Saturday, May 3, 2008

Baby Care


Taking Care of Baby
Welcome to parenthood! This area of our site provides information of interest to parents of infants through toddlers. The initial months of the parent/child relationship are extremely important. The topics presented here should not only help you to be an effective parent but a happy one as well.


You and Your Newborn Baby: a guide to the first months after birth

Regardless of whether labor is long or short, whether it is hard or easy whether a baby is born vaginally or by cesarean, most parents recall the first hours and days after birth as crystal-clear images surrounded by haze. It is in this haze that you first take in your baby and make a giant leap from pregnancy to parenting.
Despite all the anticipatory parenting done before conception and during pregnancy, despite weeks of feeling movement within and fantasizing about your baby, despite months of having strange dreams, worrisome thoughts, and musings about what kind of parent you will be, the first time you hold your baby in your arms and call yourself mother or father, mama or papa, mommy or daddy, an awareness floods over you that life will never be the same again. Another human being is now dependent upon you for survival. More than anything else, you want to be the best parent possible.
Your awareness of your baby's dependency and your desire to be a good parent will together be a great source of energy and a great source of stress. Both are part of being a parent.
Becoming a good parent means much more than knowing a lot about babies. Ask pediatric doctors or nurses what it was like for them to be new parents. They will tell you that all their knowledge about babies was not enough to keep them from being over whelmed by their own babies. All new parents feel the same way. All new parents work at knowing, understanding, and loving their babies. Your baby will work just as hard at learning to know, understand, and love you. This is the process of attachment-the work that parents and babies do together to form a deep and lasting love. It is what becoming a family is all about.
This book is written to give you some help as you make the transition from pregnancy to parenting. It offers ideas on things you can do to make this time of change easier. It is written as much to encourage as to teach you. Besides providing the information you need about taking care of yourself and your baby, it can help build your confidence in your own wisdom about your family's needs. You will find the postpartum period easier if you know what to expect during this time, if you actively participate in health-care decisions, and if you build a network of support that nurtures your growing family.
New families in the United States face some challenges that families in most other countries do not. In the United States, where nearly 99 percent of women give birth in hospitals, the average hospital stay after childbirth is two days for a woman who has given birth vaginally, three to four days for a woman who has given birth by cesarean. In many communities, new families are discharged from the hospital within twenty-four hours of birth. Such early discharge will probably become the norm by the year 2000.
In most other countries, both industrialized and developing, the postpartum period is seen as being at least as important as the prenatal period. Because of this, women giving birth in hospitals have longer stays. More importantly, services are brought to the homes of new families. No matter how long the stay in a hospital or birth center, the family's transition to home-and to sole responsibility for the newborn-is overwhelming. in many countries all new families are visited at home by midwives, nurses, or other trained personnel who teach parenting skills, assess the mother's and baby's health, and provide moral support (and sometimes, as in the Netherlands, government-paid helpers do the housekeeping!). In the United States, such services are now provided to only a small minority of women.


Other Changes You May Notice.

The day after birth, you may ache all over from the work you did in labor. Your arms and legs may be sore from pulling back on your legs while pushing out the baby.
Although achy legs are normal, tenderness, pain, or warmth in your calves and swollen or reddened veins are warning signs that you should report to your doctor or midwife immediately. These signs could indicate thrombophlehitis, an inflammation of a vein that can result in formation of a blood clot. Postpartum women are at slightly increased risk of this because the vein walls normally relax somewhat in pregnancy. To reduce the risk of thrombophlebitis, increase circulation in your legs by doing foot rotations (see page 2 1) and by getting up and walking soon after birth. Thrombophlebitis is treated with bed rest, elevation of the affected leg, hot packs, and the use of elastic stockings. Medications may also be needed to prevent infection and clot formation. The affected leg should not be massaged.
Joints that relaxed in pregnancy to allow for the baby's growth and birth will return to their pre-pregnancy condition within several weeks of birth. Many women, however, feel that the rib cage and pelvis remain slightly expanded for the rest of their lives.
Abdominal muscles are relaxed after birth, so the abdomen is soft and still rounded. All women have some degree of separation of the abdominal muscles, which lessens with exercise.
Any stretch marks you have will seem more obvious after birth than before. Although stretch marks never completely disappear, they fade to silvery white lines in the months after childbirth. Darkened areas of the skin, such as the areola and the linea nigra, a dark line from the belly button to pubic bone, may tighten but may not completely fade.
Many women note changes in their hair after birth-most commonly, profuse hair loss. This is because pregnancy hormones stimulate hair growth. With the drop in these hormones, the extra hair that grew in pregnancy will fall out. This begins around three months after birth and usually ends within a couple of months.
Perhaps the most common feeling of new mothers after childbirth is that of being bone-tired. This seems especially true of women who have just had their first babies. Often, fatigue is combined with such excitement in the first days that sleep is difficult. The usual aches and pains of the early postpartum period can make it even harder to sleep. But beyond the first few days after birth, most women find daily naps are essential to their well-being.


Caring for Yourself after a Cesarean.

Each woman recovers in her own unique way after cesarean birth, just as after vaginal birth. Pain medications can help during the first few days (the medications given are considered safe during breastfeeding). The nurses will assist you in getting up the first time, learning to cough or huff to keep your chest clear, dealing with the gas that can follow surgery, and learning to hold your baby in ways that are comfortable for you. If assistance is not available when you need it, press your call button and ask for help.
All new parents can benefit from assistance at home after childbirth, but for a woman who has had a cesarean birth such help is essential for at least the first week. Not only are you undergoing a transformation to a nonpregnant state and learning to care for your new baby, you are recovering from major surgery. Adequate help, allowing you to rest often during the day, can make a great difference in how quickly you feel strong and well. Taking care of yourself and your baby should be your only duties until you feel ready to take on more.

25 Things Every Mother Should Know: How you mother your baby does make a difference

Twenty-eight years ago I (Martha) became a mother for the first time. Even though I had "R.N." after my name I was pretty frightened. All those babies I'd played "Mommy" with in the hospital were other people's babies, not my own. I had to learn how to be a mother to my little Jimmy from scratch. It was intense and personal learning, and I have been privileged to experience it intensely and personally seven more times.
My husband, Bill, learned along with me all the things we discuss in this book for brand-new mothers. My voice, speaking mother-to-mother, will dominate the book, with Bill's interjected here and there to give his perspective as a father and pediatrician.
This is not a traditional baby-care book. You won't find anything in it about diaper rash, cord care, or how to give a bath. You can get that information from a lot of other sources. Instead, this book is a guide to mothering your baby, and it is as much about the process of becoming a mother as it is about babies. It will help you to get to know your baby better, and we hope that it will also help you understand yourself as you take on this new, motherly role.
We believe that babies have a lot to teach mothers. Listening to your baby and responding to his or her cues will lead you into a parenting style that will help both of you thrive. Biology and infant behavior will help you get started and build your confidence as you and your baby develop a two-way trusting relationship. But this is not an ideal world we live in, and there are forces you'll meet along the way that can make you doubt your mothering intuition. We hope that this book will prepare you for some of those bumps in the road, and will help you meet the challenges and changes ahead.
Mothering and fathering eight children has taught us a lot. We are very different persons from the ones we were before we had children, and most, if not all, of these differences are for the better. Although personal growth is sometimes hard, we've had a lot of fun along the way. Fun in your life with your baby is what will convince you and the baby that life is good. Enjoy your baby!
How you mother your baby does make a difference.
Mothering in the twentieth century has become a tricky business. We can take our babies' survival pretty much for granted, and in this way we differ from all the mothers who have come before us. Instead we worry about whether our babies will grow up to be happy and productive, a more complicated issue.
Nobody yet has scientifically tested and perfected a parenting system that guarantees children will turn out okay. Much of the research focuses on what goes wrong, rather than what goes right, and psychologists from Freud onward have often laid the blame on mothers. This creates a lot of anxiety, as mothers struggle to raise psychologically healthy children. Mothers often feel that the stakes are high on everything they do, and the possibility of making serious mistakes makes the job of parenting seem frightening.
In reaction to Freud, there's another school of thought that suggests that mothers aren't all that critical to their children's psyches. Children need dependable caregivers, yes, but these are more or less interchangeable, and group care not only is satisfactory, it also makes children independent at an earlier age. Babies do prefer their parents, but they really don't need all that one-on-one attention that goes along with traditional mothering. It's interesting that these theories have evolved at a time when more and more mothers of young children are in the workforce.
So where do you fit in? How important are you, a responsive, nurturing, trustworthy mother, to your baby's development? How do you know if you're making a difference?
In the parenting business, science often fails us. It's hard to study behavior that is as complicated as mother-and-infant interactions, much less relate these interactions to how children behave and feel years later. "Experts" speculate, spinning advice out of tiny threads of evidence, but who really knows?
I believe that experienced parents--parents of children who are turning out well---have the answers. Bill and I have talked to thousands of wise and seasoned mothers over the years, and while we don't pretend that this is a scientific sample, we do feel confident about relaying what we've learned from all these families. We believe that how you mother your children makes a difference in the kind of people they become.
The mothering advice that we have given in this book reflects a style that we call attachment parenting. For babies, attachment parenting includes closeness right from birth, responding sensitively to cries, baby wearing, sharing sleep, and breastfeeding. The involvement of the father, both directly with the baby and in support of the mother, is also important. These practices together make up a very nurturing style of baby care, one that yields a wonderful sensitivity between mother and child. The mother understands what the baby is thinking, most of the time, and the baby responds well to the mother's care. Babies who experience attachment parenting rarely need to cry to get their needs met (though they may cry plenty when something hurts or bothers them), because they can communicate in other, more subtle ways. Mothers who nurture in this style feel confident that they are doing the right things for their children, because they feel they can perceive their babies' needs, and because their babies are happiest when they are most responsive. Even high-need babies can be mellowed by this style of parenting into children who are fun to be with.
There are long-range benefits to attachment parenting. As a baby cared for this way turns into a toddler, he is easy to manage. His mother has a pretty good idea of what he is trying to do or say, so the young explorer is less likely to get terribly frustrated. Since he trusts his mother and wants very much to stay in her good graces, a word of warning or some creative redirection from her is often all that's needed to head off problem behavior.
As children of attached parents grow older, the benefits continue. These kids internalize their parents' sensitivity toward them. They have an inner sense of what is right and are bothered when situations violate their values. They know themselves well and can remain true to their own character in the midst of a crowd going in another direction. They are compassionate and understanding with other people. Having learned intimacy from their early closeness with their parents, they go on to establish and maintain healthy relationships with other people. They bring their parents joy and pride.
So, are you important to your baby? Yes, you are. You as his mother know him best and are the person he trusts most and will look to for guidance in the months and years to come. You are his window to the world and his faithful interpreter of what is going on inside him. Your relationship is built on a long history of knowing each other, a history that begins even before birth. Because this relationship is grounded in love and trust and many small interactions, it can tolerate mistakes and misunderstandings. No single moment is critically important. What counts is the harmony that is developing between you.
So relax and enjoy your baby. This is a special time in your life, and while it's full of worries and adjustments, it is also full of wonder. You have much to look forward to. Being a mother can enrich every corner of your life. Get ready for a marvelous journey.
When you bring home a new baby, remember you are modeling parenting for your older children. Also, you are bringing up someone else's future husband or wife, father or mother. The parenting styles children learn are the ones they are most likely to follow when they become parents. Here is an example of how modeling affects children: A mother brought her newborn, Erin, and her two-and-a-half-year-old, Tiffany, into my office for checkups. During her examination, Erin began to cry. Tiffany rushed to her mother, pulled at her mother's skirt, and exclaimed, "Mommy, Erin cry; pick up, rock-rock, nurse!" This little child had just described responsive parenting according to her mother's model. When Tiffany becomes a mother and her baby cries, what do you imagine she will do? She won't consult a book or call her doctor. She will intuitively pick up, rock-rock, and nurse.

Friday, April 25, 2008

Hepatitis

Hepatitis:
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids (e.g. from blood transfusions or invasive medical procedures using contaminated equipment). Hepatitis B is also transmitted by sexual contact.
The symptoms of hepatitis include jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
What is hepatitis?
Hepatitis means inflammation of the liver, and the most common cause is infection with one of 5 viruses, called hepatitis A,B,C,D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. It can take several months to a year to feel fit again. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.
Hepatitis E:
Hepatitis is a general term meaning inflammation of the liver. Hepatitis is a disease that can be caused by a variety of different viruses such as hepatitis A, B, C, D and E. Since the development of jaundice is a characteristic feature of liver disease, a correct diagnosis can only be made by testing patients' sera for the presence of specific viral antigens and/or anti-viral antibodies.
Hepatitis E (HEV) was not recognized as a distinct human disease until 1980. Hepatitis E is caused by infection with the hepatitis E virus, a non-enveloped, positive-sense, single-stranded RNA virus.
Although man is considered the natural host for HEV, antibodies to HEV or closely related viruses have been detected in primates and several other animal species
How is HEV transmitted?
HEV is transmitted via the faecal-oral route. Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. Consumption of faecally contaminated drinking water has given rise to epidemics, and the ingestion of raw or uncooked shellfish has been the source of sporadic cases in endemic areas. There is a possibility of zoonotic spread of the virus, since several non-human primates, pigs, cows, sheep, goats and rodents are susceptible to infection. The risk factors for HEV infection are related poor sanitation in large areas of the world, and HEV shedding in faeces.
Person-to-person transmission is uncommon. There is no evidence for sexual transmission or for transmission by transfusion
.
Where is HEV a problem?
The highest rates of infection occur in regions where low standards of sanitation promote the transmission of the virus. Epidemics of hepatitis E have been reported in Central and South-East Asia, North and West Africa, and in Mexico, especially where faecal contamination of drinking water is common. However, sporadic cases of hepatitis E have also been reported elsewhere and serological surveys suggest a global distribution of strains of hepatitis E of low pathogenicity.
When is a HEV infection life-threatening?
In general, hepatitis E is a self-limiting viral infection followed by recovery. Prolonged viraemia or faecal shedding are unusual and chronic infection does not occur.
Occasionally, a fulminant form of hepatitis develops, with overall patient population mortality rates ranging between 0.5% - 4.0%. Fulminate hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20% among pregnant women in the 3rd trimester.
The disease!
The incubation period following exposure to HEV ranges from 3 to 8 weeks, with a mean of 40 days. The period of communicability is unknown. There are no chronic infections reported.
Hepatitis E virus causes acute sporadic and epidemic viral hepatitis. Symptomatic HEV infection is most common in young adults aged 15-40 years. Although HEV infection is frequent in children, it is mostly asymptomatic or causes a very mild illness without jaundice (anicteric) that goes undiagnosed.
Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting, and fever, although the disease may range in severity from subclinical to fulminant.
Diagnosis!
Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available.
Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.
Surveillance and control:
Surveillance and control procedures should include


1 provision of safe drinking water and proper disposal of sanitary waste
2 monitoring disease incidence
3 determination of source of infection and mode of transmission by epidemiologic investigation
4 detection of outbreaks
5 spread containment

Treatment:

Hepatitis E is a viral disease, and as such, antibiotics are of no value in the treatment of the infection. There is no hyperimmune E globulin available for pre- or post-exposure prophylaxis. HEV infections are usually self-limited, and hospitalization is generally not required. No available therapy is capable of altering the course of acute infection.
As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease. Hospitalization is required for fulminant hepatitis and should be considered for infected pregnant women.

Hepatitis B:

Hepatitis B is one of the major diseases of mankind and is a serious global public health problem. It is preventable with safe and effective vaccines that have been available since 1982. Of the 2 billion people who have been infected with the hepatitis B virus (HBV), more than 350 million have chronic (lifelong) infections. These chronically infected persons are at high risk of death from cirrhosis of the liver and liver cancer, diseases that kill about one million persons each year. Although the vaccine will not cure chronic hepatitis, it is 95% effective in preventing chronic infections from developing, and is the first vaccine against a major human cancer. In 1991, the World Health Organization (WHO) called for all children to receive the hepatitis B vaccine, and 116 countries have added this vaccine to their routine immunization programmes. However, the children in the poorest countries, who need the vaccine the most, have not been receiving it because their governments cannot afford it. Fortunately, hepatitis B vaccine will soon be available in these countries with the assistance of the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund for Children's Vaccines.

Who gets hepatitis B?

In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. In these regions liver cancer caused by HBV figures among the first three causes death by cancer in men.
High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected. Infection is less common in Western Europe and North America, where less than 1% are chronically infected.
Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.

How do people get infected ?

Hepatitis B virus is transmitted by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, HBV is 50 to 100 times more infectious than HIV.
The main ways of getting infected with HBV are:


1: Perinatal (from mother to baby at the birth)
2: Child-to-child transmission
3: Unsafe injections and transfusions
4: Sexual contact

Hepatitis C:

The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with the hepatitis C virus can lead to chronic liver disease and is the leading reason for liver transplant in the United States.

The hepatitis C virus can be spread by:

1: sharing drug needles
2: getting a tattoo or body piercing with unsterilized tools
3: blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
4: transmission from mother to newborn
5: sexual contact (although this is less common)

Diagnosis:

All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms:

Hepatitis, in its early stages, may cause flu-like symptoms, including:

1: malaise (a general ill feeling)
2: fever
3: muscle aches
4: loss of appetite
5: nausea
6: vomiting
7: diarrhea
8: jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.
If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

Wednesday, April 16, 2008

Breast Cancer


How Breast Cancer Happens

Breast profile:

A Ducts

B Lobules

C Dilated section of duct to hold milk

D Nipple

E Fat

F Pectoralis major muscle

G Chest wall/rib cage

Enlargement

A Normal duct cells

B Basement membrane

C Lumen (center of duct)

The breast is a gland designed to make milk. The lobules in the breast make the milk, which then drains through the ducts to the nipple.
Like all parts of your body, the cells in your breasts usually grow and then rest in cycles. The periods of growth and rest in each cell are controlled by genes in the cell's nucleus. The nucleus is like the control room of each cell. When your genes are in good working order, they keep cell growth under control. But when your genes develop an abnormality, they sometimes lose their ability to control the cycle of cell growth and rest.

Breast cancer is an uncontrolled growth of breast cells.

Cancer has the potential to break through normal breast tissue barriers and spread to other parts of the body. While cancer is always caused by a genetic "abnormality" (a "mistake" in the genetic material), only 5–10% of cancers are inherited from your mother or father. Instead, 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and life in general.
While there are things every woman can do to help her body stay as healthy as possible (such as eating a balanced diet, not smoking, minimizing stress, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is counterproductive.

Who Gets Breast Cancer?

Breast cancer is the most common cancer to affect women. In 2007, it is estimated that there will be about 178,480 new cases of invasive breast cancer diagnosed in the United States, along with 62,030 new cases of non-invasive breast cancer.
Every woman is at SOME risk for breast cancer—this is merely the "risk" of living as a woman. But there are many risk factors that can make one woman's picture differ substantially from another's. When you understand your own particular risk profile, you are in a better position to manage it and don't have to fear the unknown.
The medical experts for Who Gets Breast Cancer? are:
Carol Cherry, R.N., O.C.N., oncology nurse, Fox Chase Cancer Center, Pennsylvania
Marisa C. Weiss, M.D., breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, Pennsylvania

Individual Risk Factors

Growing older is the biggest risk for breast cancer. The longer you live, the higher your risk:
From birth to age 39, 1 woman in 231 will get breast cancer (<0.5% risk).
From ages 40–59, the chance is 1 in 25 (4% risk).
From ages 60–79, the chance is 1 in 15 (nearly 7%).
The risk of getting breast cancer over the course of an entire lifetime, assuming you live to age 90, is one in 7, with an overall lifetime risk of 14.3%.
Risk increases with age because the wear and tear of living increases the risk that a genetic abnormality, or "mistake," will develop that your body doesn't find and fix.
Personal history of breast cancer is a risk factor for breast cancer recurrence or the formation of a new breast cancer. In other words, if you have already been diagnosed with breast cancer, your risk of developing it again is higher than if you had never had the disease. The risk is about 1% per year, so that over a 10-year period, your risk would be about 10%. However, there is medication available to help you reduce that risk.
Family history of breast cancer can have a significant impact on your risk, but don't automatically assume that any case of breast cancer in your family means you are a high-risk candidate. For example, if your grandmother was diagnosed with breast cancer at age 75, this does NOT mean your risk of the disease is increased. Your grandmother was most likely just one of the 1 in 15 women in that age bracket who gets breast cancer from the wear and tear of aging.
Other patterns of family history may strongly suggest an inherited gene abnormality that is independent of normal aging, and is associated with a relatively higher risk of breast cancer. The following signs suggest that there may be an inherited gene abnormality in your family (These apply to either your mother's OR your father's side of the family):
having a mother, sister, or daughter with breast cancer
having multiple generations of family members affected by breast or ovarian cancer
having relatives who were diagnosed with breast cancer at a young age (under 50 years old)
having relatives who had both breasts affected by cancer
You can inherit a breast cancer gene abnormality from your mother OR your father. If one of your parents has a gene abnormality, you have a 50% risk of inheriting the gene from him or her. If you do inherit a gene abnormality, your risk of developing the disease depends on the specific abnormality found, the pattern of its behavior in your family, plus the uniqueness of your own body. The risk of breast cancer in these families ranges greatly—from 40–80% over the course of a lifetime. Keep in mind that breast cancer caused by an inherited gene abnormality is not necessarily any more severe or less treatable than other types of breast cancer.
Certain types of breast cancer gene abnormalities are also associated with a higher risk of ovarian cancer (from 20–60%).
Genetic counseling can help you better define and understand the significance of your own family history.

Prolonged Estrogen Exposure

Prolonged, uninterrupted exposure to estrogen can increase breast cancer risk. Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. This includes estrogen that your own body produces normally, as well as estrogen you might take as a pill (for example, menopause hormone therapy). The following risk factors for breast cancer are related to prolonged exposure to estrogen without any breaks or interruptions:
starting menstruation at a young age (more years of the body producing estrogen)
going through menopause at a late age (more years of the body producing estrogen)
taking menopause hormone replacement therapy for over five years with estrogen alone, or with estrogen and progesterone (risk increases by 5–40%, but most breast cancers that are diagnosed in women on hormone therapy tend to be very early stage and very treatable)
never having had a full-term pregnancy
having a first full-term pregnancy after age 30 (more years of the body producing estrogen without the break from regular cycles)
being overweight, which increases the production of estrogen outside the ovaries and adds to the overall level of estrogen in the body
exposure to estrogens in the environment (such as estrogen fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which mimic the effects of estrogen in the body)
having more than two alcoholic drinks per week, which can limit your liver's ability to regulate blood estrogen levels.

Breast Cellular Changes

Breast cellular changes may be associated with an increased risk of breast cancer. These are found when a breast biopsy (tissue sample) is taken and the breast cells are examined under a microscope. Two cellular changes associated with breast cancer risk are:
atypical ductal hyperplasia—an overactive growth of cells lining the breast ducts
lobular carcinoma in situ—an uncontrolled growth of lobular cells, the cells that make breast milk

Smoking, Diet, and Stress

Smoking is associated with a small increase in breast cancer risk.
Diet plays an important role in your level of risk for breast cancer. Some say that 30% of all cancers can be attributed to an inadequate or unhealthy diet. Many strong opinions have been expressed on this subject, and books claiming to have "the answer" have been on the bestseller list.
The truth is, we don't yet know the answers. Several large medical studies have not been able to demonstrate a clear connection between eating high-fat foods and having a higher risk of breast cancer. Ongoing studies are attempting to clarify this issue further. We CAN say that avoiding high-fat foods is a healthy choice for many reasons: It lowers the "bad" cholesterol (low-density lipoproteins) and increases the "good" cholesterol (high-density lipoproteins); it makes more room in your diet for healthier foods; and it helps keep your weight at a healthier level. Being overweight IS a known factor for an increased risk of breast cancer.
Stress has not been clearly associated with increased breast cancer risk. But you can say with confidence that stress stinks. It's not good for your overall health and well-being.

Friday, April 11, 2008

Medical sonography


Medical sonography (ultrasonography)


is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, their size, structure and any pathological lesions with real time tomographic images. It is also used to visualize a fetus during routine and emergency prenatal care. Ultrasound scans are performed by medical health care professionals called sonographers. Obstetric sonography is commonly used during pregnancy. Ultrasound has been used to image the human body for at least 50 years. It is one of the most widely used diagnostic tools in modern medicine. The technology is relatively inexpensive and portable, especially when compared with modalities such as magnetic resonance imaging (MRI) and computed tomography (CT). As currently applied in the medical environment, ultrasound poses no known risks to the patient.[5] Sonography is generally described as a "safe test" because it does not use ionizing radiation, which imposes hazards, such as cancer production and chromosome breakage. However, ultrasonic energy has two potential physiological effects: it enhances inflammatory response; and it can heat soft tissue.[6] Ultrasound energy produces a mechanical pressure wave through soft tissue. This pressure wave may cause microscopic bubbles in living tissues, and distortion of the cell membrane, influencing ion fluxes and intracellular activity. When ultrasound enters the body, it causes molecular friction and heats the tissues slightly. This effect is very minor as normal tissue perfusion dissipates heat. With high intensity, it can also cause small pockets of gas in body fluids or tissues to expand and contract/collapse in a phenomenon called cavitation (this is not known to occur at diagnostic power levels used by modern diagnostic ultrasound units). The long-term effects of tissue heating and cavitation are not known.[7] There are several studies that indicate the harmful side effects on animal fetuses associated with the use of sonography on pregnant mammals. A noteworthy study in 2006 suggests exposure to ultrasound can affect fetal brain development in mice. This misplacement of brain cells during their development is linked to disorders ranging "from mental retardation and childhood epilepsy to developmental dyslexia, autism spectrum disorders and schizophrenia, the researchers said. However, this effect was only detectable after 30 minutes of continuous scanning. [8] A typical fetal scan, including evaluation for fetal malformations, typically takes 10-30 minutes.[9] There is no link made yet between the test results on animals, such as mice, and the possible outcome to humans. Widespread clinical use of diagnostic ultrasound testing on humans has not been done for ethical reasons. The possibility exists that biological effects may be identified in the future, currently most doctors feel that based on available information the benefits to patients outweigh the risks.[10] Obstetric ultrasound can be used to identify many conditions that would be harmful to the mother and the baby. For this reason many health care professionals consider that the risk of leaving these conditions undiagnosed is much greater than the very small risk, if any, associated with undergoing the scan. According to Cochrane review, routine ultrasound in early pregnancy (less than 24 weeks) appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible.[11]
Sonography is used routinely in obstetric appointments during pregnancy, but the FDA discourages its use for non-medical purposes such as fetal keepsake videos and photos, even though it is the same technology used in hospitals.

HIV/AIDS & STDs

HIV/AIDS & STDs



Testing and treatment of sexually transmitted diseases (STDs) can be an effective tool in preventing the spread of HIV, the virus that causes AIDS. An understanding of the relationship between STDs and HIV infection can help in the development of effective HIV prevention programs for persons with high-risk sexual behaviors.
Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.Testing and treatment of sexually transmitted diseases (STDs) can be an effective tool in preventing the spread of HIV, the virus that causes AIDS. An understanding of the relationship between STDs and HIV infection can help in the development of effective HIV prevention programs for persons with high-risk sexual behaviors.



What is the link between STDs and HIV infection?



Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons (Wasserheit, 1992).
There is substantial biological evidence demonstrating that the presence of other STDs increases the likelihood of both transmitting and acquiring HIV.




Increased susceptibility:STDs appear to increase susceptibility to HIV infection by two mechanisms. Genital ulcers (e.g., syphilis, herpes, or chancroid) result in breaks in the genital tract lining or skin. These breaks create a portal of entry for HIV. Additionally, inflammation resulting from genital ulcers or non-ulcerative STDs (e.g., chlamydia, gonorrhea, and trichomoniasis) increase the concentration of cells in genital secretions that can serve as targets for HIV (e.g., CD4+ cells).



Increased infectiousness:STDs also appear to increase the risk of an HIV-infected person transmitting the virus to his or her sex partners. Studies have shown that HIV-infected individuals who are also infected with other STDs are particularly likely to shed HIV in their genital secretions. For example, men who are infected with both gonorrhea and HIV are more than twice as likely to have HIV in their genital secretions than are those who are infected only with HIV. Moreover, the median concentration of HIV in semen is as much as 10 times higher in men who are infected with both gonorrhea and HIV than in men infected only with HIV. The higher the concentration of HIV in semen or genital fluids, the more likely it is that HIV will be transmitted to a sex partner.



How can STD treatment slow the spread of HIV infection?



Evidence from intervention studies indicates that detecting and treating STDs may reduce HIV transmission.
STD treatment reduces an individual's ability to transmit HIV. Studies have shown that treating STDs in HIV-infected individuals decreases both the amount of HIV in genital secretions and how frequently HIV is found in those secretions (Fleming, Wasserheit, 1999).
Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious. It is critical that all individuals, especially those with herpes, know whether they are infected with HIV and, if uninfected with HIV, take measures to protect themselves from infection with HIV.
Among individuals with both herpes and HIV, trials are underway studying if treatment of the genital herpes helps prevent HIV transmission to partners.



What are the implications for HIV prevention?



Strong STD prevention, testing, and treatment can play a vital role in comprehensive programs to prevent sexual transmission of HIV. Furthermore, STD trends can offer important insights into where the HIV epidemic may grow, making STD surveillance data helpful in forecasting where HIV rates are likely to increase. Better linkages are needed between HIV and STD prevention efforts nationwide in order to control both epidemics.
In the context of persistently high prevalence of STDs in many parts of the United States and with emerging evidence that the U.S. HIV epidemic increasingly is affecting populations with the highest rates of curable STDs, the CDC/HRSA Advisory Committee on HIV/AIDS and STD Prevention (CHAC) recommended the following:
Early detection and treatment of curable STDs should become a major, explicit component of comprehensive HIV prevention programs at national, state, and local levels;
In areas where STDs that facilitate HIV transmission are prevalent, screening and treatment programs should be expanded;
HIV testing should always be recommended for individuals who are diagnosed with or suspected to have an STD.
HIV and STD prevention programs in the United States, together with private and public sector partners, should take joint responsibility for implementing these strategies.
CHAC also notes that early detection and treatment of STDs should be only one component of a comprehensive HIV prevention program, which also must include a range of social, behavioral, and biomedical interventions.

Thursday, March 6, 2008

madisancompaness

Disease Prevention for Teens

The teen years are a time of growth that involves experimentation and risk taking. For some teens, the social pressures of trying to fit in can be too much. These years can be even more troubling for teens who are confronted with teenage pregnancy, substance abuse, violence, delinquency, suicide, depression, unintentional injuries and school failure. Parents often walk a tightrope between allowing their teenager to gain some independence and helping them to deal with their feelings during this difficult and challenging time in their lives.
Teenagers recognize that they are developmentally between child and adult. Emerging cognitive abilities and social experiences lead teens to question adult values and experiment with health-risk behaviors. Some behaviors threaten current health, while other behaviors may have long-term health consequences. The changes in cognitive abilities offer an opportunity to help teenagers develop attitudes and lifestyles that can enhance their health and well-being. Teen disease prevention includes maintaining a healthy diet, exercising regularly, preventing injuries, and screening annually for potential health conditions that could adversely affect teenage health.

Immunizations


Teens should receive a trivalent Tdap vaccine booster at the 11–12 year visit if not previously vaccinated within five years. With the exception of the Tdap booster at 11–12 years, routine boosters should be administered every 10 years.
Teenagers should receive a second dose of MMR at 11–12 years of age, unless there is documentation of two vaccinations earlier during childhood. The first vaccination is generally given at 1 year of age. MMR should not be administered to pregnant teens.
Teens, 11–12 years of age, who have not received their second Varivax vaccination as part of a routine childhood schedule and who do not have a reliable history of chickenpox should receive this booster vaccination. The first dose is generally given at 1 year of age.
Most infants complete their immunization series against hepatitis B by their first birthday. If not completed, this should be accomplished by teens 11–12 years of age. Hepatitis A should be given to teens who are traveling or living in countries with high or intermediate hepatitis A virus (HAV), live in communities with high rates of HAV, have chronic liver disease, are injecting drug users, or are males who have sex with males. Complete immunization requires two vaccinations separated by a minimum of six months.
Meningococcal vaccine—All teens 11–12 years of age should receive a onetime only vaccination to prevent meningococcal diseases (meningitis, general body sepsis, etc). Of note, this has become a mandatory vaccination for college.
Female teens should be immunized against human papillomavirus (HPV). HPV is the leading cause of cervical cancer and genital warts. Three vaccinations over a six-month period are necessary for maximum protection.
Annual vaccination against influenza is recommended for all teens.

What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) are infections that can be transferred from one person to another through any type of sexual contact. STDs are sometimes referred to as sexually transmitted infections (STIs) since they involve the transmission of a disease-causing organism from one person to another during sexual activity. It is important to realize that sexual contact includes more than just sexual intercourse (vaginal and anal). Sexual contact includes kissing, oral-genital contact, and the use of sexual "toys," such as vibrators. STDs probably have been around for thousands of years, but the most dangerous of these conditions, the acquired immunodeficiency syndrome (AIDS), has only been recognized since 1984.
Many STDs are treatable, but effective cures are lacking for others, such as HIV, HPV, and hepatitis B and C. Even gonorrhea, once easily cured, has become resistant to many of the older traditional antibiotics. Many STDs can be present in, and spread by, people who do not have any symptoms of the condition and have not yet been diagnosed with an STD. Therefore, public awareness and education about these infections and the methods of preventing them is important.
There really is no such thing as "safe" sex. The only truly effective way to prevent STDs is abstinence. Sex in the context of a monogamous relationship wherein neither party is infected with a STD also is considered "safe." Most people think that kissing is a safe activity. Unfortunately, syphilis, herpes, and other infections can be contracted through this relatively simple and apparently harmless act. All other forms of sexual contact carry some risk. Condoms are commonly thought to protect against STDs. Condoms are useful in decreasing the spread of certain infections, such as chlamydia and gonorrhea; however, they do not fully protect against other infections such as genital herpes, genital warts, syphilis, and AIDS. Prevention of the spread of STDs is dependent upon the counseling of at-risk individuals and the early diagnosis and treatment of infections.

What is gonorrhea?

Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrheae that is transmitted by sexual contact. Gonorrhea is one of the oldest known sexually transmitted diseases. It is estimated that over one million women are currently infected with gonorrhea. Among women who are infected, 25-40% also will be infected with chlamydia, another type of bacteria that causes another STD. (Chlamydia infection is discussed later in this article.)
Contrary to popular belief, gonorrhea cannot be transmitted from toilet seats or door handles. The bacterium that causes gonorrhea requires very specific conditions for growth and reproduction. It cannot live outside the body for more than a few seconds or minutes, nor can it live on the skin of the hands, arms, or legs. It survives only on moist surfaces within the body and is found most commonly in the vagina, and, more commonly, the cervix. (The cervix is the end of the uterus that protrudes into the vagina.) It can also live in the tube (urethra) through which urine drains from the bladder. Gonorrhea can even exist in the back of the throat (from oral-genital contact) and in the rectum.

Treatment of gonorrhea

In the past, the treatment of uncomplicated gonorrhea was fairly simple. A single injection of penicillin cured almost every infected person. Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillin, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications. Gonorrheal infections that infect the cervix, rectum, urethra, or throat are usually treated with one 400 mg oral dose of cefixime or an intramuscular injection of 125 mg of ceftriaxone. Alternative antibiotic regimens include: cefpodoxime, one 400 mg oral dose; ciprofloxacin, one 500 mg oral dose; ofloxacin, one 400 mg oral dose; levofloxacin, one oral 250 mg dose; and levofloxacin, one 250 mg oral dose. An intramuscular injection of 2 g of spectinomycin is also an alternative treatment in nonpregnant patients, but this treatment is not effective for throat infections caused by gonorrhea.
Because some developing bacterial strains are resistant to certain antibiotics, ceftriaxone is the recommended treatment for all patients in Hawaii and California and for persons who acquired the infection in certain parts of the world. Treatment should always include medication that will treat chlamydia (such as azithromycin or doxycycline) as well as gonorrhea, because gonorrhea and chlamydia commonly exist together in the same person. The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their partners may be infected as well. Treating the partners also prevents reinfection of the woman.
Women suffering from PID require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require intravenous administration of antibiotics. Recommended treatment regimens for PID include.

madisancompaness



Disease Prevention for Teens




The teen years are a time of growth that involves experimentation and risk taking. For some teens, the social pressures of trying to fit in can be too much. These years can be even more troubling for teens who are confronted with teenage pregnancy, substance abuse, violence, delinquency, suicide, depression, unintentional injuries and school failure. Parents often walk a tightrope between allowing their teenager to gain some independence and helping them to deal with their feelings during this difficult and challenging time in their lives.
Teenagers recognize that they are developmentally between child and adult. Emerging cognitive abilities and social experiences lead teens to question adult values and experiment with health-risk behaviors. Some behaviors threaten current health, while other behaviors may have long-term health consequences. The changes in cognitive abilities offer an opportunity to help teenagers develop attitudes and lifestyles that can enhance their health and well-being. Teen disease prevention includes maintaining a healthy diet, exercising regularly, preventing injuries, and screening annually for potential health conditions that could adversely affect teenage health.




Immunizations





Teens should receive a trivalent Tdap vaccine booster at the 11–12 year visit if not previously vaccinated within five years. With the exception of the Tdap booster at 11–12 years, routine boosters should be administered every 10 years.
Teenagers should receive a second dose of MMR at 11–12 years of age, unless there is documentation of two vaccinations earlier during childhood. The first vaccination is generally given at 1 year of age. MMR should not be administered to pregnant teens.
Teens, 11–12 years of age, who have not received their second Varivax vaccination as part of a routine childhood schedule and who do not have a reliable history of chickenpox should receive this booster vaccination. The first dose is generally given at 1 year of age.
Most infants complete their immunization series against hepatitis B by their first birthday. If not completed, this should be accomplished by teens 11–12 years of age. Hepatitis A should be given to teens who are traveling or living in countries with high or intermediate hepatitis A virus (HAV), live in communities with high rates of HAV, have chronic liver disease, are injecting drug users, or are males who have sex with males. Complete immunization requires two vaccinations separated by a minimum of six months.
Meningococcal vaccine—All teens 11–12 years of age should receive a onetime only vaccination to prevent meningococcal diseases (meningitis, general body sepsis, etc). Of note, this has become a mandatory vaccination for college.
Female teens should be immunized against human papillomavirus (HPV). HPV is the leading cause of cervical cancer and genital warts. Three vaccinations over a six-month period are necessary for maximum protection.
Annual vaccination against influenza is recommended for all teens.