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Category Archives: Health

Head Injuries Carry Long Term Death Risk

The risk of death after head injury remained significantly increased for as long as 13 years, irrespective of the severity of the injury, results of a case-control study showed.

Overall, patients with a history of head injury had more than a twofold greater risk of death than did two control groups of individuals without head injury.

Among young adults, the risk disparity ballooned to more than a fivefold difference, Scottish investigators reported online in the Journal of Neurology, Neurosurgery and Psychiatry.

“More than 40% of young people and adults admitted to hospital in Glasgow after a head injury were dead 13 years later,” Dr. Thomas M. McMillan, of the University of Glasgow, and coauthors wrote in the discussion of their findings. “This stark finding is not explained by age, gender, or deprivation characteristics.”

“As might be expected following an injury, the highest rate of death occurred in the first year after head injury,” they continued. “However, risk of death remained high for at least a further 12 years when, for example, death was 2.8 times more likely after head injury than for community controls.”

Previous studies of mortality after head injury have focused primarily on early death, either during hospitalization or in the first year after the injury. Whether the excess mortality risk persists over time has remained unclear, the authors noted.

Few studies have compared mortality after head injury with expected mortality in the community. To provide that missing context, McMillan and coauthors conducted a case-control study involving 757 patients who incurred head injuries of varying severity from February 1995 to February 1996 and were admitted to a Glasgow-area hospital.

For comparison, the investigators assembled two control groups, both matched with the cases for age, sex, and socioeconomic status and one matched for duration of hospitalization after injury not involving the head.

One control group was comprised of persons hospitalized for other injured and other comparison group included healthy non-hospitalized adults.

The cases comprised 602 men and 155 women who had a mean age of 43, and almost 70 percent were in the lowest socioeconomic quintile.

At the end of follow-up, 305 of the head-injured patients had died, compared with 215 of the hospitalized control group, and 135 of healthy, non-hospitalized adults.

Mortality after one year remained significantly higher in the head-injury group—34 percent versus 24 percent among the hospitalized comparison group and 16 percent for the healthy non-hospitalized adults.

Overall, the head-injury group had a death rate of 30.99/1,000/ year versus 13.72/1,000/year in the community controls and 21.85/1,000/year in the hospitalized-other injury control group.

The disparity was greater among younger adults (15 to 54), who had a rate of 17.36/1,000/year versus 2.21/1,000/year in the community controls. Older adults in the head injury group had a death rate of 61.47/1,000/year compared with 39.45/1,000/year in the community controls.

“Demographic factors do not explain the risk of death late after head injury, and there is a need to further consider factors that might lead to health vulnerability after head injury and in this way explain the range of causes of death,” the authors wrote in conclusion. “The elevated risk of mortality after mild head injury and in younger adults makes further study in this area a priority.”

Facebook Effect For Your Health

Is it us, or are news headlines about Facebook’s impact on our health popping up more and more these days? Considering that 51 percent of Americans over age 12 now have profiles on the social networking site compared to 8 percent just three years ago, according to new data from Edison Research, it’s no wonder there are entire scientific journals devoted to the psychology of social networking, and piles of studies analyzing such sites’ effects on our moods, body image, friendships, and marriages.

Negative conditions such as “Facebook depression” or Facebook-fueled divorces bear the brunt of the media blitz, but much of the body of research actually points to positive perks from Facebook use. Here, a deeper look at how all those “likes,” “pokes,” and status updates are really affecting you and your family’s well-being, and how you can outsmart some of the potentially negative side effects.

Health Benefits of Facebook

Research shows that Facebook can:

  1. Fuel self-esteem. In a Cornell University study, students felt better about themselves after they updated their Facebook profiles; a control group of students who didn’t log onto the site didn’t experience such a mood lift. The very act of posting something about yourself — regardless of what you write — can boost your self-confidence because you control the image you present to your network of friends, according to researchers.Similarly, according to a Michigan State University study, students with low self-esteem and happiness levels who used Facebook more frequently felt more connected to friends and campus life than those who logged on less often.
  2. Strengthen friendship bonds. In a small study of heavy Facebook-using young British adults between ages 21 and 29, Lancaster University researchers found that the site helped cement positive interactions among friends. Both private messages and wall posts allowed Facebook users to confide in their friends, surf down memory lane, and laugh out loud, promoting happy feelings.
  3. Stamp out shyness and loneliness. In a soon-to-be-published Carnegie Mellon study, researchers who surveyed more than 1,100 avid Facebook-using adults found that receiving messages from friends and consuming info from friends’ news feeds boosted feelings of connectedness, especially in people with self-described “low social skills.” Authors say that for shy people, gleaning information from news feeds and profiles can help start conversations they otherwise might not be comfortable enough to strike up. “People who are uncomfortable chatting face to face gain more through their use of the site,” says study co-author Moira Burke, a PhD candidate in the university’s Human-Computer Interaction Institute.Similar benefits hold true for tweens and teens: Australian researchers who studied more than 600 students between age 10 and 16 found that communicating online helped improve communication skills for lonely adolescents, giving them an outlet to talk more comfortably about personal topics.

Health Risks of Facebook

Research also shows that Facebook can:

  1. Cause depression. A recently published American Academy of Pediatrics (AAP) paper made a major splash when it described Facebook depression — a condition said to result when tweens and teens spend too much time on social media, leading them to turn to “substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors.”However, the phenomenon is more anecdotal than based on solid science, and some experts suggest that it’s more of a correlation — that people who are depressed may simply be more likely to use Facebook. “People who are already feeling down or depressed might go online to talk to their friends, and try and be cheered up,” wrote John M. Grohol, PsyD, founder and editor-in-chief of PsychCentral.com on his blog. “This in no way suggests that by using more and more of Facebook, a person is going to get more depressed.”

    In one of the papers cited by the AAP report, researchers found that the more time first-time Internet users spent online, the more likely they were to experience loneliness and depression but a follow-up study showed such effects disappeared a year later, according to Dr. Grohol. “It may simply be something related to greater familiarity with the Internet,” he wrote. In another paper referenced by the AAP report, the depression-Facebook link only held true among people with “low-quality” friendships; people with good pals did not experience depression with increasing Facebook use.

  2. Trigger eating disorders. The more time adolescent girls spent on the social networking site, the more likely they were to develop eating disorders such as anorexia, bulimia, and extreme dieting, Israeli researchers recently found. Exposure to online fashion and music content, as well as watching TV shows like Gossip Girl, were also associated with an increased risk for eating disorders.But researchers aren’t saying that social networking sites necessarily cause eating disorders; as with Facebook depression, it may be that people prone to eating disorders spend more time online. What’s more, the researchers found that parents can help protect their daughters from harmful effects of media: The children of parents who were aware of what their daughters were viewing online — and talked to them about what they saw and how much time they spent — were less prone to develop eating disorders, according to study authors.
  3. Split up marriages. Facebook was referenced in 20 percent of divorce petitions processed in 2009 by Divorce-Online, a British law firm. Time magazine reported that feuding spouses use their Facebook pages to air dirty laundry, while their lawyers use posts as evidence in divorce proceedings. Sexual health expert Ian Kerner, PhD, recently blogged on CNN that he’s seen many relationships destroyed by “Facebook bombs” — people reconnecting with high school sweethearts or other blasts from the past that can lead to emotional, if not actual, cheating.

    “The mistake I often see is when someone gets friended or messaged by an ex and doesn’t tell their partner,” Kerner told Everyday Health. “It’s a slippery slope from the moment you don’t disclose information.”

    He warns that it’s easy to over-romanticize the past, which can cause people to check out of their current relationship. Kerner advises couples to not keep secrets about whom they’re chatting with on Facebook. And while the site certainly makes it easy to reconnect with old flames and flirt behind the façade of your computer, the potential damage it can do depends on the stability of your relationship in the first place. “It all depends on your level of trust in your spouse,” says Kerner. “Have a dialogue, set some rules. The key is transparency.”

8 Simple Tips to Cut Your Cell Phone Cancer Risk

Does the World Health Organization’s statement that cell phones may cause cancerhave you thinking twice about making that phone call?

Of course it’s alarming to think that something that’s become such a can’t-live-without can be linked to brain cancer, but there’s a lot even the most cell phone-addicted people can do to minimize health risks.

Any potential links to cancer stem from the low levels of radiation cell phones emit. Lower your exposure to the radiation, and you’ll reduce the potential links to cancer or other health problems:

  1. Use a headset. Sounds obvious, but headsets emit much less radiation than cell phones do, according to the Environmental Working Group (EWG), and they keep your cell phone away from your head. The farther away you are from a source of radiation, the less damage it can do.
  2. Text when you can. Your constantly texting teens are onto something: Cell phones use less energy (and emit less radiation) when you text than when you talk, says the EWG. Texting also keeps the radiation source farther away from your brain.
  3. Use cell phones for FYI-only calls. Don’t use your cell phone for that long overdue, hour-long catch-up with your sister. Keep calls as short as possible —Do you need me to get the dry cleaning, honey? — and switch to a landline if they’re veering off into chitchat territory.
  4. Watch the bars. Can you hear me now? If you’re struggling to maintain a connection, ditch the call and wait until you have better service. When your phone has fewer signal bars, it has to work harder (and, therefore, emit more radiation) to connect.
  5. Keep the phone away from your ear when you can. EMF-Health.comrecommends waiting for the call to connect before you bring the phone to your ear, which minimizes radiation exposure. And when you talk, tilt the phone away from your ear and bring it in close when you’re listening. That’s because the radiation levels are “significantly less when a cell phone is receiving signals than when it is transmitting,” Lin Zhong, assistant professor of electrical and computer engineering at Rice University in Houston, told The New York Times.
  6. Don’t make calls in elevators or cars. You already it’s dangerous to talk and drive; EMF-Health.com says that cell phones use more power to establish a connection in enclosed metal spaces like cars and elevators.
  7. Make sure your kids use the landline. It seems like even toddlers are using cell phones today, but experts say kids are the most vulnerable to potential radiation dangers. The EWG says children’s brains absorb twice as much cell phone radiation as adults. According to The New York Times, health authorities in Britain, France, Germany, and Russia all have warnings against letting children use cell phones.
  8. Buy a low-radiation phone. Some cell phones emit more radiation than others; if you’re in the market for a new phone, EMF-Health.com recommends that you consider the phone’s SAR (specific absorption rate), a way of measuring the radiation absorbed by the body. It’s usually listed in the phone’s instruction manual. You can also look at the EWG’s report of cell phone SARs here — from the LG Quantum’s 0.35 W/kg on the low end to the Motorala Bravo’s 1.59 W/kg on the high end.

Exercise and Talk Help Ease Chronic Fatigue Syndrome

Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling— improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.

Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.

Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.

In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.

In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”

“The number of serious adverse events was miniscule,” she added.

Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.

“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.

However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.

“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.

In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”

The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.

“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.

“We know that cognitive behavioral therapy and gentle physical conditioning help people cope with any chronic disease — even congestive heart failure and multiple sclerosis,” Natelson said in an interview with MedPage Today.

Chronic fatigue syndrome is characterized by persisting or relapsing fatigue for at least six months that cannot be explained by any other physical or psychiatric disorder.

The fatigue is debilitating, and often is accompanied by joint and muscle pain, headaches, and tenderness of the lymph nodes.

In an editorial published with the study, Dr. Gijs Bleijenberg, and Dr. Hans Knoop, of Radboud University in Nijmegen, the Netherlands, explained the differences in these types of treatment for chronic fatigue.

“Both graded exercise therapy and cognitive behavior therapy assume that recovery from chronic fatigue syndrome is possible and convey this hope more or less explicitly to patients. Adaptive pacing therapy emphasizes that chronic fatigue syndrome is a chronic condition, to which the patient has to adapt,” Bleijenberg and Knoop wrote.

Graded exercise therapy and cognitive behavioral therapy have both been recommended by the U.K. National Institute for Health and Clinical Excellence, although evidence supporting these approaches remains sparse.

Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.

These groups advocate exercise pacing and specialist medical care, according to the investigators.

To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.

Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.

More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.

At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:

  • Cognitive behavioral therapy, 59 percent
  • Graded exercise therapy, 61 percent
  • Adaptive pacing therapy, 42 percent
  • Specialist medical care, 45 percent

The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:

  • Cognitive behavioral therapy, 30 percent
  • Graded exercise therapy, 28 percent
  • Adaptive pacing therapy, 16 percent
  • Specialist medical care, 15 percent

Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.

Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.

White’s group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.

They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.

Live Long and Be Positive

Patients with coronary heart disease who have positive expectations about recovery, expressing beliefs such as “I can still live a long and healthy life,” had greater long-term survival, researchers reported.

Among a cohort of almost 3,000 patients undergoing coronary angiography, those with the highest expectations for outcomes actually had the best outcomes, Dr. John C. Barefoot, and colleagues from Duke University Medical Center in Durham, N.C.

“Patients differ widely in terms of their psychological reactions to major illnesses such as coronary heart disease,” Barefoot’s group explained online in the Archives of Internal Medicine.

To explore the specific potential influence of recovery expectations, rather than overall optimistic personality traits, the investigators enrolled 2,818 patients with clinically significant disease and followed them for about 15 years.

Recovery expectations were assessed on the Expectations for Coping Scale, in which patients agreed or disagreed with statements such as “I doubt that I will ever fully recover from my heart problems” and “My heart condition will have little or no effect on my ability to do work.”

Patients were stratified into quartiles according to their expectation scores.

After adjustment for multiple variables, the mortality rate in the highest quartile — the most optimistic group — was 32 per 100 versus 46 per 100, respectively, “illustrating a substantial magnitude of this effect even after taking multiple covariates into account,” Barefoot and colleagues observed.

“These observations add to a compelling body of evidence that endorsing optimistic expectations for one’s future heart health is associated with clinically important benefits to cardiovascular outcomes,” Dr. Robert Gramling, and Dr. Ronald Epstein, of the University of Rochester in New York, wrote in a commentary accompanying the study.

“The degrees of evidence observed in these studies suggest that optimism is a powerful ‘drug’ that compares favorably with highly effective medical therapies,” they wrote.

Other experts advised caution, however.

“Like all observational studies, unmeasured patient characteristics may have contributed to the better outcomes,” observed Dr. Steven E. Nissen, of the Cleveland Clinic.

“Patients with a ‘positive’ attitude may simply be healthier than patients with a negative attitude. In fact, their ‘attitude’ may reflect their health status,” Nissen wrote to MedPage Today and ABC News in an e-mail.

Two “plausible” hypotheses can help explain the study findings, according to Barefoot and colleagues.

First, patients who are optimistic may use more effective strategies to cope with recovery from illness, by addressing the problem and reducing risk factors.

Second, patients whose outlook is more negative may experience worse stress that in turn could have harmful cardiac effects.

Limitations of the study, according to the investigators, included the possibility of confounders and selection bias.

“These findings argue for expanded efforts to understand the influence of recovery expectations and the potential benefits of attempts to modify them,” Barefoot’s group concluded.

However, the potential efficacy of such efforts is uncertain, according to Dr. James Kirkpatrick, of the University of Pennsylvania in Philadelphia.

“Whether a patient’s outlook can be changed (or patients can change their outlook) and improve results, and whether there are other factors which might make these patients do better, is unknown. One of those factors might be that cardiovascular providers give better care to patients with a positive outlook — perhaps spending more time with them or being more conscientious,” wrote Kirkpatrick in an email toMedPage Today and ABC News.

“Future studies will need to take this possible mechanism into account,” wrote Kirkpatrick.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging.

One author has a patent pending on an allele as a marker of cardiovascular disease and stress, and is a founder and major stockholder in Williams LifeSkills Inc.

Editorialist Gramling is funded by the National Palliative Care Research Center and the Greenwall Foundation.

Dangerous Bacteria in Outside Hospitals

The dangerous bacteria Clostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit “historic highs,” U.S. health officials reported Tuesday.

C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients,” Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. “C. difficile is causing many Americans to suffer and die.”

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

“This failure is more difficult to accept because these are treatable, often preventable deaths,” Arias said. “We know what can be done to do a better job of protecting our patients.”

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile’s overall impact.

According to the new report, 94 percent of C. difficile infections are related to medical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors’ offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body’s “good” bacteria for several months.

That’s when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficileshould be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, “All these recommendations are fine; the problem is they are not going to work, you can’t stop these practices. This bug exists in a climate of overuse of antibiotics.”

It is hard to eradicate C. difficile because it buries itself in the colon, then recurs and testing isn’t always accurate, Siegel said. “It’s a pervasive problem in hospitals, and even in communities,” he said.

Medications Safety

The U.S. Food and Drug Administration (FDA) judges a drug to be safe enough to approve when the benefits of the medicine outweigh the known risks for the labeled use.

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:

  • Speak up
  • Ask questions
  • Find the facts
  • Evaluate your choices
  • Read the label and follow directions

Speak Up

The more information your health care team knows about you, the better the team can plan the care that’s right for you.

The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.

They also need to know all the medicines and treatments you use, whether all the time or only some of the time. Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn’t.

It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one.

Be sure to include:

  • prescription medicines, including any samples your doctor may have given you
  • over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)
  • dietary supplements, including vitamins and herbs
  • any other treatments
  • any allergies, and any problems you may have had with a medicine
  • anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost

Ask Questions

Your health care team can help you make the best choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.

Find the Facts

Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:

  • brand and generic (chemical) names
  • active ingredients — to make sure that you aren’t using more than one medicine with the same active ingredient
  • inactive ingredients — if you have any problems with ingredients in medicines, such as colors, flavors, starches, sugars
  • uses (“indications” and “contraindications”) — why you will be using it, and when the medicine should/should not be used
  • warnings (“precautions”) — safety measures to make sure the medicine is used the right way, and to avoid harm
  • possible interactions — substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine
  • side effects (“adverse reactions”) — unwanted effects that the medicine can cause, and what to do if you get them
  • possible tolerance, dependence, or addiction – problems that some medicines can cause, and what you can do to avoid them
  • overdose — what to do if you use too much
  • directions — usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food
  • storage instructions — how and where to keep the medicine
  • expiration — date after which the medicine may not work, or may be harmful to use

Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers. If you have questions, ask your health care team.

Evaluate your Choices — Weigh the Benefits and Risks

After you have all the information, think carefully about your choices. Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you. This is how you weigh the benefits and risks. The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

Read the Label and Follow Directions

Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use. Using too much of any active ingredient may increase your chance of unwanted side effects.

Read the label each time you buy an OTC medicine or fill your prescription. When buying an OTC, read the “Drug Facts” label carefully to make sure it is the right medicine for you. Prescription and OTC medicines don’t always mix well with each other. Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too. Ask the pharmacist if you have questions.

Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it. If you’ve bought the medicine before, make sure that this medicine has the same shape, color, size, and packaging. Anything different? Ask your pharmacist. If your medicine tastes different when you use it, tell your health care team.

Read and save all the information you get with your medicine.

Read the label each time before you use the medicine. Be sure it’s right in 5 ways:

  1. the right medicine
  2. for the right patient
  3. in the right amount
  4. at the right time
  5. in the right way (for example, swallow instead of chew a pill)

Follow directions on the label and from your health care team. When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.

If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member. Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner. When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.

Tips to Eat a Healthy Diet

If you are what you eat, it follows that you want to stick to a healthy diet that’s well balanced. “You want to eat a variety of foods,” says Stephen Bickston, MD, AGAF, professor of internal medicine and director of the Inflammatory Bowel Disease Center at Virginia Commonwealth University Health Center in Richmond. “You don’t want to be overly restrictive of any one food group or eat too much of another.”

Healthy Diet: The Building Blocks

The best source of meal planning for most Americans is the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services Food Pyramid. The pyramid, updated in 2005, suggests that for a healthy diet each day you should eat:

  • 6 to 8 servings of grains. These include bread, cereal, rice, and pasta, and at least 3 servings should be from whole grains. A serving of bread is one slice while a serving of cereal is 1/2 (cooked) to 1 cup (ready-to-eat). A serving of rice or pasta is 1/2 cup cooked (1 ounce dry). Save fat-laden baked goods such as croissants, muffins, and donuts for an occasional treat.
  • 2 to 4 servings of fruits and 4 to 6 servings of vegetables. Most fruits and vegetables are naturally low in fat, making them a great addition to your healthy diet. Fruits and vegetables also provide the fiber, vitamins, and minerals you need for your body’s systems to function at peak performance. Fruits and vegetables also will add flavor to a healthy diet. It’s best to serve them fresh, steamed, or cut up in salads. Be sure to skip the calorie-laden toppings, butter, and mayonnaise, except on occasion. A serving of raw or cooked vegetables is equal to 1/2 cup (1 cup for leafy greens); a serving of a fruit is 1/2 cup or a fresh fruit the size of a tennis ball.
  • 2 to 3 servings of milk, yogurt, and cheese. Choose dairy products wisely. Go for fat-free or reduced-fat milk or cheeses. Substitute yogurt for sour cream in many recipes and no one will notice the difference. A serving of dairy is equal to 1 cup of milk or yogurt or 1.5 to 2 ounces of cheese.
  • 2 to 3 servings of meat, poultry, fish, dry beans, eggs, and nuts. For a healthy diet, the best ways to prepare beef, pork, veal, lamb, poultry, and fish is to bake or broil them. Look for the words “loin” or “round” in cuts of meats because they’re the leanest. Remove all visible fat or skin before cooking, and season with herbs, spices, and fat-free marinades. A serving of meat, fish, or poultry is 2 to 3 ounces. Some crossover foods such as dried beans, lentils, and peanut butter can provide protein without the animal fat and cholesterol you get from meats. A ¼ cup cooked beans or 1 tablespoon of peanut butter is equal to 1 ounce of lean meat.
  • Use fats, oils, and sweets sparingly. No diet should totally eliminate any one food group, even fats, oils, and sweets. It’s fine to include them in your diet as long as it’s on occasion and in moderation, Bickston says.

Healthy Diet: Eat Right and the Right Amount

How many calories you need in a day depends on your sex, age, body type, and how active you are. Generally, active children ages 2 to 8 need between 1,400 and 2,000 calories a day. Active teenage girls and women can consume about 2,200 calories a day without gaining weight. Teenage boys and men who are very active should consume about 3,000 calories a day to maintain their weight. If you’re not active, you calorie needs drop by 400 to 600 calories a day.

The best way to know how much to eat is to listen to your body, says Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill. “Pull away from the table when you’re comfortable but not yet full. Wait about 20 minutes,” he says. “Usually your body says, ‘That’s good.’ If you’re still hungry after that, you might want to eat a little more.”

Healthy Diet: Exercise Is Part of the Plan

At the bottom of the new USDA food pyramid is a space for exercise. Exercise is an important component of a well-balanced diet and good nutrition. You can reap “fabulous rewards,” says Dr Novey, just by exercising and eating “a healthy diet of foods that nature provides.”

Tips to Good Personal Hygiene

Personal hygiene habits such as washing your hands and brushing and flossing your teeth will help keep bacteria, viruses, and illnesses at bay. And there are mental as well as physical benefits. “Practicing good body hygiene helps you feel good about yourself, which is important for your mental health,” notes Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill. People who have poor hygiene — disheveled hair and clothes, body odor, bad breath, missing teeth, and the like — often are seen as unhealthy and may face discrimination.

Personal Hygiene: Healthy Habits Include Good Grooming

If you want to minimize your risk of infection and also enhance your overall health, follow these basic personal hygiene habits:

  • Bathe regularly. Wash your body and your hair often. “I’m not saying that you need to shower or bathe every day,” remarks Dr. Novey. “But you should clean your body and shampoo your hair at regular intervals that work for you.” Your body is constantly shedding skin. Novey explains, “That skin needs to come off. Otherwise, it will cake up and can cause illnesses.”
  • Trim your nails. Keeping your finger and toenails trimmed and in good shape will prevent problems such as hang nails and infected nail beds. Feet that are clean and dry are less likely to contract athlete’s foot, Novey says.
  • Brush and floss. Ideally, you should brush your teeth after every meal. At the very least, brush your teeth twice a day and floss daily. Brushing minimizes the accumulation of bacteria in your mouth, which can cause tooth decay and gum disease, Novey says. Flossing, too, helps maintain strong, healthy gums. “The bacteria that builds up and causes gum diseasecan go straight to the heart and cause very serious valve problems,” Novey explains. Unhealthy gums also can cause your teeth to loosen, which makes it difficult to chew and to eat properly, he adds. To maintain a healthy smile, visit the dentist at six-month intervals for checkups and cleanings.
  • Wash your hands. Washing your hands before preparing or eating food, after going to the bathroom, after coughing or sneezing, and after handling garbage, goes a long way toward preventing the spread of bacteria and viruses. Keep a hygiene product, like an alcohol-based sanitizing gel, handy for when soap and water isn’t available.
  • Sleep tight. Get plenty of rest — 8 to 10 hours a night — so that you are refreshed and are ready to take on the day every morning. Lack of sleepcan leave you feeling run down and can compromise your body’s natural defenses, your immune system, Novey says.

Personal Hygiene: Poor Hygiene Hints at Other Issues

If someone you know hasn’t bathed or appears unkempt, it could be a sign that he or she is depressed. “When people are sad or depressed, they neglect themselves,” Novey says. Talking about the importance of proper personal hygiene for preventing illnesses and providing personal hygiene items may help some people. Be candid but sensitive and understanding in your discussions, Novey says. Despite your best efforts, your friend or loved one may need professional help. You should encourage them to see a counselor or doctor if their personal hygiene doesn’t improve.

Personal Hygiene: Good Habits Help Keep You Healthy

For most people, good hygiene is so much a part of their daily routines that they think little about it. They bathe, they brush their teeth, visit the dentist and doctor for regular checkups, and wash their hands when preparing or eating food and handling unsanitary items. To keep those you care about healthy and safe, help them learn, and be sure that they are practicing, good personal hygiene.

Chemical Found in Blood Holds

Even within the normal range, higher bilirubin levels appear to be associated with reduced risks of lung cancer, chronic obstructive pulmonary disease (COPD), and death, a longitudinal, prospective analysis of a large database showed.

For every 0.1-mg/dL increase in bilirubin level, the rate of lung cancer dropped by 8 percent in men and 11 percent in women, according to Laura Horsfall, MSc, of University College London, and colleagues.

In addition, the same incremental increase in bilirubin was associated with a 6 percent decline in the rate of COPD and a 3 percent decline in mortality for both sexes, the researchers reported in the Feb. 16 issue of the Journal of the American Medical Association.

“Based on our findings, bilirubin levels within the normal range appear to capture information about patients that may reflect a combination of environmental and genetically determined susceptibility to respiratory diseases,” they wrote.

Most people are familiar with bilirubin because of its role in jaundice — the yellowing of the skin that is sometimes seen in newborns but is also associated with liver disease.

Bilirubin is actually a byproduct of the turn over of red blood cells — the cells that carry oxygen throughout the body. Healthy individuals constantly replace old red blood cells with new ones. As the old cells are broken down they produce bilirubin, a chemical characterized by a distinctive yellow color.

The Best Diet for Healthy Lungs

The spleen and the liver taking in bilirubin and use it to break down or metabolize other substances into bile, which is used to aid digestion.

Although the study cannot establish causality for any of the relationships, there is some experimental evidence that bilirubin has benefits for respiratory health because of its cytoprotective properties, including antioxidant, anti-inflammatory, and antiproliferative effects, according to the researchers.

They noted that a better understanding of the possible mechanisms linking bilirubin levels to lung cancer, COPD, and death may lead to potential therapies that target the activity of UGT1A1, a liver enzyme responsible for converting insoluble bilirubin to an excretable form.

Horsfall and her colleagues examined data from the Health Improvement Network, a U.K. primary care research database.

Their analysis included 504,206 patients ages 20 and older from 371 practices. All of the patients had recorded serum bilirubin levels but no evidence of hepatobiliary or hemolytic disease.

Median bilirubin levels were 0.64 mg/dL in men and 0.53 mg/dL in women.

Through a median follow-up of eight years, there were 1,341 incident cases of lung cancer, 5,863 incident cases of COPD, and 23,103 all-cause deaths. The corresponding rates per 10,000 person-years were 2.5, 11.9, and 42.5.

For men, the rate of lung cancer per 10,000 person-years dropped from 5.0 in the lowest decile of bilirubin levels to 3.0 in the fifth decile. Similar declines were seen for COPD (19.5 to 14.4) and death (51.3 to 38.1).

The findings were similar for all outcomes in women, and the declines in both sexes remained significant after adjustment for age, body mass index, systolic blood pressure, smoking, alcohol intake, and a measure of social deprivation.

The authors acknowledged some limitations of the study, including possible residual confounding by unmeasured environmental exposures or race/ethnicity and the inability to establish causality for the observed relationships.