the wrinkles, but cope with the zits brought on by the extra oil or sensitivity to a new product?

There's a smarter way to handle acne and wrinkles.

1. Interpret the acne

2. Allow your skin to improve as you use self-awareness to remove zits.

Interpret the acne

While dealing with acne and wrinkles, target the acne first because acne is an autoimmune disease. Having an autoimmune disease means that your thoughts, emotions, and/or environment are affecting you in an adverse way and require immediate attention. Thus, acne may reveal that you need to relax more, change your eating habits, reframe your interpersonal dialogue, stop dating that jerk from the office and/or make another beneficial alteration to your lifestyle.

Zits arrive on your face to report on some unpleasant activities within your body and life. Once you get feedback from these zits, you can take action to send the zits away while augmenting your health in the process.

Acne is usually an indication various hidden or overlooked health problems. Here's a sample of the questions you should ask yourself when dealing with acne so that you can unravel the mystery behind your zits. Are you:

Regular?

About 70% of your immune system is located in your intestines. If this area is blocked with waste, your immuno-defenses are down. So, instead of waste leaving your body via the rectum, it chooses to leave through the skin. Waste leaving the skin can cause an infection that presents itself as acne.

Tense?

Tension likewise reduces the vigor of the immune system. Take a few deep breaths throughout the day to calm your body. Take a long walk in the fresh air to wind down.

Eating nutritionally?

Cases of acne have been improved with consuming foods containing zinc, essential fatty acids, vitamin A and a host of other nutrients. All of these vital nutrients are available in leafy green vegetables, fruits and olive oil.

Worried about unresolved issues?

Not resolving personal issues creates conflict and tension in the body. Again, these issues most be addressed to avoid undue stress within the body.

Exercising daily?

Exercise reduces stress and gives you an opportunity to subconsciously contemplate challenges that you may be facing. Physical activity also keeps your muscles and intestines toned, which keeps encourages regularity.

Changing pillowcase frequently?

Using a dirty pillowcase aggravates an acne condition. Your face naturally secretes oils during the night. These oils are sticky. So if you pillowcase if dirty, you are allowing your face to collect extra waste during the night, which could further clog your pores.

Moving or changing your job/career?

New demands or feelings of lose can sometimes accompany change. Transfer these emotions into something constructive by writing in a journal or envisioning how these changes are going to benefit you. Find comfort in these changes and opportunities for new beginnings.

Experiencing excessive facial hair growth and erratic periods?

Conditions such as acne, excessive facial hair, and erratic periods could indicate an androgen disorder or other underlying hormonal imbalances. Your doctor can provide you with a series of endocrine tests to ascertain your hormone levels and what corrective actions you should take. Ricardo Azziz, M.D, who serves as Chair of the Department of Obstetrics and Director of the Center for Androgen-Related Disorders at Cedars-Sinai Medical Center, estimates that 80 percent of women with excessive androgen levels suffer from an endocrine disorder called polycystic ovary syndrome (PCOS). Dr. Azziz adds that women with PCOS often have insulin resistance and are at increased risk for developing Type II diabetes, hypertension and heart disease.

Once the acne is under control you can move on to the wrinkles. Another reason for treating the zits first is because if you alter your lifestyle in such as way as to free yourself from acne, and you doing this in a healthy and patient fashion, you will actually lessen the number of wrinkles you have.

Health is wholeness and beauty is a reflection of robust health. You'll never buy robust health in a jar. It is a mind, body, spirit and environmental support system that garners full-bodied health. Lets look at want you actually need from a "beauty cream".

Face Cream Education There are five basic ingredients in any given anti-aging or anti-wrinkling cream.

1. The oil or moisturizer

2. The preservatives to keep the cream from spoiling.

3. A scent or flavor

4. A color

5. The active ingredient.

Only one of these components is essential, the oil. The preservative is only needed to keep the cream useful. Your face does not need preservation because the skin is alive. Since some people have allergies to scents and colors in cosmetics, the body says that these two ingredients are not necessary. The active ingredient is usually the latest cosmetic drug or multivitamin that is supposed to lift or dramatically reverse your age by 5-20 years.

Researchers S. Jay Olshansky, Leonard Hayflick and Bruce A. Carnes bluntly comment on the antics of cosmetic companies in their report No Truth to the Fountain of Youth, published in the June 2002 edition of Scientific American. The authors warn everyone aiming to reverse the signs of times on their face that, "? anyone purporting to offer an anti-aging product today is either mistaken or lying".

I bet you are thinking, "Won't that oil make acne worse?" The answer is not if you are using the right oil. Some essential oils such as bergamont, lavender, lemon, neroli, sandalwood, tea tree and ylang ylang have cleansing and antibacterial properties which help combat acne infections. Other essential oil like geranium, clary sage and orange regulate the production of oil on the face. When mixed with a carrier oil such as jojoba or camellia, these essential oils are ideal moisturizers.

Nothing that you put on your face will truly change your appearance. Creams are useful, but they are only one instrument in an orchestra of anti-aging concerts. Health starts on the inside. If you want to improve your beauty start with how you treat yourself and feed yourself. I mean not only what foods you eat but what thoughts you eat.

You may eat thoughts of the sort, "I can't?", "I had a stressful day", "I'm tired of?", "I can't wait until?", "I'm getting old", "My body isn't as healthy as it used to be". The menu is endless. If you want to look young and healthy, you have to think young and healthy thoughts. Here's steps to jumpstart your quest:

Start by changing your thinking. Develop your own youth model, i.e. with steps you'll take to maintain your vitality and stick to it.

Enjoy nutritious foods. A study in the Journal of American College of Nutrition found that eating a variety of fruits and vegetables and using olive oil every day could help keep wrinkles away. The researchers found that people who ate a diet rich in green leafy vegetables, beans, olive oil, nuts and multigrain breads, while avoiding butter, red meat and sugary goodies, were less predisposed to wrinkling. Researchers believe that antioxidant vitamins, such as A, C and E, which are found in fruits and vegetables, may help protect the skin from environmental damage.

Use a gentle cleanser each day.

Steam your face everyday for 5-15 minutes, especially if your have acne. The steam removes waxy build-up on the skin while it stimulates circulation. This combo of benefits cleans to pores to reduce the possibility of acne while firming up the skin and facial muscles.

Exfoliate your skin daily.

Moisturize your face in the morning and evening with natural oils. In addition to the acne fighting oils listed above, you can mix essential oils such as frankinsense, myrrh, neroli and rose to help encourage the growth of new skin cells. You can create a moisturizer by diluting 1-3 of your favorite essential oils in a carrier oil such as jojoba or camellia oil in a ration of 1 part essential oil to 3 parts carrier oil.

Massage your face daily when you apply your facial oil.

Lie down on an incline bench for 5-20 minutes each day to let the blood flow to your head.

Wear a sunhat in the sun.

Give yourself a light skin peel once a month.

Finally, forty can still be fabulous and your beauty-plan a lot less enigmatic. Just remember the basics, interpret the messages of your zits, and educate yourself about wrinkle creams- you don't need them.

Whats The Real Cause Of Acne?

2006-06-16T23:37:00.000-07:00

Most acne medications only mask the symptoms of acne and does nothing to stop the real cause of acne. This is why people buy acne products month after month (year after year). And every time they stop using the product acne would come back again and again.

What you need to do is find out what the real cause of acne is and stop it.

So what's the real cause of acne?

Acne occurs when your body contains more toxics than your kidneys and bowels can remove. (Your kidneys and bowels are the two primary channels of elimination that your body expel toxics and waste products through.)

These toxics can be the accumulation of fat stored chemicals the liver can not wash out or there may be a problem with fat digestion, fat accumulation, food allergy, or even the accumulation of hormones that your body produces.

Once these toxics build up, your kidneys and bowels can get overloaded and clogged up, causing it to not function properly. When that happens some of the load will be dumped onto your liver. One of your liver's main roles is to metabolize pile up fat into usable energy for your body.

This means, your liver will be doing some of your kidney's work. So now, your liver gets overloaded and it too will not work at full capacity.

What happens when your bowels, kidneys, and liver gets overloaded?

When that happen your body will expel toxins through your lungs and skin (your secondary channels of elimination). And this is when acne occurs. This is when your skin starts to breakout.

But whatever the toxic source is that's causing this problem, acne is a sign that your bowels and kidneys are overloaded with toxins, waste products, or hormones.

It is a sign that your liver is growing weaker in its detoxification abilities (and it will continue to grow weaker if you do not do what it takes to get rid of the toxics in your body).

So if you think that acne is your only problem, think again, your liver, kidneys, and bowels are getting weaker every time you breakout.

Acne Laser Treatment - Are You Interested In Laser Surgery for Acne ?

2006-06-16T23:35:00.000-07:00

There are so many options for acne treatment on the market. On one end there are several different types of medication and topical treatments, on the other there are various different natural or organic products. But, do all these products work? Well, most of these products do deliver on their promises. But, the key point being that there is no one size fits all solution in the area of acne treatment. This is understandable because everyone doesn't have the same skin type either. To address these needs various different laser treatment providers have sprung up all over the place.

A quick recap of how pimples are formed

Our skin has tiny pores connected to oil producing glands underneath the skin. These glands produce oils that moves dead skin cells to the skin surface. The 'pipe' that is connecting the pore to the gland clog up due to excess oil production. This results in the formation of pimples. There are different varieties of this problem and each has a different name - blackheads, whiteheads, acne vulgaris, acne rosacea etc. You will definitely want to consult a dermatologist to understand your condition.

Now, coming back to our main discussion. The procedure for the laser treatment is fairly straightforward. A very powerful, high-speed and extremely accurate laser is controlled by the laser technician. So, what does the beam do? The beam destroys the specific excess oil producing glands that are under the skin and destroy any existing bacteria in these areas.

Sounds simple enough. Now, you might be wondering if this is all there is to it. Well of course not. As with any other medical procedure you should be aware of certain drawbacks of laser treatment.
* At times, one treatment isn't enough. It's hard to predict whether all the excess oil producing glands and bacteria have been taken care of. So, you might have to go through the procedure a couple of times till you are able to achieve the desired result.
* The other problem is that this treatment is expensive. The cost ranges depending on the experience of the provider, quality of the laser facilities etc. So, bear in mind that this might not be a one-time deal when you are shopping for laser treatment providers.

So, there you have it. Both sides of the story. While it is easy to measure the drawbacks in monetary terms, it is hard to measure how much the self-esteem of the individual is raised once this procedure is completed successfully. That feeling is one word - priceless!

Keratoconus

2006-06-04T20:37:00.000-07:00

Keratoconus is a degenerative non-inflammatory disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal even curve. Keratoconus can cause substantial distortion of the vision, with multiple images, streaking and sensitivity to light all often reported by the patient. Though frequently thought of as a rare condition, keratoconus is the most common distrophy of the cornea, affecting around one person in a thousand, and seems to occur equally in all ethnic groups worldwide. It is typically diagnosed in the patient's adolescent years and attains its most severe state in the twenties and thirties.

Keratoconus is a little-understood disease with an uncertain cause, and the course of its progression following diagnosis is unpredictable. The associated deterioration in vision, if in both eyes, can affect the person's ability, for example, to drive a car legally. It does not, however, lead to blindness, and in most cases, corrective lenses are effective enough to allow the patient to continue to drive and likewise function normally. Further progression of the disease may lead to a need for surgery. Keratoconus continues to be somewhat of a mysterious disease, but it can be successfully managed with a variety of clinical and surgical techniques often with little or no impairment to the patient's quality of life.

History

In a 1748 doctoral dissertation, a German oculist named Burchard Mauchart provided an early description of a case of keratoconus, which he called staphyloma diaphanum. However, it was not until 1854 that British physician John Nottingham clearly described keratoconus and distinguished it from other ectasias of the cornea. Nottingham reported the cases of "conical cornea" that had come to his attention, and described several classic features of the disease, including polyopia, weakness of the cornea, and difficulty matching corrective lenses to the patient's vision. In 1859 British surgeon William Bowman used an ophthalmoscope (recently invented by German physician and physicist Hermann von Helmholtz) to diagnose keratoconus, and described how to angle the instrument's mirror so as to best see the conical shape of the cornea. Bowman also attempted to restore the vision by pulling on the iris with a fine hook inserted through the cornea and stretching the pupil into a vertical stenopeic slit like that of a cat. He reported that he had had a measure of success with the technique, restoring vision to an 18-year old woman who had previously been unable to count fingers at a distance of 8 inches (20 cm). By 1869, when the pioneering Swiss ophthalmologist Johann Horner wrote a thesis entitled On the treatment of keratoconus, the disorder had acquired its current name. The treatment at that time, endorsed by the leading German ophthalmologist Albrecht von Gräfe, was an attempt to physically reshape the cornea by chemical cauterization with a silver nitrate solution and application of a miosis-causing agent with a pressure dressing. In 1888 the treatment of keratoconus became one of the first practical applications of the then newly-invented contact lens, when the French physician Eugene Kalt manufactured a glass scleral shell which improved vision by compressing the cornea into a more regular shape.Since the start of the twentieth century, research on keratoconus has both improved understanding of the disease and greatly expanded the range of treatment options.

Features

Symptoms

People with early keratoconus typically notice a minor blurring of their vision and come to their clinician seeking corrective lenses for reading or driving. At early stages, the symptoms of keratoconus may be no different from those of any other refractive defect of the eye. As the disease progresses, vision deteriorates, sometimes rapidly. Visual acuity becomes impaired at all distances, and night vision is often quite poor. Some individuals have vision in one eye that is markedly worse than that in the other eye. Some develop photophobia (sensitivity to bright light), eye strain from squinting in order to read, or itching in the eye. Otherwise, there is little or no sensation of pain.

The classic symptom of keratoconus is the perception of multiple 'ghost' images, known as monocular polyopia. This effect is most clearly seen with a high contrast field, such as a point of light on a dark background. Instead of seeing just one point, a person with keratoconus sees many images of the point, spread out in a chaotic pattern. This pattern does not typically change from day to day, but over time it often takes on new forms. Patients also commonly notice streaking and flaring distortion around light sources.

Signs and diagnosis

Prior to any physical examination, the diagnosis of keratoconus frequently begins with an ophthalmologist's or optometrist's assessment of the patient's medical history, particularly the chief complaint and other visual symptoms, the presence of any history of ocular disease or injury which might affect vision, and the presence of any family history of ocular disease. An eye chart, such as a standard Snellen chart of progressively smaller letters, is then used to determine the patient's visual acuity. The eye examination may proceed to measurement of the localised curvature of the cornea with a manual keratometer, with detection of irregular astigmatism suggesting a possibility of keratoconus. Severe cases can exceed the instrument's measuring ability. A further indication can be provided by retinoscopy, in which a light beam is focused on the patient's retina and the reflection, or reflex, observed as the examiner tilts the light source back and forth. Keratoconus is amongst the ophthalmic conditions that exhibit a scissor reflex action of two bands moving toward and away from each other like the blades of a pair of scissors.

If keratoconus is suspected, the ophthalmologist or optometrist will search for other characteristic findings of the disease by means of slit lamp examination of the cornea. An advanced case is usually readily apparent to the examiner, and can provide for an unambiguous diagnosis prior to more specialised testing. Under close examination, a ring of yellow-brown to olive-green pigmentation known as a Fleischer ring can be observed in around half of keratoconic eyes, and is caused by deposition of the iron oxide hemosiderin within the corneal epithelium. The Fleischer ring is subtle, and may not be readily detectable in all cases, but becomes more evident when viewed under a cobalt blue filter. Similarly, around 50% of subjects exhibit Vogt's striae, fine stress lines within the cornea caused by stretching and thinning. The striae temporarily disappear while slight pressure is applied to the eyeball. A highly pronounced cone can create a V-shaped indentation in the lower eyelid when the patient's gaze is directed downwards, known as Munson's sign. Other clinical signs of keratoconus will normally have presented themselves long before Munson's sign becomes apparent, and so this finding, though a classic sign of the disease, tends not to be of primary diagnostic importance.

A handheld keratoscope, sometimes known as Placido's disk, can provide the examiner with a simple non-invasive visualization of the surface of the cornea by projecting a series of concentric rings of light onto the cornea. A more definitive diagnosis of keratoconus can be obtained using corneal topography, in which an automated instrument projects the illuminated pattern onto the cornea and determines its topology from analysis of the digital image. The topographical map indicates any distortions or scarring present in the cornea, with keratoconus revealed by a characteristic steepening of curvature which is usually inferior to (below) the centreline of the eye. The technique can record a snapshot of the degree and extent of the deformation as a benchmark for assessing its rate of progression. It is of particular value in providing a detection of the disorder in its early stages when other signs have not yet presented.

Once the presence of keratoconus has been established, its degree may be classified by a number of means helpful to the examiner:

* The steepness of greatest curvature from mild (< 45 D), advanced (up to 52 D) or severe (> 52 D);

* The morphology of the cone: nipple (small: 5 mm and near-central), oval (larger, below-center and often sagging), or globus (more than 75% of cornea affected);

* The corneal thickness from mild (> 506 μm) to advanced (< 446 μm).

Increasing use of corneal topography has led to a decline in the use of these terms by some practitioners.

Epidemiology

The National Eye Institute reports that keratoconus is the most common corneal dystrophy in the United States, affecting approximately 1 in every 2,000 Americans, but some reports place the figure as high as 1 in every 500. The inconsistency may be due to variations in diagnostic criteria, with some cases of high astigmatism intepreted as those of keratoconus, and vice versa. A long-term study found a mean incidence rate of 2.0 new cases per 100,000 population per year. Males and females, and all ethnicities appear equally susceptible, though some recent studies have cast doubt upon this, suggesting a higher prevalence amongst females; the literature however varying as to its extent. Keratoconus is normally bilateral, affecting both eyes, although the distortion is usually asymmetric and is rarely completely identical in both corneas. Unilateral cases tend to be uncommon, and may in fact be very rare if a very mild condition in the better eye is simply below the limit of clinical detection. It is common for keratoconus to be diagnosed first in one eye and not until later in the other. As the condition then progresses in both eyes, the vision in the earlier eye will often persist to be poorer than that in its fellow.

Prognosis

Patients with keratoconus typically present initially with mild astigmatism, commonly at the onset of puberty, and are diagnosed as having the disease by the late teenage years or early 20s. In rare cases keratoconus can occur in children or not present until later adulthood. A diagnosis of the disease at an early age may indicate a greater risk of severity in later life. Patients' vision will seem to fluctuate over a period of months, driving them to change lens prescriptions frequently but as the condition worsens, contact lenses become required in the majority of cases. The course of the disorder can be quite variable, with some patients remaining stable for years or indefinitely, while others progress rapidly or experience occasional exacerbations over a long and otherwise steady course. Most commonly, keratoconus progresses for a period of ten to twenty years before the course of the disease generally ceases.

In advanced cases, bulging of the cornea can result in a localized rupture of Descemet's membrane, an inner layer of the cornea. Aqueous humor from the eye's anterior chamber seeps into the cornea before Descemet's membrane reseals. The patient experiences pain and a sudden severe clouding of vision, with the cornea taking on a translucent milky-white appearance known as a corneal hydrops. Although disconcerting to the patient, the effect is normally temporary and after a period of six to eight weeks the cornea usually returns to its former transparency. The recovery can be aided non-surgically by bandaging with an osmotic saline solution. Although a hydrops usually causes increased scarring of the cornea, occasionally it will benefit a patient by creating a flatter cone, aiding the fitting of contact lenses. Very occasionally, in extreme cases, the cornea thins to the point that a partial rupture occurs, resulting in a small, bead-like swelling on the cornea that has been filled with fluid. When this occurs, a corneal transplant can become urgently necessary to avoid complete rupture and resulting loss of the eye.

Pathophysiology and cause

Despite considerable research, the etiology of keratoconus remains somewhat of a mystery. According to the United States National Keratoconus Foundation, it is likely that keratoconus can arise from a number of different factors: genetic, environmental or cellular, any of which may form the trigger for the onset of the disease. Once initiated, the disease normally develops by progressive dissolution of Bowman's layer, the membrane lying between the corneal epithelium and stroma. As the two come into contact, cellular and structural changes in the cornea adversely affect its integrity and lead to the bulging and scarring that are characteristic of the disorder. Within any individual keratoconic cornea, there may be found regions of degenerative thinning coexisting with regions undergoing wound healing.

The visual distortion experienced by the patient comes from two sources, one being the irregular deformation of the surface of the cornea; the other being scarring that occurs on its exposed highpoints. These factors act to form regions on the cornea that map an image to different locations on the retina and give rise to the symptom of monocular polyopia. The effect can worsen in low light conditions as the dark-adapted pupil dilates to expose more of the irregular surface of the cornea. Scarring appears to be an aspect of the corneal degradation; however, a recent, large, multi-center study suggests that abrasion by contact lenses may increase the likelihood of this finding by a factor of over two.

A number of studies have indicated that keratoconic corneas show signs of increased activity by proteases, a class of enzymes that break some of the collagen cross-linkages in the corneal stroma, with a simultaneous reduced expression of protease inhibitors. Other studies have suggested that reduced activity by the enzyme aldehyde dehydrogenase may be responsible for a build-up of free radicals and oxidising species in the cornea. It seems likely that, whatever the pathogenetical process, the damage caused by activity within the cornea results in a reduction in its thickness and biomechanical strength.

A genetic predisposition to keratoconus has been observed, with the disease running in certain families, and incidences reported of concordance in identical twins. The frequency of occurrence in close family members is not clearly defined, though it is known to be considerably higher than that in the general population, and studies have obtained estimates ranging between 6% and 19%. A responsible gene has not been expressly identified: two studies involving isolated, largely homogenetic communities have contrarily mapped putative gene locations to chromosomes 16q and 20q. However, most genetic studies agree on a dominant autosomal model of inheritence. Keratoconus is also diagnosed more often in people with Down syndrome, though the reasons for this link have not yet been determined. Keratoconus has been associated with atopic diseases, which include asthma, allergies, and eczema, and it is not uncommon for several or all of these diseases to affect one person. A number of studies suggest that vigorous eye rubbing may contribute to the progression of keratoconus, and that patients should be discouraged from the practice.

Treatment

Contact lenses

In early stages of keratoconus, spectacles can suffice to correct for the mild astigmatism. As the condition progresses, spectacles may fail to provide the patient with a satisfactory degree of visual acuity, and most clinical practitioners will move to managing the condition with contact lenses.

In keratoconic patients, contact lenses improve vision by means of tear fluid filling the gap between the irregular corneal surface and the smooth regular inner surface of the lens, thereby creating the effect of a smoother cornea. Many specialized types of contact lenses have been developed for keratoconus, and affected people may seek out both doctors specialized in conditions of the cornea, and contact-lens fitters who have experience managing patients with keratoconus. The irregular cone presents a challenge and the fitter will endeavour to produce a lens with the optimal contact, stability and steepness. Some trial-and-error fitting may prove necessary.

Traditionally, lenses for keratoconus have been the "hard" or rigid gas-permeable contact lens variety, although manufacturers have also produced specialized "soft" or hydrophilic lenses. A soft lens has a tendency to conform to the conical shape of the cornea, thus nulling its effect. To counter this, hybrid lenses have been recently developed which are hard in the centre and encompassed by a soft skirt. Soft or hybrid lenses do not however prove effective for every patient.

Some patients also find good vision correction and comfort with a "piggyback" lens combination, in which gas permeable rigid lenses are worn over soft lenses, both providing a degree of vision correction. One form of piggyback lens makes use of a soft lens with a countersunk central area to accept the rigid lens. Fitting a piggyback lens combination requires experience on the part of the lens fitter, and tolerance on the part of the keratoconic patient.

Scleral lenses are sometimes prescribed for cases of advanced or very irregular keratoconus; these lenses cover a greater proportion of the surface of the eye and hence can offer improved stability. The larger size of the lenses may make them unappealing or uncomfortable to some, however their easier handling can find favor with patients with reduced dexterity, such as the elderly.

Surgical options

Corneal transplant

Between 10% to 25% of cases of keratoconus will progress to a point where vision correction is no longer possible, thinning of the cornea becomes excessive, or scarring as a result of contact lens wear causes problems of its own, and a corneal transplantation or penetrating keratoplasty becomes required. Keratoconus is the most common grounds for conducting a penetrating keratoplasty, accounting for around a quarter of such procedures. The corneal transplant surgeon trephines a lenticule of corneal tissue and then grafts the donor cornea to the existing eye tissue, usually using a combination of running and individual sutures. The cornea does not have a direct blood supply, and so donor tissue is not required to be blood type matched. Eye banks check the donor corneas for any disease or cellular irregularities.

The acute recovery period can take four to six weeks and full post-operative vision stabilization often takes a year or more but most transplants are very stable in the long term. The National Keratoconus Foundation reports that penetrating keratoplasty has the most successful outcome of all transplant procedures, and when performed for keratoconus in an otherwise healthy eye, its success rate can be 95% or greater. The sutures used usually dissolve over a period of three to five years but individual sutures can be removed during the healing process if they are causing irritation to the patient.

Cornea transplants for keratoconus are usually performed under sedation as outpatient surgery, and require careful follow-up with an eye surgeon for a number of years. Frequently, vision is greatly improved after the surgery, but even if the actual visual acuity does not improve, because the cornea is a more normal shape after the healing is completed, patients can more easily be fitted with corrective lenses. Complications of corneal transplants are mostly related to vascularization of the corneal tissue and rejection of the donor cornea. Vision loss is very rare, though difficult-to-correct vision is possible. When rejection is severe, repeat transplants are often attempted, and are frequently successful. Keratoconus will not normally reoccur in the transplanted cornea; incidences of this have been observed, but are usually attributed to incomplete excision of the original cornea or inadequate screening of the donor tissue. The long-term outlook for corneal transplants performed for keratoconus is usually favorable once the initial healing period is completed and a few years have elapsed without problems.

Epikeratophakia

Rarely, a non-penetrating keratoplasty known as an epikeratophakia (or epikeratoplasty) may be performed in cases of keratoconus. The corneal epithelium is removed and a lenticule of donor cornea grafted on top of it. The procedure requires a greater level of skill on the part of the surgeon, and is less frequently performed than a penetrating keratoplasty as the outcome is generally less favorable. It may however be seen as an option in a number of cases, particularly for young patients.

Corneal ring segment inserts

A recent surgical alternative to corneal transplant is the insertion of intrastromal corneal ring segments. A small incision is made in the periphery of the cornea and two thin arcs of polymethyl methacrylate slid between the layers of the corneal stroma either side of the pupil, the incision then being closed. The segments push out against the curvature of the cornea, flattening the peak of the cone and returning it to a more natural shape. The procedure, carried out on an outpatient basis under local anaesthesia, offers the benefit of being reversible and even potentially exchangeable as it involves no removal of eye tissue.

The two principle types of intrastromal rings available are known by the trade names of Intacs and Ferrara rings. Intacs are flatter and less centrally placed than the prismatic Ferrara rings. Intacs were first approved by the FDA in the United States in 1999 for myopia; this was extended to the treatment of keratoconus in July 2004. Ferrara rings await FDA approval for keratoconus. A development on the concept involves the injection of a transparent synthetic gel into a channel bored through the stroma. As the gel polymerises, it stiffens and takes on similar properties to the pre-formed rings.

Clinical studies on the effectiveness of intrastromal rings on keratoconus are in their early stages, and results have so far been generally encouraging, though they have yet to enter into wide acceptance with all refractive surgeons. In common with a penetrating keratoplasty, the requirement for some vision correction in the form of hydrophilic (soft) contact lenses or spectacles may remain subsequent to the operation. Potential complications of intrastromal rings include accidental penetration through to the anterior chamber when forming the channel, post-operative infection of the cornea, and migration or extrusion of the segments. The rings offer a good chance of vision improvement even in otherwise hard to manage eyes, but it is not guaranteed and in a few cases may worsen.

Radial keratotomy

Radial keratotomy is a refractive surgery procedure where the surgeon makes a spoke-like pattern of incisions into the cornea to modify its shape. This early surgical option for myopia has been largely superseded by LASIK and other similar procedures. Unfortunately, LASIK cannot be used for people with keratoconus because removal of corneal tissue can further damage their already weakened corneas. In Germany, for example, performing laser treatment on kerataconus patients is illegal.

For similar reasons, radial keratotomy has also generally not been used for keratoconic patients. However, an Italian clinic has reported some success with a modified asymmetric radial keratotomy procedure, in which the incisions are confined to one sector of the eye. The corneal thickness is first measured using a pachymeter, then the surgeon makes cuts to a depth of 70-80% of the measured thickness. The patient may initially experience photophobia and fluctuation of vision after radial keratotomy, just as with other forms of refractive surgery.

Riboflavin

A new treatment which has shown success but which has not yet been approved in all countries involves a one-time application of riboflavin eye drops to the eye. The riboflavin, when activated by approximately 30 minutes illumination with UV-A light, augments the collagen cross-links within the stroma and so recovers some of the cornea's mechanical strength. The treatment, developed at the Dresden University of Technology, has been shown to slow or arrest the progression of keratoconus, and in some cases even reverse it, particularly when applied in combination with intracorneal ring segments. Clinical trials are continuing, and to date relatively few procedures have been performed but the technique is showing promise in treating early cases of the disease. Corrective lenses may still be required after the treatment but it is hoped that it could limit further deterioration in the patient's vision and reduce the case for keratoplasty.

Related disorders

Several other non-inflammatory eye disorders, generally rarer than keratoconus, also cause thinning of the cornea:

Keratoglobus
Keratoglobus is a very rare condition that may be genetically related to keratoconus. It causes corneal thinning, primarily at the margins, resulting in a spherical, slightly enlarged eye.

Pellucid marginal degeneration
Pellucid marginal degeneration causes thinning of a narrow (1-2 mm) band of the cornea, usually along the inferior corneal margin. It causes an irregular astigmatism that can often be corrected by spectacles.

Posterior keratoconus
Keratoconus and posterior keratoconus are distinct disorders, despite their similar names. Posterior keratoconus is a rare abnormality, usually congenital, which causes a non-progressive thinning of the inner surface of the cornea. Posterior keratoconus generally affects only a single eye.

Disease

2006-05-19T00:04:00.000-07:00

A disease is an abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person afflicted or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, syndromes, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories.

Pathology is the study of diseases. The subject of systematic classification of diseases is referred to as nosology. The broader body of knowledge about human diseases and their treatments is medicine. Many similar (and a few of the same) conditions or processes can affect animals (wild or domestic). The study of diseases affecting animals is veterinary medicine. Plants as well can suffer from a variety of processes such as infection, nutrient deficiency, or deleterious mutation. The study of diseases affecting plants is termed plant pathology.

Syndromes, illness and disease

Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as "syndromes". Furthermore, numerous conditions of unknown etiology are referred to as "diseases" in many contexts.

Illness, although often used to mean disease, can also refer to a person's perception of their health, regardless of whether they in fact have a disease. A person without any disease may feel unhealthy and believe he has an illness. Another person may feel healthy and believe he does not have an illness even though he may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or stroke.

Transmission of disease

Some diseases, such as influenza, are contagious or infectious, and can be transmitted by any of a variety of mechanisms, including aerosols produced by coughs and sneezes, by bites of insects or other carriers of the disease, from contaminated water or food, etc.

Other diseases, such as cancer and heart disease are not considered to be due to infection, although micro-organisms may play a role.

Social significance of disease

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions as diseases of post-traumatic stress disorder, also known as "shell shock"; repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread.

A condition may be considered to be a disease in some cultures or eras but not in others. Oppositional-defiant disorder, attention-deficit hyperactivity disorder, and, increasingly, obesity are conditions considered to be diseases in the United States and Canada today, but were not so-considered decades ago and are not so-considered in some other countries. Lepers were a group of afflicted individuals who were historically shunned and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomena, though not all diseases evoke extreme social stigma.

A disease can also be caused by repeated high anger or stress.

List of childhood diseases

2006-05-19T00:02:00.000-07:00

The term childhood disease is sometimes subjective, and does not refer to an accepted, categorical list. Nearly all the diseases in this list can also be contracted by adults, and, of course, all children can contract diseases not categorized as "childhood diseases".

Some childhood diseases include:

* Candidiasis ("Thrush")
* Chicken pox
* Chagas disease
* Croup
* Cytomegalovirus (the virus most frequently transmitted before birth)
* Duchenne muscular dystrophy
* Measles
* Mumps
* Rheumatic fever
* Rubella
* Whooping cough
* fifth disease

CANDIDIASIS

Candidiasis, commonly called yeast infection or thrush, is a fungal infection of any of the Candida species, of which Candida albicans is probably the most common.

Locations

In immunocompetent people, candidiasis can usually only be found in exposed and moist parts of the body, such as:

* the oral cavity (oral thrush)
* the vagina (vaginal candidiasis or thrush)
* folds of skin in the diaper area (diaper rash)
* the most common cause of vaginal irritation or vaginitis
* can also occur on the male genitals, particularly in uncircumcised men.

In immunocompromised patients, the Candida infection can become systemic, causing a much more serious condition, fungemia.

Causes

Yeast organisms are always present in all people, but are usually prevented from "overgrowth" (uncontrolled multiplication resulting in symptoms) by naturally occurring microorganisms.

At least three quarters of all women will experience candidiasis at some point in their lives. The Candida albicans organism is found in the vaginas of almost all women and normally causes no problems. However, when it gets out of balance with the other "normal flora," such as lactobacilli (which can also be harmed by using douches), an overgrowth and symptoms can result. Pregnancy, the use of oral contraceptives and some antibiotics, and diabetes mellitus increase the risk of infection.

Symptoms

The most common symptoms are itching and irritation of the vagina and/or vulva. A whitish or whitish-gray discharge may be present, sometimes resembling cottage cheese, and may have a "yeasty" smell like beer or baking bread. Many women mistake the symptoms of the more common bacterial vaginosis for a yeast infection. In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33 percent of women who were self treating for a yeast infection actually had a yeast infection. Instead they had either bacterial vaginosis or a mixed-type infection. Currently, bacterial vaginosis can only be diagnosed during a doctor's visit.

Diagnosis

KOH (potassium hydroxide) preparation can be diagnostic. A scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% solution of KOH is then placed on the slide. The KOH dissolves the skin cells but leaves the Candida untouched. When viewed under a microscope the hyphae and pseudo spores of Candida are visible. Their presence in large numbers strongly suggest a yeast infection.

Swab and culture is performed by rubbing a sterile swab on the infected skin surface. The swab is then rubbed across a culture medium. The medium is incubated for several days, during which time colonies of yeast and or bacteria develop. The characteristics of the colonies provide a presumptive diagnosis of the organism.

Treatment

Candidiasis is alleged to be successfully treated either with home remedies or, in the case of a more severe infection, with either over the counter or prescription antifungal medications. Home remedies for candidiasis include the consumption or direct application of yogurt, which contains lactobacillus (probiotics, "friendly" bacteria that kill yeast), acidophilus tablets or salves, and even lightly crushed cloves of garlic, which yield allicin, an antifungal. Boric acid has also been used to treat yeast infections when gelcaps are filled with boric acid powder and two are inserted at bedtime for three to four nights.

While home remedies can offer relief in minor cases of infection, seeking medical attention can be necessary because the extent of the infection sometimes cannot be judged well by the sufferer. Prescription medication is often the only solution to an infection; the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, topical ketoconazole. In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. These medications are not effective against the more common bacterial vaginosis.

If indicated, an underlying reason should be looked for. As an example, oral candidiasis is often linked to the use of inhaled steroids in asthma medication. Patients on long term inhaled steroids should rinse their mouth after each dose of steroids. It can also be the first sign of a more serious condition, such as HIV. Babies with diaper rash should have their diaper areas kept clean, dry, and exposed to air as much as possible. Sugar assists the overgrowth of yeast; thus, the increased prevalence of yeast infections in patients with diabetes mellitus, as noted above. In the case of frequent yeast infections, sugar can be looked to as a culprit and should be avoided. Nutritionists often recommend avoidance diets, eliminating sugar and often many other foods for a period. Extensive antibiotic treatment is sometimes implicated, and probiotics are then recommended.

Following the health tips at vulvovaginal health can help prevent vaginal candidiasis. Local treatment may include vaginal suppositories or medicated douches.

CHICKENPOX

Chickenpox, also spelled chicken pox, is the common name for Varicella simplex, classically one of the childhood infectious diseases caught and survived by most children.

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. It starts with conjunctival and catarrhal symptoms, moderate fever and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox (pocks), small open sores which heal mostly without scarring.

Effects

Chickenpox has a two-week incubation period and is highly contagious by air transmission two days before symptoms appear. Therefore, chickenpox spreads quickly through schools and other places of close contact. Once someone has been infected with the disease, they usually develop protective immunity for life. It is fairly rare to get the chickenpox multiple times, but it is possible for people with irregular immune systems. As the disease is more severe if contracted by an adult, parents have been known to ensure their children become infected before adulthood.

The disease is rarely fatal: if fatality occurs, the actual death is usually from varicella pneumonia, and occurs more frequently in pregnant women. In the US, 55 percent of chickenpox deaths were in the over-20 age group. Doctors advise pregnant women not known to be immune and who come into contact with chickenpox should contact their doctor immediately, as the virus can cause serious problems for the fetus. In the UK Varicella antibodies are measured as part of the routine of antenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune.

Later in life, viruses remaining in the nerves can develop into the painful disease shingles, particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Some of these will develop zoster-associated pain or post-herpetic neuralgia, described usually as "horrible" or "excruciating". A chickenpox vaccine has been available since 1995, and is now required in some countries for children to be admitted into elementary school. In addition, effective medications (e.g., aciclovir) are available to treat chickenpox in healthy and immunocompromised persons. Symptomatic treatment—calamine lotion to ease itching and paracetamol to reduce fever—is widely used. Aspirin is contraindicated in children with chickenpox, as it can lead to Reye's syndrome.

History

One history of medicine book claims Giovanni Filippo (1510–1580) of Palermo gave the first description of varicella (chickenpox). Subsequently in the 1600s, an English physician named Richard Morton described what he thought was a mild form of smallpox as "chicken pox." Later, in 1767, a physician named William Heberden, also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox. However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease.

There are many explanations offered for the origin of the name chickenpox:

* the specks that appear looked as though the skin was picked by chickens,
* the disease was named after chick peas, from a supposed similarity in size of the seed to the lesions
* Samuel Johnson suggested that the disease was "no very great danger," thus a "chicken" version of the pox
* the term reflects a corruption of the Old English word, "giccin", which meant "itching"

As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic.

During the medieval era, oatmeal was discovered to soothe the sores, and oatmeal baths are today still commonly given to relieve itching.

Infection

Chickenpox is highly infectious and spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. Touching the fluid from a chicken pox blister can also spread the disease. A persons with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. This may take between 5-10 days[1]. It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.

The chicken pox lesions (blisters) start as a 2-4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chicken pox. After about 8-12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a craterlike scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chicken pox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not sent back to school until all lesions have crusted over.

The contagious period for chickenpox begins about 2 days before the rash appears and lasts until all the blisters are crusted over. A child with chickenpox should be kept out of school until all of the blisters have dried, which is usually about 1 week, but you don't have to wait until all the scabs fall off to let your child get back to a normal schedule.

It is a debated fact as to whether a person, once infected with Chicken Pox can contract the disease again. Although numerous sources claim it is not possible, there have been reported cases of repeat infections.

Vaccination

Routine vaccination against varicella zoster virus is performed mainly in the United States, and the incidence of chickenpox has been dramatically reduced there (from 4 million cases per year in the pre-vaccine era to approximately 400,000 cases per year as of 2005). In Europe most countries do not currently vaccinate against varicella, though the vaccine is gaining wider acceptance. Australia, Canada, and other countries have now adopted recommendations for routine immunization of children and susceptible adults against chickenpox. Other countries, such as Germany and The United Kingdom have targeted recommendations for the vaccine, e.g. for susceptible health care workers at risk of varicella exposure.

Chickenpox is most often a mild disease -- especially for children. Prior to the introduction of vaccine, there were around 4,000,000 cases per year in the US, mostly children, yet typically 100 or fewer people died. Though mostly children caught it, the majority of deaths (by as much as 80%) were among adults. Additionally, chickenpox involved the hospitalization of about 10,000 people each year. During 2003 and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospitalizations have substantially declined in the US due to vaccination, though the rate of shingles infection has increased for the same reason. The vaccine has more recently been determined to be effective at preventing shingles (zoster) in persons 60 years of age and older, if administered regularly.

The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated more than thirty years ago with no evidence of waning immunity, while others have become vulnerable in as few as 6 years. Assessments of duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness, and we are only now entering an era in the US where the long-term efficacy of varicella vaccine can be accurately gauged (Goldman, 2005).

CHAGAS DISEASE

Chagas disease (also called American trypanosomiasis) is a human tropical parasitic disease which occurs in the Americas, particularly in South America. Its pathogenic agent is a flagellate protozoan named Trypanosoma cruzi, which is transmitted to humans and other mammals mostly by hematophagous insects of the subfamily Triatominae (Family Reduviidae). Those insects are known by numerous common names varying by country, including assassin bug, benchuca, vinchuca, kissing bug, chipo, barbeiro, et cetera. The most common insect species belong to the genera Triatoma, Rhodnius, and Panstrongylus. Other forms of transmission are possible, though, such as ingestion of food contaminated with parasites, blood transfusion and fetal transmission.

Trypanosoma cruzi is a member of the same genus as the infectious agent of African sleeping sickness, but its clinical manifestations, geographical distribution, life cycle and insect vectors are quite different.

History

The disease was named after the Brazilian physician and infectologist Carlos Chagas, who first described it in 1909, but the disease was not seen as a major public health problem in humans until the 1960s. He discovered that the intestines of Triatomidae harbored a flagellate protozoan, a new species of the Trypanosoma genus, and was able to prove experimentally that it could be transmitted to marmoset monkeys which were bitten by the infected bug.

Chagas named the pathogenic parasite that causes the disease Schizotrypanum cruzi (later renamed to Trypanosoma cruzi), after Oswaldo Cruz, the noted Brazilian physician and epidemiologist who fought successfully epidemics of yellow fever, smallpox, and bubonic plague in Rio de Janeiro and other cities in the beginning of the 20th century. Chagas’ work is unique in the history of medicine, because he was the only researcher so far to describe completely a new infectious disease: its pathogen, vector, host, clinical manifestations, and epidemiology. Nevertheless, he at least believed falsely until 1925, that the main infection route is by the sting of the insect and not by the feces, as it was proposed by his colleague Emile Brumpt 1915 and assured by Dias 1932, Cardoso 1938 and Brumpt himself 1939.

On another historical point of view, it has been hypothesized that Charles Darwin might have suffered from this disease as a result of a bite of the so-called Great Black Bug of the Pampas (vinchuca) (see Illness of Charles Darwin). The episode was reported by Darwin in his diaries of the Voyage of the Beagle as occurring in March 1835 to the east of the Andes near Mendoza. Darwin was young and in general good health though six months previously he had been ill for a month near Valparaiso, but in 1837, almost a year after he returned to England, he began to suffer intermittently from a strange group of symptoms, becoming very incapacitated for much of the rest of his life. Attempts to test Darwin's remains at the Westminster Abbey by using modern PCR techniques were met with a refusal by the Abbey's curator.

Epidemiology and geographical distribution

Chagas disease currently affects 16-18 million people, killing around 20,000 people annually and with some 100 million at risk of acquiring the disease. Chronic Chagas disease remains a major health problem in many Latin American countries, despite the effectiveness of hygienic and preventive measures, such as eliminating the transmitting insects, which have reduced to zero new infections in at least two countries of the region. With increased population movements, however, the possibility of transmission by blood transfusion has become more substantial in the United States. Also, T. cruzi has already been found infecting wild opossums and raccoons as far as North Carolina.

The disease is distributed in the Americas, ranging from the southern United States to southern Argentina, mostly in poor, rural areas of Central and South America.

The disease is almost exclusively found in rural areas, where the Triatominae can breed and feed on the natural reservoirs (the most common ones being opossums and armadillos) of T.cruzi. Depending on the special local interactions of the vectors and their hosts, other infected humans, domestic animals like cats, dogs, guinea pigs and wild animals like rodents, monkeys, ground squirrels (Spermophilus beecheyi) and many other could also serve as important parasite reservoirs. Though Triatominae bugs feed on birds, these seem to be immune against infection and therefore are not considered to be a T. cruzi reservoir, but they remain suspicious to be a constant feeding resource for the vectors in the surroundings of human stay.

The popular name of the vector insect in Brazil, barbeiro ("the barber"), so called because it sucks the blood at night by biting the face of its victims, reveals some of its habits. The insects, who develop a predominantly domiciliary and anthropophilic behaviour once they have infested a house, usually hide during the day in crevices and gaps in the walls and roofs of poorly constructed homes. More rarely, better constructed houses may harbor the insect vector, due to the use of rough materials for making roofs, such as bamboo and thatch. A mosquito net, wrapped under the mattress, will provide protection in these situations, when the adult insect might sail down from above, but one of the five nymphal stages (instars) could crawl up from the floor.

Even when the colonies of the insects are eradicated in the house and around (domestic animal shelters), they again can arrive (also by flying short distances) from nearby nature (possibly a palm tree), where animals and the insect which are part of the ancient, natural silvatic infection cycle use to live. This especially can happen in zones with mixed open savannah, clumps of trees, etc., interspersed by human habitation.

Dense vegetation, like in tropical rain forests, and urban habitats, are not ideal for the establishment of the human transmission cycle. However, in regions where the sylvatic habitat and its fauna are thinned out by economical exploitation and human habitation, such as in newly deforested areas of the Amazon region, this may occur, when the insects are searching for a new prey.

Clinical manifestations

The human disease occurs in two stages: the acute stage shortly after the infection, and the chronic stage that may develop over 10 years.

In the acute phase, a local skin nodule called a chagoma can appear at the site of inoculation. When the inoculation site is the conjunctival mucous membranes, the patient may develop unilateral periorbital edema, conjunctivitis, and preauricular lymphadenitis. This constellation of findings is referred to as Romaña's sign. The acute phase is usually asymptomatic, but can present with manifestations that include fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, and myocarditis. Some acute cases (10 to 20%) resolve over a period of 2 to 3 months into an asymptomatic chronic stage, only to reappear after several years.

The symptomatic chronic stage may not occur for years or even decades after initial infection. The disease affects the nervous system, digestive system and heart. Chronic infections result in various neurological disorders, including dementia, damage to the heart muscle (cardiomyopathy, the most serious manifestation), and sometimes dilation of the digestive tract (megacolon and megaesophagus), as well as weight loss. Swallowing difficulties may be the first symptom of digestive disturbances and may lead to malnutrition. After several years of an asymptomatic period, 27% of those infected develop cardiac damage, 6% develop digestive damage, and 3% present peripheral nervous involvement. Left untreated, Chagas disease can be fatal, in most cases due to the cardiomyopathy component.

Laboratory diagnosis

Demonstration of the causal agent is the diagnostic procedure in acute Chagas disease. It almost always yields positive results, and can be achieved by:

* Microscopic examination: a) of fresh anticoagulated blood, or its buffy coat, for motile parasites; and b) of thin and thick blood smears stained with Giemsa, for visualization of parasites; it can be confused with the 50% longer Trypanosoma rangeli, which has not shown any pathogenity in humans yet.
* Isolation of the agent by: a) inoculation into mice; b) culture in specialized media (e.g. NNN, LIT); and c) xenodiagnosis, where uninfected Reduviidae bugs are fed on the patient's blood, and their gut contents examined for parasites 4 weeks later.
* Various Immunodiagnostic tests; (also trying to distinguish strains (zymodemes) of T.cruzi with divergent pathogenities).
o Complement fixation
o indirect hemagglutination
o IFA, Indirect fluorescent assay
o RIA, Radio-immunoassay
o ELISA, Enzyme-Linked Immunosorbent Assay
o PCR, Polymerase chain reaction, most promising

Treatment

Medication for Chagas disease is usually only effective when given during the acute stage of infection. The drugs of choice are azole or nitroderivatives such as benznidazole or nifurtimox (under an Investigational New Drug protocol from the CDC Drug Service), but resistance to these drugs has already been reported. Furthermore, these agents are very toxic and have many adverse effects, and cannot be taken without medical supervision. A 10-year study of chronic administration of drugs in Brazil has revealed that these drugs are not totally effective, too, in removing parasitemia. Thus, the decision about whether to use antiparasitic therapy should be individualized in consultation with an expert.

In the chronic stage, treatment involves managing the clinical manifestations of the disease, e.g., drugs and heart pacemaker for chronic heart failure and heart arryhthmias; surgery for megaintestine, etc., but the disease per se is not curable in this phase. Chronic heart disease caused by Chagas is now a common reason for heart transplantation surgery. Until recently, however, Chagas disease was considered a contraindication for the procedure, since the heart damage could recur as the parasite was expected to seize the opportunity provided by the immunosuppression that follows surgery. The research that changed the indication of the transplant procedure for Chagas disease patients was conducted by Dr. Adib Jatene's group at the Heart Institute of the University of São Paulo, in São Paulo, Brazil. The research noted that survival rates in Chagas patients can be significantly improved by using lower dosages of the immunosuppressant drug cyclosporine. Recently, direct stem cell therapy of the heart muscle using bone marrow cell transplantation has been shown to dramatically reduce risks of heart failure in Chagas patients. Patients have also been shown to benefit from the strict prevention of reinfection, though the reason for this is not yet clearly understood.

Some examples for the struggle for advances:

* Use of oxidosqualene cyclase inhibitors and cysteine protease inhibitors has been found to cure experimental infections in animals.
* Dermaseptins from frog species Phyllomedusa oreades and P. distincta. Anti-Trypanosoma cruzi activity without cytotoxicity to mammalian cells.
* The sesquiterpene lactone dehydroleucodine (DhL) affects the growth of cultured epimastigotes of Trypanosoma cruzi
* The genome of the disease has been sequenced. Proteins that are produced by the disease but not by humans have been identified as possible drug targets to defeat the disease.

Prevention

A reasonably effective vaccine was developed in Ribeirão Preto in the 1970s, using cellular and subcellular fractions of the parasite, but it was found economically unfeasible. More recently, the potential of DNA vaccines for immunotherapy of acute and chronic Chagas disease is being tested by several research groups.

Prevention is centered on fighting the vector (Triatoma) by using sprays and paints containing insecticides (synthetic pyrethroids), and improving housing and sanitary conditions in the rural area. For urban dwellers, spending vacations and camping out in the wilderness or sleeping at hostels or mud houses in endemic areas can be dangerous, a mosquito net is recommended. If the traveller intends to travel to the area of prevalence, he/she should get information on endemic rural areas for Chagas disease in traveller advisories, such as the CDC.

In most countries where Chagas disease is endemic, testing for blood donors is already mandatory, since this can be an important route of transmission. In the past, blood donors where mixed with 0,25 g/L of gentian violet successfully to kill parasites.

With all these measures, some landmarks were achieved in the fight against Chagas disease in Latin America: a reduction by 72% of the incidence of human infection in children and young adults in the countries of the Initiative of the Southern Cone, and at least two countries (Uruguay, in 1997, and Chile, in 1999), were certified free of vectorial and transfusional transmission. In Brazil, with the largest population at risk, 10 out of the 12 endemic states were also certified free.

Some stepstones of vector control:

* A yeast trap has been tested for monitoring infestations of certain species of the bugs:"Performance of yeast-baited traps with Triatoma sordida, Triatoma brasiliensis, Triatoma pseudomaculata, and Panstrongylus megistus in laboratory assays."
* Promising results were gained with the treatment of vector habitats with the fungus Beauveria bassiana, (which is also in discussion for malaria- prevention):"Activity of oil-formulated Beauveria bassiana against Triatoma sordida in peridomestic areas in Central Brazil."
* Targeting the symbionts of Triatominae

CROUP

Croup (also called laryngotracheobronchitis) is a disease which afflicts infants and young children, typically aged between 3 months and 5 years.

Symptoms

It is characterized by a harsh 'barking' cough, stridor and fever.

The 'barking' cough of croup is diagnostic.

In diagnosing croup, it is important for the physician to consider and exclude other causes of shortness of breath.

Causes

It is most often caused by parainfluenza virus, but other viral and bacterial infections can also cause it. It is the body's reaction to the infection that causes the respiratory distress, not the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults, making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.

Treatment

Treatment of croup depends on the severity encountered.

* One of the simplest ways to treat or help with croup is to take hot showers that steam (the steam moisturizes the airway) or just use a humidifier, which has a similar effect. These simple methods usually help a lot. However, they may not be enough to completely get rid of the croup in moderate to severe cases.

* Mild croup with no stridor and just the cough may just be watched or a small dose of inhaled or oral steroids may be given.

* Moderate to severe croup may require airway intervention and oxygen supplementation in addition to steroids, depending on the amount of respiratory distress.

* Adrenaline may also be given in cases of severe croup, either via nebulizer or injected intramuscularly or intravenously.

CYTOMEGALOVIRUS

Cytomegalovirus (CMV), is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). It belongs to the Betaherpesvirinae subfamily of Herpesviridae. The name means "cell very big virus".

CMV especially attacks salivary glands and may also be devastating or even fatal to fetuses. CMV infection can also be life threatening for patients who are immunocompromised (e.g. patients with HIV or organ transplant recipients). CMV viruses are found in many mammal species, but generally are specific only to that species.

Species

* Cercopithecine herpesvirus 5 (CeHV-5) - African green monkey cytomegalovirus
* Cercopithecine herpesvirus 8 (CeHV-8) - Rhesus monkey cytomegalovirus
* Human herpesvirus 5 (HHV-5) - Human cytomegalovirus
* Pongine herpesvirus 4 (PoHV-4)

Tentative species:

* Aotine herpesvirus 1 (AoHV-1) - Herpesvirus aotus 1
* Aotine herpesvirus 3 (AoHV-3) - Herpesvirus aotus 3

General information

Cytomegalovirus, or CMV, is found universally throughout all geographic locations and socioeconomic groups, and infects between 50% and 85% of adults in the United States by 40 years of age. CMV is also the virus most frequently transmitted to a developing child before birth. CMV infection is more widespread in developing countries and in areas of lower socioeconomic conditions. For most healthy persons who acquire CMV after birth there are few symptoms and no long-term health consequences. Some persons with symptoms experience infectious mononucleosis, with prolonged fever, and a mild hepatitis. A very sore throat is also common. Once a person becomes infected, the virus latently persists in the body for the person's life. Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease. Therefore, for the vast majority of people, CMV infection is not a serious problem.

However, CMV infection is important to certain high-risk groups. Major areas of concern are (1) the risk of infection to the unborn baby during pregnancy, (2) the risk of infection to people who work with children, and (3) the risk of infection to the immunocompromised person, such as organ transplant recipients and persons infected with human immunodeficiency virus (HIV).

The virus acts by blocking cell apoptosis via the mitochondria and causing massive cell enlargement, which is the source of the virus' name.

Characteristics of the virus

CMV is a member of the herpesvirus group, which includes herpes simplex virus types 1 and 2, varicella-zoster virus (which causes chickenpox and shingles), and Epstein-Barr virus (which, together with CMV, is the main cause for infectious mononucleosis). These viruses share a characteristic ability to remain latent within the body over a long period.

Initial CMV infection, which may have few symptoms, is always followed by a prolonged, inapparent infection during which the virus resides in cells without causing detectable damage or clinical illness. Severe impairment of the body's immune system by medication or disease (see below) may reactivate the virus from the latent or dormant state.

Infectious CMV may be shed in the bodily fluids of any previously infected person, and thus may be found in urine, saliva, blood, tears, semen, and breast milk. The shedding of virus may take place intermittently, without any detectable signs, and without causing symptoms.

As a result of efforts to create an attenuated-virus vaccine, there currently exist two general classes of CMV. Clinical isolates comprise those viruses obtained from patients and represent the wild-type viral genome, while laboratory strains have been cultured extensively in the lab setting and typically contain numerous accumulated mutations. Most notably, the laboratory strain AD169 appears to lack a 15kb region of the 200kb genome that is present in clinical isolates. This region contains 19 open reading frames whose functions have yet to be elucidated. AD169 is also unique in that it is unable to enter latency and nearly always assumes lytic growth upon infection.

Transmission and prevention

Transmission of CMV occurs from person to person. Infection requires close, intimate contact with a person excreting the virus in their saliva, urine, or other bodily fluids. CMV can be sexually transmitted and can also be transmitted via breast milk, transplanted organs, and rarely from blood transfusions.

Although the virus is not highly contagious, it has been shown to spread in households and among young children in day care centers. Transmission of the virus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. Therefore, care should be taken when handling children and items like diapers. Simple hand washing with soap and water is effective in removing the virus from the hands.

CMV infection without symptoms is common in infants and young children; as a result, it is common to not exclude from school or an institution a child known to be infected. Similarly, hospitalized patients are not typically separated or isolated.

Specific situations

Pregnancy

The incidence of primary (or first) CMV infection in pregnant women in the United States varies from 1% to 3%. Healthy pregnant women are not at special risk for disease from CMV infection. When infected with CMV, most women have no symptoms and very few have a disease resembling mononucleosis. It is their developing unborn babies that may be at risk for congenital CMV disease. CMV remains the most important cause of congenital (meaning from birth) viral infection in the United States. For infants who are infected by their mothers before birth, two potential problems exist:

* Generalized infection may occur in the infant, and symptoms may range from moderate enlargement of the liver and spleen (Hepatosplenomegaly) (with jaundice) to fatal illness. With supportive treatment most infants with CMV disease usually survive. However, from 80% to 90% will have complications within the first few years of life that may include hearing loss, vision impairment, and varying degrees of mental retardation.
* Another 5% to 10% of infants who are infected but without symptoms at birth will subsequently have varying degrees of hearing and mental or coordination problems.

However, these risks appear to be almost exclusively associated with women who previously have not been infected with CMV and who are having their first infection with the virus during pregnancy. Even in this case, two-thirds of the infants will not become infected, and only 10% to 15% of the remaining third will have symptoms at the time of birth. There appears to be little risk of CMV-related complications for women who have been infected at least 6 months prior to conception. For this group, which makes up 50% to 80% of the women of child-bearing age, the rate of newborn CMV infection is 1%, and these infants appear to have no significant illness or abnormalities.

The virus can also be transmitted to the infant at delivery from contact with genital secretions or later in infancy through breast milk. However, these infections usually result in little or no clinical illness in the infant.

To summarize, during a pregnancy when a woman who has never had CMV infection becomes infected with CMV, there is a potential risk that after birth the infant may have CMV-related complications, the most common of which are associated with hearing loss, visual impairment, or diminished mental and motor capabilities. On the other hand, infants and children who acquire CMV after birth have few, if any, symptoms or complications.

Recommendations for pregnant women with regard to CMV infection:

* Throughout the pregnancy, practice good personal hygiene, especially handwashing with soap and water, after contact with diapers or oral secretions (particularly with a child who is in day care).
* Women who develop a mononucleosis-like illness during pregnancy should be evaluated for CMV infection and counseled about the possible risks to the unborn child.
* Laboratory testing for antibody to CMV can be performed to determine if a women has already had CMV infection.
* Recovery of CMV from the cervix or urine of women at or before the time of delivery does not warrant a cesarean section.
* The demonstrated benefits of breast-feeding outweigh the minimal risk of acquiring CMV from the breast-breeding mother.
* There is no need to either screen for CMV or exclude CMV-excreting children from schools or institutions because the virus is frequently found in many healthy children and adults.

Childcare

Most healthy people working with infants and children face no special risk from CMV infection. However, for women of child-bearing age who previously have not been infected with CMV, there is a potential risk to the developing unborn child (the risk is described above in the Pregnancy section). Contact with children who are in day care, where CMV infection is commonly transmitted among young children (particularly toddlers), may be a source of exposure to CMV. Since CMV is transmitted through contact with infected body fluids, including urine and saliva, child care providers (meaning day care workers, special education teachers, therapists, as well as mothers) should be educated about the risks of CMV infection and the precautions they can take. Day care workers appear to be at a greater risk than hospital and other health care providers, and this may be due in part to the increased emphasis on personal hygiene in the health care setting.

Recommendations for individuals providing care for infants and children:

* Female employees should be educated concerning CMV, its transmission, and hygienic practices, such as handwashing, which minimize the risk of infection.
* Susceptible nonpregnant women working with infants and children should not routinely be transferred to other work situations.
* Pregnant women working with infants and children should be informed of the risk of acquiring CMV infection and the possible effects on the unborn child.
* Routine laboratory testing for CMV antibody in female workers is not recommended, but can be performed to determine their immune status

Immunocompromised patients

Primary (or the initial) CMV infection in the immunocompromised patient can cause serious disease. However, the more common problem is the reactivation of the latent virus.

In patients with a depressed immune system, CMV-related disease may be much more aggressive. CMV hepatitis may cause fulminant liver failure. Specific disease entities recognised in those people are cytomegalovirus retinitis (inflammation of the retina, characterised by a "pizza pie appearance" on ophthalmoscopy) and cytomegalovirus colitis (inflammation of the large bowel).

Infection with CMV is a major cause of disease and death in immunocompromised patients, including organ transplant recipients, patients undergoing hemodialysis, patients with cancer, patients receiving immunosuppressive drugs, and HIV-infected patients. Because of this risk, exposing immunosuppressed patients to outside sources of CMV should be minimized. Whenever possible, patients without CMV infection should be given organs and/or blood products that are free of the virus.

Patients without CMV infection who are given organ transplants from CMV-infected donors should be given prophlyactic treatment with valganciclovir (ideally) or ganciclovir and require regular serological monitoring to detect a rising CMV titre, which should be treated early to prevent a potentially life-threatening infection becoming established.

Diagnosis of infection

Most infections with CMV are not diagnosed because the virus usually produces few, if any, symptoms and tends to reactivate intermittently without symptoms. However, persons who have been infected with CMV develop antibodies to the virus, and these antibodies persist in the body for the lifetime of that individual. A number of laboratory tests that detect these antibodies to CMV have been developed to determine if infection has occurred and are widely available from commercial laboratories. In addition, the virus can be cultured from specimens obtained from urine, throat swabs, bronchial lavages and tissue samples to detect active infection. Both qualitative and quantitative PCR testing for CMV are available as well, allowing physicians to monitor the viral load of CMV-infected patients.

CMV should be suspected if a patient:

* Has symptoms of infectious mononucleosis but has negative test results for mononucleosis and Epstein Barr virus, or,
* Shows signs of hepatitis, but has negative test results for hepatitis A, B, and C.

For best diagnostic results, laboratory tests for CMV antibody should be performed by using paired serum samples. One blood sample should be taken upon suspicion of CMV, and another one taken within 2 weeks. A virus culture can be performed at any time the patient is symptomatic.

Laboratory testing for antibody to CMV can be performed to determine if a woman has already had CMV infection. However, routine laboratory testing of all pregnant women is costly and the need for testing should therefore be evaluated on a case-by-case basis.

Serologic testing

The enzyme-linked immunosorbent assay (or ELISA) is the most commonly available serologic test for measuring antibody to CMV. The result can be used to determine if acute infection, prior infection, or passively acquired maternal antibody in an infant is present. Other tests include various fluorescence assays, indirect hemagglutination, polymerase chain reaction (PCR) and latex agglutination.

An ELISA technique for CMV-specific IgM is available, but may give false-positive results unless steps are taken to remove rheumatoid factor or most of the IgG antibody before the serum sample is tested. Because CMV-specific IgM may be produced in low levels in reactivated CMV infection, its presence is not always indicative of primary infection. Only virus recovered from a target organ, such as the lung, provides unequivocal evidence that the current illness is caused by acquired CMV infection. If serologic tests detect a positive or high titer of IgG, this result should not automatically be interpreted to mean that active CMV infection is present. However, if antibody tests of paired serum samples show a fourfold rise in IgG antibody and a significant level of IgM antibody, meaning equal to at least 30% of the IgG value, or virus is cultured from a urine or throat specimen, the findings indicate that an active CMV infection is present.

Relevance to blood donors

Although the risks discussed above are generally low, CMV assays are part of the standard screening for non-directed blood donation (donations not specified for a particular patient) in the U.S. CMV-negative donations are then earmarked for transfusion to infants or immunocompromised patients. Some blood donation centers may maintain lists of donors whose blood is CMV negative due to special demands.

Treatment

No treatment is generally necessary for CMV infection in the healthy individual since the majority of infections resolve on their own. Antiviral drug therapy is now being evaluated in infants.

Ganciclovir treatment is used for patients with depressed immunity who have either sight-related or life-threatening illnesses. Valganciclovir (marketed as Valcyte) is an antiviral drug that is also effective and is given orally. Foscarnet can be given in patients with CMV resistant to ganciclovir, though foscarnet is not as well tolerated as ganciclovir.

Vaccines are still in the research and development stage.

DUCHENNE MUSCULAR DYSTROPHY

Duchenne muscular dystrophy (DMD) (also known as muscular dystrophy - Duchenne type) is an inherited disorder characterized by rapidly progressive muscle weakness which starts in the legs and pelvis and later affects the whole body. Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy. It usually affects only boys, but in rare cases it can also affect girls. It is an X-linked recessive inherited disease. A milder form of this disease is known as Becker Muscular dystrophy (BMD). In Becker muscular dystrophy, most of the symptoms are similar to Duchenne, but the onset is later and the course is milder.

DMD is named after the French neurologist Guillaume Benjamin Amand Duchenne (1806-1875), who first described the disease in the 1860s. One third of the cases are known to be caused by development of spontaneous mutations in the dystrophin gene, while the remainder are inherited. Boys with DMD develop weak muscles because the muscle fibers that were present at birth are destroyed. It is due to mutations in the dystrophin gene, which encodes a cell membrane protein in myocytes (muscle cells).

Genetics

Duchenne dystrophy is a type of dystrophinopathy which includes a spectrum of muscle disease caused by mutations in the DMD gene, which encodes the protein dystrophin. Becker's muscular dystrophy is a milder type of dystrophinopathy. Although it is caused by a defective gene, it often occurs in people from families without a known family history of the condition.

Duchenne muscular dystrophy is inherited in an X-linked recessive pattern. This means that women are almost never affected; women normally have two X chromosomes, one of which contains a normal, dominant copy of the gene that will make enough of the protein for them to avoid symptoms. Women who carry the defective gene can pass an abnormal X on to their sons, however. Since boys have an X from their mother and a Y from father, there is no second X to make up for the defective gene from the carrier mother. The sons of carrier females each have a 50% chance of having the disease, and the daughters each have a 50% chance of being carriers. Daughters of men with Duchenne will always be carriers, since they will inherit an affected X chromosome from their father (note that the diagram only shows the results from an unnaffected father).

Prenatal testing, such as amniocentesis, for pregnancies at risk is possible if the DMD disease-causing mutation has been identified in a family member or if informative linked markers have been identified.

In 30% of the cases, the disease is a result of a spontaneous mutation.

In some female cases, DMD is caused by skewed x inactivation. In these cases, two copies of the x chromosome exist, but for reasons currently unknown, the flawed x chromosome manifests instead of the unflawed copy. In these cases, a mosaic form of DMD is seen, in which some muscle cells are completely normal while others exhibit classic DMD findings. The effects of a mosaic form of DMD on long-term outlook is not known.

Symptoms

* Muscle weakness
* Rapidly progressive
* Frequent falls
* Difficulty with motor skills (running, hopping, jumping)
* Progressive difficulty walking
* Ability to will be lost by age 11
* Fatigue
* Intellectual impairment (in approx. 30% of Duchenne's patients)
* Skeletal deformities
* Chest and back (scoliosis)
* Muscle deformities
* Contractures of heels, legs
* Pseudohypertrophy of tongue and calf muscles
* Mild mental retardation in some cases

Symptoms usually appear before age 6 and may appear as early as infancy. There is progressive muscle weakness of the legs and pelvis, which is associated with a loss of muscle mass (wasting). Muscle weakness also occurs in the arms, neck, and other areas, but not as severely or as early as in the lower half of the body. Calf muscles initially enlarge -- the enlarged muscle tissue is eventually replaced by fat and connective tissue (pseudohypertrophy). Muscle contractures occur in the legs, rendering the muscles unusable because the muscle fibers shorten and fibrosis occurs in connective tissue.

Treatment

There is no known cure for Duchenne muscular dystrophy. Treatment is aimed at control of symptoms to maximize the quality of life. Physical activity is encouraged. Inactivity (such as bed rest) can worsen the muscle disease. Physical and occupational therapy may be helpful to maintain muscle strength and function. Orthopaedic appliances (such as braces and wheelchairs) may improve mobility and the ability for self-care.

MEASLES

Measles, also known as rubeola, is a disease caused by a virus of the genus Morbillivirus.

Reports of measles go back to at least 700, however, the first scientific description of the disease and its distinction from smallpox is attributed to the Persian physician Ibn Razi (Rhazes) 860-932 who published a book entitled "Smallpox and Measles" (in Arabic: Kitab fi al-jadari wa-al-hasbah). In 1954, the virus causing the disease was isolated, and licensed vaccines to prevent the disease became available in 1963.

Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious - 90% of people without immunity sharing a house with an infected person will catch it. Airborne precautions should be taken for all suspected cases of measles.

The incubation period usually lasts for 10-12 days (during which there are no symptoms).

Infected people remain contagious from the appearance of the first symptoms until 3-5 days after the rash appears.

Symptoms

The classical symptoms of measles include a fever for at least three days duration, and the three C's - cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40 degrees Celsius (105 Fahrenheit). Koplik's spots seen inside the mouth are pathognomic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.

The rash in measles is classically described as a generalised, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body. The measles rash also classically "stains" by changing colour to dark brown from red before disappearing later. The rash can be itchy.

Diagnosis

A detailed history should be taken including course of the disease so far, vaccination history, contact history, and travel history.

Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs above. Observation of Koplik's spots is also diagnostic of measles.

Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens.

Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis.

Treatment

There is no specific treatment for uncomplicated measles. Patients with uncomplicated measles will recover with rest and supportive treatment.

Complications

Complications with measles are relatively common, ranging from relatively common and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis). Complications are usually more severe amongst adults who catch the virus.

The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 percent.

Public health

In developed countries, most children are immunised against measles at the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A "booster" vaccine is then given between the ages of four and five. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dorm or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune. In developing countries, measles remains common.

The recent vaccine controversy in the UK regarding a potential link between the combined MMR vacine (vaccinating children from mumps, measles and rubella) and autism has prompted a resurgence in popularity of the "measles party", where parents deliberately infect the child with measles in order to build up the child's immunity without requiring an injection. This practice poses many health risks to the child, and has been discouraged by the UK's National Health Service.

Measles is a significant infectious disease because, while the rate of complications is not high, the disease itself is so infectious that the sheer number of people who would suffer complications in an outbreak amongst non-immune people would quickly overwhelm available hospital resources. If vaccination rates fall, the number of non-immune persons in the community rises and the risk of an outbreak of measles consequently rises.

According to the World Health Organization (WHO), measles is a leading cause of vaccine preventable childhood mortality - there were 30 million cases and 875,000 deaths caused by measles every year.The WHO and the United Nations Children's Fund (UNICEF) reports that the global immunization drive has cut measles deaths by nearly half between 1999 and 2004 (from 871,000 in 1999 to an estimated 454,000 in 2004), "thanks to major national immunization activities and better access to routine childhood immunization".

MUMPS

Mumps or epidemic parotitis is a viral disease of humans. Prior to the development of vaccination, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.

Symptoms of mumps tend to be mild, such as painful swelling of the salivary glands and testicles, rash and fever. In teenagers and adults, the symptoms can be more severe and complications (such as infertility or subfertility (see PMID 8692089, PMID 2368216, PMID 2100952) are relatively common, although still rare in absolute terms. The disease is generally self-limiting, and there is no specific treatment apart from controlling the symptoms with painkillers.

Causes and risks

The mumps are caused by a paramyxovirus, and is spread from person to person by saliva droplets or direct contact with articles that have been contaminated with infected saliva. The parotid glands (the salivary glands between the ear and the jaw) are usually involved. Unvaccinated children between the ages of 2 and 12 are most commonly infected, but the infection can occur in other age groups. Orchitis (swelling of the testes) occurs in 10-20% of infected males, but sterility only rarely ensues; a viral meningitis occurs in about 5% of those infected. In older people, other organs may become involved including the central nervous system, the pancreas, the prostate, the breasts, and other organs.

The incubation period is usually 12 to 24 days. Mumps is generally a mild illness in children in developed countries. After adolescence, mumps tends to affect the ovary, causing oophoritis, and the testis, causing orchitis. The mature testis is particularly susceptible to damage from mumps which can lead to infertility. Adults infected with mumps are more likely to develop severe symptoms and complications.

Symptoms

The more common symptoms of mumps are:

* Swelling of the parotid gland (or parotitis) in >90% of patients.
* Fever
* Headache
* Sore throat
* Orchitis, referring to painful inflammation of the testicle (see also PMID 2219620).

Signs and tests

A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, serology or a saliva test for the virus may be carried out.

Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area, acetaminophen (paracetamol) for pain relief (aspirin is discouraged in children with a viral illness because of the risk of Reye's syndrome). Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.

Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.

Prognosis

The disease is self-limiting, and general outcome is good, even if other organs are involved. Sterility in men from involvement of the testes is very rare. After the illness, life-long immunity to mumps generally occurs.

Complications

Known complications of mumps include:

* Infection of other organ systems
* Sterility in men (this is quite rare, and mostly occurs in older men)
* Mild forms of meningitis (rare, 40% of cases occur without parotid swelling)
* Encephalitis (very rare, rarely fatal)
* Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral

Prevention

The most common preventative measure against mumps is the MMR immunization (vaccine). This not only protects against mumps, but also protects against measles and rubella. The WHO recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12-15 months and 4-6 years.The vaccination is repeated in some locations between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. Efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%.

Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. Disagreeing, the WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.

Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000 (Atkinson W, Humiston S, Wolfe C, Nelson R Editors. Epidemiology and Prevention of Vaccine-Preventable Diseases, 5th Edition, Centers for Disease Control and prevention.) In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%). The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 152,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.

RHEUMATIC FEVER

Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain.

General information

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. In the Western countries, it became fairly rare since the 1950's, possibly due to higher hygienic standards. While it is far less common in the United States since the beginning of the 20th century, there have been a few outbreaks since the 1980s. Although the disease seldom occurs, it is serious and has a mortality of 2 - 5%.

Rheumatic fever primarily affects children between ages six and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3 %. The rate of development is far lower in individuals who have received antibiotic treatment. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the happy happy heart valves are involved.

Diagnosis: Modified Jones Criteria

T. Duckett Jones, MD first published these criteria in 1944. They have been periodically revised by the American Heart Association in collaboration with other groups. Two major criteria, or one major and two minor criteria, when there is also evidence of a previous strep infection support the diagnosis of rheumatic fever.

Major Criteria

* Carditis: inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.
* Migratory polyarthritis: a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
* Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease.
* Erythema marginatum: a long lasting rash that begins on the trunk or arms as macules and spread outward to form a snakelike ring while clearing in the middle. This rash never starts on the face and is made worse with heat.
* Subcutaneous nodules (a form of Aschoff bodies): painless, firm collections of collagen fibers on the back of the wrist, the outside elbow, and the front of the knees. These now occur infrequently.

Minor Criteria

* Fever: temperature elevation
* Arthralgia: Joint pain without swelling
* Laboratory abnormalities: increased Erythrocyte sedimentation rate, increased C reactive protein, leukocytosis
* Electrocardiogram abnormalities: a prolonged PR interval
* Evidence of Group A Strep infection: positive culture for Group A Strep, elevated or rising Antistreptolysin O titre

Other Signs and Symptoms

* Abdominal pain
* Epistaxis

Pathophysiology

Rheumatic fever is an autoimmune disease which occurs after an untreated Group A streptococcal infection, typically a throat infection. The antibodies formed against the bacteria attack parts of the body, typically the joints and the heart. This occurs because the streptoccal M antigen can stimulate B cells which are cross reactive with cardiac myosin.

Group A Streptococcus pyogenes has a cell wall that is composed of branched polymers which sometimes contain "M proteins" which are highly antigenic. The antibodies formed against these proteins sometimes cross-react with normal tissue causing damage. Depending on the site of damage, this can lead to the clinical symptoms described above.

Treatment

The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.

Infection

Patients with positive cultures for Streptococcus pyogenes should be treated with Penicillin as long as allergy is not present. This treatment will not alter the course of the acute disease.

Inflammation

Patients with significant symptoms may require corticosteroids. Salicylates are useful for pain.

Heart failure

Some patients develop significant carditis which manifests as congestive heart failure. This requires the usual treatment for heart failure: diuretics, digoxin, etcetera. Unlike normal heart failure, rheumatic heart failure responds well to corticosteroids.

Prevention

Prevention of recurrence is achieved by eradicating the acute infection and prophylaxis with antibiotics. The American Heart Association recommends prophylaxis continue at least 10 years.

RUBELLA

Rubella (also known as epidemic roseola, German measles, liberty measles or three-day measles) is a disease caused by the Rubella virus. It is often mild and an attack can pass unnoticed. However, this can make the virus difficult to diagnose. The virus usually enters the body through the nose or throat. The disease can last 1-5 days. Children recover more quickly than adults. Like most viruses living along the respiratory tract, it is passed from person to person by tiny droplets in the air that are breathed out. Rubella can also be transmitted from a mother to her developing baby through the bloodstream via the placenta. The virus has an incubation period of 2 to 3 weeks during which it becomes established.

The name German measles has nothing to do with Germany. It comes from the Latin germanus, meaning "similar", since rubella and measles share many symptoms.

Symptoms

Symptoms of rubella include:

* swollen glands or lymph nodes (may persist for up to a week)
* fever (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])
* rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears on the first or third day of the illness but it disappears after a few days with no staining or peeling of the skin)
* Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate
* flaking, dry skin
* inflammation of the eyes
* nasal congestion
* joint pain and swelling
* pain in the testicles
* loss of appetite
* headache
* nerves become weak or numb (very rare)

Risks

Rubella can affect anyone of any age and is generally a mild disease. However, rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman.

Prevention and treatment

Symptoms are usually treated with acetaminophen until the disease has run its course. There is no treatment available for congenital rubella.

Fewer cases of rubella occur since a vaccine became available in 1969, although decreased uptake of the MMR vaccine (e.g. in the UK) is expected to lead to a rise in incidence. In most Western countries, the vast majority of people are vaccinated against rubella as children at 12 to 15 months of age. A second dose is required before age 11. The vaccine gives lifelong protection against rubella. A side-effect of the vaccine can be transient arthritis.

The immunization program has been quite successful with Cuba declaring the disease eradicated in the 1990s and the United States eradicating it in 2005. Every minister of health in the Americas plans to eliminate the disease by 2010.

PERTUSSIS (whooping cough)

Pertussis, also known as "whooping cough", is a highly contagious disease that is one of the leading causes of vaccine-preventable deaths. There are 30–50 million cases per year, and about 300,000 deaths per year. Most deaths occur in children under one year of age. Ninety percent of all cases occur in developing countries. It is caused by certain species of the bacterium Bordetella—usually B. pertussis, but some cases are caused by B. parapertussis.

The disease was recognizably described as early as 1578 by Guillaume de Baillou (1538-1616), but earlier reports date back at least to the 12th century. B. pertussis was isolated in pure culture in 1906 by Jules Bordet and Octave Gengou. The complete B. pertussis genome of 4,086,186 base pairs was sequenced in 2002.

Characterization

The disease is characterized initially by mild respiratory infections symptoms such as cough, sneezing, and runny nose (catarrhal stage). After one to two weeks the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound (paroxysmal stage). Coughing fits may be followed by vomiting not necessarily due to nausea but due to the sheer violence of the fit itself, which in severe cases leads to malnutrition. The fits, that do occur on their own, can also be triggered by yawning, stretching, laughing, or yelling. Coughing fits gradually diminish over one to two months. Other complications of the disease include pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection.

Transmission

The disease is spread by contact with airborne discharges from the mucous membranes of infected people. Laboratory diagnosis include; Calcium alginate throat swab, culture on Bordet-Gengou medium, immunofluorescence and serological methods. Treatment of the disease with antibiotics (often erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole) results in the person becoming less infectious but probably does not significantly alter the outcome of the disease. Close contacts who receive appropriate antibiotics, "chemoprophylaxis", during the 7–21 day incubation period may be protected from developing symptomatic disease.

Vaccines

Pertussis vaccines were initially formulated in 1926—most notable by Dr. Louis W. Sauer of Northwestern University and Evanston Hospital—as whole-cell preparations, but are now available as acellular preparations, which cause fewer side effects. They offer protection for only a few years, and are given so that immunity lasts through childhood, the time of greatest exposure and greatest risk. The immunizations are often given in combination with tetanus and diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years. Traditionally, pertussis vaccines are not given after age seven, as the frequency of side effects associated with the immunization tends to increase with age. The most serious side-effects of immunization are neurological: they include seizures and hypotonic episodes. An acellular vaccine preparation for older individuals is available in Canada and Europe, and two such products are being evaluated for their safety in adolescents and adults in the United States; a Food and Drug Administration decision was approved for use of the vaccine for 11-64 year olds in August 2005.

Other notes

The disease is much milder in adults than in children and many cases go undiagnosed or misdiagnosed. People may suffer from B. pertussis infection more than once in their life.

This disease is one of several that ravaged Native American populations after Europeans colonized the New World.

The Chinese call this disease the '100 Days Cough' due to the length that it lasts among most people.

Bordetella pertussis elaborates several virulence factors, including: pertussis toxin, an adenylate cyclase toxin, filamentous hemagglutinin, a tracheal cytotoxin, fimbriae, and pertactin.

FIFTH DISEASE

Fifth disease is also referred to as erythema infectiosum (meaning infectious redness) and as slapped cheek syndrome, slap face or slapped face.

In 1975 its cause was discovered to be Parvovirus B19.

The bright red cheeks are a defining symptom of the infection in children (hence the name "slapped cheek disease"), but the rash will not extend over the bridge of the nose or around the mouth. In addition to the red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations. Teenagers and adults may present with a self-limited arthritis.

Patients are usually no longer infectious once the characteristic rash of this disease has appeared. Any age may be affected although it is most common in children aged six to ten years. By the time adulthood is reached about half the population will have become immune following infection at some time in their past. Outbreaks can arise especially in nurseries and schools.

The disease is usually mild, but it does have the ability to cause some serious problems: it is associated with spontaneous abortion in pregnant women, and with transient aplastic crisis in persons with chronic hemolytic anemia. Primary infection in the first trimester has been linked to hydrops fetalis. The rash can last a couple of weeks and may itch.

The name fifth disease stems from the fact that when diseases causing childhood rashes were enumerated, it was the fifth listed.

Longevity

2006-05-19T00:01:00.000-07:00

Longevity is defined as long life or the length of a person's life (life expectancy). Reflections on longevity have usually gone beyond acknowledging the basic shortness of human life and have included thinking about methods to extend life. Longevity has been a topic not only for the scientific community but also for writers of travel, science fiction and utopian novels. The longest human lifespan on record that has been authenticated is the 122 years 164 days of Jeanne Calment, though fiction, legend, and mythology have proposed or claimed vastly longer lifespans in the past or future and longevity myths frequently allege them to exist in the present.

Presently

Various factors contribute to an individual's longevity. Significant factors in life expectancy include genetics, access to health care, hygiene, diet, exercise and lifestyle. Below is a list of life expectancies in different types of countries[1]:

* First World: . . . 77-83 years (eg. Canada: 80.1 years, 2005 est)
* Second World:. 65-77 years (eg. Russia: 67.1 years, 2005 est)
* Third World:. . . 35-60 years (eg. Mozambique: 40.3 years, 2005 est)

Tobacco smoking is generally accepted to significantly reduce longevity, and is one of the main statistical factors explaining differences in life expectancy between advanced nations. This may be offset by other factors; Japan, a country with a high rate of tobacco consumption, has one of the highest life expectancies in the world (81.15 years, 2005 est). Hong Kong, a dense 7 million people city with constant stress, recently reported a higher life expectancy than Japan (81.39 years, 2005 est)

Population longevities can be seen as increasing due to increases in life expectancies around the world:

* Australia: . . 80 years in 2002, 80.39 years in 2005
* Italy:. . . . . . 79.25 years in 2002, 79.68 years in 2005
* France: . . . .79.05 years in 2002, 79.60 years in 2005
* Germany: . . 77.78 years in 2002, 78.65 years in 2005
* UK: . . . . . . 77.99 years in 2002, 78.4 years in 2005
* USA: . . . . . 77.4 years in 2002, 77.7 years in 2005

Records

The current validated longevity records can be found in the list of supercentenarians. Notable individuals include:

* Jeanne Calment (1875-1997, 122 years and 164 days) - oldest person ever whose age has been verified by modern documentation; born 1875, lived to the age of 122. This defines the human lifespan, which is set by the oldest documented individual who ever lived.
* Shigechiyo Izumi (1865-1986, 120 years 237 days, disputed) - oldest male ever recognized by the Guinness Book of World Records; authentication largely questioned by modern conflation.
* Christian Mortensen (1882-1998, 115 years) - oldest male widely accepted by scholars

History

Reaching an old age has fascinated people for ages. There are many organizations dedicated to exploring the causes behind aging, ways to prevent aging, and ways to reverse aging. Despite the fact that it is no more than human nature to not wish to surrender to old age and death, a few organizations are against antiaging, because they believe it sacrifices the best interests of the new generation, that it is unnatural, or unethical. Others are dedicated towards it, seeing it as a form of transhumanism and the pursuit of immortality. Even among those who do not wish for eternal life, longevity may be desired to experience more of life, to provide a greater contribution to humanity.

Religion

The Bible contains many accounts of long-lived humans, the oldest being Methuselah living to be 969 years old (Genesis 5:27). Today some maintain that the unusually high longevity of Biblical patriarchs are the result of an error in translation: lunar cycles were mistaken for the solar ones, and that the actual ages being described would have been 13.5 times less. This makes Methuselah's described 72, still an impressive number bearing in mind the average life expectancy at the time. This rationalization, however, seems doubtful too since patriarchs such as Mahalalel (ibid 5:15) and Enoch (ibid 5:21) were said to have become fathers after 65 "years". If the lunar cycle claim were accepted this would translate to an age of about 4 years and 10 months. One Christian apologist claim is that the life span of humans has changed; that originally man was to have everlasting life, but due to man's sin, God progressively shortened man's life in the "four falls of mankind" -- first to less than 1000 years, then to under 500, 200, and eventually 120 years.

Non-fundamentalist Christians, skeptics and atheists tend to consider such stories to be among the longevity myths, noting that age exaggeration tends to be greater in "mythical" periods in many cultures; the early emperors of Japan or China often ruled for more than a century, according to tradition. With the advent of modern accountable record-keeping, age claims fell to realistic levels; even later in the Bible King David died at 70 years; other kings in their 30s, 40s, and 50s. The Bible also says that after those long living people died, God decided that humans would not be permitted to live more than 120 years (Genesis 6:3.)

Future

The mainstream view on the future of longevity, such as the US Census Bureau, is that life expectancy in the USA will be in the mid-80s by the year 2050 (up from 77 today) and will top out eventually in the low 90s, barring major scientific advances that can change the rate of human aging itself, as opposed to merely treating the effects of aging as is done today. The Census Bureau also predicted that the USA would have 5.3 million people aged over 100 in 2100.

Recent increases in the rates of obesity-related diseases, such as diabetes, hypertension, and heart disease, may however drastically slow or reverse this trend toward increasing life expectancy in the developed world.

Non-human biological longevity

Living:

* Methuselah (tree) - 4700-year-old bristlecone pine in the White Mountains of California, the oldest known living organism.
* Harriet - a 175-year-old Galápagos tortoise, the oldest known living animal.
* Cheeta - a 74-year old chimpanzee, the longest lived known chimpanzee.

Dead:

* Adwaitya - an Aldabra Giant Tortoise, died at 255 years old, the oldest known animal.
* A Bowhead Whale killed in a hunt was found to be approximately 211 years old, the longest lived mammal known.

Mental health

2006-05-19T00:00:00.000-07:00

Mental health is a concept that refers to a human individual's emotional and psychological well-being. Merriam-Webster defines mental health as "A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life."

According to the World Health Organization (WHO), there is no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined. In general, most experts agree that "mental health" and "mental illness" are not opposites. In other words, the absence of a recognized mental disorder is not necessarily an indicator of mental health.

One way to think about mental health is by looking at how effectively and successfully a person functions. Feeling capable and competent; being able to handle normal levels of stress, maintain satisfying relationships, and lead an independent life; and being able to "bounce back," or recover from difficult situations, are all signs of mental health.

Overview

Some experts consider mental health as a continuum. Thus, an individual's mental health may have many different possible values. Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if they do not have any diagnosable mental illness. This definition of mental health highlights emotional well being, the capacity to live a full and creative life and the flexibility to deal with life's inevitable challenges. Many therapeutic systems and self-help books offer methods and philosophies espousing presumably effective strategies and techniques for further improving the mental wellness of otherwise healthy people. Currently the science of psychology is leaning towards the biological approach, i.e. widespread, although controversial, use of psychoactive drugs in the treatment of mental illness.

World Health Organization definition of mental health

"Mental health has been defined variously by scholars from different cultures. Concepts of mental health include subjective well-being, percieved self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From a cross-cultural perspective, it is nearly impossible to define mental health comprehensively. It is, however, generally agreed that mental health is broader than a lack of mental disorders."

Mental hygiene concept

Dr. William Glasser, a psychiatrist engaged in therapeutics and counseling, describes 'Mental Hygiene' in his book Mental Health or Mental Illness (1961), following the dictionary definition of hygiene as the establishment and maintenance of health, i.e. mental health. Currently, many mental health professionals focus less upon enhancing mental health than on treating psychological symptoms with psychoactive medications.

Mental health, as a concept, is quite distinct from mental illness, and enhancement of mental health plays no part in what most mental health professionals actually do. Instead, the Western medical model relies primarily upon the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or ICD-10 to diagnose and treat the symptoms associated with what they call mental illnesses and disorders.

Psychopathology

Physicians, including psychiatrists, and other health and mental health professionals and researchers, generally agree that an illness is likely present when a defined pathology can be found in brain tissue. Illness that directly arise in connection with such pathology are often neurological in nature; Parkinson's disease and Alzheimer's disease are two examples. When no known identifiable organic or physical pathology is present, as is often the case in patients diagnosed with depression, mania, neurosis, and other mental illnesses, the question arises as to whether it is correct to attribute the very real symptoms to scientifically defined causes, i.e. a specific pathology. To a degree, certain indicators, such as reduced thyroid function, support medical hypotheses such as the chemical imbalance theory. The DSM-IV defines and attributes mental illnesses to 'chemical imbalances', for which neuropsychiatric drugs are now widely (and in the view of some board certified psychiatrists, wrongly) prescribed. (See Glasser: WARNING--Psychiatry Can Be Hazardous To Your Mental Health (Harper-Collins, 2004) and Treating Mental Health as a Public Health Problem -- A New Leadership Role for the Helping Professions and Robert Whitaker: Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Perseus Publishing, 2002))

Opposition to biological psychiatry

Opposing viewpoints to biological psychiatry theories include those of anti-psychiatry advocates, who contend psychiatric patients do not necessarily have a mental illness, but in fact are individuals who do not ascribe to the conventional belief system, or consensus reality, shared by most other people in their culture or race.

According to some critics of the reigning medical model, such as Glasser, the Public Health model has been successfully delivering physical health to millions of people for hundreds of years. He explains how this model could be expanded into a low cost Public Mental Health Delivery model, one that could be put into practice easily by all mental health professionals and institutions, by hiring mental health professionals to deliver services without diagnoses (and without strict reliance on drugs) directly to people who need professional help.

Dr. Glasser's work is closely associated with Choice theory.

Mental health promotion

Mental health promotion works from the principle that everyone has mental health needs, not just people who have been diagnosed with a mental illness. Mental health promotion is essentially concerned with making changes to society that will promote people's mental well-being.

Mental health promotion is a term that covers a variety of strategies. These strategies can be seen to occur at three levels:

* Individual - encouragement of invidual resources by promotion of interventions for self-esteem, coping, assertiveness in areas such as parenting, the workplace or personal relationships.
* Communities - increasing social inclusion and cohesion, developing support structures that promote mental health in workplaces, schools and neighbourhoods.
* Government reduce socioeconomic barriers to mental health at governmental level by promoting equal access for all and support for vulnerable citizens.

Health education

2006-05-18T23:58:00.001-07:00

Health education is defined as the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health.

Education for health begins with people as they are, with whatever interests they may have in improving their living conditions. Its aim is to develop in them a sense of responsibility for health conditions, as individuals and as members of families and communities. In communicable disease control, health education commonly includes an appraisal of what is known by a population about a disease, an assessment of habits and attitudes of the people as they relate to spread and frequency of the disease, and the presentation of specific means to remedy observed deficiencies. (Washington State Department of Health)

Health education is included in the curriculum of most schools. In the United States, some forty states require the teaching of health education. A comprehensive health education curriculum consists of planned learning experiences which will assist students to achieve desirable understandings, attitudes and practices related to critical health issues including, but not limited to, the following: emotional health and a positive self image; appreciation, respect for, and care of the human body and its vital organs; physical fitness; health issues of alcohol, tobacco and drug use and abuse; health misconceptions and quackery; effects of exercise on the body systems and on general well being; nutrition and weight control; sexual relationships, the scientific, social and economic aspects of community and ecological health; communicable and degenerative diseases including sexually transmitted diseases; disaster preparedness; safety and driver education; choosing professional medical and health services; and choices of health careers.

Health profession

2006-05-18T23:58:00.000-07:00

A health profession is a profession in which a person exercises skill or judgment or provides a service related to:
(a) the preservation or improvement of the health of individuals, or
(b) the treatment or care of individuals who are injured, sick, disabled, or infirm.

The delivery of modern health care depends on an expanding group of highly trained professionals coming together as an interdisciplinary team. Individuals are called health professionals if they participate in delivery of health care in some way. Thus, it is a rather broad term.

Examples of members of the health professions

Medical doctors have specializations on the medicine page. Often included as adjunct to allopathic medicine are osteopaths who are licensed with the same limitations and privileges as medical doctors. Dentistry, optometry, podiatry, and psychology, while separate disciplines from medicine, are often considered medical fields in the wider definition of the term. These practitioners are granted independent license to practice medicine and surgery and provide or prescribe medications within their fields. Practitioners such as physician assistants, nurse practitioners and midwives also treat patients and prescribe medication in many legal jurisdictions; however, they do so under the direction and supervision of an independently licensed practitioner.

Medical professional in its broadest sense denotes a person involved in a skilled medicine or health related occupation, such as:

* physician assistants and dental hygienists
* nurses of various qualifications, and nursing assistants
* pharmacists
* Medical technologists
* hospital corpspeople in a military organisation
* paramedics and emergency medical technicians
* technicians specialising in respiratory care and x-ray photography
* trained first responders such as most lifeguards and many firefighters and police officers
* medical assistants working side by side with physicians and other members of the health care team mostly in private or group medical practices and clinics
* biomedical equipment technicians or bmets responsible for maintaining and repairing medical and patient care equipment in hospitals
* medical librarians acquire, organize and disseminate health information to health care professionals and health care consumers

The foundation sciences underpinning human medicine overlap veterinary medicine, which includes both veterinarians and veterinary technicians (also veterinary technologist).

Health disparities

2006-05-18T23:57:00.000-07:00

Health disparities refer to gaps in the quality of health and health care across racial and ethnic groups. The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care."

In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Hispanics[citation needed]. When compared to whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes[citation needed]. Among the disease-specific examples of racial and ethnic disparities in the United States is the cancer incidence rate among African Americans, which is 10 % higher than among whites[citation needed]. In addition, adult blacks and Hispanics have approximately twice the risk as whites of developing diabetes[citation needed]. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.

Causes of health disparities

There is debate about what causes health disparities between ethnic and racial groups. However, it is generally accepted that disparities can result from three main areas:

* From the personal, socioeconomic, and environmental characteristics of different ethnic and racial groups (such as how certain racial groups, on average, live in poorer areas with high incidents of lead-based paint, which can harm children).
* From the barriers certain racial and ethnic groups encounter when trying to enter into the health care delivery system; and
* From the quality of health care different ethnic and racial groups receive.

Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive.

Disparities in access to health care

Reasons for disparities in access to health care are many, but can include the following:

* Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites.
* Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.
* Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.
* Legal barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.
* Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.
* The health care financing system. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.
* Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.
* Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.
* Health literacy. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.
* Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4 % of physicians in the United States are African American, and Hispanics represent just 5 %, even though these percentages are much less than their groups' proportion of the United States population.

Disparities in quality of health care

Health disparities in the quality of care different ethnic and racial groups receive can include:

* Problems with patient-provider communication. This communication is critical for the delivery of appropriate and effective treatment and care and, regardless of a patient’s race, miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. Among non-English-speaking populations in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during health care visits report having one. Additional communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. For example, patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.
* Provider discrimination. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than other patients. Some research suggests that minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.

Ending health disparities

The Commonwealth Fund, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:

* Consistent racial and ethnic data collection by health care providers.
* Effective evaluation of disparities-reduction programs.
* Minimum standards for culturally and linguistically competent health services.
* Greater minority representation within the health care workforce.
* Establishment or enhancement of government offices of minority health.
* Expanded access to services for all ethnic and racial groups.
* Involvement of all health system representatives in minority health improvement efforts.

Public health

2006-05-18T23:56:00.000-07:00

Public health is concerned with threats to the overall health of a community based on population health analysis. Health is defined and promoted differently by many organizations. The World Health Organization, the United Nations body that sets standards and provides global surveillance of disease, defines health as: "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

The population in question can be as big as a handful of people or, in the case of a pandemic, whole continents. Public health has many sub-fields, but is typically divided into the categories of epidemiology, biostatistics and health services. environmental, social and behavioral health, and occupational Health, are also important fields in public health.

The focus of a public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease can be vital to preventing it in others, such as during an outbreak of an infectious disease. Vaccination programs and distribution of condoms are examples of public health measures.

Many countries have their own government agencies, sometimes known as ministries of health, to respond to domestic health issues. In the United States, the frontline of public health initiatives are state and local health departments. The Surgeon General-led United States Public Health Service, and the Centers for Disease Control and Prevention in Atlanta, although based in the United States, are also involved with several international health issues in addition to their national duties.

There is a vast discrepancy between access to healthcare and public health intiatives between developed nations and developing nations. In the developing world, many public health infrastructures are still forming. There may not be enough trained health workers or monetary resources to provide even a basic level of medical care and disease prevention. As a result, a large majority of disease and mortality in the developing world results from and contributes to extreme poverty. In many countries in Africa, governments spend less than USD$10 per person on healthcare, while, in the United States, the federal government spent approximately USD$4,500 per capita in 2000.

Many diseases are preventable through simple, non-medical methods. Public health plays a very important role in prevention efforts in the developing world, either through the local health system or through international non-governmental organizations.

The major postgraduate degree related to this field is the Master of Public Health (M.P.H.) or Master of Health Science, while the United States medical residency specialty is General Preventive Medicine and Public Health.

History of public health

In some ways, public health is a modern concept, although it has roots in antiquity. From the early beginnings of human civilization, it was recognized that polluted water and lack of proper waste disposal may spread vector-borne diseases. Early religions attempted to regulate behavior that specifically related to health, from types of food eaten, to the extent which certain behaviors could be indulged, such as drinking alcohol or sexual relations. The establishment of governments placed responsibility on leaders to develop public health policies and programs to gain some understanding of the causes of disease to ensure stability, prosperity, and maintain order.

Early public health interventions

By Roman times, it was well understood that proper diversion of human waste was a necessary tenet of public health in urban areas. The Chinese developed the practice of variolation following a smallpox epidemic around 1000 BC. An individual without the disease could gain some measure of immunity against it by inhaling the dried crusts that formed around lesions of infected individuals. Also, children were protected by innoculating a scratch on their forearms with the pus from a lesion. This practice was not documented in the West until the early-1700s, and was used on a very limited basis. The practice of vaccination did not become prevalent until the 1820s, following the work of Edward Jenner to treat smallpox.

During the 14th century Black Death in Europe, it was believed that removing bodies of the dead would further prevent the spread of the bacterial infection. This did little to stem the plague, however, which was actually spread by rodent-borne fleas. Burning areas of cities resulted in much greater benefit, since it removed the rodent infestations. The development of quarantine in the medieval period helped mitigate the effects of other infectious diseases. However, according to Michel Foucault, the plague model of governmentality was to be opposed to the later cholera model. Cholera, which second pandemic devastated Europe between 1829 and 1851, was first fought by the use of what Foucault called "social medecine", which focused on flux, circulation of air, location of cemeteries, etc. All those concerns were thus mixed with urbanistic concerns of the management of populations, which Foucault designed by the concept of "biopower".

The science of epidemiology was founded by John Snow's identification of a polluted public water well as the cause of an 1854 cholera outbreak in London. John believed in the germ theory of disease as opposed to the prevailing miasma theory. Although miasma theory taught correctly that disease is a result of poor sanitation, it was based only upon the prevailing theory of spontaneous generation. Microorganisms, which are now known to cause many of the most common infectious diseases, were first observed around 1680 by Anton van Leeuwenhoek. But the modern era of public health did not begin until the 1880s, when the culmination of Robert Koch's germ theory and Louis Pasteur's production of artificial vaccines revolutionized the study of infectious disease.

Modern public health

As the rate of infectious diseases in the developed world decreased through the 20th century, public health began to put more focus on chronic diseases such as cancer and heart disease. Meanwhile, the developing world remained plagued by largely preventable infectious diseases, exacerbated by malnutrition and poverty.

Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Richard Wilkinson has been a major contributor to this area of study.

Modern public health is often concerned with the addressing determinants of health across a population, rather than advocating for individual behaviour change. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships - these are known as "social determinants of health." A social gradient in health runs through society, with those that are poorest generally suffering the worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum (WHO, 2003). The new public health seeks to address these health inequalities by advocating for population-based policies that improve the health of the whole population in an equitable fashion.

With the passing of the years, the increasing of natural disasters, and the threats of terrorism with WMD (Weapons of Mass Destruction), the Department of Defense of United States, must take measures to stay alert and prepare for a possible major incident in our Nation. Experiences like the one on September 11, 2001 is one of the motivation in creating a NRP (National Response Plan) on December 2004, where all our Health Care System and the EMS (Emergency Management System) together with Federal, State, Local, tribal, private-sector, and nongovernmental organizations will be unified in the same plan. The Public Health Department has a new challenge to integrate in their program to a solid knowledge of prevention, preparedness, response, and recovery in case of a natural disaster, terrorism attack or other emergency situation inside of the United States Homeland Security. Public Health and Medical services as part of the Emergency Support Function will work together in detailing the missions, policies, structures, and responsibilities. Due to the constant changes in our life and lifestyles, Public Health Department will keep working and functioning according to all those challenges for the wellbeing of the American people.

Public health programs

Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging, although public health generally receives significantly less government funding compared with medicine. In recent years, public health programs providing vaccinations have made incredible strides in promoting health, including the eradication of smallpox, a disease that plagued humanity for thousands of years.

One of the most important public health issues facing the world currently is HIV/AIDS. Tuberculosis, which claimed the lives of authors Franz Kafka and Charlotte Bronte, and composer Franz Schubert, among others, is also reemerging as a major concern due to the rise of HIV/AIDS-related infections and the development of strains resistant to standard antibiotics.

A controversial aspect of public health is that related to the control of smoking. Many nations have implemented major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Proponents argue that smoking is one of the major killers in all developed countries, and that they have a duty to reduce the death rate, both through limiting passive smoking and by providing fewer opportunities for smokers to smoke. Opponents say that this undermines individual freedom and personal responsibility, (often using the phrase nanny state in the UK) and worrying that the state may take power to remove more and more choice in the name of better population health overall.

Economics of public health

The application of health economics to the realm of public health has been rising in importance since the 1980s. Health economics studies can show, for example, where limited public resources might best be spent to save lives or cause the greatest increase in quality of life.

Human sexuality

2006-05-18T23:55:00.000-07:00

Human sexuality refers to the expression of sexual sensation and related intimacy between human beings, as well as the expression of identity through sex and as influenced by or based on sex. There are a great many forms of human sexuality. The sexuality of human beings comprises a broad range of behavior and processes, including the physiological, psychological, social, cultural, political, and spiritual or religious aspects of sex and human sexual behavior. Philosophy, particularly ethics and the study of morality, as well as theology, also address the subject. In almost any historical era or culture, the arts, including literary and visual arts, as well as popular culture, present a substantial portion of a given society's views on sexuality. In most societies and legal jurisdictions, there are legal bounds on what sexual behavior is permitted. Sexuality varies across the cultures and regions of the world, and has continually changed throughout history.

A large variety of books, educational websites, and local education/support/social organizations exist for various forms of sexuality.

Scope of human sexuality

The term human sexuality covers a very wide range including:

* The physiology (or actual biology) of human sexuality, and sexually related aspects of how the body works.
* Who and what others, people interact or are attracted to, sexually. (Sexual orientation)
* How we see ourselves, which may differ from the physical form we have, ie, personal identity. (Intersex, transsexual)
* How we come to choose the sexual choices we make. (Environment, choice, and sexual orientation)
* How humans act in seeking sexual activity, and with sexual partners, and the scope of sexually oriented behaviours. (Human sexual behavior)
* The psychological significance of sex, which may be related to its emotional effects, its physiological effects, or tied up with other psychological aspects, such as power, control, or the need for security.
* Sex and its relationship to social structure, thus sex within marriage, religion, morality and the law.
* Arts and media depiction of sexuality.
* Sex education
* Social norms, traditions and rituals related to sexuality
* Understanding of sexual activity outside those norms. (see Paraphilia)
* How society judges where lines are to be drawn, what constitutes unacceptable conduct, who is vulnerable to its abuse, and how they are protected or violators dealt with.
* Research into human sexuality. (such as the Kinsey Reports)
* Positions

Physiological aspects

Human sexuality can be influenced by hormonal changes in the development of the fetus during pregnancy. Many claim its manner of expression is largely because of genetic predisposition. Others say it is because of one's own personal experimentation in early life, and thus the establishment of preferences. A less divisive approach recognises that both factors may have a mutual role to play. Human physiology and gender makes certain forms of sexual expression possible.

Sexual dysfunction addresses a variety of biological circumstances whereby human sexual function is impaired. These manifestations can be in the form of libido diminution or performance limitations. Both male and female can suffer from libido reduction, which can have roots in stress, loss of intimacy, distraction or derive from other physiological conditions.

Performance limitations may most often affect the male in the form of erectile dysfunction. Causes of this may derive from various forms of disease pathology including cardiovascular disease, which can reduce penile blood flow along with supply of blood to various parts of the body. Moreover environmental stressors such as prolonged exposure to elevated sound levels or over-illumination can also induce cardiovascular changes especially if exposure is chronic.

Social aspects

Human sexuality can also be understood as part of the social life of humans, governed by implied rules of behavior and the status quo. Thus, it is claimed, sexuality influences social norms and society in turn influences the manner in which sexuality can be expressed. Since the invention of the mass media, things such as movies and advertising have given sexuality even more ability to shape the environments in which we live. Some see sexuality as distilled (often into stereotypes) and then repeatedly expressed in commercialized forms.

Gender identity is an aspect of human sexuality that can be affected by one's social environment, and differerent social environments can have specific attributes they associate with each sex, such as certain types of dress, colors, behaviors. A common example in Western media could be the portrayal of a little boy in blue shorts and a white T-shirt playing with a toy truck, while a girl is shown in a pink dress playing with a doll.

Society and politics

Sex education

Sex education is the introduction of sexual topics within an educational context. Almost all western countries have some form of sex education, but the nature varies hugely. In some countries (such as Australia and much of Europe) so-called "age appropiate" sex education often begins in pre-school, whereas other (notably the USA) countries leave sex education to the teenage years and even the late teenage years. Sex education covers a whole range of topics from "where do babies come from?" to the contraception versus abstinence debate to self-examination and signs of sexual diseases.

Cultural and psychiatric aspects

Human sexual behavior in most individuals is typically influenced, or heavily affected by norms from the culture in which the individual lives. Examples of such norms are prohibitions on sexual intercourse before marriage, or against homosexual sexualities, or other activities, because the religion to which the individual's culture adheres forbids such activities. Oftentimes, such culturally induced behaviors do not reflect the natural sexual inclinations of the individual.

Those who wish to express a dissident sexuality are often forced to form sub-cultures within the main culture due to various forms of oppression or repression. In other cases, forms of sexuality may develop into a fetish or alternately develop as a form of psychiatric disorder or taboo, (paraphilia).

Nutrition

2006-05-18T23:54:00.000-07:00

Nutrition is a science which studies the relationship between diet and states of health and disease. Dieticians are Health professionals who are specialised in this area of expertise. They are also the only highly trained health professionals able to provide safe, evidence based and accurate dietary advice and interventions.

Between the extremes of optimal health and death from starvation or malnutrition, there is an array of disease states that can be caused or alleviated by changes in diet. Deficiencies, excesses and imbalances in diet can produce negative impacts on health, which may lead to diseases such as scurvy, obesity or osteoporosis, as well as psychological and behavioral problems. Moreover, excessive ingestion of elements that have no apparent role in health, (e.g. lead, mercury, PCBs, dioxins), may incur toxic and potentially lethal effects, depending on the dose. The science of nutrition attempts to understand how and why specific dietary aspects influence health.

Overview

The human body comprises chemical compounds such as water, amino acids (proteins), fatty acids (lipids), nucleic acids (DNA/RNA), and carbohydrates (e.g. sugars). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, and phosphorus, and may or may not contain minerals such as calcium, iron, and zinc. Minerals ubiquitously occur in the form of salts and electrolytes. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones/vitamins, phospholipids, hydroxyapatite), both in the human body and in organisms (e.g. plants, animals) that humans eat.

The human body necessarily comprises the elements that humans eat and absorb into the bloodstream. The digestive system, except in the unborn fetus, participates in the first step which makes the different chemical compounds and elements in food available for the trillions of cells of the body. In the digestive process of an average adult, about seven litres of liquid, known as digestive juices, exit the internal body and enter the lumen of the digestive tract. The digestive juices help break chemical bonds between ingested compounds as well as modulate the conformation and/or energetic state of the compounds/elements. However, many compounds/elements are absorbed into the bloodstream unchanged, though the digestive process helps to release them from the matrix of the foods where they occur. Any unabsorbed matter is excreted in the feces. But only a minimal amount of digestive juice is eliminated by this process; the intestines reabsorb most of it; otherwise the body would rapidly dehydrate; (hence the devastating effects of persistent diarrhea).

Study in this field must take carefully into account the state of the body before ingestion and after digestion as well as the chemical composition of the food and the waste. Comparing the waste to the food can determine the specific types of compounds and elements absorbed by the body. The effect that the absorbed matter has on the body can be determined by finding the difference between the pre-ingestion state and the post-digestion state. The effect may only be discernible after an extended period of time in which all food and ingestion must be exactly regulated and all waste must be analyzed. The number of variables (e.g. 'confounding factors') involved in this type of experimentation is very high. This makes scientifically valid nutritional study very time-consuming and expensive, and explains why a proper science of human nutrition is rather new.

In general, eating a variety of fresh, whole (unprocessed) foods has proven hormonally and metabolically favourable compared to eating a monotonous diet based on processed foods. In particular, fresh, whole foods provide higher amounts and a more favourable balance of essential and vital nutrients per unit of energy, resulting in better management of cell growth, maintenance, and mitosis (cell division) as well as of appetite and energy balance. A generally more regular eating pattern (e.g. eating medium-sized meals every 3 to 4 hours) has also proven more hormonally and metabolically favourable than infrequent, haphazard food intake.

History

Humans evolved as omnivorous hunter-gatherers over the past 250,000 years. Early diets were primarily vegetarian with infrequent game meats and fish where available.

Agriculture developed about 10,000 years ago in multiple locations throughout the world, providing grains such as wheat, rice, and maize, with staples such as bread and pasta. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. The importance of food purity was recognized when bulk storage led to infestation and contamination risks. Cooking developed as a ritualistic activity due to efficiency and reliability concerns requiring adherence to strict recipes and procedures, and also contributed to demands for food purity and consistency.

Antiquity through Enlightenment

* c. 475 BC: Anaxagoras reasoned that food is absorbed by the human body and therefore contained "homeomerics" (generative components), thereby deducing the existence of nutrients.
* c. 400 BC: Hippocrates says, "Let food be your medicine and medicine be your food."
* The first recorded nutritional experiment is found in the Bible's Book of Daniel. Daniel and his friends were captured by the king of Babylon during an invasion of Israel. Selected as court servants, they were to share in the king's fine foods and wine. But they objected, preferring vegetables (pulses) and water in accordance with their Jewish dietary restrictions. The king's chief steward reluctantly agreed to a trial. Daniel and his friends received their diet for 10 days and were then compared to the king’s men. Appearing healthier, they were allowed to continue with their diet.
* 1500s: Scientist and artist Leonardo da Vinci compared metabolism to a burning candle.
* 1747: Dr. James Lind, a physician in the British navy, performed the first scientific nutrition experiment, discovering that lime juice saved sailors who had been at sea for years from scurvy, a deadly and painful bleeding disorder. The discovery was ignored for forty years, after which British sailors became known as "limeys." The essential vitamin C within lime juice would not be recognized until the 1930s.
* 1770: Antoine Lavoisier, the "Father of Nutrition and Chemistry" discovered the details of metabolism, demonstrating that the oxidation of food is the source of body heat.
* 1790: George Fordyce recognized calcium necessary for fowl survival.

Modern era through 1941

* Early 1800s: The elements carbon, nitrogen, hydrogen and oxygen were recognized as the primary components of food, and methods to measure their proportions were developed.
* 1816: François Magendie discovers that dogs fed only carbohydrates and fat lost their body protein and died in a few weeks, but dogs also fed protein survived, identifying protein as an essential dietary component.
* 1840: Justus Liebig discovers the chemical makeup of carbohydrates (sugars), fats (fatty acids) and proteins (amino acids.)
* 1860s: Claude Bernard discovers that body fat can be synthesised from carbohydrate and protein, showing that the energy in blood glucose can be stored in fat as glycogen.
* Early 1880s: Kanehiro Takaki observed that Japanese sailors developed beriberi (or endemic neuritis, a disease causing heart problems and paralysis) but British sailors did not. Adding milk and meat to Japanese diets prevented the disease.
* 1896: Baumann observed iodine in thyroid glands.
* 1897: Christiaan Eijkman worked with natives of Java, who also suffered from beriberi. Eijkman observed that chickens fed the native diet of white rice developed the symptoms of beriberi, but remained healthy when fed unprocessed brown rice with the outer bran intact. Eijkman cured the natives by feeding them brown rice, discovering that food can cure disease. Over two decades later, nutritionists learned that the outer rice bran contains vitamin B1, also known as thiamine.
* Early 1900s: Carl Von Voit and Max Rubner independently measure caloric energy expenditure in different species of animals, applying principles of physics in nutrition.
* 1906: Wilcock and Hopkins showed that the amino acid tryptophan was necessary for the survival of mice. Gowland Hopkins recognized "accessory food factors" other than calories, protein and minerals, as organic materials essential to health but which the body can not synthesise.
* 1912: Casmir Funk coined the term vitamin, a vital factor in the diet, from the words "vital" and "amine," because these unknown substances preventing scurvy, beriberi, and pellagra, were thought then to be derived from ammonia.
* 1913: Elmer V. McCollum discovered the first vitamins, fat soluble vitamin A, and water soluble vitamin B (in 1915; now known to be a complex of several water-soluble vitamins) and names vitamin C as the then-unknown substance preventing scurvy.
* 1919: Sir Edward Mellanby incorrectly identified rickets as a vitamin A deficiency, because he could cure it in dogs with cod liver oil.
* 1922: McCollum destroys the vitamin A in cod liver oil but finds it still cures rickets, naming vitamin D
* 1922: H.M. Evans and L.S. Bishop discover vitamin E as essential for rat pregnancy, originally calling it "food factor X" until 1925.
* 1925: Hart discovers trace amounts of copper are necessary for iron absorption.
* 1927: Adolf Otto Reinhold Windaus synthesizes vitamin D, for which he won the Nobel Prize in Chemistry in 1928.
* 1928: Albert Szent-Gyorgyi isolates ascorbic acid, and in 1932 proves that it is vitamin C by preventing scurvy. In 1935 he synthesizes it, and in 1937 he wins a Nobel Prize for his efforts. Szent-Gyorgyi concurrently elucidates much of the citric acid cycle.
* 1930s: William Cumming Rose identifies essential amino acids, necessary proteins which the body can not synthesize.
* 1935: Underwood and Marston independently discover the necessity of cobalt.
* 1936: Eugene Floyd Dubois shows that work and school performance are related to caloric intake.
* 1938: The chemical structure of vitamin E is discovered by Erhard Fernholz, and it is synthesised by Paul Karrer.
* 1941: The first Recommended Dietary Allowances (RDAs) were established by the National Research Council.

Recent

* 2002 Study shows relation between nutrition and violent behavior
* 2005 Obesity may be caused by adenovirus rather than bad nutrition[2]

Nutrition and Health

Ill health can be caused by an imbalance of nutrients, producing either an excess or deficiency, which in turn affects body functioning cumulatively. Moreover, because most nutrients are, in some way or another, involved in cell-to-cell signalling (e.g. as building block or part of a hormone or signalling 'cascades'), deficiency or excess of various nutrients affects hormonal function indirectly. Thus, because they largely regulate the expression of genes, hormones represent a link between nutrition and how our genes are expressed, i.e. our phenotype. The strength and nature of this link are continually under investigation, but observations especially in recent years have demonstrated a pivotal role for nutrition in hormonal activity and function and therefore in health.

Essential and non-essential amino acids

The body requires amino acids to produce new body protein (protein retention) and to replace damaged proteins (maintenance) that are lost in the urine. In animals amino acid requirements are classified in terms of essential (an animal cannot produce them) and non-essential (the animal can produce them from other nitrogen containing compounds) amino acids. Consuming a diet that contains adequate amounts of essential (but also non-essential) amino acids is particularly important for growing animals, who have a particularly high requirement.

Vitamins

Mineral and/or vitamin (tocotrienol and tocopherol) deficiency or excess may yield symptoms of diminishing health such as goitre, scurvy, osteoporosis, weak immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health (including eating disorders), among many others.

As of 2005, twelve vitamins and about the same number of minerals are recognized as "essential nutrients", meaning that they must be consumed and absorbed - or, in the case of vitamin D, alternatively synthesized via UVB radiation - to prevent deficiency symptoms and death. Certain vitamin-like substances found in foods, such as carnitine, have also been found essential to survival and health, but these are not strictly "essential" to eat because the body can produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food (particularly in fresh vegetables), which have many known and yet to be explored properties including antioxidant activity (see below). Other essential nutrients include essential amino acids, choline and the essential fatty acids.

Fatty acids

In addition to sufficient intake, an appropriate balance of essential fatty acids - omega-3 and omega-6 fatty acids - has been discovered to be crucial for maintaining health. Both of these unique "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins which function as hormones. The omega-3 eicosapentaenoic acid (EPA) (which can be made in the body from the omega-3 essential fatty acid alpha-linolenic acid (LNA), or taken in through marine food sources), serves as building block for series 3 prostaglandins (e.g. weakly-inflammation PGE3). The omega-6 dihomo-gamma-linolenic acid (DGLA) serves as building block for series 1 prostaglandins (e.g. anti-inflammatory PGE1), whereas arachidonic acid (AA) serves as building block for series 2 prostaglandins (e.g. pro-inflammatory PGE 2). Both DGLA and AA are made from the omega-6 linoleic acid (LA) in the body, or can be taken in directly through food. An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins, which partly explains the importance of omega-3/omega-6 balance for cardiovascular health. In industrialised societies, people generally consume large amounts of processed vegetable oils that have reduced amounts of essential fatty acids along with an excessive amount of omega-6 relative to omega-3.

The rate of conversions of omega-6 DGLA to AA largely determines the production of the respective prostaglandins PGE1 and PGE2. Omega-3 EPA prevents AA from being released from membranes, thereby skewing prostaglandin balance away from pro-inflammatory PGE2 made from AA toward anti-inflammatory PGE1 made from DGLA. Moreover, the conversion (desaturation) of DGLA to AA is controlled by the enzyme delta-5-desaturase, which in turn is controlled by hormones such as insulin (up-regulation) and glucagon (down-regulation). Because different types and amounts of food eaten/absorbed affect insulin, glucagon and other hormones to varying degrees, not only the amount of omega-3 versus omega-6 eaten but also the general composition of the diet therefore determine health implications in relation to essential fatty acids, inflammation (e.g. immune function) and mitosis (i.e. cell division).

Sugars

Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function (i.e. insulin resistance) as a decisive factor in many disease states. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microinjuries and clot formation (i.e. heart disease) and exaggerated cell division (i.e. cancer). Hyperinsulinemia and insulin resistance (the so-called metabolic syndrome) are characterized by a combination of abdominal obesity, elevated blood sugar, elevated blood pressure, elevated blood triglycerides, and reduced HDL cholesterol. The negative impact of hyperinsulinemia on prostaglandin PGE1/PGE2 balance may be significant.

The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overfatness and insulin resistance is clear, the exact (likely multifarious) causes of insulin resistance remain less clear. Importantly, it has been demonstrated that appropriate exercise, more regular food intake and reducing glycemic load (see below) all can reverse insulin resistance in overfat individuals (and thereby lower blood sugar levels in those who have type 2 diabetes).

Obesity can unfavourably alter hormonal and metabolic status via resistance to the hormone leptin, and a vicious cycle may occur in which insulin/leptin resistance and obesity aggravate one another. The vicious cycle is putatively fuelled by continuously high insulin/leptin stimulation and fat storage, as a result of high intake of strongly insulin/leptin stimulating foods and energy. Both insulin and leptin normally function as satiety signals to the hypothalamus in the brain; however, insulin/leptin resistance may reduce this signal and therefore allow continued overfeeding despite large body fat stores. In addition, reduced leptin signalling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate.

There is debate about how and to what extent different dietary factors -- e.g. intake of processed carbohydrates, total protein, fat, and carbohydrate intake, intake of saturated and trans fatty acids, and low intake of vitamins/minerals -- contribute to the development of insulin- and leptin resistance. In any case, analogous to the way modern man-made pollution may potentially overwhelm the environment's ability to maintain 'homeostasis', the recent explosive introduction of high Glycemic Index- and processed foods into the human diet may potentially overwhelm the body's ability to maintain homeostasis and health (as evidenced by the metabolic syndrome epidemic).

Antioxidants are another recent discovery. As cellular metabolism/energy production requires oxygen, potentially damaging (e.g. mutation causing) compounds known as radical oxygen species or free radicals form as a result. For normal cellular maintenance, growth, and division, these free radicals must be sufficiently neutralized by antioxidant compounds, some produced by the body with adequate precursors (glutathione, Vitamin C in most animals) and those that the body cannot be produced can only be obtained through the diet through direct sources (Vitamin C in humans, Vitamin A, Vitamin K) or produced by the body from other compounds (Beta-carotene converted to Vitamin A by the body, Vitamin D synthesized from cholesterol by sunlight). Different antioxidants are now known to function in a cooperative network, e.g. vitamin C can reactivate free radical-containing glutathione or vitamin E by accepting the free radical itself, and so on. Some antioxidants are more effective than others at neutralizing different free radicals. Some cannot neutralize certain free radicals. Some cannot be present in certain areas of free radical development (Vitamin A is fat-soluble and protects fat areas, Vitamin C is water soluble and protects those areas). When interacting with a free radical, some antioxidants produce a different free radical compound that is less dangerous or more dangerous than the previous compound. Having a variety of antioxidants allows any byproducts to be safely dealt with by more efficient antioxidants in neutralizing a free radical's butterfly effect.

Intestinal bacterial flora

It is now also known that the human digestion system contains a population of a range of bacteria which are essential to digestion, and which are also affected by the food we eat. The role and significance of the intestinal bacterial flora is under investigation. Both good and bad bacteria inhabit the digestive system. It is estimated that in the Western world, most people are no longer in a homeostatic balance. It is ideal to have 80% good to 20% bad, typically differentiated by gram negative and gram positive staining, respectively; however, in western diets it is more likely to be the other way around. Consuming processed food that are low in nutrients and high in sugar will allow bad bacteria to flourish.

Phytochemicals

A growing area of interest is the effect upon human health of trace chemicals, collectively called phytochemicals. Although technically the term refers to nutrients from edible plants, especially highly colored fruits and vegetables, they are sometimes found in animal products. Unlike the anecdotal and sometimes specious nutritional claims of medicinal herbs and compounds, the effects of phytochemicals increasingly survive rigorous testing by prominent health organizations.

Perhaps the most rigorously tested phytochemical is zeaxanthin, a yellow-pigmented carotenoid present in many yellow and orange fruits and vegetables. Repeated studies have shown a strong correlation between ingestion of zeaxanthin and the prevention and treatment of age-related macular degeneration. [4] Less rigorous studies have proposed a correlation between zeaxanthin intake and cataracts. [5] A second carotenoid, lutein, has also been shown to lower the risk of contracting AMD. Both compounds have been observed to collect in the retina when ingested orally, and they serve to protect the rods and cones against the destructive effects of light.

Another caretenoid, beta-cryptoxanthin, appears to protect against chronic joint inflammatory diseases, such as arthritis. While the association between serum blood levels of beta-cryptoxanthin and substantially decreased joint disease has been established, neither a convincing mechanism for such protection nor a cause-and-effect have been rigorously studied. [6] Similarly, a red phytochemical, lycopene, has substantial credible evidence of negative association with development of prostate cancer.

The correlations between the ingestion of some phytochemicals and the prevention of disease are, in some cases, enormous in magnitude. For example, several studies have correlated high levels of zeaxanthin intake with roughly a 50% reduction in AMD. The difficulties in demonstrating causative properties and in applying the findings to human diet, however, are similarly enormous. The standard for rigorous proof of causation in medicine is the double-blind study, a time-consuming, difficult and expensive process, especially in the case of preventative medicine. While new drugs must undergo such rigorous testing, pharmaceutical companies have a financial interest in funding rigorous testing and may recover the cost if the drug goes to market. No such commercial interest exists in studying chemicals that exist in orange juice and spinach, making funding for medical research difficult to obtain.

Even when the evidence is obtained, translating it to practical dietary advice can be difficult and counter-intuitive. Lutein, for example, occurs in many yellow and orange fruits and vegetables and protects the eyes against various diseases. However, it does not protect the eye nearly as well as zeaxanthin, and the presence of lutein in the retina will prevent zeaxanthin uptake. Additionally, evidence has shown that the lutein present in egg yolk is more readily absorbed than the lutein from vegetable sources, possibly because of fat solubility. [7] At the most basic level, the question "should you eat eggs?" is complex to the point of dismay, including misperceptions about the health effects of cholesterol in egg yolk, and its saturated fat content.

As another example, lycopene is prevalent in tomatoes (and actually is the chemical that gives tomatoes their red color). It is more highly concentrated, however, in processed tomato products such as commercial pasta sauce, or Tomato Soup, than in fresh "healthy" tomatoes. Such sauces, however, tend to have high amounts of salt, sugar, other substances a person may wish or even need to avoid.

Probably the best practical solution is to follow mother's advice: eat your fruits and veggies.

Nutrition and sports

Nutrition is very important for improving sports performance. The most common means to improve performance through diet is the practice of eating large quantities of protein, usually red meat, when attempting to build muscle mass; its efficacy is doubtful, as daily protein intake even on a normal diet usually outweighs the amount of muscle protein which can be synthesized in a day.

To enhance their speed of muscle synthesis, athletes will focus a great deal on how to best accelerate their tissue recovery. Icing/heating the muscles to reduce swelling and increase blood flow, along with plenty of rest, and rehabilitative low-intensity exercising, stretching, and massage thereapy, along with plenty of sleep and nutrition (such as water and creatine), are instrumental in this. Also, before playing a sport, it would help to drink water or an energy drink with elecrolytes to help prevent dehydration.

Nutrition and longevity

Calorie restriction

Lifespan may be somehow related to the amount of food energy consumed[8]. A pursuit of this principle of caloric restriction followed, involving research into longevity of those who reduced their food energy intake while attempting to optimize their micronutrient intake. Perhaps not surprisingly, some people found that cutting down on food reduced their quality of life so considerably as to negate any possible advantages of lengthening their lives. However, a small set of individuals persists in the lifestyle, going so far as to monitor blood lipid levels and glucose response every few months. See Calorie Restriction Society.

Underlying this research was the hypothesis that oxidative damage was the agent which accelerated aging, and that aging was retarded when the amount of carbohydrates (and thereby insulin release) was reduced through dietary restriction.

However, recent research has produced increased longevity in animals (and shows promise for increased human longevity) through the use of insulin uptake retardation. This was done through altering an animal’s metabolism to allow it to consume similar food-energy levels to other animals, but without building up fatty tissue[9].

This has set researchers off on a line of study which presumes that it is not low food energy consumption which increases longevity. Instead, longevity may depend on an efficient fat processing metabolism, and the consequent long term efficient functioning of our organs free from the encumbrance of accumulating fatty deposits[10]. Thus, longevity may be related to maintained insulin sensitivity. However, several other factors including low body temperature seem to promote longevity also and it is unclear to what extent each of them contribute.

Antioxidants have recently come to the forefront of longevity studies which have included the FDA and Brunswick labs.

Whole Plant Food Diet

In China “some areas have essentially no cancer or heart disease, while in other areas, they reflect up to a 100-fold increase.” (this and all quotes from The China Study, by T. Colin Campbell PhD) Coincidentally, diets in China range from entirely plant-based to heavily animal-based, depending on the location. In contrast, diseases of affluence like cancer and heart disease are common throughout the United States. Most Americans eat an animal protein based diet, with relatively few calories coming from plant foods. China's homogeneous gene pool, low rates of migration, and large localized variations in diet and disease incidence provide an ideal study basis leading to reliable data.

The research makes a good case that animal protein is "one of the most toxic agents" in our diets. Evidently, it's better for our bodies to break plant proteins down into amino acids and then piece them together slowly to form human proteins, versus quickly as when one eats animal proteins containing amino acids very closely matching our own needs. Also, “the richer the diet is in the kinds and amounts of nutrients and antioxidants provided by foods of plant origin, the lower the risk of chronic degenerative diseases.”

The cover article of the November 2005 issue of National Geographic is titled The Secrets of LIVING LONGER.

The article starts out with the sentence "What if I said you could add up to ten years to your life?" It's basically a lifestyle survey of three populations ... Sardinians, Okinawans, and Adventists (right here in America) ... who generally display longevity and "suffer a fraction of the diseases that commonly kill people in other parts of the developed world, and enjoy more healthy years of life. In sum, they offer three sets of "best practices" to emulate. The rest if up to you."

In common with all three groups is to "Eat fruits, vegetables, and whole grains."

The article noted that a NIH funded study of 34,000 Seventh-Day Adventists between 1976 and 1988 "...found that the Adventists' habit of consuming beans, soy milk, tomatoes, and other fruits lowered their risk of developing certain cancers. It also suggested that eating whole wheat bread, drinking five glasses of water a day, and, most surprisingly, consuming four servings of nuts a week reduced their risk of heart disease. And it found that not eating red meat had been helpful to avoid both cancer and heart disease." Searching “34,000 Seventh-Day Adventists” will take you to several interesting study related sites.

The French paradox

It has been discovered that people living in the south live longer. Even though they consume a comparable amount of saturated fats, the rate of heart disease is lower in Southern France. Scientists believe that this could be a result of the regular consumption of low amounts of red wine on a daily basis. It is also possible that this could be the result of smaller consumption of processed carbohydrate and other junk foods.

On the other hand, living in the South requires the body to produce less heat, allowing a slower, and therefore healthier, metabolic rate.

Nutrition, industry and food processing

Since the Industrial Revolution some two hundred years ago, the food processing industry has invented many technologies that both help keep foods fresh longer and alter the fresh state of food as they appear in nature. Cooling is the primary technology that can help maintain freshness, whereas many more technologies have been invented to allow foods to last longer without becoming spoiled. These latter technologies include pasteurisation, autoclavation, drying, salting, and separation of various components, and all appear to alter the original nutritional contents of food. Pasteurisation and autoclavation (heating techniques) have no doubt improved the safety of many common foods, preventing epidemics of bacterial infection. But some of the (new) food processing technologies undoubtedly have downfalls as well.

Modern separation techniques such as milling, centrifugation, and pressing have enabled upconcentration of particular components of food, yielding flour, oils, juices and so on, and even separate fatty acids, amino acids, vitamins, and minerals. Inevitably, such large scale upconcentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce food's content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet to be discovered substances. Because of reduced nutritional value, processed foods are often 'enriched' or 'fortified' with some of the most critical nutrients (usually certain vitamins) that were lost during processing. Nonetheless, processed foods tend to have an inferior nutritional profile than do whole, fresh foods, regarding content of both sugar and high GI starches, potassium/sodium, vitamins, fibre, and of intact, unoxidized (essential) fatty acids. In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids.

A dramatic example of the effect of food processing on a population's health is the history of epidemics of beri-beri in people subsisting on polished rice. Removing the outer layer of rice by polishing it removes with it the essential vitamin thiamine, causing beri-beri. Another example is the development of scurvy among infants in the late 1800's in the United States. It turned out that the vast majority of sufferers were being fed milk that had been heat-treated (as suggested by Pasteur) to control bacterial disease. Pasteurisation was effective against bacteria, but it destroyed the vitamin C.

As mentioned, lifestyle- and obesity-related diseases are becoming increasingly prevalent all around the world. There is little doubt that the increasingly widespread application of some modern food processing technologies has contributed to this development. The food processing industry is a major part of modern economy, and as such it is influential in political decisions (e.g. nutritional recommendations, agricultural subsidising). In any known profit-driven economy, health considerations are hardly a priority; effective production of cheap foods with a long shelf-life is more the trend. In general, whole, fresh foods have a relatively short shelf-life and are less profitable to produce and sell than are more processed foods. Thus the consumer is left with the choice between more expensive but nutritionally superior whole, fresh foods, and cheap, usually nutritionally inferior processed foods. Because processed foods are often cheaper, more convenient (in both purchasing, storage, and preparation), and more available, the consumption of nutritionally inferior foods has been increasing throughout the world along with many nutrition-related health complications.

Advice and guidance on nutrition

Governmental policies

Most Governments provide guidance on good nutrition, and some also impose mandatory labeling requirements upon processed food manufacturers to assist consumers in complying with such guidance. Current dietary guidelines in the United States are presented in the concept of a food pyramid. There is no apparent consistency in science-based nutritional recommendations between countries, indicating the role of politics as well as cultural bias in research emphasis and interpretation.

Teaching

Nutrition is taught in schools in many countries. In England and Wales the Personal and Social Education and Food Technology curriculums include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging.

Issues

Challenging issues in modern nutrition include:

"Artificial" interventions in food production and supply:

* Should genetic engineering be used in the production of food crops and animals?
* Are the use of pesticides, and fertilizers damaging to the foods produced by use of these methods (see also organic farming)?
* Are the use of antibiotics and hormones in animal farming ethical and/or safe?

Sociological issues:

* Is it possible to eat right on a low-income? Is proper nutrition economically skewed? How do we increase access to whole foods in impoverished neighborhoods?
* How do we minimise the current disparity in food availability between first and third world populations (see famine and poverty)?
* How can public advice agencies, policy making and food supply companies be coordinated to promote healthy eating and make wholesome foods more convenient and available?
* Do we need nutritional supplements in the form of pills, powders, liquids, etc.?
* How can the developed world promote good worldwide nutrition through minimising import tariffs and export subsidies on food transfers?

Research Issues:

* How do different nutrients affect appetite and metabolism, and what are the molecular mechanisms?
* What yet to be discovered important roles do vitamins, minerals, and other nutrients play in metabolism and health?
* Are the current recommendations for intake of vitamins and minerals appropriate?
* How and why do different cell types respond differently to chronically elevated circulating levels of insulin, leptin, and other hormones?
* What does it take for insulin resistance to develop?
* What other molecular mechanisms may explain the link between nutrition and lifestyle-related diseases?
* What role does the intestinal bacterial flora play in digestion and health?
* How essential to proper digestion are the enzymes contained in food itself, which are usually destroyed in cooking (see Living foods diet)?
* What more can we discover through what has been called the phytochemical revolution?

Auxology

2006-05-18T23:53:00.001-07:00

Auxology is a meta-term covering the study of all aspects of human physical growth; though it is also a fundamental of biology, generally. Auxology is a highly multi-disciplinary science involving health sciences / medicine (pediatrics, general practice, endocrinology, neuroendocrinology, physiology, epidemiology), and to a lesser extent: nutrition, genetics, anthropology, anthropometry, ergonomics, history, economic history, economics, socioeconomics, sociology, public health, and psychology, among others.

Etymology

Auxology: aux-, pertaining to growth, from Greek auxē, "to increase"; -o-, generic phoenetic combining form, here denoting relationship to growth, stimulation, or acceleration; -logy, pertaining to the study of or science of, from Middle English -logie, from Old French, from Latin -logia, from Greek -logiā, from legein, "to speak", and -logos "word", "speech" and "one who deals with", thus "the character or department of one who speaks or treats of (a certain subject)".

Some Auxologists

* Barry Bogin (anthropologist)
* Noel Cameron (pediatrician)
* J. W. Drukker (economist, historian, ergonomist)
* Stanley Engerman (economist)
* Robert Fogel (economist)
* Theo Gasser (statistician, human biologist)
* Francis E. Johnston (anthropologist)
* John Komlos (economist, anthropometric historian)
* Gregory Livshits (human biologist)
* Robert Margo (economist)
* Alex F. Roche (pediatrician)
* Lawrence M. Schell (anthropologist)
* Nevin Scrimshaw (nutritionist)
* Anne Sheehy (human biologist)
* Richard Steckel (economist, anthropometric historian)
* Pak Sunyoung (anthropologist)
* James M. Tanner (pediatrician)
* Vincent Tassenaar (historian)
* Lucio Vinicius (anthropologist, human biologist)

Healthy eating

2006-05-18T23:53:00.000-07:00

Healthy eating is the practice of making choices about what or how much one eats with the intention of improving or maintaining good health. Typically this means following recommendations of "experts" regarding a nutritional diet. The recommendations may address:

* total calorie consumption;
* balance of major nutrients (e.g., proteins, fats, carbohydrates);
* increased consumption of foods designated as beneficial;
* decreased consumption of foods designated as detrimental;
* increased consumption of specific vitamins or other micronutrients;
* avoidance of certain food additives (dyes, preservatives, sweeteners);
* avoidance of environmental food contaminants (e.g., mercury, pesticides, herbicides, aflatoxins)
* methods of food preparation (e.g., raw versus cooked).

The "experts" may be academically certified, or may be self-appointed. The evidence underlying their recommendations may be strong or weak by scientific standards. Our ideas of what counts as "healthy" have varied in different times and places, according to scientific advances in the field of nutrition, cultural fashions, religious proscriptions, or personal considerations.

Nutritional advice

Many governments and other organizations provide nutritional advice and launch schemes in order to promote healthy eating. Diets which lead to obesity (being severely overweight), diabetes, and other medical conditions, are a severe drain of resources for national health providers, and on businesses due to reduced productivity of staff. Moreover, personal well-being and overall happiness can be severely curtailed by a compromised diet.

A recent health campaign by the American government has attempted to impress the purported need to eat lots of fruit and vegetables using the slogan "5 a day". Adverts have given examples of what a portion of fruit or vegetables amounts to, and how 5 or more portions can be incorporated into one's diet.

Governments also put pressure on businesses to promote healthful food options, and regularly consider measures, such as banning the advertising of fast food, limiting the availablity of junk food in state-run schools, and taxing foods which are high in fat.

There is also near-unanimous agreement that hydrogenated fats (aka trans fats) are not a healthful form of food energy, and that consuming flaxseed oil or some types of fish and seafood (a source of omega-3 fatty acids) before meat and poultry may contribute to an individual's health and longevity. Unfortunately, consumption of predatory fish at the top of the food chain (such as swordfish, mackerel, shark, and albacore tuna) increases one's exposure to mercury and PCBs, so the hazards may outweigh the health benefits as most fish contains trace amounts of pollution. However, not all predatory fish swim in mercury/PCB-polluted waters (chiefly these are off the eastern seaboard of North America), so one need not neccessarily exclude the consumption of these fish.

Eggs have long been a source of controversy -- egg yolks are richer in cholesterol than egg whites, and should be consumed in moderation, whereas egg whites are almost pure protein and contain little or no substances suspected of causing obesity or heart disease.

Dairy products have had a shorter history of controversy, and charges levelled at dairy focus typically on one of three lines of reasoning. First, that the allegedly-poor conditions present on large-scale dairy farms may lead to sickened cows, which may lead to sickened (high pus) milk. Second, that milk is naturally meant to fatten baby cows into grown heifers in a few short years, and hence may be incompatible with a balanced human diet. Third, that healthy bone structures in humans require both calcium and magnesium. Milk and other dairy products are cited as being high in calcium, but lacking the magnesium levels required for strong bones. Such a deficiency would be mitigated by consuming other foods high in magnesium, such as nuts, seeds, green leafy vegetables, even certain mineral waters high in the element.

Carrots have also been proven to show improvements in many areas of health such as improved vision as well as lowering the risk of cancers caused by high cholesterol levels in the body. The main component of carrots responsible for improving vision is Beta carotene. This is also responsible for acting as an anti-oxidant which lowers free radicals, thus lowering the threat of cancer or heart attacks.

Research is being done on the effects of various chemicals - foods and nonfoods - on the mammal physiology. Such research is often funded by medical organizations, or pharmaceutical companies. Each study should be assessed in context: who was funding the research, and what the immediate goals were.

Fears of high cholesterol were frequently voiced up until the mid-1990s. However, more recent research has shown that the distiction between high- and low-density lipoprotein ('good' and 'bad' cholesterol, respectively) must be addressed when speaking of the potential ill effects of cholesterol. High density lipoprotein is often prevelent in animal products, such as bacon and egg yolks, whereas low density lipoprotein is more common in plant and fish tissues, such as olive oil and salmon.

Toxins

Almost all foods contain tiny amounts of toxins (natural poisonous substances), which normally do not pose a great danger to a healthy individual, due to low concentration. At higher toxin concentrations, a given food could simply not be considered a food. Some toxins may still have negative heath effects on susceptible people. For instance, many are allergic to some nuts, such as peanuts. The ingredient usually cited as being most critical to good health, water, has even been known to result in death when consumed excessively.

Food additives

Some people claim that food additives, such as artificial sweeteners, colorants, preserving agents, and flavourants may cause health problems even though they were extensively tested before being allowed on the market. For example, artificial colorants are claimed to cause hyperactivity in susceptible children. As another example, people on calorie restricted diets often choose to buy products advertised as "reduced calorie" or "no sugar added". These products contain artificial sweeteners. These are safe to consume in small quantities, and are of low toxicity. Safety studies may well show some advantage in substitutions, product by product. Over a period of time, many different products are approved for sale, each one relying on a study done in isolation, and each one suggesting the artificially sweetened product has fewer associated health problems than equivalent all-natural products. When dieters buy reduced-calorie soft drinks, biscuits, cakes, flavoured water, yogurt, and so on, all may contain combinations of the leading artificial sweeteners aspartame, acesulfame potassium or sucralose. Cumulative doses are at higher levels than those on which the safety studies were based.

The issue of sweetening is just one example. Other taste-enhancing additives (e.g. salt substitutes) or flavourants are also hidden in processed foods and drink, as are colourants. Mandatory food labelling is one attempt to overcome the problem. This invites the consumer to check the ingredients of their foods before consumption. However, the average person has no training in organic chemistry and its nutritional effects. Neither is it practical for individuals to manage score cards recording all the nutrients they consume.

Some would assert that research into the toxicity of many varied artificial ingredients has been inconclusive. The USA's Food and Drug Administration has very stringent requirements for the introduction of new food ingredients, and this includes rigorous testing on animals, where the animals are given exorbitant amounts of these chemicals - far more than humans ever would be likely to consume.

Obesity

2006-05-18T23:51:00.000-07:00

Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and mammals is increased to a point where it is thought to be a significant risk factor in certain health conditions, leading to increased mortality. Obesity is relatively rare among animals in the wild, but it is common in domestic animals (who may be overfed and underexercised), and increasingly in humans.

Excessive body weight has been shown to correlate with various important diseases, particularly cardiovascular disease, diabetes mellitus type 2, sleep apnea and osteoarthritis. It is also considered a risk factor for certain cancers. Interventions, such as diet and exercise as well as medication and weight-loss surgery (in severe cases) are frequently recommended to reduce the risk of developing disease.

Definition

is a concept that is being continually redefined, largely because accurate estimations of body fat are difficult to obtain, and different forms of fat have different health implications. The most commonly used parameters are the body mass index, the waist-hip ratio and more advanced determinations of body fat.

BMI

Body mass index (BMI), also called the Quetelet number or Quetelet index, is currently the most widely accepted calculation of excess body fat for human beings, especially for screening purposes and to monitor effect of treatments.

BMI was developed by the Belgian statistician and anthropometrist Adolphe Quetelet[1]. It is calculated by dividing the subject's weight in kilograms by the square of his/her height in meters (BMI = W / h2). For example, a person who weighs 75 kilograms and stands 1.8 meters tall would have a BMI of 75/(1.82)=23.148. The number 23.148 is then compared to a table of definitions.

The current definitions commonly in use establish the following values, agreed in 1997 and published in 2000:

* A BMI below 18.5 is characterized as underweight
* A BMI of 18.5 - 24.999 is characterized as normal weight
* A BMI of 25.0 - 29.999 is characterized as overweight or pre-obese
* A BMI of 30.0 - 34.999 is characterized as obese
* A BMI of 35.0 or higher is characterized as severely (or morbidly) obese

BMI is most accurate for people who live a sedentary lifestyle. It thus cannot distinguish between weight from body fat, muscle mass, or bone mass, so the table above is inaccurate for example in athletes, children or the elderly. Because muscle is more dense than fat, most amateur athletes would be classified as "overweight" and most professional athletes have enough muscle mass to be classified as "obese" or even "severely obese", when in fact their body fat percentage is very low and they are in no danger of developing any health problems correlative to carriage of excess fat. Children, meanwhile, have higher bone density in the years before puberty because of their smaller size, and that also results in skewed BMI values. In the case of elderly people, muscular atrophy and/or osteoporosis can also decrease the value of a BMI calculation.

There is the additional problem of sex differences between men and women. White and East Asian women tend to have less muscle mass and bone density than men of the same height. The same is not true of black and Polynesian women, however. In the future, a healthy BMI for a given individual may be defined to some extent by their ethnic group, racial origin, or sex, but that is not the case now.

The defining ranges of the categories are occasionally adjusted, and can differ from country to country - which underscores the arbitrary nature of the correlation. In June 1998 the National Institutes of Health brought official U.S. category definitions into line with those used by the WHO, moving the American "overweight" threshold from BMI 27 to BMI 25. Thresholds are in principle designed to be "best estimates" concerning health risk at the time they are established and are also designed to ensure cohort uniformity in epidemiological studies. About 30,000,000 Americans moved from "ideal" weight to being "overweight".

In 2000, the WHO was advised to consider lowering the BMI threshold for overweight in East Asians from BMI 25 to BMI 23, and for obesity in East Asians from BMI 30 to BMI 25, due to epidemiological studies indicating that East Asians suffer a greater number of obesity-related health conditions at lower BMI values. To date, the WHO has not made any changes pursuant to those recommendations.

Additionally, some clinicians suggest raising the BMI thresholds for people with sub-Saharan African and Polynesian ancestry, because members of these groups have a greater ratio of lean body mass to fat at all body weights. The proposed thresholds for these groups are BMI 26 for overweight, and BMI 32 for obesity. Again, to date, no major professional or medical organization has officially adopted this suggestion.

Waist circumference

BMI does not take into account differing ratios of adipose to lean tissue; nor does it distinguish between differing forms of adiposity, some of which may correlate more closely with cardiovascular risk. Increasing understanding of the biology of different forms of adipose tissue has shown that visceral or central obesity (male-type or apple-type obesity) has a much stronger correllation, particularly with cardiovascular disease, than the BMI alone[3].

The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (<0.9 for men and <0.85 for women) are both used as measures of central obesity.

Body fat measurement

An alternative way to determine obesity is to assess percent body fat. Doctors and scientists generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. Two simpler methods for measuring body fat are the skinfold test, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer; or bioelectrical impedance analysis, usually only carried out at specialist clinics.

Gestalt

In practice, in most examples of overweight that may designate risk, both doctor and patient can see "by eye" whether excess fat is a concern. In these cases, BMI thresholds provide simple targets all patients can understand.

Etymology

Obesity is the nominal form of obese which comes from the Latin obēsus, which means "stout, fat, or plump." Ēsus is the past participle of edere (to eat), with ob added to it. In Classical Latin, this verb is seen only in past participial form. Its first attested usage in English was in 1651, in Noah Biggs's Matæotechnia Medicinæ Praxeos.

Cultural and social significance

Culture and obesity

In several human cultures, obesity is associated with physical attractiveness, strength, and fertility. Some of the earliest known cultural artifacts, known as Venus figurines, are pocket-sized statuettes representing an obese female figure. Although their cultural significance is unrecorded, their widespread use throughout pre-historic Mediterranean and European cultures suggests a central role for the obese female form in magical rituals, and suggests cultural approval of (and perhaps reverence for) this body form. This is most likely due to their abilty to easily bear children and survive famine.

In contrast, in modern Western culture, a more slender body shape is more typically considered desirable. "Thinness" is often considered more important for women than men.

Obesity was occasionally considered a symbol of wealth and social status in cultures prone to food shortages or famine. Well into the early modern period in European cultures, it often served this role. But as food security was realised, it came to serve more as a visible signifier of "lust for life", appetite, and immersion in the realm of the erotic. This was especially the case in the visual arts, such as the paintings of Rubens (1577–1640), whose regular use of the full female figures gives us the description Rubenesque for plumpness. Obesity can also be seen as a symbol within a system of prestige. "The kind of food, the quantity, and the manner in which it is served are among the important criteria of social class. In most tribal societies, even those with a highly stratified social system, everyone - royalty and the commoners - ate the same kind of food, and if there was famine everyone was hungry. With the ever increasing diversity of foods, food has become not only a matter of social status, but also a mark of one's personality and taste."

Not all contemporary cultures disapprove of obesity, although the Western preference for thinness is increasingly being exported worldwide as part of the process of globalization. Few cultures have escaped the "Westernization" of body shape preference, though cultures which are traditionally more approving (to varying degrees), include some African, Arabic, Indian, and Pacific Island cultures. Especially in the past decades, obesity has come to be seen more as a medical condition. There is also a small but vocal fat acceptance movement that seeks to challenge weight-based discrimination.

Popular culture

Various stereotypes of obese people have found their way into expressions of popular culture. A common stereotype is the obese character who has a warm and dependable personality, presumedly in compensation for social exclusion, but equally common is the obese vicious bully. Gluttony and obesity are commonly depicted together in works of fiction. In cartoons, obesity is used to comedic effect, with fat cartoon characters having to squeeze through narrow spaces, frequently getting stuck, or even exploding.

It can be argued that depiction in popular culture adds to and maintains commonly perceived stereotypes, in turn harming self esteem of obese people. A charge of discrimination on the basis of appearance could be leveled against these depictions.

On the other hand, obesity is often associated with positive characteristics such as good humor (the stereotype of the jolly fat man like Santa Claus), and some people are more sexually attracted to obese people than to slender people (see chubby culture, fat admirer).

Causes

Causative factors

When food energy intake exceeds energy expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout the body take in the energy and store it as fat. In its simplest conception, therefore, obesity is only made possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight."

In all individuals, the excess energy utilized to generate fat reserves is minute relative to the total number of calories consumed. This means that very fine perturbations in the energy balance can lead to large fluctuations in weight over time. To illustrate, an obese 40 year old who carries 100 lb of adipose tissue has only consumed about 25 more calories per day than he has burned on average - or the equivalent of an apple every three days. In comparison a very lean 40-year-old who carries only 15 lb of body fat will have exceeded his daily energy expenditure by about four calories a day - the equivalent of an apple every 18 days.

Factors that have been suggested to contribute to the development of obesity include:

* Sedentary lifestyle
* Genetic factors
* A high glycemic diet (i.e. a diet that consists of meals that give high postprandial blood sugar)
* Weight cycling, caused by repeated attempts to lose weight by dieting
* Underlying illness (e.g. hypothyroidism)
* Genetic disorders (e.g. Prader-Willi syndrome)
* Eating disorders (such as binge eating disorder)
* Stressful mentality
* Insufficient sleep
* Psychotropic medications
* Smoking cessation

As with many medical conditions, the caloric imbalance that results in obesity often develops from a combination of genetic and environmental factors. Polymorphisms in various genes controlling appetite, metabolism, and adipokine release predispose to obesity, but the condition requires availability of sufficient calories, and possibly other factors, to develop fully. Various genetic abnormalities that predispose to obesity have been identified (such as Prader-Willi syndrome and leptin receptor mutations), but known single-locus mutations have been found in only about 5% of obese individuals. While it is thought that a large proportion of the causative genes are still to be identified, much obesity is likely the result of interactions between multiple genes, and non-genetic factors are likely also important.

Some eating disorders are associated with obesity, especially binge eating disorder (BED). As the name indicates, patients with this disorder are prone to overeat, often in binges. A proposed mechanism is that the eating serves to reduce anxiety, and some parallels with substance abuse can be drawn. An important additional factor is that BED patients often lack the ability to recognize hunger and satiety, something that is normally learned in childhood. Learning theory suggests that early childhood conceptions may lead to an association between food and a calm mental state.

Evolutionary aspects

Although there is no definitive explanation for the recent increase of obesity, the thrifty gene hypothesis provides some understanding of this phenomenon. In times when food was scarce, the ability to take advantage of rare periods of abundance and use such abundance by storing energy efficiently was undoubtedly an evolutionary advantage. Individuals with greater adipose reserves were more likely to survive famine. This tendency to store fat is likely maladaptive in a society with adequate and stable food supplies. Although many people likely have a genetic propensity towards obesity, in most cases this propensity requires the modern environment with increased caloric availability and decreased requirements for physical labor in order to be expressed fully.

Neurobiological mechanisms

Flier summarizes the many possible pathophysiological mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until leptin was discovered in 1994. Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of appetite and food intake, storage patterns of adipose tissue, development of insulin resistance. Since leptin's discovery, ghrelin, orexin, PYY 3-36, cholecystokinin, adiponectin, and numerous other mediators have been studied. The adipokines are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases.

Leptin and ghrelin are considered to be complementary in their influence on appetite, with ghrelin produced by the stomach modulating short-term appetitive control (i.e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin-deficient, many more obese individuals are thought to be leptin-resistant, and this resistance has been implicated in obesity in some people, is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese subjects.

Neuroscientific approaches hinge on the action of the aforementioned hormones and mediators on the hypothalamus, the part of the brain that is thought to produce hunger signals for higher centers and induce food intake behavior. Lesion studies in the 1940s and 1950s identified two regions of the hypothalamus — the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH) — as the brain's hunger and satiety centers, respectively. Specific lesions to a mouse's LH suppressed its appetite while damaging the VMH caused overeating.

Studies of the distribution of the leptin receptor in the mid-1990s cast doubt upon this dual center theory of hunger and satiety. Leptin's effect on the arcuate nucleus melanocortin system is now considered central to the regulation of feeding and metabolism.

Societal causes

While it may often appear obvious why a certain individual gets fat, it is far more difficult to understand why the average weight of certain societies have recently been growing. While genetic causes are central to understanding obesity, they cannot fully explain why one culture grows fatter than another.

This is most notable in the United States. In the years from just after the Second World War until 1960 the average person's weight increased, but few were obese. In the two and a half decades since 1980 the growth in the rate of obesity has accelerated markedly and is increasingly becoming a public health concern.

There are a number of theories as to the cause of this change since 1980. Most believe it is a combination of various factors.

* Lack of activity: obese people appear to be less active in general than lean people, and not just because of their obesity. A controlled increase in calorie intake of lean people did not make them less active; correspondingly when obese people lost weight they did not become more active. Weight change does not affect activity levels, but the converse seems to be the case.

* One of the most important is the much lower relative cost of foodstuffs: massive changes in agricultural policy in the United States and Europe have led to food prices for consumers being lower than at any point in history. Sugar and corn syrup, two huge sources of food energy, are some of the most subsidized products by the United States government. This can raise costs for consumers in some areas but greatly lower it in others. Current debates into trade policy highlight disagreements on the effects of subsidies.

* Increased marketing has also played a role. In the early 1980s the Reagan administration lifted most regulations pertaining to advertising to children. As a result, the number of advertisements seen by the average child increased greatly, and a large proportion of these were for fast food and sweets.

* Changes in the price of mineral oil and petrol are also believed to have had an effect, as unlike during the 1970s it is now affordable in the United States to drive everywhere — at a time when public transit goes underused. At the same time more areas have been built without sidewalks and parks.

* The changing workforce as each year a greater percent of the population spends their entire workday behind a desk or computer, seeing virtually no exercise. In the kitchen the microwave oven has seen sales of calorie-dense frozen convenience foods skyrocket and has encouraged more elaborate snacking.

* A social cause that is believed by many to play a role is the increasing number of two income households in which one parent no longer remains home to look after the house. This increases the number of restaurant and take-out meals.

* Urban sprawl may be a factor: obesity rates increase as urban sprawl increases, possibly due to less walking and less time for cooking.

* Since 1980 both sit-in and fast food restaurants have seen dramatic growth in terms of the number of outlets and customers served. Low food costs, and intense competition for market share, led to increased portion sizes — for example, McDonalds french fries portions rose from 200 calories (840 kilojoules) in 1960 to over 600 calories (2,500 kJ) today.

* Increased food production is a probable factor. The U.S. produces three times more food than U.S. residents eat.

* Increasing affluence itself (including many of the above factors as accompaniments of affluence) may be a cause, or contributing factor since obesity tends to flourish as a disease of affluence in countries which are developing and becoming westernised. This is supported by a dip in American GDP after 1990, the year of the Gulf War, followed by an exponential increase. U.S. obesity statistics followed the same pattern, offset by two years.

* An aging population may also be a major factor, as the likelihood of becoming obese increases with age. Beyond their twenties, the older a person becomes the slower their metabolism becomes, reducing the amount of calories required to sustain the body, thus if a person does not reduce their intake of food with age, they will become obese over time. As the average age of individuals within a society increases, the rate of obesity also increases. This situation is exacerbated by the baby boom generation, which represents a disproportionately large portion of the population in many countries and is currently nearing the latter end of the typical lifespan in affluent nations, and therefore is in the high-risk zone for obesity.

Interestingly an increase in the number of Americans who exercise and diet occurred before the increase in obesity, and some scholars have even argued that these trends actually encouraged obesity. Nearly all diets fail, with participants resuming their previous eating habits or even engaging in binge eating. Many then see an overall increase in their weight. If the diet is then repeated and abandoned again, a pattern of rising and falling weight is established, known as weight cycling. Similarly those who work out but then stop can end up being heavier than those who never exercised.

Poverty link

Some obesity co-factors are resistant to the theory that the "epidemic" is a new phenomenon. In particular, a class co-factor consistently appears across many studies. Comparing net worth with BMI scores, a 2004 study found obese American subjects approximately half as wealthy as thin ones. When income differentials were factored out, the inequity persisted — thin subjects were inheriting more wealth than fat ones. Another study finds women who married into higher status predictably thinner than women who married into lower status.

Complications

Obesity, especially central obesity (male-type or waist-predomimant obesity), is an important risk factor for the "metabolic syndrome" ("syndrome X"), the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An inflammatory state is present, which — together with the above — has been implicated in the high prevalence of atherosclerosis (fatty lumps in the arterial wall), and a prothrombotic state may further worsen cardiovascular risk.

Apart from the metabolic syndrome, obesity is also correlated (in population studies) with a variety of other complications. For many of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. Most confidence in a direct cause is given to the mechanical complications in the following list, compiled by the American Medical Association for general physicians:

* Cardiovascular: congestive heart failure, enlarged heart and its associated arrhythmia and dizziness, cor pulmonale, varicose veins, and pulmonary embolism
* Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility
* Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones), hernia, and colorectal cancer
* Renal and genitourinary: urinary incontinence, glomerulopathy, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth
* Integument (skin and appendages): stretch marks, acanthosis nigricans, lymphedema, cellulitis, carbuncles, intertrigo
* Musculoskeletal: hyperuricemia (which predisposes to gout), immobility, osteoarthritis, low back pain
* Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia10.
* Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, Pickwickian syndrome, asthma
* Psychological: Depression, low self esteem, body image disorder, social stigmatization

While being severely obese has many health ramifications, those who are somewhat overweight face little increased mortality or morbidity. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight. This may in part be attributable to lower mortality rates in diseases where death is either caused or contributed to by significant weight loss due to the greater risk of being underweight experienced by those in the ideal category. Another factor which may confound mortality data is smoking, since obese individuals are less likely to smoke. Osteoporosis is known to occur less in slightly overweight people.

Therapy

The mainstay of treatment for obesity is an energy-limited diet and increased exercise. In studies, diet and exercise programs have consistently produced an average weight loss of approximately 8% of total body mass on average (excluding study drop-outs). While not all dieters will be satisfied with this outcome, studies have shown that a loss of as little as 5% of body mass can create enormous health benefits.

A more intractable therapeutic problem appears to be weight loss maintenance. Of dieters who manage to lose 10% or more of their body mass in studies, 80-95% will regain that weight within two to five years. It appears that the homeostatic mechanisms regulating body weight are very robust (see leptin, for example), and vigorously defend against weight loss. Much important research is now being devoted to determining what factors can improve the currently dismal weight loss maintenance rates.

Recent scientific research has cast some doubt over whether or not dieting actually improves health, with some studies indicating that dieting may in fact be more detrimental than remaining overweight

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:

1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
2. If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
4. In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The patient needs to be aware of the potential complications.
5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

Much research focuses on new drugs to combat obesity, which is seen as the biggest health problem facing developed countries. Nutritionists and many doctors feel that these research funds would be better devoted to advice on good nutrition, healthy eating, and promoting a more active lifestyle.

Medication most commonly prescribed for diet/exercise-resistant obesity is orlistat (Xenical®, which reduces intestinal fat absorption by inhibiting pancreatic lipase) and sibutramine (Reductil®, Meridia®, an anorectic). In the presence of diabetes mellitus, there is evidence that the anti-diabetic drug metformin (Glucophage®) can assist in weight loss — rather than sulfonylurea derivatives and insulin, which often lead to further weight gain. The thiazolidinediones (rosiglitazone or pioglitazone) can cause slight weight gain, but decrease the "pathologic" form of abdominal fat, and are therefore often used in obese diabetics.

Increasingly, bariatric surgery is being used to combat obesity. The most common weight loss surgery in Europe and Australia is the adjustable gastric band where a silicone ring is placed around the top of the stomach to help restrict the amount of food eaten in a sitting. This surgery has been FDA approved in the United States since 2001 but has been being used in other parts of the world since the early 1990s. It is considered the safest and least invasive of the available weight loss surgeries such as Roux-en-Y gastric bypass surgery (RNY), biliopancreatic diversion, and stomach stapling (also known as "vertical banded gastroplasty", VBG). Unlike those more invasive techniques the band surgery does not cut into or reroute any of the digestive tract and is completely reversible. Removing the implant returns the stomach to its pre-surgical norm. All of these surgeries can be done laparoscopically. The more invasive of the surgeries usually bypass or remove some portion of the patient's intestines which causes malabsorption and dumping. All of these surgeries come with risk to the patient, from the LAP-BAND which has a mortality rate of 1 in 2000 to the RNY Bypass which has a mortality rate of 1 in 200. RNY surgery appears to be popular because the weight tends to come off faster than with the band but studies have shown that at 3-6 years out the amount of weight lost and the amount of loss maintained is nearly identical. Therefore the patient needs to consider the long term ramifications of their choice.

None of these weight loss surgeries should be considered lightly and all risks must be examined and weighed against the risks of remaining obese. Bariatric surgery is not the easy way out, it requires the patient to make lifelong changes to their diet if they are to keep the lost weight off in the long term. Restrictive surgeries such as the adjustable gastric band offer the patient a built-in tool but it should be considered a tool not a magic solution. They can help a person to eat less but they cannot choose what the patient puts in their mouth, thus the need for long term commitments to eat properly.

Controversies

There is continuous debate over obesity, at several levels. While scientific evidence for particular risks and treatments is fairly firm, the evidence informing debates on exact causation, social impact and necessary policy responses is much less clear-cut. In the area of policy and public debate, statistics demonstrating correlations are typically misinterpreted as demonstrating causation, a fallacy known as the spurious relationship. As much of the data is open to interpretation, there have been many "experts" taking positions, as well as policy pressure groups, influencing the debate from various angles.

Medicalization of obesity

Controversy exists as to whether the concept of "obesity" is a valid one. Critics assert that physically active people are healthier than the sedentary regardless of their body weight. The focus on weight and body mass is fed, in their view, by a diet promotion industry, drug companies, and segments of the medical profession for profit purposes, by promoting a vision that equates health with slenderness, and makes extreme slenderness of a sort that is quite difficult for most people to achieve an ideal. In The Obesity Myth, Paul Campos writes that:

... (F)rom the perspective of a profit-maximising medical and pharmaceutical industry, the ideal disease would be one that never killed those who suffered from it, that could not be treated effectively, and that doctors and their patients would nevertheless insist on treating anyway. Luckily for it, the American health care industry has discovered (or rather invented) just such a disease. It is called "obesity". Basically, obesity research in America is funded by the diet and drug industry — that is, the economic actors who have the most to gain from the conclusion that being fat is a disease that requires aggressive treatment. Many researchers have direct financial relationships with the companies whose products they are evaluating.

Health effects of obesity

Opposing Campos are voices such as Greg Critser, who writes in Fat Land that the statistics such campaigners use are based on a selective sample of research data — a selection designed to emphasise obesity co-factors such as poor fitness, rather than obesity itself. Critser notes that advocates of the Obesity Myth position typically rely heavily on a study by Dr. Steven Blair at the Cooper Institute, Texas, which showed that fit, fat subjects were healthier than unfit, skinny subjects:

... Taking out the fitness variable and looking at body weight only, Blair admitted: "Men with a BMI of >30 were generally less physically fit and had more unfavorable risk factors than men in the lower BMI groups". Lower weight men had higher good cholesterol, lower bad cholesterol, and higher treadmill times than fatter men. "The highest death rate," he added, "was observed among those men in the highest BMI category and correspondingly lower death rates were observed in each subsequently lower BMI category." And when one looks at the difference between low fit men in all categories — which one might think would be most useful since most obese people are not fit — Blair's upbeat message fades: Normal weight nonfit men had an age-adjusted death rate (the number of excess deaths in the studied group) of 52.1; unfit fat men had the higher rate of 62.1. More: Unfit lean men were half as likely to have a history of hypertension than unfit fat men. In the real world, even according to Blairism, the fat are more likely to die early — and to live precariously — than the lean.

Medical responses to obesity

Conventional wisdom recommends that the obese adopt strategies to lose weight in order to mitigate the health risks associated with obesity. There is controversy both over what those strategies realistically include, and also whether such a goal does actually result in better health outcomes.

Weight reduction strategies include dietary changes, exercise regimes, weight loss drugs, and surgical interventions (see Therapy, above, for complete list). Of these, "miracle diets" are most contested, with several studies suggesting that short-term weight loss typically results in metabolic adjustments leading to weight gain in the longer term.

Conventional wisdom holds that obesity is caused by over-indulgence in fatty or sugary foods, portrayed as either a failure of will power or a species of addiction. Various specialists strongly oppose this view. For example, Professor Thomas Sanders of King's College London emphasises the need for balance between activity and consumption:

In trials, there is no evidence suggesting that reducing fat intake has an effect on obesity. As long as your expenditure equals what you eat, you won't put on weight, regardless of how high the fat content is in your diet (The Times, London, 10 March 2004).

Prevalence and public interest

What qualifies a medical condition as a matter of public interest, rather than a private health issue between doctor and patient, are its social costs. The estimation or measurement of the social cost of obesity is an extraordinarily hazardous statistical task, for two separate reasons.

Firstly, the collation of evidence concerning the prevalence of obesity, or especially changing rates of prevalence, is open to several types of distortion. In the case of the UK, for one example, uninterpreted public health statistics may contradict the common belief that obesity is reaching epidemic proportions. More generally, average weight increases with age — so a population with an increasing proportion of older people will have a higher average weight, regardless of changes to diet or activity.

Secondly, since obesity is the correlate of a long list of factors which have significant health consequences in their own right, there may be no fact of the matter about which costs to attribute to obesity per se, and which are more properly costed to these co-factors. For one example, the proven relationship between obesity and low social status means that any group of obese persons' health outcomes will be significantly lowered by their average access to medical care, as a socioeconomic class, which will be, on average, lower than that of any non-obese control group.

Researchers from the U.S. Centers of Disease Control and Prevention in Atlanta[15] erroneously reported that approximately 400,000 US deaths annually were associated with poor diet and little exercise, and that if the trend continued, this would be 500,000 in 2005, overtaking smoking as the leading cause of death. These statistics are fiercely contested, and error was admitted by the CDC in November 2004. In particular, studies of this nature are normally unable to distinguish causes of death, so include many accidental deaths, murders etc., which ought not to be costed to obesity.

Canada and Europe are generally considered to be somewhat behind the United States in the trend towards overweight, with the rest of the world mixed. Some nations like Egypt, China and Mexico have also suffered from greatly increasing rates of obesity.

In March 2005 the International Obesity Task Force, a global coalition of obesity scientists and research centres advising the European Union, estimated that Finland, Germany, Greece, Cyprus, the Czech Republic, Slovakia, and Malta have exceeded the United States figure of 67% for overweight or obese males. The task force estimated in 2003 that about 200 m of the 350 m adults living in what is now the European Union may be overweight or obese.

Policy responses to obesity

On top of controversies about the causes of obesity, and about its precise health implications, come policy controversies about the correct policy approach to obesity. The main debate is between "personal responsibility" advocates, who resist regulatory attempts to intervene in citizen's private dietary habits, and "public interest" advocates, who promote regulations, on the same public health grounds as the restrictions applied to tobacco products. In the U.S., a recent bout in this controversy involves the so-called Cheeseburger Bill, an attempt to indemnify food industry businesses from frivolous law suits by obese clients.

"Personal responsibility" advocates work on the basis that, as the microbiologist Rene Dubos once said, health ought not to be considered an end in itself, but "the condition best suited to reach goals that each individual formulates for himself" . Any other definition permits authorities to curtail the autonomy of the self-determining individual, imposing quantity over quality of life onto them, undermining their civil liberties. As much as principled doctors, personal responsibility arguments have also been offered by food producer lobbies. In 1961, for example, as President John F Kennedy raised concerns about a lack of fitness in American society, a spokesman for the U.S. Dairy industry, Frank R. Neu, wrote advertorials warning We May Be Sitting Ourselves To Death . Not food regulation, but personal exercising, is moved as the solution.

The "public interest" advocate John Banzhaf has found a way to harness personal responsibility arguments to the public interest side of the debate in the U.S., via recent changes to HMO regulations which enable health insurance providers to differentiate between obese and regular customers in their pricing. The "public interest" objective is that obese people will have to pay extra for their health maintenance, bringing "personal responsibility" to bear on their consumption choices. This new tactic is controversial itself — if a causal link pertains from low social status to obesity (see above), the net effect will be increased costs for low income members of HMOs, particularly ethnic minorities, and reduced costs for slim, middle class white members.

On July 16, 2004, the United States Department of Health and Human Services officially classified obesity as a disease. Speaking to a Senate committee, Tommy Thompson, the Secretary of Health and Human Services, stated that Medicare would cover obesity-related health problems. However, reimbursement would not be given if a treatment was not proven to be effective.

Prevalence of obesity in American children

A recent study has shown the prevalence of obesity in children in the United States in 1999 to 2000 to be as follows:

* Ages 2 to 5 - Boys 9.9%, Girls 11%
* Ages 6 to 11 - Boys 16%, Girls 14.5%
* Ages 12 to 19 - Boys 15.5%, Girls 15.5%

A study conducted at the American Institute for Research of Dietary Habits found that by 2010, 21% of American children will be considered obese.

Health

2006-05-18T23:39:00.000-07:00

Health is a term that refers to a combination of the absence of illness, the ability to cope with everyday activities, physical fitness, and high quality of life. In any organism, health can be said to be a "state of balance," or analogous to homeostasis, and it also implies good prospects for continued survival. Wellness is a term sometimes used to describe the psychological state of being healthy, but is most often used in the field of alternative medicine to describe one's state of being.

The most widely accepted definition is that of the World Health Organization (WHO). It states that "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1946). In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life." The WHO definition is not without criticism, as some argue that health cannot be defined as a state at all, but must be seen as a process of continuous adjustment to the changing demands of living and of the changing meanings we give to life. The WHO definition is therefore considered by many as an idealistic goal rather than a realistic proposition.

Health is maintained through the science of medicine, but can also be improved by individual effort. Physical fitness, weight loss, healthy eating, stress management training and stopping smoking and other substance abuse are examples of steps to improve one's health. Workplace programs are recognized by an increasingly large number of companies for their value in improving health and well-being of their employees, and increasing morale, loyalty and productivity at work. A company may provide a gym with exercise equipment, start smoking cessation programs, provide nutrition, weight or stress management training. Other programs may include health risk assessments and health screenings.

Alternative medicine can sometimes be used to improve health. However, with the lack of scientific proof through double blind testing, the placebo effect should be assumed to provide the health improvement in the case of successful alternative treatments until such testing can provide proof of any effects besides placebo. This is because as someone who feels well from their (possibly subconcious) belief in the therapies may lower their stress levels, resulting in beneficial effects on numerous factors, including blood pressure, gastrointestinal functioning, and immune response. The field of psychoneuroimmunology explores these links.

An increasing measure of the health of populations is height, which is strongly regulated by nutrition and health care, among other standard of living and quality of life matters. The study of human growth, its regulators and its implications is known as auxology.