Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. It is often called a “silent” disease because it has no discernable symptoms until there is a bone fracture. Like other tissues in the body, bone tissue is in a state of constant flux – remodeling and rebuilding. There are many influences on bone mass and strength, such as genetics, hormones, physical exercise and diet (especially intake of calcium, phosphate, vitamin D, and other nutrients). Osteoporosis occurs when there are problems with these factors, resulting in more bone loss than bone rebuilding. Osteoporosis can strike at any age and affects both men and women. One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in their lifetime. In the U.S. today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at increased risk for this disease.
Osteoporosis is a disease that is characterized by low bone mass and a deterioration in the microarchitecture of bone that increases its susceptibility to fracture.
Normal bone mineral density (BMD) measured using dual x-ray absorptiometry is a T-score that falls within 1 standard deviation (SD) of the reference mean for healthy, young white women. Based on epidemiologic studies, the World Health Organization (WHO) defines osteoporosis as a BMD (hip, spine, or wrist) that is 2.5 SDs or more below the reference mean for healthy, young white women (corresponding to a T-score below –2.5) and defines osteopenia as a BMD that is between 1 and 2.5 SDs below the reference mean.
Men generally have 20 percent greater BMD than women. Blacks have 20 percent greater bone density than whites. Therefore, neither men nor blacks are affected with osteoporosis as frequently as white women, although they can develop the disease. Glucocorticoids can induce osteoporosis in any of these groups.
Sunday, January 10, 2010
Osteoporosis
Impact of Osteoporosis
Osteoporosis is twice as common in white and Hispanic women as in black women. In white women 50 years and older, the lifetime risk of osteoporotic fractures approaches 40 percent.4 More than 90 percent of hip and vertebral fractures in elderly white women are attributed to osteoporosis.
Osteoporosis is responsible for almost 1 million vertebral and hip fractures annually. In 1995, osteoporotic fractures resulted in 2.5 million physician visits, 432,000 hospitalizations, and 180,000 nursing home admissions. In the United States alone, annual medical expenditures for the management of osteoporotic fractures may be as high as $15 billion.
Vertebral fractures trigger back pain, limit activity, and confine patients to bed. Multiple vertebral fractures cause kyphosis and loss of height. Fracture at any site increases the risk for subsequent fracture: up to 20 percent of women who have an incident vertebral fracture incur another fracture within one year. One analysis found that postmenopausal women with hip or clinical (i.e., symptomatic) vertebral fractures had an age-adjusted increased risk of death (greater than sixfold risk after hip fracture, greater than eightfold risk after vertebral fracture) during the next four years.
How to Do Breast Feeding
Breastfeeding is the natural, physiologic way of feeding infants and young children milk, and human milk is the milk made specifically for human infants. Formulas made from cow’s milk or soy beans (most of them) are only superficially similar, and advertising which states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to assure breastfeeding is a happy experience for both mother and baby.
The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for four to six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in many health care institutions and make breastfeeding difficult, even impossible, for some mothers and babies. For breastfeeding to be well and properly established, a good early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.
The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole which is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Here are a few ways breastfeeding can be made easy:
1. The baby should be at the breast immediately after birth. The vast majority of newborns can be put to breast within minutes of birth. Indeed, research has shown that, given the chance, babies only minutes old will often crawl up to the breast from the mother’s abdomen, and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who "self-attach" run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin to skin contact between mothers and babies keeps the baby as warm as an incubator.
2. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods. Health facilities which have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often bogus reasons are given for separations. One example is the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ "observation".
3. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever method gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, he will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Nipple confusion includes not just the baby refusing the breast, but also the baby not taking the breast as well as he could and thus not getting milk well and /or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented.
4. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but usually supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid, not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.
5. Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula. It is very effective, and very unethical, marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. "But I need formula because the baby is not getting enough!". Maybe, but, more likely, you weren’t given good help and the baby is simply not getting your milk well. Get good help. Formula samples are not help.
6. A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being "helped" by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be skeptical, and ask for help from someone who knows.
7. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk which is available. Get help to fix the baby’s latch, and use compression to get the baby more milk. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.
ETOLOGY OF ANAEMIA
Anaemia is the result of a wide variety of causes that can be isolated, but more often coexist. Globally, the most significant contributor to the onset of anaemia is iron deficiency so that IDA and anaemia are often used synonymously, and the prevalence of anaemia has often been used as a proxy for IDA. It is generally assumed that 50% of the cases of anaemia are due to iron deficiency, but the proportion may vary among population groups and in different areas according to the local conditions.
The main risk factors for IDA include a low intake of iron, poor absorption of iron from diets high in phytate or phenolic compounds, and period of life when iron requirements are especially high (i.e.growth and pregnancy).
Among the other causes of anaemia, heavy blood loss as a result of menstruation, or parasite infections such as hookworms, ascaris, and schistosomiasis can lower blood haemoglobin (Hb) concentrations. Acute and chronic infections, including malaria, cancer, tuberculosis, and HIV can also lower blood Hb concentrations. The presence of other micronutrient deficiencies, including vitamins A and B12, folate, riboflavin, and copper can increase the risk of anaemia. Furthermore, the impact of haemoglobinopathies on anaemia prevalence needs to be considered within some populations.
Diet During Lactation
Body image is among the greatest concerns of women during the first year after childbirth. The desire to lose weight and tone muscles in the postpartum period is common concern after child birth in today's society. Weight reduction can be difficult for anyone at anytime, but a mother who is trying to return to her pre-pregnancy weight is also challenged with additional stresses of increased child care commitments, less rest and sleep, household responsibilities, and, possibly, returning to work outside the home. A woman trying to be successful at weight management while breastfeeding will need the support of her family, friends, employer, and medical caregiver.
This article provides preliminary recommendations for diet and exercise programming for breastfeeding women who have the desire and, in consultation with their health care provider, have determined that weight management is necessary.
Lactation places significant energy demands upon the mother, causing the additional expenditure of more that 500 calories per day. The recommended diet is at least 1,800 calories per day, the minimum recommended intake for lactating women. The food eaten should consists largely of complex carbohydrates, low in fat and sugar, and contains the necessary meat and dairy products to meet minimum safe nutritional intake guidelines (United States Department of Agriculture [USDA], 1995). No effort should be made to deliberately restrict total calorie intake, and women should feel free to eat to satiety when they are hungry but to refrain from becoming overly full.
There is a need to make use of dietary exchange list to simplify meal planning and facilitates eating and recording food intake. The exchange list represented below consists of six groups of foods classed together because of similar calorie content and percentage of carbohydrates, protein, and fat. The numbers and types of exchanges eaten should be recorded after each meal in a daily food log to keep a written track of the daily food intake. The strength of this type of dietary recommendation, which uses exchange lists, is that it allows the woman to plan and prepare her own menus based on the type of foods she and her family prefer.
The diet should be composed of approximately 60% of carbohydrate (<=10% of which is composed of refined sugars), 20% protein, and 20-25% fat (<=33% of which is composed of saturated fats.) Eat three or more meals per day, and eat snacks of fruit, vegetables, and grains whenever hungry.
It is important to dispel the myth that it is acceptable to eat as much as desired of any food touted by manufacturers as low- or non-fat. Foods in this category (particularly snacks and desserts) are often found to be high in refined sugar and calories. This diet is also nutritionally sound and conducive to a lifelong pattern of healthful eating by the woman and her family. Vitamin and mineral supplements are not necessary but may be taken at the discretion of the woman and her health care provider, especially if her food choices provide marginal dietary intake of calcium, magnesium, zinc folate, and vitamins B6 and B12. Excessive drinking of beverages with high sugar, caffeine, or alcohol content is discouraged.
Calcium
Calcium is one of the micronutrients that we need for growth. Here is a simple explanation about Calcium. Calcium is a mineral that plays an important role in the development and maintenance of the bones. Calcium is also needed in tooth formation and is important in other body functions. Calcium is one of the most important and most abundant minerals in the human body. The main function of Calcium in the bloodstream plays an important role in blood clotting, transmission of nerve impulses, muscle contraction, and other metabolic activities. In the bloodstream, calcium maintains a constant balance with phosphate.
We can get Calcium from some foods source of calcium such as Eggs, green leafy vegetables, broccoli, legumes, nuts, and whole grains provide calcium but in smaller amounts than dairy products.
Our body just absorbs of Calcium Only about 10-30% of the calcium in food is absorbed into the body. Calcium must be broken down by the digestive system before the body can use it. Calcium is absorbed into the body in the small intestine. The absorption of calcium is influenced by such factors as the amount of vitamin D hormone in the body and the level of calcium already present in the bloodstream. The "fizz" in fizzy drinks like soda and Champagne inhibits the absorption of calcium and takes calcium out of the bones. Thus about 99% of the body's calcium is stored in bone tissue. The remaining 1% of the body's calcium circulates in the blood and other body fluids.
Breast Feeding
Feelings about how to parent seem to shift with every generation. A new way of parenting, sometimes called attachment parenting, has emerged and it challenges many of the rigid teachings of our mother's generation. Although breastfeeding is on the rise now, women are still dealing with the repercussions of previous generations. Not too long ago mainstream women did not breastfeed at all and the ones that did were taught to follow strict schedules.
Some thought of breastfeeding as primitive. Formula was touted as being equal to or superior to breast milk. Only recently, has the fact that "breast is best" been acknowledged. Other women were in the workforce. They may have felt that breastfeeding was not an option for them. They did not have the modern breast pump available to them. The medical community may not have encouraged breastfeeding at the time. It is not hard to imagine. After all, even with all the knowledge about the benefits of breastfeeding there are still many health professionals today that are uneducated and unsupportive of breastfeeding. With all the challenges in the way of breastfeeding, it is understandable why many women of yesterday did not choose to breastfeed
Breastfeeding has come a long way but still many of the old thinking still carries on. Women are more educated on the subject; however, even with the many books and other information available, people are often most influenced by their immediate family and friends. Having the support of friends and family can boost the chances of having a successful breastfeeding experience. On the other hand, having to deal with criticism and misinformation from the people you are close to can sabotage a new mom trying to breastfeed.
There are many ways to deal with the negativity of others. One of the best things you can do is to try to understand why the person feels the way they do. Is it because they were taught differently about breastfeeding? Were they indoctrinated with the ideas that breastfeeding is primitive or inferior? Or is it that they feel breasts are a sexual object? Maybe they have never seen someone breastfeed and it makes them uncomfortable. This is the case with a lot of people. Once breastfeeding in public becomes more commonplace, perhaps, this will become less of a problem. Whatever the case, finding out the root of the person's issues with breastfeeding may help to resolve the tension.
ASSESSING ANAEMIA
Hb concentration is the most reliable indicator of anaemia at the population level, as opposed to clinical measures which are subjective and therefore have more room for error. Measuring Hb concentration is relatively easy and inexpensive, and this measurement is frequently used as a proxy indicator of iron deficiency. However, anaemia can be caused by factors other than iron deficiency.
In addition, in populations where the prevalence of inherited haemoglobinopathies is high, the mean level of Hb concentration may be lowered. This underlines that the etiology of anaemia should be interpreted with caution if the only indicator used is Hb concentration. The main objective for assessing anaemia is to inform decision-makers on the type of measures to be taken to prevent and control anaemia. This implies that in addition to the measurement of Hb concentration, the causes of anaemia need to be identified considering that they may vary according to the population.
ANAEMIA
Anaemia is a public health problem that affects populations in both rich and poor countries. Although the primary cause is iron deficiency, it is seldom present in isolation.
More frequently it coexists with a number of other causes, such as malaria, parasitic infection, nutritional deficiencies, and haemoglobinopathies.
Given the importance of this pathology in the world, numerous countries conduct interventions to reduce anaemia; particularly in the groups most susceptible to its devastating effects: pregnant women and young children. In order to assess the impact of these interventions, the adequacy of the strategies implemented, and the progress made in the fight against anaemia, information on anaemia prevalence must be collected. This is the primary objective of the WHO Global Database on Anaemia.
However, estimates of anaemia prevalence by themselves are only useful if they are associated with a picture of the various causal factors that contribute to the development of anaemia in specific settings. Indeed these factors are multiple and complex, and it is critical to collect accurate information about them to provide the basis for developing the best interventions for anaemia control.
In the last three decades, there have been various attempts to produce estimates of the prevalence of anaemia at different levels including at the global level, but until the present time, there has never been a systematic review of all of the data collected and published with the objective of deriving regional and global estimates.
The WHO Global Database on Anaemia has filled this gap: data from 93 countries, representing as much as 76% of the population in the case of preschool-age children, were analysed and used to develop statistical models to generate national prevalence estimates for countries with no data within the time frame specified.
It is surprising that given the public health importance of anaemia, there are numerous countries lacking national prevalence data. Moreover, most survey data are related to the three population groups: preschool-age children, pregnant women, and non-pregnant women of reproductive age, which is why the report focuses on these groups.
The data available for school-age children, men, and the elderly were not sufficient to generate regional or countrylevel estimates for these groups, and therefore only global estimates for these groups are presented.
In addition, despite the fact that iron deficiency is considered to be the primary cause of anaemia, there are few data on the prevalence of this deficiency. The likely reason is that iron assessment is difficult because the available indicators of iron status do not provide sufficient information alone and must be used in combination to obtain reliable information on the existence of iron deficiency.
Furthermore, there is no real consensus on the best combination of indicators to use. Another reason is that the role of factors other than iron deficiency in the development of anaemia has been underestimated by public health officials, because for a long time anaemia has been confused with iron deficiency anaemia, and this has influenced the development of strategies and programmes designed to control anaemia.
In this report, the prevalence of anaemia is presented by country and by WHO regions. Because these prevalence data may be used to identify programme needs by other United Nations agencies, we have presented the estimates classified by United Nations regions in the annexes. In addition, one chapter is dedicated to the criteria used to identify, revise, and select the surveys, and the methodology developed to generate national, regional, and global estimates.
A lesson learned from producing this report is that in order for the database to reach its full potential, data should be collected on other vulnerable population groups such as the elderly and school-age children, and surveys should be more inclusive and collect information on iron status and other causes of anaemia.
This report is written for public health officials, nutritionists, and researchers. We hope that readers find it useful and feel free to share any comments with us.
What is the cervix?
The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix is a passageway:
• The cervix connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.
• The cervix makes mucus. During sex, mucus helps sperm move from the vagina through the cervix into the uterus.
• During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens to allow the baby to pass through the vagina.
What is cancer?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the cervix can be benign or malignant. Benign growths are not cancer. They are not as harmful as malignant growths (cancer).
• Benign growths (polyps, cysts, or genital warts):
o are rarely a threat to life
o don't invade the tissues around them
• Malignant growths (cervical cancer):
o may sometimes be a threat to life
o can invade nearby tissues and organs
o can spread to other parts of the body
Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues. The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis. See the Staging section for information about cervical cancer that has spread.
(source: http://emedicine.medscape.com/article/)
Risk factors and causes of cervical cancer
When you get a diagnosis of cancer, it's natural to wonder what may have caused the disease. Doctors cannot always explain why one woman develops cervical cancer and another does not. However, we do know that a woman with certain risk factors may be more likely than others to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found a number of factors that may increase the risk of cervical cancer. For example, infection with HPV (human papillomavirus) is the main cause of cervical cancer. HPV infection and other risk factors may act together to increase the risk even more:
• HPV infection: HPV is a group of viruses that can infect the cervix. An HPV infection that doesn't go away can cause cervical cancer in some women. HPV is the cause of nearly all cervical cancers.
HPV infections are very common. These viruses are passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own.
Some types of HPV can cause changes to cells in the cervix. If these changes are found early, cervical cancer can be prevented by removing or killing the changed cells before they can become cancer cells. The NCI fact sheet Human Papillomaviruses and Cancer: Questions and Answers has more information.
A vaccine for females ages 9 to 26 protects against two types of HPV infection that cause cervical cancer. The NCI fact sheet Human Papillomavirus (HPV) Vaccines: Questions and Answers has more information.
• Lack of regular Pap tests: Cervical cancer is more common among women who don't have regular Pap tests. The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer.
• Smoking: Among women who are infected with HPV, smoking cigarettes slightly increases the risk of cervical cancer.
• Weakened immune system (the body's natural defense system): Infection with HIV (the virus that causes AIDS) or taking drugs that suppress the immune system increases the risk of cervical cancer.
• Sexual history: Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection.
• Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may slightly increase the risk of cervical cancer among women with HPV infection. However, the risk decreases quickly when women stop using birth control pills.
• Having many children: Studies suggest that giving birth to many children (5 or more) may slightly increase the risk of cervical cancer among women with HPV infection.
• DES (diethylstilbestrol): DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)
Having an HPV infection or other risk factors does not mean that a woman will develop cervical cancer. Most women who have risk factors for cervical cancer never develop it
AIDS
The first recognised cases of the acquired immune deficiency syndrome (AIDS) occurred in the summer of 1981 in America. Reports began to appear of Pneumocystis carinii pneumonia and Kaposi’s sarcoma in young men, who it was subsequently realised were both homosexual and immunocompromised.
Even though the condition became known early on as AIDS, its cause and modes of transmission were not immediately obvious. The virus now known to cause AIDS in a proportion of those infected was discovered in 1983 and given various names. The internationally accepted term is now the human immunodeficiency virus (HIV). Subsequently a new variant has been isolated in patients with West African connections.
The definition of AIDS has changed over the years as a result of an increasing appreciation of the wide spectrum of clinical manifestations of infection with HIV. Currently, AIDS is defined as an illness characterised by one or more indicator diseases. In the absence of another cause of immune deficiency and without laboratory evidence of HIV infection (if the patient has not been tested or the results are inconclusive), certain diseases when definitively diagnosed are indicative of AIDS. Also, regardless of the presence of other causes of immune deficiency, if there is laboratory evidence of HIV infection, other indicator diseases that require a definitive, or in some cases only a presumptive, diagnosis also constitute a diagnosis of AIDS.
In 1993 the Centers for Disease Control (CDC) in the USA extended the definition of AIDS to include all persons who are severely immunosuppressed (a CD4 count <200 _ 106/1) irrespective of the presence or absence of an indicator disease. For surveillance purposes this definition has not been accepted within the UK and Europe. In these countries AIDS continues to be a clinical diagnosis defined by one or more of the indicator diseases mentioned. The World Health Organisation (WHO) also uses this clinically based definition for surveillance within developed countries. WHO, however, has developed an alternative case definition for use in sub-Saharan Africa. This is based on clinical signs and does not require laboratory confirmation of infection. Subsequently this definition has been modified to include a positive test for HIV antibody.
