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[ { "answer_id": 15174, "author": "mehmet", "author_id": 12828, "author_profile": "https://health.stackexchange.com/users/12828", "pm_score": 0, "selected": false, "text": "<p>Based on data of the <a href=\"https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html\" rel=\"nofollow noreferrer\">Center for Disease Control and Prevention</a>, the number of annual human fatalities due to rabies is less than 5 in the entire US. Thus, that put the chances to much less than 1% for a family of 5 over 10 years. So, I conclude it does not seem to be worth having the pre-exposure vaccination in abundance of caution. </p>\n" }, { "answer_id": 15175, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 2, "selected": false, "text": "<p>I asked a couple of medical doctors about this and they said a rabies vaccine was not necessary. The rabies vaccine is indicated for people at high risk of exposure to the rabies virus such as researchers working with rabies, veterinarians, and animal control personnel. </p>\n\n<p>They do however recommend staying current with tetanus vaccines as an outdoor cat could possibly pick up some of the bacteria that causes tetanus in their claws and possibly transmit it to a person if they scratch them.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15194", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12678/" ]

[ { "answer_id": 15174, "author": "mehmet", "author_id": 12828, "author_profile": "https://health.stackexchange.com/users/12828", "pm_score": 0, "selected": false, "text": "<p>Based on data of the <a href=\"https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html\" rel=\"nofollow noreferrer\">Center for Disease Control and Prevention</a>, the number of annual human fatalities due to rabies is less than 5 in the entire US. Thus, that put the chances to much less than 1% for a family of 5 over 10 years. So, I conclude it does not seem to be worth having the pre-exposure vaccination in abundance of caution. </p>\n" }, { "answer_id": 15175, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 2, "selected": false, "text": "<p>I asked a couple of medical doctors about this and they said a rabies vaccine was not necessary. The rabies vaccine is indicated for people at high risk of exposure to the rabies virus such as researchers working with rabies, veterinarians, and animal control personnel. </p>\n\n<p>They do however recommend staying current with tetanus vaccines as an outdoor cat could possibly pick up some of the bacteria that causes tetanus in their claws and possibly transmit it to a person if they scratch them.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15228", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12868/" ]

[ { "answer_id": 15275, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 3, "selected": true, "text": "<h2>It‘s all about algorithms</h2>\n\n<p>What you have done with the OPQPRST is a great start, but to save yourself even more trouble, there is one more algorithm which can help you:</p>\n\n<h2><a href=\"https://en.wikipedia.org/wiki/SAMPLE_history\" rel=\"nofollow noreferrer\">SAMPLER</a></h2>\n\n<p>Standing for </p>\n\n<ul>\n<li><strong>S</strong>ymptoms [include OPQPRST in this] </li>\n<li><strong>A</strong>llergies</li>\n<li><strong>M</strong>edication you are currently taking</li>\n<li><strong>P</strong>ast illnesses</li>\n<li><strong>L</strong>ast oral intake (+ last menstruation for women)</li>\n<li><strong>E</strong>vents that lead to the symptoms </li>\n<li><strong>R</strong>isk factors (i.e. smoking, alcoholism, addictions etc.)</li>\n</ul>\n\n<p>This is an algorithm that‘s used by professionals for patient assessement after the <a href=\"https://en.wikipedia.org/wiki/ABC_(medicine)#CABC\" rel=\"nofollow noreferrer\">cABCDE</a> check (which only applies in traumatology and you don’t really need to use with general practitioners)</p>\n\n<h2>Pain Assesement</h2>\n\n<p>The scale you are using is great, but I recommend to give a reference point: <em>If 10 is my pain during labour, this broken arm is around 3</em> gives doctors more information that just saying <em>three</em> because pain is highly subjective and for someone who had a lot of pain before, the scale might really be different compared to someone who got lucky in life \nso far or didn’t birth children (yet).</p>\n\n<h2>Medication</h2>\n\n<p>Write down a list of the medicine you are taking before a visit. That way you can convey more information than <em>two small white pills in the morning and a large blue one after supper</em>.</p>\n" }, { "answer_id": 15322, "author": "Kate Gregory", "author_id": 400, "author_profile": "https://health.stackexchange.com/users/400", "pm_score": 2, "selected": false, "text": "<p>Is your issue that your forget to mention your [stomach pain, rash, sleeplessness] or that you forget where it was, how much it hurt, etc? The sorts of things you have in your question would appear relevant only to the latter. For the former, a little notebook in which you write literally one or two words should be enough for you to remember to mention it, with the actual details being supplied from memory, no?</p>\n\n<p>I have a dedicated notebook that is only for doctor appointments and I write things in it as they happen or occur to me. It might say \"thyroid refill\" if I'm getting low on them. Or it might say \"back pain\" or whatever. Often I write things the doctor says in the same book in case I need to check them later. It's simple, almost free, secure, and private.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15271", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2205/" ]

[ { "answer_id": 15279, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 5, "selected": true, "text": "<p>Fluoride can be absorbed into the teeth and form fluoroapatite only in children up to 6-8 years of age (<a href=\"https://www.webmd.com/oral-health/guide/fluoride-treatment\" rel=\"noreferrer\">WebMD</a>). </p>\n\n<p>Later, fluoride from toothpaste may still be helpful, because it stimulates the incorporation of calcium and phosphorus into the enamel that has been demineralized (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543617/\" rel=\"noreferrer\">PubMed Central, 2006</a>). So, fluoride stimulates remineralization and thus <em>slows down</em> the development of caries; it doesn't mean that it <em>cures</em> caries.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606595/\" rel=\"noreferrer\">Recent advancements in fluoride: A systematic review (PubMed Central, 2015)</a></p>\n\n<blockquote>\n <p>A summary of RCTs on fluoride concentration in toothpastes showed a\n positive dose response: Pastes with 1000–1500 ppm F showed 23% caries\n reduction compared to fluoride-free placebo; this value increased to\n 36% for pastes with around 2500 ppm F. For pastes having below 1000\n ppm F, no significant difference was found with placebo, probably due\n to the small number of studies.</p>\n</blockquote>\n\n<p>^^ The above means, there was less caries after fluoridated paste use, and not that the established caries was cured. </p>\n" }, { "answer_id": 15617, "author": "sue", "author_id": 7617, "author_profile": "https://health.stackexchange.com/users/7617", "pm_score": 3, "selected": false, "text": "<p>The main protective effect of fluoride is outside the tooth, not inside. </p>\n\n<blockquote>\n <p>Small amounts of fluoride in solution around the tooth inhibit\n demineralization more effectively than incorporated fluoride and have\n a much greater caries-protective potential than a large proportion of\n fluorapatite in enamel mineral. Schweiz Monatsschr Zahnmed 122:\n 1030–1036 (2012)</p>\n</blockquote>\n\n<p>For example, even an incredible amount of fluoride has limited protective effect. In a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2839893\" rel=\"nofollow noreferrer\">classic study</a>, Ogaard compared the resistance of fluoroapatite (shark enamel) and hydroxyapatite (human enamel) against a high caries challenge in a human in vivo model. Two samples of shark enamel and human enamel were each placed in removable appliances in six children and carried for 1 month and a plaque retentive device was placed over each enamel sample. The results showed that the mean total mineral loss (delta Z) was 1680 vol% micron in human enamel and 965 vol% micron in shark enamel. The corresponding mean values for lesion depth were 90 micron and 36 micron, respectively. It was concluded that <strong>even shark enamel containing 30,000 ppm F has a limited resistance against caries attacks</strong>.</p>\n\n<p>In a later <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11908400\" rel=\"nofollow noreferrer\">review</a>, the same author concludes that </p>\n\n<blockquote>\n <p>The fluoride concentration in the apatitic structure of enamel does\n not have as significant an effect on reducing caries as a continuous\n presence of fluoride in the plaque liquid.</p>\n</blockquote>\n\n<p>Hence, to receive the protective effect of the fluoride, we require to keep it near the tooth surface all time. </p>\n" } ]

[ "https://health.stackexchange.com/questions/15277", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12902/" ]

[ { "answer_id": 15337, "author": "Count Iblis", "author_id": 856, "author_profile": "https://health.stackexchange.com/users/856", "pm_score": 0, "selected": false, "text": "<p>Note: the following answer has been completely rewritten.</p>\n\n<p>There are a large number of microbes in the intestines, their presence is essential for being able to digest food properly. The lining of the intestines contains living cells, so any method that completely sterilizes the gut will also do severe damage to the gut. Sterilizing the skin, in contrast, is a different matter, in that case <a href=\"https://www.popularmechanics.com/science/health/a17047003/uv-light-could-zap-flu-pandemics-before-they-start/\" rel=\"nofollow noreferrer\">far UV-C</a> light can kill microbes without doing damage because far UV-C light doesn't penetrate the skin deep enough to affect living cells.</p>\n\n<p>This means that the only safe way to do this (involving aggressive chemicals, radiation or whatever other means) is to make sure the patient will survive with damaged intestines, and that requires putting the patient on <a href=\"https://en.wikipedia.org/wiki/Parenteral_nutrition\" rel=\"nofollow noreferrer\">total parenteral nutrition</a>.</p>\n" }, { "answer_id": 15343, "author": "anongoodnurse", "author_id": 169, "author_profile": "https://health.stackexchange.com/users/169", "pm_score": 2, "selected": false, "text": "<p>It isn't possible to completely sterilize the gut of a living person. Repeat: not possible under any circumstance in a living person. </p>\n\n<p>You can dramatically decrease the number of organisms by using high-dose antibiotics and flushing out the gut copiously, and by copiously, I mean your intake plus an osmotic agent is so high that you have explosive diarrhea that looks like pure water. (It's not.)</p>\n\n<p>Even with all this, swabbing will reveal plenty of CFU's (colony forming units) from what appears to be a perfectly pristine gut. </p>\n\n<p>Drinking several gallons of household bleach would give you even less desirable results, not to mention it would kill you. </p>\n\n<p>That's not to say there aren't any animals with perfectly microbe-free intestines. There are germ-free mice, rats, and possibly a few other animals by now. Obtaining them is difficult: they must be harvested by sacrificing a pregnant female, and under the most stringent sterile conditions, removing fetuses from the uterus, and growing the offspring in a sterile environment, feeding them sterile food (obviously processed), etc. Allow these animals to reproduce, and the result is- eventually- germ-free colonies. </p>\n\n<p>The cost is phenomenal. If it were possible to sterilize mice guts more easily, it would have been done. </p>\n\n<p>_{<a href=\"https://irp.nih.gov/catalyst/v19i4/germ-free-mice\" rel=\"nofollow noreferrer\">Germ Free Mice</a>}</p>\n" } ]

[ "https://health.stackexchange.com/questions/15336", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9768/" ]

[ { "answer_id": 15347, "author": "Dave Liu", "author_id": 140, "author_profile": "https://health.stackexchange.com/users/140", "pm_score": 3, "selected": false, "text": "<p><strong>YES</strong>, according to:\n<a href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072481/\" rel=\"nofollow noreferrer\">The National Center for Biotechnology Information (NCBI) of the United States</a> </p>\n\n<p>and\n<a href=\"https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/how-it-works/\" rel=\"nofollow noreferrer\">National Heath Service (NHS) of the United Kingdom.</a></p>\n\n<p>Cognitive Behavioral Therapy is a clinically approved method to treat depression, <strong>without the usage of medication.</strong></p>\n\n<p>Cognitive behavioral therapy (CBT) is a common and well-studied form of psychotherapy, combining cognitive and behavioral therapy.</p>\n\n<p>The goal is to reveal and change false and distressing beliefs, because it is often not only the things and situations themselves that cause problems, but the importance that we attach to them too.</p>\n\n<p>For example, a dangerous thought pattern might be when somebody immediately draws negative conclusions from an occurrence, generalizes them and applies them to similar situations. In psychology, this generalized way of thinking is called “over-generalizing.” Another distressing error in reasoning is “catastrophizing”: If something disturbing happens, people immediately draw exaggerated conclusions about the scope of the supposed disaster ahead.</p>\n\n<p>Such thought patterns can sometimes develop into self-fulfilling prophecies and make life difficult for the people affected. Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts. It also helps people to think more clearly and to control their own thoughts better.</p>\n\n<p><strong>How does behavioral therapy work?</strong></p>\n\n<p>Behavioral therapy assumes that human behavior is learned and can therefore be unlearned or relearned and aims to find out whether certain behavioral patterns make your life difficult or intensify your problems. In the second step you work on changing these behavioral habits.</p>\n\n<p>For example, people who have developed depressive thoughts often tend to withdraw and give up their hobbies. As a result, they feel even more unhappy and isolated. Cognitive therapy helps to identify this mechanism and find ways to become more active again.</p>\n\n<p>Cognitive behavioral therapy focuses on current problems and finding solutions for them. It is much more concerned with dealing with current problems. The most important thing is helping people to help themselves: They should be able to cope with their lives again without therapy as soon as possible. This does not mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thought and behavioral patterns.</p>\n\n<p>As an example, in anxiety disorders, behavioral therapy often includes learning methods to help you calm down. For example, you can learn to reduce anxiety by consciously breathing in and out deeply so that your body and breathing can relax. When doing this you concentrate on your breathing instead of what is bringing on your anxiety. These kinds of techniques can help you to calm down instead of getting all worked up with anxiety.</p>\n\n<p><strong>When is cognitive behavioral therapy an option?</strong></p>\n\n<p>Cognitive behavioral therapy is used to treat conditions such as depression, anxiety and obsessive-compulsive disorders, and addictions.</p>\n\n<p>Cognitive behavioral therapy requires the patient's commitment and own initiative. Therapy can only be successful if the patient actively takes part in the treatment and also works on their problems between sessions. This can be a considerable challenge, especially with severe conditions such as depression or anxiety disorders. That is why medication is sometimes used at first to quickly relieve the worst symptoms so that psychotherapy can be started.</p>\n\n<p>Choosing a certain kind of psychotherapy also depends on the goals. If you feel the need for deep insight into the causes of your problems, cognitive behavioral therapy is probably not the right choice. It is particularly useful if you are mainly interested in tackling specific problems and are only secondarily concerned with the “why.”</p>\n\n<p><strong>How long does it take?</strong></p>\n\n<p>It is important that you and your psychotherapist have a close and trusting working relationship. It can sometimes take a while to find the right therapist.</p>\n\n<p>In the first session, you will briefly explain your current problems and outline your expectations. That forms the basis for discussing the goals of therapy and the therapy plan. The plan can be adjusted if your personal goals change over the course of therapy.</p>\n\n<p>Therapy often includes recording your own thoughts in a journal over a certain period of time. The therapist will then check the following things with you: Do I perceive things appropriately and realistically? What happens if I behave differently than I normally do in a certain situation? You will regularly discuss any problems you may have and progress that you have made.</p>\n\n<p>Cognitive behavioral therapy also uses relaxation exercises, stress and pain relief methods, and certain problem-solving strategies.</p>\n\n<p>Some people already feel much better after a few sessions, while others need treatment for several months. This depends on the kind and severity of the problems, among other things. An individual session lasts about an hour. Sessions usually take place once a week. Cognitive behavioral therapy is offered in psychotherapy practices, hospitals and rehabilitation clinics- sometimes also offered as group therapy.</p>\n\n<p><strong>Can cognitive behavioral therapy also have side effects?</strong></p>\n\n<p>Side effects resulting from psychotherapy cannot be ruled out. Being directly confronted with your problems or anxieties may be very stressful at first, and relationships might also suffer as a result. It is crucial to speak openly with your psychotherapist if any difficulties come up during therapy.</p>\n\n<blockquote>\n <p>'We saw that a third of people had a difficult memory resurface, had\n more anxiety, or felt stressed. It was also not uncommon to have a\n poor relationship with the therapist or low-quality treatment.'\n - <a href=\"https://www.sciencedaily.com/releases/2017/02/170207092804.htm\" rel=\"nofollow noreferrer\">Science Daily study of internet-based CBT</a></p>\n</blockquote>\n\n<p>The <a href=\"http://su.diva-portal.org/smash/record.jsf?pid=diva2%3A1045149&amp;dswid=6171\" rel=\"nofollow noreferrer\">same study</a> from Science Daily mentions:</p>\n\n<blockquote>\n <p>\"The general finding of the present thesis is that negative effects do\n occur in ICBT[Internet Cognitive Behavioral Therapy] and that they are characterized by deterioration,\n non-response, and adverse and unwanted events, similar to\n psychological treatments delivered face-to-face.\"</p>\n</blockquote>\n\n<p>Additionally, there are several studies of CBT's long term effects which point out:</p>\n\n<blockquote>\n <p>Psychological therapy services need to recognise that anxiety\n disorders tend to follow a chronic course and that good outcomes with\n CBT over the short term are no guarantee of good outcomes over the\n longer term.</p>\n</blockquote>\n\n<ul>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11379970\" rel=\"nofollow noreferrer\">Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland.</a></li>\n</ul>\n\n<p><strong>Is it actually effective??? Yes, current medical studies seem to indicate so.</strong></p>\n\n<blockquote>\n <p>In general, the evidence-base of CBT is very strong. However,\n additional research is needed to examine the efficacy of CBT for\n randomized-controlled studies. Moreover, except for children and\n elderly populations, no meta-analytic studies of CBT have been\n reported on specific subgroups, such as ethnic minorities and low\n income samples.</p>\n</blockquote>\n\n<p><strong>When is CBT NOT suitable?</strong></p>\n\n<p>Immediate crises in which an individual is at-risk of hurting themselves or others are commonly addressed with rapid-acting medication, since CBT might not be fast enough, relative to the situation. Sometimes, the side-effects and other risks of taking medications will out-weigh the risk of that person taking dangerous actions.</p>\n\n<p>Additionally, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297171/pdf/jrsocmed00009-0012.pdf\" rel=\"nofollow noreferrer\">an article reviewing the suitability of CBT</a> notes:</p>\n\n<blockquote>\n <p>Clients with unfocused, multiple, or very chronic problems, including\n those with a diagnostic label of severe personality disorder, are\n unlikely to benefit from short-term CBTs</p>\n</blockquote>\n\n<p><strong>All in all, it's worth considering.</strong></p>\n\n<blockquote>\n <p>Cognitive behavior therapy (CBT) is efficacious in the acute treatment\n of depression and may provide a viable alternative to antidepressant\n medications (ADM) for even more severely depressed unipolar patients\n when implemented in a competent fashion.</p>\n</blockquote>\n\n<ul>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933381/\" rel=\"nofollow noreferrer\">The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses</a> </li>\n</ul>\n\n<blockquote>\n <p>CBT does appear to have an enduring effect that protects against\n subsequent relapse and recurrence following the end of active\n treatment, something that cannot be said for medications.</p>\n</blockquote>\n\n<ul>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933381/\" rel=\"nofollow noreferrer\">Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators</a></li>\n</ul>\n\n<blockquote>\n <p>CBI was found to be superior to [Behavioral Intervention] in the reduction of panic symptoms,\n behavioral avoidance, safety behaviors, and cognitions. A large\n percentage of the CBI group patients met the criteria for clinically\n significant change with a large magnitude of change.</p>\n</blockquote>\n\n<ul>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755166/\" rel=\"nofollow noreferrer\">Cognitive behavior therapy in the treatment of panic disorder</a></li>\n</ul>\n" }, { "answer_id": 17616, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 3, "selected": true, "text": "<p>I came across <a href=\"https://psychology.stackexchange.com/q/1977/7604\">a similar question in Psychology.SE</a> whilst researching CBT for a course I was studying.</p>\n\n<h2>The short answer</h2>\n\n<p>As I will cover in the long answer, there has been a lot of articles stating that CBT is very effective, and there are articles which have stated that it is not as effective as has been claimed.</p>\n\n<blockquote>\n <p>CBT is not a single model of therapy, applicable to all clients in all situations. This has been one of the criticisms levelled at CBT, that its 'one size fits all' approach to the complex nature of human problems will, inevitably, fail to meet the needs of many, or (at best), simply focus on symptom reduction. (Reeves, 2013)</p>\n</blockquote>\n\n<p>There are a fair few factors which can prevent CBT from becoming effective, and a trained and certified CBT practitioner will be able to assess the suitability of CBT. If they operate ethically, they will not go ahead with providing CBT to someone who it would not benefit.</p>\n\n<p>One of the biggest factors which doesn't allow CBT to work is that if the client is not willing <strong>or able</strong> to challenge their thoughts and behaviours, then CBT will not be effective.</p>\n\n<h2>Long answer</h2>\n\n<p>For the long answer, which will help to explain <strong>some</strong> of the reasons why CBT may not work with some people, I will be using a lot of the work I put into an essay I had to write for my psychotherapy course which covered Cognitive Behavioural Therapy (CBT) and <a href=\"http://www.counselling-directory.org.uk/integrative-therapy.html\" rel=\"nofollow noreferrer\">integrative approaches to therapy</a>.</p>\n\n<p>CBT is an integrative model of approach and we had to look at how an integrative approach may be used to support the client within a case study provided.</p>\n\n<hr>\n\n<h3>Case study provided</h3>\n\n<p>Hassan has been referred to you for work-related stress and anxiety. He has a management position and is finding it difficult to cope. At present the information you have is that he is a 42 years old Muslim man, married with 2 children. He has lived in the UK since the age of 5 when his parents travelled here. His father died two years later and Hassan, as the eldest son, has felt responsible for the wellbeing of his mother and sisters as well as his own family.</p>\n\n<p>Your referral is through an employee assistance scheme. Hassan’s assessment shows high level of anxiety without depression. He is otherwise fit and healthy. You may offer him six sessions with a further six sessions if appropriate.</p>\n\n<hr>\n\n<p>An article (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071164\" rel=\"nofollow noreferrer\">Dhami &amp; Sheikh, 2000</a>) adapted from a chapter in <em>Caring for Muslim Patients</em>, published by Radcliffe Medical Press, Oxford, England; provides key insights needed to allow Muslim clients' concerns to be adequately heard. The vignettes section of the article gives a few sayings of Muhammad regarding relationships with parents and one of them points out that you should “strive to serve them”.</p>\n\n<p>If the client has had the opportunity to fully integrate with the western culture they are living in, they may be more open to challenging their thoughts and beliefs, however we need to be mindful that as therapists, just like we are not here to judge, for an example, on sexuality (<a href=\"https://pinktherapyblog.com/2016/02/17/why-i-am-resigning-from-the-british-association-for-counselling-and-psychotherapy/\" rel=\"nofollow noreferrer\">Pink Therapy, 2016</a>) (<a href=\"https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdf\" rel=\"nofollow noreferrer\">UKCP, 2015</a>), we are not in a position to judge whether a cultural or religious belief is right or wrong, especially when we are not priests, vicars, rabbis, imams or the like. Not only that, if the client is devout in their religious beliefs, then we are not going to change those beliefs very easily, if at all. (<a href=\"http://churchandstate.org.uk/2015/10/the-problem-with-faith-11-ways-religion-is-destroying-humanity/\" rel=\"nofollow noreferrer\">Babilonia, 2015</a>)</p>\n\n<p>The only time when we can intervene in any religious or cultural beliefs is when it is believed that laws may be broken such as the FGM Act (<a href=\"https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information\" rel=\"nofollow noreferrer\">Home Office, 2016</a>) (<a href=\"http://www.cps.gov.uk/legal/d_to_g/female_genital_mutilation/#a02\" rel=\"nofollow noreferrer\">Crown Prosecution Service, n.d.</a>), in which case, we would refer the legal case to the necessary authorities and it would be down to the legal profession and not the therapist.</p>\n\n<h3>Strengths and Limitations of integrative approaches to counselling</h3>\n\n<p><strong>Strengths</strong></p>\n\n<p>Integrative counselling and psychotherapy can be seen as one of the most effective approaches within counselling. (<a href=\"http://www.counselling-directory.org.uk/counsellor-articles/integrative-psychotherapy-is-the-best-approach\" rel=\"nofollow noreferrer\">The Counselling Directory, 2013</a>) The idea behind the integrative approach is that no single approach suits every client and therefore you use different approaches and models of therapy to suit the situation and client. The article within The Counselling Directory cited also states that integrative therapy has four different categories:</p>\n\n<ul>\n<li><strong>common factors</strong><br>Looking at the common tools available in each approach that can be useful in the therapy. Therapist/Client rapport, therapist qualities – <a href=\"https://en.wikipedia.org/wiki/Unconditional_positive_regard\" rel=\"nofollow noreferrer\">positive regard</a>, and <a href=\"https://en.wikipedia.org/wiki/Carl_Rogers#Incongruence\" rel=\"nofollow noreferrer\">congruence</a> etc. – emotional release, and clarification etc.</li>\n<li><strong>technical eclecticism</strong><br>The therapist looks at and selects the best interventions by relying on experience and knowledge of what has worked in the past for others, through theories and research literature.</li>\n<li><strong>theoretical integration</strong><br>The combination of two approaches with a common philosophy. The combined ideas are theoretically the same as each other. For example, cognitive behavioural therapy (CBT) is part of the theoretical integration category, as it is a combination of behaviourism and behaviour therapy, and cognitive theories and their application in therapeutic settings (Reeves, 2013), plus, cognitive analytical therapy is also a theoretical integration of psychodynamic therapy and cognitive therapy.</li>\n<li><strong>assimilative integration</strong><br>The therapist primarily sticks to one therapeutic approach, for example Humanistic or psychodynamic, but the therapist will use strategies and models from other therapeutic approaches as well. The combination of ideas will assimilate the pure form of the primary therapeutic approach.</li>\n</ul>\n\n<p><strong>Limitations</strong></p>\n\n<p>The limitations of any integrative therapy depend on the category of integration.</p>\n\n<p><strong><em>Theoretical integration</em></strong></p>\n\n<p>One problem identified in theoretical integration is that it is difficult to integrate some theories; for example, it is difficult to integrate psychodynamic theory and behavioural theory. The psychodynamic approach suggests that our early experiences from birth onwards and their impacts lead to our psychological problems, where behaviour theory sees problems as much more agreeable to change (Reeves, 2013). These differences result in incompatibilities between these theories.</p>\n\n<p><strong><em>Assimilative integration</em></strong></p>\n\n<p>With this kind of integration, there is no balance compared to the other forms of integration. Where the therapist is primarily psychodynamic or humanistic, for example, they will pick and choose ideas from other approaches which may not be put forward by their primary approach, but can work very effectively and contribute to the treatment or treatment plan.</p>\n\n<p><strong><em>Technical eclecticism</em></strong></p>\n\n<p>This shares similarities and differences with assimilative integration, but it has no theoretical underpinning to the approach. (<a href=\"http://www.counselling-directory.org.uk/counsellor-articles/integrative-psychotherapy-is-the-best-approach\" rel=\"nofollow noreferrer\">The Counselling Directory, 2013</a>)</p>\n\n<p>As CBT is a theoretical integrative model, and it is difficult to integrate some theories, CBT cannot and does not incorporate any psychodynamic theories. However, if you are going to work in a fully integrative manner, you need to bear in mind the theories within the psychodynamic approach too. If therapy seems to need some psychodynamic interventions, then you may need to drop CBT sessions sometimes and concentrate on the psychodynamic interventions, maybe through Cognitive Analytical Therapy instead, before continuing with CBT.</p>\n\n<h3>The basic concept of CBT</h3>\n\n<p>Cognitive Behavioural Therapy (CBT) was developed by <a href=\"https://en.wikipedia.org/wiki/Aaron_T._Beck\" rel=\"nofollow noreferrer\">Aaron Temkin Beck</a>, and as mentioned before, CBT is a combination of behaviourism and behaviour therapy, and cognitive theories and their application in therapeutic settings (Reeves, 2013). CBT helps to change how you think, hence the word <em>Cognitive</em>, and what you do, hence the word <em>Behaviour</em>.</p>\n\n<p>A difficult life situation, relationship or practical problem can lead to:</p>\n\n<ul>\n<li>Altered thinking</li>\n<li>Altered emotions and feelings</li>\n<li>Altered behaviour</li>\n<li>Altered physical feelings or symptoms</li>\n</ul>\n\n<p>Things can happen the other way too. Any of the above alterations can lead to a difficult life situation, relationship or practical problem (<a href=\"https://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx\" rel=\"nofollow noreferrer\">Royal College of Psychiatrists, n.d.</a>).</p>\n\n<p>CBT works by trying to get the client to think about a situation in a more helpful way in order to move forward using more helpful behaviours.</p>\n\n<h3>The basic concept of REBT</h3>\n\n<p>Rational Emotive Behaviour Therapy (REBT) has generally been put under the same umbrella as CBT, however although it has similarities, REBT is different. Where CBT was developed by <a href=\"https://en.wikipedia.org/wiki/Aaron_T._Beck\" rel=\"nofollow noreferrer\">Aaron Beck</a>, REBT was developed by <a href=\"https://en.wikipedia.org/wiki/Albert_Ellis\" rel=\"nofollow noreferrer\">Albert Ellis</a> when he started to lose faith in the type of psychoanalysis he was using.</p>\n\n<p>REBT is a practical and action-led model of therapy and personal growth. It doesn’t just focus on the client’s behaviours, but also allows the client to understand the behaviours of others and provide techniques that will help to solve future problems.</p>\n\n<p>Although REBT looks primarily at our current beliefs and behaviours, it also looks at the cause and effect of past experiences and beliefs which create our present beliefs and behaviours. It does this whilst aiming to change irrational beliefs into rational ones quickly rather than slowly, however, one key point to note is that the therapist does not impose rational beliefs on the client, but accepts there are non-rational beliefs that may help people achieve happiness. That way, the therapist is accepting the client’s value system.</p>\n\n<p>REBT, uses an A-B-C-D-E formula.</p>\n\n<ul>\n<li><strong>A</strong>ctivating Experience<br>Also referred to by some as the Initial Sensitising Event (ISE), this is the root cause of our unhappiness</li>\n<li><strong>B</strong>eliefs<br>Irrational self-defeating beliefs that are the source of our unhappiness, or come about as a result of the ISE</li>\n<li><strong>C</strong>onsequences<br>The neurotic symptoms and negative feelings and emotions that result from the ISE and/or Beliefs</li>\n<li><strong>D</strong>ispute<br>We must dispute and challenge these irrational beliefs in order for the client to enjoy a balanced outlook in life</li>\n<li><strong>E</strong>ffects<br>The client must learn to enjoy the effects of the new rational beliefs and get used to the changes, letting them become the new norm.</li>\n</ul>\n\n<h3>The shortfalls of CBT</h3>\n\n<p>As mentioned before, One of the ideas put forward about CBT is that it is a suitable form of therapy for all human problems. This idea can be damaging in some respects, as CBT is not suitable for all psychological conditions.</p>\n\n<p>Interestingly, whilst researching the overall efficacy of CBT, I came across a few items of note.</p>\n\n<ul>\n<li>Carl Rogers emphasised the quality of the therapeutic relationship as a necessary and sufficient condition for successful therapy (<a href=\"http://www.shoreline.edu/dchris/psych236/Documents/Rogers.pdf\" rel=\"nofollow noreferrer\">Rogers, 1957</a>) whereas CBT therapists tend to see the alliance as more instrumental in ensuring the patient’s adherence to the treatment protocol (e.g. <a href=\"https://doi.org/10.1002/cpp.481\" rel=\"nofollow noreferrer\">Dunn, et al., 2006</a>) (<a href=\"https://doi.org/10.1017/S003329171500032X\" rel=\"nofollow noreferrer\">Goldsmith, et al., 2015</a>)</li>\n<li>The Countess of Mar in the House of Lords suggested the results of a trial into the effectiveness of CBT and GET (graded exercise therapy) had been artificially inflated (BACP, 2013)</li>\n<li>An international team of researchers (<a href=\"https://doi.org/10.1002/wps.20346\" rel=\"nofollow noreferrer\">Cuijpers, et al., 2016</a>) concludes that<br>\n\n<blockquote>\n <p>…CBT is ‘probably effective’ with major depression, general anxiety disorder, panic disorder and social anxiety disorder, but not as effective as has been claimed, due to publication bias, poor quality of studies, and the use of waiting list control groups as a comparator. (BACP, 2016)</p>\n</blockquote></li>\n<li>CBT is as much based on the development of a therapeutic alliance as it is in a psychodynamic and humanistic approach. The success of therapy will be, at least partly, informed by the nature of the therapeutic process, and not simply the application of particular theoretical ideas, as some suggest (Reeves, 2013)</li>\n<li>Recent literature provides fairly strong evidence that CBT in addition to antipsychotic medication is effective in the management of acute as well as chronic schizophrenia (<a href=\"https://doi.org/10.1097/00001504-200503000-00009\" rel=\"nofollow noreferrer\">Rathod &amp; Turkington, 2005</a>). However, I would stress that CBT was not used alone in any of these studies from what I have seen. It was used carefully in conjunction with psychiatric help and antipsychotic medication.</li>\n</ul>\n\n<p>An alternative to CBT called Metacognitive Therapy (MCT) has been touted to be better than CBT. But it was developed by Manchester University (<a href=\"https://medicalxpress.com/news/2020-05-therapy-effective-cognitive-behavioral-depression.html\" rel=\"nofollow noreferrer\">Addelman, 2020</a>) and studied by Manchester University (<a href=\"https://doi.org/10.3389/fpsyg.2019.02621\" rel=\"nofollow noreferrer\">Wells, 2019</a>) so more independent studies are needed.</p>\n\n<p>Either way, if the client is not able or willing to challenge their thoughts and behaviours, then CBT will not be effective.</p>\n\n<hr>\n\n<h2>References</h2>\n\n<p>Addelman, M. (2020). <em>New therapy more effective than cognitive behavioral therapy for depression.</em>\nRetrieved from: <a href=\"https://medicalxpress.com/news/2020-05-therapy-effective-cognitive-behavioral-depression.html\" rel=\"nofollow noreferrer\">https://medicalxpress.com/news/2020-05-therapy-effective-cognitive-behavioral-depression.html</a></p>\n\n<p>Babilonia, S. (2015). <em>Challenging religious privilege in public life</em>.\nRetrieved from: <a href=\"http://churchandstate.org.uk/2015/10/the-problem-with-faith-11-ways-religion-is-destroying-humanity/\" rel=\"nofollow noreferrer\">http://churchandstate.org.uk/2015/10/the-problem-with-faith-11-ways-religion-is-destroying-humanity/</a></p>\n\n<p>BACP. (2013). Policy. <em>Therapy Today, 24</em>(2), p. 52.</p>\n\n<p>BACP. (2016). News. <em>Therapy Today, 27</em>(8), p. 6.</p>\n\n<p>Crown Prosecution Service. (n.d). <em>Female Genital Mutilation Legal Guidance.</em>\nRetrieved from: <a href=\"http://www.cps.gov.uk/legal/d_to_g/female_genital_mutilation/#a02\" rel=\"nofollow noreferrer\">http://www.cps.gov.uk/legal/d_to_g/female_genital_mutilation/#a02</a></p>\n\n<p>Cuijpers, P. et al. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. <em>World Psychiatry, 15</em>(3), pp. 245-258. <a href=\"https://doi.org/10.1002/wps.20346\" rel=\"nofollow noreferrer\">https://doi.org/10.1002/wps.20346</a></p>\n\n<p>Dhami, S. &amp; Sheikh, A. (2000). The Muslim family: predciament and promise. <em>The Western Journal of Medicine, 173</em>(5), pp. 352-356. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071164\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071164</a></p>\n\n<p>Dunn, H., Morrison, A. P. &amp; Bentall, R. P. (2006). The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clinical <em>Psychology &amp; Psychotherapy, 13</em>(3), pp. 145-152. <a href=\"https://doi.org/10.1002/cpp.481\" rel=\"nofollow noreferrer\">https://doi.org/10.1002/cpp.481</a></p>\n\n<p>Goldsmith, L. P., Lewis, S. W., Dunn, G. &amp; Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. <em>Psychological Medicine, 45</em>(11), pp. 2365-2373. <a href=\"https://doi.org/10.1017/S003329171500032X\" rel=\"nofollow noreferrer\">https://doi.org/10.1017/S003329171500032X</a></p>\n\n<p>Home Office. (2016). <em>Mandatory reporting of female genital mutilation: procedural information.</em>\nRetrieved from: <a href=\"https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information\" rel=\"nofollow noreferrer\">https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information</a></p>\n\n<p>Pink Therapy. (2016). <em>Why I am resigning from the British Association for Counselling and Psychotherapy.</em> Retrieved from: <a href=\"https://pinktherapyblog.com/2016/02/17/why-i-am-resigning-from-the-british-association-for-counselling-and-psychotherapy/\" rel=\"nofollow noreferrer\">https://pinktherapyblog.com/2016/02/17/why-i-am-resigning-from-the-british-association-for-counselling-and-psychotherapy/</a></p>\n\n<p>Rathod, S. &amp; Turkington, D. (2005). Cognitive behaviour therapy for schizophrenia: a review. <em>Current Opinion in Psychiatry, 18</em>(2), pp. 159-163. <a href=\"https://doi.org/10.1097/00001504-200503000-00009\" rel=\"nofollow noreferrer\">https://doi.org/10.1097/00001504-200503000-00009</a></p>\n\n<p>Reeves, A. (2013). <em>An Introduction to Counselling and Psychotherapy: From Theory to Practice</em>. London: SAGE Publications Ltd..</p>\n\n<p>Rogers, C. (1957). <em>The Necessary and Sufficient Conditions of Therapeutic Personality Change.</em>\nRetrieved from: <a href=\"http://www.shoreline.edu/dchris/psych236/Documents/Rogers.pdf\" rel=\"nofollow noreferrer\">http://www.shoreline.edu/dchris/psych236/Documents/Rogers.pdf</a></p>\n\n<p>Royal College of Psychiatrists. (n.d.) <em>5 Areas Assessment.</em>\nRetrieved from: <a href=\"https://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx\" rel=\"nofollow noreferrer\">https://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx</a></p>\n\n<p>The Counselling Directory. (2013). <em>Integrative Psychotherapy as an Effective Form of Counselling.</em>\nRetrieved from: <a href=\"http://www.counselling-directory.org.uk/counsellor-articles/integrative-psychotherapy-is-the-best-approach\" rel=\"nofollow noreferrer\">http://www.counselling-directory.org.uk/counsellor-articles/integrative-psychotherapy-is-the-best-approach</a></p>\n\n<p>UKCP. (2015). <em>Memorandum of Understanding (MoU) on Conversion Therapy in the UK.</em>\nAvailable at: <a href=\"https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdf\" rel=\"nofollow noreferrer\">https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdf</a></p>\n\n<p>Wells A (2019) Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. <em>Frontiers in Psychology, 10</em>(2621). <a href=\"https://doi.org/10.3389/fpsyg.2019.02621\" rel=\"nofollow noreferrer\">https://doi.org/10.3389/fpsyg.2019.02621</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/15346", "https://health.stackexchange.com", "https://health.stackexchange.com/users/140/" ]

[ { "answer_id": 15385, "author": "Kate Gregory", "author_id": 400, "author_profile": "https://health.stackexchange.com/users/400", "pm_score": 1, "selected": false, "text": "<p>If A and B occur together more than would be expected, most people assume that A causes B or B causes A. <a href=\"https://en.wikipedia.org/wiki/Confounding\" rel=\"nofollow noreferrer\">Confounding</a> refers to the case where something else affects both of them, making them appear more directly related than they truly are.</p>\n\n<p>For example, say I do a study and discover that most Olympic athletes come from wealthy families, at a rate far more than everyone else. I find a <strong>correlation</strong> between wealth and Olympic success. Some people might say \"that makes sense, they get put into expensive sports when they're young, their families can buy equipment and pay coaches, and they can concentrate on their sport instead of having to work at a job in their teens and twenties.\" But someone else might point out that tall people are generally richer than short people -- more successful, get more promotions, etc, and for most sports, taller people do better. Or is it that rich people, who eat better and have less stress, grow up taller than poor people? Anyway, maybe their tallness is causing their sports excellence and is correlated with their wealth. Height becomes a confounding factor. Does it explain all the wealth/Olympic correlation? Or most of it? Or just a little bit of it?</p>\n\n<p>Shared familial confounding refers to things like \"if your parents are tall, you'll probably also be tall and so will your siblings.\" It could also refer to \"if your parents had a lot of success in sports, they will encourage you to do it too\" -- and whatever factors led them to their success in sports may or may not still exist for you.</p>\n\n<p>You can try to separate the confounding in the athlete study by looking at sports in which being taller isn't an advantage, or sports that don't require years of expensive training, equipment, memberships, vacation trips to ski resorts etc. You can also look at adopted children, who don't share genes with their parents, to try to reduce some of the \"tall child from a tall parent\" aspect. It's hard.</p>\n\n<p>In your study, you can imagine the question is \"does getting a lot of childhood infections mean you're more likely to be psychotic?\" and they I suppose I have to deal with \"does being psychotic mean your children, who inherit your tendency to psychosis in their genes or by the way you raise them, are more likely to get a lot of infections?\" as well as \"is there something that runs in families that might make you psychotic <strong>and</strong> more likely to get a lot of childhood infections?\" - either by having a weak immune system or by being exposed to some other agent or by being raised a certain way or having certain genes. Those are shared familial confounding,</p>\n" }, { "answer_id": 15386, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 0, "selected": false, "text": "<p><a href=\"https://en.wikipedia.org/wiki/Confounding\" rel=\"nofollow noreferrer\">Confounding</a>:</p>\n\n<blockquote>\n <p>In statistics, a confounder (also confounding variable or confounding factor) is a variable that influences both the dependent variable and independent variable causing a spurious association. Confounding is a causal concept, and as such, cannot be described in terms of correlations or associations. </p>\n</blockquote>\n\n<p>That is: you see a correlation between two variables and try to understand the causality that <em>might</em> connect the two variables you look at. If there is a causal factor, but an indirect/external one concerning your two variables of interest then you only have confirmed the correlation, but are not much the wiser for the probable causal link connecting them. This is very often a problem if we like to hunt for monocausal explanations and in reality there are more factors than one influencing the outcome of any observation.</p>\n\n<p>If variables A and B are correlated, that's interesting. If A causes B it's fantastic to know. But If C causes A and B, and you do not know about C, it's still a dark box. You want to get to know C and how much iz is causing anything on A and/or B. Sometimes it is not easy to manipulate C, then you must at least identify C and better yet try to control C.</p>\n\n<p>The study mentioned in the news report is:</p>\n\n<blockquote>\n <p><a href=\"https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671412\" rel=\"nofollow noreferrer\">Association of Childhood Infection With IQ and Adult Nonaffective Psychosis in Swedish Men. A Population-Based Longitudinal Cohort and Co-relative Study</a> </p>\n \n <p>Second, is the association between childhood infection and adult psychotic disorders likely to be causal, or could this be explained by shared familial confounding? A 2015 study used co-relative control analyses to show that shared familial confounding is an unlikely explanation for the association between lower premorbid IQ and adult psychotic disorders. The IQ-psychosis association was similar in the general population and in cousin, half-sibling, and full-sibling pairs with differing IQs. If there were confounding by shared familial risk factors, the association would be expected to become progressively weaker in groups sharing increasing levels of genes and environment compared with the general population; this was not the case. These findings also suggest that unique (nonshared) environmental risk factors may contribute to lower premorbid IQ in individuals with schizophrenia. Childhood infection may be such an environmental factor not shared within families. To our knowledge, no study has examined the effect of shared familial confounding on the association between childhood infection and adult psychosis. We are not aware of any independent replication of the co-relative analyses of premorbid IQ and adult psychosis.</p>\n</blockquote>\n\n<p>This is perhaps easier to understand if already explained in a headline:</p>\n\n<blockquote>\n <p><a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2008.01974.x/full\" rel=\"nofollow noreferrer\">Familial (shared environmental and genetic) factors and the foetal origins of cardiovascular diseases and type 2 diabetes: a review of the literature</a></p>\n</blockquote>\n\n<p>In that article you have the following visual explanation:</p>\n\n<blockquote>\n <p><a href=\"https://i.stack.imgur.com/kS4K5.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/kS4K5.png\" alt=\"enter image description here\"></a><br>\n Familial (socio-economic and genetic) confounding of the association between birth weight and risk of cardiovascular diseases and type 2 diabetes.</p>\n</blockquote>\n\n<p>So, in your case, the study tries to determine whether childhood infections are the most important causal factor for explaining the observed correlation for adult psychotic disorders, or whether there are shared influences that might attribute their bit to an explanation. Among those familial variables in this study were: </p>\n\n<blockquote>\n <p>Winter birth (December to May), migration status (either parent born outside Sweden), parental history of NAP (from NPR), household crowding (ie, when the number of livable rooms minus 1 is greater than the number of people living in the house), and parental highest socioeconomic status when the participant was aged 8 to 12 years were included as potential confounders.</p>\n</blockquote>\n\n<p>That made them feel confident enough to reach the following conclusion:</p>\n\n<blockquote>\n <p>We present evidence that early childhood is a sensitive period for the effects of infection on IQ and risk of NAP. The associations of adult NAP with early-childhood infection and adolescent IQ are not fully explained by shared familial factors and may be causal. Lower premorbid IQ in NAP arises from unique environmental factors, such as early-childhood infection or other factors intimately related to this. Childhood infection may increase risk of adult NAP by affecting neurodevelopment and by exaggerating the effects of cognitive vulnerability to psychosis.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/15384", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2248/" ]

[ { "answer_id": 15455, "author": "Kate Gregory", "author_id": 400, "author_profile": "https://health.stackexchange.com/users/400", "pm_score": 2, "selected": false, "text": "<p>You are not going to find what you seek, because any list small enough to be a decent answer here would be an overly restrictive diet - you need variety.</p>\n\n<p>That said, if you buy:</p>\n\n<ul>\n<li>rice (white or brown - you'll be getting plenty of fibre so white is ok)</li>\n<li>lentils (not the expensive du puy ones, any other kind)</li>\n<li>dried beans</li>\n<li>vegetables that keep without refrigeration (carrots, onions, potatoes, cabbage etc)</li>\n<li>canned tomatoes, tomato sauce etc</li>\n<li>pasta</li>\n<li>greens (eg kale) when you can - buy them and use them the same day, then don't have greens until you shop again</li>\n<li>canned tuna and salmon</li>\n<li>oatmeal (not the instant kind) for breakfast, and some dried fruit to throw into it</li>\n<li>some spices as your budget allows</li>\n<li>olive or canola oil (keeps without refrigeration) for frying the veg to start a flavourful soup, stew, or sauce</li>\n</ul>\n\n<p>You can use these to create daily meals like this:</p>\n\n<ul>\n<li>breakfast: oatmeal and dried fruit</li>\n<li>lunch: soup with rice or noodles, lentils, and a lot of vegetables</li>\n<li>dinner: stew with similar ingredients to the lunch</li>\n</ul>\n\n<p>You can vary this by making a salad of greens, carrot, cabbage, and the canned fish, by buying a loaf of bread and making sandwiches of peanut butter or tuna or salmon salad (this will require some mayonnaise) and so on. </p>\n\n<p>You will be able to eat for WELL under your budget. These foods will provide protein, vitamin C, vitamin A, and fibre. You might be a little low on calcium, so drinking milk or eating cheese can take care of that, though they require refrigeration. You could go out, buy a litre of milk for a few dollars and a small (half pound?) package of cheese and make macaroni and cheese from that (drinking the excess milk) and be in a good place. (Or take a calcium supplement, or buy a milk-based drink when you go out each day.) If you can grow your own food, then you can have greens every day and do even better.</p>\n\n<p>Looking for some references about what makes a healthy diet? Here's <a href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/multimedia/mediterranean-diet/sls-20077104\" rel=\"nofollow noreferrer\">the Mayo Clinic on the Mediterranean Diet</a>. Here's the <a href=\"https://bluezones.com/recipes/food-guidelines/\" rel=\"nofollow noreferrer\">Blue Zones guidelines on eating</a>. You can find a lot of advice like this online.</p>\n\n<p>$10 a day is actually a high budget if you are only buying food with it (no toilet paper, soap, shampoo etc) and you are not buying meat or processed foods such as canned soup or frozen dinners. For example Amazon will sell me 2 kg of rice for $5 Cdn, which is probably $4 US and <a href=\"http://www.cooksinfo.com/rice\" rel=\"nofollow noreferrer\">this site</a> suggests 50g per serving. Even if you double that you would get 20 servings for your $4, or 20 cents a serving. Beans? Dried beans on Amazon look like $4 Cdn a pound, and again you won't eat anywhere near a pound of dried beans per serving. And of course your local Asian supermarket is going to be cheaper than Amazon prices. So feeding just one person on $10 a day is not challenging. Eating essentially the same food day after day, having to cook for 30-60 minutes each day, having to remember to soak the beans the night before -- these things become challenging and this is why your local store sells so much frozen pizza. </p>\n" }, { "answer_id": 15471, "author": "paparazzo", "author_id": 6848, "author_profile": "https://health.stackexchange.com/users/6848", "pm_score": -1, "selected": false, "text": "<p><a href=\"https://www.dsld.nlm.nih.gov/dsld/dailyvalue.jsp\" rel=\"nofollow noreferrer\">Nutrition guidelines</a> </p>\n\n<p>Total fat = 65 g<br>\nSat fat = 20 g<br>\nCholesteral = 300 mg<br>\nSodium = 2,400 mg<br>\nCarbohydrate = 300 g<br>\nProtein = 50 g<br>\nCalories 2000 </p>\n\n<p>Lets look at a single day example </p>\n\n<pre><code> fat chol Na Carb protein cal cost\n 65 300 2400 300 50 2000 \n\n1 cup dried beans 0 0 60 88 28 240 $0.20\n1 egg 6 185 70 0 6 70 $0.25\nbanana 0.4 0 1 27 1.3 105 $0.25\n1 cup yogurt 8.5 32 113 12 9 1 49 $0.80\n2 cup red lettuce 0.2 0 14 1.2 0.8 28 $0.20\n1 tblspn olive oil 14 0 0 0 0 119 $0.40\n2 slice ww bread 2 0 224 24 7.2 140 $0.40\n1 red pepper 0.4 0 5 7 1.2 37 $1.00\n\n 31.5 217 487 159.2 53.5 888 $3.50 \n</code></pre>\n\n<p>Say two meals like this. You get all essentials (a little short on cal) for $7.00. And you even splurge on a red pepper. If anything heavy on protein so have rice for the other meal. Don't have an egg on the other meal because of chol. You could eat pretty good for $7.00 a day.</p>\n\n<p>You only need calcium a couple days a week. Eat the yogurt or milk the day you shop. Red pepper is kind of pricey but rich in vitamins. Substitute other vitamin rich vegetables. </p>\n\n<p>Since you have basic nutrients can add in cheap white potatoes for calories. </p>\n\n<p>For green you can go with red lettuce, broccoli, asparagus etc. Stay away from iceberg lettuce as low in calories and nutrients.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15453", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13074/" ]

[ { "answer_id": 15459, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 3, "selected": true, "text": "<p>We can't give personal advice but the CDC does give generic advice, and talks about people over the age of 65 with uncertain immunization status.</p>\n\n<p><a href=\"https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf\" rel=\"nofollow noreferrer\">https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/H2W8b.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/H2W8b.png\" alt=\"enter image description here\"></a></p>\n\n<p>And in general, the elderly and others with impaired immune systems often require more frequent dosing of vaccines to ensure immunity is maintained.</p>\n" }, { "answer_id": 15460, "author": "John Melville", "author_id": 13080, "author_profile": "https://health.stackexchange.com/users/13080", "pm_score": 2, "selected": false, "text": "<p>I think this is likely to be benign. The OP does not say how long the interval between the injections was, but let us presume it was at least several weeks.</p>\n\n<p>When we do catch up immunizations for infants, they often get spaced at roughly monthly intervals without ill effect. And the mechanistic idea of vaccines seems to suggest that a second dose would have few ill effects. (There would be very little difference between a second dose of vaccine and an encounter with wild type virus. The whole idea of the vaccine is that encountering the virus again will <strong>not</strong> make you sick.)</p>\n" } ]

[ "https://health.stackexchange.com/questions/15457", "https://health.stackexchange.com", "https://health.stackexchange.com/users/8973/" ]

[ { "answer_id": 15477, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>Yes.</p>\n\n<p><a href=\"https://medlineplus.gov/ency/article/000313.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>:</p>\n\n<blockquote>\n <p>People with <strong>type 2</strong> diabetes often have no symptoms at first. They may not have symptoms for many years.</p>\n</blockquote>\n\n<p><a href=\"https://books.google.si/books?id=sZODtZoWvlEC&amp;pg=PA413&amp;lpg=PA413&amp;dq=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;source=bl&amp;ots=m5eziNcqgX&amp;sig=-Vc1_dQ_lvsbLtSZJ9SFNw0IlFY&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;f=false\" rel=\"nofollow noreferrer\">Google Books: The Epidemiology of Diabetes Mellitus, p. 413...Recent Trends In Screening and Prevention of <strong>Type 1</strong> Diabetes</a>:</p>\n\n<blockquote>\n <p>Mild asymptomatic hyperglycemia precedes by months or years overt insulin dependence among persons with islet auto-antibodies.</p>\n</blockquote>\n\n<p>In diabetes type 1, symptoms usually develop much quicker, though.</p>\n\n<p><a href=\"https://www.diabetes.co.uk/diabetes-symptoms.html\" rel=\"nofollow noreferrer\">Diabetes.co.uk</a>:</p>\n\n<blockquote>\n <p>In type 1 diabetes, the signs and symptoms can develop very quickly,\n and can develop significantly over the course of weeks or even days -\n particularly in children or adolescents.</p>\n</blockquote>\n" }, { "answer_id": 16870, "author": "Hichame Yessou", "author_id": 7307, "author_profile": "https://health.stackexchange.com/users/7307", "pm_score": 2, "selected": false, "text": "<p>Speaking for type 1 diabetes, and supposing that a patient has exited his/her \"Honeymoon\" phase, the timespan before accusing severe symptoms (hypo/hyperglycemia) is very short and highly depending on <strong>what it is being eaten</strong> and on the <strong>physical activity</strong> done.<br> There are several indicators that could raise red flags, like: <strong>drinking a high amount of water</strong> (5-6 to 9-10 litres per day) with the consequent high frequency of urinating (a symptom of hyperglycemia), the <strong>need of eating voraciously</strong> and with more quantities (a symptom of hypoglycemia), and so on. <br> \nThe fastest way to detect whether or not these symptoms are related to diabetes is with a simple finger stick blood sugar test.</p>\n\n<p><a href=\"http://www.jdrf.org/t1d-resources/symptoms/\" rel=\"nofollow noreferrer\">Symptoms</a> <br>\n<a href=\"https://www.diabetes.co.uk/blood-glucose/honeymoon-phase.html\" rel=\"nofollow noreferrer\">Honeymoon period</a><br>\n<a href=\"https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017\" rel=\"nofollow noreferrer\">Diagnostic</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/15475", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13092/" ]

[ { "answer_id": 15477, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>Yes.</p>\n\n<p><a href=\"https://medlineplus.gov/ency/article/000313.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>:</p>\n\n<blockquote>\n <p>People with <strong>type 2</strong> diabetes often have no symptoms at first. They may not have symptoms for many years.</p>\n</blockquote>\n\n<p><a href=\"https://books.google.si/books?id=sZODtZoWvlEC&amp;pg=PA413&amp;lpg=PA413&amp;dq=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;source=bl&amp;ots=m5eziNcqgX&amp;sig=-Vc1_dQ_lvsbLtSZJ9SFNw0IlFY&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;f=false\" rel=\"nofollow noreferrer\">Google Books: The Epidemiology of Diabetes Mellitus, p. 413...Recent Trends In Screening and Prevention of <strong>Type 1</strong> Diabetes</a>:</p>\n\n<blockquote>\n <p>Mild asymptomatic hyperglycemia precedes by months or years overt insulin dependence among persons with islet auto-antibodies.</p>\n</blockquote>\n\n<p>In diabetes type 1, symptoms usually develop much quicker, though.</p>\n\n<p><a href=\"https://www.diabetes.co.uk/diabetes-symptoms.html\" rel=\"nofollow noreferrer\">Diabetes.co.uk</a>:</p>\n\n<blockquote>\n <p>In type 1 diabetes, the signs and symptoms can develop very quickly,\n and can develop significantly over the course of weeks or even days -\n particularly in children or adolescents.</p>\n</blockquote>\n" }, { "answer_id": 16870, "author": "Hichame Yessou", "author_id": 7307, "author_profile": "https://health.stackexchange.com/users/7307", "pm_score": 2, "selected": false, "text": "<p>Speaking for type 1 diabetes, and supposing that a patient has exited his/her \"Honeymoon\" phase, the timespan before accusing severe symptoms (hypo/hyperglycemia) is very short and highly depending on <strong>what it is being eaten</strong> and on the <strong>physical activity</strong> done.<br> There are several indicators that could raise red flags, like: <strong>drinking a high amount of water</strong> (5-6 to 9-10 litres per day) with the consequent high frequency of urinating (a symptom of hyperglycemia), the <strong>need of eating voraciously</strong> and with more quantities (a symptom of hypoglycemia), and so on. <br> \nThe fastest way to detect whether or not these symptoms are related to diabetes is with a simple finger stick blood sugar test.</p>\n\n<p><a href=\"http://www.jdrf.org/t1d-resources/symptoms/\" rel=\"nofollow noreferrer\">Symptoms</a> <br>\n<a href=\"https://www.diabetes.co.uk/blood-glucose/honeymoon-phase.html\" rel=\"nofollow noreferrer\">Honeymoon period</a><br>\n<a href=\"https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017\" rel=\"nofollow noreferrer\">Diagnostic</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/15514", "https://health.stackexchange.com", "https://health.stackexchange.com/users/8212/" ]

[ { "answer_id": 15547, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 1, "selected": false, "text": "<p>No, not that I'm aware. You might see this referred to in Chiropractic charts but <a href=\"https://en.wikipedia.org/wiki/Chiropractic\" rel=\"nofollow noreferrer\">chiropractic</a> is an alternative non-science based system.</p>\n<blockquote>\n<p>Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Proponents claim that such disorders affect general health via the nervous system. These claims are not backed by any evidence.</p>\n<p>^{Sources cited by the wikipedia article:}<br />\n^{- Ernst E (May 2008). &quot;Chiropractic: a critical evaluation&quot;. Journal of Pain and Symptom Management. 35 (5): 544–62. doi:<a href=\"https://doi.org/10.1016%2Fj.jpainsymman.2007.07.004\" rel=\"nofollow noreferrer\">10.1016/j.jpainsymman.2007.07.004</a>.}<br />\n^{- &quot;<a href=\"https://www.nhs.uk/conditions/chiropractic/\" rel=\"nofollow noreferrer\">Chiropractic</a>&quot;. NHS Choices. 20 August 2014. Retrieved 19 September 2016.}</p>\n</blockquote>\n" }, { "answer_id": 15556, "author": "Dylan Russell", "author_id": 12870, "author_profile": "https://health.stackexchange.com/users/12870", "pm_score": 2, "selected": false, "text": "<p>I'm not entirely certain what you mean by \"spine misalignment\", but there are certainly traumatic injuries to the cervical neck that can indirectly result in full or partial blindness. This would usually occur due to neurovascular compromise. Cervical artery dissections with subsequent cerebral infarction and homonymous hemianopia are a classic cause of visual loss after trauma.</p>\n\n<p>For further reading on post-traumatic visual loss, I would refer you to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998754/\" rel=\"nofollow noreferrer\">this review article</a>.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15544", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12815/" ]

[ { "answer_id": 15561, "author": "bertieb", "author_id": 8653, "author_profile": "https://health.stackexchange.com/users/8653", "pm_score": 3, "selected": true, "text": "<h1>In some cases, antibiotics are given to close contacts</h1>\n<p>Bacterial <a href=\"https://www.nhs.uk/conditions/meningitis/\" rel=\"nofollow noreferrer\">meningitis</a> is an example of an infection which antibitics would be given to close contacts of someone suffering from a confirmed case, whether the contacts displayed signs and symptoms of meningitis themselves- a <em>prophylactic</em> antibiotic supply.</p>\n<p>There are a number of official recommendations on this (for the UK at least):</p>\n<p>NICE have a <a href=\"https://cks.nice.org.uk/meningitis-bacterial-meningitis-and-meningococcal-disease#!scenario:2\" rel=\"nofollow noreferrer\">'managing close contacts' scenario</a>:</p>\n<blockquote>\n<p>Prophylaxis against meningococcal disease should be considered for the following close contacts, regardless of meningococcal vaccination status:</p>\n<ul>\n<li>People who have had prolonged close contact with the case in a household-type setting during the 7 days before onset of illness (for example, people who are living or sleeping in the same household, pupils in the same dormitory, boy/girlfriends, or university students sharing a kitchen in a hall of residence).</li>\n</ul>\n<p>[...]</p>\n<p>Antibiotic prophylaxis should be given as soon as possible (ideally within 24 hours) after the diagnosis of the index case.</p>\n</blockquote>\n<p>There is also <a href=\"https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/322008/Guidance_for_management_of_meningococcal_disease_pdf.pdf\" rel=\"nofollow noreferrer\">UK government guidance (dating from 2012) on choice of antibiotic</a> [PDF warning], which recommends ciprofloxacin over rifampicin.</p>\n" }, { "answer_id": 15565, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 2, "selected": false, "text": "<p>Each person needs to be treated on their own merits except in the situation as described in bertieb's answer where you have a highly virulent and potentially lethal infection. And then there's the question of tuberculosis where infected contacts also <a href=\"http://www.who.int/tb/areas-of-work/laboratory/contact-investigation/en/\" rel=\"nofollow noreferrer\">need to be treated</a>.</p>\n\n<p>So, if the parents or other contacts have the same infection, and are not able to clear this themselves, then yes they need to be treated on their own merits.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15557", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6814/" ]

[ { "answer_id": 15560, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>Yes, an abdominal CT scan can reveal abnormal mucous lining in the small intestine, for example, in Crohn's disease (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144110/\" rel=\"nofollow noreferrer\">PubMed Central</a>), lymphoma, etc.</p>\n\n<p>Additional investigations, such as capsule endoscopy and biopsy with histological examination, are usually needed to establish the exact diagnosis.</p>\n" }, { "answer_id": 15562, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 0, "selected": false, "text": "<p><a href=\"https://doi.org/10.1148/rg.263055162\" rel=\"nofollow noreferrer\">https://doi.org/10.1148/rg.263055162</a></p>\n\n<blockquote>\n <p>Computed tomographic (CT) enterography combines the improved spatial and temporal resolution of multi–detector row CT with large volumes of ingested neutral enteric contrast material to permit visualization of the small bowel wall and lumen. Adequate luminal distention can usually be achieved with oral hyperhydration, thereby obviating nasoenteric intubation and making CT enterography a useful, well-tolerated study for the evaluation of diseases affecting the mucosa and bowel wall. Unlike routine CT, which has been used to detect the extraenteric complications of Crohn disease such as fistula and abscess, CT enterography clearly depicts the small bowel inflammation associated with Crohn disease by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory changes. As a result, CT enterography is becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/15559", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12940/" ]

[ { "answer_id": 15575, "author": "Kenneth Kho", "author_id": 13142, "author_profile": "https://health.stackexchange.com/users/13142", "pm_score": 1, "selected": false, "text": "<p>This is quite simple. Prostatitis or not, you will naturally urinate more in lower temperature. <a href=\"https://www.scienceabc.com/humans/why-do-we-urinate-more-when-were-cold.html\" rel=\"nofollow noreferrer\">https://www.scienceabc.com/humans/why-do-we-urinate-more-when-were-cold.html</a> Frequent urination would probably makes you suffer more.</p>\n" }, { "answer_id": 15594, "author": "Dan.k", "author_id": 13119, "author_profile": "https://health.stackexchange.com/users/13119", "pm_score": -1, "selected": false, "text": "<p>With temperature dropping, the sympathetic nerve become more exciting. The prostate gland shrinks while crypt and blood vessel expands. This results in chronic congestion, which increases the internal pressure within the urethra and the risk of a backward flow. </p>\n\n<p>The change of the urethra intensifies the blockage of prostate fluid and it triggers prostatitis with symptoms of:</p>\n\n<ul>\n<li>frequent and urgent urination</li>\n<li>painful urination</li>\n<li>abdominal pain</li>\n<li>pain in testicles</li>\n</ul>\n" } ]

[ "https://health.stackexchange.com/questions/15571", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13050/" ]

[ { "answer_id": 15656, "author": "Mark", "author_id": 333, "author_profile": "https://health.stackexchange.com/users/333", "pm_score": 4, "selected": false, "text": "<p><a href=\"https://en.wikipedia.org/wiki/Prostatitis\" rel=\"noreferrer\">Prostatitis</a> isn't an STD, or a contagious disease, or even a disease at all. The term \"prostatitis\" simply refers to <a href=\"https://en.wikipedia.org/wiki/Inflammation\" rel=\"noreferrer\">inflammation</a> of the prostate gland. The underlying condition causing the inflammation could be any of a number of things, which, yes, include contagious and sexually-transmitted diseases.</p>\n" }, { "answer_id": 23740, "author": "Amandababy", "author_id": 17291, "author_profile": "https://health.stackexchange.com/users/17291", "pm_score": 0, "selected": false, "text": "<p>Prostatitis is a common disease in men. It's neither a STD nor a contagious disease. <em><a href=\"https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766\" rel=\"nofollow noreferrer\">Prostatitis</a></em> often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.</p>\n\n<p>Prostatitis treatments depend on the underlying cause.Like antibiotics or a diuretic and anti-inflammatory pill. Bedides, there are some home remedies, like have a warm sitz bath, \nand avoid activities that can irritate your prostate, such as prolonged sitting or bicycling.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15624", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13177/" ]

[ { "answer_id": 15874, "author": "kitkat1224", "author_id": 13283, "author_profile": "https://health.stackexchange.com/users/13283", "pm_score": -1, "selected": false, "text": "<p>This is tough question to answer because it depends so much on the exact location, the type of highway, how busy it is, and the surrounding vegetation, structures, wind, etc.</p>\n\n<p>Pollution is mainly measured not only by the types of chemical and compounds in the air, but also by their size... as in Particulate Matter PM2.5, and P10 which denotes how large the particles they are. \nIn most countries there does occur air-quality monitoring in some locations. \nHowever, when it comes to particulate matter, there is a the dose-response which indicated that there is no level where health effects do not occur.</p>\n\n<p>Furthermore, it's not just cars that this pollution comes form, as they can occur naturally or in industrial areas. For example, I live in a mining town, and we measure air quality on a regular basis due to the coal dust which blows over from the mines and settles over the town. </p>\n\n<p>The exact answer to 'how far away' cannot be answered for definite. You should live a location where the air-quality is well within the national standards for your country (if you have any).</p>\n\n<p>At the very least, the further away the better, at least 1km would take you out of the higher risk zones.</p>\n\n<p>References: </p>\n\n<p>[1].<a href=\"http://npi.gov.au/resource/particulate-matter-pm10-and-pm25\" rel=\"nofollow noreferrer\">http://npi.gov.au/resource/particulate-matter-pm10-and-pm25</a>\n[2].<a href=\"https://sandiego.urbdezine.com/2015/05/28/what-is-a-safe-distance-to-live-or-work-near-high-auto-emission-roads/\" rel=\"nofollow noreferrer\">https://sandiego.urbdezine.com/2015/05/28/what-is-a-safe-distance-to-live-or-work-near-high-auto-emission-roads/</a></p>\n" }, { "answer_id": 15875, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 4, "selected": true, "text": "<p>To answer this question you would need to find the source of the information. I found the study mentioned in the article in the Toronto Star (<a href=\"https://doi.org/10.1016/S0140-6736(16)32399-6\" rel=\"noreferrer\">Chen, et al. 2017</a>); and while studying risks of dementia, Parkinson's disease and multiple sclerosis, with emphasis mine, they said:</p>\n\n<blockquote>\n <p>In this population-based cohort study, we assembled two population-based cohorts including all adults aged 20–50 years (about 4·4 million; multiple sclerosis cohort) and all adults aged 55–85 years (about 2·2 million; dementia or Parkinson's disease cohort) who resided in Ontario, Canada on April 1, 2001. <strong>Eligible patients were free of these neurological diseases, Ontario residents for 5 years or longer, and Canadian-born.</strong></p>\n</blockquote>\n\n<p>Between 2001, and 2012, they identified </p>\n\n<ul>\n<li>243,611 incident cases of dementia,</li>\n<li>31,577 cases of Parkinson's disease, and</li>\n<li>9,247 cases of multiple sclerosis.</li>\n</ul>\n\n<p>They provided adjusted hazard ratios in the study - a comparison of the effect of different variables on survival or other outcomes that develop over time (Dawson, 2008). See also <a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/hazard-ratio\" rel=\"noreferrer\">https://www.sciencedirect.com/topics/medicine-and-dentistry/hazard-ratio</a></p>\n\n<p>The adjusted hazard ratio of incident dementia was</p>\n\n<ul>\n<li>1·07 for people living less than 50 m from a major traffic road (95% CI 1·06–1·08),</li>\n<li>1·04 (1·02–1·05) for 50–100 m,</li>\n<li>1·02 (1·01–1·03) for 101–200 m, and</li>\n<li>1·00 (0·99–1·01) for 201–300 m\nversus further than 300 m (<em>p</em> for trend=0·0349).</li>\n</ul>\n\n<blockquote>\n <p>No association was found with Parkinson's disease or multiple sclerosis.</p>\n</blockquote>\n\n<p>Based on the averages used in the study, statistically speaking you will need to be living at least 200 metres (just over 218.5 yards) away from any major road to be relatively free of risk.</p>\n\n<h2>References</h2>\n\n<p>Chen, H., Kwong, J. C., Copes, R., Tu, K., Villeneuve, P. J., Van Donkelaar, A., ... &amp; Wilton, A. S. (2017). Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study. <em>The Lancet</em>, 389(10070), 718-726.<br>DOI: <a href=\"https://doi.org/10.1016/S0140-6736(16)32399-6\" rel=\"noreferrer\">10.1016/S0140-6736(16)32399-6</a></p>\n\n<p>Dawson, G. F. (2008). Measures of Effect. In: <em>Easy Interpretation of Biostatistics: The Vital Link to Applying Evidence in Medical Decisions</em>. Philadelphia, PA: Saunders<br>DOI: <a href=\"https://doi.org/10.1016/B978-1-4160-3142-0.50027-4\" rel=\"noreferrer\">10.1016/B978-1-4160-3142-0.50027-4</a> (Free Preview)</p>\n" }, { "answer_id": 18228, "author": "Terrance38", "author_id": 15337, "author_profile": "https://health.stackexchange.com/users/15337", "pm_score": 2, "selected": false, "text": "<p>There are many factors to consider. The pollution level (and risk) depends on at least the following:</p>\n\n<ul>\n<li>typical wind direction during rush hour</li>\n<li>density of trees between you and the road</li>\n<li>elevation difference between you and the road</li>\n<li>presence of a noise wall between you and the road</li>\n<li>level and type of traffic on the road</li>\n</ul>\n\n<p>This page aggregated a large number of studies to try to answer this and settled on greater than 300 meters. Based on the studies cited in it and everything I've seen, that seems reasonable.</p>\n\n<p><a href=\"http://blog.cityprojections.com/2018/12/how-far-should-you-live-from-road-to.html\" rel=\"nofollow noreferrer\">http://blog.cityprojections.com/2018/12/how-far-should-you-live-from-road-to.html</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/15865", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13373/" ]

[ { "answer_id": 15908, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 3, "selected": true, "text": "<p>The tea preparation used in the study was described:</p>\n\n<blockquote>\n <p>Cold Hibiscus extract was prepared by soaking 15 g of Hibiscus calyces in 500 ml of cold distilled water at 4&deg;C for a whole day. The boiled extract was prepared by macerating 15 g of H. sabdariffa calyces with 500 ml boiling distilled water for 15 min and allowed to cool to room temperature. Both extracts were filtered through Whatman’s # 1 filter paper. Each mouse was given orally 0.2 ml of the prepared extract, which contains 6 mg of Hibiscus calyces. This represents a dose of 200 mg/kg body weight and is equivalent to 2 cups consumed by an average person.</p>\n</blockquote>\n\n<p>In the results of the study, cold\nand boiled H. <em>sabdariffa</em> extract treated mice had 43.5% and 52.5% abnormal spermatozoa, respectively. How it would play out in humans is difficult to say.</p>\n\n<p>The paper was concluded with the following:</p>\n\n<blockquote>\n <p>The results also suggest that the apparent safety of this herb should be re-evaluated and precautions taken against heavy over-consumption as a beverage, although the sensitivity\n toward this herb may be different for man in relation to rodents and care must be taken in extrapolating animal experimental studies with humans.</p>\n</blockquote>\n" }, { "answer_id": 15911, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": false, "text": "<p>There is a very bold distinction in terminology to observe between impotence – or <a href=\"https://en.wikipedia.org/wiki/Erectile_dysfunction\" rel=\"nofollow noreferrer\">erectile dysfunction</a> –, and <a href=\"https://en.wikipedia.org/wiki/Infertility\" rel=\"nofollow noreferrer\">fertility</a> or changes to the testis and spermatozoa.</p>\n\n<p>The <a href=\"https://www.sciencedirect.com/science/article/pii/S0065128111001164?via%3Dihub\" rel=\"nofollow noreferrer\">study in question</a> does not say anything about impotence but reported a </p>\n\n<blockquote>\n <p>The results clearly demonstrate that aqueous extracts from dried calyx of H. sabdariffa, either cold or boiled, alter normal sperm morphology and testicular ultrastructure and adversely influence the male reproductive <strong><em>fertility</em></strong> in albino mice.</p>\n</blockquote>\n\n<p>This cautionary tale is an interesting result and has to be followed up, just like the authors conclude, not in the least, because:</p>\n\n<blockquote>\n <p>The results also suggest that the apparent safety of this herb should be re-evaluated and precautions taken against heavy over-consumption as a beverage, although the sensitivity toward this herb may be different for man in relation to rodents and care must be taken in extrapolating animal experimental studies with humans.</p>\n</blockquote>\n\n<p><strong>But</strong> </p>\n\n<p>These results are not only new but solitary. Not only is this herb apparently used abundantly and already for a very long time, the traditional folk wisdom for this herb has no adverse effects recorded. While that may not count as much, it is a weak indicator not to be dismissed entirely.</p>\n\n<p>Contrasting to Mahmoud's findings, a recent review found </p>\n\n<blockquote>\n <p>Additionally, deleterious effects on the testis and spermatozoa and an adverse influence in the male reproductive fertility of albino mice were also reported after a cHs WE was administered daily for 4 weeks in a dose of 200 mg/kg (Y. I. Mahmoud, 2012). In contrast to these studies, long term administration of Hs WE for 10 weeks and hibiscus anthocyanins (50–200 mg/kg b.w.) for 5 days did not affect the male reproductive system in rats (Ali et al., 2012).[…]<br>\n <strong>Based on the data presented above, dosages up to 200 mg/kg should be safe and not show signs of toxicity, but further studies, most importantly with chemically well characterised extracts, are warranted.[…]</strong>\n Taken together, the data available today from preclinical and clinical studies does not provide substantiated evidence of any therapeutically relevant interaction potential of commonplace teas or beverages containing hibiscus and its preparations. This complements the evidence based on the complete absence of drug interaction case reports involving hibiscus in the scientific literature.<br>\n _{From: <a href=\"https://www.sciencedirect.com/science/article/pii/S030881461400692X?via%3Dihub\" rel=\"nofollow noreferrer\">Inês Da-Costa-Rocha et al.: \"Hibiscus sabdariffa L. – A phytochemical and pharmacological review\", Food Chemistry 165 (2014) 424–443</a>, DOI: <a href=\"https://doi.org/10.1016/j.foodchem.2014.05.002\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/j.foodchem.2014.05.002</a>}</p>\n</blockquote>\n\n<p>Most of the available data indicates a large range of overall safety for this herb. Even the systematic review above bases its evaluation on the Mahmoud paper in concluding that 200mg/kg body weight per day should be of no concern.</p>\n\n<p>But the Mahmoud paper has several <em>grave</em> weaknesses:</p>\n\n<ul>\n<li>the whole shebang of scientific procedures is based on a single batch of herbs</li>\n<li>this batch was procured on a local market</li>\n<li>the batch was not tested for pesticides or similar adulterations</li>\n<li>the batch was chemically not very well defined at all, but just used as is, phytochemicals in natural products vary in sometimes astounding amounts</li>\n<li>no hint of a possible mechanism of action was given</li>\n</ul>\n\n<p>Other studies on Hibiscus species come to almost diametrically opposed conclusions regarding infertility for sabdariffa:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27847454\" rel=\"nofollow noreferrer\">Idris: Protective role of Hibiscus sabdariffa calyx extract against streptozotocin induced sperm damage in diabetic rats. 2012</a></p>\n</blockquote>\n\n<p>Or regarding impotence, as one herb traditionally used against impotence in male was reported as Hibiscus mutabilis (<a href=\"https://www.sciencedirect.com/science/article/pii/S0378874117313375?via%3Dihub\" rel=\"nofollow noreferrer\">Ethnomedicobotanical study of indigenous knowledge on medicinal plants used for the treatment of reproductive problems in Nalbari district, Assam, India, 2018</a>)</p>\n\n<h3>Summary</h3>\n\n<p>There is no evidence presented for <em>this</em> hibiscus species (sabdariffa) as a cause for impotence. A single study came to the conclusion that Hibiscus sabdariffa extract might interfere with rodent fertility. </p>\n\n<p>Even if rodents displayed detrimental effects, which are nowhere sure to be translatable into human effects, in this unreplicated, not followed-up, single study with its severe limitations, even rodents might rest assured until:</p>\n\n<ul>\n<li>the effects are replicated </li>\n<li>in human cells at least</li>\n<li>the chemical makeup of samples is ascertained</li>\n<li>possible adulterations are ruled out</li>\n<li>(a mechanism of action is proposed)</li>\n</ul>\n\n<p>Taking too large doses of anything is not recommended anyway. For this herb it seems as if two cups a day will not do much harm.</p>\n" } ]

[ "https://health.stackexchange.com/questions/15906", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11042/" ]

[ { "answer_id": 15918, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 2, "selected": false, "text": "<p>Probably nothing diagnostic would be seen using a handheld magnifying lens. Preferably one would use a microscope but that also has limitations.</p>\n\n<blockquote>\n <p>Microscopic examination of the infected hairs may provide immediate confirmation of the diagnosis of ringworm and establishes whether the fungus is small-spore or large-spore ectothrix or endothrix.</p>\n</blockquote>\n\n<p><a href=\"https://emedicine.medscape.com/article/1091351-workup\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/1091351-workup</a></p>\n" }, { "answer_id": 15932, "author": "Iamnenebi", "author_id": 13431, "author_profile": "https://health.stackexchange.com/users/13431", "pm_score": 0, "selected": false, "text": "<p>You will see hyphae (which produce spores that appear as crusted plaque-likelesions on the scalp)</p>\n\n<p><a href=\"https://www.hairlossrevolution.com/fungal-infections/\" rel=\"nofollow noreferrer\">HairlossRevolution</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/15915", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13431/" ]

[ { "answer_id": 16032, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 2, "selected": false, "text": "<p>Most studies have mostly looked at fish or fish oil consumption and the incidence of rheumatoid arthritis whereas you appear to be asking about a chondroprotective effect of fish oil for the development of osteoarthritis. </p>\n\n<p>This study <a href=\"https://doi.org/10.1093/rheumatology/key011\" rel=\"nofollow noreferrer\">What is the evidence for a role for diet and nutrition in osteoarthritis?</a> published April 2018 has reviewed the literature as it is and has concluded</p>\n\n<blockquote>\n <p>Since diet may potentially affect OA, we reviewed the literature on the relationship between nutrition and OA risk or progression, aiming to provide guidance for clinicians. For overweight/obese patients, weight reduction, ideally incorporating exercise, is paramount. The association between metabolic syndrome, type-2 diabetes and OA risk or progression may partly explain the apparent benefit of dietary-lipid modification resulting from increased consumption of long-chain omega-3 fatty-acids from oily fish/fish oil supplements. A strong association between OA and raised serum cholesterol together with clinical effects in statin users suggests a potential benefit of reduction of cholesterol by dietary means. </p>\n</blockquote>\n\n<p>So, you might prevent osteoarthritis by keeping your cholesterol (and weight) low, and the pain might be less noticeable should you develop osteoarthritis if you have a diet high in long-chain n-3 fatty-acids.</p>\n" }, { "answer_id": 16064, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>Intense athletic training could be the risk for physical damage (\"wear and tear\") of the joint cartilage. The closest condition to this I can think of is osteoarthritis.</p>\n\n<p><strong>Fish oil does not seem to prevent or treat osteoarthritis.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295086/\" rel=\"nofollow noreferrer\">Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials (PubMed Central, 2017)</a>:</p>\n\n<blockquote>\n <p>A significant effect was found in patients with rheumatoid\n arthritis...but not in osteoarthritis patients.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653978/\" rel=\"nofollow noreferrer\">Managing osteoarthritis (PubMed, 2015)</a>:</p>\n\n<blockquote>\n <p>Fish oil has not been found to reduce the structural progression of\n knee arthritis.</p>\n</blockquote>\n\n<p><strong>About the fish oil dosage and safety:</strong> (<a href=\"https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/#en30\" rel=\"nofollow noreferrer\">Office of Dietary Supplements</a>)</p>\n\n<blockquote>\n <p>High doses of DHA and/or EPA (900 mg/day of EPA plus 600 mg/day DHA or\n more for several weeks) might reduce immune function due to\n suppression of inflammatory responses. Doses of 2–15 g/day EPA and/or\n DHA might also increase bleeding time by reducing platelet aggregation\n [5]. However, according to the European Food Safety Authority,\n long-term consumption of EPA and DHA supplements at combined doses of\n up to about 5 g/day appears to be safe [167]. It noted that these\n doses have not been shown to cause bleeding problems or affect immune\n function, glucose homeostasis, or lipid peroxidation. The FDA\n recommends not exceeding 3 g/day EPA and DHA combined, with up to 2\n g/day from dietary supplements. Some doses used in clinical trials\n exceed these levels.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/16008", "https://health.stackexchange.com", "https://health.stackexchange.com/users/209/" ]

[ { "answer_id": 16044, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 3, "selected": false, "text": "<p>The American label^{<strong>1</strong>} says \"sodium\", it does not say \"salt\". Surprising accuracy, but it really is just that one half of the salt molecule that counts and that is counted! It's really just the sodium. Only Na and not NaCl.</p>\n\n<blockquote>\n <p><strong>Sodium:</strong>\n What It Is<br>\n The words “salt” and “sodium” are often used interchangeably, but they do not mean the same thing. Sodium is a mineral and one of the chemical elements found in salt. Salt (also known by its chemical name, sodium chloride) is a crystal-like compound that is abundant in nature and is used to flavor and preserve food.<br>\n <a href=\"https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Sodium.pdf\" rel=\"nofollow noreferrer\">FDA: factsheets: Sodium.pdf</a></p>\n</blockquote>\n\n<p>\"Salts\" are also different from NaCl alone (e.g. KNO₃ for meats) and very common sources from the industry include Sodium nitrate, Sodium citrate, Monosodium glutamate [MSG], Sodium benzoate, Baking powder, Baking soda.</p>\n\n<p>To quickly estimate the salt equivalent of label-Na: 1g Na ~> 2.5g NaCl </p>\n\n<p>This should result for the example, \"a 20 fluid ounce bottle of Coke currently says that it has 75mg of 'Sodium' in it.\"<br>\nThis means 75mg of sodium ions Na⁺ and this equals roughly 187,5mg of the dissolved table salt molecule NaCl.<br>\n_{Although a cola typically contains no salt at all according to the <a href=\"https://www.coca-cola.co.uk/drinks/coca-cola/coca-cola\" rel=\"nofollow noreferrer\">official Coca Cola website UK: Salt=0g</a>, or <a href=\"https://ndb.nal.usda.gov/ndb/search/list?qlookup=14400\" rel=\"nofollow noreferrer\">4mg/100g according to the USDA</a> and usually very few sodium from other sources (example <a href=\"http://www.opensoda.org/?p=130\" rel=\"nofollow noreferrer\">OpenCola, v2009</a>: Sodium Citrate, Sodium Benzoate).} </p>\n\n<p>To quote from <a href=\"http://www.worldactiononsalt.com/less/how/labels/\" rel=\"nofollow noreferrer\">Reading Labels (worldactiononsalt)</a>:</p>\n\n<blockquote>\n <blockquote>\n <ul>\n <li>Foods high in salt have more than 1.5g salt / 100g (or 0.6g sodium / 100g)</li>\n <li>Foods low in salt have less than 0.3g salt /100g (or 0.1g sodium / 100g)</li>\n </ul>\n </blockquote>\n \n <p>Calculating the salt content of food\n Some food labels may only state the sodium content.\n To convert sodium to salt, you need to multiply the amount by 2.5.\n For example, 1g of sodium per 100g = 2.5 grams of salt per 100g</p>\n \n <p>You then need to know the weight of the serving portion in grams e.g. 30g</p>\n \n <p>Then divide the concentration of salt per 100g by 100 and multiply by the serving size.<br>\n e.g. Kellogg’s Rice Krispies contain 0.65g of sodium per 100g and 1 bowl (serving) is 30g;</p>\n \n <p>0.65g sodium per 100g x 2.5 = 1.6g salt per 100g<br>\n 1.6 ÷ 100 = 0.01 salt per 1g of Rice Krispies<br>\n 0.1 x 30 = 0.3g salt per 30g serving </p>\n \n <p>The maximum recommended intake for the day for a child aged 3 is 2g. Therefore, 1 bowl of the breakfast cereal contains around one-sixth (15%) of the recommended intake for the whole day.</p>\n</blockquote>\n\n<p>Further information can be found at <a href=\"https://www.thekitchn.com/a-guide-to-sodium-labeling-sodium-savvy-205267\" rel=\"nofollow noreferrer\">What Sodium Labels Mean: A Guide to Decoding Sodium Labels</a>.</p>\n\n<blockquote>\n <p>Many people think of salt and sodium as being the same thing, but they aren’t. Sodium is a mineral that occurs throughout nature in more than 80 forms. It is the sixth most abundant naturally occurring element on the planet, and it is essential to many of life’s functions. In the human body, in particular, sodium is crucial in maintaining the intricate balance of fluids in and around the body’s cells, and we can’t live without it.<br>\n <strong>Ninety percent of the sodium we eat comes in the form of salt.</strong> Salt is a naturally occurring compound that consists of 40 percent sodium and 60 percent chloride.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Recipes/American-Heart-Association-Eat-Less-Salt-Sample-Recipes_UCM_452096_Article.jsp\" rel=\"nofollow noreferrer\">American Heart Association: \"Eat Less Salt\", Clarkson Potter: New York, 2013.</a></p>\n\n<hr>\n\n<p>_{1: Alas, the EU seems to go backward on this and proscribes now again on labels to use \"salt\" instead of \"sodium\". (<a href=\"https://www.lebensmittelklarheit.de/forum/natrium-kennzeichnung\" rel=\"nofollow noreferrer\">Natrium-Kennzeichnung</a>)}</p>\n" }, { "answer_id": 16063, "author": "paparazzo", "author_id": 6848, "author_profile": "https://health.stackexchange.com/users/6848", "pm_score": 1, "selected": false, "text": "<p>It refers to exactly what is says - Na.</p>\n\n<p>It would be Na not the ion.</p>\n\n<p>Na is not just from NaCl. It is in baking soda.</p>\n\n<p>Look up nutrition on table salt<br>\n<a href=\"http://www.calorieking.com/foods/calories-in-herbs-spices-table-salt_f-ZmlkPTY0NTAw.html\" rel=\"nofollow noreferrer\">NaCl nutrition</a><br>\n100 mg NaCl has 38.758 mg of Na<br>\nWhich is consistent with molecular weight of 11 and 17. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16043", "https://health.stackexchange.com", "https://health.stackexchange.com/users/5371/" ]

[ { "answer_id": 16082, "author": "user181463", "author_id": 12733, "author_profile": "https://health.stackexchange.com/users/12733", "pm_score": -1, "selected": false, "text": "<p>Iris has dilator and constrictor pupillae\nWhile cilliary musckes act by contraction and relaxation not antagonism</p>\n" }, { "answer_id": 16093, "author": "astrocito", "author_id": 13571, "author_profile": "https://health.stackexchange.com/users/13571", "pm_score": 2, "selected": false, "text": "<p>The eye is formed by three layers. From the outside to the inside, you have:</p>\n\n<ol>\n<li>The fibrous layer: formed by the cornea and the sclera.</li>\n<li>The vascular layer: formed (from posterior to anterior) by the choroid, ciliar body and iris.</li>\n<li>The neural layer: formed by the retina.</li>\n</ol>\n\n<p>Another important \"element\" is the lens, which changes the focal distance of the eye.</p>\n\n<p>Focusing on the second layer, the ciliar body is \"attatched\" to the lens by small extentions called ciliary processes. These have ciliary muscules that upon stimulation, they contract and create a respective response on the lens.\nBasically there is an adjustment of the lens in order to create a clear image of what you see from a close distance. </p>\n\n<p><a href=\"http://histology.medicine.umich.edu/resources/eye\" rel=\"nofollow noreferrer\">Here's some additional information if you'd like to read more about the eye in general.</a></p>\n\n<p>Edit: After reading DoctorWhom's comment, I'd like to add two links that might help.\n<a href=\"https://www.sciencedirect.com/topics/neuroscience/accommodation-reflex\" rel=\"nofollow noreferrer\">Oculomotor Nerve - Accommodation reflex</a> (Jean-Pierre Barral, Alain Croibier 2009) \n<a href=\"http://hyperphysics.phy-astr.gsu.edu/hbase/vision/accom.html\" rel=\"nofollow noreferrer\">Complementary information</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16073", "https://health.stackexchange.com", "https://health.stackexchange.com/users/8087/" ]

[ { "answer_id": 16091, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": -1, "selected": false, "text": "<p>To be picky, it does not need to be \"gym\" (gym or fitness classes, jogging...); it is <strong>regular physical activity</strong> of lower intensity (walking, cycling to work...) that can already be healthy.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28708630\" rel=\"nofollow noreferrer\">Health benefits of physical activity: a systematic review of current systematic reviews (PubMed, 2017)</a>:</p>\n\n<blockquote>\n <p>...marked health benefits are observed with relatively minor volumes\n of physical activity.</p>\n</blockquote>\n\n<p>You can <strong>eat less calories</strong> than you burn if you want to lose weight.</p>\n\n<p>Both physical activity and weight loss (if overweight) can be healthy; there is no need to overthink which is better. Do one or another or both, according to what you think is realistic for you to maintain long-term.</p>\n" }, { "answer_id": 16092, "author": "Othya", "author_id": 830, "author_profile": "https://health.stackexchange.com/users/830", "pm_score": 1, "selected": false, "text": "<p>You mention \"health and longevity\"...</p>\n\n<p>Unless you're suffering from obesity-related health issues, eating less calories will not help you with \"health and longevity\". Eating balanced and nutritious meals is more important than calories if your concern is \"health and longevity\" (and not weight gain/loss).</p>\n\n<p>\"Health and longevity\" is very subjective, and largely depends on other life factors.. for example, if Bob goes to the gym every day, and eats very healthily, but also is a heroin addict, then eating healthily and exercising likely won't really matter. That's an extreme example, but I hope it does prove a point.</p>\n\n<p>If you're talking strictly about weight gain/loss, it's all about calories in &lt;--> calories out. Simply put, if you eat less calories then you burn, you will lose weight. Exercising allows you to eat more (because you're burning more).</p>\n" } ]

[ "https://health.stackexchange.com/questions/16090", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13570/" ]

[ { "answer_id": 16313, "author": "drg", "author_id": 13597, "author_profile": "https://health.stackexchange.com/users/13597", "pm_score": 1, "selected": false, "text": "<p>I spoke with a doctor the other day and they said that the body releases histamines when under stress. The histamines are there to attack foreign bodies, however there are none from stress. They then \"attack\" the skin and cause it to become inflamed and produce hives. </p>\n" }, { "answer_id": 16619, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>The mechanism of stress hives (urticaria):</p>\n\n<p>Stress, for example, <a href=\"https://acaai.org/allergies/types/skin-allergies/hives-urticaria\" rel=\"nofollow noreferrer\">emotional stress</a> or <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15909063\" rel=\"nofollow noreferrer\">insomnia</a> triggers the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16461989\" rel=\"nofollow noreferrer\">mast cells</a> in the skin to release histamine. Histamine dilates the small arteries in the skin and makes them \"porous,\" which allows some fluid from the blood to escape into the space between the cells.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16123", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13597/" ]

[ { "answer_id": 16313, "author": "drg", "author_id": 13597, "author_profile": "https://health.stackexchange.com/users/13597", "pm_score": 1, "selected": false, "text": "<p>I spoke with a doctor the other day and they said that the body releases histamines when under stress. The histamines are there to attack foreign bodies, however there are none from stress. They then \"attack\" the skin and cause it to become inflamed and produce hives. </p>\n" }, { "answer_id": 16619, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>The mechanism of stress hives (urticaria):</p>\n\n<p>Stress, for example, <a href=\"https://acaai.org/allergies/types/skin-allergies/hives-urticaria\" rel=\"nofollow noreferrer\">emotional stress</a> or <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15909063\" rel=\"nofollow noreferrer\">insomnia</a> triggers the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16461989\" rel=\"nofollow noreferrer\">mast cells</a> in the skin to release histamine. Histamine dilates the small arteries in the skin and makes them \"porous,\" which allows some fluid from the blood to escape into the space between the cells.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16195", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13660/" ]

[ { "answer_id": 16237, "author": "bretddog", "author_id": 2193, "author_profile": "https://health.stackexchange.com/users/2193", "pm_score": -1, "selected": false, "text": "<p>Society is pulling us in directions that degenerates us on so many levels. That something is becoming popular and normal is not any indication whatsoever that it's a better choice, or even a comparable choice. It simply means this is the \"new normal\". Just look at all the health problems directly correlated to modern western society which is not found in more primitive populations. Normal has nothing to do with what is best, or what is healthy. </p>\n\n<p>There are risks to performing a C-section : </p>\n\n<p><a href=\"https://jennifermargulis.net/everyone-i-know-had-a-c-section-whats-the-big-deal/\" rel=\"nofollow noreferrer\">https://jennifermargulis.net/everyone-i-know-had-a-c-section-whats-the-big-deal/</a> </p>\n\n<p>Why is it getting more normal to do a C-section? </p>\n\n<blockquote>\n <p>doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.</p>\n</blockquote>\n\n<p><a href=\"https://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections\" rel=\"nofollow noreferrer\">https://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections</a></p>\n\n<p>However..<br>\nThe most important factor for making this choice may be the impact on your baby's health. </p>\n\n<p>You need to research how a c-section impacts the microbiome, strength of immune system, digestive system and correlation with chronic diseases. There has been a lot of focus on this over the last decade. It's not popular topics that you get stuffed in your face, but there are a lot of litterature and studies if you just google these search terms. The gut/immune/brain connection is where the true breakthrough in medical science is happening today. We need to pay attention to and educate ourselves in this field if we want to stay healthy and get healthy children. </p>\n\n<p><a href=\"http://sciencenordic.com/c-section-infants-don%E2%80%99t-get-enough-good-microbes\" rel=\"nofollow noreferrer\">C-section infants don’t get enough good microbes</a></p>\n\n<p><a href=\"https://www.rainbowlight.com/blog/vaginal-versusbys-microbiome\" rel=\"nofollow noreferrer\">Vaginal vs. Cesarean Birth: Effects on Baby's Microbiome</a></p>\n\n<p><strong>EDIT:</strong> </p>\n\n<p>Adding some reliable references backing up the points mentioned. Most links above also have further links to medical journals. </p>\n\n<p>3.7 times higher risk of maternal mortality with cesarean vs vaginal delivery: </p>\n\n<p><a href=\"https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the-Primary-Cesarean-Delivery\" rel=\"nofollow noreferrer\">https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the-Primary-Cesarean-Delivery</a></p>\n\n<p>\"finds an increase in the C-section rate in the Medicare population after C-sections became more highly reimbursed\nrelative to vaginal deliveries. Specifically, they found a 0.7 ppt increase for a $100 increase in the fee differential.\"</p>\n\n<p><a href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856\" rel=\"nofollow noreferrer\">https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856</a></p>\n\n<p>\"Meta-analyses of cohort and case-control studies find a positive association [of caesarean delivery] with type 1 diabetes (based on 20 studies),2 asthma (23 studies),3 and obesity (nine studies).4 We did not find any meta-analyses that reported no association with these outcomes.\" \n<a href=\"https://www.bmj.com/content/350/bmj.h2410\" rel=\"nofollow noreferrer\">https://www.bmj.com/content/350/bmj.h2410</a></p>\n\n<p>\"planned c-section is associated with early breastfeeding cessation.\" </p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847344/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847344/</a></p>\n\n<p>\"Maternal morbidity associated with multiple repeat cesarean deliveries\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16738145\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/16738145</a></p>\n\n<p>\"Cesarean delivery associated with childhood diseases\" (allergy, asthma, celiac disease, diabetes, gastroenteritis)</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/</a></p>\n\n<p>\"primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after the birth\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9890463/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/9890463/</a></p>\n\n<p>\"The mode of delivery was associated with differences in intestinal microbes 7 years after delivery.\"\n\"There is accumulating evidence that intestinal bacteria play an important role in the postnatal development of the immune system. 30 Thus, if the intestinal flora develops differently depending on the mode of delivery, the postnatal development of the immune system might also be different.\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/</a></p>\n\n<p>\"Vaginal birth after cesarean was related to a 31% (95% CI: 17%, 47%) lower risk of offspring obesity compared to repeat cesarean section. In within-family analysis, individuals born by cesarean had a 64% (8%, 148%) higher odds of obesity than their siblings born vaginally.\"</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854473/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854473/</a></p>\n" }, { "answer_id": 16238, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<p>If we are assuming that there is no valid reason¹ for a c-section, a c-section is obsolete per definition. Any operation has risks and strains the body: The anesthesia, the cutting of the body to name the two obvious points. If an operation is not indicated, it shouldn’t be performed. So, if c-section are not medically indicated, they shouldn’t be performed.</p>\n<p>If there was a valid reason for the c-section, the answer is obvious: Do get a c-section.</p>\n<hr />\n<p>Some references:</p>\n<blockquote>\n<p>Based on the available data, and using internationally accepted methods to assess the evidence with the most appropriate analytical techniques, WHO concludes: Caesarean sections are effective in saving maternal and infant lives, but <em>only when they are required for medically indicated reasons</em>.</p>\n<p>^{Emphasis Mine, Taken from <a href=\"http://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf;jsessionid=56C82847E77844D5EA214D5D5369B9D4?sequence=1\" rel=\"nofollow noreferrer\">WHO Statement on Caesarean Section Rates</a></p>\n</blockquote>\n<p>A more elaborate source:</p>\n<blockquote>\n<p><strong>Experts who believe c-sections should only be performed for medical reasons point to the risks.</strong> These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger. [...]</p>\n<p>The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) <strong>agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles.</strong> ACOG states that &quot;<em>if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing</em>&quot; a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.</p>\n</blockquote>\n<p>If you are even more interested, <a href=\"https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the-Primary-Cesarean-Delivery\" rel=\"nofollow noreferrer\">this is a great source as well</a>.</p>\n<hr />\n<p>1: These include psychological factors. If a to-be mother is as an example afraid of natural delivery, this can be considered a valid reason after evaluation.}</p>\n" } ]

[ "https://health.stackexchange.com/questions/16236", "https://health.stackexchange.com", "https://health.stackexchange.com/users/-1/" ]

[ { "answer_id": 16259, "author": "mattia.b89", "author_id": 6615, "author_profile": "https://health.stackexchange.com/users/6615", "pm_score": 2, "selected": false, "text": "<p>I think most people do not <em>drink</em> a such quantity of water.\nThink: 2 litres are more or less equal to 8 glasses, but on average we have: 2 for breakfast, 2 for lunch, 2 for dinner <a href=\"https://www.cdc.gov/nutrition/data-statistics/plain-water-the-healthier-choice.html\" rel=\"nofollow noreferrer\">[ 1 ]</a>, that's just above 1 litre of water.</p>\n\n<p>I think your thought is true: <strong>it's hard to drink 2L of water</strong>.</p>\n\n<p>Anyway I think (but I don't have any refs...) people <em>intake</em> (drink+eating) more than 2L of water. If we take in account eating vegetables and fruits (90% w/w of water if raw, less if cooked) as well meat and fish (70% w/w cooked), we reach the goal of 2L of water per day.</p>\n" }, { "answer_id": 16268, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p><em>In short: It may not be possible to recommend any fixed amount of water to anyone, because the water needs differ from person to person, and for a given person, from day to day, which mainly depends on the extent of sweating.</em></p>\n\n<p>According to <a href=\"https://www.nap.edu/read/10925/chapter/6#80\" rel=\"nofollow noreferrer\">Dietary References for Water, National Academic Press (p. 80, Table 4-2)</a>, an estimated minimal loss of water (when not sweating) in a healthy adult is <strong>~1 liter per day,</strong> so this is the minimal amount of water one should consume (from foods and beverages combined).</p>\n\n<p><a href=\"http://www.dtic.mil/dtic/tr/fulltext/u2/a559016.pdf\" rel=\"nofollow noreferrer\">Dehydration and Rehydration, Defense Technical Information Center</a>:</p>\n\n<blockquote>\n <p>The daily water needs of <em>sedentary men</em> are <strong>~1.2 L or ~2.5 L</strong> and\n increase to <strong>~3.2 L</strong> if performing <em>modest physical activity.</em> Compared\n with sedentary adults, <em>active adults who live in a warm environment</em>\n are reported to have daily water needs of <strong>~6 L.</strong></p>\n</blockquote>\n\n<p>According to <a href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256\" rel=\"nofollow noreferrer\">Mayo Clinic</a>, you can know you are well hydrated when:</p>\n\n<ul>\n<li>You are not thirsty.</li>\n<li>Your urine is clear or straw yellow.</li>\n<li>You maintain your usual body weight from day to day (for example, 2 liters water loss results in 2 kilograms or 4.4 pounds of body weight loss).</li>\n<li>The skin at the back of your hand recoils instantly when you pinch and release it (skin turgor test, <a href=\"https://medlineplus.gov/ency/imagepages/17223.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>).</li>\n</ul>\n" }, { "answer_id": 16275, "author": "Count Iblis", "author_id": 856, "author_profile": "https://health.stackexchange.com/users/856", "pm_score": 2, "selected": false, "text": "<p>We can find the answer <a href=\"https://www.cdc.gov/nchs/products/databriefs/db242.htm\" rel=\"nofollow noreferrer\">here</a>:</p>\n\n<blockquote>\n <p>Among U.S. adults, men consumed an average of 3.46 liters (117 ounces) of water per day, and women consumed 2.75 liters (93 ounces) per day.\n Men aged 60 and over consumed less water (2.92 liters) than men aged 20–39 (3.61 liters) and 40–59 (3.63 liters). Similarly, women aged 60 and over consumed less water (2.51 liters) than women aged 20–39 (2.78 liters) and 40–59 (2.9 liters).\n Non-Hispanic white men and women consumed more water daily than non-Hispanic black and Hispanic men and women.\n Water intake increased with physical activity level for both men and women.\n Among men, 30% of total water consumed was plain water (with the remainder from other foods and liquids) compared with 34% for women.</p>\n</blockquote>\n\n<p>So, the intake of plain water is about 1 liter, but people also drink other liquids like e.g. soft drinks that are not counted as plain water (e.g. the average soda intake is about 0.5 liters per day). As the article points out, the adequate total water intake from all foods and liquids has been set at 3.7 liters by the Institute of medicine (IoM), so the average intake falls short of the adequate intake. So, most people would benefit from a higher plain water intake, they would get closer to the IoM recommended intake and it would likely come at the expense of unhealthy soda intake. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16258", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13737/" ]

[ { "answer_id": 16376, "author": "muzzi", "author_id": 13840, "author_profile": "https://health.stackexchange.com/users/13840", "pm_score": 0, "selected": false, "text": "<p>Reading on paper is way better from all perspectives. When you read on paper you are able to focus more and you are not putting pressure on your eyes and your brain passes the signals which help you stay relaxed. While on the other hand, when you read on any electronic device you are much more likely to damage your eyesight as well as weaken your brain. Doctors say a person must have 10 minutes break in 1 hour of continues using laptop or Tab. This is very important otherwise he/she may harm his/her mental as well as physical health.</p>\n" }, { "answer_id": 16380, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": true, "text": "<p>To first establish a baseline: Reading is great for your brain, your mind, your intellect. But it can be bad for everything else. You sit, you concentrate, you stress your eyes.</p>\n\n<p>It is such a common causal connection that the NHS simplifies the analysis of causes for myopia down to genes and:</p>\n\n<blockquote>\n <p>Short-sightedness (myopia) usually occurs when the eyes grow slightly too long, which means they're unable to produce a clear image of objects in the distance.<br>\n It's not clear exactly why this happens, but it's thought to be the result of a combination of genetic and environmental factors that disrupt the normal development of the eye.<br>\n <strong>Too little time outdoors</strong><br>\n Research has found that spending time playing outside as a child may reduce your chances of becoming short-sighted, and existing short-sightedness may progress less quickly.<br>\n This may be related to light levels outdoors being much brighter than indoors. Both sport and relaxation outdoors appear to be beneficial in reducing the risk of short-sightedness.<br>\n <strong>Excessive close work</strong><br>\n Spending a lot of time focusing your eyes on nearby objects, such as reading, writing and possibly using hand-held devices (phones and tablets) and computers can also increase your risk of developing short-sightedness.<br>\n An \"everything in moderation\" approach is therefore generally recommended. Although children should be encouraged to read, they should also spend some time away from reading and computer games each day doing outdoor activities.<br>\n _{<a href=\"https://www.nhs.uk/conditions/short-sightedness/causes/\" rel=\"nofollow noreferrer\">NHS: Short-sightedness (myopia), Causes</a> (2015)}</p>\n</blockquote>\n\n<p>\"Too little time outdoors\" is a shortcut for expressing giving the muscles and lenses of your eyes a workout with natural variation. Outdoors you usually have to focus objects that vary quite a bit in terms of distance etc. The evidence is slowly coming in for interventions regarding these stresses to improve things:</p>\n\n<blockquote>\n <p>A stronger effect was found at a school in southern Taiwan, where teachers were asked to send children outside for all 80 minutes of their daily break time instead of giving them the choice to stay inside. After one year, doctors had diagnosed myopia in 8% of the children, compared with 18% at a nearby school\n _{Elie Dolgin: <a href=\"https://www.nature.com/polopoly_fs/1.17120!/menu/main/topColumns/topLeftColumn/pdf/519276a.pdf?origin=ppub\" rel=\"nofollow noreferrer\">\"The Myopia Boom. Short-Sightedness is Reaching Epidemic Proportions. Some Scientists Think they have Found a Reason Why.\"</a> Nature, Vol. 519, 19 March 2015, 276–278. Also, compare with <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-1313.1987.tb00760.x\" rel=\"nofollow noreferrer\">David L. Ehrlich: \"Near Vision Stress: Vergence Adaptation and Accommodative Fatigue\", OPO, Volume 7, Issue 4 1987.</a>}</p>\n</blockquote>\n\n<p>Reading on screens is so much worse that its effects got their own term: <a href=\"https://en.wikipedia.org/wiki/Computer_vision_syndrome\" rel=\"nofollow noreferrer\">Computer vision syndrome</a>.</p>\n\n<blockquote>\n <p>Some decades back, before the advent of computers, the office work involved a range of activities, including typing, filing, reading and writing etc. All these activities are different from each other and needed different types of posture and vision, causing a natural break from each activity. With the computer all these activities were combined and needed no change of posture or vision of the user from his desktop. It certainly improved the quality of the work and efficiency but caused ocular problems, such as dry eye, redness, irritation, eye strain, tired eyes, temporary blurred vision, light sensitivity and muscular problems that stem from using a computer. All these symptoms collectively referred to as computer vision syndrome, which comprised of ocular surface abnormalities or accommodative spasms and/or extra-ocular (ergonomic) aetiologies due to improper posture such as neck and upper back pain and headache.<br>\n The major contributors to CVS is thought to be the dry eye, the visual effects of video display terminals (VDT) such as lighting, glare, display quality, refresh rates and radiation and positioning of computer monitors.<br>\n _{<a href=\"https://gmj.sljol.info/article/10.4038/gmj.v11i1.1115/galley/1023/\" rel=\"nofollow noreferrer\">Saman Wimalasundera: \"Computer vision syndrome\", Galle Medical Journal, Vol 11: No. 1, September 2006.</a>}</p>\n</blockquote>\n\n<p>Since now we have <a href=\"https://health.economictimes.indiatimes.com/news/diagnostics/millions-at-risk-of-computer-vision-syndrome/52515980?redirect=1\" rel=\"nofollow noreferrer\">Millions at risk of computer vision syndrome</a> it seems quite easy to refer to this simplified risk hierarchy: no reading, paper reading, screen reading. But it should be clear that this problem is indeed one that can be mitigated with adhering to proper ergonomic principles. Apart from the behaviour a user/reader might adapt, such as variation in distance, breaks, body posture, the different sources – or better surfaces – of reading material should be watched out for. A high gloss magazine read on a sunny beach might be quite stressful for the eyes whereas an ergonomic, non-glare, high resolution display might fare quite a bit better.</p>\n\n<blockquote>\n <p>Significant eye symptoms relate to VDU use often occur and should not be underestimated. The increasing use of electronic devices with flat-panel display should prompt users to take appropriate measures to prevent or to relieve the eye symptoms arising from their use.<br>\n _{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916147/\" rel=\"nofollow noreferrer\">Esteban Porcar et al.: \"Visual and ocular effects from the use of flat-panel displays\", Int J Ophthalmol. 2016; 9(6): 881–885.</a> doi:10.18240/ijo.2016.06.16}</p>\n</blockquote>\n\n<p>While these ergonomics were theoretically known for a long time and the progressivists promised a brighter future (pun intended):</p>\n\n<blockquote>\n <p>Most people now have some contact with computers either at work or at home. With survey evidence suggesting that perhaps 50% or more of these individ- uals complain of some form of eye problems associ- ated with using computers, eye-care professionals, ergonomists and engineers are faced with a major chal- lenge. Improvements in display technologies continue apace and the next generation of displays will produce images of equivalent quality to typeset hardcopy. Speech recognition and synthesis are already available and this and other technologies are likely to reduce the visual demands of interacting with a computer.<br>\n In the meantime, solving the problems of individual users requires a holistic approach, taking account of workstation design, workpractices and psychological factors as well as optometric data.<br>\n _{<a href=\"https://www.sciencedirect.com/science/article/pii/S0275540897000677\" rel=\"nofollow noreferrer\">W.DavidThomson: \"Eye problems and visual display terminals—the facts and the fallacies\", Ophthalmic and Physiological Optics, Volume 18, Issue 2, March 1998, Pages 111-119</a>}</p>\n</blockquote>\n\n<p>it seems that neither consumers nor some vendors and producers seem to really care. One of the largest manufacturers of displays, in phones, tablets, desktops and laptops has indeed not a single non-glare display on offer. If this is an oversight from the manufacturer, you still should not buy such a rotten fruit if you value your eyesight and have to read from displays.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16307", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13783/" ]

[ { "answer_id": 16376, "author": "muzzi", "author_id": 13840, "author_profile": "https://health.stackexchange.com/users/13840", "pm_score": 0, "selected": false, "text": "<p>Reading on paper is way better from all perspectives. When you read on paper you are able to focus more and you are not putting pressure on your eyes and your brain passes the signals which help you stay relaxed. While on the other hand, when you read on any electronic device you are much more likely to damage your eyesight as well as weaken your brain. Doctors say a person must have 10 minutes break in 1 hour of continues using laptop or Tab. This is very important otherwise he/she may harm his/her mental as well as physical health.</p>\n" }, { "answer_id": 16380, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": true, "text": "<p>To first establish a baseline: Reading is great for your brain, your mind, your intellect. But it can be bad for everything else. You sit, you concentrate, you stress your eyes.</p>\n\n<p>It is such a common causal connection that the NHS simplifies the analysis of causes for myopia down to genes and:</p>\n\n<blockquote>\n <p>Short-sightedness (myopia) usually occurs when the eyes grow slightly too long, which means they're unable to produce a clear image of objects in the distance.<br>\n It's not clear exactly why this happens, but it's thought to be the result of a combination of genetic and environmental factors that disrupt the normal development of the eye.<br>\n <strong>Too little time outdoors</strong><br>\n Research has found that spending time playing outside as a child may reduce your chances of becoming short-sighted, and existing short-sightedness may progress less quickly.<br>\n This may be related to light levels outdoors being much brighter than indoors. Both sport and relaxation outdoors appear to be beneficial in reducing the risk of short-sightedness.<br>\n <strong>Excessive close work</strong><br>\n Spending a lot of time focusing your eyes on nearby objects, such as reading, writing and possibly using hand-held devices (phones and tablets) and computers can also increase your risk of developing short-sightedness.<br>\n An \"everything in moderation\" approach is therefore generally recommended. Although children should be encouraged to read, they should also spend some time away from reading and computer games each day doing outdoor activities.<br>\n _{<a href=\"https://www.nhs.uk/conditions/short-sightedness/causes/\" rel=\"nofollow noreferrer\">NHS: Short-sightedness (myopia), Causes</a> (2015)}</p>\n</blockquote>\n\n<p>\"Too little time outdoors\" is a shortcut for expressing giving the muscles and lenses of your eyes a workout with natural variation. Outdoors you usually have to focus objects that vary quite a bit in terms of distance etc. The evidence is slowly coming in for interventions regarding these stresses to improve things:</p>\n\n<blockquote>\n <p>A stronger effect was found at a school in southern Taiwan, where teachers were asked to send children outside for all 80 minutes of their daily break time instead of giving them the choice to stay inside. After one year, doctors had diagnosed myopia in 8% of the children, compared with 18% at a nearby school\n _{Elie Dolgin: <a href=\"https://www.nature.com/polopoly_fs/1.17120!/menu/main/topColumns/topLeftColumn/pdf/519276a.pdf?origin=ppub\" rel=\"nofollow noreferrer\">\"The Myopia Boom. Short-Sightedness is Reaching Epidemic Proportions. Some Scientists Think they have Found a Reason Why.\"</a> Nature, Vol. 519, 19 March 2015, 276–278. Also, compare with <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-1313.1987.tb00760.x\" rel=\"nofollow noreferrer\">David L. Ehrlich: \"Near Vision Stress: Vergence Adaptation and Accommodative Fatigue\", OPO, Volume 7, Issue 4 1987.</a>}</p>\n</blockquote>\n\n<p>Reading on screens is so much worse that its effects got their own term: <a href=\"https://en.wikipedia.org/wiki/Computer_vision_syndrome\" rel=\"nofollow noreferrer\">Computer vision syndrome</a>.</p>\n\n<blockquote>\n <p>Some decades back, before the advent of computers, the office work involved a range of activities, including typing, filing, reading and writing etc. All these activities are different from each other and needed different types of posture and vision, causing a natural break from each activity. With the computer all these activities were combined and needed no change of posture or vision of the user from his desktop. It certainly improved the quality of the work and efficiency but caused ocular problems, such as dry eye, redness, irritation, eye strain, tired eyes, temporary blurred vision, light sensitivity and muscular problems that stem from using a computer. All these symptoms collectively referred to as computer vision syndrome, which comprised of ocular surface abnormalities or accommodative spasms and/or extra-ocular (ergonomic) aetiologies due to improper posture such as neck and upper back pain and headache.<br>\n The major contributors to CVS is thought to be the dry eye, the visual effects of video display terminals (VDT) such as lighting, glare, display quality, refresh rates and radiation and positioning of computer monitors.<br>\n _{<a href=\"https://gmj.sljol.info/article/10.4038/gmj.v11i1.1115/galley/1023/\" rel=\"nofollow noreferrer\">Saman Wimalasundera: \"Computer vision syndrome\", Galle Medical Journal, Vol 11: No. 1, September 2006.</a>}</p>\n</blockquote>\n\n<p>Since now we have <a href=\"https://health.economictimes.indiatimes.com/news/diagnostics/millions-at-risk-of-computer-vision-syndrome/52515980?redirect=1\" rel=\"nofollow noreferrer\">Millions at risk of computer vision syndrome</a> it seems quite easy to refer to this simplified risk hierarchy: no reading, paper reading, screen reading. But it should be clear that this problem is indeed one that can be mitigated with adhering to proper ergonomic principles. Apart from the behaviour a user/reader might adapt, such as variation in distance, breaks, body posture, the different sources – or better surfaces – of reading material should be watched out for. A high gloss magazine read on a sunny beach might be quite stressful for the eyes whereas an ergonomic, non-glare, high resolution display might fare quite a bit better.</p>\n\n<blockquote>\n <p>Significant eye symptoms relate to VDU use often occur and should not be underestimated. The increasing use of electronic devices with flat-panel display should prompt users to take appropriate measures to prevent or to relieve the eye symptoms arising from their use.<br>\n _{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916147/\" rel=\"nofollow noreferrer\">Esteban Porcar et al.: \"Visual and ocular effects from the use of flat-panel displays\", Int J Ophthalmol. 2016; 9(6): 881–885.</a> doi:10.18240/ijo.2016.06.16}</p>\n</blockquote>\n\n<p>While these ergonomics were theoretically known for a long time and the progressivists promised a brighter future (pun intended):</p>\n\n<blockquote>\n <p>Most people now have some contact with computers either at work or at home. With survey evidence suggesting that perhaps 50% or more of these individ- uals complain of some form of eye problems associ- ated with using computers, eye-care professionals, ergonomists and engineers are faced with a major chal- lenge. Improvements in display technologies continue apace and the next generation of displays will produce images of equivalent quality to typeset hardcopy. Speech recognition and synthesis are already available and this and other technologies are likely to reduce the visual demands of interacting with a computer.<br>\n In the meantime, solving the problems of individual users requires a holistic approach, taking account of workstation design, workpractices and psychological factors as well as optometric data.<br>\n _{<a href=\"https://www.sciencedirect.com/science/article/pii/S0275540897000677\" rel=\"nofollow noreferrer\">W.DavidThomson: \"Eye problems and visual display terminals—the facts and the fallacies\", Ophthalmic and Physiological Optics, Volume 18, Issue 2, March 1998, Pages 111-119</a>}</p>\n</blockquote>\n\n<p>it seems that neither consumers nor some vendors and producers seem to really care. One of the largest manufacturers of displays, in phones, tablets, desktops and laptops has indeed not a single non-glare display on offer. If this is an oversight from the manufacturer, you still should not buy such a rotten fruit if you value your eyesight and have to read from displays.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16353", "https://health.stackexchange.com", "https://health.stackexchange.com/users/1500/" ]

[ { "answer_id": 16359, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 4, "selected": true, "text": "<h2>TL;DR</h2>\n\n<p>Free sugars are all instances were sugar can be avoided and is not essential. It is encouraged to cut down the free sugars intake because sugar has many negative health effects:</p>\n\n<p>Sugar</p>\n\n<ul>\n<li>increases the risk of obesity</li>\n<li>is linked to diabetes</li>\n<li>is linked to fatal cardiovascular disease</li>\n<li>encourages caries</li>\n<li>is linked to the Alzheimer’s disease</li>\n<li>is linked to ADHD</li>\n</ul>\n\n<hr>\n\n<blockquote>\n <p>There is a wealth of evidence from many different types of investigation, including human studies, animal experiments and experimental studies in vivo and in vitro to show the role of dietary sugars in the etiology of dental caries (21). Collectively, data from these studies provide an overall picture of the cariogenic potential of carbohydrates. Sugars are undoubtedly the most important dietary factor in the development of dental caries. Here, the term ‘‘sugars’’ refers to all monosaccharides and disaccharides, while the term ‘‘sugar’’ refers only to sucrose. <strong>The term ‘‘free sugars’’ refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, fruit juices and syrups.</strong> The term ‘‘fermentable carbohydrate’’ refers to free sugars, glucose polymers, oligosaccharides and highly refined starches; it excludes non-starch polysaccharides and raw starches.</p>\n \n <p>^{Source: <em>Joint WHO/FAO Expert Consultation, 2003</em>, \"<strong><a href=\"http://apps.who.int/iris/bitstream/handle/10665/42665/WHO_TRS_916.pdf;jsessionid=F07A1857FEE48931A02F354C88EB2AF3?sequence=1\" rel=\"nofollow noreferrer\">WHO Technical Report Series 916 Diet, Nutrition, and the Prevention of Chronic Diseases</a></strong>\", Geneva. 2003, p.109, Emphasis Mine}</p>\n</blockquote>\n\n<p>Semantically, the main difference is that <em>free sugars</em> are refined, and non-free sugars are unrefined. This is not really a chemical difference in the molecule (refined glucose is still glucose), but rather in the process of manufacturing products and foods. </p>\n\n<p><a href=\"https://www.webmd.com/food-recipes/features/health-effects-of-sugar\" rel=\"nofollow noreferrer\">The medical effects of free sugar are the same as of non-free sugar</a> - glucose is glucose no matter what fancy name you give it and where you put it.</p>\n\n<p>But free sugar is mostly a food additive and not essential: Carbohydrates and starches are unavoidable, but adding household sugar or honey to foods as additives is unnecessary:</p>\n\n<blockquote>\n <p>Free sugars* contribute to the overall energy density of diets and higher intakes of free sugars threaten the nutrient quality of the diet by providing significant energy without specific nutrients, leading to unhealthy weight gain and increased risk of obesity and various NCDs, particularly dental caries which is the most prevalent NCD globally.</p>\n \n <p>^{Source: WHO.gov. <strong><a href=\"http://www.who.int/elena/titles/free-sugars-adults-ncds/en/\" rel=\"nofollow noreferrer\">Reducing free sugars intake in adults to reduce the risk of noncommunicable diseases</a></strong>}</p>\n</blockquote>\n\n<p>Other negative health effects of free sugar are summarised here:</p>\n\n<blockquote>\n <p>Free sugars contribute to the overall energy density of diets, and may\n promote a positive energy balance (5-7). Sustaining energy balance is\n critical to maintaining healthy body weight and ensuring optimal\n nutrient intake (8). <strong>There is increasing concern that intake of free\n sugars – particularly in the form of sugar-sweetened beverages –\n increases overall energy intake and may reduce the intake of foods\n containing more nutritionally adequate calories, leading to an\n unhealthy diet, weight gain and increased risk of NCDs</strong> (9-13). Another\n concern is the <strong>association between intake of free sugars and dental\n caries</strong> (3, 4, 14-16). Dental diseases are the most prevalent NCDs\n globally (17, 18) and, although great improvements in prevention and\n treatment of dental diseases have occurred in the past decades,\n problems still persist, causing pain, anxiety, functional limitation\n (including poor school attendance and performance in children) and\n social handicap through tooth loss. The treatment of dental diseases\n is expensive, consuming 5–10% of health-care budgets in industrialized\n countries, and would exceed the entire financial resources available\n for the health care of children in most lower income countries (17,\n 19).</p>\n \n <p>^{Source: WHO. <strong><a href=\"http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1\" rel=\"nofollow noreferrer\">Sugars intake for adults and children</a></strong>. p.1, Emphasis Mine}</p>\n</blockquote>\n\n<p>Furthermore, <a href=\"https://www.health.harvard.edu/blog/eating-too-much-added-sugar-increases-the-risk-of-dying-with-heart-disease-201402067021\" rel=\"nofollow noreferrer\">eating too much added sugar increases the risk of dying with heart disease (Harvard Health Blog)</a> and is correlated to ADHD development.</p>\n\n<blockquote>\n <p>In the past decade, we have become increasingly aware of strong associations between overweight/obesity and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. </p>\n \n <blockquote>\n <p>^{Source: Davis, Caroline: <strong><a href=\"https://link.springer.com/article/10.1007%2Fs11920-010-0133-7\" rel=\"nofollow noreferrer\">Attention-deficit/Hyperactivity Disorder: Associations with Overeating and Obesity</a></strong>. 2010\n </blockquote>\n</blockquote>\n\n<p>Last but not least, <a href=\"https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-12-114\" rel=\"nofollow noreferrer\">links between sugar intake and the Alzheimer’s Disease have been found.</a></p>\n\n<p>The only good news is that the current consensus regarding sugar addiction is that sugar is not addictive for humans:</p>\n\n<blockquote>\n <p>We find little evidence to support sugar addiction in humans, and findings from the animal literature suggest that addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar. These behaviours likely arise from intermittent access to sweet tasting or highly palatable foods, not the neurochemical effects of sugar.</p>\n \n <p>Source: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174153/\" rel=\"nofollow noreferrer\">Sugar addiction: the state of the science</a>}</p>\n</blockquote>\n" }, { "answer_id": 16399, "author": "pizi", "author_id": 13398, "author_profile": "https://health.stackexchange.com/users/13398", "pm_score": 1, "selected": false, "text": "<p>Imagine that your arteries are hallways and that your muscle cells are apartments with doors withing those hallways.</p>\n\n<p>When glucose enters your bloodstream, the body says, \"Hey pancreas! There is energy in the hallways, I need insulin!\" Imagine insulin like agents who come and unlock the doors. The energy then gets into your muscle cells and you are full of energy.</p>\n\n<p>That's what happens when everything works well.</p>\n\n<p><a href=\"https://i.stack.imgur.com/ofUuI.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/ofUuI.jpg\" alt=\"Arteries the Hallways and Doors the Muscle Cell Doors\"></a></p>\n\n<p>What happens when too much glucose enters your bloodstream too quickly? The body says, \"Hey Pancreas! I need insulin immediately!\". Pancreas says, \"How much boss?\" The body demands, \"Millions within minutes!\" Pancreas replies, \"What?! I can't do that!\" So it tries to create as many insulin agents as possible, but it's not enough.</p>\n\n<p>here aren't enough insulin agents to unlock the doors so too much energy ends up in the bloodstream. And we can't have any of that. So the body goes to plan B. It releases some of it through urine and converts some of it to fat. That's Diabetes type 1.</p>\n\n<p>There is another scenario. Energy enters the bloodstream. Pancreas is working great. There are enough insulin agents, but they can't get to the doors. The doors are blocked by garbage so that the agents can't even reach the handle. What is this garbage? It's fat. It piles up on the apartment doors and prevents insulin agents can't get to it. That's Diabetes type 2. (<a href=\"https://nutritionfacts.org/video/what-causes-insulin-resistance/\" rel=\"nofollow noreferrer\">1</a>) </p>\n\n<p>How does too much glucose enter the bloodstream too quickly? When we consume foods that contain carbohydrates which are deprived of all or almost all fiber. You see, fiber are like traffic controllers who control how fast energy is absorbed into the bloodstream.</p>\n\n<p>If the sugar is bound to fiber, then the traffic controllers do its work. If not, then it's like opening the borders and letting everyone run through without any order. This causes chaos in the bloodstream.</p>\n\n<p>Free sugars are sugars which are not bound to fiber the traffic controllers. Non free sugars are sugars bound to fiber and this is sugar which is consumed when you eat whole fruits and vegetables. No juicing!</p>\n" } ]

[ "https://health.stackexchange.com/questions/16358", "https://health.stackexchange.com", "https://health.stackexchange.com/users/-1/" ]

[ { "answer_id": 16415, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 1, "selected": false, "text": "<h2>TL;DR</h2>\n\n<p>An AED stops the heart from beating entirely (beneficial in some situations), and has nothing to do with the death of cells during a heart attack.</p>\n\n<hr>\n\n<p>The rhythm of the heart is regulated by electrical signals which are controlled by the sinoatrial node and the atrioventricular node. An adequate simulation of this can be seen in this gif:</p>\n\n<p><a href=\"https://i.stack.imgur.com/Z94wk.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Z94wk.gif\" alt=\"enter image description here\"></a></p>\n\n<p>^{Source for animation: <a href=\"https://m.imgur.com/gallery/a3gkASD\" rel=\"nofollow noreferrer\">Battlinbill07 on imgur.com</a>}</p>\n\n<p>This cycle is fairly stable and beats throughout your whole life (although some beats are skipped and some people have heart arrhythmias from birth onwards).</p>\n\n<p>Sometimes, the cycle messes up and heart arrhythmia ensues. Some types prevent proper blood circulation and result in the death of a patient. Some are also problematic because CPR is not efficient in those scenarios.</p>\n\n<p>The AED sends a strong electric signal through the heart. <a href=\"https://acls.com/free-resources/knowledge-base/vf-pvt/shockable-rhythms\" rel=\"nofollow noreferrer\">For some shockable rhythms</a>, this is recommended and will result in an asystole (a flatline). In some TV dramas, this causes the patient to wake up, but in fact a de-fibrillator only stops the heart activity entirely, thus also eliminating fibrillations. Sometimes, this will synchronise the nodes and the heart starts to beat again normally, and sometimes even the synchronisation doesn’t help and an asystole is the result. This is why defibrillating a flatline is totally useless, despite being often done in TV shows. After the AED created an asystole, CPR is most effective and will result in better survival chances than CPR with fibrillation.</p>\n\n<hr>\n\n<p>A heart attack is the result of a blocked artery and leads to the slow death of the heart muscle due to low oxygen supply. The heart stops beating long before the entire muscle died, and some of the process is reversible. Usually, a heart attack leads to an asystole when the heart stops beating, which is not a shockable rhythm and an AED will not recommend a shock.</p>\n\n<p>A cardiac arrest (wrongly used interchangeably for heart attack) is the general failure of the heart to beat and has many causes (including a heart attack), some of them arrhythmias where a shock may improve survival chances.</p>\n" }, { "answer_id": 16426, "author": "whitebeltcoder", "author_id": 8951, "author_profile": "https://health.stackexchange.com/users/8951", "pm_score": 1, "selected": true, "text": "<p>That's right Adrian, it restarts because the damage wasn't sufficient to turn it incapable of functioning. But it may develop cardiac insufficiency as the time passes by.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16408", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13858/" ]

[ { "answer_id": 16444, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>In general, for healthy non-pregnant individuals, synthetic vitamins are:</p>\n\n<ul>\n<li>Unnecessary, until you have a balanced mixed diet</li>\n<li>Less efficient than vitamins naturally present in foods, because they do not come with all additional beneficial nutrients found in foods</li>\n</ul>\n\n<p>Source: <a href=\"https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx\" rel=\"nofollow noreferrer\">Office of Dietary Supplements</a></p>\n\n<hr>\n\n<p>UPDATE: Some, but not all, studies have found associations between long-term vitamin supplements intake and harmful effects, but the cause-effect relationships have been not clearly established. </p>\n\n<p>According to one <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169010/\" rel=\"nofollow noreferrer\">2011 study</a>, <em>vitamin E</em> supplements significantly increase the risk of prostate cancer among healthy men.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21987192\" rel=\"nofollow noreferrer\">Another 2011 study</a>: In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental <em>iron.</em></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24219377\" rel=\"nofollow noreferrer\">A 2013 systematic review</a>: Supplementation with multivitamins does not appear to increase all-cause mortality or cancer or cardiovascular incidence or mortality.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241405/\" rel=\"nofollow noreferrer\">A 2016 review</a>: Taking supplements of <em>vitamin E, A, C, D, and folic acid</em> for prevention of disease or cancer is not always effective, and can even be harmful to the health.</p>\n\n<p>Chemically, the synthetic and natural vitamins are the same. Some synthetic vitamins can come in the form of salts, such as thiamin mononitrate or sodium ascorbate; I have no information about side effects of such vitamin formulations. </p>\n" }, { "answer_id": 16450, "author": "Stephen B.", "author_id": 13892, "author_profile": "https://health.stackexchange.com/users/13892", "pm_score": 2, "selected": false, "text": "<p>Without providing links to any of these claims, it's not really possible to say anything about them. If these \"synthetic vitamins\" are different than normal vitamins, sure, they could potentially have detrimental effects on your body. But even naturally-occurring vitamins can have detrimental effects in excess.</p>\n\n<p>However, assuming the vitamins are themselves pure, there's no chemical difference between vitamins derived from something in nature versus being synthesized in a lab. Vitamin C from an orange has the same chemical structure as Vitamin C that was chemically synthesized, and there's no way for your body to tell the difference. </p>\n\n<p>That said, it's always good to get plenty of vitamins in your diet, not because of any effect from the vitamins themselves, but just because the food that provides vitamins tends to be healthier for you anyway. A multivitamin or vitamin supplements can ensure that you're getting adequate levels of those vitamins even if there's a deficiency in your diet.</p>\n\n<p>For more information, you can see the <a href=\"https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm118079.htm\" rel=\"nofollow noreferrer\">FDA's webpage about vitamins</a>.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16443", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13886/" ]

[ { "answer_id": 16456, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 3, "selected": false, "text": "<p>The bulk of the evidence says dextromethorphan (DM) is no better than placebo.</p>\n\n<p><a href=\"https://www.medscape.com/viewarticle/803288\" rel=\"nofollow noreferrer\">(2013) Do Cough Remedies Work?</a></p>\n\n<blockquote>\n <p>Studies involving use of dextromethorphan in children have reported no\n clinically significant difference in symptoms of cough compared with\n placebo.[1] This lack of effect is not affected by dose, because\n studies of higher doses of dextromethorphan have also reported no\n difference in symptoms.[2] In adult patients with upper respiratory\n infection, there is no added benefit of using dextromethorphan or\n codeine.[3,4]</p>\n</blockquote>\n\n<p>_{\n1. (2006) Child assessment of dextromethorphan, diphenhydramine, and placebo for nocturnal cough due to upper respiratory infection. <a href=\"https://www.medscape.com/medline/abstract/16928841\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/16928841</a><br>\n2. (2004) Dose-response relationship with increasing doses of dextromethorphan for children with cough. <a href=\"https://www.medscape.com/medline/abstract/15531013\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/15531013</a><br>\n3. (2000) Antitussive efficacy of dextromethorphan in cough associated with acute upper respiratory tract infection. <a href=\"https://www.medscape.com/medline/abstract/11045895\" rel=\"nofollow noreferrer\">https://www.medscape.com/medline/abstract/11045895</a><br>\n}</p>\n\n<p>There is <a href=\"https://www.medscape.com/medline/abstract/6852361\" rel=\"nofollow noreferrer\">one study</a> that found DM to be more effective than codeine, but it was very small (16 patients) and quite old (1983). It is not compelling.</p>\n" }, { "answer_id": 16461, "author": "whitebeltcoder", "author_id": 8951, "author_profile": "https://health.stackexchange.com/users/8951", "pm_score": 2, "selected": false, "text": "<p>What you've read seems to be the case, as this systematic review shows <a href=\"http://www.cochrane.org/CD001831/ARI_over-the-counter-otc-medications-for-acute-cough-in-children-and-adults-in-community-settings\" rel=\"nofollow noreferrer\" title=\"Cochrane review\">Cochrane review</a>; there is no evidence for its use.\nThere isn't evidence against its use either (I guess it hasn't shown security problems) but it doesn't seem sensible to spend your money or the health system's on medication with no evidence of efficacy.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16449", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11958/" ]

[ { "answer_id": 16726, "author": "PousaliDey", "author_id": 7643, "author_profile": "https://health.stackexchange.com/users/7643", "pm_score": -1, "selected": false, "text": "<p>One cannot undergo medical tests to <strong>prevent</strong> common diseases. Instead, the <strong>purpose</strong> of those tests is to know the \"Current\" health <em>status</em> of a person.</p>\n\n<p>Once it's known, then one can take <strong>precautionary measures to prevent common diseases</strong>!!</p>\n\n<p>There are different sets of medical tests for different age groups, e.g. Men over 50 years of age are requested to undergo a \"PSA test\" every year to prevent the risk of prostate cancer.</p>\n\n<p>Basically, the medical tests depend on a lot of factors such as, man's age, his body type, eating habits, his job, geographical area and many more! Hope this helps.</p>\n\n<p>Ref link: <a href=\"https://www.cancer.org/cancer/prostate-cancer/early-detection/acs-recommendations.html\" rel=\"nofollow noreferrer\">Age for Prostate exam</a>.</p>\n\n<p>Thanks for the update! @DoctorWhom</p>\n" }, { "answer_id": 16727, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>Tests that one may want to do <strong>annually:</strong> </p>\n\n<ul>\n<li><a href=\"http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.WzYb9NUzZpg\" rel=\"nofollow noreferrer\">Blood pressure</a>; increased BP is a risk factor for heart disease</li>\n<li><a href=\"https://www.cancer.org/cancer/skin-cancer/prevention-and-early-detection/skin-exams.html\" rel=\"nofollow noreferrer\">Checking your skin for moles</a>, which can develop into cancer</li>\n<li><a href=\"https://oregon.providence.org/our-services/l/lipid-profile-cholesterol-and-triglycerides/\" rel=\"nofollow noreferrer\">Blood cholesterol and triglycerides (lipid profile)</a>; increased levels are risk factors for coronary heart disease</li>\n<li><a href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" rel=\"nofollow noreferrer\">Blood glucose</a> to check for diabetes mellitus</li>\n<li>Dental check for caries</li>\n<li>Eye examination</li>\n<li><a href=\"https://www.cancer.gov/types/prostate/psa-fact-sheet\" rel=\"nofollow noreferrer\">PSA test</a> for prostate cancer</li>\n<li>Fecal blood test, colonoscopy and other <a href=\"https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html\" rel=\"nofollow noreferrer\">tests for colorectal cancer</a> ( for those with a family history of colorectal cancer)</li>\n<li>Computed tomography or other <a href=\"https://www.cdc.gov/cancer/lung/basic_info/screening.htm\" rel=\"nofollow noreferrer\">tests for lung cancer</a> (for smokers)</li>\n</ul>\n\n<p>I'm not aware of any recommendation for <strong>monthly</strong> tests for healthy men.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16460", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13900/" ]

[ { "answer_id": 16484, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 3, "selected": true, "text": "<p>This is a good question, and although as you correctly state that HIV is an STI (see <a href=\"https://health.stackexchange.com/a/16502\">STI vs STD vs Sexually Transmitted Virus?</a>) there is a difference with HIV which is one reason why it may be separated from others.</p>\n\n<p>It can be thought that HIV is separated from STIs in factsheet titles etc. because HIV is a virus when others are not, but there are other STI viruses. For example, there is:</p>\n\n<ul>\n<li><a href=\"https://www.nhs.uk/chq/Pages/2611.aspx\" rel=\"nofollow noreferrer\">Human Papilloma Virus (HPV)</a>, which is the name for a group of viruses that affect your skin and the moist membranes lining your body.</li>\n<li><a href=\"https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm\" rel=\"nofollow noreferrer\">Herpes</a>, which is caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).</li>\n</ul>\n\n<p>It can also be thought that HIV is separated from STIs in factsheet titles etc. because HIV can be fatal, but there are other STIs which can lead to death. For example:</p>\n\n<ul>\n<li><a href=\"https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm\" rel=\"nofollow noreferrer\">Syphilis</a> can affect multiple organ systems, including the brain, nerves, eyes, liver, heart, and blood vessels. The effects on the heart can lead to death.</li>\n<li><a href=\"https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm\" rel=\"nofollow noreferrer\">Gonorrhea</a> can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis. This condition can be life threatening.</li>\n<li><a href=\"https://www.cdc.gov/std/hpv/stdfact-hpv.htm\" rel=\"nofollow noreferrer\">HPV (Human Papillomavirus)</a> can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).</li>\n</ul>\n\n<h2>Possible reasons for separating HIV from other STIs in factsheets</h2>\n\n<ol>\n<li>The key thing with HIV is that <strong>apart from <a href=\"https://www.cdc.gov/hepatitis\" rel=\"nofollow noreferrer\">Hepatitis</a></strong>, which is also viral, all other STIs are generally only transmittable only through sexual contact. HIV can be transmitted through infected blood transfusions, use of infected needles, or through contact between <strong>broken skin</strong> of 2 or more people.</li>\n</ol>\n\n<p><strong>Note: Skin to skin contact with unbroken skin is safe</strong></p>\n\n<ol start=\"2\">\n<li><p>STIs are infections and STDs are the diseases as a result of the infection. Some STDs don't share the same name as the STI which caused it.</p></li>\n<li><p>(This applies to your question) The linked factsheets etc. you provided are talking about the links between HIV and other STIs.</p></li>\n</ol>\n\n<h2>How reason 3 applies here</h2>\n\n<p>Reading the <a href=\"https://www.cdc.gov/std/hiv/stdfact-std-hiv-detailed.htm\" rel=\"nofollow noreferrer\">detailed version of the CDC factsheet on HIV and STDs</a>:</p>\n\n<blockquote>\n <p>[P]eople who get syphilis, gonorrhea, and herpes often also have HIV or are <strong>more likely to get HIV</strong> in the future. One reason is the behaviors that put someone at risk for one infection (not using condoms, multiple partners, anonymous partners) often put them at risk for other infections. Also, because STD and HIV tend to be linked, when someone gets an STD it suggests they got it from someone who may be at risk for other STD and HIV. Finally, a sore or inflammation from an STD may allow infection with HIV that would have been stopped by intact skin.</p>\n</blockquote>\n\n<p>Another interesting fact is that studies that have lowered the risk of STD in communities have not necessarily lowered the risk of HIV. Risk of HIV was lowered in one community trial (<a href=\"https://doi.org/10.1016/S0140-6736(95)91380-7\" rel=\"nofollow noreferrer\">Grosskurth, et al. 1995</a>), but not in 3 others (<a href=\"https://doi.org/10.1016/S0140-6736(98)06439-3\" rel=\"nofollow noreferrer\">Wawer, et al., 1999</a>; <a href=\"https://doi.org/10.1016/S0140-6736(03)12598-6\" rel=\"nofollow noreferrer\">Kamali, et al., 2003</a>; <a href=\"https://doi.org/10.1371/journal.pmed.0040102\" rel=\"nofollow noreferrer\">Gregson, et al., 2007</a>).</p>\n\n<p>Also, treating individuals for STDs has not necessarily lowered their risk of acquiring HIV (<a href=\"https://journals.lww.com/aidsonline/Fulltext/2001/07270/Effect_of_interventions_to_control_sexually.12.aspx\" rel=\"nofollow noreferrer\">Ghys, et al., 2001</a>; <a href=\"https://doi.org/10.1001/jama.291.21.2555\" rel=\"nofollow noreferrer\">Kaul, et al., 2004</a>).</p>\n\n<h2>Further Reading</h2>\n\n<p><a href=\"https://www.nhs.uk/chq/Pages/2611.aspx\" rel=\"nofollow noreferrer\">What is HPV?</a> — NHS<br>\n<a href=\"https://www.cdc.gov/std/hpv/stdfact-hpv.htm\" rel=\"nofollow noreferrer\">Genital HPV Infection Fact Sheet</a> — CDC</p>\n\n<p><a href=\"https://www.cdc.gov/hepatitis\" rel=\"nofollow noreferrer\">Hepatatis Factsheets</a> - CDC</p>\n\n<p><a href=\"https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm\" rel=\"nofollow noreferrer\">Genital Herpes Fact Sheet</a> - CDC</p>\n\n<h2>References</h2>\n\n<p>Ghys, P. D., Diallo, M. O., Ettiegne-Traore, V., Satten, G. A., Anoma, C. K., Maurice, C., ... &amp; Laga, M. (2001). Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers. <em>Aids</em>, 15(11), 1421-1431.<br>Retrieved from: <a href=\"https://journals.lww.com/aidsonline/Fulltext/2001/07270/Effect_of_interventions_to_control_sexually.12.aspx\" rel=\"nofollow noreferrer\">https://journals.lww.com/aidsonline/Fulltext/2001/07270/Effect_of_interventions_to_control_sexually.12.aspx</a></p>\n\n<p>Grosskurth, H., Todd, J., Mwijarubi, E., Mayaud, P., Nicoll, A., Newell, J., ... &amp; Changalucha, J. (1995). Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. <em>The lancet</em>, 346(8974), 530-536.<br>DOI: <a href=\"https://doi.org/10.1016/S0140-6736(95)91380-7\" rel=\"nofollow noreferrer\">10.1016/S0140-6736(95)91380-7</a></p>\n\n<p>Gregson, S., Adamson, S., Papaya, S., Mundondo, J., Nyamukapa, C. A., Mason, P. R., ... &amp; Anderson, R. M. (2007). Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe. <em>PLoS medicine</em>, 4(3), e102.<br>DOI: <a href=\"https://doi.org/10.1371/journal.pmed.0040102\" rel=\"nofollow noreferrer\">10.1371/journal.pmed.0040102</a></p>\n\n<p>Kamali, A., Quigley, M., Nakiyingi, J., Kinsman, J., Kengeya-Kayondo, J., Gopal, R., ... &amp; Whitworth, J. (2003). Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. <em>The Lancet</em>, 361(9358), 645-652.<br>DOI: <a href=\"https://doi.org/10.1016/S0140-6736(03)12598-6\" rel=\"nofollow noreferrer\">10.1016/S0140-6736(03)12598-6</a></p>\n\n<p>Kaul, R., Kimani, J., Nagelkerke, N. J., Fonck, K., Ngugi, E. N., Keli, F., ... &amp; Ronald, A. R. (2004). Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial. <em>Jama</em>, 291(21), 2555-2562.<br>DOI: <a href=\"https://doi.org/10.1001/jama.291.21.2555\" rel=\"nofollow noreferrer\">10.1001/jama.291.21.2555</a></p>\n\n<p>Wawer, M. J., Sewankambo, N. K., Serwadda, D., Quinn, T. C., Kiwanuka, N., Li, C., ... &amp; Ahmed, S. (1999). Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. <em>The lancet</em>, 353(9152), 525-535.<br>DOI: <a href=\"https://doi.org/10.1016/S0140-6736(98)06439-3\" rel=\"nofollow noreferrer\">10.1016/S0140-6736(98)06439-3</a></p>\n" }, { "answer_id": 16494, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p><em>Question:</em> If HIV is an STI, then why is HIV often listed separately, for example:</p>\n\n<ul>\n<li><a href=\"https://www.avert.org/learn-share/hiv-fact-sheets/sexually-transmitted-infections\" rel=\"nofollow noreferrer\">HIV &amp; Sexually Transmitted Infections Fact sheet</a></li>\n<li><a href=\"https://www.cdc.gov/std/hiv/stdfact-std-hiv.htm\" rel=\"nofollow noreferrer\">STDs and HIV – CDC Fact Sheet</a></li>\n<li><a href=\"https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/stds_hiv.htm\" rel=\"nofollow noreferrer\">What You Need To Know About the Links Between HIV and STDs</a></li>\n</ul>\n\n<p><em>Reason 1.</em> The articles linked above have \"HIV and STI\" or \"HIV or STDs\" in the titles because they describe how a person with a certain sexually transmitted disease (STD), for example, genital herpes is at increased risk to catch HIV virus. So, there is not really any \"listed separately\" situation here.</p>\n\n<p><em>Reason 2.</em> In some older articles, like <a href=\"http://sti.bmj.com/content/sextrans/70/6/418.full.pdf\" rel=\"nofollow noreferrer\">this one</a> from 1994, \"STDs and AIDS,\" are separated to make an emphasis on AIDS and compare the known STDs with AIDS, which was relatively new at the time.</p>\n\n<p>Apart from the fact, that AIDS is the most severe/deadly STD, there is no biological reason to list them separately: HIV is a virus but so is Herpes; AIDS is a systemic disease and if left untreated it is often deadly, but the same is true for <a href=\"http://www.soc.ucsb.edu/sexinfo/article/syphilis\" rel=\"nofollow noreferrer\">syphilis</a>. It's more about how the authors decide to title their articles.</p>\n\n<hr>\n\n<p>Explanation of the terms used to prevent confusion:</p>\n\n<p><strong>HIV</strong> refers to either the human immunodeficiency <em>virus</em> or, when this enters the body, to <em>HIV infection,</em> which is a sexually transmitted <em>infection</em> (STI). HIV infection becomes a sexually transmitted <em>disease</em> (STD), namely <strong>AIDS,</strong> only when it causes damage to the body and, usually, symptoms. So an STI is not already an STD, but in practice, both acronyms are often used as synonyms.</p>\n" }, { "answer_id": 16503, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": false, "text": "<p>From a rigorous scientific viewpoint, it at first makes indeed not much sense to list STIs and HIV separately. HIV is a virus that once it is in your body and you have antibodies developed will have caused an STI, which once it progresses to the symptoms of AIDS, becomes an STD that nobody wants.</p>\n\n<p>So it is mainly a historically formed cultural response to single out HIV. And a result of attention marketing.</p>\n\n<p>HIV spread very rapidly in the West from the late 70s onwards, it was seen as an incurable deadly disease – that was new, and initially not even widely recognised as an STD, but sometimes as God's revenge, a form of cancer etc. –that just takes long enough to kill everyone infected to enable all those promiscuous sinners to infect a large number of people.<br>\n_{(<a href=\"https://www.cambridge.org/core/books/the-origins-of-aids/2BDB50F42C4E17103286A3043647AA4D\" rel=\"nofollow noreferrer\">Jaques Pepin: \"The Origins of AIDS\", Cambridge University Press: Cambridge, New York, 2011,</a> ch 13 Globalisation.)}</p>\n\n<p>At the time of identification the public mind just had a lot of sex from the sexual revolution and saw other STDs as a souvenir from being very active, to be worn in pride since antibiotics could cure the most prominent bacterial infections with unprecedented effectiveness. This carefree and wrong attitude towards many STDs is still somewhat prevalent. </p>\n\n<blockquote>\n <p>The advent of the gay liberation movement in the late 1960s and 1970s led to the creation of a more self-confident ‘out’ gay community with a number of activist and campaigning groups. Sexual liberation became an important component of gay life; many sexually active gay men came to regard attendance at STD clinics as a regular, if inconvenient, aspect of sexual life.<br>\n By the mid-1960s, the number of attendances at STD clinics was increasing dramatically. The ‘sexual revolution’ of the ‘permissive society’, the advent of the oral contraceptive pill and the declining popularity of the condom all contributed to an increase of STDs, particularly viral infections. The increased incidence of STDs was seen in official circles as ‘primarily a reflection of sexual promiscuity in the population’; rather than prostitutes, however, the main social groups now seen to be responsible were teenagers, immigrants, asymptomatic promiscuous women and homosexuals.<br>\n _{(<a href=\"http://www.history.ac.uk/reviews/review/248\" rel=\"nofollow noreferrer\">Roger Davidson and Lesley A. Hall (Eds.)</a>: \"Sex, Sin and Suffering.\n Venereal disease and European society since 1870\", Routledge: London, New York, 2001, p 246–247.)}</p>\n</blockquote>\n\n<p>In the case of HIV/AIDS these social background factors of scientific medicine still linger on:</p>\n\n<blockquote>\n <p>Scientific discoveries such as the discovery of a new disease exert a fascination not only on the scientific community and the lay public, but also on social scientists. For the first, discovery is the main drive and the ultimate goal. For the lay public, it is often accompanied by the promise of curing illnesses and improving people’s lives. For social scientists, scientific discoveries are the domain where the role, influence, and limitations of social factors – such as interests, resources, and relationships – can be perhaps best examined.<br>\n That such factors play a role in discovery making has not been contested; the question is whether scientific discoveries are evaluated, acknowledged, and accepted by the scientific community according to universal standards of rationality or according to the resources, influence, and social relationships of the scientists themselves. The positivist tradition has solved this problem by distinguishing between the context of discovery and the context of justification. Whereas the former is messy (involving serendipity, accident, resources, interests, and the like), the latter is determined by rigorous criteria of universal applicability.<br>\n This distinction has been contested by sociologists and historians of science alike who argue that, in practice, the two contexts are indistinguishable: justification takes place in the process of discovery itself (e.g., Nickles 1992, p. 89; Hacking 1996, p. 51). Consequently, justification is not exclusively determined by logical criteria; factors such as interests, resources, and networks of relationships play a considerable role (Stump 1996, p. 445). </p>\n \n <p>_{<a href=\"http://www.cambridge.org/core_title/gb/245053\" rel=\"nofollow noreferrer\">Alex Preda: \"AIDS, Rhetoric, and Medical Knowledge\", Cambridge University Press: Cambridge, New York, 2005</a>, p47.}</p>\n</blockquote>\n\n<p>\"Getting AIDS\" is still seen by the larger public as the most dangerous of all STDs, with most others either classified as manageable or less important in their consequences. Whether true or not is irrelevant in the public's mind, and even these attitudes seem in decline and attention is unhealthily highly put on AIDS/HIV treatment advances, \"normal lives\", and now even the possibilities of vaccinations getting closer.</p>\n\n<p>If this reason for keeping HIV singled out when talking about STI/STDs is historical, why keep it separate? </p>\n\n<p>On the one hand, there is this connection between other STDs and HIV/AIDS, mentioned in other answers: having one increases to chance of catching the other. But it is also theorised that from a public health standpoint awareness and acceptance of preventive measures, testing and treatments might be improved simultaneously – not to mention the all important funding of research, prevention programs – the hypothesis of \"epidemiological synergy (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1595015\" rel=\"nofollow noreferrer\">Wasserheit 1992</a>; <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10448335\" rel=\"nofollow noreferrer\">Fleming and Wasserheit 1999</a>).\"</p>\n\n<blockquote>\n <p>_{Charles Klein &amp; Delia Easton: \"Structural Barriers and Facilitators in HIV Prevention: A Review of International Research\"; Sevgi O. Aral &amp; Thomas A. Peterman: \"STD Diagnosis and Treatment as an HIV Prevention Strategy\"; in: <a href=\"https://www.springer.com/us/book/9780306467318\" rel=\"nofollow noreferrer\">Ann O’Leary (Ed.): \"Beyond Condoms. Alternative Approaches to HIV Prevention\", Kluwer Academic Publishers: New York, Boston, 2002</a>.)}<br>\n STD control for HIV prevention is a controversial interface between well-financed HIV prevention programs and less wealthy STD prevention programs. STD experts are frustrated at the lack of HIV and other resources committed to this HIV prevention strategy. Some HIV experts are skeptical of the motivations of the proponents of this strategy, and think the potential for HIV prevention by STD control has been exaggerated. Between these two camps lies a huge mass of data accumulated by hundreds of studies conducted over the past 15 years. Synthesizing this data is particularly important for HIV prevention world wide, because the developing countries where STD control programs have been weak are often the countries where the AIDS epidemic has been most devastating.\n While epidemiological and microbiological evidence support the existence of a two-way relationship between STDs and HIV infection, the relationship between early and appropriate diagnosis and treatment of STDs and prevention of spread of HIV needs to be further elaborated. The parameters that need to be specified in such elaboration include 1) factors related to the STI: the specific STI; whether the STI is symptomatic or asymptomatic; whether the STI is incident (new) infection or prevalent (chronic or long standing) infection; and perhaps the stage of the sexually transmitted infection; 2) factors related to the population, which may also function as multipliers of the STI effect: age-gender composition; patterns of sexual mixing and concurrency; prevalence of male circumcision; 3) factors related to the phases of the STD and HIV epidemics: for example, whether the HIV and STD epidemics are nascent or generalized epidemics; 4) factors related to the goals of the HIV prevention program: objectives related topreventing the acquisition of infection among the uninfected; objectives related to preventing the transmission of infection by the infected; objectives related to provision of services to protect the personal health of individual members of the population; objectives related to protecting public health, i.e., limiting the spread of HIV infections: objectives related to targeting primary prevention of HIV through behavior change versus primary prevention of HIV through control of co-factors. The appropriate approach to the implementation of STD control for HIV prevention in a specific setting depends on the values of all of the above factors. In addition, many of the above factors are interdependent, and it is important to consider their reciprocal influences.</p>\n</blockquote>\n\n<p>It seems quite useful from an epidemiological view to just not neglect one of the two closely interconnected halves of this problem realm. And previously, after the advent of penicillin, the public mind and imaginations (including those of politicians) did start to neglect other STDs as long as the discussion went for funding, morals and opinions were always cheap. </p>\n\n<blockquote>\n <p>From this perspective, rhetorical practices are not an obstacle but rather a necessary ingredient of expert democracy. Bridging the gap between science and the general public has become crucial to the public sphere and democracy. This means we must acknowledge that rhetorical practices do matter and act accordingly.<br>\n _{Preda (2005): \"How Rhetorical Practices Matter for AIDS Prevention\", p229ff.}</p>\n</blockquote>\n\n<hr>\n\n<p>To sum this position up: HIV/AIDS was seen as something different from what was known as STI/STDs even by medical professionals, it is still seen as \"different\" in the public eye. Apart from being \"on of the most <a href=\"http://www.enjoyliving.at/lieben-und-leben-magazin/lust-und-liebe/sexualitaet/haeufige-geschlechtskrankheiten-ein-ueberblick.html\" rel=\"nofollow noreferrer\">\"popular\" STIs</a> it is also seen as the deadliest. Apart from the historical reasons that lead to it being listed separately, this separation is continued for science communication reasons. It is thought to help with awareness, prevention, testing and treatment. In really short terms: sticklers, like me, point out quite rightly that HIV/AIDS is an STI/STD. But the usual presentation now is both historically grown <em>and</em> useful. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16483", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12472/" ]

[ { "answer_id": 16501, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>STI = sexually transmitted infection</p>\n\n<p>STD = sexually transmitted disease</p>\n\n<p>Strictly speaking, not all STIs are STDs. Infection merely means the presence of the microbes in the body and if it does not cause any symptoms, it is called asymptomatic infection, not a disease. Only when a HIV infection causes damage to the body, which usually comes with symptoms, it becomes a disease (STD), namely AIDS.</p>\n\n<p>HIV = human immunodeficiency virus. When someone catches HIV, he/she only catches a virus, which may or may not cause AIDS. The same way as you can catch some rhinoviruses and as a result you may or may not develop common cold. </p>\n\n<p><a href=\"https://www.medicalnewstoday.com/articles/316019.php\" rel=\"nofollow noreferrer\">MedicalNewsToday: HIV vs. AIDS: What is the difference?</a></p>\n\n<blockquote>\n <p>HIV infection and AIDS are not the same condition, and they are not\n the same diagnosis.</p>\n \n <p>HIV is a virus that attacks a type of white blood cell called a CD4\n cell in the body's immune system.</p>\n \n <p>AIDS is a syndrome, or range of symptoms, that may develop in time in\n a person with HIV who does not receive treatment. <strong>A person can have\n HIV without developing AIDS, but it is not possible to have AIDS\n without first having HIV.</strong></p>\n</blockquote>\n\n<hr>\n\n<p>Bottom line: HIV = an STI (infection), which may or may not become an STD (disease), called AIDS.</p>\n" }, { "answer_id": 16502, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 4, "selected": true, "text": "<h2>Short Answer</h2>\n\n<p>HIV is a virus and when the HIV virus has invaded the body it becomes an infection (specifically an STI <strong>only if and when</strong> transmitted through sexual contact).</p>\n\n<p>Whilst the terms STI and STD are often used interchangeably, really and truthfully, they are different.</p>\n\n<p><strong>A sexually transmitted virus is an STI when inside the body, and an STI is <em>not necessarily</em> an STD</strong>.</p>\n\n<h2>Longer Answer</h2>\n\n<p>As an example of the confusion which can occur, there are articles that labeled herpes as a “sexually transmitted disease” (STD), while others favoured the term “sexually transmitted infection” (STI) (<a href=\"https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference\" rel=\"noreferrer\">Depasse, 2017</a>). Even government health agencies like the National Institutes of Health (NIH) use the terms interchangeably (<a href=\"https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types\" rel=\"noreferrer\">NIH, 2017</a>), often without explanation for doing so. With such ambiguity, it’s hard to discern fact from fiction.</p>\n\n<h2>Key Terms</h2>\n\n<p><strong>Pathogen</strong>: A pathogen is a microorganism that can cause disease. There are five major types of pathogens: bacteria, viruses, fungi, protozoa, and helminths (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>).</p>\n\n<p><strong>Infection</strong>: An infection resulting from when a pathogen invades and begins growing within a host (e.g., a human) (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>; <a href=\"https://c.merriam-webster.com/medlineplus/infection\" rel=\"noreferrer\">MedlinePlus, n.d.</a>).</p>\n\n<p><strong>Disease</strong>: A disease results <strong>only if and when</strong>, as a consequence of the invasion and growth of a pathogen, tissue function is impaired (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NIH, 2007</a>) it is when the body’s ability to perform normal functions is interrupted or changed, usually presenting with certain signs and symptoms. <a href=\"https://c.merriam-webster.com/medlineplus/disease\" rel=\"noreferrer\">MedlinePlus, n.d.(a)</a>).</p>\n\n<p>With these terms, the definitions of STI and STD in my question stands:</p>\n\n<blockquote>\n <h2>STI</h2>\n \n <p>Stands for Sexually Transmitted Infection — <strong>an infection</strong> caused by bacteria or virus which has been transmitted through sexual contact.</p>\n \n <h2>STD</h2>\n \n <p>Stands for Sexually Transmitted Disease — <strong>a disease</strong> caused by the infection of a bacteria or virus transmitted through sexual contact.</p>\n</blockquote>\n\n<p>Therefore, both Jan and I are correct with regard to HIV. HIV is a virus (a pathogen), and when the HIV virus has invaded the body it becomes an infection (specifically an STI <strong>only if and when</strong> transmitted through sexual contact). HIV by itself is not a disease (STD) but causes AIDS which is the STD (the symptom of advanced HIV infection). HIV is still present as an STI with AIDS being an STD.</p>\n\n<p>Whilst the terms STI and STD are often used interchangeably, really and truthfully, they are different.</p>\n\n<h2>References</h2>\n\n<p>Depasse, E. (2017). <em>STD vs. STI: Is There a Difference? And Why Does It Matter? - HealthCentral</em><br>Retreivable from: <a href=\"https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference\" rel=\"noreferrer\">https://www.healthcentral.com/article/std-vs-sti-is-there-a-difference</a></p>\n\n<p>MedlinePlus. (n.d.). <em>Infection - Medical Dictionary</em><br>Retreivable from: <a href=\"https://c.merriam-webster.com/medlineplus/infection\" rel=\"noreferrer\">https://c.merriam-webster.com/medlineplus/infection</a></p>\n\n<p>MedlinePlus. (n.d.(a)) <em>Disease - Medical Dictionary</em><br>Retrievable from: <a href=\"https://c.merriam-webster.com/medlineplus/disease\" rel=\"noreferrer\">https://c.merriam-webster.com/medlineplus/disease</a></p>\n\n<p>NIH. (2007). Understanding emerging and re-emerging infectious diseases. Biological sciences curriculum study. <em>NIH Curriculum Supplement Series. National Institutes of Health, Bethesda, MD</em>.<br>NIH Bookshelf ID: <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK20370/\" rel=\"noreferrer\">NBK20370</a></p>\n\n<p>NIH. (2017). <em>What are some types of and treatments for sexually transmitted diseases (STDs) or sexually transmitted infections (STIs)?</em><br>Retreivable from: <a href=\"https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types\" rel=\"noreferrer\">https://www.nichd.nih.gov/health/topics/stds/conditioninfo/types</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16500", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7951/" ]

[ { "answer_id": 16513, "author": "Gordon", "author_id": 13819, "author_profile": "https://health.stackexchange.com/users/13819", "pm_score": 3, "selected": true, "text": "<p>National Institutes of Health - Health Professionals Fact Sheet on Potassium</p>\n<blockquote>\n<p><strong>Dietary potassium</strong></p>\n<p>In healthy people with normal kidney function, high dietary potassium intakes do not pose a health risk because the kidneys eliminate excess amounts in the urine. In addition, there is no evidence that high intakes of dietary potassium have adverse effects. Therefore, the Food and Nutrition Board did not set a UL for potassium.</p>\n<p>^{Source: National Institutes of Health - <a href=\"https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/#h8\" rel=\"nofollow noreferrer\">Health Professionals Fact Sheet on Potassium, Health Risks from Excessive Potassium</a>}</p>\n</blockquote>\n<p>Note, the article speaks of dietary potassium, what we would consume in the diet.</p>\n<p>A lot of sites on the internet make the (dubious?) assumption that all persons are under the care of a doctor, and hence they would know if they had inadequate kidney function. But of course, for various reasons, not everyone is under the care of a doctor.</p>\n<p>Nevertheless, I hope the above information is helpful. I would suggest that people may want to read the entire article on potassium that I linked.</p>\n" }, { "answer_id": 31014, "author": "Peter Bernhard", "author_id": 21148, "author_profile": "https://health.stackexchange.com/users/21148", "pm_score": 1, "selected": false, "text": "<p>&quot;Does potassium really raise cortisol? Are there any published research articles confirming this?&quot;</p>\n<p>My google search &quot;effects of potassium intake on cortisol&quot; brought up:</p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/33870711/\" rel=\"nofollow noreferrer\">Dreier et al.,</a> Effect of Increased Potassium Intake on Adrenal Cortical and Cardiovascular Responses to Angiotensin II: A Randomized Crossover Study, J Am Heart Assoc. 2021:</p>\n<p>&quot;... Increased potassium intake lowers blood pressure in patients with hypertension, but increased potassium intake also elevates plasma concentrations of the blood pressure-raising hormone <em>aldosterone</em>.</p>\n<p>This argues for aldosterone, not cortisol, being the hormone that does react to potassium intake. That should be accepted knowledge.</p>\n<p>My search found only one other study:</p>\n<p><a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0041008X07000531?via%3Dihub\" rel=\"nofollow noreferrer\">Li/Lin</a>, Interacting influence of potassium and polychlorinated biphenyl on cortisol and aldosterone biosynthesis, Toxicology and Applied Pharmacology\nVolume 220, Issue 3, 1 May 2007, Pages 252-261:\n&quot;Giving human adrenocortical H295R cells 14 mM <em><strong>KCl</strong></em> for 24 h significantly induced <em><strong>not only aldosterone</strong></em> biosynthesis <em><strong>but also cortisol biosynthesis</strong></em>. Pre-treating the cells with polychlorinated biphenyl 126 (PCB126) further increased potassium-induced aldosterone and cortisol productions in a dose-dependent manner, ...&quot;</p>\n<p>From both quotes you might infer that as a principle it is acknowledged that high potassium intake is able to increase aldosterone, and that it comes to a surprise to find out the same for cortisol.</p>\n<p>Interestingly, both hormones seem to be relevant with Addison's disease (which is primarily known for not enough cortisol only), whereas with Cushing's disease (i.e. too much cortisol) it's only the cortisol. Cp. Wikipedia on <a href=\"https://en.wikipedia.org/wiki/Addison%27s_disease\" rel=\"nofollow noreferrer\">Addison's disease</a>: &quot;... endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone...&quot;, and on <a href=\"https://en.wikipedia.org/wiki/Cushing%27s_syndrome\" rel=\"nofollow noreferrer\">Cushing's</a>: Aldosterone/potassium not mentioned. However, there seem to be cases to be classified as Cushing's that involve both hormones, see <a href=\"https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0395-y\" rel=\"nofollow noreferrer\">Ren et al.</a>, Hypercortisolism and primary aldosteronism caused by ... adenomas ..., 2019,&quot;...Herein, we report a patient with co-existing cortisol-producing and aldosterone-producing adrenocortical adenomas, one in each adrenal gland. ...&quot;. On the other hand, <a href=\"https://en.wikipedia.org/wiki/Primary_aldosteronism\" rel=\"nofollow noreferrer\">Conn's syndrome</a> is defined by too much aldosterone, and cortisol not involved.</p>\n<p>Here's my personal hint to it: All this might mnemonically be reconciled by tentatively hypothesizing for the sake of learning that, as cortisol is the first and only hormone to regulate blood pressure after waking up (levels are high in the morning) to raise blood pressure, thus indirectly raising renal filtration and at the same time renal reabsorption. There seems no more than only basic accepted knowledge about the issue of potassium excretion and reabsorption: potassium is freely filtrated, and it is reabsorbed via cells by so called Na+/K+-ATPase (proximal tubuli; to distinguish from the aldosterone exchange of potassium excreted against sodium). Try some search on &quot;cortisol potassium renal reabsorption&quot;: the role of cortisol mediated blood pressure on reabsorption of potassium (and sodium) is rather unclear, and it seems no more than a theoretical possibility that cortisol has some direct effect on Na+/K+-ATPase. If yes, that should argue in favour of my own personal approach to Li/Lins's paper: Could surprisingly found increase of cortisol be caused by increase of aldosterone and excessive excretion of potassium (coupled with excessive reabsorption of sodium)? Reabsorption of NaCl, known to be used for plasma expansion, might lead to a rise of cortisol and cortisol induced filtration. Conn's disease (too much aldosterone, no cortisol involved, i.e. contrary to the above no rise in cortisol from reabsorption of potassium) can be differentiated against the findings of the cited study: With Conn's there is no elevated potassium <em>intake</em> (wording of your question). Mnemonically, one might even look upon polychlorinated biphenyl as a functional equivalent of NaCl in that sense (blood volume and pressure).</p>\n<p>The above thus tries to reconcile the findings of that single study with traditional knowledge that &quot;elevated potassium&quot; (your question) does not &quot;lead to elevated cortisol&quot; (according to the above: potassium does not raise blood pressure).</p>\n<p>The source your question refers to (&quot;Selfhacked&quot;) might have - erroneously maybe - not only have exchanged cause and effect but also high and low (to make it right...) as (something Wikipedia on Cushing's does not mention) low potassium levels are known effects of high cortisol levels.</p>\n<p>See some bing search about this (not some standard knowledge, I guess)</p>\n<p><a href=\"https://www.bing.com/search?q=potassium%20cushing&amp;PC=U316&amp;FORM=CHROMN\" rel=\"nofollow noreferrer\">https://www.bing.com/search?q=potassium+cushing&amp;PC=U316&amp;FORM=CHROMN</a></p>\n<p>Cortisol seems to be cause not effect in respect of the regulation of blood pressure and blood sugar, both of which might relate to potassium level (effect not cause):</p>\n<p>About the issue of potassium and blood sugar see, e.g., this video on <a href=\"https://www.bing.com/videos/search?q=insuline%20potassium%20blood&amp;docid=608004195014698940&amp;mid=60F2C95D6B9B08A87E2260F2C95D6B9B08A87E22&amp;view=detail&amp;FORM=VIRE\" rel=\"nofollow noreferrer\">Insuline and potassium relationship</a>. Again, potassium level is considered not cause but effect.</p>\n<p>About cause and effect in the context not of blood sugar but blood pressure see, e.g., <a href=\"https://my.clevelandclinic.org/health/articles/22187-cortisol\" rel=\"nofollow noreferrer\">How does cortisol regulate blood pressure?</a></p>\n<p>&quot;...The exact way in which cortisol regulates blood pressure in humans is unclear. However, elevated levels of cortisol can cause high blood pressure, and lower-than-normal levels of cortisol can cause low blood pressure.&quot;</p>\n<p>Maybe the statement you quote is based on the known fact that high potassium levels (potassium consumption) are consistent with low blood pressure, implicitely hypothesizing that low blood pressure then leads to cortisol secretion. Conversely, for blood sugar quoted video's issue shows that raised potassium in blood is consistent with high levels of blood sugar which apparently do not call for a raise in cortisol.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16505", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2248/" ]

[ { "answer_id": 16653, "author": "JWC", "author_id": 14054, "author_profile": "https://health.stackexchange.com/users/14054", "pm_score": 4, "selected": true, "text": "<p>The only thing that keeps a patient in cardiac arrest alive is constant, high-quality chest compression.</p>\n\n<p>Cardioversion (\"shocking\") of a patient aims to return the heart to normal (sinus) rhythm in the case that a cardiac arrest is due to a dysrhythmia. If it works, great - return of spontaneous circulation (ROSC) will be achieved and there will be signs of this; coughing, spluttering, pulse etc.</p>\n\n<p>We assume that it will not be successful and immediately resume compressions because even a couple of seconds delay in chest compressions dramatically reduces organ perfusion and worsens outcome.</p>\n\n<p>A couple of chest compressions in a patient who has been successfully cardioverted will not do any particular harm and the downsides of waiting to see if it has worked are huge.</p>\n" }, { "answer_id": 23703, "author": "Floyd Mitchell", "author_id": 19666, "author_profile": "https://health.stackexchange.com/users/19666", "pm_score": 2, "selected": false, "text": "<p>There are several studies that emphasize the importance of providing rapid and deep compressions and that CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion. </p>\n\n<p>Here is an excerpt from one of the studies:</p>\n\n<p>\"After a successful shock, the rescuer was expected to assess the patient for a return of pulse after conversion of the ventricular rhythm. However, the delivery of repeat shocks (if necessary) and checking of the patient's pulse were found to delay the resumption of CPR for 60 seconds or more. Also, even after conversion, the ventricle was often stunned, so that its effective mechanical function did not return with the resumption of sinus rhythm. These issues, along with the finding that the ventricular rhythm was converted to sinus rhythm with the first shock in 85% of cases (13) led the AHA to modify the algorithm so as to specify only a single shock before immediate resumption of CPR, with a check of the patient's cardiac rhythm and pulse only after 3 minutes of continued compressions (14). This change in the resuscitation guideline, like the elimination of rescue breathing, maximizes the time during resuscitation for chest compressions and thus optimizes efforts to provide tissue perfusion.\"</p>\n\n<p>Sources: </p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116356/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116356/</a></p>\n\n<p><a href=\"https://www.aedusa.com/training\" rel=\"nofollow noreferrer\">https://www.aedusa.com/training</a></p>\n\n<p><a href=\"https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.165674\" rel=\"nofollow noreferrer\">https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.165674</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16534", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13962/" ]

[ { "answer_id": 16652, "author": "JWC", "author_id": 14054, "author_profile": "https://health.stackexchange.com/users/14054", "pm_score": 3, "selected": true, "text": "<p>ICD-10 is a classification system which can be used to record certain disease states of a patient, e.g. <code>I50</code> meaning \"Heart failure\" or <code>I50.1</code> meaning \"Left ventricular failure\".</p>\n\n<p>SNOMED CT provides multiple advantages:</p>\n\n<ol>\n<li>SNOMED CT covers all clinical terms, not just disease states. For example we can say <code>85232009</code> meaning \"left heart failure\" but we could also say <code>163053002</code> meaning \"raised JVP\", <code>162965007</code> meaning \"lung crackles heard\", <code>421346005</code> meaning \"3+ pitting oedema\".</li>\n</ol>\n\n<p>Alternatively, we could say <code>315261000000101</code> meaning \"patient advised to attend emergency department\", <code>239471000000109</code> meaning \"emergency ambulance call\" and <code>1079771000000108</code> meaning \"transported by ambulance\".</p>\n\n<ol start=\"2\">\n<li>SNOMED CT has a grammar, allowing the creation of \"expressions\". For example, we can say:</li>\n</ol>\n\n<p><code>236721000000106</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure)\"</p>\n\n<p><code>236721000000106:363704007=91470000</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure) into the axilla\"</p>\n\n<p><code>236721000000106:363704007=91470000, 272741003 = 7771000</code> meaning \"Implantation of intravenous dual chamber cardiac pacemaker system (procedure) into the axilla, left side\"</p>\n\n<ol start=\"3\">\n<li>SNOMED CT is far more granular than ICD-10. There are many more specific codes. Furthermore, SNOMED CT expressions as above allow almost any clinical concept to be described in detail.</li>\n</ol>\n\n<p>I would strongly recommend this guide for learning more about SNOMED CT (<a href=\"https://confluence.ihtsdotools.org/display/DOCSTART/SNOMED+CT+Starter+Guide\" rel=\"nofollow noreferrer\">https://confluence.ihtsdotools.org/display/DOCSTART/SNOMED+CT+Starter+Guide</a>)</p>\n" }, { "answer_id": 19386, "author": "userJT", "author_id": 15631, "author_profile": "https://health.stackexchange.com/users/15631", "pm_score": -1, "selected": false, "text": "<p>There are two sets of terminologies because their different purpose. It also sometimes useful to have a competition of two terminologies.</p>\n\n<p>(btw - we also have 2 app stores that serve the same purpose. We really need just one. But we have two for some good reasons)</p>\n" } ]

[ "https://health.stackexchange.com/questions/16544", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13969/" ]

[ { "answer_id": 16567, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": false, "text": "<p>It is the information leaflet, which usually comes with all drugs, that should tell you to take them with or without food.</p>\n\n<hr>\n\n<p>For <em>one/few time use,</em> it can be better to take them <strong>on an empty stomach or with water</strong> because they will pass through it quicker and will be absorbed quicker, so they will likely act quicker and stronger (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574824/\" rel=\"nofollow noreferrer\">PubMed Central</a>).</p>\n\n<p>Examples: </p>\n\n<ul>\n<li><a href=\"https://beta.nhs.uk/medicines/paracetamol-for-adults/\" rel=\"nofollow noreferrer\">Paracetamol</a></li>\n<li><a href=\"http://theconversation.com/do-you-need-to-take-some-painkillers-with-food-to-protect-your-stomach-47156\" rel=\"nofollow noreferrer\">Aspirin, ibuprofen, diclofenac and other nonsteroidal anti-inflammatory drugs (NSAIDs) when taken for up to 3 days</a></li>\n</ul>\n\n<hr>\n\n<p>For <em>the long-term use,</em> it is better to take them <strong>with food</strong> to reduce the risk of stomach inflammation.</p>\n\n<p>Examples:</p>\n\n<ul>\n<li><a href=\"http://theconversation.com/do-you-need-to-take-some-painkillers-with-food-to-protect-your-stomach-47156\" rel=\"nofollow noreferrer\">NSAIDs, when taken for >3 days</a></li>\n</ul>\n" }, { "answer_id": 16571, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 5, "selected": true, "text": "<p>Ibuprofen and Aspirin <a href=\"https://www.whocc.no/atc_ddd_index/?code=M01AE&amp;showdescription=no\" rel=\"noreferrer\">are both non-steroidal anti-inflammatory drugs (NSAIDs)</a>. These NSAIDs can be differentiated into selective NSAIDs and non-selective NSAIDs. </p>\n\n<p>Non-selective NSAIDs such as Ibuprofen and Aspirin are both COX-1 [<em>Cyclooxygenase-1, also known as prostaglandin-endoperoxide synthase 1 (PTGS-1)</em>] and COX-2 inhibitors [<em>Cyclooxygenase-2 respectively</em>]. (For the sake of completion: Selective NSAIDs only inhibit COX-2).</p>\n\n<p>Both PTGS inhibitors prevent prostaglandin synthesis, which is a hormone amongst many other functions responsible for transmitting pain to the brain. </p>\n\n<p>However, because <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18549814\" rel=\"noreferrer\">a study from 2008</a> notes that COX-1 promotes the production of the natural mucus lining that protects the inner stomach and contributes to reduced acid secretion and reduced pepsin content, (and hence an inhibitor such as all non-selective NSAIDs will decrease said mucus), <a href=\"https://www.nps.org.au/australian-prescriber/articles/the-vascular-effects-of-cox-2-selective-inhibitors\" rel=\"noreferrer\">PTGS-1 inhibitors increase the <em>risk of serious gastrointestinal bleeding and ulceration</em></a> (and other stomach-upsetting symptoms).</p>\n\n<p>Hence it is recommended to consume such non-selective NSAIDs with food, <a href=\"https://www.nhs.uk/chq/Pages/866.aspx?CategoryID=73&amp;SubCategoryID=103\" rel=\"noreferrer\">because this will allegedly lessen the symptoms</a>. </p>\n\n<p>It used to be \"mandatory\" to eat food before taking such medicine, but in 2015, <a href=\"https://pharmadispatch.com/news/chnages-for-ibuprofen\" rel=\"noreferrer\">the Australian Medicines Handbook has stepped back from this standpoint and now only encourages taking it with water and eating only if it does in fact upset one's stomach.</a> A <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18335848\" rel=\"noreferrer\">study published in 2007</a> has already found that the negative side-effects are dosage and time-dependent. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23163547\" rel=\"noreferrer\">Furthermore, a more recent study from 2015 found that the effect of food might not be as positive as expected.</a></p>\n\n<p>So, this seems to be a pretty mixed bag. I find the solution of the Australian Medicines Handbook reasonable however: Don't take them with food unless you have gastrointestinal problems. If those problems should be severe, as always consult a physician.</p>\n\n<hr>\n\n<p>Other common painkillers such as <a href=\"https://www.whocc.no/atc_ddd_index/?code=N02BE01\" rel=\"noreferrer\">paracetamol</a> that are not NSAIDs and thus not PTGS-1 inhibitors <a href=\"http://www.familydoctor.co.nz/categories/medication/paracetamol-a-patients-guide/\" rel=\"noreferrer\">can be taken without food</a>, as they are not stomach-upsetting. </p>\n" }, { "answer_id": 16573, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": false, "text": "<p>It is indeed important to differentiate the drug in question and the individual and the intention for using the drug and the way it is taken, temporally.</p>\n\n<p>Painkillers – or <a href=\"https://en.wikipedia.org/wiki/Analgesic\" rel=\"nofollow noreferrer\">analgesics</a> – come in a wide variety, be that in the form of <a href=\"https://en.wikipedia.org/wiki/Opioid\" rel=\"nofollow noreferrer\">opioids</a>, <a href=\"https://en.wikipedia.org/wiki/Cannabinoid\" rel=\"nofollow noreferrer\">cannabinoids</a>, <a href=\"https://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug\" rel=\"nofollow noreferrer\">NSAIDs</a>, <a href=\"https://en.wikipedia.org/wiki/Channel_modulator\" rel=\"nofollow noreferrer\">ion-channel_modulators</a>, <a href=\"https://en.wikipedia.org/wiki/Myorelaxant\" rel=\"nofollow noreferrer\">myorelaxants</a> or uncategorised drugs like <a href=\"https://en.wikipedia.org/wiki/Ketamine\" rel=\"nofollow noreferrer\">ketamine</a>. Not all are usually administered orally or even effective that way, by far not all are even available prescription free. As should become clear by now, \"a general guideline\" is almost impossible to formulate.</p>\n\n<p>You have to inquire about one specific drug in question. And even then it will be complicated and our picture about every single one of all those drugs is still evolving and however detailed it may seem, incomplete. Follow the advice given on the leaflet, by your pharmacist and doctor.</p>\n\n<p>Taking the example of cannabinoids, it is common knowledge that a full stomach will delay the effects of the active ingredients, but the simultaneous ingestion of a little bit of fat will increase the absorption of them. The more interesting molecules are all lipophilic and quite waste to digest in isolation.</p>\n\n<p>It will be also a quite different story if we are talking about a one-time paracetamol administration or a long term course of aspirin, to name just one example pair.</p>\n\n<p>The possible side-effects and interactions are different for each drug in question and each individual will fall on a different place of the scale of possible consequences. That does still not take into account the different foods that might interact with the drugs and the stomachs content.</p>\n\n<p>Some important problems to keep an eye on when reading the accompanying leaflet are for example time the drug is in the stomach (gastric emptying) or the pH with the drug and with or with food (buffering).</p>\n\n<p><a href=\"https://www.physiology.org/doi/pdf/10.1152/physrev.00004.2008\" rel=\"nofollow noreferrer\">Prostaglandins, NSAIDs, and Gastric Mucosal Protection: Why Doesn’t the Stomach Digest Itself?</a> (Physiol Rev 88: 1547–1565, 2008; doi:10.1152/physrev.00004.2008.)</p>\n\n<p>Since both other answers are basically correct on their own, I will only add some details that wouldn't fit into comments.</p>\n\n<p>Concernig absorption rates: \n<a href=\"https://link.springer.com/article/10.1007%2FBF02235637\" rel=\"nofollow noreferrer\">Absorption of acetylsalicylic acid from unbuffered and buffered gastric contents</a> and <a href=\"https://doi.org/10.1002/jps.2600530203\" rel=\"nofollow noreferrer\">Gastrointestinal Factors in Aspirin Absorption: A Quantitative Study</a> but that is in contrast to <a href=\"https://doi.org/10.1016/0041-008X(60)90053-3\" rel=\"nofollow noreferrer\">Absorption of aspirin from the stomach in man</a>, <a href=\"https://doi.org/10.1002/jps.2600720727\" rel=\"nofollow noreferrer\">Influence of food on aspirin absorption from tablets and buffered solutions</a>, <a href=\"https://doi.org/10.1002/jps.2600730917\" rel=\"nofollow noreferrer\">Kinetics of aspirin absorption following oral administration of six aqueous solutions with different buffer capacities</a>.</p>\n\n<p>The most common side-effect of taking drugs orally is probably an upset stomach, but one of the more important effects might be actual bleeding, even with low dose aspirin: <a href=\"http://www.nature.com/articles/ajg2000570\" rel=\"nofollow noreferrer\">Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin</a></p>\n\n<p>While the already mentioned COX inhibition is a problem in itself, many natural substances occurring naturally in food are also known to exhibit this action, very probably increasing the risk if even ever so slightly. Substances that might act in this way: </p>\n\n<blockquote>\n <p>Therefore, caution should be exercised if combining aspirin with any \"natural\" supplements with COX-2-inhibiting properties, such as garlic extracts, curcumin, bilberry, pine bark, ginkgo, fish oil, resveratrol, genistein, quercetin, resorcinol, and others.<br>\n _{<a href=\"https://en.wikipedia.org/wiki/Aspirin#Adverse_effects\" rel=\"nofollow noreferrer\">Wikipedia: Aspirin</a>}</p>\n</blockquote>\n\n<p>As a personal anecdote I might also add saffron to the list of side-effects enhancers.</p>\n\n<p>But look how aspirin and paracetamol differ in their pharmocokinetics.</p>\n\n<blockquote>\n <p>These factors would modulate the kinetics in the inflammatory focus, thereby prolonging the therapeutic action of the drug beyond that expected based on analysis of plasma pharmacokinetics. However, ion trapping also results in acidic compounds achieving high concentrations in the stomach wall and kidney, in which blockade of prostanoid synthesis causes the typical organ toxicity elicited by these compounds. Due to their lack of acidic structure, other COX inhibitors, such as dipyrone and paracetamol, are distributed homogenously throughout the body at therapeutic doses and induce analgesia, but induce no or very slight anti-inflammatory effects. This is partly due to their low concentration in inflamed tissues. (p14) </p>\n \n <p>All NSAIDs approved by the US Food and Drug Administration carry the same boxed warning for cardiovascular and gastrointestinal risk. These state “NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk” and “NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events,” respectively. (p37/8)<br>\n _{<a href=\"https://www.springer.com/de/book/9783319338873\" rel=\"nofollow noreferrer\">Angel Lanas (Ed): \"NSAIDs and Aspirin. Recent Advances and Implications for Clinical Management\", Springer, 2016</a>. DOI 10.1007/978-3-319-33889-7\n}</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/16564", "https://health.stackexchange.com", "https://health.stackexchange.com/users/45/" ]

[ { "answer_id": 16585, "author": "DoctorWhom", "author_id": 6776, "author_profile": "https://health.stackexchange.com/users/6776", "pm_score": 4, "selected": true, "text": "<p>There are several issues regarding dairy that have to be taken into consideration.</p>\n\n<p>One is the link between casein and cancers. I have heard a presentation from the author of some of the prominent studies on the subject, and have reduced my own family's intake of dairy based on findings. An example of another author's findings is <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166373/\" rel=\"noreferrer\">this paper</a>, which concludes</p>\n\n<blockquote>\n <p>The milk protein, casein, promotes the proliferation of prostate\n cancer cells such as PC3 and LNCaP.</p>\n</blockquote>\n\n<p>Secondly is the fact that many adults lose the ability to digest lactose, which happens by slow loss of the enzyme on the intestinal brush border. Many don't realize it because of the slow onset. Symptoms of gas and diarrhea/constipation and abdominal pain are common, because the bacteria in the late gut DO digest it and produce quite a bit of gas, and it serves as an osmotic laxative.</p>\n\n<p>Third, there are conflicting studies on the health impact of fat in milk. Generally, saturated fats from animal sources are advised to be avoided due to increasing cardiovascular risk via cholesterol levels. However, some studies have suggested full fat milk is actually better than skim in terms of health impact. Verdict is still out on that.</p>\n" }, { "answer_id": 16589, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": false, "text": "<p><strong>In short: According to several recent systematic reviews of studies, milk consumption is not associated with significant side effects, increased mortality, cancer, osteoporosis, heart disease or stroke.</strong></p>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122229/\" rel=\"nofollow noreferrer\">Milk and dairy products: <strong>good or bad for human health?</strong> An assessment of the totality of scientific evidence (PubMed, 2016)</a></p>\n\n<blockquote>\n <p>very few adverse effects have been reported.</p>\n \n <p>milk and dairy intake was inversely associated with colorectal cancer,\n bladder cancer, gastric cancer, and breast cancer, and not associated\n with risk of pancreatic cancer, ovarian cancer, or lung cancer, while\n the evidence for prostate cancer risk was inconsistent.</p>\n \n <p>There was no consistent association between milk or dairy intake and\n cardiovascular disease, coronary heart disease or stroke</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966685/\" rel=\"nofollow noreferrer\">Food Sources of <strong>Saturated Fat</strong> and the Association With Mortality: A Meta-Analysis (PubMed, 2013)</a></p>\n\n<blockquote>\n <p>...high intakes of milk, cheese, yogurt, and butter were not associated with a\n significantly increased risk of mortality compared with low intakes.</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22081694\" rel=\"nofollow noreferrer\">Milk and <strong>acid-base balance:</strong> proposed hypothesis versus scientific evidence (PubMed, 2011)</a></p>\n\n<blockquote>\n <p>Recently the lay press has claimed a hypothetical association among\n dairy product consumption, generation of dietary acid, and harm to\n human health. This theoretical association is based on the idea that\n the protein and phosphate in milk and dairy products make them\n acid-producing foods, which cause our bodies to become acidified,\n promoting diseases of modern civilization. Some authors have suggested\n that dairy products are not helpful and perhaps detrimental to bone\n health because higher osteoporotic fracture incidence is observed in\n countries with higher dairy product consumption. However, scientific\n evidence does not support any of these claims.</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778815/\" rel=\"nofollow noreferrer\">Dairy product consumption and risk of <strong>hip fracture:</strong> a systematic review and meta-analysis (PubMed, 2018)</a></p>\n\n<blockquote>\n <p>Consumption of total dairy products and cream was not significantly\n associated with the risk of hip fracture. There was insufficient\n evidence to deduce the association between milk consumption and risk\n of hip fracture. A lower threshold of 200 g/day milk intake may have\n beneficial effects, whereas the effects of a higher threshold of milk\n intake are unclear.</p>\n</blockquote>\n\n<hr>\n\n<p>Disclaimer: My conclusion is not that milk is healthy and I am not trying to encourage anyone to drink it. I just haven't found convincing evidence that it is unhealthy. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16584", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14011/" ]

[ { "answer_id": 16593, "author": "sue", "author_id": 7617, "author_profile": "https://health.stackexchange.com/users/7617", "pm_score": 3, "selected": false, "text": "<p>Yes, the presence of calculus prevent the demineralization of the surface of the tooth. This is a common finding during routine scaling or calculus removal, where usually the underlying enamel is intact. </p>\n\n<p>Also, there is a paper about this issue: <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0528.2005.00227.x\" rel=\"nofollow noreferrer\">Evidence for putting the calculus: caries inverse relationship to work</a> who found</p>\n\n<blockquote>\n <p>caries prevalence is highly significantly lower in calculus-prone than in calculus-free subjects</p>\n</blockquote>\n\n<p>You can found the detailed explanation on the <a href=\"https://www.wiley.com/en-us/Dental+Caries%3A+The+Disease+and+its+Clinical+Management%2C+3rd+Edition-p-9781118935828\" rel=\"nofollow noreferrer\">Fejerskov's Textbook of Dental Caries</a>, and the principal ideal is: <strong>if you have calculus means that the intraoral enviroment is saturated with minerals <em>and</em> with pH levels above 5.0, hence demineralization of enamel is very difficult if not not feasible at all.</strong> </p>\n" }, { "answer_id": 16647, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 1, "selected": false, "text": "<p>Yes, it is according to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/\" rel=\"nofollow noreferrer\">Keyes and Rams (2016)</a></p>\n\n<blockquote>\n <p>Results: Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin.</p>\n</blockquote>\n\n<p><strong>References</strong></p>\n\n<p>Keyes, P. H., &amp; Rams, T. E. (2016). Dental calculus arrest of dental caries. <em>Journal of oral biology (Northborough, Mass.)</em>, 3(1). PMCID: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/\" rel=\"nofollow noreferrer\">PMC4950958</a> PDF: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/pdf/nihms761315.pdf\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950958/pdf/nihms761315.pdf</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16591", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2882/" ]

[ { "answer_id": 16630, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": false, "text": "<p>\"Recreational drugs\" have \"psychotropic effects,\" which means they affect the mood and perception of stimuli in the brain. Both alcohol and heroin are psychotropic drugs. <a href=\"https://sites.duke.edu/apep/module-2-the-abcs-of-intoxication/content-alcohol-interacts-with-receptors-in-the-brain-to-produce-its-effects/\" rel=\"nofollow noreferrer\">Alcohol</a> acts mainly on the GABA and glutamate receptors in the brain resulting in disinhibited behavior. <a href=\"https://www.drugabuse.gov/publications/drugfacts/heroin\" rel=\"nofollow noreferrer\">Heroin</a> acts on the opioid receptors in the brain, which results in euphoria.</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Nerve_agent\" rel=\"nofollow noreferrer\">Military nerve gases</a>, even if they have some effects on mood, they mainly have unpleasant physical effects by increasing the activity of the neurotransmitter acetylcholine in the parasympathetic nerves and between the nerves and muscles, which results in vomiting, diarrhea, increased salivation, stopping breathing and heart beating and eventually death. So, by decreasing the dose of a nerve gas you would still likely have more unpleasant toxic effects than pleasant psychotropic effects.</p>\n\n<p>UPDATE:</p>\n\n<p>Nerve gases may actually have some psychotropic effects in the brain as a \"side effect\" (as apposed to their \"main effects\" in the peripheral nerves and muscles). But, by decreasing the dose to a non-lethal dose, they would still likely have more unpleasant main effects than pleasant psychotropic effects, so there would be no point to use them. You can think of organophosphate pesticides as a much weaker (\"diluted\") form of organophosphate nerve gases. You can further dilute pesticides, but it is not likely you'll get an acceptable ratio of pleasant/unpleasant effects from them. </p>\n" }, { "answer_id": 16650, "author": "faustus", "author_id": 12881, "author_profile": "https://health.stackexchange.com/users/12881", "pm_score": 4, "selected": true, "text": "<p>Okay, this is the closest you're going to get to a \"military grade\" nerve agent that elevates your mood: using <strong>botox as an antidepressant</strong>. </p>\n\n<p>Botulinum toxin A (botox) is a nerve agent. In fact, it's the most potent toxin known, and could potentially be used as a bioweapon. </p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028942/\" rel=\"noreferrer\"><strong>Botulinum toxin: Bioweapon &amp; magic drug (Dhaked, et al. 2010)</strong></a></p>\n \n <p>Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram positive bacillus. <strong>Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people.</strong> The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle associated proteins responsible for acetylcholine release into the neuromuscular junction. <strong>As a military or terrorist weapon, botulinum toxin could be disseminated via aerosol or by contamination of water or food supplies, causing widespread casualties.</strong> A fascinating aspect of botulinum toxin research in recent years has been development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for treatment of human diseases. In the late 1980s, Canada approved use of the toxin to treat strabismus, in 2001 in the removal of facial wrinkles and in 2002, the FDA in the United States followed suit. The present review focuses on both warfare potential and medical uses of botulinum neurotoxin.</p>\n</blockquote>\n\n<p>However, if you injected, say, 40 units of botox into your procerus and corrugator supercilii frown muscles, you would get a drug with a robust antidepressant effect. The effect size is quite impressive and the antidepressant effect may be greater than what is typically seen from conventional antidepressants:</p>\n\n<blockquote>\n <p><strong><a href=\"https://doi.org/10.1055/s-0035-1559621\" rel=\"noreferrer\">Treating Depression with Botulinum Toxin: A Pooled \n Analysis of Randomized Controlled Trials (Magid, et al. 2015)</a></strong></p>\n \n <p>Botulinum toxin A (BTA) injection into the glabellar region is currently being studied as a treatment for major depressive disorder (MDD). Here we explore efficacy data of this novel approach in a pooled analysis.A literature search revealed 3 RCTs on this topic. Individual patient data and clinical end points shared by these 3 trials were pooled and analyzed as one study (n=134) using multiple regression models with random effects.In the pooled sample, the BTA (n=59) and the placebo group (n=75) did not differ in the baseline variables. Efficacy outcomes revealed BTA superiority over placebo: Improvement in the Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale 6 weeks after baseline was 45.7% for BTA vs. 14.6% for placebo (p&lt;0.0001), corresponding to a BTA response rate of 54.2% (vs. 10.7%) and a BTA remission rate of 30.5% (vs. 6.7%). Equalling the status of a meta-analysis, this study increases evidence that a single treatment of BTA into the glabellar region can reduce symptoms of MDD. Further studies are needed to better understand how BTA exerts its mood-lifting effect. </p>\n</blockquote>\n\n<p>The proposed mechanism of action is quite interesting. It's thought that afferents in the face can influence your mood by sending feedback to the amygdala. In short, botox works by paralysing the frown muscles in your face. And if you can't frown, then perhaps you can't feel so down:</p>\n\n<blockquote>\n <p><strong><a href=\"http://www.botoxfordepression.com/wp-content/uploads/2016/11/Finzi-and-Rosenthal-Journal-of-Psychiatric-Research-80-2016-93-96-2.pdf\" rel=\"noreferrer\">Emotional proprioception: Treatment of depression with afferent facial feedback<br>(Finzi &amp; Rosenthal, 2016)</a></strong></p>\n \n <p>We develop the concept of emotional proprioception, whereby the muscles of facial expression play a central role in encoding and transmitting information to the brain’s emotional circuitry, and describe its underlying neuroanatomy. We explore the role of facial expression in both reflecting and influencing depressed mood. The circuitry involved in this latter effect is a logical target for treatment with botulinum toxin, and we review the evidence in support of this strategy. Clinical trial data suggest that botulinum toxin is effective in treating depression. We discuss the clinical and theoretical implications of these data. This novel treatment approach is just one example of the potential importance of the cranial nerves in the treatment of depression.</p>\n</blockquote>\n\n<p><strong>References</strong></p>\n\n<p>Dhaked, R. K., Singh, M. K., Singh, P., &amp; Gupta, P. (2010). Botulinum toxin: bioweapon &amp; magic drug. <em>The Indian journal of medical research</em>, 132(5), 489. PMCID: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028942/\" rel=\"noreferrer\">PMC3028942</a></p>\n\n<p>Finzi, E., &amp; Rosenthal, N. E. (2016). Emotional proprioception: treatment of depression with afferent facial feedback. <em>Journal of psychiatric research</em>, 80, 93-96. DOI: <a href=\"https://doi.org/10.1016/j.jpsychires.2016.06.009\" rel=\"noreferrer\">10.1016/j.jpsychires.2016.06.009</a></p>\n\n<p>Magid, M., Finzi, E., Kruger, T. H. C., Robertson, H. T., Keeling, B. H., Jung, S., ... &amp; Wollmer, M. A. (2015). Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials. <em>Pharmacopsychiatry</em>, 25(06), 205-210. DOI: <a href=\"https://doi.org/10.1055/s-0035-1559621\" rel=\"noreferrer\">10.1055/s-0035-1559621</a></p>\n" }, { "answer_id": 16702, "author": "Fizz", "author_id": 10980, "author_profile": "https://health.stackexchange.com/users/10980", "pm_score": 2, "selected": false, "text": "<p>Contra to Jan's answer, \"so they do not have psychotropic effects\"... actually they do. First, acetylcholine is a CNS neurotransmitter as well. Second, nerve agents <a href=\"https://academic.oup.com/bjaed/article/6/6/230/287821\" rel=\"nofollow noreferrer\">aren't that selective</a> (like many psychiatric drugs actually):</p>\n\n<blockquote>\n <p>Nerve agents cause excessive stimulation of the cholinergic system, with stimulation of muscarinic receptors at autonomic effector organs, stimulation then depression of skeletal muscle and autonomic ganglia, and stimulation of cholinergic receptors in the CNS [...]. They also bind to nicotinic, cardiac muscarinic and glutamate NMDA (N-methyl-D-aspartate) receptors directly and antagonize GABA (γ-aminobutyric acid) neurotransmission.</p>\n</blockquote>\n\n<p>The CNS effects of nerve agents [are] (same source): </p>\n\n<blockquote>\n <p>Headache, anxiety, irritability, ataxia, fatigue, amnesia, hypothermia, lethargy, unconsciousness, central respiratory depression, convulsions, coma. </p>\n</blockquote>\n\n<p>Additionally you get all the non-CNS effects (they're specified for each type of receptor in the source, but I've compressed them below):</p>\n\n<blockquote>\n <p>Miosis, eye pain, glandular hypersecretion (salivary, bronchial and lachrymal), sweating, bradycardia (QT prolongation or atrioventricular block), bronchoconstriction, vomiting, diarrhoea, urination, Tachycardia, hypertension (adrenal medulla), Fasciculations, weakness, muscular paralysis, rhabdomyolysis, depressed ventilation </p>\n</blockquote>\n\n<p>Probably most of these and some of the CNS effects would be (very) undesirable for a recreational drug. There's also the fact that possessing a nerve agent would be seen possibly as terrorism threat and so forth... So, why bother when you get most of those (listed) CNS results with alcohol?</p>\n" } ]

[ "https://health.stackexchange.com/questions/16625", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13791/" ]

[ { "answer_id": 16634, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<blockquote>\n<p>I have a magic number X. Take a guess what it could be?</p>\n<p>Is it 15?</p>\n<p>No, 15 is too high.</p>\n<p>Is it 12?</p>\n<p>No, 12 is too low.</p>\n</blockquote>\n<hr />\n<p>This leaves you with the mathematical average of 13.5, but that doesn’t help you because you don’t know wo how much too high and how much too low your other guesses were. What if we allow real numbers, and not only natural numbers? Then there would be an infinite number of a possible magic number (although you could get quite close with a few iterations).</p>\n<p>The same principle applies to your prescription as well. You don’t know how much too strong and how much too low they were. And furthermore, eyes change. Maybe you’re cylinder has changed completely, or you got astigmatism?</p>\n<p>Bottom line: The answer is no, you can’t get a meaningful result, but you can try to average-out everything. You might get closer and you might be off worse than with either prescription. Visit an eye-doctor answer let them measure.</p>\n" }, { "answer_id": 16636, "author": "argentum2f", "author_id": 14040, "author_profile": "https://health.stackexchange.com/users/14040", "pm_score": 3, "selected": true, "text": "<p>You should not try to self diagnose an eye prescription. </p>\n\n<p>That being said, I'm going to partly disagree with the previous answer based on some technicalities. First, the process you describe is actually close to what real eye doctors use. They use a \n<a href=\"https://en.wikipedia.org/wiki/Phoropter\" rel=\"nofollow noreferrer\">phoropter</a> (machine with all the lenses) to test one prescription then test another. They keep going until they find a point where one is too strong, and the other too blurry. Then they narrow the increments and check in between. This is an iterative process to get down to the exact prescription - so you definitely need more than 2 data points unless you happen to start with the right 2 points.</p>\n\n<p>Now, phoropter's typically measure in 0.25 <a href=\"https://en.wikipedia.org/wiki/Dioptre\" rel=\"nofollow noreferrer\">diopter</a> increments - so glasses prescriptions would be better represented by a finite subset of natural numbers than the real numbers - they go up and down in finitely sized increments, and there are a finite number of them.</p>\n\n<p>So, if your two test prescriptions happen to be only 2 increments apart, and you are sure that one is too strong and one is too week, then yes, if you average the two you should get the correct prescription.</p>\n\n<p><strong>Note:</strong> There are some additional considerations, such as astigmatism, that may need to be accounted for - so you can't even use two pairs of glasses that are close to what you need IF they don't have the correct astigmatism factor or eye spacing. So again, you should always get a proper prescription from an eye-doctor.</p>\n\n<p>By analogy consider US shoe sizes - if I give you a size 9 and it's slightly to small, and then I give you a size 10, and it's slightly to big, then you could gnerally conclude you are a size 9.5 (the average of the two) because shoe sizes go in .5 increments. There is no 9.3, or 9.8, etc. to worry about. However, that wouldn't work if you had abnormally wide feet (such as 9.5EE), or if I gave you too test pairs such as 7 and 10, because you could be anywhere between the two - not necessarily exactly the average.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16633", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14055/" ]

[ { "answer_id": 16657, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 3, "selected": true, "text": "<p>Mata is onto that issue for quite some time:</p>\n<blockquote>\n<p><a href=\"https://doi.org/10.1359/jbmr.080705\" rel=\"nofollow noreferrer\">Zhan Huang Timothy D Sargeant James F Hulvat Alvaro Mata Pablo Bringas Jr Chung‐Yan Koh Samuel I Stupp Malcolm L Snead: &quot;Bioactive Nanofibers Instruct Cells to Proliferate and Differentiate During Enamel Regeneration&quot;, JBMR, Volume23, Issue12, December 2008, Pages 1995-2006</a></p>\n</blockquote>\n<p>His latest publication has a less obvious on-topic title:</p>\n<blockquote>\n<p><a href=\"https://doi.org/10.1038/s41467-018-04319-0\" rel=\"nofollow noreferrer\">Sherif Elsharkawy, Maisoon Al-Jawad, Maria F. Pantano, Esther Tejeda-Montes, Khushbu Mehta, Hasan Jamal, Shweta Agarwal, Kseniya Shuturminska, Alistair Rice, Nadezda V. Tarakina, Rory M. Wilson, Andy J. Bushby, Matilde Alonso, Jose C. Rodriguez-Cabello, Ettore Barbieri, Armando del Río Hernández, Molly M. Stevens, Nicola M. Pugno, Paul Anderson &amp; Alvaro Mata: &quot;Protein disorder–order interplay to guide the growth of hierarchical mineralized structures&quot;, Nature Communicationsvolume 9, Article number: 2145 (2018)</a><br />\nA major goal in materials science is to develop bioinspired functional materials based on the precise control of molecular building blocks across length scales. Here we report a protein-mediated mineralization process that takes advantage of disorder–order interplay using elastin-like recombinamers to program organic–inorganic interactions into hierarchically ordered mineralized structures. The materials comprise elongated apatite nanocrystals that are aligned and organized into microscopic prisms, which grow together into spherulite-like structures hundreds of micrometers in diameter that come together to fill macroscopic areas. The structures can be grown over large uneven surfaces and native tissues as acid-resistant membranes or coatings with tuneable hierarchy, stiffness, and hardness. Our study represents a potential strategy for complex materials design that may open opportunities for hard tissue repair and provide insights into the role of molecular disorder in human physiology and pathology.</p>\n</blockquote>\n<p>A more accessible press release is found at</p>\n<blockquote>\n<p><a href=\"https://www.qmul.ac.uk/media/news/2018/se/scientists-develop-material-that-could-regenerate-dental-enamel-.html\" rel=\"nofollow noreferrer\">Scientists develop material that could regenerate dental enamel</a>\nResearchers at Queen Mary University of London have developed a new way to grow mineralised materials which could regenerate hard tissues such as dental enamel and bone.</p>\n</blockquote>\n<p>While incredibly promising we might want to hold out horse for a little bit longer:</p>\n<blockquote>\n<p>The research team is now looking into developing applications for this material.</p>\n<p>“The technology could benefit many people and [commercialization] is the ultimate goal of our work,” says Alvaro Mata, who led the research group.[…]\n“It is certainly a possibility,” Mata elaborates. “The kinds of regenerative challenges that we are talking about will require collaboration between disciplines and integration of different technologies. We are very keen to collaborate with different people to make things happen.”[…]\nThe UK seems to be a hotspot for research into tooth regeneration. At King’s College London, researchers performed experiments in mice that showed that an Alzheimer’s drug stimulated natural repair processes in stem cells found inside teeth to fill cavities.</p>\n<p>On the industrial side of things, the Swiss company Credentis is developing protein molecules that help apatite crystals form new enamel and using its technology in a range of oral care products, from toothpaste and mouthwash to chewing gum. The British company BioMin Technologies uses glass-ceramic biomaterials that release phosphate molecules in response to acidic conditions in order to repair dental enamel.</p>\n<p>With the combined efforts in biotech and academia, it’s exciting to think we may one day be able to regenerate our enamel and coax our teeth into filling their own cavities. Who knows, these research efforts may help us avoid another uncomfortable visit to the dentist.<br />\n_{<a href=\"https://labiotech.eu/dental-enamel-biopolymers/\" rel=\"nofollow noreferrer\">British Researchers Regenerate Tooth Enamel With Biopolymers</a>}</p>\n</blockquote>\n" }, { "answer_id": 16658, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 1, "selected": false, "text": "<p>I was going to post a possible answer when @LangLangC posted some interesting articles.</p>\n\n<p>Interestingly there is another atricle:</p>\n\n<blockquote>\n <p><a href=\"https://doi.org/10.3389/fphys.2017.00368\" rel=\"nofollow noreferrer\">Shuturminska, K., Tarakina, N. V., Azevedo, H. S., Bushby, A. J., Mata, A., Anderson, P., &amp; Al-Jawad, M. (2017). Elastin-Like Protein, with Statherin Derived Peptide, Controls Fluorapatite Formation and Morphology. <em>Frontiers in physiology</em>, 8, 368.</a><br>\n The process of enamel biomineralization is multi-step, complex and mediated by organic molecules. The lack of cells in mature enamel leaves it unable to regenerate and hence novel ways of growing enamel-like structures are currently being investigated. Recently, elastin-like protein (ELP) with the analog <em>N</em>-terminal sequence of statherin (STNA₁₅-ELP) has been used to regenerate mineralized tissue. Here, the STNA₁₅-ELP has been mineralized in constrained and unconstrained conditions in a fluoridated solution. We demonstrate that the control of STNA₁₅-ELP delivery to the mineralizing solution can form layered ordered fluorapatite mineral, via a brushite precursor. We propose that the use of a constrained STNA₁₅-ELP system can lead to the development of novel, bioinspired enamel therapeutics.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/16642", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7951/" ]

[ { "answer_id": 16661, "author": "BillDOe", "author_id": 2833, "author_profile": "https://health.stackexchange.com/users/2833", "pm_score": 3, "selected": false, "text": "<p>I found <a href=\"https://www.drugs.com/article/taking-your-medicine.html\" rel=\"noreferrer\">this list</a> on drugs.com: </p>\n\n<blockquote>\n <ol>\n <li>Practice Makes Perfect! Learn About Your Medicines</li>\n <li>Pill Boxes</li>\n <li>Electronic Applications and Pill Reminders</li>\n <li>Calendar Alerts</li>\n <li>Tie Your Medication Doses with a Daily Activity</li>\n <li>Get Help from Family Members or Friends</li>\n <li>Keep an Up-to-Date List of Your Medication Names, Strengths, Dose, and Number of Remaining Refills</li>\n <li>Ask Your Doctor and Pharmacist to Help Simplify Your Medication Regimen</li>\n </ol>\n</blockquote>\n\n<p>The summaries seem pretty self-explanatory, but you can check out the website for details.<br><br>For item 4 I use MS Outlook reminders for my daily gabapentin doses.</p>\n" }, { "answer_id": 16664, "author": "faustus", "author_id": 12881, "author_profile": "https://health.stackexchange.com/users/12881", "pm_score": 2, "selected": false, "text": "<p><em><strong>What empirical evidence is there to with regards to methods, techniques and strategies to improve treatment noncompliance among individuals whose noncompliance is characterised by a tendency to have difficulty recalling if they have correctly adhered with their physician's dosing instructions?</strong></em></p>\n<p>The literature is scant. However, one strategy to improve treatment adherence that is both simple, inexpensive and supported by peer-reviewed empirical evidence is the use of a pillbox.</p>\n<p>The following relates to the use of pillboxes with respect to compliance with HART medications:</p>\n<blockquote>\n<p><strong><a href=\"https://doi.org/10.1086/521250\" rel=\"nofollow noreferrer\">Pillbox Organizers are Associated with Improved Adherence to HIV Antiretroviral Therapy and Viral Suppression: a Marginal Structural Model Analysis</a></strong></p>\n<p>Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown.</p>\n<p>Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment.</p>\n<p>Results. Pillbox organizer use was estimated to improve adherence by 4.1%–4.5% and was associated with a decrease in viral load of 0.34–0.37 log10 copies/mL and a 14.2%–15.7% higher probability of achieving a viral load ⩽400 copies/mL (odds ratio, 1.8–1.9). All effect estimates were statistically significant.</p>\n<p>Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ∼$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy.</p>\n</blockquote>\n<p>However, caution should be exercised before inferring that there might be benefit to the use of pillboxes in relation to other pharmacotherapies e.g. antihypertensives.</p>\n<p><strong>EDIT</strong></p>\n<p>With regards to polypharmacy involving three or more agents e.g. chronic or more complicated conditions, the following meta-analysis seems to suggest that there is no benefit of reminder devices on medication adherence relative to the use of pillboxes:</p>\n<blockquote>\n<p><strong><a href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2605527\" rel=\"nofollow noreferrer\">Effect of Reminder Devices on Medication Adherence: the REMIND Randomized Clinical Trial Links</a></strong></p>\n<p>Objective: To compare the effect of 3 low-cost reminder devices on medication adherence.</p>\n<p>Design, Setting, and Participants: This 4-arm, block-randomized clinical trial involved 53 480 enrollees of CVS Caremark, a pharmacy benefit manager, across the United States. Eligible participants were aged 18 to 64 years and taking 1 to 3 oral medications for long-term use. Participants had to be suboptimally adherent to all of their prescribed therapies (with a medication possession ratio of 30% to 80%) in the 12 months before randomization. Participants were stratified on the basis of the medications they were using at randomization: medications for cardiovascular or other nondepression chronic conditions (the chronic disease stratum) and antidepressants (the antidepressant stratum). In each stratum, randomization occurred within blocks defined by whether all of the patient's targeted medications were dosed once daily. Patients were randomized to receive in the mail a pill bottle strip with toggles, digital timer cap, or standard pillbox. The control group received neither notification nor a device. Data were collected from February 12, 2013, through March 21, 2015, and data analyses were on the intention-to-treat population.</p>\n<p>Main Outcomes and Measures: The primary outcome was optimal adherence (medication possession ratio ≥80%) to all eligible medications among patients in the chronic disease stratum during 12 months of follow-up, ascertained using pharmacy claims data. Secondary outcomes included optimal adherence to cardiovascular medications among patients in the chronic disease stratum as well as optimal adherence to antidepressants.</p>\n<p>Results: Of the 53 480 participants, mean (SD) age was 45 (12) years and 56% were female. In the primary analysis, 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill bottle strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up. There was no statistically significant difference in the odds of optimal adherence between the control and any of the devices (standard pillbox: odds ratio [OR], 1.03 [95% CI, 0.95-1.13]; digital timer cap: OR, 1.00 [95% CI, 0.92-1.09]; and pill bottle strip with toggles: OR, 0.94 [95% CI, 0.85-1.04]). <strong>In direct comparisons, the odds of optimal adherence were higher with a standard pillbox than with the pill bottle strip (OR, 1.10 [95% CI, 1.00-1.21]). Secondary analyses yielded similar results.</strong></p>\n<p>Conclusions and Relevance: <strong>Low-cost reminder devices did not improve adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions.</strong> The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence.</p>\n<p>Importance: Forgetfulness is a major contributor to nonadherence to chronic disease medications and could be addressed with medication reminder devices.</p>\n</blockquote>\n<p>In the above analysis, we do note that use of a standard pillbox does seem to improve adherence when compared with a pill bottle strip (OR = 1.10).</p>\n<p>However, as meta-analyses are susceptible to regression to the mean, caution must also be exercised as well.</p>\n<p>It's prudent to note that no peer reviewed evidence will be able to demonstrate that pillboxes or any other method, technique or strategy does or does not not work for any one individual for any variant of pharmacotherapy for any period of time in their life.</p>\n<p>In short: individual differences, bro.</p>\n" }, { "answer_id": 17911, "author": "Vinayaka Dj", "author_id": 15098, "author_profile": "https://health.stackexchange.com/users/15098", "pm_score": 2, "selected": false, "text": "<p>You can try out Tablet Reminder Mobile application which helps you to remind.\nHere is some of the medication reminder apps</p>\n\n<ol>\n<li><a href=\"https://play.google.com/store/apps/details?id=com.medisafe.android.client\" rel=\"nofollow noreferrer\">Medisafe</a> </li>\n<li><a href=\"https://play.google.com/store/apps/details?id=eu.smartpatient.mytherapy\" rel=\"nofollow noreferrer\">MyTherapy</a></li>\n<li><a href=\"https://play.google.com/store/apps/details?id=com.appzweb.tabloo\" rel=\"nofollow noreferrer\">Tabloo</a></li>\n</ol>\n" }, { "answer_id": 17913, "author": "blacksmith37", "author_id": 9688, "author_profile": "https://health.stackexchange.com/users/9688", "pm_score": 2, "selected": false, "text": "<p>When I took a number of meds during chemo ; I had a simple paper chart for each day with the meds listed. I would mark each one with the time(s) I took it. This may be too simple for some , but it worked well for an old person with memory impaired by chemo. Other factors like temperature may easily be added. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16659", "https://health.stackexchange.com", "https://health.stackexchange.com/users/96/" ]

[ { "answer_id": 16706, "author": "WendyG", "author_id": 13752, "author_profile": "https://health.stackexchange.com/users/13752", "pm_score": 3, "selected": true, "text": "<p>well once I woke up that was easy to find</p>\n\n<blockquote>\n <p>These short-term declines stem from temporary changes in the brain\n rather than cold or flu symptoms themselves, he said. Seasonal viruses\n reduce mental alertness by interfering with neurotransmitters such as\n noradrenaline, associated with reaction times.</p>\n</blockquote>\n\n<p><a href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/why-brain-fog-from-the-common-cold-isnt-all-in-your-head/article36812938/\" rel=\"nofollow noreferrer\">https://www.theglobeandmail.com/life/health-and-fitness/health/why-brain-fog-from-the-common-cold-isnt-all-in-your-head/article36812938/</a></p>\n" }, { "answer_id": 16753, "author": "Nora M", "author_id": 14145, "author_profile": "https://health.stackexchange.com/users/14145", "pm_score": 1, "selected": false, "text": "<p>It may be caused by excessive energy used to defeat the viruses or adverse bacteria-the triggers of cold and flu. Your body lacks enough energy to operate the physical activity, which affects the oxygen transmitting to your brain, so you could feel tired or fatigue to think or finish a simple motion. Also, cold medicines commonly have certain side effects such as drowsiness, which can intensify the feeling of fatigue. \nSleeping and doing exercise help to produce more energy, which can shorten the time of treatment and enhance the immunity. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16703", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13752/" ]

[ { "answer_id": 16757, "author": "mattia.b89", "author_id": 6615, "author_profile": "https://health.stackexchange.com/users/6615", "pm_score": 0, "selected": false, "text": "<p><strong>[WIP]</strong></p>\n\n<p>Fruit fibres help regulate sugar blood level <a href=\"https://www.everydayhealth.com/type-2-diabetes/diet/control-high-blood-sugar-with-fiber/\" rel=\"nofollow noreferrer\">[1]</a>.<br>\nThank to this, if you do not just extract juice from your blender but you drink/eat to whole processed fruit, I think that will not be an issue for diabetes, or better, it has the same <em>value</em> of eating the same <em>entire</em> fruit.</p>\n\n<hr>\n\n<p>What I don't know:</p>\n\n<ol>\n<li>does mastication play a role in this game?</li>\n<li>does blender break fibres? if yes, how them compare to the whole ones?</li>\n</ol>\n\n<p><strong>EDIT:</strong> linked answer <a href=\"https://health.stackexchange.com/questions/1099/is-it-better-to-eat-fruit-as-they-are-than-to-have-them-in-liquid-form\">Is it better to eat fruit as they are, than to have them in liquid form?</a></p>\n" }, { "answer_id": 16765, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>The question is about whole fruits vs blended fruits (smoothies), but I haven't found any studies about smoothies, so I included those about fruit juices. Both the smoothies and the fruit juices are liquid, so they pass the stomach faster than whole fruits, which can result in higher blood glucose spikes (a possible risk factor for diabetes). The other aspect is that smoothies probably contain about the same amount of fiber than whole fruits, while fruit juices contain much less fiber. Fiber likely decreases blood glucose spikes after meals.</p>\n\n<p>Concluding from <a href=\"https://academic.oup.com/ajcn/article-abstract/55/2/436/4715317\" rel=\"nofollow noreferrer\">academic.oup.com</a>, blending fruits probably does not affect the fiber in the nutritional sense:</p>\n\n<blockquote>\n <p>The quantitative measurement of dietary fiber does not recognize its\n diverse actions on nutrient absorption...</p>\n</blockquote>\n\n<p>According to 2 systematic reviews of studies, intake of 100% fruit juice (no sugar added) is not associated with diabetes type 2.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682091\" rel=\"nofollow noreferrer\">Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis (PubMed, 2014)</a></p>\n\n<blockquote>\n <p>A higher intake of sugar-sweetened fruit juice was significantly\n associated with risk of type 2 diabetes, while intake of 100% fruit\n juice was not associated with risk of developing type 2 diabetes.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736636/\" rel=\"nofollow noreferrer\">100 % Fruit juice and measures of glucose control and insulin sensitivity: a systematic review and meta-analysis of randomised controlled trials (PubMed, 2017)</a></p>\n\n<blockquote>\n <p>Overall, findings from this meta-analysis of RCT suggest a neutral\n effect of 100 % fruit juice on glycaemic control. These findings are\n consistent with findings from some observational studies suggesting\n that consumption of 100 % fruit juice is not associated with increased\n risk of diabetes.</p>\n</blockquote>\n\n<p>However, according to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26199070\" rel=\"nofollow noreferrer\">one 2015 systematic review</a>:</p>\n\n<blockquote>\n <p>both artificially sweetened beverages and fruit juice were unlikely to\n be healthy alternatives to sugar sweetened beverages for the\n prevention of type 2 diabetes.</p>\n</blockquote>\n\n<p>And finally, according to one study, which followed nurses for 18 years: \n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453647/\" rel=\"nofollow noreferrer\">Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women (PubMed, 2008)</a>:</p>\n\n<blockquote>\n <p>Consumption of green leafy vegetables and fruit was associated with a\n lower hazard of diabetes, whereas consumption of fruit juices may be\n associated with an increased hazard among women.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/16746", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14140/" ]

[ { "answer_id": 16833, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<h2>The ingredients one by one</h2>\n\n<ul>\n<li><p><strong>Sorbitol</strong>:<br>\nAn alcohol sugar, and a sugar substitute. However, xylitol has become more widely used because a few type of bacteria (Streptococcus mutans) can process sorbitol and as such it is more anticariogenic.</p>\n\n<blockquote>\n <p>In addition, sorbitol has one-third fewer calories and 60 % the sweetening activity of sucrose and is used as a sugar replacement in diabetes.<br>\n <em>_{Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/5780#section=Top\" rel=\"nofollow noreferrer\">PubChem</a></em>}</p>\n</blockquote></li>\n<li><p><strong>L-theanine</strong>:<br>\nThe use of theanine is widely debated:</p>\n\n<blockquote>\n <p>The German Federal Institute for Risk Assessment, an agency of their Federal Ministry of Food and Agriculture, objects to the addition of L-theanine to beverages. The European Food Safety Authority EFSA advised negatively on health claims related to L-theanine and cognitive function, alleviation of psychological stress, maintenance of normal sleep, and reduction of menstrual discomfort. Therefore, health claims for L-theanine are prohibited in the European Union.<br>\n _{<em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/439378#section=Top\" rel=\"nofollow noreferrer\">Pubchem</a></em>}</p>\n</blockquote>\n\n<p>Its mechanism of action is pretty complicated, it appears to be mostly are neuro-agent (although literature is contradictive there as well), but I'll research more.</p></li>\n<li><p><strong>Caffeine</strong>:<br>\nCaffeine is a vasoconstrictor. As such, it constricts the arteries and - in this case more importantly - the arterioles. The skin turns paler because less blood reaches it surface. This way, heat radiation from the skin is limited in the extremities. This also happens when you feel cold, and it explains why feet and hands start to get cold first. This is however the opposite of what you describe (but similar to the way Raynauds affects your body temperature)</p></li>\n<li><p><strong>Calcium Stearate</strong>:<br>\nNothing more than a flow agent and surface conditioner, also used in other candies such as Smarties</p></li>\n<li><p><strong>Steviol Glycoside</strong>:<br>\nArtificial sweetener, more commonly known as Stevia. </p></li>\n<li><p><strong>Acesulfame K (potassium)</strong>:<br>\nAnother artificial sweetener </p></li>\n<li><p><strong>Vitamins and Flavour Agents</strong><br>\nThey won't have anything to do with it.</p></li>\n</ul>\n\n<hr>\n\n<p>Speculations:</p>\n\n<ol>\n<li><p>It is the caffeine.\nThis is kind of contradicting what I wrote above, but <a href=\"https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-suggests-caffeine-intake-may-worsen-menopausal-hot-flashes-night-sweats/\" rel=\"nofollow noreferrer\">some studies</a> associate the caffeine with hot flashes in the female menopause. The underlying mechanism is not yet understood (and in fact, other studies claim that caffeine decreases the risk), but that might be.</p></li>\n<li><p>It's a placebo effect. Maybe you once felt warmer due to other reasons after consuming it, and now it's just a placebo. </p></li>\n</ol>\n" }, { "answer_id": 16895, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 1, "selected": false, "text": "<p>Your experience that alcohol warms your fingers and the fact that the drug <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2076403\" rel=\"nofollow noreferrer\">nifedipine</a> is used in Raynaud's symptoms relief suggest that the mechanism involved in warming fingers is <em>vasodilation.</em></p>\n\n<p>From the list of ingredients in your product, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22819553\" rel=\"nofollow noreferrer\"><strong>L-theanine</strong> can cause arterial vasodilation</a> and could therefore be theoretically responsible for symptoms relief.</p>\n\n<p><strong>Caffeine</strong> can have a vasoconstricting effect, but, according to <a href=\"https://www.uptodate.com/contents/initial-treatment-of-the-raynaud-phenomenon\" rel=\"nofollow noreferrer\">UpToDate</a>, \"its xanthine-related properties may result in systemic vasodilation,\" which may result in fingers warming.</p>\n\n<p>I have not found any credible medical source that would suggest either L-theanine or caffeine for treatment of Raynaud's, though.</p>\n\n<p><strong>Melatonin</strong> can also have a vasodilating effect (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044053/\" rel=\"nofollow noreferrer\">PubMed</a>):</p>\n\n<blockquote>\n <p>When ingested as a supplement in humans, melatonin enhances the\n cutaneous vasodilating response during heating and blunts the\n cutaneous vasoconstrictor response during cooling. </p>\n</blockquote>\n" }, { "answer_id": 17471, "author": "Benjamin Martin", "author_id": 13963, "author_profile": "https://health.stackexchange.com/users/13963", "pm_score": 2, "selected": true, "text": "<p>EDIT: Its thoracic outlet syndrome. If I do certain stretches it goes away</p>\n\n<h2>Old:</h2>\n\n<p>So I looked into it, and I found those ingredients are actually good for \"carpel tunnel\" which has been found to be related to raynauds in some cases... this is essentially a pinched nerve due to bad posture (common in computer scientists). I don't think I have this in my hands, but probably in my shoulders or back (from hunching over a computer all day over years). So I started looking into youtube videos relating to this and got some suggestions for things to try. Luckily I have found that when I straighten my <strong>neck back</strong> (and decompress the right bone/nerve), I can feel the problem going away immediately. Its weird, I can't really explain it but I also notice an almost immediate difference in the way my hands feel.</p>\n\n<p>Anyways, I'm going to a good chiropractor to investigate and hopefully correct this problem, I will update this thread later with any updates. We will see.</p>\n\n<p>Also important to note I've never had it in my toes or anything.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16822", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13963/" ]

[ { "answer_id": 16874, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 2, "selected": false, "text": "<p>No, it's not true that the breast tissue caused by gynecomastia can never go away. According to the <a href=\"https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799\" rel=\"nofollow noreferrer\">Mayo Clinic</a> (emphasis mine):</p>\n\n<blockquote>\n <p><strong>Most cases of gynecomastia regress over time without treatment.</strong>\n However, if gynecomastia is caused by an underlying condition, such as\n hypogonadism, malnutrition or cirrhosis, that condition may need\n treatment. If you're taking medications that can cause gynecomastia,\n your doctor may recommend stopping them or substituting another\n medication.</p>\n</blockquote>\n\n<p>So the first step in dealing with gynecomastia is to identify and treat the factor causing it. That may mean treating an underlying condition or it may mean stopping or changing medications. Once that's been addressed all that's needed is time, and the time needed can be measured in months or even years. </p>\n\n<p>If the breast tissue doesn't go away despite appropriate treatment and the sufferer finds the tissue intolerable, two options remain: medication and surgery. Again, according to Mayo:</p>\n\n<blockquote>\n <p><strong>Medications</strong></p>\n \n <p>Medications used to treat breast cancer and other conditions, such as\n tamoxifen (Soltamox), raloxifene (Evista) and aromatase inhibitors\n (Arimidex), may be helpful for some men with gynecomastia. Although\n these medications are approved by the Food and Drug Administration,\n they have not been approved specifically for this use.</p>\n \n <p><strong>Surgery to remove excess breast tissue</strong></p>\n \n <p>If you still have significant\n bothersome breast enlargement despite initial treatment or\n observation, your doctor may advise surgery. Two gynecomastia surgery\n options are:</p>\n \n <p><strong>Liposuction</strong>. This surgery removes breast fat, but not the breast gland\n tissue itself. </p>\n \n <p><strong>Mastectomy</strong>. This type of surgery removes the breast\n gland tissue. The surgery is often done endoscopically, meaning only\n small incisions are used. This less invasive type of surgery involves\n less recovery time.</p>\n</blockquote>\n" }, { "answer_id": 23729, "author": "pbond", "author_id": 19697, "author_profile": "https://health.stackexchange.com/users/19697", "pm_score": 1, "selected": false, "text": "<p>First, vitamin D supplementation does not seem to increase testosterone levels. Most high quality trials see either no increase, or a very very small one:\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/32446600/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/32446600/</a></p>\n\n<p>Second, zinc might negate a transient exercise-induced decrease in testosterone. There is no evidence this is clinically meaningful:\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/17984944/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/17984944/</a>\nAnd (short-term) zinc deficiency might decrease testosterone. So in case you're zinc deficient, supplementation is (of course) wise.\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/1609752/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/1609752/</a></p>\n\n<p>Treating gynecomastia is a whole different ball game. This is either done by surgery or sometimes off-label with endocrine treatment. Endocrine treatment refers to drugs that counteract estrogenic action. Since estrogenic action lies at the root of gynecomastia development.</p>\n\n<p>Several of such drugs have been tested in clinical research, including: Tamoxifen (Nolvadex), clomiphene (Clomid), raloxifene (Evista) and Anastrozol (Arimidex).</p>\n\n<p>Of these drugs, clomiphene and anastrozol don't seem so effective against it. Of raloxifene only one trial is available which suggests good results. However, it's a low quality trial.</p>\n\n<p>Finally, a lot of research demonstrates that tamoxifen (Nolvadex) is effective against gynecomastia.</p>\n\n<p>More details can be found here in case you're interested: <a href=\"https://peterbond.org/post/endocrine-treatment-of-gynecomastia\" rel=\"nofollow noreferrer\">https://peterbond.org/post/endocrine-treatment-of-gynecomastia</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16838", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13947/" ]

[ { "answer_id": 16871, "author": "Hichame Yessou", "author_id": 7307, "author_profile": "https://health.stackexchange.com/users/7307", "pm_score": 4, "selected": true, "text": "<p>Yes and no. <br>Type 2 Diabetes is a metabolic disease in which a person’s body still produces insulin but is unable to use it effectively. Reversing Type 2 Diabetes is more <strong>a factor of improving the insulin resistance levels in the long term</strong>.<br>It depends on several factors whether or not is feasible to reverse the pathology, one among them is the duration of the T2D. Besides that, you can accomplish the reversal by improving your eating habits, your level of physical activity and your general lifestyle habits. There is no medicine that will reverse this pathology. <br>\nType 2 diabetes is generally treated with metformin, which is a treatment and not a cure. <br>\nReaching an <strong>HbA1c below 6%</strong> without hypoglycemic drugs could be considered as a reversal of the pathology.</p>\n\n<p><a href=\"https://www.diabetes.co.uk/reversing-diabetes.html\" rel=\"noreferrer\">Reverse Type 2 Diabetes</a><br>\n<a href=\"https://www.jdrf.ca/news-and-media/fact-sheets/about-type-1-and-type-2-diabetes/\" rel=\"noreferrer\">Type 2 Diabetes</a> <br>\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248697/\" rel=\"noreferrer\">Exercise in Type 2 Diabetes</a><br>\n<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24959782\" rel=\"noreferrer\">Diet in Type 2 Diabetes</a></p>\n" }, { "answer_id": 17878, "author": "kenorb", "author_id": 114, "author_profile": "https://health.stackexchange.com/users/114", "pm_score": 2, "selected": false, "text": "<p>There is no cure yet, however, there are some studies which are showing promising results.</p>\n\n<p>For example, one study from 2011 demonstrated the benefits of taking <a href=\"https://en.wikipedia.org/wiki/Nicotinamide_mononucleotide\" rel=\"nofollow noreferrer\"><em>β-Nicotinamide Mononucleotide</em></a> (NMN) in dealing with <a href=\"https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2\" rel=\"nofollow noreferrer\">diabetes type 2</a> (T2D). This a long-term metabolic disorder, is directly associated with over-use of body fat and calories. Mouse studies demonstrated that NMN enhances glucose tolerance by restoring NAD+ levels (HFD-induced T2D mice ameliorating glucose intolerance).</p>\n\n<p>Another study from 2016, demonstrated the benefits of taking nicotinamide riboside (NR) by improving glucose tolerance, reduced weight gain, liver damage and while protecting against diabetic neuropathy.</p>\n\n<p>Both studies suggests that increased NAD+ metabolism might address glycemic control and be neuroprotective.</p>\n\n<p>References:</p>\n\n<ul>\n<li><p>2011: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21982712\" rel=\"nofollow noreferrer\">Nicotinamide mononucleotide, a key NAD(+) intermediate, treats the pathophysiology of diet- and age-induced diabetes in mice</a>.</p>\n\n<blockquote>\n <p>Type 2 diabetes (T2D) has become epidemic in our modern lifestyle, likely due to calorie-rich diets overwhelming our adaptive metabolic pathways. One such pathway is mediated by nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in mammalian NAD(+) biosynthesis, and the NAD(+)-dependent protein deacetylase SIRT1. Here, we show that NAMPT-mediated NAD(+) biosynthesis is severely compromised in metabolic organs by high-fat diet (HFD). Strikingly, nicotinamide mononucleotide (NMN), a product of the NAMPT reaction and a key NAD(+) intermediate, ameliorates glucose intolerance by restoring NAD(+) levels in HFD-induced T2D mice. NMN also enhances hepatic insulin sensitivity and restores gene expression related to oxidative stress, inflammatory response, and circadian rhythm, partly through SIRT1 activation. Furthermore, NAD(+) and NAMPT levels show significant decreases in multiple organs during aging, and NMN improves glucose intolerance and lipid profiles in age-induced T2D mice. These findings provide critical insights into a potential nutriceutical intervention against diet- and age-induced T2D.</p>\n</blockquote></li>\n<li><p>2016: <a href=\"https://www.nature.com/articles/srep26933\" rel=\"nofollow noreferrer\">Nicotinamide Riboside Opposes Type 2 Diabetes and Neuropathy in Mice</a></p>\n\n<blockquote>\n <p>Male C57BL/6J mice raised on high fat diet (HFD) become prediabetic and develop insulin resistance and sensory neuropathy. The same mice given low doses of streptozotocin are a model of type 2 diabetes (T2D), developing hyperglycemia, severe insulin resistance and diabetic peripheral neuropathy involving sensory and motor neurons. Because of suggestions that increased NAD+ metabolism might address glycemic control and be neuroprotective, we treated prediabetic and T2D mice with nicotinamide riboside (NR) added to HFD. NR improved glucose tolerance, reduced weight gain, liver damage and the development of hepatic steatosis in prediabetic mice while protecting against sensory neuropathy. In T2D mice, NR greatly reduced non-fasting and fasting blood glucose, weight gain and hepatic steatosis while protecting against diabetic neuropathy. The neuroprotective effect of NR could not be explained by glycemic control alone. Corneal confocal microscopy was the most sensitive measure of neurodegeneration. This assay allowed detection of the protective effect of NR on small nerve structures in living mice. Quantitative metabolomics established that hepatic NADP+ and NADPH levels were significantly degraded in prediabetes and T2D but were largely protected when mice were supplemented with NR. The data justify testing of NR in human models of obesity, T2D and associated neuropathies.</p>\n</blockquote></li>\n<li><p>Article: <a href=\"http://herbnutritionals.com/nutraceuticals/nicotinamide-mononucleotide-nmn\" rel=\"nofollow noreferrer\">What is nicotinamide mononucleotide?</a></p></li>\n<li><p>Forum: <a href=\"https://www.longecity.org/forum/topic/97853-new-study-on-nr-vs-diabetic-neuropathy/\" rel=\"nofollow noreferrer\">New Study on NR vs. Diabetic Neuropathy</a></p></li>\n</ul>\n" }, { "answer_id": 19000, "author": "Philip Marais", "author_id": 15878, "author_profile": "https://health.stackexchange.com/users/15878", "pm_score": 1, "selected": false, "text": "<p>Yes, there is a cure.</p>\n\n<p>It won't be 100% effective for all diabetics to completely forgo all of their medication, but around 80% of diabetics will be able to go off all of their medication.</p>\n\n<p>This is one of many articles that address this particular topic: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/</a></p>\n\n<p>In short, the cause of insulin resistance is chronic over consumption of high carbohydrate diets, and particularly high fructose diets.</p>\n\n<p>This may be a little extreme a perspective for those with a more orthodox view of nutrition, but bare with me. <em>Carbohydrates in excess</em> is toxic to the liver and other organs, in a similar way that alcohol is. Chronic over consumption of carbohydrate, above the body's ability to process it safely, leads to long term pathology of a number of organs, the kidneys, the liver, neurons, retina, which is why diabetics often present with, kideney disease, eye issues, foot numbness, and fatty livers.</p>\n\n<p>If someone got sick from over consuming alcohol (fatty liver disease) the best way to treat such a person is to reduce the alcohol consumption such that it removes the cause of the toxicity.</p>\n\n<p>For diabetics, it is the same. Diabetics are no longer capable of processing any amount of sugar or carbohydrate safely on their own.</p>\n\n<p>If you remove the toxin, most diabetics respond extremely well, and many even reverse much of the long term damage from being insulin resistant all those years.</p>\n\n<p>EDIT:</p>\n\n<p>Liver toxicity mediated by fructose and excess carbohydrate:</p>\n\n<p>NAFLD &amp; NASH mediated by glucose/fructose causing de novo lipogenesis. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893377/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893377/</a>\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372893/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372893/</a> \n<a href=\"https://openheart.bmj.com/content/4/2/e000631\" rel=\"nofollow noreferrer\">https://openheart.bmj.com/content/4/2/e000631</a></p>\n\n<p>The role of insulin resistance in NAFLD <a href=\"https://academic.oup.com/jcem/article/91/12/4753/2656230\" rel=\"nofollow noreferrer\">https://academic.oup.com/jcem/article/91/12/4753/2656230</a></p>\n\n<p>I understand the orthodox perspective of treating insulin resistance and diabetes as chronic progressive diseases. I am not arguing about the accuracy of the orthodox contexts. I am merely suggesting that there is a host of research that suggests that diabetes is NOT a chronic and terminal illness as it is currently understood and managed, but that it is in fact, a condition that is caused by the over consumption of carbohydrate, sugar, and particularly high fructose diets.</p>\n\n<p>It has also been shown, that removal of in order of impact, fructose, sucrose, glucose and starchy carbohydrates, diabetic patients respond rapidly, by showing reduced fasting insulin, glucose and HbA1c, recuced LDL and triglycerides, increased HDL, reduced inflammatory markers like GGT CRP and base white cell counts.</p>\n\n<p>All of those CVD markers improve with carbohydrate restriction by reducing the need for insulin in the first place. <a href=\"https://peerj.com/articles/6273/\" rel=\"nofollow noreferrer\">https://peerj.com/articles/6273/</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16863", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9637/" ]

[ { "answer_id": 16927, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 1, "selected": false, "text": "<p>For diabetes, it is important to control glucose levels. This can easily be done (to a varying degree of accuracy) by checking the urine for glucose.</p>\n<blockquote>\n<p>Urine tests were once the main type of testing used to measure glucose levels in people who potentially had diabetes. However, they are less common now that blood tests have become more accurate and easier to use.</p>\n<p>^{<a href=\"https://www.healthline.com/health/glucose-test-urine#purpose\" rel=\"nofollow noreferrer\">Healthline.com</a>}</p>\n</blockquote>\n<p>Nowadays, blood sugar is simply determined by a blood test (and a lab isn't even needed, glucose meters can measure on the spot), and so the extensive urine test is no longer required. Speaking from my limited experience, blood tests were performed every 3 hours (which is incidentally the same period you described for the Zimnitsky Test).</p>\n<p>Now, urine tests are also performed if kidney failures/diseases are suspected, but I have to double-check how often. I doubt that it was on a daily basis, let alone a 3-hour basis.</p>\n" }, { "answer_id": 16995, "author": "Arsak", "author_id": 2159, "author_profile": "https://health.stackexchange.com/users/2159", "pm_score": 3, "selected": true, "text": "<p>So far, I could not find evidence that the Zimnitsky test is applied in exactly the same way in western countries.</p>\n\n<p>The <a href=\"https://en.wikipedia.org/wiki/Urine_specific_gravity\" rel=\"nofollow noreferrer\">urine specific gravity</a> \nis a parameter that is assessed during urine analysis.\nThis can be measured from a single urine sample as well as from a <a href=\"https://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/24-hour_urine_collection_92,P08955\" rel=\"nofollow noreferrer\">24-hour urine collection</a>.</p>\n\n<p>If I understood your sources regarding the Zimnitsky test correctly, it basically also tests urine for its specific gravity over a time period of 24 hours.\nHowever, the difference is that during Zimnitsky test eight (to twelve) individual samples are tested, not a collection. </p>\n" } ]

[ "https://health.stackexchange.com/questions/16926", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2248/" ]

[ { "answer_id": 16934, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 1, "selected": false, "text": "<p>Reducing risk factors like overweight, alcohol, sedatives and smoking is important and it can sometimes be minimized by sleeping on the side rather than supine.\nBut obstructive sleep apnea causes major health problems due to increased blood pressure (especially cardiovascular events like stroke or heart attacks) so CPAP should definitely be considered. Otherwise a good blood preassure control with medication (and with the lifestyle changes mentioned above) are essential.</p>\n\n<p>You can read about it in this article: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/\" rel=\"nofollow noreferrer\">Obstructive sleep apnoea syndrome and its management</a></p>\n\n<p>There is a section <strong>Alternatives to PAP</strong> which might be the most relevant for your question.</p>\n" }, { "answer_id": 16939, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 3, "selected": true, "text": "<h2>Breathing difficulties during sleep determined to be caused by the narrowing or closing of their airway</h2>\n\n<p>Breathing difficulties during sleep indicates suffering of Obstructive Sleep Apnoea (OSA). Support is available in the UK from the charity called <a href=\"http://www.sleep-apnoea-trust.org\" rel=\"nofollow noreferrer\">The Sleep Apnoea Trust Association (SATA)</a></p>\n\n<p>There are two types of breathing interruption characteristic of OSA (<a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea\" rel=\"nofollow noreferrer\">NHS, 2016</a>):</p>\n\n<ul>\n<li><strong>apnoea</strong><br>where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it's called an apnoea when the airflow is blocked for 10 seconds or more</li>\n<li><strong>hypopnoea</strong><br>a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more</li>\n</ul>\n\n<h2>Treatment Methods</h2>\n\n<p>There are 3 main forms of treatment available (<a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea/#treating-osa\" rel=\"nofollow noreferrer\">NHS, 2016</a> &amp; <a href=\"http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea\" rel=\"nofollow noreferrer\">SATA, n.d.</a>):</p>\n\n<ul>\n<li><strong>lifestyle changes</strong><br>such as losing excess weight, cutting down on alcohol and sleeping on your side</li>\n<li><strong>wearing a mandibular advancement device (MAD) - also known as mandibular splints</strong><br>this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep<br><br>There are 2 forms of mandibular splints available\n\n<ul>\n<li><strong>One bought in the high street<br>(Cost is cheap in comparison to other methods but by personal experience, they only last a month or so at best before having to by another one.)</strong><br>These are moulded to the shape of your jawline by warming up in hot water and clenching your teeth together with the splint in place with your bottom jaw forward whilst the mould cools and sets.</li>\n<li><strong>One bought through your dentist<br>(More expensive than through the high street, but said to last a few years)</strong><br>These are created and provided through your dentist in order to be custom made to fit your jaw perfectly. There are different types which you can discuss with your dentist in order to select the right one for you.</li>\n</ul></li>\n<li><strong>using a continuous positive airway pressure (CPAP) device<br>(These are generally for more severe/chronic OSA and some models can be more expensive than others)</strong><br>these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask</li>\n</ul>\n\n<h2>References</h2>\n\n<p>NHS (2016). <em>Obstructive sleep apnoea</em> [Online]<br>Retrieved from: <a href=\"https://www.nhs.uk/conditions/obstructive-sleep-apnoea\" rel=\"nofollow noreferrer\">https://www.nhs.uk/conditions/obstructive-sleep-apnoea</a></p>\n\n<p>SATA (n.d.). Treatment of Sleep Apnoea <em>The Sleep Apnoea Trust Association</em> [Online]<br>Retrieved from: <a href=\"http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea\" rel=\"nofollow noreferrer\">http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/16931", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11501/" ]

[ { "answer_id": 16943, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<h2>No.</h2>\n<blockquote>\n<p>Allergy, which is an exaggerated immune sensitivity to certain environmental compounds, usually plants, or less commonly microorganisms, metals and other materials.</p>\n<p>^{McConnell, Thomas H. (2007). <a href=\"https://books.google.de/books?id=chs_lilPFLwC&amp;pg=PA159&amp;redir_esc=y#v=onepage&amp;q&amp;f=false\" rel=\"nofollow noreferrer\">The Nature of Disease: Pathology for the Health Professions</a>. Baltimore, Mar.: Lippincott Williams &amp; Wilkins. p. 159. ISBN 978-0-7817-5317-3. Archived from the original on 8 September 2017.}</p>\n</blockquote>\n<p>Cold temperature is not an environmental compound and thus can't trigger an allergy.</p>\n" }, { "answer_id": 16944, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>There is no true allergy to cold, but there is a condition called <strong>cold urticaria,</strong> which is a subtype of <a href=\"https://en.wikipedia.org/wiki/Physical_urticaria\" rel=\"noreferrer\">physical urtiaria</a>. Other subtypes of physical urticaria include increased sensitivity to physical pressure, water, heat, sun exposure, etc. </p>\n\n<p><a href=\"https://www.mayoclinic.org/diseases-conditions/cold-urticaria/symptoms-causes/syc-20371046\" rel=\"noreferrer\">Mayo Clinic: Cold Urticaria</a></p>\n\n<blockquote>\n <p>Cold urticaria is a skin reaction to cold that appears within minutes\n after cold exposure. Affected skin develops reddish, itchy welts\n (hives).</p>\n</blockquote>\n\n<p>The condition most commonly occurs in young adults.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16941", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9637/" ]

[ { "answer_id": 16982, "author": "Don_S", "author_id": 7166, "author_profile": "https://health.stackexchange.com/users/7166", "pm_score": 3, "selected": false, "text": "<p><a href=\"https://en.wikipedia.org/wiki/Body_mass_index\" rel=\"noreferrer\">BMI</a> is absolutely <strong>NOT</strong> a good indicator of health. At least not on its own.</p>\n\n<p>It is made up of two measurements only: height and weight. Height is a stable property, and a person cannot do anything about it (nothing physiological and permanent, at any rate). Body weight, however, is comprised of different types of tissues in the body, most notably fat and muscle tissues (and let us not forget that <a href=\"https://water.usgs.gov/edu/propertyyou.html\" rel=\"noreferrer\">~60% of our body weight is water</a>...).</p>\n\n<p>Growth of either type of tissue adds mass to the body, which means that your weight increases <strong>by the same amount</strong> whether you develop muscles or build fat tissues through overeating (mass is mass for both types of tissues, volume is not). Therefore, it is entirely possible for two people of the same height to have the same weight and therefore the same BMI value, even though one is fat and the other is well-muscled. <strong>Your body weight does not tell you if you have more fat than muscle or vice versa</strong>. (see also <a href=\"https://en.wikipedia.org/wiki/Body_mass_index#Does_not_differentiate_between_muscle_mass_and_fat_mass\" rel=\"noreferrer\">this section</a> in the Wikipedia entry).</p>\n\n<p>Of course, being overweight may lead to adverse health issues, and being fit and physically active is considered protective against such issues (see <a href=\"http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\" rel=\"noreferrer\">WHO page</a> about obesity and overweight). The point is that BMI score does not tell you if you are the former or the latter, it only gives you some estimation of the ratio between your height and weight and therefore should not be used alone for estimation (just like you say your doctor did).</p>\n\n<p>So why do we STILL use BMI in a health-related context?</p>\n\n<p>The main reason is probably that it very convenient and straightforward. Only two easily-measured values, which a person usually knows at any time. Thus, it is very available. This also makes it very popular, in the sense that people can talk about it outside of the medical context (i.e. not only when talking to a healthcare professional). Obviously historical reasons play a small part also.</p>\n\n<p>There are some variations and alternatives to make better use of BMI, see <a href=\"https://en.wikipedia.org/wiki/Body_mass_index#Alternatives\" rel=\"noreferrer\">here</a>.</p>\n\n<p>See also this <a href=\"https://www.independent.co.uk/life-style/health-and-families/bmi-stop-measuring-weight-height-health-measure-fitness-fat-a7894951.html\" rel=\"noreferrer\">nice article</a> from The Independet about the subject.</p>\n" }, { "answer_id": 16986, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>In short: You can have a high BMI (weight in kg/height in m squared) due to:</p>\n\n<ul>\n<li>Excessive fat</li>\n<li>Large muscle mass developed by training</li>\n<li>\"Large frame size,\" which is genetic, and includes thick bones, relatively lot of muscle mass ad large internal organs. With this large frame, you can have a high BMI without excessive fat, but for BMI as high as 30.4, you would very likely have some excessive fat. However, if the fat is evenly distributed, it may not make you look very fat.</li>\n</ul>\n\n<hr>\n\n<p>What's considered normal body weight, depends on the <strong>body frame size.</strong> According to this <a href=\"http://www.healthchecksystems.com/heightweightchart.htm\" rel=\"nofollow noreferrer\">height/weight chart</a>, for a 6'0\" high man with a small frame, 149 pounds can be normal and for one with a large frame 188 pounds can be normal.</p>\n\n<p><a href=\"https://medlineplus.gov/ency/imagepages/17182.htm\" rel=\"nofollow noreferrer\">Body frame size</a> is genetically determined and is associated with the bone <em>thickness</em> (not bone <em>density</em>). Body frame size can be evaluated from your height and wrist circumference.</p>\n\n<p>BMI 30.4 is not in a normal range for any frame, so the excessive weight must come from excessive fat (unless you have developed a lot of muscles by training). There are different types of obesity - if fat is evenly distributed through the body, you, again, won't look that obese as if fat is mainly in your belly (abdominal obesity, apple type) or around the buttocks and thighs (pear type).</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Obesity\" rel=\"nofollow noreferrer\"><strong>Obesity</strong></a> is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. According to <a href=\"https://www.cdc.gov/healthyweight/effects/index.html\" rel=\"nofollow noreferrer\">CDC.gov</a>, people who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions...including high blood pressure, coronary heart disease, diabetes type 2, etc.</p>\n\n<p>According to various <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935926/\" rel=\"nofollow noreferrer\">study reviews</a>, <strong>abdominal obesity</strong> is associated with significantly higher risk of various diseases than other types of obesity.</p>\n" } ]

[ "https://health.stackexchange.com/questions/16981", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14328/" ]

[ { "answer_id": 17030, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>The all-inclusive term for <strong>abnormal growths</strong> is <a href=\"https://library.med.utah.edu/WebPath/NEOHTML/NEOPL102.html\" rel=\"nofollow noreferrer\"><strong>neoplasm</strong></a> or, in Latin, neoplsia:</p>\n\n<blockquote>\n <p>Neoplasia is new, uncontrolled growth of cells that is not under\n physiologic control.</p>\n</blockquote>\n\n<p>Abnormal growths can be:</p>\n\n<ul>\n<li><strong>Benign:</strong> growing but not spreading or destroying nearby tissues</li>\n<li><strong>Malignant:</strong> invading nearby tissues or spreading to distant organs</li>\n</ul>\n\n<p>The term <a href=\"https://www.medicinenet.com/script/main/art.asp?articlekey=5863\" rel=\"nofollow noreferrer\"><strong>tumor</strong></a> refers to any abnormal localized mass of tissue, either benign or malignant.</p>\n\n<p>The term <a href=\"https://en.wikipedia.org/wiki/Polyp_(medicine)\" rel=\"nofollow noreferrer\"><strong>polyp</strong></a> covers all tumors that grow from the mucous membranes and project into the lumen of an organ.</p>\n" }, { "answer_id": 17031, "author": "Armatus", "author_id": 12506, "author_profile": "https://health.stackexchange.com/users/12506", "pm_score": 3, "selected": true, "text": "<p>Dysplasia describes abnormal cell morphology or differentiation without the proliferation rate being affected. Dysplasias can result in an increased number of one type of cell as a result of another type of cell being reduced in number (e.g. because the first type is failing to differentiate into the second, but not because any cell is proliferating more than usual).</p>\n\n<p>Hyperplasia describes increased cell proliferation which results from an adequate response to a growth signal. This includes for example red blood cell hyperplasia as a result of hypoxic environment or erythropoietin treatment.</p>\n\n<p>Neoplasia covers all forms of abnormal cell proliferation. Unlike a hyperplasia, neoplastic cells proliferate regardless of growth signal presence or absence. If the neoplastic cells are adhesive, they may stay together as a lump and form a tumour. If they invade other tissues, they are malignant and also called cancer.</p>\n\n<p>Polyps are abnormal \"growths\", i.e. appendages grown from a tissue that do not normally occur. Usually, the tissue that has grown itself is not abnormal; rather, there are abnormal amounts of a signal instructing the tissue to grow. In this case, the polyp is usually hyperplastic (increased cell number), and sometimes also hypertrophic (increased cell size). Polyps can progress to neoplasms, usually first benign, and at late stages malignant.</p>\n\n<p>The only term describing both hyper- and neoplasias is \"hyperproliferation\", which is not a medical term. This still doesn't include dysplasia, and I can't think of a term that would. Maybe \"non-nascent cell behaviours\"...</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Dysplasia\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Dysplasia</a> has a quick overview of -plasias and -trophies.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17027", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14361/" ]

[ { "answer_id": 17043, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p><a href=\"http://www.nutrientsreview.com/carbs\" rel=\"nofollow noreferrer\">Carbohydrates</a> can be categorized according to how well they are digested or absorbed:</p>\n\n<p>a) WELL-DIGESTIBLE (4 Cal/g):</p>\n\n<ul>\n<li>Sugars:\n\n<ul>\n<li>Monosaccharides (glucose, fructose, galactose, mannose...)</li>\n<li>Disaccharides (sucrose, lactose, maltose...)</li>\n</ul></li>\n<li>Oligosaccharides (fructo-oligosaccharides, galacto-oligosaccharides...)</li>\n<li>Polysaccharides:\n\n<ul>\n<li>Starch</li>\n<li>Glycogen</li>\n</ul></li>\n</ul>\n\n<p>b) POORLY DIGESTIBLE/ABSORBABLE (2 Cal/g):</p>\n\n<ul>\n<li>Sugar alcohols or polyls (maltitol, mannitol, sorbitol, xylitol...)</li>\n</ul>\n\n<p>c) NON-DIGESTIBLE (2 Cal/g):</p>\n\n<ul>\n<li>Dietary fiber (various oligo- and polysaccharides, such as oligofructans and cellulose)</li>\n</ul>\n\n<p><a href=\"https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-carbohydrates/counting-carbohydrates/learning-to-read-labels/understanding-fiber/\" rel=\"nofollow noreferrer\">Diabetics</a> who want to calculte how carbohydrates will affect their blood sugar levels need to subtract the amount of fiber from total carbohydrates.</p>\n\n<p>Source: <a href=\"https://www.nature.com/articles/1602938/tables/3\" rel=\"nofollow noreferrer\">Calories in specific carbohydrates (Nature.com)</a></p>\n" }, { "answer_id": 17049, "author": "Gordon", "author_id": 13819, "author_profile": "https://health.stackexchange.com/users/13819", "pm_score": 3, "selected": true, "text": "<p>This is from Uviv. Cal. San Francisco, \"Understanding Fiber\", </p>\n\n<blockquote>\n <p>To summarize – you need to take the total amount of carbohydrate in a serving MINUS the carbohydrate in the fiber.<br>(Source: <a href=\"https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-carbohydrates/counting-carbohydrates/learning-to-read-labels/understanding-fiber\" rel=\"nofollow noreferrer\">Diabetes Teaching Center at the University of California, San Francisco</a>)</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/17038", "https://health.stackexchange.com", "https://health.stackexchange.com/users/473/" ]

[ { "answer_id": 17058, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>In the <a href=\"https://www.bodybuilding.com/content/protein-carbs-fat.html\" rel=\"nofollow noreferrer\">bodybuilding scene</a>, the logic that you need to consume carbohydrates to build muscles is this:</p>\n\n<blockquote>\n <p>Protein calories will be used as an energy source when the body is\n lacking fat or carbohydrate calories for fuel. When the body receives\n sufficient quantities of proteins, fats and carbohydrates, protein\n will carry out its specific functions.</p>\n</blockquote>\n\n<p>Note, that the article never says you need to consume \"a lot\" of carbohydrates or have them with every meal; they don't even need to be carbohydrates - fats will do the same: provide calories for energy, so the proteins won't get burned and could be incorporated into the muscles.</p>\n\n<p>Garri, which is made from <a href=\"https://scielo.conicyt.cl/pdf/rchnut/v40n2/art12.pdf\" rel=\"nofollow noreferrer\">cassava</a>, contains a lot of soluble fiber, which can cause a lot of gas if consumed in great amounts. There are other high-carb foods with much less soluble fiber, for example, bread, pasta, potatoes and rice.</p>\n\n<p>Having >60% carbs in your diet is a risk factor for increased blood triglycerides, which might be further associated with increased risk of diabetes or heart disease, though (<a href=\"http://Having%20%3E60%25%20carbs%20in%20your%20diet%20is%20a%20risk%20factor%20for%20increased%20blood%20triglycerides,%20which%20might%20be%20further%20associated%20with%20increased%20risk%20of%20diabetes%20or%20heart%20disease,%20though.\" rel=\"nofollow noreferrer\">PubMed, 2000</a>).</p>\n\n<p>According to the following study, carbohydrate intake as such does not help to increase muscle mass: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850644/\" rel=\"nofollow noreferrer\">Is carbohydrate needed to further stimulate muscle protein synthesis/hypertrophy following resistance exercise? (PubMed, 2013)</a></p>\n\n<blockquote>\n <p>In conclusion, whilst it cannot be excluded that carbohydrate addition\n may provide benefits for recovering athletes, on the basis of\n available data, <em>no further beneficial actions of carbohydrates,</em>\n irrespective of GI, are evident concerning muscle hypertrophy when a\n protein supplement that maximally stimulate muscle protein synthesis\n is ingested.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14594866\" rel=\"nofollow noreferrer\">Another study (PubMed, 2004)</a>:</p>\n\n<blockquote>\n <p>We conclude that ingestion of carbohydrates improved net leg protein\n balance after resistance exercise. However, the effect was minor and\n delayed compared with the previously reported effect of ingestion of\n amino acids.</p>\n</blockquote>\n" }, { "answer_id": 17072, "author": "Count Iblis", "author_id": 856, "author_profile": "https://health.stackexchange.com/users/856", "pm_score": 2, "selected": true, "text": "<p>There is a much simpler reason why bulking up on carbs is good in general, also for bodybuilding. Your body needs energy, and hole grain carbs are a healthy source of energy, as its loaded with vitamins, minerals and fiber. The alternative would be to eat fat for energy but this has two drawbacks.</p>\n\n<p>The first drawback is that fat is pretty much an empty calorie source, it contains no vitamins, no minerals, and no fibers. While we do need small amounts of fats to absorb fat soluble vitamins and to get our essential Omega-3 and Omega-6 faty acids, we don't need it for energy.</p>\n\n<p>The second drawback is that burning carbs requires less oxygen than burning fat, because carbs contain more oxygen atoms than fat molecules. This is particularity important when doing cardio exercise. A body builder might not be too much concerned with that, but most body builders do build in quite some cardio training in their routine to maintain a good weight and fitness.</p>\n\n<p>As far as general health is concerned, there is quite strong evidence that limiting fat intake to 15% of total calories is good for health. As <a href=\"https://academic.oup.com/ije/article/41/5/1225/712708\" rel=\"nofollow noreferrer\">mentioned here</a>, in Uganda in the 1950s the rate of coronary heart disease in the African population was almost zero, while in the Asian population it was similar to what it is in the Western World. The explanation according to the article, for this difference is the fat in the diet.</p>\n\n<p>A recent finding is that the Tsimané people have <a href=\"https://www.theguardian.com/society/2017/mar/17/tsimane-of-the-bolivian-amazon-have-worlds-healthiest-hearts-says-study\" rel=\"nofollow noreferrer\">extremely low levels of heart disease</a>, much lower than lowest observed results in modern societies like the Japanese people in Okinawa or people sticking to the Mediterranean diet. The Tsimané people's diet contains roughly the same amount of fat as that of the Africans in Uganda in the 1950, its roughly 15% of the calorie intake.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17046", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6972/" ]

[ { "answer_id": 17051, "author": "Ella", "author_id": 14376, "author_profile": "https://health.stackexchange.com/users/14376", "pm_score": -1, "selected": false, "text": "<p>Lots of bacteria can be found in one's beard. Microbiologists found that men's facial hair can contain as much bacteria as your average toilet seat and even contained bacteria you'd find in a toilet. To be cautious, make sure you wash your hands regularly and avoid playing with and twirling the hair.</p>\n" }, { "answer_id": 17052, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 2, "selected": false, "text": "<p>A better comparison than \"beard vs toilet\" may be \"face with beard vs face without beard.\"</p>\n\n<p>This is actually a reasonable concern in the context of healthcare, where healthcare staff can be a vector for disease and where vulnerable people are numerous. If facial hair is a reservoir for disease, it might be reasonable to recommend that healthcare staff remain clean-shaven.</p>\n\n<p>Wakeam, et al. found that clean-shaven men versus those with facial hair had different compositions of facial bacteria. Men with facial hair actually had <em>less</em> of some bacteria such as <em>Staphylococcus aureus</em>. The authors suggest that small cuts from shaving might actually promote colonization in some cases. </p>\n\n<p>Overall, though, they conclude that there isn't really any increased risk from the facial bacterial milieu of those with facial hair (there are separate studies looking at issues with surgical masks, etc, but I feel it's a bit of a stretch to go into that here).</p>\n\n<p>Lab techs with facial hair had numerically a few more bacterial species present than those without, but the differences aren't substantial and don't really represent any risk (Lindeholm and Arpi 2016) - importantly, coagulase-negative staphylococci were more common in the clean-shaven techs, which are normal skin bacteria but are also a risk for infection of open wounds.</p>\n\n<p><strong>Summary and answer to the question</strong></p>\n\n<p>Beards might have more bacteria than a typical toilet, but an unbearded face probably does, too. People, and animals more generally, are great hosts for a variety of microbial species.</p>\n\n<hr>\n\n<p>Wakeam, E., Hernandez, R. A., Morales, D. R., Finlayson, S. R. G., Klompas, M., &amp; Zinner, M. J. (2014). Bacterial ecology of hospital workers' facial hair: a cross-sectional study. Journal of Hospital Infection, 87(1), 63-67.</p>\n\n<p>Lindeholm, Y. N., &amp; Arpi, M. (2016). Facial hair–what about clinical microbiology technicians?. Journal of Hospital Infection, 93(3), 313-314.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17050", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14377/" ]

[ { "answer_id": 17057, "author": "Prince", "author_id": 6972, "author_profile": "https://health.stackexchange.com/users/6972", "pm_score": 2, "selected": false, "text": "<p>You can't give accurate values to the exact level of brightness needed for optimal reading. There are several factors that affect such things such as type of display, ambient light, type of work, program you are working with.</p>\n\n<p>If the brightness is reduced to a minimum, it forces the eyes to exert more strain which would damage the eye as excessive eye strain could cause permanent eye damage.</p>\n\n<p>The best thing to do is to apply the <a href=\"https://www.medicalnewstoday.com/articles/321536.php\" rel=\"nofollow noreferrer\">20-20-20</a> rule which says that every 20 minutes, look at something 20 feet away for 20 seconds.</p>\n" }, { "answer_id": 17066, "author": "Uniphonic", "author_id": 14354, "author_profile": "https://health.stackexchange.com/users/14354", "pm_score": 2, "selected": false, "text": "<p>I think it depends on the brightness of other light in the room. To reduce eye strain you should try to keep your screen at a similar light intensity compared to the rest of the light in the room.</p>\n\n<p>A particular <a href=\"https://www.drweil.com/health-wellness/body-mind-spirit/vision/can-watching-tv-in-the-dark-hurt-your-eyes/\" rel=\"nofollow noreferrer\">study showed that eye strain was increased</a> when watching a bright screen in a dark room.</p>\n\n<blockquote>\n <p>\"The result of all this testing and observation was that there was less eyestrain, discomfort and visual fatigue when the volunteers watched the movie against a lighted wall. \"</p>\n</blockquote>\n\n<p>For my self, I try to use more ambient lights that point at the ceiling, or by pointing a desk lamp at the wall behind my monitor, so it smooths out the light and doesn't make one spot so bright. You can also find LED lights that stick on the back of a computer, which point at the wall, to increase the amount of ambient light in a room. Try to keep the screen not too much brighter than the other things in the room.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17056", "https://health.stackexchange.com", "https://health.stackexchange.com/users/12067/" ]

[ { "answer_id": 17069, "author": "user29173", "author_id": 14388, "author_profile": "https://health.stackexchange.com/users/14388", "pm_score": -1, "selected": false, "text": "<p>Your liver will create all the cholesterol needed for your body, unless you have some birth malformations or genetic disseases you will be fine. </p>\n\n<p>Your doctor is right, there's no such too thing a too low cholesterol.</p>\n\n<p>Listen to your doctor and don't risk your life because of skme internet articles.</p>\n" }, { "answer_id": 17070, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p>Some doctors think there is not enough evidence that low cholesterol levels are harmful.</p>\n\n<p><a href=\"https://www.health.harvard.edu/heart-health/is-my-ldl-cholesterol-too-low\" rel=\"nofollow noreferrer\">Ask the doctor: Is my LDL cholesterol too low? (Harvard.edu, 2012)</a></p>\n\n<blockquote>\n <p>There really isn't evidence of harm from driving your LDL too low. In\n the past, some scientists worried that extremely low LDL levels could\n result in blood vessel ruptures and perhaps increase the risk of\n getting certain types of cancer. Those concerns have faded after\n neither occurred in large clinical trials that involved reducing\n people's LDL to very low levels.</p>\n \n <p>Still, taking larger doses of atorvastatin...increases the risk of\n statin side effects, which include muscle and liver damage. For that\n reason, moving to a lower dose is a good idea.</p>\n</blockquote>\n\n<p><a href=\"https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-level/faq-20057952\" rel=\"nofollow noreferrer\">Can your total cholesterol level be too low? (Mayo Clinic)</a></p>\n\n<blockquote>\n <p>Although the risks are rare, very low levels of LDL cholesterol may be\n associated with an increased risk of:</p>\n \n <ul>\n <li>Cancer</li>\n <li>Hemorrhagic stroke</li>\n <li>Depression</li>\n <li>Anxiety</li>\n <li>Preterm birth and low birth weight if your cholesterol is low while you're pregnant</li>\n </ul>\n \n <p>The potential risk of lowering LDL cholesterol to very low levels has\n not been confirmed, and its association with certain health risks is\n still under debate.</p>\n</blockquote>\n\n<p>Still, according to some studies, there might be some risks of too low cholesterol levels (usually caused by taking statins).</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247776/\" rel=\"nofollow noreferrer\">Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults (PubMed)</a></p>\n\n<blockquote>\n <p>Groups with the lowest group having TC &lt; 160 mg/dL as well as the\n highest group having >= 240 mg/dL were associated with higher\n cardiovascular disease mortality...Based on the results of this study,\n caution should be taken in prescribing statins for primary prevention\n among people at low cardiovascular risk in Korean adults.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299064/\" rel=\"nofollow noreferrer\">Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case–control study (PubMed, 2012)</a></p>\n\n<blockquote>\n <p>This study confirms an increased risk of primary intracerebral\n hemorrhage associated with low cholesterol both in men and women,\n especially in older individuals.</p>\n</blockquote>\n\n<p>One who has very low cholesterol levels can discuss with a doctor about adjusting the dose or statins or even stopping them.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17068", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14387/" ]

[ { "answer_id": 17102, "author": "Gordon", "author_id": 13819, "author_profile": "https://health.stackexchange.com/users/13819", "pm_score": 1, "selected": false, "text": "<p>I think non-fat plain yogurt has 45% of the RDA for calcium, or you could get 100% from three glasses of milk. I have found magnesium to be a challenge so I supplement magnesium. <a href=\"https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/\" rel=\"nofollow noreferrer\">https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/</a></p>\n\n<p>If you start the day with a fortified American breakfast cereal, you can pick up a lot of vitamins and some minerals in the morning depending on the brand, and the calcium in the milk; though in my opinion some of the cereals are a little too rich in iron (100%), which depending on what else you eat that day that has iron one can end up with a potentially excessive iron load over time (for men and postmenopausal women). <a href=\"https://ods.od.nih.gov/factsheets/Iron-Consumer/\" rel=\"nofollow noreferrer\">https://ods.od.nih.gov/factsheets/Iron-Consumer/</a></p>\n\n<p>Choline can be a bit of a challenge, three eggs will give you around 440mg (147 to 115 per egg). The adequate intake for men is 550mg in the U.S. There is no RDA for choline yet, just a recommendation for an adequate intake. I tend to forget about choline and I have to remind myself to think about it, but choline is one of those nutrients that I recommend people talk to their doctor before they take a supplement (see potential issue with TMAO). Cleveland Heart Lab. <a href=\"http://www.clevelandheartlab.com/blog-category/tmao/\" rel=\"nofollow noreferrer\">http://www.clevelandheartlab.com/blog-category/tmao/</a></p>\n\n<p>I'm sure I don't get the required nutrients every single day, but at least I try to give it some serious attention, and then I don't worry about it excessively. </p>\n\n<p>P.S. I think people can benefit from researching vitamin D and A on their own. Some people pick up Vitamin D well from the sun, and some don't. . I think there is a role for preformed \"real\" vitamin A in the diet (occasional calf liver, etc.). As far as preformed vitamin A supplements, it is wise to discuss it with a doctor before supplementing. <a href=\"https://ods.od.nih.gov/factsheets/VitaminD-Consumer/\" rel=\"nofollow noreferrer\">https://ods.od.nih.gov/factsheets/VitaminD-Consumer/</a></p>\n\n<p>Of potential interest to diabetics, \"pre-diabetics\" and their physicians. Vitamin A. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623591/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623591/</a></p>\n\n<p>This page here contains a lot of information in one place. <a href=\"https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx\" rel=\"nofollow noreferrer\">https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx</a></p>\n" }, { "answer_id": 20418, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 0, "selected": false, "text": "<p>It is realistic to get all the nutrients you need by consuming foods without fortification and supplements.</p>\n\n<p>In general (not as a strict rule), mineral and vitamin needs increase with the calories you spend, which mainly increase with physical activity. If you spend 5,000 Calories/day, you will likely need more vitamins/minerals than if you spend 1,500.</p>\n\n<p>There are different criteria for mineral/vitamin requirements:</p>\n\n<ul>\n<li>US: <strong><a href=\"http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2019/DRI-Tables-2019/1_EARV.pdf?la=en\" rel=\"nofollow noreferrer\">Estimated Average Requirements (EAR)</a>,</strong> which meet the needs of 50% of the individuals in each sex and age group <strong>(probably most appropriate for someone who needs ~2,000 Calories/day).</strong></li>\n<li>US: <strong><a href=\"http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2019/DRI-Tables-2019/2_RDAAIVVE.pdf?la=en\" rel=\"nofollow noreferrer\">Recommended Dietary Allowances (RDA)</a>,</strong> which meet the needs of nearly all (97.5%) individuals (including heavy physical workers and athletes)</li>\n<li>UK: <strong><a href=\"https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Oct%202016.pdf\" rel=\"nofollow noreferrer\">Reference Nutrient Intakes</a>,</strong> defined the same way as the US RDA</li>\n<li>US (by FDA) <strong><a href=\"https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/factsheets/vitamin_and_mineral_chart.pdf\" rel=\"nofollow noreferrer\">Daily Value (DV)</a>,</strong> which is similar to RDA, but with even higher recommendations.</li>\n</ul>\n\n<p>When people discuss about mineral/vitamin requirements, they usually refer to the US RDA values, but they are several reasons to believe those amounts are significantly higher than what an average adult needs, for example:</p>\n\n<ul>\n<li>For <strong>potassium,</strong> they were not sure, so they did not call it RDA, but Adequate Intake (AI): previously it was 4.7 g/day and recently they lowered it to 3.4 g/day.</li>\n<li>For <strong>calcium,</strong> in the US, the RDA is 1,000 mg/day, while in the UK, the RNI is 700 mg/day.</li>\n<li>For <strong>vitamin C,</strong> the RDA is 75 mg/day, EAR is 65 mg/day and NRI is 40 mg/day.</li>\n<li>For <strong>folate,</strong> the RDA is 400 µg/day, EAR is 320 µg/day and NRI is 200 µg/day.</li>\n</ul>\n\n<p>Nutrient requirements refer to what you need every day in average, so if you get more one day you need less the next day.</p>\n\n<p>To find foods high in a particular nutrient, you can check <a href=\"http://www.nutrientsreview.com/\" rel=\"nofollow noreferrer\">Nutrients Review</a>. To finds which nutrients a certain food contains, you can check <a href=\"https://nutritiondata.self.com/\" rel=\"nofollow noreferrer\">NutritionData</a>. </p>\n" } ]

[ "https://health.stackexchange.com/questions/17100", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14412/" ]

[ { "answer_id": 17178, "author": "blacksmith37", "author_id": 9688, "author_profile": "https://health.stackexchange.com/users/9688", "pm_score": 0, "selected": false, "text": "<p>The problem is the obvious electrolyte loss , especially if you mean distilled water.It may not be a problem with a diet containing enough electrolytes. </p>\n" }, { "answer_id": 24712, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 1, "selected": false, "text": "<p>As pointed out by the <a href=\"https://biology.stackexchange.com/a/7194/29337\">more reputable answer</a> at the <a href=\"https://biology.stackexchange.com/q/2250/29337\">similar question at Biology.SE</a> (backed with sources of information and hence more highly voted), what would happen if you drank only distilled water is nothing perceptible. The only place where concentrations of distilled water would ever be high enough to conceivably matter is in the tissues of the mouth and throat, and even there, the effect would be temporary.</p>\n<blockquote>\n<p>Compare drinking 8 glasses of either distilled or tap water every day. <a href=\"http://www.mgwater.com/mgrank.shtml\" rel=\"nofollow noreferrer\">With tap water</a>, you're looking at less than 200 ppm of Mg, Na, K, and Ca combined. That's less than 400mg of total mineral content per day. Given that the combined RDA of all of those minerals is on the order of <a href=\"http://www.iom.edu/Activities/Nutrition/SummaryDRIs/%7E/media/Files/Activity%20Files/Nutrition/DRIs/5_Summary%20Table%20Tables%201-4.pdf\" rel=\"nofollow noreferrer\">7g for an adult male</a>, this is not <em>nothing</em>, but it's certainly small. Your dietary intake of these minerals probably varies by more than this daily, and your intestines, kidneys, sweat glands and mineral storage organs (like your bones and muscles) are constantly maintaining the mineral blood levels within a <em>very</em> narrow range, despite handling a throughput of several pounds of water and food daily. They might have to work slightly harder to manage this range if you drank nothing but distilled water, but in a healthy adult, normal intakes already vary by more than this amount without major problems. For example, the average American <a href=\"http://www.cdc.gov/features/dssodium/\" rel=\"nofollow noreferrer\">consumes more than 3.4 grams of sodium daily</a>, while a <a href=\"http://www.ucsfhealth.org/education/guidelines_for_a_low_sodium_diet/index.html\" rel=\"nofollow noreferrer\">low-sodium diet is on the order of 2g</a>. Low-sodium diets have been widely studied in the medical literature, and are considered safe.</p>\n<p>As for pH, the lowered pH is caused by increased carbon-dioxide absorption to form carbonic acid. Just as carbon dioxide is more soluble in distilled water, it is less soluble in stomach acid, and may be burped out. Would you die of acidosis from drinking seltzer water all the time? If that were the case, I'm sure there would be big health warnings about drinking soda, <a href=\"http://www.popsci.com/scitech/article/2008-07/will-drinking-carbonated-beverages-weaken-my-bones\" rel=\"nofollow noreferrer\">while it seems relatively benign</a>. Furthermore, your body produces and excretes (through the lungs) <a href=\"http://en.wikipedia.org/wiki/Carbon_dioxide#Human_physiology\" rel=\"nofollow noreferrer\">around 1kg of CO2 daily</a>, dwarfing any extra CO2 you might get by drinking distilled water. If the small amounts of CO2 found in distilled water were dangerous, jogging would be invariably fatal.</p>\n<p>If you were to drink nothing but distilled water, and eat no food, you probably would die of hyponatremia within a few weeks. But you would also die of hyponatremia if you were to drink nothing but tap water, though perhaps slightly more slowly.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/17176", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11471/" ]

[ { "answer_id": 17861, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": true, "text": "<p><strong>Macronutrient (carbs, proteins, fats) composition of a diet does not have a significant direct effect on weight loss.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735822/\" rel=\"nofollow noreferrer\">Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (PubMed, 2009, a randomized clinical trial involving 811 overweight adults)</a></p>\n\n<blockquote>\n <p>Reduced-calorie diets result in clinically meaningful weight loss\n regardless of which macronutrients they emphasize.</p>\n</blockquote>\n\n<p>On the other hand, certain macronutrient compositions and forms <em>may</em> be associated with <strong>increased satiety</strong> (and hence lower food intake):</p>\n\n<ul>\n<li>Solid, compared to liquid carbs (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10878689\" rel=\"nofollow noreferrer\">PubMed, 2011</a>)</li>\n<li>Foods high in fiber, such as whole-grain pasta, compared to refined-grain pasta (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27496788\" rel=\"nofollow noreferrer\">PubMed, 2016</a>)</li>\n<li>Foods high in viscous soluble fiber, such as whole-grain oats (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26724486\" rel=\"nofollow noreferrer\">PubMed, 2016</a>)</li>\n<li>Low-carb, high fat diets (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873405/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>)</li>\n</ul>\n" }, { "answer_id": 19752, "author": "Fahad Ur Rehman Khan", "author_id": 16569, "author_profile": "https://health.stackexchange.com/users/16569", "pm_score": -1, "selected": false, "text": "<p>When it comes to losing weight, your eating habits and food choices matter a lot to achieve your fitness goals. You have to quit junk and unhealthy food and add healthy and nutrient-rich foods to your diet. No matter how many crunches or push-ups you can do in a day, if you will not fill your diet with healthy foods and break your unhealthy eating habits, then you are not going to maintain a healthy weight, quoting <a href=\"https://explorediet.co.uk/best-foods-for-weightloss/?utm_source=FWL\" rel=\"nofollow noreferrer\">Explore Diet</a>, a UK based blog here, that \"By eating healthy, it can help you lose weight but in a meaningful way.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17259", "https://health.stackexchange.com", "https://health.stackexchange.com/users/-1/" ]

[ { "answer_id": 17377, "author": "Bruce Kirkpatrick", "author_id": 14251, "author_profile": "https://health.stackexchange.com/users/14251", "pm_score": 3, "selected": false, "text": "<p>The first part of your question is very difficult to answer for the reasons mentioned in <a href=\"https://health.stackexchange.com/users/8212/narusan\">Narusan</a>'s comment: Specifically, comparing cancer incidence rates between many different groups of cancer survivors and people from matched demographics who have never had cancer is going to be very difficult, especially since these sets of data would be sourced from varied studies without the same controls. However, the second part of your question—whether the original type of treatment plays a role in new cancer formation (secondary malignancies)—has been investigated.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301605005882\" rel=\"nofollow noreferrer\"><strong>&quot;The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy.&quot; Kry <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics.</em> 2005.</strong></a></p>\n<p>Results: Depending on treatment energy, the IMRT treatments required 3.5–4.9 times as many monitor units to deliver as did the conventional treatment. The conservative maximum risk of fatal second malignancy was 1.7% for conventional radiation, 2.1% for IMRT using 10-MV X-rays, and 5.1% for IMRT using 18-MV X-rays.</p>\n<p>Conclusion: The risk of fatal secondary malignancy differed substantially between IMRT [intensity-modulated radiation therapy] and conventional radiation therapy for prostate cancer, as well as between different IMRT approaches. Perhaps this risk should be considered when choosing the optimal treatment technique and delivery system for patients who will undergo prostate radiation.</p>\n</blockquote>\n<p>Here, IMRT was shown to deliver a higher &quot;out-of-field&quot; dose (raditation to untargeted parts of the body) and had a greater associated risk of secondary malignancies than conventional radiation.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301608008158\" rel=\"nofollow noreferrer\"><strong>&quot;Risk of Developing Second Cancer From Neutron Dose in Proton Therapy as Function of Field Characteristics, Organ, and Patient Age.&quot; Jarlskog <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics. 2008.</em></strong></a></p>\n<p>Results: The main contributors (&gt;80%) to the neutron-induced risk are neutrons generated in the treatment head. Treatment volume can influence the risk by up to a factor of ∼2. Young patients are subject to significantly greater risks than are adult patients because of the geometric differences and age dependency of the risk models. Breast cancer should be the main concern for females. For males, the risks of lung cancer, leukemia, and thyroid cancer were significant for pediatric patients. In contrast, leukemia was the leading risk for an adult. Most lifetime risks were &lt;1% (70-Gy treatment). The only exceptions were breast, thyroid, and lung cancer for females. For female thyroid cancer, treatment risk can exceed baseline risk.</p>\n<p>Conclusion: The risk of developing a second malignancy from neutrons from proton beam therapy of a brain lesion is small (i.e., presumably outweighed by the therapeutic benefit) but not negligible (i.e., potentially greater than the baseline risk). The patient's age at treatment plays a major role.</p>\n</blockquote>\n<p>Like the IMRT, neutron bombardment from proton therapy was shown to have off-target effects and contribute to new cancers.</p>\n<p>Hopefully, these papers serve as decent representations of different secondary malignancy potentials with respect to primary cancer therapies. In the article <a href=\"https://www.nccn.org/patients/resources/life_after_cancer/understanding.aspx\" rel=\"nofollow noreferrer\">&quot;Understanding Your Risk of Developing Secondary Cancers,&quot;</a> the National Comprehensive Cancer Network reminds readers to prioritize their care without regard to comparatively low-probability secondary malignancies:</p>\n<blockquote>\n<p>...patients should not cause themselves undue worry about this possibility. &quot;The biggest risk to patients with cancer is the cancer that they are battling. They should follow the treatment plan designed by their oncologist and not worry about other factors. The vast majority of patients are not going to develop a secondary malignancy because of cancer treatment for the original cancer.&quot;</p>\n</blockquote>\n<p>Finally, some medical imaging techniques are similar to those cancer therapies that are more likely to cause secondary malignancies. The <a href=\"http://www.philrutherford.com/Radiation_Risk/BEIR/BEIR_VII.pdf\" rel=\"nofollow noreferrer\">BEIR VII report &quot;Health Risks from Exposure to Low Levels of Ionizing Radiation&quot;</a> includes risk estimates for different imaging and radiology techinques (although <a href=\"https://www.sciencedirect.com/science/article/pii/S1120179717302338\" rel=\"nofollow noreferrer\">some academic debate exists</a> on whether it's an appropriate estimation tool for this, the table below uses data from BEIR VII). Keep in mind that any amount of ionizing radiation is not good for your dividing cells!</p>\n<p><a href=\"https://i.stack.imgur.com/3MWRk.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3MWRk.png\" alt=\"BEIR VII Estimated Doses\" /></a></p>\n<p>(XR: x-ray; NM: nuclear medicine; CT: computerized tomography; IR: interventional radiology)</p>\n" }, { "answer_id": 17379, "author": "Chris", "author_id": 14056, "author_profile": "https://health.stackexchange.com/users/14056", "pm_score": 2, "selected": false, "text": "<p>This is a big topic and there is a huge amount of medical literature and research on the effectiveness of treatments and survival rates, so I will try to give a general overview and take a different slant to the other answer.</p>\n\n<p>Many factors affect recurrence rates, including the type of cancer, treatment, family history and the passage of time. Cancer is not just one disease but a very wide range of conditions, so it is hard to generalise.</p>\n\n<p>This can be considered from two aspects:</p>\n\n<ol>\n<li><p>Cancer that returns after treatment</p></li>\n<li><p>New cancers that develop separately from a previous one</p></li>\n</ol>\n\n<hr>\n\n<p><strong>Cancer that returns after treatment</strong></p>\n\n<p>Having one type of cancer does make you more likely to have a second cancer of that type in future, as it may suggest an underlying genetic or environmental susceptibility. For example, some people carry mutations of the <a href=\"https://en.m.wikipedia.org/wiki/BRCA1\" rel=\"nofollow noreferrer\">BRCA</a> genes that are linked with breast, ovarian and prostate cancers. If these gene mutations are present, there is an increased risk of several types of cancer (and probably a significant family history). Fundamentally, all cancers arise from damage or mutations to DNA. BRCA is normally involved in repair of DNA damage, so mutations that prevent this increase the likelihood of DNA damage causing a cancer.</p>\n\n<p>However, most times that cancer “comes back” are because it never went away fully in the first place. Even a single malignant cell escaping treatment can cause a recurrence some time later. This varies greatly on the type of cancer, grade (how aggressive the cancer is, tested by histology and <a href=\"https://en.m.wikipedia.org/wiki/Immunohistochemistry\" rel=\"nofollow noreferrer\">immunohistochemisty</a> for example) and stage (how far the cancer has spread, measured by imaging such as MRI). Here is a link to further explanations of <a href=\"https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-stages-and-grades-mean/\" rel=\"nofollow noreferrer\">grading and staging cancer</a>.</p>\n\n<p>Another source: <a href=\"https://www.cancerresearchuk.org/about-cancer/what-is-cancer/why-some-cancers-come-back\" rel=\"nofollow noreferrer\">Cancer Research UK - Why some cancers come back</a></p>\n\n<p>We do not have technology that can detect just a few malignant cells that might remain after treatment, which is why people are monitored for years post-treatment.</p>\n\n<p>This is where the term <em>cancer survivor</em> is a little misleading. There is actually an <a href=\"https://xkcd.com/931/\" rel=\"nofollow noreferrer\">XKCD cartoon</a> that has a good visual representation of this.</p>\n\n<hr>\n\n<p><strong>New cancers that develop separately</strong></p>\n\n<p>As mentioned above, certain genetic susceptibilities may mean someone with one type of cancer is more prone to another separate one at baseline. For example, someone who has breast cancer and a BRCA mutation is at increased risk of ovarian cancer as well.</p>\n\n<p>I was going to talk about the carcinogenic effects of treatments like radiotherapy and chemotherapy and the risk of cancer arising solely due to these treatments, but this has been covered excellently in the answer by Bruce. If that was the intended focus of the question you should definitely accept that answer :)</p>\n\n<p>Source: <a href=\"https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/second-cancers-after-breast-cancer.html\" rel=\"nofollow noreferrer\">Second cancers after breast cancer</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17369", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9688/" ]

[ { "answer_id": 17377, "author": "Bruce Kirkpatrick", "author_id": 14251, "author_profile": "https://health.stackexchange.com/users/14251", "pm_score": 3, "selected": false, "text": "<p>The first part of your question is very difficult to answer for the reasons mentioned in <a href=\"https://health.stackexchange.com/users/8212/narusan\">Narusan</a>'s comment: Specifically, comparing cancer incidence rates between many different groups of cancer survivors and people from matched demographics who have never had cancer is going to be very difficult, especially since these sets of data would be sourced from varied studies without the same controls. However, the second part of your question—whether the original type of treatment plays a role in new cancer formation (secondary malignancies)—has been investigated.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301605005882\" rel=\"nofollow noreferrer\"><strong>&quot;The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy.&quot; Kry <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics.</em> 2005.</strong></a></p>\n<p>Results: Depending on treatment energy, the IMRT treatments required 3.5–4.9 times as many monitor units to deliver as did the conventional treatment. The conservative maximum risk of fatal second malignancy was 1.7% for conventional radiation, 2.1% for IMRT using 10-MV X-rays, and 5.1% for IMRT using 18-MV X-rays.</p>\n<p>Conclusion: The risk of fatal secondary malignancy differed substantially between IMRT [intensity-modulated radiation therapy] and conventional radiation therapy for prostate cancer, as well as between different IMRT approaches. Perhaps this risk should be considered when choosing the optimal treatment technique and delivery system for patients who will undergo prostate radiation.</p>\n</blockquote>\n<p>Here, IMRT was shown to deliver a higher &quot;out-of-field&quot; dose (raditation to untargeted parts of the body) and had a greater associated risk of secondary malignancies than conventional radiation.</p>\n<blockquote>\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0360301608008158\" rel=\"nofollow noreferrer\"><strong>&quot;Risk of Developing Second Cancer From Neutron Dose in Proton Therapy as Function of Field Characteristics, Organ, and Patient Age.&quot; Jarlskog <em>et al.</em> <em>International Journal of Radiation Oncology Biology Physics. 2008.</em></strong></a></p>\n<p>Results: The main contributors (&gt;80%) to the neutron-induced risk are neutrons generated in the treatment head. Treatment volume can influence the risk by up to a factor of ∼2. Young patients are subject to significantly greater risks than are adult patients because of the geometric differences and age dependency of the risk models. Breast cancer should be the main concern for females. For males, the risks of lung cancer, leukemia, and thyroid cancer were significant for pediatric patients. In contrast, leukemia was the leading risk for an adult. Most lifetime risks were &lt;1% (70-Gy treatment). The only exceptions were breast, thyroid, and lung cancer for females. For female thyroid cancer, treatment risk can exceed baseline risk.</p>\n<p>Conclusion: The risk of developing a second malignancy from neutrons from proton beam therapy of a brain lesion is small (i.e., presumably outweighed by the therapeutic benefit) but not negligible (i.e., potentially greater than the baseline risk). The patient's age at treatment plays a major role.</p>\n</blockquote>\n<p>Like the IMRT, neutron bombardment from proton therapy was shown to have off-target effects and contribute to new cancers.</p>\n<p>Hopefully, these papers serve as decent representations of different secondary malignancy potentials with respect to primary cancer therapies. In the article <a href=\"https://www.nccn.org/patients/resources/life_after_cancer/understanding.aspx\" rel=\"nofollow noreferrer\">&quot;Understanding Your Risk of Developing Secondary Cancers,&quot;</a> the National Comprehensive Cancer Network reminds readers to prioritize their care without regard to comparatively low-probability secondary malignancies:</p>\n<blockquote>\n<p>...patients should not cause themselves undue worry about this possibility. &quot;The biggest risk to patients with cancer is the cancer that they are battling. They should follow the treatment plan designed by their oncologist and not worry about other factors. The vast majority of patients are not going to develop a secondary malignancy because of cancer treatment for the original cancer.&quot;</p>\n</blockquote>\n<p>Finally, some medical imaging techniques are similar to those cancer therapies that are more likely to cause secondary malignancies. The <a href=\"http://www.philrutherford.com/Radiation_Risk/BEIR/BEIR_VII.pdf\" rel=\"nofollow noreferrer\">BEIR VII report &quot;Health Risks from Exposure to Low Levels of Ionizing Radiation&quot;</a> includes risk estimates for different imaging and radiology techinques (although <a href=\"https://www.sciencedirect.com/science/article/pii/S1120179717302338\" rel=\"nofollow noreferrer\">some academic debate exists</a> on whether it's an appropriate estimation tool for this, the table below uses data from BEIR VII). Keep in mind that any amount of ionizing radiation is not good for your dividing cells!</p>\n<p><a href=\"https://i.stack.imgur.com/3MWRk.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3MWRk.png\" alt=\"BEIR VII Estimated Doses\" /></a></p>\n<p>(XR: x-ray; NM: nuclear medicine; CT: computerized tomography; IR: interventional radiology)</p>\n" }, { "answer_id": 17379, "author": "Chris", "author_id": 14056, "author_profile": "https://health.stackexchange.com/users/14056", "pm_score": 2, "selected": false, "text": "<p>This is a big topic and there is a huge amount of medical literature and research on the effectiveness of treatments and survival rates, so I will try to give a general overview and take a different slant to the other answer.</p>\n\n<p>Many factors affect recurrence rates, including the type of cancer, treatment, family history and the passage of time. Cancer is not just one disease but a very wide range of conditions, so it is hard to generalise.</p>\n\n<p>This can be considered from two aspects:</p>\n\n<ol>\n<li><p>Cancer that returns after treatment</p></li>\n<li><p>New cancers that develop separately from a previous one</p></li>\n</ol>\n\n<hr>\n\n<p><strong>Cancer that returns after treatment</strong></p>\n\n<p>Having one type of cancer does make you more likely to have a second cancer of that type in future, as it may suggest an underlying genetic or environmental susceptibility. For example, some people carry mutations of the <a href=\"https://en.m.wikipedia.org/wiki/BRCA1\" rel=\"nofollow noreferrer\">BRCA</a> genes that are linked with breast, ovarian and prostate cancers. If these gene mutations are present, there is an increased risk of several types of cancer (and probably a significant family history). Fundamentally, all cancers arise from damage or mutations to DNA. BRCA is normally involved in repair of DNA damage, so mutations that prevent this increase the likelihood of DNA damage causing a cancer.</p>\n\n<p>However, most times that cancer “comes back” are because it never went away fully in the first place. Even a single malignant cell escaping treatment can cause a recurrence some time later. This varies greatly on the type of cancer, grade (how aggressive the cancer is, tested by histology and <a href=\"https://en.m.wikipedia.org/wiki/Immunohistochemistry\" rel=\"nofollow noreferrer\">immunohistochemisty</a> for example) and stage (how far the cancer has spread, measured by imaging such as MRI). Here is a link to further explanations of <a href=\"https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-stages-and-grades-mean/\" rel=\"nofollow noreferrer\">grading and staging cancer</a>.</p>\n\n<p>Another source: <a href=\"https://www.cancerresearchuk.org/about-cancer/what-is-cancer/why-some-cancers-come-back\" rel=\"nofollow noreferrer\">Cancer Research UK - Why some cancers come back</a></p>\n\n<p>We do not have technology that can detect just a few malignant cells that might remain after treatment, which is why people are monitored for years post-treatment.</p>\n\n<p>This is where the term <em>cancer survivor</em> is a little misleading. There is actually an <a href=\"https://xkcd.com/931/\" rel=\"nofollow noreferrer\">XKCD cartoon</a> that has a good visual representation of this.</p>\n\n<hr>\n\n<p><strong>New cancers that develop separately</strong></p>\n\n<p>As mentioned above, certain genetic susceptibilities may mean someone with one type of cancer is more prone to another separate one at baseline. For example, someone who has breast cancer and a BRCA mutation is at increased risk of ovarian cancer as well.</p>\n\n<p>I was going to talk about the carcinogenic effects of treatments like radiotherapy and chemotherapy and the risk of cancer arising solely due to these treatments, but this has been covered excellently in the answer by Bruce. If that was the intended focus of the question you should definitely accept that answer :)</p>\n\n<p>Source: <a href=\"https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/second-cancers-after-breast-cancer.html\" rel=\"nofollow noreferrer\">Second cancers after breast cancer</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17384", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11826/" ]

[ { "answer_id": 17449, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 3, "selected": false, "text": "<p>There is not enough evidence either in support or in rebuttal...</p>\n\n<blockquote>\n <p>EFFECTS OF CHRONIC OR REPEATED EXPOSURE:<br>\n Nicotine is a teratogen (capable of causing birth defects). Other developmental toxicity or reproductive toxicity risks are unknown. The information about nicotine as a carcinogen is inconclusive.</p>\n \n <p>^{<a href=\"https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750028.html\" rel=\"nofollow noreferrer\">cdc.gov</a>}</p>\n \n <p>In summary, the findings of animal studies do not support the hypothesis that nicotine is a complete carcinogen. It is a tumor promoter in some experimental models, although not for tobacco-specific nitrosamines. Studies examining other classes of tobacco smoke carcinogens (e.g., polycyclic aromatic hydrocarbons) would need to be performed to better define the potential cancer risk inferred from animal studies. </p>\n \n <p><em>[...]</em></p>\n \n <p>There is insufficient data to conclude that nicotine causes or contributes to cancer in humans, but there is evidence showing possible oral, esophageal, or pancreatic cancer risks. Additionally, there is substantial experimental evidence indicating that nicotine is bioactive for a number of carcinogenic mechanisms in experimental systems. Although in vitro data are suggestive of relevant biological activity, this is not supported overall by the most recent experimental animal studies. In humans, there has been limited research and only one relatively short–term follow-up study on nicotine and cancer.</p>\n \n <p>_{Surgeongeneral.gov, <a href=\"https://www.surgeongeneral.gov/library/reports/50-years-of-progress/sgr50-chap-5.pdf\" rel=\"nofollow noreferrer\">Chapter 5 Nicotine</a> (PDF)}</p>\n</blockquote>\n" }, { "answer_id": 17454, "author": "viuser", "author_id": 11471, "author_profile": "https://health.stackexchange.com/users/11471", "pm_score": 1, "selected": false, "text": "<p>I'd want to add to Narusan's answer the following: While nicotine by itself doesn't seem to be a carcinogen, to some degree it <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783463/\" rel=\"nofollow noreferrer\">may be converted</a> to carcinogenic N-nitrosonornicotine (a tobacco-specific nitrosamine) in the body, for example by bacterial activity. How much depends, among other things, on the route of administration.</p>\n\n<blockquote>\n <p>If Nicotine causes cancer, then as Potato or Tomatoes contain Nicotine according to the studies above, they would surely cause cancer as well.</p>\n</blockquote>\n\n<p>Even if that <em>were</em> (!) true, so what? In the probabilistic model of epidemiology “cause” is <strong>not</strong> like the ‘everyday’ conception of cause.</p>\n\n<p>For example, the classification is by the strength of evidence, not the degree of risk. That's why we hear something <a href=\"https://www.theguardian.com/society/2015/oct/26/bacon-ham-sausages-processed-meats-cancer-risk-smoking-says-who\" rel=\"nofollow noreferrer\">like this</a>:</p>\n\n<blockquote>\n <p>Bacon, ham and sausages rank alongside cigarettes as a major cause of cancer, the World Health Organisation has said, placing cured and processed meats in the same category as asbestos, alcohol, arsenic and tobacco.</p>\n</blockquote>\n\n<p>Therefore, I don't see a <em>reductio ad absurdum</em>.</p>\n\n<p>On a more serious note, even with eggplants you'd have to eat 10 kg to get to the level of a single cigarette.</p>\n\n<p>But that's not even why your reasoning is fallacious. It's wrong, like with the <a href=\"https://www.reuters.com/article/us-california-lawsuit-coffee/cancer-warnings-to-be-served-up-with-coffee-in-california-idUSKBN1I930H\" rel=\"nofollow noreferrer\">coffee cancer warnings</a> in California, to not consider the <em>whole</em> product (vegetable/fruit/…). <strong>You have to balance the carcinogens vs. the antioxidants and anticancer agents.</strong></p>\n" }, { "answer_id": 17456, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 3, "selected": true, "text": "<p>It is a common way to demonise substances in saying that they \"cause cancer\". In the case of recreational or habitual tobacco smoking there is no longer much debate over whether that is true or not. \"Smoking causes cancer\" is a commonly accepted fact now.</p>\n\n<p>But what exactly causes cancer within this model? Smoke from a cigarette is a mixture of evaporated plant material, pyrolised material, burnt paper etc. Quite a lot of substances in differing mixtures. An exact explanation of cause and effect for each \"ingredient\" of smoke is much more difficult than a relatively simple epidemiological correlation and conclusion or even a lab experiment with copious amounts of smoke.</p>\n\n<p>For nicotine ioslated and on itself it has recently been said that:</p>\n\n<blockquote>\n <ul>\n <li>In small doses, nicotine speeds up cell growth. In larger doses, it’s poisonous to cells.</li>\n <li>Nicotine kick-starts a process called epithelial-mesenchymal transition (EMT). EMT is one of the important steps in the path toward malignant cell growth.</li>\n <li>Nicotine decreases the tumor suppressor CHK2. This may allow nicotine to overcome one of the body’s natural defenses against cancer.</li>\n <li>Nicotine can abnormally speed up the growth of new cells. This has been shown in tumor cells in the breast, colon, and lung.</li>\n <li>Nicotine can lower the effectiveness of cancer treatment.</li>\n </ul>\n \n <p>via <a href=\"https://www.healthline.com/health/does-nicotine-cause-cancer#nicotine-and-cancer\" rel=\"nofollow noreferrer\">Healthline</a></p>\n</blockquote>\n\n<p>That can be criticised on numerous grounds. Whether a substance interferes with cancer treatments is wholly irrelevant to the question whether the substances causes it.<br>\nAssertions like these without the numbers, for example dose-response, effect sizes etc. I tend to either follow up to their sources or just ignore them altogether.</p>\n\n<p>In this case the source is </p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/\" rel=\"nofollow noreferrer\">Tore Sanner &amp; Tom K. Grimsrud: \"Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment – A Review\", Frontiers in Oncology. 2015; 5: 196</a>. PMID 26380225 DOI 10.3389/fonc.2015.00196</p>\n</blockquote>\n\n<p>In there all of the points above quoted by healthline are present. Any yet they have to hide a caveat in the middle of the conclusion part:</p>\n\n<blockquote>\n <p>At present, it is not possible to draw a conclusion whether nicotine itself may act as a complete carcinogen.</p>\n</blockquote>\n\n<p>The demonisation of just nicotine seems to be mostly twofold, if we substract all the annoyances from smoking tobacco: habit or even addiction forming and limited amount of joy.</p>\n\n<p>If we look just at the substance alone, and exclude smoking or vaping or liquid-preparation inhalation, what is left?</p>\n\n<p>A practical outlook would be to examine nicotine replacement therapy.</p>\n\n<blockquote>\n <p><a href=\"https://link.springer.com/article/10.1007/s00204-016-1856-y\" rel=\"nofollow noreferrer\">Peter N. Lee &amp; Marc W. Fariss: \"A systematic review of possible serious adverse health effects of nicotine replacement therapy\", Archives of Toxicology (2017) 91:1565–1594</a>:</p>\n \n <p>We conducted a systematic literature review to identify and critically evaluate studies of serious adverse health effects (SAHEs) in humans using nicotine replacement therapy (NRT) products. Serious adverse health effects refer to adverse events, leading to substantial dis- ruption of the ability to conduct normal life functions. Strength of evidence evaluations and conclusions were also determined for the identified SAHEs. We evaluated 34 epidemiological studies and clinical trials, relating NRT use to cancer, reproduction/development, CVD, stroke and/or other SAHEs in patients, and four meta-analyses on effects in healthy populations. The overall evidence suffers from many limitations, the most significant being the short-term exposure (≤12 weeks) and follow-up to NRT product use in most of the studies, the common failure to account for changes in smoking behaviour following NRT use, and the sparse information on SAHEs by type of NRT product used. The only SAHE from NRT exposure we identified was an increase in respiratory congenital abnormalities reported in one study. Limited evidence indicated a lack of effect between NRT exposure and SAHEs for CVD and various reproduction/developmental endpoints. <strong>For cancer, stroke and other SAHEs, the evidence was inadequate to demonstrate any association with NRT use</strong>. Our conclusions agree with recent statements from authoritative bodies.</p>\n</blockquote>\n\n<p>Although we cannot categorically exclude the possibility that nicotine alone is a cancer causing or a cancer promoting agent with 100% certainty, we might conclude that the low level of serious adverse health effects from psychotropically effective doses in nicotine replacement therapy are a good indicator for the general safety of the <a href=\"https://medicalsciences.stackexchange.com/questions/10993/how-much-nicotine-is-in-tea-and-vegetables\">miniscule levels of nicotine</a> found in tomatoes, potatoes and even the egregious eggplant.</p>\n\n<p>Conflicts of interest:\nThis answer does not promote or advertise or justify the use of nicotine in any way. It does call for a sober evaluation of its properties. It also does promote and advertise the ingestion of vegetables disregarding the amount of nicotine in them completely.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17446", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7951/" ]

[ { "answer_id": 17526, "author": "user6131", "author_id": 14796, "author_profile": "https://health.stackexchange.com/users/14796", "pm_score": -1, "selected": false, "text": "<p>As far as I know Babesiosis is very similar to Paludism. The main parasite in the US, Babesiosis Microti, is supposed to be less agressive than Paludism agents. This is however quite insure with Babesia Divergent. The main parasite in Europe. There are way less reported cases in Europe and these are way more severe. However this could be because mild cases are ignored since the disease is rare in Europe.</p>\n\n<p>Symptoms vary from nothing to repetitive severe flu like syndrome that can last a few weeks. The most severe - life threatening - cases are observed with asplenic and immunodepressed patients. The parasite attacks red blood cells and can, if in great numbers, cause anemia. </p>\n\n<p>This type of flu like symptoms are more likely to be confused with a chronic fatigue syndrome than a Fibromyalgia. The main reason is that fatigue is generally more important than pain. The other is that it is not constant but relapsing.</p>\n\n<p>However some Lyme doctors do not think the same way. But I did not find any evidence.</p>\n" }, { "answer_id": 17529, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>Here's a brief description of tests for babesiosis (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12804380\" rel=\"nofollow noreferrer\">PubMed, 2003</a>):</p>\n\n<blockquote>\n <p>A CBC [Complete Blood Count] is a useful screening test since anemia and thrombocytopenia are\n commonly observed and parasites may be visualized on blood smear.\n Conclusive diagnosis of this disease generally depends upon\n microscopic examination of thin blood smears. Babesia frequently are\n overlooked, however, because parasitemia tends to be sparse, often\n infecting fewer than 1% of erythrocytes early in the course of the\n illness. Identification of amplifiable babesial DNA by polymerase\n chain reaction (PCR) has comparable sensitivity and specificity to\n microscopic analysis of thin blood smear for detection of babesia in\n blood. Serologic testing provides useful supplementary evidence of\n infection because a robust antibody response characterizes human\n babesial infection, even at the time that parasitemia first becomes\n detectable.</p>\n</blockquote>\n\n<p>There are many other conditions with musculoskeletal pain and fatigue that can be confused with fibromyalgia (various types of arthritis, myositis, etc.).</p>\n\n<p>There is no laboratory test for fibromyalgia, so a diagnosis is by exclusion of other conditions (<a href=\"https://www.niams.nih.gov/health-topics/fibromyalgia#tab-diagnosis\" rel=\"nofollow noreferrer\">niams.nih.gov</a>). </p>\n" } ]

[ "https://health.stackexchange.com/questions/17524", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14796/" ]

[ { "answer_id": 17548, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 3, "selected": false, "text": "<blockquote>\n<p>To date, there has been no randomized clinical trial of low‐volume alcohol consumption that has assessed any mortality outcome. Therefore, the literature about the mortality effects of alcohol consumption consists entirely of observational studies.</p>\n<p>^{Source: Naimi, Timothy S. et al. <strong><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/add.13451\" rel=\"noreferrer\">Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality. Addiction</a></strong>. Volume 112, Issue 2, February 2017, p. 207-214}</p>\n</blockquote>\n<p>This is important to note. All studies, including the ones cited by me and LangLangC, are observational meta-analyses. They take census data and data from other studies and do some statistical calculations with that. Those are accurate, but it is tricky to avoid selection biases, and without a clinical trial, one can only show correlation and not causation. Even with double-blind randomly controlled trials (RCTs), one can run into biases and common factors that fake causation.</p>\n<p>As an example for this case: Maybe most 'moderate' drinkers are wealthy (they can afford a bit of alcohol and upper-class drinking, but are well-educated enough not to become addicts) and thus have more access to health services, hence decreasing their morbidity in comparison to other groups. This doesn't mean that drinking moderately is healthy, but that being wealthy is healthy.</p>\n<p>With that being said:</p>\n<h2>Yes, it has been disproven</h2>\n<p>A recent article published in The Lancet which is the largest meta analysis to date has a very comprehensive overview of risks associated with moderate to high-level drinking. The J-curve only exists for very few hand-picked risks:</p>\n<p><a href=\"https://i.stack.imgur.com/nnihB.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/nnihB.jpg\" alt=\"enter image description here\" /></a></p>\n<p>While small amounts of alcohol might decrease the risk of ischaemic heart diseases and diabetes, the cumulative risk is increasing for every quantity of alcohol consumed.</p>\n<p>In a sense, it doesn't help you if you are at half the risk of dying from a heart attack when the risk of having a seizure is tripled (greatly simplified).\n<a href=\"https://i.stack.imgur.com/GevRJ.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/GevRJ.jpg\" alt=\"\" /></a></p>\n<p>The study itself is quite comprehensive and not that difficult to understand, so I highly recommend a read-through. It has been covered by most newspapers as well, but not all news coverage was accurate.</p>\n<blockquote>\n<p>Griswold, Max G, et al. “<strong><a href=\"https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2\" rel=\"noreferrer\">Alcohol Use and Burden for 195 Countries and Territories, 1990–2016: a Systematic Analysis for the Global Burden of Disease Study 2016.</a></strong>” The Lancet, vol. 392, no. 10152, 2018, pp. 1015–1035.</p>\n</blockquote>\n<p>This is even more convincing as there seems to be a selection bias favouring 'moderate' drinkers.</p>\n<blockquote>\n<p>After reviewing the possible sources of selection bias in observational studies about the relationship between low‐volume alcohol consumption and mortality, <strong>selection bias is another reason to suggest that existing research may overestimate protective effects systematically from ‘moderate’ alcohol consumption.</strong> There are a number of sources of selection bias inherent in comparing established low‐volume drinkers with non‐drinkers. Low‐volume drinkers who are enrolled into studies constitute a particular group of drinkers who chose to begin drinking, tolerated or enjoyed its effects, did not die prior to study enrollment, did not become heavy drinkers, did not stop drinking and were of sufficient physical and mental capacity to be enrolled into studies several decades after drinking initiation. <strong>Overall, most sources of selection bias favour low‐volume drinkers in relation to non‐drinkers.</strong> Studies that attempt to address these types of bias generally find attenuated or non‐significant relationships between low‐volume alcohol consumption and cardiovascular disease, which is the major source of possible protective effects on mortality. <strong>Furthermore, observed mortality effects among established low‐volume drinkers are of limited relevance to health‐related decisions about whether to begin drinking or whether to continue drinking purposefully into old age.</strong></p>\n<p>^{Source: Naimi, Timothy S. et al. <strong><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/add.13451\" rel=\"noreferrer\">Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality. Addiction</a></strong>. Volume 112, Issue 2, February 2017, p. 207-214}</p>\n</blockquote>\n<hr />\n<h2>Discussion</h2>\n<p>Prompted by LangLangC's excellent answer, I wanted to expand my answer a bit. The study I cited mainly proves that the relative risk is monotonic increasing: At no level of alcohol consumption, the overall relative risk is smaller than at any previous level. The J-shaped curve does exist for a few risks (mainly associated with cardiovascular diseases).</p>\n<p>What conclusions should one draw from this?</p>\n<ul>\n<li>Shifting from 1 standard drink to 0 standard drinks does not seem all too sensible, one does not gain a significant decrease of relative risk but does loose some quality of life</li>\n<li><strong>Shifting from 0 standard drinks to 1 standard drink also doesn't seem sensible, as one does not gain a significant increase of relative risk either</strong>.</li>\n</ul>\n<p>The second implication needs to be true in order for the J-curve claim to be valid, and hence I consider it disproven.</p>\n" }, { "answer_id": 18331, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 3, "selected": false, "text": "<p>No. \"The J-curve\" was not recently disproven, but the evidence for it slightly\nmodified. The correlational observation is still that no and low amounts of drinking do not have seriously negative health outcomes associated with them.</p>\n\n<p>What has changed is what conclusions campaigners for \"zero alcohol\" draw from that evidence.</p>\n\n<p>We do not have any evidence that any intervention on that level has positive consequences: either recommendations of moving from zero to one or from two to zero seems to not be founded on firm evidence. Only going lower from high is.</p>\n\n<hr>\n\n<p>It seems to depend on the way the observational, epidemiological and correlational data is used. That is: how the data is gathered, analysed and interpreted. And how puritan the belief systems of the researchers are.</p>\n\n<p>Drinking large amounts of alcohol is bad. Doing that daily is bad.\nA relative recent study amassed a huge dataset and concluded that the only safe amount of alcohol is zero. This got even published in The Lancet as </p>\n\n<blockquote>\n <p><a href=\"https://doi.org/10.1016/S0140-6736(18)31310-2\" rel=\"nofollow noreferrer\">\"Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016\"</a> </p>\n</blockquote>\n\n<p>The key findings are communicated in the extreme, globally, and badly:</p>\n\n<blockquote>\n <p>Analysing data from 15 to 95-year-olds, the researchers compared people who did not drink at all with those who had one alcoholic drink a day.<br>\n They found that out of 100,000 non-drinkers, 914 would develop an alcohol-related health problem such as cancer or suffer an injury.<br>\n But an extra four people would be affected if they drank one alcoholic drink a day.<br>\n For people who had two alcoholic drinks a day, 63 more developed a condition within a year and for those who consumed five drinks every day, there was an increase of 338 people, who developed a health problem.</p>\n</blockquote>\n\n<p>That is from a baseline of 914 problems in 100000 people an increase to 918 people in 100000 for one drink a day. As one can see, problems usually related to alcohol develop in 914 non-drinkers already or as well and one drink a day means trouble for an additional 4 people.</p>\n\n<p>Is much or not? If that is difficult to picture mentally, The Lancet provides you the service of a picture that gets overlooked in the sensationalist press:</p>\n\n<blockquote>\n <p><a href=\"https://i.stack.imgur.com/PGMyk.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/PGMyk.jpg\" alt=\"enter image description here\"></a></p>\n</blockquote>\n\n<p>The relative risk increase – in a study that claims zero is the only safe level – for one drink per day is effectively zero as well.</p>\n\n<p>This study aims at scare mongering and has to admit that </p>\n\n<blockquote>\n <p>Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. </p>\n</blockquote>\n\n<p>This study still does not challenge \"moderate alcohol consumption may be preventive for some conditions such as ischaemic heart disease and diabetes\" but looks at the effects associated with each individual health outcome together with level of alcohol consumption. When those inferences are then combined into an aggregate according to the author's model we arrive at the picture above.</p>\n\n<blockquote>\n <p>Specifically, comparing no drinks with one drink a day the risk of developing one of the 23 alcohol-related health problems was 0.5% higher — meaning 914 in 100,000 15–95 year olds would develop a condition in one year if they did not drink, but 918 people in 100,000 who drank one alcoholic drink a day would develop an alcohol-related health problem in a year. </p>\n \n <p>This increased to 7% in people who drank two drinks a day (for one year, 977 people in 100,000 who drank two alcoholic drinks a day would develop an alcohol-related health problem) and 37% in people who drank five drinks every day (for one year, 1252 people in 100,000 who drank five alcoholic drinks a day would develop an alcohol-related health problem).</p>\n</blockquote>\n\n<p>How do experts judge this data? </p>\n\n<blockquote>\n <p><a href=\"http://www.sciencemediacentre.org/expert-reaction-to-systematic-analysis-of-the-health-impacts-of-alcohol/\" rel=\"nofollow noreferrer\">David Spiegelhalter, Winton Professor for the Public Understanding of Risk at the University of Cambridge, said</a>:</p>\n \n <p>“According to data provided by the authors but not published in the paper, to suffer one extra alcohol-related health problem, around 1,600 people would need to drink two drinks totalling 20g (2.5 units) of alcohol a day for a year. This is equivalent to around 32 standard 70cl bottles of gin over a year, so a total of 50,000 bottles of gin among these 1,600 people is associated with one extra health problem. <strong>This indicates a very low level of harm in moderate drinkers, and suggests UK guidelines of an average of 16g a day (2 units) are very low-risk indeed.</strong></p>\n \n <p>“Given the pleasure presumably associated with moderate drinking, claiming there is no ‘safe’ level does not seem an argument for abstention. There is no safe level of driving, but government do not recommend that people avoid driving. Come to think of it, there is no safe level of living, but nobody would recommend abstention.”</p>\n</blockquote>\n\n<p>This same year another Lancet paper tried to tackle the problem:</p>\n\n<blockquote>\n <p><a href=\"https://doi.org/10.1016/S0140-6736(18)30134-X\" rel=\"nofollow noreferrer\">Angela M Wood et al.: \"Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies\", Volume 391, Issue 10129, p1513-1523, April 14, 2018</a><br>\n Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.<br>\n <strong>In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week.</strong> For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.</p>\n</blockquote>\n\n<p>Again, a call \"to lower guidelines\". Despite the result that for some outcomes the lowest risk was <em>not</em> \"zero drinks\" but that the relative risk increases, clearly, if you go below 100g of pure alcohol a week! </p>\n\n<blockquote>\n <p>From the <a href=\"https://www.thelancet.com/cms/10.1016/S0140-6736(18)30134-X/attachment/5b9e9977-5741-4caf-9ab1-ab873eef63fc/mmc1.pdf\" rel=\"nofollow noreferrer\">supplementary material</a>: (click to enlarge)<br>\n <a href=\"https://i.stack.imgur.com/Qc0U2.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Qc0U2s.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/H4bV0.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/H4bV0s.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/UUzrf.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/UUzrfs.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/wZ6T8.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/wZ6T8s.png\" alt=\"enter image description here\"></a></p>\n</blockquote>\n\n<p>Do these numbers really suggest that not drinking alcohol – either never or even worse to quit drining – is to be seen as a potential risk factor? The huge difference between never-drinkers and ex-drinkers might spoil that party a bit. An equally plausible explanation for that is that dislike for alcohol might be a sign for already frail or future health problems. </p>\n\n<h1>Summary</h1>\n\n<p>The vast majority of findings show that moderate drinking (definitions of that may vary as much as does individual tolerance) is associated with a low risk and that there is an ultimately unexplained correlation between drinking a bit and slightly longer life expectancy. The <a href=\"https://en.wikipedia.org/wiki/French_paradox\" rel=\"nofollow noreferrer\">French Paradox</a> keeps on giving.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17546", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6604/" ]

[ { "answer_id": 24388, "author": "Sikander", "author_id": 15514, "author_profile": "https://health.stackexchange.com/users/15514", "pm_score": 2, "selected": false, "text": "<blockquote>\n<p>Although ACCP recommends 7- to 10-day aspirin intake cessation before surgery in patients with low cardiovascular risk, the results of our study suggest that aspirin intake cessation not longer than 96 hours can be adequate.</p>\n</blockquote>\n<blockquote>\n<p>The recommendation to stop aspirin intake for 7 to 10 days is based only on the concern for the mature platelets during exposure to aspirin.</p>\n</blockquote>\n<p>Source: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/#!po=66.9355\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008770/#!po=66.9355</a>.</p>\n<p>There are some mechanisms that may modulate the antiplatelet effects in the presence of aspirin and after aspirin cessation:-</p>\n<ol>\n<li><p>Immature platelets, which are reticulated and larger, have less attenuated and more elevated platelet activity than mature platelets in the presence of aspirin. Moreover, the inhibition of human megakaryocyte cyclooxygenase with low doses of aspirin is incomplete, and megakaryocyte cyclooxygenase seems to recover within 12 hours after aspirin ingestion.</p>\n</li>\n<li><p>Interruption of the platelet function by aspirin results in the production of new platelets, presumably through the action of a feedback system controlling thrombocytopoiesis. These newly formed platelets may help in speedy recovery of the platelet activity.</p>\n</li>\n</ol>\n<p>These mechanisms above are responsible for speedy recovery of platelet activity before the average lifespan of platelets.</p>\n<p>The concern for mature platelets (as I have mentioned in the quotation box) can also be applied to individuals before platelet donation i.e to wait for average lifetime of platelets which is 7-10 days (the duration which you are backing up in your question, without any reference, at least for me) before donation. Otherwise, according to <a href=\"http://apps.who.int/iris/bitstream/10665/76724/1/9789241548519_eng.pdf?ua=1\" rel=\"nofollow noreferrer\">who</a> guidelines one must defer from donating blood 5 days after taking aspirin and 48 hrs after taking other NSAIDS (The blood bank nearby me defer from donating for 3 days).</p>\n" }, { "answer_id": 30580, "author": "melvio", "author_id": 23654, "author_profile": "https://health.stackexchange.com/users/23654", "pm_score": 2, "selected": false, "text": "<p>For this answer, I'll assume that with <em>“anti-inflammatory pills”</em> we're exclusively talking about NSAIDs.</p>\n<p>In summary, I see multiple reasons why donors have to wait a few days after taking NSAIDs. In summary:</p>\n<ol>\n<li>To get fresh platelets into their blood</li>\n<li>To decrease the odds of inadvertently transmitting a masked infection</li>\n<li>To prevent directly transmitting NSAIDs to the patient.</li>\n</ol>\n<h5>1. Platelets</h5>\n<p>Aspirin inhibits platelet activation by <em>irreversibly</em> acetylating their COX enzymes[1]. The average lifespan of a platelet indeed is around 8-10 days[1]. However, let's say you take aspirin once on day 1, then you'll be inhibiting young and old platelets alike. On day 4-5, about half of those inhibited platelets will have been replaced by new and uninhibited platelets.</p>\n<h5>2. Infection Transmission</h5>\n<p>Infections often present with fever, pains/discomfort, and 'feeling sick'. NSAIDs are analgesic and antipyretic,\nso NSAIDs could theoretically 'mask' an infection. Given the myriads of possible incubation periods and contagion durations of infections, mandating a waiting period can be used as a general method to reduce the risk of transmitting a 'hidden' pathogen.</p>\n<h5>3. Plasma Contamination</h5>\n<p>NSAIDs are capable of providing some incredibly dangerous side effect.\nFor example, Stevens-Johnson syndrome, toxic epidermal necrolysis can be caused by NSAIDs[2]. These side effects are rare, but they can be deadly.<br />\nMoreover, birth defects can result from taking NSAIDs during the pregnancy[2].\nWaiting 8 days should be sufficient to 'wash out' NSAIDs from the donor's plasma in most cases, even for those with longer half lives (e.g. Etoricoxib has a half-life of about 22 hours[3])</p>\n<hr />\n<p>[1] Rang and Dale, ISBN-13: 978-1-4377-1933-8, Chapter 26: Anti-inflammatory and immunosuppressant drugs<br />\n[2] <a href=\"https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/i/ibuprofen__systemisch\" rel=\"nofollow noreferrer\">https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/i/ibuprofen__systemisch</a>_<br />\n[3] DOI: 10.1345/aph.1E543, PMID: 15827069</p>\n" } ]

[ "https://health.stackexchange.com/questions/17575", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11458/" ]

[ { "answer_id": 17632, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 3, "selected": false, "text": "<p>I share your feelings about gallbladder removal being barbaric.</p>\n\n<p>Here is some reasoning why most gallbladder conditions are treated by gallbladder removal.</p>\n\n<ol>\n<li>Alternative treatments, such as <strong>gallstone dissolution</strong> with ursodeoxycholic acid is effective only for <strong>small gallstones (&lt;0.5 cm);</strong> also, after discontinuation of treatment, the stones often reappear (<a href=\"https://emedicine.medscape.com/article/175667-treatment#showall\" rel=\"nofollow noreferrer\">Emedicine</a>).</li>\n<li>Making a cut in the gallbladder and removing gallstones is a major risk for a serious abdominal infection (peritonitis), which can occur even after gallbladder removal (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464996/\" rel=\"nofollow noreferrer\">PubMed</a>). This is especially critical in <strong>acute gallbladder inflammation.</strong></li>\n<li><strong>Chronic gallbladder inflammation</strong> can cause pain and gallbladder removal is pretty much the only known treatment (<a href=\"https://medlineplus.gov/ency/article/000217.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>).</li>\n<li>To effectively treat <strong>gallbladder cancer,</strong> you typically need to remove some tissue around it (safe margin) and this is most reliably done by removing the gallbladder.</li>\n</ol>\n\n<p>It is true that about 1/3 of people, after gallbladder removal, will have long-term problems with diarrhea, but this is due to irritation by large amounts of bile that constantly flows from the liver to the intestine and not due to fat maldigestion (<a href=\"https://www.mayoclinic.org/tests-procedures/cholecystectomy/expert-answers/gallbladder-removal/faq-20058481\" rel=\"nofollow noreferrer\">Mayo Clinic</a>). Many people will have no symptoms.</p>\n\n<p>If the origin of pain is in the gallbladder, the pain should disappear after gallbladder removal. The pain that persists after the removal usually arises from the <em>bile ducts</em> that stay in the body, for example, due to stones in the bile ducts or sphincter of Oddi dysfunction.</p>\n\n<p>In elderly or severely ill individuals, who are not fit enough to undergo gallbladder removal, drainage of the gallbladder can be performed as a palliative measure with a temporary effect (<a href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0058062/\" rel=\"nofollow noreferrer\">PubMed Health</a>). </p>\n" }, { "answer_id": 17707, "author": "kit", "author_id": 14957, "author_profile": "https://health.stackexchange.com/users/14957", "pm_score": 2, "selected": false, "text": "<p>Simple answer. \"Once a stone former, always a stone former\"</p>\n\n<p>\"Gallstones recur in about 50% of patients, and that the risk of recurrence is confined mainly to the first 5 years after dissolution.\" Hence, we remove them</p>\n\n<p>Source:</p>\n\n<p>Management of recurrent gallstones.\nReview article\nLanzini A, et al. Baillieres Clin Gastroenterol. 1992</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/1486214/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/m/pubmed/1486214/</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17630", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7949/" ]

[ { "answer_id": 17704, "author": "kit", "author_id": 14957, "author_profile": "https://health.stackexchange.com/users/14957", "pm_score": 4, "selected": true, "text": "<blockquote>\n <p>The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects</p>\n</blockquote>\n\n<p><strong>Source:</strong><br>\nGruenwald, I., Appel, B., Kitrey, N. D., &amp; Vardi, Y. (2013). Shockwave treatment of erectile dysfunction. <em>Therapeutic Advances in Urology</em>, 5(2), 95–99. doi: <a href=\"https://doi.org/10.1177/1756287212470696\" rel=\"nofollow noreferrer\">10.1177/1756287212470696</a></p>\n\n<p>Also available from NCBI <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607492/\" rel=\"nofollow noreferrer\">here</a>.</p>\n\n<p>P.S. personal advice: don't trust Facebook articles unless they are linked to reliable sources (e.g. .org, .gov, etc)</p>\n" }, { "answer_id": 18651, "author": "EDtreatment", "author_id": 13942, "author_profile": "https://health.stackexchange.com/users/13942", "pm_score": 2, "selected": false, "text": "<p>The research on this topic is a little mixed, but a new study[1] published in January 2019 reviewed almost 40 previous studies, and concluded the shockwave therapy significantly improves erectile function in patients with vasculogenic ED.</p>\n\n<p>One problem remains, however. The is an external treatment, which in most countries means it does not need government approval; therefore, the government mandated trials have not been done.</p>\n\n<p>Those trials determine the safety and effectiveness of a treatment, but they also establish treatment protocols. Without those studies, each doctor or clinic may determining their own protocols, and they may not be as effective as treatments administered in peer-reviewed studies.</p>\n\n<p>My current recommendation would be, check it out, but use caution.</p>\n\n<p>[1] Sokolakis, Ioannis; Hatzichristodoulou, Georgios. “Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.” International Journal of Impotence Research. Jan 2019.\n<a href=\"https://www.nature.com/articles/s41443-019-0117-z\" rel=\"nofollow noreferrer\">https://www.nature.com/articles/s41443-019-0117-z</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17653", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14908/" ]

[ { "answer_id": 17704, "author": "kit", "author_id": 14957, "author_profile": "https://health.stackexchange.com/users/14957", "pm_score": 4, "selected": true, "text": "<blockquote>\n <p>The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects</p>\n</blockquote>\n\n<p><strong>Source:</strong><br>\nGruenwald, I., Appel, B., Kitrey, N. D., &amp; Vardi, Y. (2013). Shockwave treatment of erectile dysfunction. <em>Therapeutic Advances in Urology</em>, 5(2), 95–99. doi: <a href=\"https://doi.org/10.1177/1756287212470696\" rel=\"nofollow noreferrer\">10.1177/1756287212470696</a></p>\n\n<p>Also available from NCBI <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607492/\" rel=\"nofollow noreferrer\">here</a>.</p>\n\n<p>P.S. personal advice: don't trust Facebook articles unless they are linked to reliable sources (e.g. .org, .gov, etc)</p>\n" }, { "answer_id": 18651, "author": "EDtreatment", "author_id": 13942, "author_profile": "https://health.stackexchange.com/users/13942", "pm_score": 2, "selected": false, "text": "<p>The research on this topic is a little mixed, but a new study[1] published in January 2019 reviewed almost 40 previous studies, and concluded the shockwave therapy significantly improves erectile function in patients with vasculogenic ED.</p>\n\n<p>One problem remains, however. The is an external treatment, which in most countries means it does not need government approval; therefore, the government mandated trials have not been done.</p>\n\n<p>Those trials determine the safety and effectiveness of a treatment, but they also establish treatment protocols. Without those studies, each doctor or clinic may determining their own protocols, and they may not be as effective as treatments administered in peer-reviewed studies.</p>\n\n<p>My current recommendation would be, check it out, but use caution.</p>\n\n<p>[1] Sokolakis, Ioannis; Hatzichristodoulou, Georgios. “Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.” International Journal of Impotence Research. Jan 2019.\n<a href=\"https://www.nature.com/articles/s41443-019-0117-z\" rel=\"nofollow noreferrer\">https://www.nature.com/articles/s41443-019-0117-z</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17674", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14932/" ]

[ { "answer_id": 17685, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 4, "selected": true, "text": "<p>The FDA regulates manufacturers of drugs, not physicians, with respect to the drug approval process.</p>\n\n<p>US law does not prevent physicians from prescribing unapproved substances (presuming they aren't illegal for some other reason), as long as it is not done for unapproved research.</p>\n\n<p>That said, physicians may be restricted by local laws, professional organizations, their employers, and exposures to liability. It also isn't legal for a manufacturer to market an unapproved drug in the US, so simply obtaining an unapproved drug may be difficult.</p>\n\n<p>For Solian, for example, it is marketed and approved in Europe, but the manufacturer isn't going to ship any to the US (doing so would likely run afoul of the FDA), no pharmacy is going to stock it, etc, so having a prescription won't do much good, and anyone who <em>would</em> be willing to ship it probably would not care whether or not you have a prescription in the first place. Therefore, a physician wouldn't have much purpose in writing a prescription for it rather than one of several similar drugs available in the US.</p>\n" }, { "answer_id": 17688, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>@BryanKrause's answer is correct. To add a little more, rules and regulations for physicians are primarily set by the state medical board and state legislature. States are different in the particulars, but you can make some general statements. <a href=\"https://www.fsmb.org/globalassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf\" rel=\"noreferrer\">Generally</a>, if the treatment is intended to benefit the individual patient, there is informed consent (the unapproved status of the drug is discussed with the patient), and the physician can point to a sound scientific basis for choosing that particular drug, and everything is appropriately documented, there shouldn't be a license issue. There may be a liability risk, though. Personally, I'd be uncomfortable doing it without a compelling reason. </p>\n\n<p>The specific drug will make a difference. If it is illegal or has been pulled from the US market or denied approval due to safety concerns, I don't think a conscientious and professional US physician would recommend it. Regarding solian, an atypical antipsychotic, with <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164462/\" rel=\"noreferrer\">good evidence</a> of safety and efficacy, I'm not a psychiatrist, but I could see a possible case where a patient is stable on solian. Here, the psychiatrist <em>might</em> recommend <em>continuing</em> solian, IF the patient has access and is able to purchase the drug from a reliable source with good quality controls. These are major challenges, though. I don't think being able to purchase it on the internet would necessarily satisfy them. Given so many approved atypical antipsychotics, though, I would have a hard time imagining a case where a US psychiatrist would start a patient on solian. </p>\n" } ]

[ "https://health.stackexchange.com/questions/17681", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6786/" ]

[ { "answer_id": 17714, "author": "DoctorWhom", "author_id": 6776, "author_profile": "https://health.stackexchange.com/users/6776", "pm_score": 4, "selected": true, "text": "<p>ACEI work on the renin–angiotensin–aldosterone system (<a href=\"http://ukrocharity.org/kidney-disease/the-renin-angiotensin-system-and-blood-pressure-control/\" rel=\"noreferrer\">RAAS</a>) whereas Ca++ blockers primarily work on cardiac contractility, HR, and vessel constriction.</p>\n<p>For the ACE-Inhibitor:</p>\n<blockquote>\n<p>Cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase.</p>\n<p>^{Source: ibid}</p>\n</blockquote>\n<p>An ACE-Inhibitor inhibits the functioning of the ACE Enzyme, so less angiotensin II is produced and hence blood-vessels widen, which results in a lower blood pressure.</p>\n<p>For CCB:</p>\n<blockquote>\n<p>CCBs reduce blood pressure by limiting the amount of calcium or the rate at which calcium flows into the heart muscle and arterial cell walls. Calcium stimulates the heart to contract more forcefully. When calcium flow is limited, your heart’s contractions aren’t as strong with each beat, and your blood vessels are able to relax. This leads to lower blood pressure.</p>\n<p>^{Source: <a href=\"https://www.healthline.com/health/heart-disease/calcium-channel-blockers#how-they-work\" rel=\"noreferrer\">Healthline.com</a>}</p>\n</blockquote>\n<p><a href=\"https://www.uptodate.com/contents/high-blood-pressure-treatment-in-adults-beyond-the-basics\" rel=\"noreferrer\">This is a good article</a> for patient education on HTN treatments.</p>\n<hr />\n<p>It is seen clinically all the time that someone responds better to one class of medication than another. We see patients whose BP drops dangerously low with a tiny dose of an ACEI, and others whose BP is barely touched by high doses. High blood pressure is multifactoral and individuals may have different responses to medications for several reasons.</p>\n<ul>\n<li><p>Pharmacokinetics: Liver enzymes process (activate OR break down)\nmedications at different rates AND/OR kidneys excrete at different\nrates</p>\n</li>\n<li><p>The mechanism of blood pressure dysregulation: may differ, e.g. more related to vessel stiffness vs RAA dysregulation</p>\n</li>\n</ul>\n" }, { "answer_id": 17720, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 2, "selected": false, "text": "<p>As @DoctorWhom says, there is a great deal of variability in the effectiveness of single agents for blood pressure control. There are <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">subgroups</a> of patients who are more likely to respond or not respond to certain drugs, though. In the U.S., Black Americans tend to be less likely to respond to ACE inhibitors (and more likely to respond to thiazide diuretics, though that wasn't a drug in the question), and this difference is incorporated into the guidelines for choosing initial monotherapy (a single drug). There is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some evidence</a> that older patients are also less likely to respond to ACE inhibitors, but this <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386598/\" rel=\"nofollow noreferrer\">isn't quite as clear cut</a>. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=10737282\" rel=\"nofollow noreferrer\">Regional differences</a> may be more important than racial differences, suggesting the effect is mediated by environment and lifestyle, rather than genetics. </p>\n\n<p>For a while, European guidelines recommended exactly the pattern described in the OP for older or non-white patients (avoid ACE-inhibitors, use calcium channel blockers), because these patients were often observed to have low renin hypertension (see @DoctorWhom's answer, ACE-inhibitors work by inhibiting the renin-angiotensin-aldosterone, or RAA, axis, so a low renin hypertension wouldn't be improved with this therapy). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24107724\" rel=\"nofollow noreferrer\">Updated European guidelines</a> no longer make that recommendation. Regardless (outside of disease related reasons for choosing or avoiding a specific drug class) the best approach is to find and stick with a drug or combination that <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">brings blood pressure to the desired target</a>.</p>\n\n<p>Importantly, for anyone who might be reading this and wondering why a particular combination of antihypertensive drugs were chosen in their case, these drugs are generally given to reduce the risk of vascular and heart disease (e.g., heart attack, stroke, heart failure, and others). They target a disease determinant, blood pressure. There are goals related to that determinant, but the primary goal is downstream of the elevated blood pressure. Because of this, there are sometimes reasons to choose a drug that is more effective at preventing the end point of concern for a particular individual. These reasons might not be explained to a patient. I wish we were better at this. Some medications provide nice immediate positive feedback when taken and some don't. I've often seen patients who were put on a beta-blocker after a heart attack stop taking it, and I have to explain that their cardiologist didn't put them on the beta blocker to help them feel better, but to keep them from dying. You can read about this in a very dry, slightly impenetrable format in the most recent <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">US guidelines</a>, and in, I think, a more readable format in Cecil Medicine Ch 67. </p>\n" } ]

[ "https://health.stackexchange.com/questions/17693", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14946/" ]

[ { "answer_id": 17714, "author": "DoctorWhom", "author_id": 6776, "author_profile": "https://health.stackexchange.com/users/6776", "pm_score": 4, "selected": true, "text": "<p>ACEI work on the renin–angiotensin–aldosterone system (<a href=\"http://ukrocharity.org/kidney-disease/the-renin-angiotensin-system-and-blood-pressure-control/\" rel=\"noreferrer\">RAAS</a>) whereas Ca++ blockers primarily work on cardiac contractility, HR, and vessel constriction.</p>\n<p>For the ACE-Inhibitor:</p>\n<blockquote>\n<p>Cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase.</p>\n<p>^{Source: ibid}</p>\n</blockquote>\n<p>An ACE-Inhibitor inhibits the functioning of the ACE Enzyme, so less angiotensin II is produced and hence blood-vessels widen, which results in a lower blood pressure.</p>\n<p>For CCB:</p>\n<blockquote>\n<p>CCBs reduce blood pressure by limiting the amount of calcium or the rate at which calcium flows into the heart muscle and arterial cell walls. Calcium stimulates the heart to contract more forcefully. When calcium flow is limited, your heart’s contractions aren’t as strong with each beat, and your blood vessels are able to relax. This leads to lower blood pressure.</p>\n<p>^{Source: <a href=\"https://www.healthline.com/health/heart-disease/calcium-channel-blockers#how-they-work\" rel=\"noreferrer\">Healthline.com</a>}</p>\n</blockquote>\n<p><a href=\"https://www.uptodate.com/contents/high-blood-pressure-treatment-in-adults-beyond-the-basics\" rel=\"noreferrer\">This is a good article</a> for patient education on HTN treatments.</p>\n<hr />\n<p>It is seen clinically all the time that someone responds better to one class of medication than another. We see patients whose BP drops dangerously low with a tiny dose of an ACEI, and others whose BP is barely touched by high doses. High blood pressure is multifactoral and individuals may have different responses to medications for several reasons.</p>\n<ul>\n<li><p>Pharmacokinetics: Liver enzymes process (activate OR break down)\nmedications at different rates AND/OR kidneys excrete at different\nrates</p>\n</li>\n<li><p>The mechanism of blood pressure dysregulation: may differ, e.g. more related to vessel stiffness vs RAA dysregulation</p>\n</li>\n</ul>\n" }, { "answer_id": 17720, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 2, "selected": false, "text": "<p>As @DoctorWhom says, there is a great deal of variability in the effectiveness of single agents for blood pressure control. There are <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">subgroups</a> of patients who are more likely to respond or not respond to certain drugs, though. In the U.S., Black Americans tend to be less likely to respond to ACE inhibitors (and more likely to respond to thiazide diuretics, though that wasn't a drug in the question), and this difference is incorporated into the guidelines for choosing initial monotherapy (a single drug). There is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7755948\" rel=\"nofollow noreferrer\">some evidence</a> that older patients are also less likely to respond to ACE inhibitors, but this <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386598/\" rel=\"nofollow noreferrer\">isn't quite as clear cut</a>. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=10737282\" rel=\"nofollow noreferrer\">Regional differences</a> may be more important than racial differences, suggesting the effect is mediated by environment and lifestyle, rather than genetics. </p>\n\n<p>For a while, European guidelines recommended exactly the pattern described in the OP for older or non-white patients (avoid ACE-inhibitors, use calcium channel blockers), because these patients were often observed to have low renin hypertension (see @DoctorWhom's answer, ACE-inhibitors work by inhibiting the renin-angiotensin-aldosterone, or RAA, axis, so a low renin hypertension wouldn't be improved with this therapy). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24107724\" rel=\"nofollow noreferrer\">Updated European guidelines</a> no longer make that recommendation. Regardless (outside of disease related reasons for choosing or avoiding a specific drug class) the best approach is to find and stick with a drug or combination that <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">brings blood pressure to the desired target</a>.</p>\n\n<p>Importantly, for anyone who might be reading this and wondering why a particular combination of antihypertensive drugs were chosen in their case, these drugs are generally given to reduce the risk of vascular and heart disease (e.g., heart attack, stroke, heart failure, and others). They target a disease determinant, blood pressure. There are goals related to that determinant, but the primary goal is downstream of the elevated blood pressure. Because of this, there are sometimes reasons to choose a drug that is more effective at preventing the end point of concern for a particular individual. These reasons might not be explained to a patient. I wish we were better at this. Some medications provide nice immediate positive feedback when taken and some don't. I've often seen patients who were put on a beta-blocker after a heart attack stop taking it, and I have to explain that their cardiologist didn't put them on the beta blocker to help them feel better, but to keep them from dying. You can read about this in a very dry, slightly impenetrable format in the most recent <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=29133354\" rel=\"nofollow noreferrer\">US guidelines</a>, and in, I think, a more readable format in Cecil Medicine Ch 67. </p>\n" } ]

[ "https://health.stackexchange.com/questions/17719", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14964/" ]

[ { "answer_id": 17751, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>Because the context refers to a serum sample, and it sounds like a low quality one, you should use lipemia (or, the british variant lipaemia), not hyperlipidemia. </p>\n\n<p>See <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071188/\" rel=\"noreferrer\">here</a> for an example of the context where this is used.</p>\n\n<blockquote>\n <p>Hemolysis, icterus, and lipemia (HIL) in patient specimens may interfere with the accurate measurement of various analytes</p>\n</blockquote>\n" }, { "answer_id": 17752, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 4, "selected": true, "text": "<p>These are not really synonymous. Despite <a href=\"https://www.wikidoc.org/index.php/Lipaemia\" rel=\"noreferrer\">some sites claiming them to be</a>. Compare <a href=\"https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/hyperlipidemia\" rel=\"noreferrer\">the usage on this site</a>.</p>\n\n<p>Lipaemia is describing lab artifacts, that is roughly too much fat in the blood sample <a href=\"https://www.bmj.com/content/340/bmj.b5530\" rel=\"noreferrer\">that interferes</a> with other tests and measurements.</p>\n\n<p>Hyperlipidemia is what is wanted to get measured in a blood sample, that is lipo-proteins or roughly: cholesterol.</p>\n\n<blockquote>\n <p>Clin Chim Acta. 2013 Mar 15;418:30-2. doi: 10.1016/j.cca.2012.12.029. Epub 2013 Jan 8.\n <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23313055\" rel=\"noreferrer\">Lipaemia: causes, consequences and solutions.</a>\n Walker PL, Crook MA.</p>\n \n <p>The detection of lipaemia in a patient blood sample can be a clinical conundrum as well as an analytical nuisance. With a reported prevalence of 0.7% in all blood samples received for lipid studies its finding has been suggested to be an underappreciated problem <a href=\"https://vascular.org/patient-resources/vascular-conditions/hyperlipidemia\" rel=\"noreferrer\">5</a>. Its presence can have a significant impact on the validity of a number of routine blood tests. The intention of this report is to outline the causes of lipaemia, the clinical and analytical consequences of its presence and some of the tools the laboratory employ to reduce its effects. Both laboratory professionals and clinicians should have an appreciation of the analytical and clinical impact lipaemia may confer on routine biochemistry.</p>\n \n <hr>\n \n <p><a href=\"https://vascular.org/patient-resources/vascular-conditions/hyperlipidemia\" rel=\"noreferrer\">Hyperlipidemia</a><br>\n ALSO CALLED Hypercholesterolemia, familial hypercholesterolemia, elevated cholesterol, elevated cholesterol levels</p>\n \n <p>By Gregory L. Moneta<br>\n Hyperlipidemia is an umbrella term that refers to any of several acquired or genetic disorders that result in a high level of lipids (fats, cholesterol and triglycerides) circulating in the blood. These lipids can enter the walls of arteries and increase your risk of developing atherosclerosis (hardening of the arteries), which can lead to stroke, heart attack and the need to amputate. The risk of atherosclerosis is higher if you smoke, or if you have or develop diabetes, high blood pressure and kidney failure.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/17749", "https://health.stackexchange.com", "https://health.stackexchange.com/users/2248/" ]

[ { "answer_id": 17784, "author": "JohnP", "author_id": 64, "author_profile": "https://health.stackexchange.com/users/64", "pm_score": 1, "selected": false, "text": "<p>The definition of a Calorie (Note the big C, a food calorie is actually a kilocalorie, or 1000 small calories) is simply the amount of heat necessary to raise the temperature of 1 kilogram of water 1 degree Celsius.</p>\n\n<p>To get this, originally foods were burned in a bomb calorimeter, and the calories determined by the rise in heat of the water. Now (At least in the United States), they are determined more indirectly using the Atwater system. (This was done to comply with federal labeling laws, that require it to be estimated from food components, so elements such as fiber were taken out). </p>\n\n<p>The <a href=\"https://en.wikipedia.org/wiki/Atwater_system\" rel=\"nofollow noreferrer\">wikipedia entry is decent</a>, and has links to pages pointing out the flaws in the system, and there is a short <a href=\"https://www.scientificamerican.com/article/how-do-food-manufacturers/\" rel=\"nofollow noreferrer\">https://www.scientificamerican.com/article/how-do-food-manufacturers/</a> as well.</p>\n\n<p>So as a summation, it is an estimation of the amount of food calories that are potentially in a food. As with anything, different people process in various efficiencies, so there is no true way to know how much actual energy you personally are getting out of a food item.</p>\n" }, { "answer_id": 17785, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p>Simplified from <a href=\"http://www.fao.org/docrep/006/Y5022E/y5022e04.htm\" rel=\"nofollow noreferrer\">CALCULATION OF THE ENERGY CONTENT OF FOODS - ENERGY CONVERSION FACTORS (FAO.org)</a></p>\n\n<p>Food energy can be:</p>\n\n<ul>\n<li><strong>Combustible</strong> or <strong>ingested energy</strong> = theoretical maximum energy content of a food measured using bomb calorimetry (the energy you ingest)</li>\n<li><strong>Metabolizable energy (ME)</strong> = ingested energy minus energy lost in feces by indigestible nutrients (the energy listed on nutrition labels)</li>\n<li><strong>Net metabolizable energy (NME)</strong> = metabolizable energy minus energy converted into heat due to dietary-induced thermogenesis</li>\n</ul>\n\n<hr>\n\n<p>Comparison of ME (from food labels) and NME (potentially fattening energy) in different macronutrients (<a href=\"http://www.fao.org/docrep/006/Y5022E/y5022e04.htm\" rel=\"nofollow noreferrer\">FAO.org, table 3.3.</a>):</p>\n\n<ul>\n<li><strong>Protein</strong> (Calories/gram): ME = 4, NME = 3.2</li>\n<li><strong>Fat:</strong> ME = 9, NME = 9</li>\n<li><strong>Carbohydrates:</strong> ME = 4, NME = 4</li>\n<li><strong>Dietary fiber:</strong> ME = 2 (but wrongly counted as 4 on food labels), NME = 1.4</li>\n<li><strong>Alcohol:</strong> ME = 7, NME = 6.3</li>\n</ul>\n\n<p>On food labels, <em>dietary fiber</em> is listed under carbohydrates as having 4 Cal/g, but its ME is only 2 Cal/g and NME only 1.4 Cal/g. So, a certain carbohydrate food that has a lot of fiber can have significantly less energy than stated on the food label.</p>\n\n<p>The metabolic energy (ME) of <em>individual amino acids in proteins</em> can vary from 2 to 6 Cal/g (<a href=\"https://www.researchgate.net/publication/20915822_Energy_content_of_diets_of_variable_amino_acid_composition\" rel=\"nofollow noreferrer\">ResearchGate</a>). Most proteins contain most amino acids, but in different proportions. I haven't found, so far, if this results in significantly different caloric value of various proteins, such as in beef and egg white protein, for example.</p>\n\n<p><strong>In conclusion,</strong> net metabolic energy (NME), which is potentially fattening energy, tends to be lower than metabolic energy (ME) stated on the food labels, at least for proteins, dietary fiber and alcohol.</p>\n\n<p>The NME of certain nutrients can further differ due to personal factors, such as age, state of health, etc. and nutrient combinations (e.g., fiber can slightly inhibit the absorption of fat) (<a href=\"https://www.nature.com/articles/1602938\" rel=\"nofollow noreferrer\">European Journal of Clinical Nutrition</a>). So, Calories stated on the food labels are not fixed values, but, so far, I haven't found any evidence how could be this practically important.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17776", "https://health.stackexchange.com", "https://health.stackexchange.com/users/6615/" ]

[ { "answer_id": 17788, "author": "Bryan Krause", "author_id": 8728, "author_profile": "https://health.stackexchange.com/users/8728", "pm_score": 3, "selected": false, "text": "<p>Dietary restrictions on medication are for a variety of reasons:</p>\n\n<p><em>Interactions that prevent absorption/action</em> - this could include foods that somehow bind with the active ingredient of the drug and therefore limit it's action. The result could be similar to forgetting to take the medication at all.</p>\n\n<p><em>Interactions that prevent enzymatic breakdown</em> - these are common with certain liver enzymes that are involved in metabolism of drugs but can also be inhibited by foods. They could cause levels of the drug to build up to higher than expected levels because the active ingredient is not metabolized by the next dose.</p>\n\n<p><em>Foods that cause similar effects to the drug</em> - for example, drugs that cause drowsiness should typically not be taken with alcohol.</p>\n\n<p><strong>Because of the variety of reasons and uncertain level of severity for different drugs and different foods, all you should do is ask your doctor.</strong> You could also ask your pharmacist: it is also their job to know about interactions with drugs and they may be able to advise you. Your healthcare provider may also have something like a nurse's hotline that you can call in to, and they can either help you directly or guide you to other resources.</p>\n" }, { "answer_id": 17791, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 3, "selected": false, "text": "<p>Doxycycline is a chelating agent. As such it will form a metallo-tetracycline complex in the gut which is basically not absorbed. So, you don't get the benefit of the tetracycline. So, you should take them 3 hours before or after meals. And if you have taken it with a glass of milk, the sensible thing to do is take it again after a few hours.</p>\n\n<blockquote>\n <p>Tetracyclines have a high affinity to form chelates with polyvalent metallic cations such as Fe+++, Fe++, Al+++, Mg++ and Ca++. Many of these tetracycline-metal complexes are either insoluble or otherwise poorly absorbable from the gastro-intestinal tract. Milk and other dairy products, antacids containing polyvalent cations, as well as various iron salts ingested simultaneously with tetracycline derivatives, might interfere with their absorption by 50 to 90% or even more. </p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/946598\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/946598</a></p>\n" }, { "answer_id": 18568, "author": "Thomas TJ Checkley", "author_id": 15601, "author_profile": "https://health.stackexchange.com/users/15601", "pm_score": 2, "selected": false, "text": "<p>Bryan is correct. </p>\n\n<p>As for references as Chris Rogers requests, there are many, given the plethora of texts and papers on the subject. One good text is:</p>\n\n<p>Ritter, J., Flower, R. J., Henderson, G., Loke, Y. K., MacEwan, D. J., &amp; Rang, H. P. (2019). Rang and Dale’s pharmacology. St. Louis, Missouri: Elsevier.</p>\n\n<p>To expand on the subject, a good food to avoid if taking prescriptions is grapefruit (although other citrus fruits are currently being studied). Grapefruit irreversibly bind to CYP3A4 and can cause an increase in the drug the patient is taking, potentially elevating it to toxic levels. There is extensive literature on this subject and a literature review would yield pages of references. It is just one example of a food interacting with a drug, and since a large percentage of drugs use the CYP3A4 pathway, it is a big interaction which is highly studied.</p>\n\n<p>The OP used doxycycline as an example, and as Graham pointed out, metals such as Ca++ bind to doxy and cause it to become insoluble and therefore less able to be absorbed. However, doxycycline also commonly causes nausea; thus, often providers will advise patients they can eat something small with the doxycycline to help alleviate the nausea. Therefore, if someone ate something with doxy -- once -- most providers wouldn't worry. However, in the clinical setting of a patient who does not respond to doxycycline and reports taking the medication with breakfast and dinner, it could be prudent to consider that the doxycycline was not ineffective against the offending organism, but was taken inappropriately. It is also worth noting that while doxycycline is typically given as 100mg BID, it can be taken as 200mg OD (this could enhance patient compliance, since it is hard to to follow the instructions twice a day).</p>\n\n<p>It is worth noting that while the three interactions that Bryan mentioned are the primary types of drug interactions, there is one interaction that does not fall into this category, which I discuss with my patients regularly. Flagyl and drinking alcohol (EtOH) has long been thought to produce a disulfiram-like reaction; a disulfiram reaction is what is used by antabuse to \"treat\" alcoholism. If EtOH is used while on Antabuse the patient vomits violently and has severe abdominal cramping. It is questionable if Flagyl does indeed produce a disulfiram-like reaction or if there is something else going on (say something with serotonin). Regardless, drinking alcohol while on Flagyl is not a good idea, and it doesn't fall into any of those three categories.</p>\n\n<p>I think that as a society we have become complacent with medications, and feel like they are all pretty safe. We know that there are these serious drugs (like chemo) that are out there, but we forget that many commonly used drugs can have serious interactions and consequences. As a recommendation, if you have any questions about drugs, call the pharmacist or your provider. The pharmacists today are typically 4-year trained in a PharmD program and are highly knowledgeable about interactions (more so typically than providers) and they are a great resource for questions like this one.</p>\n" } ]

[ "https://health.stackexchange.com/questions/17787", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15019/" ]

[ { "answer_id": 17796, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>Diabetes does cause kidney problems, and is the leading cause of end stage renal disease in industrialized world (see Cecil Medicine, Chapter 126, Diabetes and The Kidney). Though neither fully prevents the development of kidney problems entirely, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=9742976\" rel=\"noreferrer\">tight glucose control</a> together with <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17054288\" rel=\"noreferrer\">blood pressure control with an ACE-inhibitor or ARB</a> slow the progression of kidney disease and reduce all cause mortality in diabetics. Early on, this is the mainstay of prevention and treatment (tight glucose control plus RAAS inhibition), but reduction of other risk factors plays an important role as well. Stopping smoking, exercising, and losing weight (while maintaining tight glucose control) are important steps (see Cecil Medicine, Ch 126, again).</p>\n" }, { "answer_id": 17798, "author": "Graham Chiu", "author_id": 3414, "author_profile": "https://health.stackexchange.com/users/3414", "pm_score": 3, "selected": true, "text": "<p>The following are the recommendations from the Joslin Center for preserving renal function in diabetes mellitus</p>\n<blockquote>\n<p>Tight control of blood glucose levels (A1C less than 7 percent)</p>\n<p>Tight control of blood pressure: aim for lower than 130/80</p>\n<p>Control of lipids: LDL (“bad”) cholesterol should be less than 100 mg/dl, HDL (“good”) cholesterol should be above 50 mg/dl and triglycerides should be less than 150 mg/dl</p>\n<p>No cigarette smoking</p>\n<p>Blood pressure-lowering drugs, such as ACE inhibitors or angiotensin receptor blockers (ARBs), are effective in protecting the kidney from damage if you have signs of diabetic kidney disease</p>\n</blockquote>\n<p><a href=\"https://www.joslin.org/info/how-to-prevent-kidney-disease.html\" rel=\"nofollow noreferrer\">https://www.joslin.org/info/how-to-prevent-kidney-disease.html</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/17795", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15018/" ]

[ { "answer_id": 17993, "author": "Kate Gregory", "author_id": 400, "author_profile": "https://health.stackexchange.com/users/400", "pm_score": 3, "selected": true, "text": "<p>It is true that there is no treatment for the Chikungunya virus and infection. That is not the same as there being no treatment for the pain. The <a href=\"https://www.cdc.gov/chikungunya/symptoms/index.html\" rel=\"nofollow noreferrer\">CDC</a> recommends acetaminophen but not aspirin or NSAIDs for the fever and pain. </p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Chikungunya\" rel=\"nofollow noreferrer\">Wikipedia</a> says:</p>\n\n<blockquote>\n <p>Symptoms usually improve within a week; however, occasionally the joint pain may last for months. The risk of death is around 1 in 1,000.</p>\n</blockquote>\n\n<p>People either cope with the pain for a week or more, or take Tylenol for it until it goes away. </p>\n" }, { "answer_id": 18009, "author": "Bruce Kirkpatrick", "author_id": 14251, "author_profile": "https://health.stackexchange.com/users/14251", "pm_score": 1, "selected": false, "text": "<p><a href=\"https://medicalsciences.stackexchange.com/users/400/kate-gregory\">Kate Gregory</a>'s answer is perfect, but I wanted to expound a little bit on the &quot;is it true that there is no treatment for Chikungunya joint pain&quot; part of your question. <a href=\"https://www.vumc.org/vvc/person/james-crowe-md\" rel=\"nofollow noreferrer\">James Crowe</a> is a very interesting physician-scientist who focuses on what he calls &quot;generalized medicine,&quot; a sort-of opposite to personalized medicine – instead of sequencing millions of individual genomes to find some shared target, his lab finds rare antibodies in single individuals who have survived or shown uncommon resistance to diseases with no known cures. In 2015, his group isolated several candidate antibodies from an individual who recovered from their Chikungunya infection. (<strong>Emphasis</strong> mine.)</p>\n<blockquote>\n<p><a href=\"https://www.cell.com/cell-host-microbe/pdfExtended/S1931-3128(15)00257-7\" rel=\"nofollow noreferrer\"><strong>Isolation and Characterization of Broad and Ultrapotent Human Monoclonal Antibodies with Therapeutic Activity against Chikungunya Virus. Smith <em>et al. Cell Host &amp; Microbe.</em> 2015.</strong></a></p>\n<p>Chikungunya virus (CHIKV) is a mosquito-transmitted RNA virus that causes acute febrile infection associated with polyarthralgia in humans. Mechanisms of protective immunity against CHIKV are poorly understood, and no effective therapeutics or vaccines are available. We isolated and characterized human monoclonal antibodies (mAbs) that\nneutralize CHIKV infectivity. <strong>Among the 30 mAbs isolated, 13 had broad and ultrapotent neutralizing activity</strong> (IC50 &lt; 10 ng/ml), and all of these mapped to domain A of the E2 envelope protein. Potent inhibitory mAbs blocked post-attachment steps required for CHIKV membrane fusion, and <strong>several were protective in a lethal challenge model in immunocompromised mice, even when administered at late\ntime points after infection</strong>. These highly protective mAbs could be considered for prevention or treatment of CHIKV infection, and their epitope location\nin domain A of E2 could be targeted for rational structure-based vaccine development.</p>\n</blockquote>\n<p>In 2017, an animal trial showed that their &quot;engineered SVIR001, a recombinant fully human monoclonal antibody (mAb)...eliminated viremia, reduced viral load at the site of infection, and diminished spread to distant target tissues in rhesus macaques when administered after infection,&quot; so there might be an imminent antibody therapy for Chikungunya, although these are often <a href=\"https://www.goodrx.com/monoclonal-antibodies\" rel=\"nofollow noreferrer\">very expensive</a>.</p>\n<blockquote>\n<p><a href=\"https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0005637&amp;type=printable\" rel=\"nofollow noreferrer\"><strong>Therapeutic administration of a recombinant human monoclonal antibody reduces the severity of chikungunya virus disease in rhesus macaques. Broeckel <em>et al. PLOS Neglected Tropical Diseases.</em> 2017.</strong></a></p>\n<p>Chikungunya virus (CHIKV) is a mosquito-borne virus that causes a febrile syndrome in humans associated with acute and chronic debilitating joint and muscle pain. Currently no licensed vaccines or therapeutics are available to prevent or treat CHIKV infections. We recently isolated a panel of potently neutralizing human monoclonal antibodies (mAbs), one (4N12) of which exhibited prophylactic and post-exposure therapeutic activity against CHIKV in immunocompromised mice. Here, we describe the development of an engineered CHIKV mAb, designated SVIR001, that has similar antigen binding and neutralization profiles to its parent, 4N12. <strong>Because therapeutic administration of SVIR001 in immunocompetent mice significantly reduced viral load in joint tissues, we evaluated its efficacy in a rhesus macaque model of CHIKV infection</strong>. Rhesus macaques that were treated after infection with SVIR001 showed rapid elimination of viremia and less severe joint infiltration and disease compared to animals treated with SVIR002, an isotype control mAb. <strong>SVIR001 reduced viral burden at the site of infection and at distant sites and also diminished the numbers of activated innate immune cells and levels of pro-inflammatory cytokines and chemokines. SVIR001 therapy; however, did not substantively reduce the induction of CHIKV-specific B or T cell responses</strong>. Collectively, these results show promising therapeutic activity of a human anti-CHIKV mAb in rhesus macaques and provide proof-of-principle for its possible use in humans to treat active CHIKV infections.</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/17992", "https://health.stackexchange.com", "https://health.stackexchange.com/users/4984/" ]

[ { "answer_id": 18017, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>It is extremely unlikely that common cold as such would kill you, but the complications could.</p>\n\n<p>The definition of a common cold is a <em>viral</em> infection of the <em>nose and throat</em> as reflected from its Latin names <a href=\"https://simple.wikipedia.org/wiki/Common_cold\" rel=\"nofollow noreferrer\">nasopharyngitis or rhinopharyngitis</a>.</p>\n\n<p>It is usually pneumonia as a complication of common cold (or <a href=\"https://www.cdc.gov/flu/consumer/symptoms.htm\" rel=\"nofollow noreferrer\">flu</a> or <a href=\"https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf\" rel=\"nofollow noreferrer\">measles</a>...) that can be deadly. A young student recently died in the US from pneumonia as a complication of common cold caused by <em>Adenovirus</em> (<a href=\"http://www.sdailynews.com/2018/11/22/university-freshman-becomes-latest-casualty-of-adenovirus/\" rel=\"nofollow noreferrer\">S Daily News</a>).</p>\n\n<p>The risk factors for common cold complications can include impaired immunity (hereditary or acquired), anatomical abnormalities of the respiratory system, co-existent lung or other disease and old age.</p>\n\n<p>EDIT:</p>\n\n<p>To answer \"I have several times <a href=\"https://www.afp.com/en/news/15/us-missionarys-body-could-be-lost-battle-preserve-isolated-tribe-doc-1b203b1\" rel=\"nofollow noreferrer\">read</a> that common cold could kill this tribe\": The article does not claim that common cold can kill them, but they <em>believe</em> it could kill them:</p>\n\n<blockquote>\n <p><em>Fears</em> that 21st century diseases as mild as the common cold could kill off the tribe, or that experiencing electricity and the internet\n would devastate their lifestyle, has left them in a guarded bubble...</p>\n</blockquote>\n" }, { "answer_id": 18027, "author": "Carey Gregory", "author_id": 805, "author_profile": "https://health.stackexchange.com/users/805", "pm_score": 2, "selected": false, "text": "<p>Adding to Jan's answer, I found this, which was just published today. Emphasis is mine.</p>\n\n<p><a href=\"https://blogs.scientificamerican.com/observations/the-american-killed-by-asian-islanders-hoped-to-save-their-souls/\" rel=\"nofollow noreferrer\">https://blogs.scientificamerican.com/observations/the-american-killed-by-asian-islanders-hoped-to-save-their-souls/</a></p>\n\n<blockquote>\n <p>Last to succumb were the Jarawa, who live in dense forests on the\n western edge of South and Middle Andaman Islands and, until 1998, were\n defending their territory with their lives. They killed settlers who\n ventured into their territory to fish or hunt game, and got killed in\n return. That year however, they succumbed to decades of pacification\n efforts originally developed by Maurice V. Portman, a colonial\n administrator. Boatloads of Indian officials and anthropologists would\n land on Jarawa beaches, leave gifts of bananas, red cloth and other\n goodies from civilization, and retreat. The Jarawa were eventually\n seduced into laying down their arms and interacting with settlers in\n peace. <strong>Almost instantly, they were beset by epidemics of pneumonia,\n mumps, measles and other diseases; <em>even the common cold seemed to be\n lethal to them</em>.</strong> No one knows how many died.</p>\n</blockquote>\n\n<p>So there seems to be evidence that contact with long-isolated tribes can be lethal to them via the common cold.</p>\n" } ]

[ "https://health.stackexchange.com/questions/18004", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9597/" ]

[ { "answer_id": 18051, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p><strong>Question: Does eating (fatty) fish help to lower high blood pressure or does it help only when eaten instead of red meat?</strong></p>\n\n<p><strong>Answer: Merely increasing fish, including oily fish, consumption without other dietary changes (especially losing excessive weight) may not help to reduce blood pressure.</strong></p>\n\n<p><strong>FISH</strong></p>\n\n<p><a href=\"https://academic.oup.com/advances/article/8/6/793/4772207\" rel=\"nofollow noreferrer\">Food Groups and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies (Academic.oup, 2017)</a>:</p>\n\n<blockquote>\n <p>In our study, fish consumption was associated with a <em>slight increase\n in hypertension risk.</em></p>\n</blockquote>\n\n<p><strong>FATTY FISH</strong></p>\n\n<p><a href=\"https://academic.oup.com/ajcn/article/108/3/576/5095501#\" rel=\"nofollow noreferrer\">Food groups and intermediate disease markers: a systematic review and network meta-analysis of randomized trials (Academic.oup.com, 2018)</a>:</p>\n\n<blockquote>\n <p>Consumption of fatty fish resulted in significant improvements in\n triglycerides and HDL cholesterol, whereas <em>no effects were observed\n for...systolic and diastolic blood pressure.</em></p>\n</blockquote>\n\n<p><strong>RED MEAT</strong></p>\n\n<p>According to one systematic review (<a href=\"https://watermark.silverchair.com/an017178.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAp0wggKZBgkqhkiG9w0BBwagggKKMIIChgIBADCCAn8GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMM8GwYaHQHY42pfzLAgEQgIICUC8fFC1hv8wybTm7yYHKADn_yKbw_1ukT6hNkIdsK-Z1WKl6OvXYLEPbXNgnn37w-EF4nvI7yREVUB5iOwy19QV6P7HoDIhvP9PQWHg6Xa6Auw9uI7hs_7n4Cm9xzapWEjjV68X1QWnHzB3oamtGJDVhOS1ZczCCcB_BvP3O8dNAdIL7JRKNJOIUf0yukILNMiY5EwD9y9Z4jCZbH63iQBsJPjF5b6G82NLDSJG1DFHnvcgKyUrsN8BD5O-XyUhA6WflXyHS9xyLuCPOYkCVw0gwUqYPRx2nWvMOKt4js8vZOqD79kI66-kZrQ3-aYj1ZPdi9elEiuExoaUmAwIu0F_qG-60diwXwk-P-RkfUrzDKQrXMh1B05p5j2qu_N6acxFBwJL0nAIKbDyCYqMh-VXUpKfFtWIHfImUc_Oyhd9bz6nkKhRhc2KAQrmCFb7UegyOP05mu9ps9cqbFkbskzcsrHW8DqbRIOMCWPjhgRjg3lptzlTe7RZTfjqExcNh_H_Vl2WM5GXWkbuMTL8hJdMY1UFKw8M2VchNUdp9qckC6054Qgs9vsqLfZk2A5tnv47gNMW_0eN-m93YR8llieQ4p1j0OcaPUBL-LP4pi7c9_EAdAvMwpOp2eXuHhlIu5Jw-5pwiZ57iReAzJUPvvLxQZ6MUMJFjiwpNxLFzd6yJsbYvbI4P9QeLLCs-YoIlxXUxci54I8uuA4mvNxye0w3sFfYRrY1JQNp6cOeXoi4gk4DrfYOg6L5iO0EklGR30HFENumknFUY126XidWCSq8\" rel=\"nofollow noreferrer\">American Society of Nutrition, 2017</a>), consumption of red meat is associated with high blood pressure, but in some other studies (<a href=\"https://www.researchgate.net/publication/264390710_Processed_and_unprocessed_red_meat_consumption_and_hypertension_in_women\" rel=\"nofollow noreferrer\">ResearchGate, 2014</a>; <a href=\"https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0252-7\" rel=\"nofollow noreferrer\">Nutrition Journal, 2017</a>) no such association have been found.</p>\n\n<p><strong>THE DIET AS A WHOLE</strong></p>\n\n<p><a href=\"https://www.cnpp.usda.gov/sites/default/files/usda_nutrition_evidence_flbrary/DietaryPatternsReport-FullFinal.pdf\" rel=\"nofollow noreferrer\">A Series of Systematic Reviews on the Relationship Between Dietary Patterns and \nHealth Outcomes (USDA.gov, 2014)</a>:</p>\n\n<blockquote>\n <p>There is strong and consistent evidence that <em>consumption of a DASH\n [Dietary Approaches to Stop Hypertension] diet results in reduced\n blood pressure in adults with above optimal blood pressure...</em> A\n dietary pattern consistent with the DASH diet is rich in fruits,\n vegetables, low-fat dairy, fish, whole grains, fiber, potassium, and\n other minerals at recommended levels, and low in red and processed\n meat, sugar-sweetened foods and drinks, saturated fat, cholesterol,\n and sodium.</p>\n</blockquote>\n" }, { "answer_id": 18085, "author": "paparazzo", "author_id": 6848, "author_profile": "https://health.stackexchange.com/users/6848", "pm_score": 0, "selected": false, "text": "<p>According to the <a href=\"http://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids\" rel=\"nofollow noreferrer\">American Heart Association</a> should have fish high in omega 3 fatty acid twice a week.</p>\n\n<blockquote>\n <p>The American Heart Association recommends eating fish (particularly\n fatty fish) at least two times (two servings) a week. Each serving is\n 3.5 ounce cooked, or about ¾ cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are\n high in omega-3 fatty acids.</p>\n \n <p>Increasing omega-3 fatty acid consumption through foods is preferable.\n However, those with coronary artery disease, may not get enough\n omega-3 by diet alone. These people may want to talk to their doctor\n about supplements. And for those with high triglycerides, even larger\n doses could help.</p>\n \n <p>Omega-3 fatty acids also decrease triglyceride levels, slow growth\n rate of atherosclerotic plaque, and lower blood pressure (slightly).</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/18033", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15182/" ]

[ { "answer_id": 18039, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>Injury or infection triggers the release of prostaglandins, which can cause pain, fever and inflammation (all of which are direct effects of prostaglandins).</p>\n\n<p><a href=\"https://www.nature.com/articles/nsb0403-233\" rel=\"nofollow noreferrer\">Painkillers and Prostaglandins (Nature)</a>:</p>\n\n<blockquote>\n <p>Prostaglandins are powerful signaling agents in the human body. The\n two-dozen or so members of this family of small lipid messengers\n underpin many profound physiological events — including vasodilation,\n vasoconstriction, bronchoconstriction, platelet activation,\n inflammation, uterine contractions, pain perception and fever.</p>\n</blockquote>\n\n<p><a href=\"https://academic.oup.com/bja/article/87/1/3/304226\" rel=\"nofollow noreferrer\">Mechanisms of inflammatory pain (Academic.oup.com)</a>:</p>\n\n<blockquote>\n <p>prostaglandins contribute to pain by directly activating nociceptors</p>\n</blockquote>\n\n<p>This means that NSAIDs can relieve pain even if there is no inflammation, for example, in tension headache (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444224/\" rel=\"nofollow noreferrer\">PubMed</a>).</p>\n" }, { "answer_id": 18042, "author": "LаngLаngС", "author_id": 11231, "author_profile": "https://health.stackexchange.com/users/11231", "pm_score": 2, "selected": false, "text": "<p>The way in that this question is framed looks like a false dichotomy.\nThe very first sentence of a recent book starts with:</p>\n<blockquote>\n<p>NSAIDs are one of the most widely prescribed drugs around the world to treat pain and inflammation.</p>\n</blockquote>\n<p>In treatment we often do want the inflammation to go down if it's overshooting.<br />\nIn treatment we often do want the pain to go down if it's overshooting.</p>\n<blockquote>\n<p>Advances on this area have proved that COX-1 and COX-2 products are involved not only in pain and inflammation but in cancer development as well. In fact, most outstanding advances in the field where discovered when these drugs were tested to prevent gastrointestinal cancer. These advances and knowledge cannot be separated today from the effects of aspirin on the cardiovascular system and on cancer prevention and treatment. In addition aspirin is still being used for the short-term treatment of cold, fever, and pain.</p>\n<p>Angel Lanas: &quot;NSAIDs and Aspirin. Recent Advances and Implications for Clinical Management&quot;, Springer: Switzerland, 2016.</p>\n</blockquote>\n<p>There is no pain-receptor to be treated with anti-pain in this class of drugs. These substances were not designed to be anything, they were discovered, and discovered to have an array of effects. They interact with a wide range of receptors, signalling pathways, and have a range of metabolic consequences.</p>\n<p>From the &quot;Chemistry&quot; chapter:</p>\n<blockquote>\n<p>This arachidonic acid cascade is of great importance in inflammation, pain, and fever. Prostanoid synthesis is significantly elevated in inflamed tissues, where PGE2 and prostacyclin (PGI2) contribute to this response by increasing local blood flow, vascular permeability, and leukocyte infiltration. These prostanoids also cause peripheral sensitization by reducing the threshold of peripheral nociceptors, while PGE2 and other prostaglandins induce central nociceptive sensitization at the spinal dorsal horn neurons. Finally, PGE2 acts at the hypothalamus to increase body temperature by increasing heat production and reducing heat loss. Likewise, inhibition of prostanoid synthesis by NSAIDs is responsible for undesired side effects such as gastrointestinal and renal toxicities, since prostanoids are physiological regulators of gastrointestinal mucosal defense and renal homeostasis.</p>\n</blockquote>\n<p>Conceptually, reducing inflammation only reduces pain if the inflammation caused the pain. If there is pain that is reduced by anti-inflammatory drugs without inflammation present, then the anti-inflammatory effect observed to be <em>a</em> feature of these drugs will have little explanatory value.</p>\n<p>In this case, these drugs can do both, separately or at the same time. There is no &quot;by-product&quot;, but a range of effects to expect. If we need just one effect, good, if we need both effects at once, even better.</p>\n" }, { "answer_id": 18109, "author": "Syed Mansoor Rashid", "author_id": 15233, "author_profile": "https://health.stackexchange.com/users/15233", "pm_score": 1, "selected": false, "text": "<p>Simply, Nonsteroidal anti-inflammatory drugs (NSAIDs) produce their therapeutic activities (Pain and Inflammation relief) through inhibition of cyclooxygenase (COX), the enzyme that makes prostaglandins (PGs).</p>\n" } ]

[ "https://health.stackexchange.com/questions/18038", "https://health.stackexchange.com", "https://health.stackexchange.com/users/8087/" ]

[ { "answer_id": 18097, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 1, "selected": false, "text": "<p>To produce Vitamin D you need to get radiated by light with wavelengths below 300 nm.\nSo let's look at the reflectance and transmittance of the materials.</p>\n\n<p>A window made of glass has a transmittance of nearly 0 % for UV-Radiation.\n<a href=\"https://physics.stackexchange.com/questions/74638/transmittance-of-glass\">https://physics.stackexchange.com/questions/74638/transmittance-of-glass</a></p>\n\n<p>The reflection depends on the surrounding. Asphalt for example has a reflectance below 5 % whereas the value for snow is close to 100 %.</p>\n\n<p>In general I would assume that reflected light on the northern hemisphere under daily circumstances is not enough for sufficient production of Vitamin D. If you live on a high mountain this might vary.</p>\n" }, { "answer_id": 18106, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>The sunlight through the window does not stimulate vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897598/\" rel=\"noreferrer\">Sunlight and Vitamin D (PubMed)</a>:</p>\n\n<blockquote>\n <p>Since glass absorbs all UVB radiation, exposure of the skin to\n sunlight that passes through glass, plexiglass, and plastic will not\n result in any production of vitamin D3 in the skin.</p>\n</blockquote>\n\n<p>The sunlight reflected from the surfaces, especially snow, can contribute to vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897581/\" rel=\"noreferrer\">Vitamin D status and sun exposure in India (PubMed)</a>:</p>\n\n<blockquote>\n <p>The geophysical parameters like...surface albedo (the fraction of\n light reflected from earth’s surface)...affect vitamin D3 production\n in the human body.</p>\n</blockquote>\n\n<p><a href=\"https://pdfs.semanticscholar.org/a09a/e99dcfa345e232ab2adb27d5961081832edc.pdf\" rel=\"noreferrer\">Who, what, where and when—influences on cutaneous vitamin D synthesis (Progress in Biophysics and Molecular Biology)</a></p>\n\n<blockquote>\n <p>This process becomes significant if surface albedo is high, e.g. if\n covered with fresh snow (albedo ~90%)...With the exception of snow,\n most natural surfaces have a low albedo in the UV, of the order 5% for\n vegetation, 10% for soils and rocks, and up to 20% for dry sand, the\n same as some concretes and cement...</p>\n</blockquote>\n\n<p>and (<a href=\"https://www.researchgate.net/publication/285056396_Vitamin_D_The_truth_about_Vitamin_D_and_sun_exposure_demystified_Finding_the_balance_for_personal_health\" rel=\"noreferrer\">Research Gate</a>)</p>\n\n<blockquote>\n <p>3-5% for water</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/18078", "https://health.stackexchange.com", "https://health.stackexchange.com/users/5290/" ]

[ { "answer_id": 18097, "author": "Community", "author_id": -1, "author_profile": "https://health.stackexchange.com/users/-1", "pm_score": 1, "selected": false, "text": "<p>To produce Vitamin D you need to get radiated by light with wavelengths below 300 nm.\nSo let's look at the reflectance and transmittance of the materials.</p>\n\n<p>A window made of glass has a transmittance of nearly 0 % for UV-Radiation.\n<a href=\"https://physics.stackexchange.com/questions/74638/transmittance-of-glass\">https://physics.stackexchange.com/questions/74638/transmittance-of-glass</a></p>\n\n<p>The reflection depends on the surrounding. Asphalt for example has a reflectance below 5 % whereas the value for snow is close to 100 %.</p>\n\n<p>In general I would assume that reflected light on the northern hemisphere under daily circumstances is not enough for sufficient production of Vitamin D. If you live on a high mountain this might vary.</p>\n" }, { "answer_id": 18106, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>The sunlight through the window does not stimulate vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897598/\" rel=\"noreferrer\">Sunlight and Vitamin D (PubMed)</a>:</p>\n\n<blockquote>\n <p>Since glass absorbs all UVB radiation, exposure of the skin to\n sunlight that passes through glass, plexiglass, and plastic will not\n result in any production of vitamin D3 in the skin.</p>\n</blockquote>\n\n<p>The sunlight reflected from the surfaces, especially snow, can contribute to vitamin D synthesis in the skin.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897581/\" rel=\"noreferrer\">Vitamin D status and sun exposure in India (PubMed)</a>:</p>\n\n<blockquote>\n <p>The geophysical parameters like...surface albedo (the fraction of\n light reflected from earth’s surface)...affect vitamin D3 production\n in the human body.</p>\n</blockquote>\n\n<p><a href=\"https://pdfs.semanticscholar.org/a09a/e99dcfa345e232ab2adb27d5961081832edc.pdf\" rel=\"noreferrer\">Who, what, where and when—influences on cutaneous vitamin D synthesis (Progress in Biophysics and Molecular Biology)</a></p>\n\n<blockquote>\n <p>This process becomes significant if surface albedo is high, e.g. if\n covered with fresh snow (albedo ~90%)...With the exception of snow,\n most natural surfaces have a low albedo in the UV, of the order 5% for\n vegetation, 10% for soils and rocks, and up to 20% for dry sand, the\n same as some concretes and cement...</p>\n</blockquote>\n\n<p>and (<a href=\"https://www.researchgate.net/publication/285056396_Vitamin_D_The_truth_about_Vitamin_D_and_sun_exposure_demystified_Finding_the_balance_for_personal_health\" rel=\"noreferrer\">Research Gate</a>)</p>\n\n<blockquote>\n <p>3-5% for water</p>\n</blockquote>\n" } ]

[ "https://health.stackexchange.com/questions/18098", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15227/" ]

[ { "answer_id": 18111, "author": "motosubatsu", "author_id": 11188, "author_profile": "https://health.stackexchange.com/users/11188", "pm_score": 3, "selected": true, "text": "<p>The term \"knee damage\" can encompass many different conditions and injuries so let's just examine at some of the more common ones you might be looking at:</p>\n\n<h2>Osteoarthritis</h2>\n\n<p><a href=\"https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-knee/?gclid=EAIaIQobChMIlYTf4KiG3wIVDrftCh3NCg62EAAYASAAEgKiQPD_BwE\" rel=\"noreferrer\">Osteoarthritis of the knee</a> is when the cartilage in the joint has become thin or worn and the body is unable to \"keep up\" with repairs. Walking generally isn't going to cause this unless you are severely overweight or you're walking in unsuitable footwear etc. Quite the reverse - after a period of rest to allow for some recuperation from a flare up walking is recommended as it is a low impact way of building strength in the knee and is good for losing weight etc. <em>Running</em> on the other hand is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11086751\" rel=\"noreferrer\">significantly higher impact</a> (walking means you experience ground reaction forces of ~ 1.2xBody weight, for running it's ~2.5xBody weight) and can aggravate the damage and you're also much more likely to experience various types of musculoskeletal injuries. Although offsetting that increased risk of injury is the potential for increased cardiovascular fitness from running vs walking.</p>\n\n<p>This is much more common in older people as the body's ability to repair itself decreases with age. </p>\n\n<h2>Tendonitis</h2>\n\n<p><a href=\"https://physioworks.com.au/injuries-conditions-1/patella-tendonitis-tendinopathy\" rel=\"noreferrer\">Patellla tendonitis</a> is an overuse injury where the patella tendon (which connects to the bottom of the knee cap) becomes inflamed or otherwise damaged such as a loss of collagen in the tendon. Similarly to osteoarthritis walking is rarely a cause of this - typically it requires much higher levels of impact than walking alone can produce unless severely overweight or excessive amounts of stair climbing. </p>\n\n<p>This can also happen in older people where it is the result of repetitive small amounts of damage over an extended period of time - and just like in osteoarthritis as the body's ability to heal falls away the rate of injury can exceed the rate of repair leading to chronic problems.</p>\n\n<p>Avoiding activities that cause pain and keeping up with low impact exercises to improve strength is recommended.</p>\n\n<h2>Summary</h2>\n\n<p>Basically if you take a sensible approach - walking on reasonably flat surfaces, keep weight low, use appropriate footwear, and apply a modicum of moderation walking generally doesn't do damage to knees unless something has compromised the body's ability to \"repair\" itself to a significant extent. The benefits however are many and can actually help <em>prevent</em> damage by improving both the strength of the joint and overall health and fitness. So that 30 mins brisk walking a day is doing you far more good than harm.</p>\n" }, { "answer_id": 20621, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 1, "selected": false, "text": "<p><strong>1) Walking can actually help, even in people who already have osteoarthritis.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146701/\" rel=\"nofollow noreferrer\">Daily walking and the risk of incident functional limitation in knee OA: An observational study (Arthritis Care Research, 2014)</a>:</p>\n\n<blockquote>\n <p>Walking over 7 days was objectively measured as steps/day within a\n cohort of people with or at risk of knee OA from the Multicenter\n Osteoarthritis Study. </p>\n \n <p>Among 1788 participants (mean age 67, mean BMI 31 kg/m2, female 60%),\n each additional 1000 steps/day was associated with a 16% and 18%\n reduction in incident functional limitation by performance-based and\n self-report measures, respectively. </p>\n \n <p>More walking was associated with less risk of functional limitation\n over two years. Walking ≥ 6000 steps/day provides a preliminary\n estimate of the level of walking activity to protect against\n developing functional limitation in people with or at risk of knee OA.</p>\n</blockquote>\n\n<p><strong>2) Risk factors for osteoarthritis</strong></p>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S1063458414013429?via%3Dihub\" rel=\"nofollow noreferrer\">Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis (Ostearthritis and Cartilage, 2015)</a>:</p>\n\n<ul>\n<li>Being overweight</li>\n<li>A job that requires a lot of knee bending, kneeling, squatting or lifting</li>\n<li>Walking disability</li>\n<li>Previous knee injury</li>\n<li>Female sex</li>\n<li>Increased age</li>\n<li>Repeated intense physical activity, for example, running >20 miles/week</li>\n</ul>\n" } ]

[ "https://health.stackexchange.com/questions/18108", "https://health.stackexchange.com", "https://health.stackexchange.com/users/433/" ]

[ { "answer_id": 18126, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 4, "selected": true, "text": "<p>Mental health conditions are diagnosed through criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) produced by the American Psychiatric Association (APA). The current version is <a href=\"https://www.psychiatry.org/psychiatrists/practice/dsm\" rel=\"noreferrer\">DSM-5</a> and the previous version was the DSM-IV.</p>\n\n<p>As you pointed out in the comments, Asperger's Disorder is a variant of Autism with a separate set of diagnostic criteria. Because of this, Autism and Asperger's Disorder was a separate diagnosis under DSM-IV even though Asperger's Disorder is on the lower end of the autistic spectrum.</p>\n\n<p>DSM-5 redefined the autism spectrum disorders expanding the <strong>umbrella term</strong> to encompass the previous diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder (<a href=\"https://web.archive.org/web/20131006210933/http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf\" rel=\"noreferrer\">APA, 2013</a>)</p>\n\n<blockquote>\n <p>Using DSM-IV, patients could be diagnosed with four separate disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or the catch-all diagnosis of pervasive developmental disorder not otherwise specified. Researchers found that these separate diagnoses were not consistently applied across different clinics and treatment centers. Anyone diagnosed with one of the four pervasive developmental disorders (PDD) from DSM-IV should still meet the criteria for ASD in DSM-5 or another, more accurate DSM-5 diagnosis. While DSM does not outline recommended treatment and services for mental disorders, determining an accurate diagnosis is a first step for a clinician in defining a treatment plan for a patient.</p>\n \n <p>The Neurodevelopmental Work Group, led by Susan Swedo, MD (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22449639\" rel=\"noreferrer\">Swedo, et al. 2012</a>), senior investigator at the National Institute of Mental Health, recommended the DSM-5 criteria for ASD to be a better reflection of the state of knowledge about autism. The Work Group believes a single umbrella disorder will improve the diagnosis of ASD without limiting the sensitivity of the criteria, or substantially changing the number of children being diagnosed. </p>\n</blockquote>\n\n<h2>References</h2>\n\n<p>APA (2013) <em>Autism Spectrum Disorder Fact Sheet</em>. [PDF Online]<br>Retrieved from: <a href=\"https://web.archive.org/web/20131006210933/http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf\" rel=\"noreferrer\">https://web.archive.org/web/20131006210933/http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf</a></p>\n\n<p>Swedo, S. E., Baird, G., Cook, E. H., Happé, F. G., Harris, J. C., Kaufmann, W. E., ... &amp; Spence, S. J. (2012). Commentary from the DSM-5 workgroup on neurodevelopmental disorders. <em>Journal of the American Academy of Child &amp; Adolescent Psychiatry, 51</em>(4), 347-349. doi: <a href=\"https://doi.org/10.1016/j.jaac.2012.02.013\" rel=\"noreferrer\">10.1016/j.jaac.2012.02.013</a> PubMed: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22449639\" rel=\"noreferrer\">22449639</a></p>\n" }, { "answer_id": 18245, "author": "Dorian Townsend", "author_id": 15176, "author_profile": "https://health.stackexchange.com/users/15176", "pm_score": 2, "selected": false, "text": "<p><strong>Asperger’s syndrome</strong> is a condition that doctors refer to as high-functioning ASD autism spectrum disorder which impacts on the individual’s ability to read and communicate socially.</p>\n\n<p>The symptoms of this condition are less severe and no such signs for language delays are observed.</p>\n\n<p>I work as a sped teacher at ACCEL, and one of the major differences between children with Asperger’s syndrome and autism is that the symptoms are mildly affected and have good language.</p>\n\n<p>Another distinction between Asperger’s syndrome and autism concerns cognitive ability.\nEarly diagnosis and treatment are important for individuals with Asperger’s syndrome to eventually live independently.</p>\n\n<p>Individuals are quite reluctant towards social communication with others and show interest in specific topics.</p>\n\n<p>Communication training and behavioral therapy can help people with the syndrome learn to socialize more successfully.</p>\n\n<p><em>References:</em></p>\n\n<p><em><a href=\"https://www.autismspeaks.org/what-asperger-syndrome\" rel=\"nofollow noreferrer\">https://www.autismspeaks.org/what-asperger-syndrome</a></em></p>\n\n<p><em><a href=\"http://www.autism-society.org/what-is/aspergers-syndrome/\" rel=\"nofollow noreferrer\">http://www.autism-society.org/what-is/aspergers-syndrome/</a></em></p>\n\n<p><em><a href=\"https://www.everydayhealth.com/aspergers/how-aspergers-different-than-autism/\" rel=\"nofollow noreferrer\">https://www.everydayhealth.com/aspergers/how-aspergers-different-than-autism/</a></em></p>\n" }, { "answer_id": 25461, "author": "Always Confused", "author_id": 7262, "author_profile": "https://health.stackexchange.com/users/7262", "pm_score": 1, "selected": false, "text": "<p>Hans Asperger, who first reported this kind of condition, used the term &quot;autistic psychopathy&quot; (<a href=\"https://doi.org/10.1017/CBO9780511526770.002\" rel=\"nofollow noreferrer\">DOI</a>). From very beginning of discovery of this condition, people were aware that Aspergers is sort of autism.</p>\n<p>Reference:</p>\n<ol>\n<li><p>Asperger, H. (n.d.). “Autistic psychopathy” in childhood. Autism and Asperger Syndrome, 37–92. doi:10.1017/cbo9780511526770.002 Translated by Uta Frith</p>\n</li>\n<li><p>Wolff, S. (1996). The first account of the syndrome Asperger described? European Child &amp; Adolescent Psychiatry, 5(3), 119–132. doi:10.1007/bf00571671 Translation of a paper entitled &quot;Die schizoiden Psychopathien im Kindesalter&quot; by Dr. G.E. Ssucharewa; scientific assistant, which appeared in 1926 in the Monatsschrift fur Psychiatrie und Neurologie 60:235-261</p>\n</li>\n</ol>\n" } ]

[ "https://health.stackexchange.com/questions/18121", "https://health.stackexchange.com", "https://health.stackexchange.com/users/9637/" ]

[ { "answer_id": 18156, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<p>I don’t know if they can be used, but they shouldn’t. Recently, sun exposure is considered more and more harmful to the skin. This is why for recommended Vitamin D levels, no sun exposure whatsoever is usually assumed, and only intake via diet considered.</p>\n<blockquote>\n<p>Because ultraviolet rays from the sun and tanning beds can cause skin cancer, the American Academy of Dermatology does not recommend getting vitamin D from sun exposure or indoor tanning.</p>\n<p>Source: <a href=\"https://www.aad.org/media/stats/prevention-and-care/vitamin-d-and-uv-exposure\" rel=\"nofollow noreferrer\">American Academy of Dermatology</a></p>\n</blockquote>\n" }, { "answer_id": 18167, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>In short: UV bulbs for reptiles and tanning beds emit mainly UV-A, which <em>does not promote vitamin D synthesis but can promote skin cancer.</em></p>\n\n<p><strong>UV light and vitamin D synthesis</strong> (<a href=\"https://www.skincancer.org/healthy-lifestyle/vitamin-d/make-vitamin-d-not-uv-a-priority\" rel=\"nofollow noreferrer\">Skin Cancer Foundation</a>):</p>\n\n<blockquote>\n <p>Our bodies manufacture vitamin D when the sun's ultraviolet B (UVB)\n rays interact with 7-dehydrocholesterol (7-DHC) present in the skin.\n However, we can produce only a limited amount of vitamin D from UVB.\n A few minutes at midday are sufficient for many Caucasians...After\n reaching the production limit, further exposure actually destroys the\n vitamin, decreasing vitamin D levels.</p>\n</blockquote>\n\n<hr>\n\n<p>Wavelengths of various <strong>ReptiGlo bulbs</strong> range from 300-640 nm (only UV-A or both UV-A and UV-B), depending on the model; the bulbs have up to 40 Watts (<a href=\"http://www.exo-terra.com/en/products/linear_fluorescent_bulbs.php\" rel=\"nofollow noreferrer\">Exo-terra.com</a>).</p>\n\n<p>Modern <strong>tanning devices</strong> provide mostly UV-A (315-400 nm); the power is 100-200 Watts (<a href=\"https://en.wikipedia.org/wiki/Indoor_tanning\" rel=\"nofollow noreferrer\">Wikipedia</a>).</p>\n\n<p><a href=\"https://www.fda.gov/ForConsumers/ucm186687.htm\" rel=\"nofollow noreferrer\">FDA.gov</a> claims that both UV-A and UV-B rays causes DNA damage, which can lead to skin cancer and that <strong>all use of tanning beds increases the risk of skin cancer,</strong> from which one can conclude that the <strong>UV reptile bulbs could do the same.</strong></p>\n\n<p>According to <a href=\"https://www.aad.org/media/stats/prevention-and-care\" rel=\"nofollow noreferrer\">Indoor Tanning (American Academy of Dermatology)</a>:</p>\n\n<ul>\n<li>Exposure to UV radiation from indoor tanning devices is associated\nwith an increased risk of <strong>melanoma</strong> and nonmelanoma skin cancer,\nincluding <strong>squamous cell carcinoma and basal cell carcinoma.</strong></li>\n<li>Using indoor tanning beds before age 35 can increase your risk of melanoma, the deadliest form of skin cancer, by 59 percent.</li>\n</ul>\n" } ]

[ "https://health.stackexchange.com/questions/18154", "https://health.stackexchange.com", "https://health.stackexchange.com/users/5096/" ]

[ { "answer_id": 18156, "author": "Narusan", "author_id": 8212, "author_profile": "https://health.stackexchange.com/users/8212", "pm_score": 2, "selected": false, "text": "<p>I don’t know if they can be used, but they shouldn’t. Recently, sun exposure is considered more and more harmful to the skin. This is why for recommended Vitamin D levels, no sun exposure whatsoever is usually assumed, and only intake via diet considered.</p>\n<blockquote>\n<p>Because ultraviolet rays from the sun and tanning beds can cause skin cancer, the American Academy of Dermatology does not recommend getting vitamin D from sun exposure or indoor tanning.</p>\n<p>Source: <a href=\"https://www.aad.org/media/stats/prevention-and-care/vitamin-d-and-uv-exposure\" rel=\"nofollow noreferrer\">American Academy of Dermatology</a></p>\n</blockquote>\n" }, { "answer_id": 18167, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>In short: UV bulbs for reptiles and tanning beds emit mainly UV-A, which <em>does not promote vitamin D synthesis but can promote skin cancer.</em></p>\n\n<p><strong>UV light and vitamin D synthesis</strong> (<a href=\"https://www.skincancer.org/healthy-lifestyle/vitamin-d/make-vitamin-d-not-uv-a-priority\" rel=\"nofollow noreferrer\">Skin Cancer Foundation</a>):</p>\n\n<blockquote>\n <p>Our bodies manufacture vitamin D when the sun's ultraviolet B (UVB)\n rays interact with 7-dehydrocholesterol (7-DHC) present in the skin.\n However, we can produce only a limited amount of vitamin D from UVB.\n A few minutes at midday are sufficient for many Caucasians...After\n reaching the production limit, further exposure actually destroys the\n vitamin, decreasing vitamin D levels.</p>\n</blockquote>\n\n<hr>\n\n<p>Wavelengths of various <strong>ReptiGlo bulbs</strong> range from 300-640 nm (only UV-A or both UV-A and UV-B), depending on the model; the bulbs have up to 40 Watts (<a href=\"http://www.exo-terra.com/en/products/linear_fluorescent_bulbs.php\" rel=\"nofollow noreferrer\">Exo-terra.com</a>).</p>\n\n<p>Modern <strong>tanning devices</strong> provide mostly UV-A (315-400 nm); the power is 100-200 Watts (<a href=\"https://en.wikipedia.org/wiki/Indoor_tanning\" rel=\"nofollow noreferrer\">Wikipedia</a>).</p>\n\n<p><a href=\"https://www.fda.gov/ForConsumers/ucm186687.htm\" rel=\"nofollow noreferrer\">FDA.gov</a> claims that both UV-A and UV-B rays causes DNA damage, which can lead to skin cancer and that <strong>all use of tanning beds increases the risk of skin cancer,</strong> from which one can conclude that the <strong>UV reptile bulbs could do the same.</strong></p>\n\n<p>According to <a href=\"https://www.aad.org/media/stats/prevention-and-care\" rel=\"nofollow noreferrer\">Indoor Tanning (American Academy of Dermatology)</a>:</p>\n\n<ul>\n<li>Exposure to UV radiation from indoor tanning devices is associated\nwith an increased risk of <strong>melanoma</strong> and nonmelanoma skin cancer,\nincluding <strong>squamous cell carcinoma and basal cell carcinoma.</strong></li>\n<li>Using indoor tanning beds before age 35 can increase your risk of melanoma, the deadliest form of skin cancer, by 59 percent.</li>\n</ul>\n" } ]

[ "https://health.stackexchange.com/questions/18230", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15339/" ]

[ { "answer_id": 18252, "author": "anongoodnurse", "author_id": 169, "author_profile": "https://health.stackexchange.com/users/169", "pm_score": 2, "selected": false, "text": "<p>Breathing in is a an active action requiring muscle. Expiration is passive, so occurs more slowly.</p>\n\n<p>Breathing in - inhalation - takes less time than exhalation.</p>\n\n<blockquote>\n <p>Normal I:E [Inspiration:Experation] ratio at rest and while asleep is 1:2 or less. On exertion the I:E ratio is 1:1. Inspiration is normally an active process (requiring work). Expiration is passive, and usually longer than the time required for exhalation, resulting an a no-flow period. When breathing spontaneously, the work of breathing is minimised by keeping inspiratory times short and tidal volumes low - just enough to get rid of the produced CO2. To minimise collapse, sighs are taken from time to time. </p>\n</blockquote>\n\n<p>Inhalation involves (unconscious) respiratory muscle use, most commonly the diaphragm, but also the chest wall muscles and even neck muscles. As I said, it's all done unconsciously, and it's done about 28,000 times a day. these muscles are doing this constantly and are well toned to do it.</p>\n\n<blockquote>\n <p>The work of breathing is done by the diaphragm, the muscles between the ribs (intercostal muscles), the muscles in the neck, and the abdominal muscles. ... The process of breathing out (called exhalation or expiration) is usually passive when a person is not exercising.</p>\n</blockquote>\n\n<p>Exhalation under normal conditions is passive. It requires no effort from muscles; in fact, it's the opposite: the muscles relax, and you exhale as they do.</p>\n\n<blockquote>\n <p>The process of breathing out (called exhalation or expiration) is usually passive when a person is not exercising. The elasticity of the lungs and chest wall, which are actively stretched during inhalation, causes them to return to their resting shape and to expel air out of the lungs when inspiratory muscles are relaxed. Therefore, when a person is at rest, no effort is needed to breathe out.</p>\n</blockquote>\n\n<p>When exercising, in order to speed O2 delivery to muscles that need it, you must actively assist exhalation. When you need to decrease the expiratory phase duration, you need to actively use muscles not normally used to exhale.</p>\n\n<blockquote>\n <p>During vigorous exercise, however, a number of muscles participate in exhalation. The abdominal muscles are the most important of these. Abdominal muscles contract, raise abdominal pressure, and push a relaxed diaphragm against the lungs, causing air to be pushed out.</p>\n</blockquote>\n\n<p>That's not \"normal\" in relaxed exhalation, therefore the use of these muscles to exhale more actively is noticable.</p>\n\n<p>_{<a href=\"http://www.anaesthesia.med.usyd.edu.au/resources/lectures/ventilation_clt/ventilation.html\" rel=\"nofollow noreferrer\">VENTILATION, VENTILATORS and HUMIDFICATION</a>}<br>\n_{<a href=\"https://www.merckmanuals.com/home/lung-and-airway-disorders/biology-of-the-lungs-and-airways/control-of-breathing\" rel=\"nofollow noreferrer\">Control of Breathing</a>}</p>\n" }, { "answer_id": 18255, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p>Exhaling through tightly pressed lips is called <strong><a href=\"https://en.wikipedia.org/wiki/Pursed_lip_breathing\" rel=\"nofollow noreferrer\">pursed lip breathing</a>,</strong> in which the effort of exhaling is felt only in the lips and cheeks. This way you increase the pressure in the small airways, which expand and thus allow easier elimination of the carbon dioxide from the lungs.</p>\n\n<hr>\n\n<p>Heavy exercise can be associated with excessive inhalation and therefore lung hyperinflation, in which carbon dioxide accumulates in your lungs. Additionally, forced expiration during exercise often collapses the bronchial wall (<a href=\"http://www.vdh.virginia.gov/content/uploads/sites/23/2016/05/MED-3017.pdf\" rel=\"nofollow noreferrer\">Virginia Department of Health</a>).</p>\n\n<p>In such physiological (non-pathological) situations, pursed lip breathing, which widens small airways, can help eliminate excessive air from your lungs. It can also help in stress-related hyperventilation syndrome (<a href=\"https://breathe.ersjournals.com/content/12/2/120\" rel=\"nofollow noreferrer\">Breathe</a>).</p>\n\n<hr>\n\n<p>Uses of pursed lip breathing in <strong>pathological conditions:</strong></p>\n\n<p><strong>1. Exercice-induced bronchoconstriction,</strong> which may or may not be a part of chronic asthma;... Stimuli for asthma attack may include: cold air, stress, physical effort...Exercise-induced bronchoconstriction appears to be common in endurance athletes, who have allergic rhinitis, are female, or who exercise in cold [and dry] weather (<a href=\"https://breathe.ersjournals.com/content/12/2/120\" rel=\"nofollow noreferrer\">Breathe</a>).</p>\n\n<p><strong>2. Emphysema,</strong> which is a type of chronic obstructive pulmonary disease (COPD), with partially collapsed airways (<a href=\"https://www.physiotherapyjournal.com/article/S0031-9406(17)30086-X/pdf\" rel=\"nofollow noreferrer\">Physiotherapy Journal, 2018</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24691248\" rel=\"nofollow noreferrer\">PubMed, 2015</a>)</p>\n\n<p>In summary, pursed lip breathing can be the reaction to normal physiological hyperinflation of the lungs during heavy exercise or due to an obstructive pulmonary disease.</p>\n" } ]

[ "https://health.stackexchange.com/questions/18238", "https://health.stackexchange.com", "https://health.stackexchange.com/users/13877/" ]

[ { "answer_id": 18316, "author": "Szeto", "author_id": 15404, "author_profile": "https://health.stackexchange.com/users/15404", "pm_score": 4, "selected": true, "text": "<p>Fat cells make up adipose tissues. Most fat in our body is stored in adipose tissue. </p>\n\n<p>It is true that <strong>we do not lose fat cells</strong>. Fat cells would only shrink in size.</p>\n\n<hr>\n\n<p>We do respiration all the time, and we need glucose to do it. The sources of glucose include: direct intake, conversion from other sugars, conversion from lipids.</p>\n\n<p>If we intake small amount of sugars and do vigorous exercise, our body will run out of glucose, and thus start extracting lipids from fat cells, and convert them to glucose for respiration. Therefore, fat cells have less content and would shrink.</p>\n\n<p>The whole process is:</p>\n\n<p>lipid from fat cells -> glucose -> undergoes respiration -> carbon dioxide and water -> exhaled</p>\n\n<p>You may refer to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18454136\" rel=\"noreferrer\">this</a> for more details.</p>\n" }, { "answer_id": 18364, "author": "Pherdindy", "author_id": 15443, "author_profile": "https://health.stackexchange.com/users/15443", "pm_score": 2, "selected": false, "text": "<p>Does not really answer your question regarding where fat cells go when you lose weight as it has been already discussed previously by the previous posts, but I had to share the link to the video on \"Where does fat go when you lose it?\". </p>\n\n<p><strong>The biochemistry behind it is:</strong></p>\n\n<p>Fat + Oxygen -> Carbon Dioxide + Water</p>\n\n<p>C₅₅H₁₀₄O₆ + 78O₂ -> 55CO₂ + 52H₂O</p>\n\n<p>Please refer to this video for a very detailed explanation from a Tedx talk: <a href=\"https://www.youtube.com/watch?v=vuIlsN32WaE\" rel=\"nofollow noreferrer\">Mathematics of Weight loss</a></p>\n\n<p>Please refer to this for the article (same author and topic as as the video): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25516540/\" rel=\"nofollow noreferrer\">When somebody loses weight, where does the fat go?</a></p>\n" } ]

[ "https://health.stackexchange.com/questions/18280", "https://health.stackexchange.com", "https://health.stackexchange.com/users/14892/" ]

[ { "answer_id": 18296, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 4, "selected": true, "text": "<p>Tap‐water iontophoresis (TWI) using direct current (DC) is considered by some to be the most effective therapy in palmoplantar hyperhidrosis, although it is debated that botulinum toxin injections may be better (<a href=\"https://doi.org/10.1111/bjd.17044\" rel=\"noreferrer\">Wade, et al. 2018</a>).</p>\n<h2>How does TWI block sweat glands, and what are the side effects?</h2>\n<p>The mechanism of action is unknown. It is hypothesised that an interrupted stimulus‐secretion‐coupling leads to a functional disturbance of sweat secretion (<a href=\"https://www.sweathelp.org/pdf/Reinauer%201993%20-%20Iontophoresis%20with%20alternating%20current%20and%20direct%20current%20offset.pdf\" rel=\"noreferrer\">Reinauer, et al. 1993</a>), which is most likely a transient functional disturbance of the secretory mechanism of eccrine glands (<a href=\"https://doi.org/10.1007/978-3-319-40221-5_95-2\" rel=\"noreferrer\">Hölzle, 2018</a>).</p>\n<p>Side‐effects of this method are discomfort, with burning and tingling, and skin irritation, including erythema and vesicles. Incorrect use may induce iontophoretic burns at sites of minor skin injury. Elaborate safety measures are required to prevent electric shock (<a href=\"https://www.sweathelp.org/pdf/Reinauer%201993%20-%20Iontophoresis%20with%20alternating%20current%20and%20direct%20current%20offset.pdf\" rel=\"noreferrer\">Reinauer, et al. 1993</a>).</p>\n<h2>References</h2>\n<p>Hölzle E. (2018) Iontophoresis. In: John S., Johansen J., Rustemeyer T., Elsner P., Maibach H. (eds) <em>Kanerva’s Occupational Dermatology</em>, 1-14. doi: <a href=\"https://doi.org/10.1007/978-3-319-40221-5_95-2\" rel=\"noreferrer\">10.1007/978-3-319-40221-5_95-2</a></p>\n<p>Reinauer, S., Neusser, A., Schauf, G., &amp; Hölzle, E. (1993). Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. <em>British Journal of Dermatology, 129</em>(2), 166-169. doi: <a href=\"https://doi.org/10.1111/j.1365-2133.1993.tb03521.x\" rel=\"noreferrer\">10.1111/j.1365-2133.1993.tb03521.x</a></p>\n<p>Wade, R., Llewellyn, A., Jones‐Diette, J., Wright, K., Rice, S., Layton, A. M., ... &amp; Woolacott, N. (2018). Management of hyperhidrosis in secondary care. <em>British Journal of Dermatology, 179</em>(3), e138-e138. doi: <a href=\"https://doi.org/10.1111/bjd.17044\" rel=\"noreferrer\">10.1111/bjd.17044</a></p>\n" }, { "answer_id": 18302, "author": "bluenote10", "author_id": 11609, "author_profile": "https://health.stackexchange.com/users/11609", "pm_score": 2, "selected": false, "text": "<p>After some more research it looks like the answers to these questions are indeed still unknown. A recent 2018 article on <a href=\"https://www.cogentoa.com/article/10.1080/2331205X.2018.1486783\" rel=\"nofollow noreferrer\"><em>Proposed mechanism of action of tap water iontophoresis for treatment of hyperhidrosis</em></a> summarizes:</p>\n<blockquote>\n<p>Tap water iontophoresis is commonly used to treat hyperhidrosis, yet the mechanism of action for this treatment remains unknown.</p>\n<p>[...]</p>\n<p>Several hypothesized mechanisms of action have been proposed for this treatment, including the reversible disruption of ion channels (Collin &amp; Whatling, 2000), dermal injury resulting in abnormal keratinization and plugging of the sweat duct (Gordon &amp; Maibach, 1969; Shelley &amp; Horvath, 1950), blockage of neuroglandular transmission (Holze &amp; Ruzicka, 1986), or inhibition of the secretory mechanism at the cellular level. However, studies to date have failed to reveal changes in the eccrine sweat glands or blockages of sweat ducts following iontophoresis (Hill, Baker, &amp; Jansen, 1981; Holze &amp; Ruzicka, 1986), and thus fail to support these hypothesized mechanisms.</p>\n</blockquote>\n<p>The proposed mechanism of action in this article is:</p>\n<blockquote>\n<p>I propose that iontophoresis works via the production of a colloid formed between the products of dark (mucin) and clear (aqueous solution) cells, and the jamming of nanomineral particles inside the lumen and/or the duct of the sweat gland, creating a blockage that temporarily prevents further sweat production or secretion.</p>\n</blockquote>\n<p>Older references on the mechanism of action:</p>\n<ul>\n<li>Reinauer S, Schauf G, Hubert M, Hölzle E (1992): <a href=\"https://www.researchgate.net/publication/296945185_Mechanism_of_action_of_tap_water_iontophoresis_Functional_disturbance_of_the_secretory_epithelium\" rel=\"nofollow noreferrer\">Mechanism of action of tap water iontophoresis: Functional disturbance of the secretory epithelium</a></li>\n<li>Hill AC, Baker GF, Jansen GT (1981): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7261675\" rel=\"nofollow noreferrer\">Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis.</a></li>\n</ul>\n<hr />\n<p>In terms of side effects e.g. effects on skin barrier function, there is some related work on saline iontophoresis:</p>\n<ul>\n<li>Singh J, Gross M, Sage B, Davis HT, Maibach HI (2000): <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10908819\" rel=\"nofollow noreferrer\">Effect of saline iontophoresis on skin barrier function and cutaneous irritation in four ethnic groups.</a></li>\n</ul>\n" } ]

[ "https://health.stackexchange.com/questions/18294", "https://health.stackexchange.com", "https://health.stackexchange.com/users/11609/" ]

[ { "answer_id": 18317, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p><strong>SUMMARY:</strong></p>\n\n<ol>\n<li><p>Individuals with H. pylori infection of the stomach can have increased amounts of the following <strong>substances</strong> in the breath:</p>\n\n<ul>\n<li>Sulfides: hydrogen sulfide (<a href=\"https://www.osha.gov/OshDoc/data_Hurricane_Facts/hydrogen_sulfide_fact.pdf\" rel=\"nofollow noreferrer\">rotten eggs smell</a>), dimethyl sulfide (<a href=\"https://en.wikipedia.org/wiki/Dimethyl_sulfide\" rel=\"nofollow noreferrer\">cabbage-like smell</a>), methyl mercaptane (<a href=\"https://www.atsdr.cdc.gov/MHMI/mmg139.pdf\" rel=\"nofollow noreferrer\">rotten cabbage smell</a>)</li>\n<li>Isobutane (<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/isobutane\" rel=\"nofollow noreferrer\">petroleum-like odor</a>), 2-butanone (<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/2-Butanone#section=Computed-Properties\" rel=\"nofollow noreferrer\">pungent sweet odor</a>) and ethyl acetate (<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/ethyl_acetate#section=Top\" rel=\"nofollow noreferrer\">fruity odor</a>)</li>\n<li>Hydrogen nitrate (<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/nitric_acid#section=Color\" rel=\"nofollow noreferrer\">choking odor</a>) and nitric oxide (<a href=\"https://www.atsdr.cdc.gov/toxfaqs/tfacts175.pdf\" rel=\"nofollow noreferrer\">sharp sweet-smelling</a>) </li>\n<li>Hydrogen cyanide (<a href=\"https://emergency.cdc.gov/agent/cyanide/basics/facts.asp\" rel=\"nofollow noreferrer\">bitter almonds smell</a>)</li>\n</ul></li>\n<li><p>The <strong>variety</strong> of the substances comes from different <strong><em>strains</em></strong> of H. pylori in different individuals and, I assume, from different foods consumed.</p></li>\n<li><p>According to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719490/\" rel=\"nofollow noreferrer\">this 2005 review (Table 3)</a>, <strong>hydrogen nitrate</strong> with choking odor seems to be most specific, but not likely diagnostic, for H. pylori. Isobutane, 2-butanone and ethyl acetate smell like ketones in a low-carb diet or uncontrolled diabetes. Sulfide and cyanide smell can appear in various other infections.</p></li>\n<li><p>The mentioned breath odors are <strong>not anatomic-specific</strong> and may arise not only from the stomach (H. pylori) but also from the mouth (parodontosis), throat (tonsil stones), or lungs (atelectasis).</p></li>\n<li><p>Symptoms, like <strong>upper abdominal bloating and excessive belching after meals,</strong> can help in diagnosis of H. pylori.</p></li>\n</ol>\n\n<hr>\n\n<p><strong>EVIDENCE:</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12090454/\" rel=\"nofollow noreferrer\">Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection (PUbMed, 2002)</a>:</p>\n\n<blockquote>\n <p>The levels of <strong>hydrogen sulphide</strong> and <strong>dimethyl sulphide</strong> in mouth\n air were also significantly higher in the [H pylori] positive\n patients...</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21321973\" rel=\"nofollow noreferrer\">Determination of volatile organic compounds in human breath for Helicobacter pylori detection by SPME-GC/MS (PubMed, 2011)</a>:</p>\n\n<blockquote>\n <p><strong>isobutane, 2-butanone</strong> and <strong>ethyl acetate</strong> were detected in the breath of persons with H. pylori in the stomach...</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16181348/\" rel=\"nofollow noreferrer\">H. pylori infection increases levels of exhaled nitrate (PubMed, 2005)</a>:</p>\n\n<blockquote>\n <p>...in H. pylori-infected patients, levels of exhaled <strong>hydrogen\n nitrate</strong> and <strong>hydrogen cyanide</strong> are found to be significantly\n elevated.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719490/\" rel=\"nofollow noreferrer\">Clinical Application of Volatile Organic Compound Analysis for Detecting Infectious Diseases (PUbMed, 2013)</a>:</p>\n\n<p>This review again mentions <strong>isobutane, 2-butanone, ethyl acetate, HCN</strong> and <strong>hydrogen nitrate</strong> in the breath of H pylori infected patients, but HCN is also detectable in exhaled-breath samples of P. aeruginosa-infected individuals.</p>\n\n<p><a href=\"https://journals.sagepub.com/doi/pdf/10.1177/1721727X1301100129\" rel=\"nofollow noreferrer\">DOES HELICOBACTER PYLORI INFECTION INCREASE THE LEVELS OF EXHALED NITRIC OXIDE?\n(SagePub, 2013)</a>:</p>\n\n<blockquote>\n <p>It seems that H. pylori-associated gastritis is accompanied by an\n increased level of exhaled <strong>nitric oxide</strong>...</p>\n</blockquote>\n\n<p>According to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16721224\" rel=\"nofollow noreferrer\">this study</a>, H. pylori was shown to produce hydrogen sulfide and <strong>methyl mercaptan</strong>...</p>\n" }, { "answer_id": 23564, "author": "Gordon", "author_id": 13819, "author_profile": "https://health.stackexchange.com/users/13819", "pm_score": 0, "selected": false, "text": "<p>Here is an interesting article. “Summary:\nBacteria that cause stomach ulcers and cancer could also be giving us bad breath, according to research published in the Journal of Medical Microbiology. For the first time, scientists have found Helicobacter pylori living in the mouths of people who are not showing signs of stomach disease.” (2008). </p>\n\n<p>“\"Although the presence of H. pylori in the mouth does not directly cause bad breath, it is associated with periodontal disease, which does cause bad breath,\" said Dr. Suzuki. \"We now need to look into the relationship between H. pylori in the mouth and in the stomach. We hope to discover the role of the mouth in transmitting H. pylori stomach infections in the near future.\" <a href=\"https://www.sciencedaily.com/releases/2008/11/081123222846.htm\" rel=\"nofollow noreferrer\">https://www.sciencedaily.com/releases/2008/11/081123222846.htm</a></p>\n\n<p>This would be H. Pylori infection of just the mouth, presumably, or at least not showing “signs” of stomach disease. Bottom line: this odor would be from gum disease caused or accelerated by H. Pylori. </p>\n\n<p>So this is another route by which H. Pylori may contribute to bad breath. </p>\n\n<p>No word on how it smells. Just bad. </p>\n" } ]

[ "https://health.stackexchange.com/questions/18309", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15404/" ]

[ { "answer_id": 18330, "author": "De Novo", "author_id": 14173, "author_profile": "https://health.stackexchange.com/users/14173", "pm_score": 3, "selected": false, "text": "<p>While there is some evidence for what we call a <em>J-shaped curve</em> in the relationship between alcohol consumption and certain health outcomes, at best this evidence only suggests people who already drink modestly have better health outcomes than people who don't drink at all. There is <strong><em>no</strong> strong evidence that starting to drink a glass a day, if you do not drink already</em>, would improve your health outcomes. There is an important point here about study design. Evidence for the J-shaped curve is generally observational, often retrospective, and can only tell you about an association between some variable and a disease outcome. It may be an important association, e.g., a valuable marker for risk of disease, but it doesn't tell you what happens if you change the variable. To know what happens when you change the variable, you typically want a randomized controlled trial. </p>\n\n<p>Abstaining from alcohol (vs. moderate consumption) is likely what we call a confounding variable. It is associated with the variable of interest (some health outcome, e.g., mortality), but it is not on the causal pathway. That is to say, people who don't drink at all may be more likely to be ill (or become ill), but they didn't get that way because they don't drink. This is well explored in <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803651/\" rel=\"nofollow noreferrer\">this meta analysis</a>. A key part here is that former drinkers who currently don't drink any alcohol appear to be the major driver of the higher risk of mortality for individuals who don't drink at all. This suggests earlier heavy drinking or illness that causes someone to stop drinking. </p>\n" }, { "answer_id": 18371, "author": "b-reddy", "author_id": 15453, "author_profile": "https://health.stackexchange.com/users/15453", "pm_score": 2, "selected": false, "text": "<p>The reason you <em>may</em> want to be a moderate drinker is they're found to have lesser rates of death from heart disease and diabetes, which are dominant causes of death in a developed society.</p>\n\n<p>This is one study I'll be referring to, as it got a lot of press last summer,</p>\n\n<ul>\n<li><a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext#fig5\" rel=\"nofollow noreferrer\">Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016</a></li>\n</ul>\n\n<p>Below, if you’re above 1, that means you have greater risk of heart disease. Below 1, lesser risk. Drinkers have less risk, until they get to 6 (!) drinks per day.</p>\n\n<p><a href=\"https://i.stack.imgur.com/bRrAW.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/bRrAW.jpg\" alt=\"heart disease drinkers\"></a></p>\n\n<p>Heart disease deaths, up to a point, go <em>down</em> as people drink more. (Specific chart is for females but same trend happens for males; bottom ticks each represent one standard drink per day.)</p>\n\n<p>Note, you need to live long enough for heart disease or diabetes to potentially kill you in order to get this benefit. If you're in a low income country, alcohol only increases your risk of death:</p>\n\n<p><a href=\"https://i.stack.imgur.com/F7AWt.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/F7AWt.jpg\" alt=\"low socioeconomic country alcohol deaths\"></a>\n<a href=\"https://i.stack.imgur.com/5RcBk.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/5RcBk.jpg\" alt=\"alcohol types of deaths\"></a></p>\n\n<p>If you're in a rich country though, you get <strong>a lot</strong> of benefit from drinking alcohol, practically completely offsetting that initial negative we saw:</p>\n\n<p><a href=\"https://i.stack.imgur.com/YX2cp.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/YX2cp.jpg\" alt=\"alcohol rich country deaths\"></a></p>\n\n<p>If you examine the causes of death above more closely, you'll see ones like violence, cirrhosis, self-harm, etc. One could make an argument these don't apply to our moderate drinker, to where you could get rid of some of those deaths. That is, you're getting less negative and more positive.</p>\n\n<h2>Cancer</h2>\n\n<p>The heart disease connection is fairly well known. Cancer is not as appreciated. Yes, alcohol can increase the risk of cancer, but it can also decrease the risk!\n<a href=\"https://i.stack.imgur.com/SmjoL.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/SmjoL.jpg\" alt=\"cancer alcohol deaths\"></a></p>\n\n<p>From </p>\n\n<ul>\n<li><a href=\"https://academic.oup.com/jnci/article/101/5/296/913713#F1\" rel=\"nofollow noreferrer\">Moderate Alcohol Intake and Cancer Incidence in Women</a></li>\n</ul>\n\n<h2>Pinning down to specific people</h2>\n\n<p>The natural next question is some variety of \"why?\"</p>\n\n<p>People pretty much always go digging for biochemical answers, but as a personal trainer who has talked to many different personalities about alcohol through the years, a (I believe) very under appreciated element of alcohol is the kind of personality who swears it off.</p>\n\n<p>For instance, on one extreme, you have the person who is an alcoholic. Any alcohol turns into way too much. Obviously not healthy.</p>\n\n<p>You also have the person who is trying to be too strict about everything in their lives. Where they're inherently neurotic. Not a recipe for longterm health.</p>\n\n<p>There is research showing drinkers weigh <em>less</em> than non-drinkers. Personally, I've found with my clients some of them, if they have a drink after a rough day, that's the end of it. While others, if they don't drink, might eat a tub of ice cream. I've also seen other trainers / nutritionists tell their clients they can't drink at all anymore, only for the clients to be miserable. \"Going to my weekly date night with my spouse isn't as enjoyable.\"</p>\n\n<p>Alcohol can mean <strong>a lot</strong> to a lot of people's social lives. If swearing it off ends up making you more lonely or isolated, that's not good for the heart. (Seriously. There is literature out there talking about the dangers of loneliness.)</p>\n\n<p>With virtually any health question or topic, you're going to be hard pressed to acceptably paint a brush to how people should behave. (No smoking is probably the only one.) If you have a family history of breast cancer maybe you shouldn't drink; if you have one of thyroid, maybe you should?</p>\n" } ]

[ "https://health.stackexchange.com/questions/18329", "https://health.stackexchange.com", "https://health.stackexchange.com/users/-1/" ]

[ { "answer_id": 18345, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p><strong>Commonly used diagnostic imaging methods</strong> are:</p>\n\n<ul>\n<li>Ultrasonography</li>\n<li>X-ray</li>\n<li>Computed tomography (CT)</li>\n<li>Magnetic resonance imaging (MRI)</li>\n<li>Scintigraphy or radionuclide scan (injecting a radioactive tracer into a vein, waiting until it collects in a certain organ, for example, the thyroid gland, and taking a picture of the tracer distribution with a scanner)</li>\n</ul>\n\n<p>All the mentioned techniques have several variants, for example Doppler ultrasound, an MRI with contrast, etc. The Wikipedia's <a href=\"https://en.wikipedia.org/wiki/Medical_imaging\" rel=\"nofollow noreferrer\">Medical Imaging</a> has a more detailed \"index\" of techiques with links to individual articles.</p>\n\n<p>On Biology SE, there's a list of websites that provide <a href=\"https://biology.stackexchange.com/questions/38774/open-database-of-medical-images/79533#79533\">open-access images</a>, some of which come with the descriptions of cases. Before buying any book, I strongly recommend you to get a clear idea about which types of books can serve your purpose. A book that can be excellent for a doctor or medical student can be useless for you. I also recommend that, for a start, you chose ONE imaging technique and research it a bit, rather than go with all imaging at once; the problems in ultrasonography are significantly different than in CT.</p>\n\n<p>Examples of <strong>weaknesses</strong> of imaging techniques: </p>\n\n<ul>\n<li>A CT and MRI, at least, are expensive.</li>\n<li>An X-ray can show only lesions that are significantly more or less radiopaque than the surrounding tissues (for example, it can show only gallstones rich in calcium but not others).</li>\n<li>An MRI of the gallbladder cannot reliably distinguish between the noncancerous polyps and cancers (<a href=\"https://pubs.rsna.org/doi/10.1148/rg.352140095\" rel=\"nofollow noreferrer\">Radio Graphics</a>).</li>\n<li>The most common problem is probably, that despite high sensitivity (ability to detect a lesion), specificity (ability to reveal/predict an exact type of the lesion) of CT and MRI scans can still be low.</li>\n</ul>\n\n<p><strong>A common question for a health practitioner</strong> that often remains unresolved after imaging is: Is the lesion cancerous or not or how likely will it develop into a cancer. For example, gallbladder polyps greater than 10 mm are significantly more likely cancerous than the smaller ones, but it is not clear if the risk increases after 5 mm or after 15 mm, for example. Also, sometimes imaging fails to show if cancer has spread to nearby organs.</p>\n\n<p>EDIT:</p>\n\n<p>To predict a lesion on a CT image, you need to know how a normal CT image looks and how a lesion looks. The knowledge about what is a lesion came from comparisons of many CT images and the actual physical situations discovered during surgery. Now, to extend this knowledge beyond what you can see with your own eyes on a CT image, you would again need to compare many CT images (using a computer program) with surgery results. </p>\n\n<p>I imagine, this would require a project in which several experienced radiologists, surgeons and computer experts would be involved. <em>One project would need to focus on a single question,</em> for example: What are predictors of gallbladder cancer in abnormal gallbladder growths detected on a CT image? Thousands of CT images and surgery results would then need to be compared to find eventual associations.</p>\n" }, { "answer_id": 18754, "author": "veritessa", "author_id": 9862, "author_profile": "https://health.stackexchange.com/users/9862", "pm_score": 1, "selected": false, "text": "<p>I would like to make a recommendation, as a researcher also working in medical imaging. You state that you are interested in predicting lesion diameter, patient gender, and patient age from the scans. However, when a radiologist reads a scan, they already know the patient gender and the patient age because that information is in the medical record. They also know the reason for the scan. For example, they will often see a display like \"Ms. Smith is a 55-year old woman with a history of lung cancer\" along with the scan itself. (And they can click on the patient's medical record and view everything in the medical record if they want.) So, I think you are better off not predicting things that are already known to the doctor. There are many other cool medical imaging tasks you can do with the DeepLesion data set, e.g. like predicting if there is a lesion in the scan.</p>\n\n<p>Here are some other resources that might help you:</p>\n\n<ol>\n<li>Overview of basic <a href=\"https://glassboxmedicine.com/2019/01/25/anatomy-for-radiology-chest/\" rel=\"nofollow noreferrer\">chest anatomy for radiology</a> and <a href=\"https://glassboxmedicine.com/2019/02/02/anatomy-for-radiology-abdomen/\" rel=\"nofollow noreferrer\">abdomen anatomy for radiology</a></li>\n<li><a href=\"https://glassboxmedicine.com/2019/01/22/anatomy-for-radiology-terms-of-location/\" rel=\"nofollow noreferrer\">Radiology terms of location</a></li>\n<li><a href=\"https://glassboxmedicine.com/2019/02/10/radiology-normal-chest-x-rays/\" rel=\"nofollow noreferrer\">How to read normal chest x-rays</a>. Chest x-rays are not CTs, but if you are just learning about medical imaging it is easier to start with chest x-rays and then move on to CTs</li>\n<li><a href=\"https://www.youtube.com/watch?v=Eg3GeUmOeYE\" rel=\"nofollow noreferrer\">Interpretation of abdominal CTs</a></li>\n</ol>\n" } ]

[ "https://health.stackexchange.com/questions/18342", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15428/" ]

[ { "answer_id": 18345, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p><strong>Commonly used diagnostic imaging methods</strong> are:</p>\n\n<ul>\n<li>Ultrasonography</li>\n<li>X-ray</li>\n<li>Computed tomography (CT)</li>\n<li>Magnetic resonance imaging (MRI)</li>\n<li>Scintigraphy or radionuclide scan (injecting a radioactive tracer into a vein, waiting until it collects in a certain organ, for example, the thyroid gland, and taking a picture of the tracer distribution with a scanner)</li>\n</ul>\n\n<p>All the mentioned techniques have several variants, for example Doppler ultrasound, an MRI with contrast, etc. The Wikipedia's <a href=\"https://en.wikipedia.org/wiki/Medical_imaging\" rel=\"nofollow noreferrer\">Medical Imaging</a> has a more detailed \"index\" of techiques with links to individual articles.</p>\n\n<p>On Biology SE, there's a list of websites that provide <a href=\"https://biology.stackexchange.com/questions/38774/open-database-of-medical-images/79533#79533\">open-access images</a>, some of which come with the descriptions of cases. Before buying any book, I strongly recommend you to get a clear idea about which types of books can serve your purpose. A book that can be excellent for a doctor or medical student can be useless for you. I also recommend that, for a start, you chose ONE imaging technique and research it a bit, rather than go with all imaging at once; the problems in ultrasonography are significantly different than in CT.</p>\n\n<p>Examples of <strong>weaknesses</strong> of imaging techniques: </p>\n\n<ul>\n<li>A CT and MRI, at least, are expensive.</li>\n<li>An X-ray can show only lesions that are significantly more or less radiopaque than the surrounding tissues (for example, it can show only gallstones rich in calcium but not others).</li>\n<li>An MRI of the gallbladder cannot reliably distinguish between the noncancerous polyps and cancers (<a href=\"https://pubs.rsna.org/doi/10.1148/rg.352140095\" rel=\"nofollow noreferrer\">Radio Graphics</a>).</li>\n<li>The most common problem is probably, that despite high sensitivity (ability to detect a lesion), specificity (ability to reveal/predict an exact type of the lesion) of CT and MRI scans can still be low.</li>\n</ul>\n\n<p><strong>A common question for a health practitioner</strong> that often remains unresolved after imaging is: Is the lesion cancerous or not or how likely will it develop into a cancer. For example, gallbladder polyps greater than 10 mm are significantly more likely cancerous than the smaller ones, but it is not clear if the risk increases after 5 mm or after 15 mm, for example. Also, sometimes imaging fails to show if cancer has spread to nearby organs.</p>\n\n<p>EDIT:</p>\n\n<p>To predict a lesion on a CT image, you need to know how a normal CT image looks and how a lesion looks. The knowledge about what is a lesion came from comparisons of many CT images and the actual physical situations discovered during surgery. Now, to extend this knowledge beyond what you can see with your own eyes on a CT image, you would again need to compare many CT images (using a computer program) with surgery results. </p>\n\n<p>I imagine, this would require a project in which several experienced radiologists, surgeons and computer experts would be involved. <em>One project would need to focus on a single question,</em> for example: What are predictors of gallbladder cancer in abnormal gallbladder growths detected on a CT image? Thousands of CT images and surgery results would then need to be compared to find eventual associations.</p>\n" }, { "answer_id": 18754, "author": "veritessa", "author_id": 9862, "author_profile": "https://health.stackexchange.com/users/9862", "pm_score": 1, "selected": false, "text": "<p>I would like to make a recommendation, as a researcher also working in medical imaging. You state that you are interested in predicting lesion diameter, patient gender, and patient age from the scans. However, when a radiologist reads a scan, they already know the patient gender and the patient age because that information is in the medical record. They also know the reason for the scan. For example, they will often see a display like \"Ms. Smith is a 55-year old woman with a history of lung cancer\" along with the scan itself. (And they can click on the patient's medical record and view everything in the medical record if they want.) So, I think you are better off not predicting things that are already known to the doctor. There are many other cool medical imaging tasks you can do with the DeepLesion data set, e.g. like predicting if there is a lesion in the scan.</p>\n\n<p>Here are some other resources that might help you:</p>\n\n<ol>\n<li>Overview of basic <a href=\"https://glassboxmedicine.com/2019/01/25/anatomy-for-radiology-chest/\" rel=\"nofollow noreferrer\">chest anatomy for radiology</a> and <a href=\"https://glassboxmedicine.com/2019/02/02/anatomy-for-radiology-abdomen/\" rel=\"nofollow noreferrer\">abdomen anatomy for radiology</a></li>\n<li><a href=\"https://glassboxmedicine.com/2019/01/22/anatomy-for-radiology-terms-of-location/\" rel=\"nofollow noreferrer\">Radiology terms of location</a></li>\n<li><a href=\"https://glassboxmedicine.com/2019/02/10/radiology-normal-chest-x-rays/\" rel=\"nofollow noreferrer\">How to read normal chest x-rays</a>. Chest x-rays are not CTs, but if you are just learning about medical imaging it is easier to start with chest x-rays and then move on to CTs</li>\n<li><a href=\"https://www.youtube.com/watch?v=Eg3GeUmOeYE\" rel=\"nofollow noreferrer\">Interpretation of abdominal CTs</a></li>\n</ol>\n" } ]

[ "https://health.stackexchange.com/questions/18359", "https://health.stackexchange.com", "https://health.stackexchange.com/users/99/" ]

[ { "answer_id": 18384, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 4, "selected": true, "text": "<p><strong>CAUSES and RISK FACTORS</strong> of skin tags</p>\n\n<p>In general, the exact cause and therefore prevention of skin tags is not known (<a href=\"https://emedicine.medscape.com/article/1060373-overview#showall\" rel=\"nofollow noreferrer\">Emedicine</a>). In some cases, skin tags could be associated with the following conditions:</p>\n\n<ul>\n<li>Skin aging and skin irritation due to obesity (<a href=\"https://emedicine.medscape.com/article/1060373-overview#showall\" rel=\"nofollow noreferrer\">Emedicine</a>)</li>\n<li>Diabetes type 2, especially if accompanied with metabolic syndrome (obesity, hyperglycemia, high blood pressure, high cholesterol levels) (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991940/\" rel=\"nofollow noreferrer\">PubMed, 2014</a>)</li>\n<li>Human papillomavirus infection - a sexually transmitted disease (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18583787\" rel=\"nofollow noreferrer\">PubMed, 2008</a>)</li>\n<li>Crohn's disease (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783618/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>)</li>\n<li>Acromegaly or gigantism - increased growth due to increased levels of the growth hormone (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16828406\" rel=\"nofollow noreferrer\">PubMed, 2006</a>)</li>\n<li>Genetic predisposition, Birt-Hogg-Dube syndrome and Nonne-Milroy-Meiges syndrome (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477464/\" rel=\"nofollow noreferrer\">PubMed, 2015</a>)</li>\n</ul>\n\n<p><strong>SKIN TAGS AS MARKERS OF COLONIC POLYPS</strong></p>\n\n<p>Studies and reviews that have found <em>no association</em> between skin tags and colonic polyps: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8410406\" rel=\"nofollow noreferrer\">PubMed, 1993</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2754216\" rel=\"nofollow noreferrer\">PubMed, 1989</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783618/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>.</p>\n\n<p>Some small studies have found <em>some association</em> between skin tags and colonic polyps: <a href=\"http://annals.org/aim/article-abstract/696614/skin-tags-cutaneous-marker-colonic-polyps?doi=10.7326%2F0003-4819-98-6-928\" rel=\"nofollow noreferrer\">Annals of Internal Medicine, 1983</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3722480\" rel=\"nofollow noreferrer\">PubMed, 1986</a>. The association may be coincidental, since the prevalence of skin tags can be as high as 46% (<a href=\"https://emedicine.medscape.com/article/1060373-overview#showall\" rel=\"nofollow noreferrer\">Emedicine</a>).</p>\n\n<p><strong>PREVENTION</strong> of skin tags can include losing weight (if necessary), avoiding skin irritation, avoiding sexually transmitted diseases and treating eventual underlying disorders. </p>\n\n<p>Skin tags do not likely develop into skin cancers (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK448169/\" rel=\"nofollow noreferrer\">Stat Pearls</a>).</p>\n\n<p>A dermatologist can <strong>REMOVE</strong> skin tags if necessary; the growths usually do not recur (<a href=\"https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13999/ProceduresSkinTagRemoval.pdf?sequence=1&amp;isAllowed=y\" rel=\"nofollow noreferrer\">University of Missouri</a>).</p>\n\n<p><a href=\"https://www.dermnetnz.org/topics/skin-tag/\" rel=\"nofollow noreferrer\">Pictures</a></p>\n" }, { "answer_id": 18386, "author": "Chris Rogers", "author_id": 7951, "author_profile": "https://health.stackexchange.com/users/7951", "pm_score": 2, "selected": false, "text": "<p>Adding to @Jan's answer, to answer the part of the question regarding how skin tags are formed, I have found that <a href=\"https://www.aocd.org/page/SkinTags\" rel=\"nofollow noreferrer\">according to the American Orthopaedic College of Dermatology (AOCD)</a>, <strong>the actual cause of acrochordons is unknown, as it is not actually known how they are formed</strong>. There are <strong>several theories</strong> however:</p>\n\n<ul>\n<li>Irritation or friction to the skin, caused by skin rubbing on skin may play a role in their formation.</li>\n<li>Diabetes causing skin tags is thought to be through insulin resistance.</li>\n<li>The Human Papilloma Virus (HPV) was present in a high percentage of growths in a study of 49 patients with skin tags, suggesting the virus plays a role in development.</li>\n<li>It is also possible that skin tags are genetic or simply due to normal aging and loss of skin elasticity.</li>\n</ul>\n\n<p>Interestingly the AOCD also mentions that a rare genetic disorder called Birt-Hogg-Dube (BHD) Syndrome is characterised by numerous skin tags along with other symptoms, however looking at <a href=\"https://rarediseases.org/rare-diseases/birt-hogg-dube-syndrome\" rel=\"nofollow noreferrer\">the National Organisation for Rare Disorders (NORD) webpage for BHD syndrome</a>, these \"skin tags\" are known as <em>fibrofolliculomas</em> and appear to be different.</p>\n\n<blockquote>\n <p>The skin papules known as fibrofolliculomas that are associated with BHD syndrome commonly occur on the scalp, face and neck, but can also be found on the ear lobes and in the oral mucosa. They are generally 2-3mm in size, dome shaped, flesh-colored and are not associated with any pain or discomfort.</p>\n</blockquote>\n\n<p>Going by the theories mentioned by the AOCD, if skin tags are caused by skin friction, or aging and loss of skin elasticity, maintaining a healthy weight can reduce the numbers as there will be less skin folds to cause skin rubbing, but otherwise, there may be nothing really that can be done to prevent skin tags.</p>\n" } ]

[ "https://health.stackexchange.com/questions/18379", "https://health.stackexchange.com", "https://health.stackexchange.com/users/7951/" ]

[ { "answer_id": 18401, "author": "Jiminy Cricket.", "author_id": 15405, "author_profile": "https://health.stackexchange.com/users/15405", "pm_score": 4, "selected": true, "text": "<blockquote>\n<p>What is the difference between Meniere's disease and Meniere's\nsyndrome? Is there any difference between the symptoms?</p>\n</blockquote>\n<p>Merriam-Webster defines <a href=\"https://www.merriam-webster.com/dictionary/disease\" rel=\"nofollow noreferrer\"><em>Disease</em></a> as:</p>\n<blockquote>\n<p>1 : a condition of the living animal or plant body or of one of its\nparts that impairs normal functioning and is typically manifested by\ndistinguishing signs and symptoms.</p>\n</blockquote>\n<p>and it defines <a href=\"https://www.merriam-webster.com/dictionary/syndrome\" rel=\"nofollow noreferrer\"><em>Syndrome</em></a> as:</p>\n<blockquote>\n<p>1 : a group of signs and symptoms that occur together and characterize\na particular abnormality or condition</p>\n<p>2 : a set of concurrent things (such as emotions or actions) that\nusually form an identifiable pattern</p>\n</blockquote>\n<p>To expand upon the basic framework supplied by the dictionary, <a href=\"https://emedicine.medscape.com/article/1159069-overview\" rel=\"nofollow noreferrer\">medscape.com</a> clarifies matters:</p>\n<blockquote>\n<p>Ménière disease is endolymphatic hydrops of unknown etiology (ie,\nidiopathic endolymphatic hydrops). [<strong>Making it the primary condition.</strong>]</p>\n<p>Ménière syndrome is endolymphatic hydrops caused by a specific\ncondition. [<strong>ie. by any of a number of known primary causes, making the syndrome secondary as such.</strong>]</p>\n<p>...both of which are both believed [<strong>sic</strong>] to result from increased pressure\nwithin the endolymphatic system.</p>\n<p>However, Ménière disease is idiopathic by definition, whereas Ménière\nsyndrome can occur secondary to various processes interfering with\nnormal production or resorption of endolymph.</p>\n</blockquote>\n<p>[<em>Words in bold - mine.</em>]</p>\n<p>It is the focus of close attention:</p>\n<blockquote>\n<p>With the growing understanding of the pathophysiology and disease\nprocesses involved with Ménière disease a re-evaluation and possible\nredefinition of this condition are well underway.</p>\n</blockquote>\n<p>Edited: By suggestion of Jan.</p>\n" }, { "answer_id": 18431, "author": "Camille Markham", "author_id": 15491, "author_profile": "https://health.stackexchange.com/users/15491", "pm_score": 2, "selected": false, "text": "<p>Basically the disease is the ailment Currently, the etiology (cause or underlying pathophysiology) of that ailment is still being researched and defined. But the disease is not a symptom of another disease process. \nThe syndrome is exactly that. A person has a disease with symptoms that are the same as the disease or highly similar, but the cause of those symptoms are actually another disease process. \nI wasn't trying to be condescending. I just feel like I tried to explain in the simplest terms which made it a long and convoluted explanation. \nDo you understand?</p>\n" } ]

[ "https://health.stackexchange.com/questions/18392", "https://health.stackexchange.com", "https://health.stackexchange.com/users/15467/" ]

[ { "answer_id": 18428, "author": "Jan", "author_id": 3002, "author_profile": "https://health.stackexchange.com/users/3002", "pm_score": 2, "selected": false, "text": "<p><strong>1.</strong> Some individuals with pollen allergy experience mouth itching and swelling after eating certain <em>raw</em> fruits, vegetables and tree nuts. The condition is called <a href=\"https://acaai.org/allergies/types/food-allergies/types-food-allergy/oral-allergy-syndrome\" rel=\"nofollow noreferrer\"><strong>oral allergy syndrome</strong></a> or <strong>pollen-food syndrome.</strong></p>\n\n<p><strong>2. A certain food allergy as such</strong> may increase intestinal permeability <strong>(leaky gut syndrome)</strong> and allow additional allergens to enter the blood, which can result in multiple food allergies (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16880015/\" rel=\"nofollow noreferrer\">PubMed, 2006</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288588/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>).</p>\n\n<p><strong>3.</strong> The use of <strong><a href=\"https://medicalsciences.stackexchange.com/questions/18354/is-there-solid-evidence-that-antibiotics-cause-allergies\">antibiotics</a></strong> in infancy can increase the risk of food allergies later in life.</p>\n\n<p><strong>4. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751572/\" rel=\"nofollow noreferrer\">Orofacial granulomatosis</a></strong> (which may or may not be associated with Crohn's disease) increases the risk for food allergies. A cinnamon- and benzoate-free diet can help (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16775496/\" rel=\"nofollow noreferrer\">PubMed, 2006</a>).</p>\n\n<p><strong>5.</strong> Children with <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696370/\" rel=\"nofollow noreferrer\">inflammatory bowel disease (Crohn's disease or ulcerative colitis)</a></strong> are at increased risk for food allergies. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230978/\" rel=\"nofollow noreferrer\">Another study</a> has found an association between inflammatory bowel disease and food allergies.</p>\n\n<p><strong>6. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16292078/\" rel=\"nofollow noreferrer\">Infections</strong> or <strong>stress</strong></a> may increase intestinal permeability and thus induce food allergies in susceptible individuals.</p>\n\n<p><strong>7.</strong> Due to <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482820/\" rel=\"nofollow noreferrer\">cross-reactivity</a></strong>, certain non-food allergens can trigger food allergies: <em>Alternaria</em> (a common mold)-spinach syndrome, dust mite-shrimp syndrome, cat-pork syndrome and bird-egg syndrome.</p>\n\n<hr>\n\n<p>As a side note, <a href=\"https://www.kidswithfoodallergies.org/page/food-protein-induced-enterocolitis-syndrome-fpies.aspx\" rel=\"nofollow noreferrer\">food protein-induced enterocolitis syndrome (FPIES)</a> can develop in infants after introducing solid foods and can present with multiple food allergies, which, unlike traditional IgE-mediated allergies, do not cause itching, hives, swelling, coughing or wheezing, but \"only\" gastrointestinal symptoms, such as diarrhea.</p>\n" }, { "answer_id": 18429, "author": "Camille Markham", "author_id": 15491, "author_profile": "https://health.stackexchange.com/users/15491", "pm_score": 1, "selected": false, "text": "<p>Experts believe having eczema increases the risk a child may develop food allergies and other allergic conditions later in life.\nAbout one-third of children with moderate to severe eczema have diagnosed food allergies. Likewise, about 30 to 40 percent of all people with eczema also have one or more food allergies.\nAccording to a recent study, young children with food allergies are more than twice as likely to develop asthma or rhinitis before age 5, compared to those without food allergies. The risk for respiratory allergies is higher in children who are allergic to milk, egg or peanut. This is also true for children with multiple food allergies (<a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">http://www.aaaai.org/</a>).</p>\n\n<p>Chronic respiratory symptoms are not thought to be caused by food allergies. When respiratory symptoms occur during allergic reactions to foods, they occur suddenly and usually are not the only symptom. Instead, they appear alongside other symptoms affecting the skin, gastrointestinal tract and other parts of the body (<a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">http://www.aaaai.org/</a>)</p>\n\n<p>People with both asthma and food allergies are at higher risk of experiencing life-threatening anaphylaxis during a food allergy reaction. Research has similarly shown that having a food allergy is linked to having worse asthma symptoms and more hospitalizations from asthma.\nIgg is the immune response to pathogens like bacteria, viruses, and fungi. It is not the type of response typical to allergens.\nIn an Allergic March the typical sequence is patients develop allergic diseases; starting first with eczema, then followed by food allergy, asthma, and allergic rhinitis <a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">aka hay fever</a>.\nI believe it is worthy to both look for an underlying cause and attempt desensitization. There may be an underlying condition that is linked to the food allergies. Yet, desensitization may also work and alleviate some of the person's suffering. </p>\n" } ]

[ "https://health.stackexchange.com/questions/18396", "https://health.stackexchange.com", "https://health.stackexchange.com/users/3002/" ]