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Fatigue: a complex symptom with wide-reaching effects
2008-01-09 21:35:00
Fatigue is associated with increased distress due to some other symptoms, includingpain. It often clusters with cachexia and anorexia, and is difficult to distinguishbetween them . It has profound effects on everyday functioning and,perhaps consequently, service use. It reduces quality of life and increases suffering.Fatigue has been associated with hospital admission and increased stress to caregivers(Hinton 1994; Robinson and Posner 1992). The needs of lay caregivers in this contextare often overlooked . A deeper comprehension of these factors isimportant in assessing patients, planning care, and in designing and testing futuretreatments for fatigue.But do the effects of fatigue stretch even wider, reaching well beyond traditionalsymptom boundaries? Having energy and vitality is an important part of self-image.Fatigue is often seen as a sign of impending deterioration. So if doctors and nurses areto discuss fatigue with patients, grasping their interpretation and understanding off...
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IS OBESITY PREVENTABLE?
2007-12-27 00:08:00
The pandemic of overweight and obesity is now so advanced and so widespread that few regions of the world (with the possible exception of parts of sub Saharan Africa) appear to have escaped the effects of this major public health problem. Previous chapters have highlighted the strong biological influences that contribute to the creation and maintenance of a positive energy balance in humans; current attempts to abate the rapid increase in body weight at both an individual and a community level have been less than inspiring. This has led some people to question whether it is possible to prevent continued increases in population body weight.Despite these concerns about the effectiveness of current obesity prevention approaches, there is indirect evidence from a range of sources that supports the view that prevention is not only feasible, but offers the only solution to controlling the worldwide epidemic of obesity. Bouchard (4) indicates that the heritability of obesity and body fat s...
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Cultural Differences as Influences on Approaches to Obesity Treatment
2007-12-27 00:02:00
Culture influences all human behavior and dialectically shapes social institutions and social interactions among populations groups and individuals. Culture has many definitions, but all embody the underlying concept of implicit and explicit guidelines that are inherited and shared by members of a particular society or societal subgroup . These guidelines define ??how to view the world, how to experience it emotionally, and how to behave in it in relation to other people, to supernatural forces or gods, and to the natural environment?? .These cultural perspectives are identifiable and transmitted from one generation to the next through distinctive symbols, language, and rituals. Of particular relevance to cross-cultural treatment issues, cultural influences on behavior tend to be relatively invisible. Certain types of behavior seem universal, natural, and nonnegotiable to those influenced by a given culture .In fact, the influence of culture often becomes evident only when cultural ...
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Obesity and the Primary Care Physician
2007-12-26 23:54:00
A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goalsand expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.Identifying the body mass index (BMI) as a fifth vital sign may also increase physician wareness and prompt counseling. This method was successfully used in a recent study where a smoking status stamp was placed on the pat...
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IN WHICH REGIONS OF THE WORLD IS HEALTH MOST AFFECTED BY ENVIRONMENTAL FACT
2007-12-25 01:23:00
Developing regions carry a disproportionately heavy burden for communicable diseases and injuries.The largest overall difference between WHO regions was in infectious diseases. The total number of healthy life years lost per capita as a result of environmental burden per capita was 15-times higher in developing countries than in developed countries. The environmental burden per capita of diarrhoeal diseases and lower respiratory infections was 120- to 150-times greater in certain WHO developing country subregions as compared to developed country subregions. These differences arise from variations in exposure to environmental risks and in access to health care.No overall difference between developed and developing countries in the fraction of noncommunicable disease attributable to the environment was observed.? However, in developed countries, the per capita impact of cardiovascular diseases and cancers is higher.The number of healthy life years lost from cardiovascular disease, as ...
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WHICH POPULATIONS SUFFER THE MOST FROM ENVIRONMENTAL HAZARDS TO HEALTH?
2007-12-25 01:21:00
Children suffer a disproportionate share of the environmental health burden.Globally, the per capita number of healthy life years lost to environmental risk factors was about 5-times greater in children under five years of age than in the total population. Diarrhoea, malaria and respiratory infections all have very large fractions of disease attributable to environment, and also are among the biggest killers of children under five years old. In developing countries, the environmental fraction of these three diseases accounted for an average of 26% of all deaths in children under five years old. Perinatal conditions (e.g. prematurity and low birth weight); protein-energy malnutrition and unintentional injuries ? other major childhood killers ? also have a significant environmental component, particularly in developing countries.On average, children in developing countries lose 8-times more healthy life years, per capita, than their counterparts in developed countries from environment...
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HOW SIGNIFICANT IS THE IMPACT OF ENVIRONMENT ON HEALTH?
2007-12-25 01:04:00
An estimated 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors.Of the 102 major diseases, disease groupings and injuries covered by the World Heal th Report in2004, environmental risk factors contributed to disease burden in 85 categories. The specific fraction of disease attributable to the environment varied widely across different disease conditions.Globally, an estimated 24% of the disease burden (healthy life years lost) and an estimated 23% of all deaths (premature mortality) was attributable to environmental factors. Among children 0?14 years of age, the proportion of deaths attributed to the environment was as high as 36%. There were large regional differences in the environmental contribution to various disease conditions ? due to differences in environmental exposures and access to health care across the regions. For example, although 25% of all deaths in developing regions were attributable to environmental causes, only 17% o...
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Differences Between the Sexes on Cholesterol?
2007-10-25 19:01:00
For a long time, medical studies didn?t include women because researchers were afraid that their menstrual cycle would skew results or that the subjects would become pregnant and have to stop taking a medication. Younger women were also less likely to have heart disease, which meant more participants would have to be included to be able to show a difference in outcomes if women were involved. More study subjects means more money to do the study, so leaving women out was a practical decision that wasn?t as sexist as it sometimes appears.Fortunately, once the benefit of a particular therapy was shown in men, the economics made it favorable to study women as well, and later studies have shown that women benefit just as much as men do from cholesterol-lowering interventions, whenever the risk is equivalent. By the time women are in their midsixties, their risk of new coronary events is similar to that of similarly aged men, so there should be little difference in treatment at that point...
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Why Won?t My Doctor Prescribe a Statin-Fibrate Combination?
2007-10-25 18:59:00
Some primary care doctors are hesitant to prescribe this combination of drugs after the deaths and other problems caused when the no-longer-available statin Baycol was mixed with fibrates. There is also a warning in the labeling of all statin medications that generally advises that they not be used in combination with fibrate therapy. Lipid specialists know that despite the risks, a statin-fibrate combination is an extremely effective way to lower lipids when combined disorders are present. As long as a patient is fully educated to watch for serious muscle side effects, I believe this combination can be safely used. If a person were unable to recognize or communicate the presence of muscle pains for any reason, however, this combination treatment should probably not be used. If you have a combined lipid disorder but your doctor is shying away from statin-fibrate therapy, you might want to ask for a referral to someone in your community who specializes in thetreatment of lipid disord...
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How to Save Money on Drugs (2)
2007-10-24 15:55:00
Shop Around for the Best PriceThe same kind of comparison shopping you might do for a car or a coffeemaker can pay off for drugs.? Buy by mail. If your prescription drugs are covered by insurance, see if the insurer has a mail-order pharmacy. Some offer lower co-payments.? Call around. You?ll find that drug prices vary from store to store. Try independent pharmacies, national chains, and megastores such as Wal-Mart and Costco.? Go online. You can find bargains or quickly compare drug prices on the Internet. (If you don?t have a computer, the ones at your public library are free to use, and many librarians will help you find information.) Many brick-andmortar pharmacies have websites that offer discounts on prescription drugs. So do ?virtual? pharmacies, which do all their business online. For the most part, shopping for prescription drugs online is safe. One way to tell if the site is legitimate is the VIPPS (Verified Internet Pharmacy Practice Sites) seal of approval from the Natio...
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How to Save Money on Drugs (1)
2007-10-24 15:50:00
You don?t need the newscasters to tell you that prescription drug prices are on the rise or that insurers are covering less of the cost. For some people, the out-of-pocket outlay for prescription drugs extracts little more than a quiet moan at the cash register. For others, it means skipping medicine or meals in order to pay. Here are some tips for cutting costs.Get Your Doctor?s HelpUnless a doctor knows you?re trying to cut corners, he or she won?t take price into consideration when filling out the prescription pad. But most doctors are willing and able to help once you mention your concern. Here are a few things to ask about:? Generic drugs. Buying generic drugs instead of the more expensive brand-name versions is one of the most effective ways to cut your monthly drug bill. For example, a month?s supply of the 20 mg dose of the brand-name statin Mevacor costs about $70, while the same amount of generic lovastatin costs about $35. There?s no need to worry that a cheaper price mea...
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The Metabolic Syndrome
2007-10-21 15:09:00
A person with metabolic syndrome has three or more of the following:? A large waist (forty inches or more for men and thirty-four inches or more for women; to measure your waist size, don?t go by your belt measurement?instead, wrap a tape measure around the largest part of your midsection and make sure you keep the tape measure parallel to the floor)? Borderline or high blood pressure (anything above 130/85 mm Hg)? A high level of triglycerides (above 150 mg/dL)? Low HDL (under 40 mg/dL for men or 50 mg/dL for women)? High fasting blood sugar (above 100 mg/dL)What does metabolic syndrome do to the body? Doctors and researchers think that metabolic syndrome?s impact on health is more than the sum of its parts. Basically, in people with this disorder, blood sugar levels stay high after a meal or snack instead of dropping to a base level as they do in most people. The pancreas, sensing still-elevated glucose levels, continues to pump out insulin. Constant high levels of insulin and blo...
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Things to Mention to Your Doctor if You Are About to Be Treated for an Abno
2007-10-21 11:00:00
Going to the doctor can be overwhelming or scary. And it?s easy to forget to ask questions or mention recent events that might have skewed a blood test result. I suggest that you bring a written list of questions or topics you want to cover. Here are some issues you might want to bring up with your doctor when discussing your recent lipid profile:Tell the doctor if you had a flu or other major or minor illness shortly before the blood test was performed. These events can dramatically alter the lipid profile, either reducing or elevating several of the lipoprotein fractions. If your diet was dramatically different from your typical diet in the weeks leading up to the lipid test, this is worth noting, because high alcohol or carbohydrate intake can cause a dramatic elevation in serum triglycerides.If you were expected to fast and didn?t, don?t be embarrassed to say so. You could end up on the wrong drug treatment if this error is not identified. If there is an abnormality (i.e., hi...
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Alternative Remedies For Heart Desease
2007-10-21 02:36:00
Several natural therapies are promoted as treatments for heart disease. Some have been put to the test in scientific studies and look promising, but others have not held up to scientific scrutiny. Many such herbal remedies and alternative treatments?available in drugstores and on the Internet?remain unproved and therefore should be taken with caution. And because herbs and other nutritional supplements are not reviewed for purity or effectiveness by the FDA, you can?t be sure that what you?re buying is effective or even that the bottle contains the substance on the label. If you take any herbal remedies, be sure to tell your doctor. These preparations may hinder or exaggerate the effects of prescription drugs used to manage cardiovascular disease. Indeed, heart patients are more vulnerable than most others to adverse drug interactions. Here is some information about two popular alternative remedies for heart disease. Of course, there are many others out there that I just don?t have ...
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What a Heart Attack Feels Like
2007-10-21 02:29:00
I hope you?ll get diagnosed and treated long before heart disease leads to a heart attack, but you should know the warning signs just in case. Unlike in the movies, where a person having a heart attack gropes his chest (and in the movies, unlike reality, it?s almost always a man) and falls to the floor, the symptoms of a reallife heart attack are often more subtle. They differ between men and women and from person to person. Generally, men will report the following:? Pain or discomfort in the chest that radiates to the shoulder or arms, to the upper back near the shoulder blades, or to the neck or jaw? Uncomfortable pressure, tightness, fullness, or ache at the center of the chest? Shortness of breath, sweating, nausea, or dizzinessWomen, on the other hand, usually report the following:? Pain in both arms or shoulders? Chest cramping or dull pain between the breasts? Shortness of breath? Feeling of indigestion? Lower abdominal pain? Severe fatigue (the least specific symptom, usuall...
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Relaxation Techniques
2007-10-19 01:51:00
Breath FocusWhat Is It? Focusing on slow, deep breathing and gently disengaging the mind from distracting thoughts and sensationsEspecially Beneficial: If you have an eating disorder or tend to hold in your stomach (may help you focus on your body in healthier ways)May Not Be Suitable: If you have health problems that make breathing difficult, such as respiratory ailments or congestive heart failureProgressive Muscle Relaxation What Is It? Tensing and relaxing all the muscles of the body from head to toe in a progressive sequenceEspecially Beneficial: At times when your mind is racing or if you have trouble sensing and releasing tensionMay Not Be Suitable: If you have an eating disorder or have had recent surgery that affects body image or if you have a condition that makes tensing the body especially uncomfortableMindfulness MeditationWhat Is It? Breathing deeply while staying in the moment by deliberately focusing on thoughts and sensations that arise during the meditation sessionE...

Are You Depressed?
2007-10-19 01:39:00
Identifying the symptoms of depression can be a useful first step toward gaining a deeper understanding of how depression, bipolar disorder, or the long-lasting low-level depression called dysthymia (pronounced dis-THIGH-me-a) affects you. It may help you open a discussion with a doctor or therapist, too.Be aware, however, that self-tests like this one cannot diagnose depression or any other mental illness. Even if they could, it?s easy to dismiss or overlook symptoms in yourself. It may help to have a friend or relative go over this checklist with you. Also, remember that your feelings count far more than the number of check marks you make. If you think you are depressed or if you have other concerns or questions after taking this test, talk with your doctor or therapist.Depression ChecklistStart by checking off any symptoms of depression that you have had for two weeks or longer. Focus on symptoms that have been present almost every day for most of the day. (The exception is the i...
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Obesity in Pregnancy
2007-10-17 17:30:00
The problem of mothers accumulating excess weight and developing obesity during pregnancy has been described for over 50 years and is a common reason given by obese women for their weight problem. Studies have shown that there is considerable variation in the amount of weight gained during gestation and that excess weight is often retained postpartum. Although the mean weight gain is quite small, some women experience extreme weight gains and others have cumulative increases in body weight after each pregnancy. Of equal concern is the potential impact upon the adiposity of a child born to an obese woman. Although only recently identified as of concern, the propensity of obese women to produce large babies, whether or not they display their increased susceptibility to gestational diabetes, is now linked to a much greater likelihood of these children becoming obese during childhood.
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Family History of Obesity and/or Diabetes
2007-10-17 17:24:00
It has long been known that obesity runs in families, although the determinants of that heritability are not likely to be all genetic, with parental influence on dietary and physical activity patterns also playing a role. Whitaker et al. examined the influence of parental obesity on the development of childhood obesity and its persistence into adulthood. They found that having at least one obese parent greatly increased one?s risk of becoming obese as an adult. However, the risks of adult obesity were magnified in subjects who had an obese parent and who were also obese as children. In younger children this effect was small or nonexistent (OR = 1.3 for children aged 1?2 years) but was very pronounced in older children (OR=17.5 in 15- to 17-year olds). Thus it would appear that identifying children with obese parents and intervening early to prevent unhealthy weight gain may allow the progression to adult obesity to be prevented.It has also been well recognized for some time that th...
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Low HDL
2007-10-16 11:05:00
Recommendations for people with low HDL levels are a little less cut-and-dried than those for the other lipid problems. That?s because we don?t have any studies showing specifically that if we raise HDL levels, heart disease risk goes down. We know HDL is good for the heart, so we believe that the higher the levels the better, but no studies have unequivocally proved that. Why? Because all the drugs we employ to raise HDL levels typically lower the LDL or triglyceride values at the same time. This makes it hard to tell which change caused the benefit of fewer heart problems. Recent animal studies have also shown that there may be good ways to raise an HDL cholesterol level and bad ways to do that, so without knowing how a drug has led to a change in HDL, one can?t readily predict if its effects would be beneficial or detrimental.None of the statins alter HDL levels very dramatically (about 4 percent to 10 percent increase), whereas the fibrates and niacin do a better job of raising ...

Stress Can Cause Brain Damage and Memory Loss
2007-10-15 18:19:00
One of the body?s responses to stress is a heightened mental state and the ability to think on your feet. While this sounds wonderful, the downside is that the chemical that causes this mental alertness, cortisol, also kills brain cells. According to Dr. Robert Sapolsky, a Stanford University biologist who has extensively researched the physical effects of stress, the cells that are most vulnerable to destruction are the ones located in the hippocampus, the part of the brain responsible for memory. The hippocampus is also the area that deteriorates when patients contract Alzheimer?s disease and other memory disorders. This research seems to point to the idea that prolonged stress could be directly related to memory problems and other cognitive disorders.Now that we?ve seen the toll that stress takes on the body and the emotions, let?s look at several strategies for managing stress.
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Stress Contributes to Some Cancers
2007-10-15 18:16:00
While the relationship between stress and cancer has not been definitely proven, enough information has been gathered to cause researchers to continue to explore the question. For example, the National Cancer Institute reports that some studies of women with breast cancer have shown significantly higher rates of occurrence of this disease among women who have experienced traumatic life events and stress within several years of their diagnosis. These factors include death of a spouse, social isolation, and other psychological factors.Studies are also under way to explore the effects of stress on the immune response of women already diagnosed with cancer to see if stress reduction can slow the progression of the cancer. One major study conducted by Ohio State University and published in the Journal of the National Cancer Institute involved high-stress and low-stress women following surgery for stage II and stage III breast cancer. The researchers found that the women who reported high...
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Reductase Inhibitors (Statins)
2007-10-14 11:26:00
Statins are the most widely used class of cholesterol-lowering drugs. Large, randomized clinical trials have shown?and continue to show?that people who use statins have a 20 percent to 40 percent reduction in death from incidents of major cardiac events in studies lasting two to six years.The study that really brought statins into the limelight was called the Scandinavian Simvastatin Survival Study, or the 4S trial. It involved 4,444 men and women, ages thirty-five to seventy, who had preexisting heart disease and high total cholesterol levels. Half took the cholesterol-lowering drug simvastatin for five years, and half took placebo tablets containing no medication. By the end of the trial, LDL levels in the treatment group had fallen by 35 percent and total cholesterol dropped by 25 percent, while no change took place in the placebo group. The treatment group also had a 30 percent lower chance of dying during the trial and a 34 percent lower chance of having a major coronary event ...

Are You a Prospect or a Suspect?
2007-10-14 07:41:00
In sports, a talented player who is just starting out in the game is known as a ?prospect,? someone who is on the verge of accomplishing great things for his team. But if he doesn?t live up to his promise on the playing field, he soon becomes ?suspect,? a person who is failing to live up to his potential. When this happens, his performance must improve or he is off the team.I watched this happen with J.J. McCleskey when he was a sevenyear veteran with the Arizona Cardinals. When the tremendously talented J.J. was unable to complete the season four years in a row due to nagging injuries, he became suspect. His coach told him, ?I don?t know what you?re doing in the off-season to get ready for the game, but whatever it is, you need to change it or you will have to start looking for another team.? I discovered that J.J.?s problem was repetitive hamstring pulls due to overstriding and improper training practices. After working with me during the off-season, J.J. was able to play the enti...
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Telling Good Studies from Bad
2007-10-10 07:46:00
An informed patient is in a much better position to partner with his or her physician to achieve optimal health. However, medical news can be misleading or hard to understand, and a little knowledge can indeed prove to be a dangerous thing. Even doctors can get caught up in promising preliminary studies and jump to false conclusions. So what can you do? What follows is a primer on interpreting medical news.Randomized controlled study. This is the gold standard of medical research. It means that researchers took a group of people and randomly gave some of them a therapy (a medication or prescription for a lifestyle change, for example) and gave the others (the control group) a placebo and compared the two results.Placebo. This is a fake treatment. If a controlled study is trying to determine whether a medication works, researchers will give the control group a fake pill so that subjects don?t know if they?re receiving the real thing. This is important because people?s minds can influ...
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Unavoidable Risk Factors For Heart Desease : Age and Family History
2007-10-09 15:40:00
AgeHeart disease becomes more prevalent with age. Simply put, older people have more heart attacks than younger people do. About 80 percent of people who die from heart attacks are over age sixty- five. In America, the risk for heart attack begins to accelerate in men after they reach the age of forty-five and in women after age fifty-five.Family History Coronary artery disease runs in families. While families share genes, they also share lifestyles such as smoking, diet, inactivity, or stress. Which is to blame, genetics or lifestyle? Both.About a dozen genetic abnormalities have been identified that seem to increase the risk for different kinds of heart problems. For instance, defects in nine different genes can cause cardiomyopathy, a form of heart failure in which the heart is unable to pump blood efficiently. In 2002, researchers reported in the journal Circulation that a variant of a gene called the peroxisome proliferator alpha may predispose people to develop a dangerously en...
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Unavoidable Risk Factors For Heart Desease : Gender
2007-10-09 15:33:00
In younger people, gender is a major predictor of risk. Before age sixty, one in five American men?but only one in seventeen women?will have had a coronary event. The naturally produced female hormone, estrogen, may be one of the reasons for this gender difference. But after a woman goes through menopause, this advantage is lost. Beyond age sixty, equality is the rule, and coronary artery disease kills 25 percent of women and men alike. In the United States, heart disease is the leading killer of both women and men.However, there are a few concerns that pertain only to women. First, although the death rate from heart disease has declined for both genders, it is declining in women less rapidly than in men. Currently, 38 percent of women who?ve had heart attacks die within a year, compared with 25 percent of men.Second, most women who die suddenly from coronary artery disease don?t have typical warning symptoms. Some may have had symptoms that they didn?t recognize as signs of heart a...
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Anger: What?s Your Score?
2007-10-08 12:10:00
Several studies have demonstrated that people with a low threshold for anger have a greater probability of high blood pressure and heart disease. When compared with calmer people, these individuals experience rage and fury more often, more intensely, and for longer periods of time.Information from a long-term epidemiological study done at Duke University called Atherosclerosis Risk in Communities (ARIC) offers some perspective on the relative importance of this risk factor. As part of the investigation, subjects were asked to complete the Spielberger State-Trait Anger Expression Inventory, a questionnaire used by psychologists to assess how anger prone a person is. Subjects had to respond to these ten statements by answering:Almost Never 1,Sometimes 2,Often 3,and Almost Always 4.The overall anger score is calculated by adding together the ratings for each statement.? I am quick-tempered.? I have a fiery temper.? I am a hotheaded person.? I get angry when I am slowed down by othe...
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Tobacco Exposure : The Risk Factors For Coronary Artery Disease
2007-10-08 12:02:00
Everyone knows that smoking is a major health hazard: it?s the leading preventable cause of death in the United States. But some people may be surprised to learn that smoking is also the most potent cardiac risk factor, increasing risk by 250 percent. Another surprise: exposure to secondhand smoke is also a major cardiac risk factor, which is why passive smoking is the nation?s thirdleading preventable cause of death. (Alcohol is the second.)In all, smoking accounts for 20 percent of all deaths from coronary artery disease. But within a year of quitting, smokers can cut this risk in half. Within two years, the cardiovascular risk for a former smoker is very close to that of a person who never smoked. Because smoking probably contributes to blood vessel inflammation, removing that irritant should slow the inflammatory process, resulting in a quick drop in heart disease risk.I see a lot of patients who know they should quit smoking, but they?re not sure how. The best approach is two-p...
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If Fish Is Good for Me, Should I Take a Fish Oil Supplement?
2007-10-05 11:24:00
Interest in the heart-healthy benefits of fish oil dates back about two decades, beginning with a 1980 study showing that Eskimos in Greenland?who eat nearly a pound of fish a day?have low rates of mortality from heart disease. In subsequent years, there has been substantial research on the effects of fish oil on the heart and arteries. Laboratory studies have shown that fish oil, which contains what are known as n-3 or omega-3 fatty acids, makes blood platelets less sticky, helps protect the linings of arteries, and may also lower blood pressure.Population studies from several countries have shown lower rates of heart disease in people who eat fish regularly. In 1998, data from the Physicians? Health Study showed that eating fish once a week versus less than once monthly halved the likelihood of dying suddenly from a heart attack. Total heart attack rates (including heart attacks that led to nonsudden death) and total cardiovascular deaths were not affected by fish consumption or t...
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