A. If there is a history of osteoporosis in your family; if you are thin, white or Asian; if you smoke or have used steroids for long periods of time; if you had irregular periods throughout most of your life; or if you are sedentary, then you are at higher risk for osteoporosis and should be screened.

If you show osteopenia (beginning of bone loss), then you should begin calcium supplementation and weight-bearing exercise and stop smoking (of course everybody should stop smoking anyway!).

If there are signs of early osteoporosis, then treatment with a medication like Fosamax should be considered. Raloxifene (Evista) is a new medication just approved by the FDA for preventing osteoporosis in postmenopausal women.

The usual preventive therapy for osteoporosis is estrogen, which is normally avoided in women who have had breast cancer. However, estrogen can be considered in some women who have had breast cancer; you need to be discuss this extensively with your gynecologist, breast surgeon and oncologist.

“Older adults with the (gene) experienced significantly greater (memory) decline” as measured by a series of tests, say researchers at Stanford University in Stanford, California, and the IVA Palo Health Care System in Palo Alto, California. Their report is published in the December issue of the Journal of the American Geriatrics Society.

The APOE gene helps regulate the activity of apolipoprotein E, a compound involved in the maintenance and repair of nerve cells. A number of studies have already associated the APOE e4 variant of the gene with accelerated mental decline. Two recent studies found that between 25% to 50% of APOE e4 carriers will eventually go on to develop Alzheimer’s disease.

The California team sought to determine if the gene variant might also be related to mid- or late-life declines in mental function. They conducted genetic and memory testing on a group of 100 individuals aged between 50-95 years, all of whom said they were “concerned about their memory function.”

The authors report that APOE e4 carriers “scored lower on a delayed recall task than those without an e4 (variant).” And they found that APOE e4 carriers who scored poorly on memory tests were “significantly younger” than other study subjects. This finding echoes the results of previous studies, which found that “the association between the e4 (variant) and (Alzheimer’s disease) is strongest in subjects younger than 70.”

At this point, the study authors do not know whether APOE e4-related memory loss in mid- or late-life constitutes an early stage of Alzheimer’s disease, or is instead a separate (and less disabling) condition. The researchers believe further study is needed to determine “whether decline on delayed recall tasks is one of the first of many cognitive changes to occur in older adults with the e4.”

“For the most part, it was resistance on the part of the surgeons — ‘This couldn’t happen to me,’ or ‘The patient will lose confidence in me,’” says Croteau, “When we’ve talked to patients, they think it’s a great idea.”

Because not all surgeons are listening, the commission is turning its attention to the patients.

“The key message here is that the patient is part of the health-care team, and the patient can help with his or her own safety by asking their surgeons to mark the site,” Croteau says.

“I agree completely with the Joint Commission that patients should ask, ‘What test am I going for?’ And marking a limb might make sense, but we’re talking about a very, very low risk,” Hayward notes.

The commission is also going to raise the stakes for hospitals and other ambulatory facilities. Right now, the “recommendations” lie somewhere between voluntary and mandatory, but the balance is likely to shift towards mandatory.

“Within the next year, we will begin a process of actively evaluating compliance with these recommendations under our accreditation standards. This makes it much more of a requirement,” says Croteau.

If the facilities fail to take appropriate actions to prevent wrong-site surgery, he adds, “they could ultimately lose their accreditation.”

What To Do

The Joint Commission on Accreditation of Healthcare Organizations advises consumers to:

Discuss your surgery with your surgeon and your primary care doctor and make sure all parties agree on exactly what will be done during the operation;

Ask to have the surgical site marked with a permanent marker and to be awake when the site is marked;

Speak up if you have any concerns. It’s OK to ask questions and expect answers that you understand;

Think of yourself as an active participant in your health care. Studies show that patients who are actively involved in making decisions about their care are more likely to have good outcomes;

And insist that your surgery be done at a JCAHO-accredited facility. These hospitals and surgery center have undergone rigorous on-site evaluations.

Prompted by the continuing errors, the watchdog agency, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), issued another alert this week to 18,000 health-care facilities across the nation.

The errors mentioned in the alert — operating on the wrong patient, performing the wrong procedure, and operating on the wrong site — are all “totally preventable,” says Doctor, executive director for strategic initiatives at the commission.

The phenomenon is hardly an epidemic, and experts caution against hysteria. Only 150 such errors have been reported since 1996.

“These are rare events. The problem is getting them to be zero,” says Doctor, director of the VA Center for Outcomes Research and a professor of medicine and public health at the University of Michigan, both in Ann Arbor. “People shouldn’t be afraid that this is a common thing.”

About 40 percent of the cases, however, involved major procedures, including brain surgery and mastectomy.

The commission presented statistics based on 126 of the 150 cases. Of those, 41 percent occurred during orthopedic/podiatric surgery, 20 percent during general surgery, 14 percent during neurosurgery, 11 percent during urologic surgery, and the remainder scattered among a variety of procedures.

By far, the majority — 75 percent — involved operating on the wrong part of the body; 13 percent involved cutting open the wrong patient, and 11 percent involved the wrong procedure.

Why are these mistakes happening?

It’s often because the patient got switched to a different operating room or because X-rays were viewed in reverse, the commission says.

The guidelines issued two years ago were intended to reduce this sort of error, it adds.

The main recommendation put out to surgeons was a deceptively simple one: Mark the site of the incision with a permanent marker. Other recommendations included going through a detailed checklist before each surgery and taking a “time out” in the operating room before starting a procedure so that surgical team members can double-check that they’re doing the right thing on the right part on the right patient.

“Of all the cases that we have, none of them occurred in an organization which was following our recommendations,” Croteau notes.

High levels of testosterone may protect young men from death or disability after head trauma, researchers say, but this protection declines as testosterone levels fall with age.

On the other hand, high levels of circulating estrogen may render women especially vulnerable to head injury in their youth.

The findings are important because “if young girls and young women are at increased risk for a bad outcome following traumatic brain injury, they might require more intensive monitoring and treatment,” said researcher Doctor of the University of California, San Diego. He presented the findings in San Diego on Sunday at the annual meeting of the Society for Neuroscience.

Farin and co-author Doctor examined data collected in two previous studies on traumatic brain injury involving over 2,300 hospitalized male and female patients of all ages.

The investigators found that “younger men (men under 50) have the best chance of survival after head injury when compared to older men or women of all ages,” Biegon told Reuters Health.

In fact, among children under 10 years of age, girls were found to be four times as likely to die from head injury compared with boys. Compared with women, men continued to have a better chance of post-injury recovery throughout their teens, 20s, 30s and 40s.

This injury “gender gap” reversed in individuals aged 50 and above, however. According to Farin, “women in their 50s, 60s or 70s are roughly twice as likely to survive traumatic brain injuries than men in the same age group.”

The reasons for these sex-based differences in outcomes may lie in circulating levels of male and female hormones. Biegon pointed out that testosterone “bulks up” brain mass in men, just as it bulks up muscles. This hormone-dependent increase in brain mass may offer young men added protection from head injury. That level of protection would later decline, however, as testosterone levels dropped with age.

On the other hand, fluctuations in estrogen and progesterone in premenopausal women might raise their levels of risk following brain injury. “For example,” Biegon said, “fluid retention–known to be part of the menstrual cycle–may be responsible for higher rates of brain swelling in younger women, which is know to be correlated with worse outcome.”

Further studies are planned to confirm whether or not sex hormones are responsible for observed differences in head trauma outcomes between the sexes. If the results of those studies are positive, the next logical step might be to test hormones as possible treatments for patients recovering from head injury.

“This would be welcome news,” Biegon said, since unlike many treatments for head injury, “the risks and benefits of sex hormones are extremely well characterized.”

In North America, preschool daycare centres are important reservoirs for HAV transmission. In one US study, it was estimated that one-third of all reported cases of HAV could be linked to daycare centers. The young children, who are “vectors” of infection, typically remain asymptomatic while their caregivers, parents and older siblings manifest jaundice and symptomatic hepatitis.

Sexual transmission of HAV is well described, particularly among homosexual males. The widespread practice of “safe sex” techniques has led to a paradoxical increase in cases reported in this group, likely related to the handling of soiled condoms.

Spectacular point-source epidemics of HAV have been widely reported in the media, but account for only a very small proportion of cases. Outbreaks have been traced to infected food handlers or other common sources. Some cases of HAV are related to the ingestion of raw shellfish. Bivalve shellfish (mollusks, not crustaceans) concentrate HAV from sewage-polluted water.

A scheme of the clinical and virological events in hepatitis A is presented in Figure 1. The incubation period is 28 days (range 20-45 days). Virus is shed in the feces for the last two weeks of the incubation period and may also be found in the blood. Prodromal symptoms such as fatigue, anorexia and lowgrade fever may be present late in the incubation period. By the time jaundice and elevated liver enzymes occur, antibodies to the virus are detectable in serum and fecal shedding of virus has ceased. IgM anti-HAV antibody is detectable in an acute infection and typically disappears within six months of infection. Neutralizing IgG anti-HAV antibody persists for life and provides immunity from repeat infection.

The single most important predictor of the clinical course of an acute HAV infection is age. As described above, symptomatic infections are uncommon in young children. In adults, 75 to 95% of infections are symptomatic, with jaundice in the majority of cases. Fulminant hepatic failure is rare but increases over the age of 40, and possibly in the context of underlying chronic liver disease (see: HAV Vaccination).

In some individuals, HAV causes a biphasic illness with a second bout of jaundice and cholestasis six to 12 weeks after the primary infection. Chronic HAV infection does not occur and liver enzymes are almost always normal within six months of infection.

The course of HAV infection may be modified through the appropriate use of pooled human immunoglobulin. In household contacts, passive prophylaxis with immunoglobulin within two weeks of exposure reduces icteric disease by more than 80% although infection is not necessarily prevented. Immunoglobulin has previously been recommended to temporarily protect against HAV infection in travellers to endemic regions of the world. Long-term immunity can now be afforded by active immunization.

Or maybe they don’t matter at all. Credentials are a process indicator, not an outcome indicator. Process indicators are often necessary, but they have limited roles in developing good outcome indicators. Rehabilitation and recovery are the primary service goal; does it follow that only credentialed professionals ought to deliver quality screening and assessment? With in-service training, could others do as good a job?

At the heart of this discussion lies the issue of how quality is to be perceived, defined, and measured. Credentials alone do not guarantee a high-quality outcome, but only permit it as a possibility. Other elements, such as active consumer participation or the specific content of screening and assessment can contribute as much, or even more, to the quality of screening and assessment. One national trend, for example, is that more and more screening and assessment instruments are standardized, and include consumers’ self-reporting as an integral part of information gathering.

There is a clear place for credentialed professionals to perform assessment – in diagnostic evaluation (including psychosocial assessment) to assist service planning and intervention. Ideally, the same professional is engaged with the consumer throughout the process and is accountable for service outcomes. However, information gathering can sometimes be performed by others, as long as interpretation for evaluation rests with the credentialed professional. A recent study by the Center for Social Work Practice at Columbia University found that standardized screening and assessment information gathered by consumers and non-credentialed professionals can be used effectively by credentialed personnel in making sound assessment and service plans.

The idea that only credentialed professionals can provide high-quality behavioral health screening and assessment is one of the tenets of mental health and substance abuse services, based on the assumption that credentialed professionals can help ensure accountability and quality of screening and assessment.

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Yet one troubling phenomenon that has permeated public behavioral health systems is the repetitive assessments performed at each referral. As a consequence, in addition to the constraint of relying on credentialed professionals to perform various service tasks, barriers to service – not to mention additional cost – are further created by repetitive assessments.

Systemic lupus erythematosus (SLE) is a chronic (constant) autoimmune (attacks itself) disease that attacks mostly through its negative influence on blood vessels, which are necessary for the maintenance of every part of the body. What that means in English is; It is an autoimmune disease and is a result of an over active immune system, meaning that the antibodies attack the body instead of protect it from diseases, bacteria and viruses.

Lupus is not contagious or infectious and although no one is quite sure what the cause is, it is thought to be hereditary and/or environmental and it can be life threatening. It is believed that certain things may trigger the onset of lupus or cause lupus to flare, these include- Ultraviolet light, certain prescription drugs & antibiotics, infections or viruses, hormones & stress.

At this time, there is no cure but the survival rate has gone from 50% to approximately 90%. Lupus affects different people in different ways and is often misdiagnosed. More people have lupus than leukemia, multiple sclerosis & muscular dystrophy

There are different forms of Lupus: Discoid Lupus affects the skin; Systemic Lupus Erythematosus attacks any of the body organs, joints and lungs; Drug Induced Lupus is caused when certain drugs create lupus-like symptoms. Women represent 90% of the people diagnosed with Lupus and minority women are diagnosed with Lupus at three times the rate of Caucasians. Lupus can strike at any age and many people look perfectly healthy. Discoid lupus can turn into systemic lupus in about 10% of cases. Systemic lupus cannot be reversed where as drug induced lupus can once the medication is discontinued. Drug induced lupus does not have central nervous system or kidney involvement.

Signs and symptoms of Lupus:

· Persistent fatigue

· Persistent weakness

· Aching all over

· Fever, which may be low grade to high

· Loss of appetite

· Involuntary weight loss

· Hair loss

· Nose bleeds

· Mouth sores

· Skin rash anywhere on the body

· Hives

· Sores

· Painful & swollen joints (arthritis)

· Stiffness of the joints when waking up.

· Chest pain

· Shortness of breath

· Persistent headache

· Nausea or vomiting

· Recurring or persistent abdominal pain

· Swelling of the feet and legs

· Puffy eyelids

· Blood in the urine

· Swollen glands

· Headaches

Medications that have been proven to induce drug related lupus are:

· Procainamide (used for heart rhythm abnormalities),

· Hydralazine (used for high blood pressure)

· Isoniazid (used for tuberculosis)

· Quinidine (used for heart rhythm abnormalities)

· Phenytoin (used for seizures

1. Lupus is difficult to diagnose and can imitate other diseases. When discussing the possibilities with a doctor (preferably a rhuematologist) have him/her take some of these commonly used test:

2. Anti nuclear test is used to determine if autoantibodies to cell nuclei are in the blood.

3. Anti-DNA test is used to determine if there are antibodies in the genetic material in the cell

4. Anti-Sm antibody test determines if there are antibodies to SM, which is a protein found in the cell nucleus

5. Detection for the presence of immune complexes in blood

6. Test to determine the level of serum complement, a group of proteins, which can occur in immune reactions

7. LE cell prep is an examination of the blood to look for a certain kind of cell, which can occur in immune reactions and other tests to check the level of C4 and C4 proteins.

It is incredibly important to not only catch lupus in its early stages but to align ourselves with good physicians and the latest developments surrounding this disease. Because this disease mimics so many others and there are so many symptoms involved, doctors tend to brush away our complaints. Know your body, know what hurts when and learn the value of research.

GLOSSARY

Antibodies-(Proteins produced by the body that are supposed to stick to bacteria and make it easy for white blood cells to destroy them. With an autoimmune disease the white blood cells attack healthy cells as well as unhealthy cells.)

Caffeine causes central nervous system stimulation by arresting the phosphodiesterase, which in turn increases the accumulation of c-AMP (cyclic adenosine 3’5′-monophosphate.) Fioricet may decrease the effectiveness of oral anticoagulants, corticosteroids, estrogens, griseofulvin (an anti-fungal drug), doxycycline, theophyllines, quinidine, and beta-adrenergic blockers. The toxic effects of a general anesthetic, methoxyflurane might be heightened by Fioricet. The potential for hepatotoxicity increases if Fioricet is utilized in conjunction with hydantoins or sulfinpyrazone. Fioricet might be more toxic if used with alcohol and various CNS depressants.

If you are someone who has a sensitivity to any part of Fioricet, then Fioricet might be wrong for you. Fioricet should be used with caution if you have increased intracranial pressure, any head injury, severe liver or kidney impairment, Addison’s disease, hypothyroidism, and prostatic hypertrophy or urethral stricture.

Side effects of using Fioricet may be dizziness, drowsiness, and lightheadedness. Because Fioricet makes people lightheaded, be careful when operating machines or when you are participating in activities that you need to be mentally alert for, like driving. While using Fioricet, don’t drink any type of alcohol. You can eat food or drink milk if you feel sick to your stomach. Put Fioricet away in a cool, dry place, out of sunlight and away from kids. You should be aware that Fioricet is very addictive, and so should just be used under careful supervision. Use Fiorcet just for the time it is prescribed, in the suggested dosage, and don’t take it more often than prescribed.

When used the right way, your tension headaches and migraines should feel better. If you think Fioricet isn’t working like it should, discuss it with your doctor so that he can prescribe something else for you.

Buying generic drugs is the most obvious first step you should take. There are medicines that are exactly like the name brand ones, however you pay much less money for them. This is really the same, but since the manufacturer of the generic version doesn’t have to use money to research it, advertise it, and it has already been accepted, they can be manufactured at a lesser cost. You should always check with your physician to see if there is a generic drug substitute, although one may not always be available.

If you’ve been taking the medicine for a long time, you should look around for cheaper options. They aren‘t always the same. Look on the Internet to find online pharmacies that sell prescription drugs cheaper.

You can also see if your doctor has something known as therapeutic substitution, which takes the place of a prescription drug by using a less costly drug, or a natural product, that you can use, that will help you just as much as the prescription drug.

Prescription drug card programs have been designed by some pharmaceutical companies to make their medications more affordable for people who otherwise would not be able to purchase them.

It is not a good idea to split the dosage to increase the amount of time that your prescription lasts. When a doctor suggests a precise dosage of a drug for you for a stated time period, there is a reason why. It would be very dangerous to veer from a doctor’s recommended medication dosage.

Don’t just believe that you are required to spend full price when you buy prescription drugs since there are several options available for you to choose from.