Thursday, 22 May 2014

Steroids and Cancer Treatments

When you hear the word steroid you may think of "roid rage" and muscle-bound gym rats with shrunken testicles. But if your doctor prescribed steroids as part of your treatment for cancer or another serious illness, don't worry. It's not "that" kind of steroid.
Your doctor is actually talking about cortisol, a form of steroid that your body produces naturally. It's different from anabolic steroids, which are the illegal muscle-building kind.

How Steroids Help

Although the cortisol-type steroids prescribed for cancer treatment are different from anabolic steroids, you still need to take them under the close supervision of your doctor or medical specialist.
You'll probably get a manmade version of the natural steroid cortisol, such as:
  • cortisone
  • hydrocortisone
  • prednisone
  • methylprednisolone
  • dexamethasone
These can help with your treatment in a variety of ways:
  • reduce nausea associated with chemotherapy and radiation
  • kill cancer cells and shrink tumors as part of chemotherapy
  • decrease swelling
  • reduce allergic reactions (before transfusions, for example)
  • lessen headaches caused by brain tumors
Sometimes, your doctor will recommend steroid treatments just to help you sleep, eat, and feel better.
Doctors can prescribe steroids for cancer treatment several ways:
  • by injection
  • through an intravenous (IV) drip
  • in liquid or pill form
  • as a cream

Steroids used in medical treatments can have some side effects, although they're not as extreme as the side effects from anabolic steroids. Talk to your doctor and ask questions if you're worried.
You may not have any side effects. But if you do, don't worry — they'll only last as long as you're taking the steroids. When you stop your treatment, things will return to normal.
Some of the more common side effects of steroid treatments include:
  • increased appetite
  • weight gain, often in unfamiliar places, like your cheeks or the back of your neck
  • mood swings
  • stomach upset or ulcers
  • osteoporosis (weaker bones)
  • vision problems
  • higher blood pressure
  • increased blood sugar. Sometimes, people develop diabetes temporarily. If you already have diabetes, you'll need to monitor your blood sugar levels more closely.
  • for girls, irregular menstruation (missed or late periods)
Less common side effects include bruising more easily, difficulty fighting infections, acne flare-ups, and increased facial hair.
If you develop several of these symptoms, you have a condition called Cushing syndrome. Sometimes it gets better if you make changes in the way you take the steroids. If you're having problems with these side effects, talk to your doctor.
Remember, you may not have any side effects. If you do, you'll probably find that they're overshadowed by the benefits of the treatment. But check with your doctor about ways to make them easier to live with.

Wednesday, 14 May 2014

How Excess Weight Affects Your Health

If you’re carrying many extra pounds, you face a higher-than-average risk of a whopping 50 different health problems. These health conditions include the nation’s leading causes of death—heart disease, stroke, diabetes, and certain cancers—as well as less common ailments such as gout and gallstones. Perhaps even more compelling is the strong link between excess weight and depression, because this common mood disorder can have a profound, negative impact on your daily life.

A Harvard study that combined data from more than 50,000 men (participants in the Health Professionals Follow-up Study) and more than 120,000 women (from the Nurses’ Health Study) revealed some sobering statistics about weight and health.

The volunteers provided their height and weight, as well as details on their diets, health habits, and medical histories. Researchers tracked the volunteers over more than 10 years. They noted the occurrence of illnesses and compared those developments with each subject’s body mass index (BMI)—an estimate of an individual’s relative body fat calculated from his or her height and weight).

Obesity increased the risk of diabetes 20 times and substantially boosted the risk of developing high blood pressure, heart disease, stroke, and gallstones. Among people who were overweight or obese, there was a direct relationship between BMI and risk: the higher the BMI, the higher the likelihood of disease.

Weight and depression

Do people gain weight because they’re depressed, or do they become depressed because they’re overweight? A review of 15 studies found evidence that both scenarios are likely true. The study, published in 2010 in the Archives of General Psychiatry, found that obese people have a 55% higher risk of developing depression over time compared with people of normal weight. Here are some reasons why obesity may increase risk of depression:

    Both conditions appear to stem (at least in part) from alterations in brain chemistry and function in response to stress.
    Psychological factors are also plausible. In our culture, thin equals beautiful, and being overweight can lower self-esteem, a known trigger for depression.
    Odd eating patterns and eating disorders, as well as the physical discomfort of being obese, are known to foster depression.

The study also found that depressed people have a 58% higher risk of becoming obese. Here are some reasons why depression may lead to obesity:

    Elevated levels of the stress hormone cortisol (common in people with depression) may alter substances in fat cells that make fat accumulation, especially in the belly, more likely, according to one theory.
    People who feel depressed often feel too blue to eat properly and exercise regularly, making them more prone to gain weight.
    Some medications used to treat depression cause weight gain.


Weight, heart disease, and stroke


Some of the most common problems seen in people who carry excess weight, such as high blood pressure and unhealthy levels of cholesterol and other fats in the blood, tend to occur together. Both can lead to concurrent health problems—namely, heart disease and stroke.

High blood pressure is about six times more common in people who are obese than in those who are lean. According to the American Heart Association, 22 pounds of excess weight boosts systolic blood pressure (the first number in a reading) by an average of 3 millimeters of mercury (mm Hg) and diastolic blood pressure (the second number) by an average of 2.3 mm Hg, which translates to a 24% increase in stroke risk.

A 2007 study in Archives of Internal Medicine examined the connection between weight and heart disease by pooling results from 21 different studies involving more than 300,000 people. The study found:

    Being overweight boosted the risk of heart disease by 32%
    Obesity increased the risk by 81%

Although the adverse effects of overweight on blood pressure and cholesterol levels could account for 45% of the increased heart disease risk, even modest amounts of excess weight can increase the odds of heart disease independent of those well-known risks, the authors concluded.

Compared with people of normal weight, overweight people face a 22% higher risk of stroke. For those who are obese, the increased risk rises to 64%, according to a 2010 report in the journal Stroke, which pooled results from 25 studies involving more than two million people.

Weight and diabetes

Overweight and obesity are so closely linked to diabetes, experts have coined the term “diabesity” to describe the phenomenon. About 90% of people with type 2 diabetes (the most common form of the disease) are overweight or obese. The incidence of diabetes rose dramatically—by nearly 65%—from 1996 to 2006.

A high blood sugar level, the hallmark of diabetes, is one of the features of metabolic syndrome. If untreated or poorly controlled, diabetes can lead to a number of grave health problems, including kidney failure, blindness, and foot or leg amputations. Diabetes is currently the seventh leading cause of death in the United States.


Weight and cancer

Some experts believe that obesity ranks as the second leading cause of cancer death, after cigarette smoking.

A study by the American Cancer Society, published in The New England Journal of Medicine, followed more than 900,000 people for 16 years. The study showed a link between excess body weight and many different cancers. Some of the findings:

    Among people ages 50 and older, overweight and obesity may account for 14% of all cancer deaths in men and 20% of all cancer deaths in women.
    In both men and women, higher BMIs were associated with a higher risk of dying from cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, or kidney.
    In men, excess weight also increased the risk of dying from stomach or prostate cancer.
    In women, deaths from cancer of the breast, uterus, cervix, or ovary were elevated in women with higher BMIs.

A 2008 review article in The Lancet reached similar conclusions. Part of the problem may lie in the fact that people who are very overweight are less likely to have cancer screening tests such as Pap smears and mammograms.

A report in The International Journal of Obesity showed that the larger the woman, the more likely she was to delay getting a pelvic exam, largely because of negative experiences with doctors and their office staff. In men, screening tests such as prostate exams may be physically difficult if people are very overweight, particularly if they tend to store fat in their hips, buttocks, or thighs.

Weight and lifespan

Being overweight or obese can make just getting around a challenge. Compared with people at a healthy weight, those carrying extra pounds have a harder time walking a quarter-mile, lifting 10 pounds, and rising from an armless chair. The burden of these problems appears to be greater than in years past, probably because people are now obese for a greater portion of their lives, experts speculate.

And because excess weight plays a role in so many common and deadly diseases, overweight and obesity can cut years off your life. A New England Journal of Medicine study that followed more than half a million 50- to 71-year-olds for a decade found an increase of 20% to 40% in death rates among people who were overweight at midlife. Among obese people, the death rate was two to three times as high.

A 2010 study in the same journal, which pooled findings from 19 studies that followed nearly 1.5 million white adults 19 to 84 years old for a similar period of time, found that the risk of death increased along with body size, ranging from 44% higher for those who were mildly obese to 250% higher for those with a BMI of 40 to 50.

Thursday, 8 May 2014

Procedures for Determining the Level of Utilization of Health Personnel and Healthcare.



In determining the level of utilization of health personnel and health care, resource planning, allocation and the evaluation of the appropriateness, medical needs and efficiency of health care service and procedures must be carefully analysed. Such analysis is of very important for health care institutions to ensure effective and
efficient patient care delivery.

Today, patient medical records include a large number of entries related to patient conditions along with treatments and procedures received. Utilization analysis based on such observational data collected through normal course of care delivery and carried out in a systematic manner can be leveraged to improve care delivery in many ways.

Two areas in particular have attracted significant attention recently. The first is the notion of hot spotting, which is the ability to identity in a timely manner patients who are heavy users of the system and their patterns of use, so that targeted intense intervention and follow up programs can be put in place to address their needs and change the existing, potentially ineffective, utilization pattern. The second is anomaly detection, where the goal is to identify utilization patterns that are unusual given patients’ clinical characteristics, including both underutilization and overutilization. The former may indicate a gap in medical service that if left unaddressed could result in further deterioration of patient’s condition leading to situations requiring more costly and less effective interventions. The latter incurs unnecessary cost and waste of precious healthcare resources that could have been directed towards cases in real need.

Estimates have put the waste caused by overutilization at more than 30% of the total medical cost and this has been confirmed by real world medical management experiences.

Method or Strategies for Mobilizing Communities for Self-Financed Projects.



Community mobilization for self-financed projects is a process. This process must be conducted with absolute trust, honesty, and inclusion. The person in charge of the mobilization must listen to the views and opinion of the people in the community and must make them to have a sense of ownership in the process.   Although receiving input from a community can take time, particularly if the person in charge of the mobilization is new to the area. However, listening to the community cannot
be over-emphasized to ensure the project's sustainability and to foster the spirit of community ownership.

The process can take any acceptable pattern provided that at every stage, the community is carried along. The following steps can be applicable in ensuring a successful community mobilization for self-financed projects:

1.    Orienting the Community

The first step in community mobilization is to orient them to the process. This can be done in a number of ways, including written communication, television, radio, or an organized meeting. Meetings are more personal and conducive to building relationships.  They also facilitate two-way communication where questions can be answered efficiently. It is advisable to start these meetings as soon as possible, so that trust and a positive working relationship can be built between parties.

2.    Arrange a meeting
Having the meeting sponsored or hosted by a respected individual or group within the community can add credibility to its agenda. This may happen through a church, school, tribe, or other local group.  Utilizing community leaders also increases the chances of reaching a cross-section of the population and not just a narrow representation. It is essential that all members of the community receive word about the mobilization process and how they can be involved. Outreach to those who are isolated, vulnerable or considered marginal is critical. If they cannot personally attend a meeting, it is important that they be represented in some way.

3.    Define the goals of the meeting
The goals of the meeting must be carefully considered and reflected in the agenda by the person in charge of the mobilization. To ensure effective mobilization, community leaders can provide assistance presenting the information in a culturally appropriate manner. Some of the community leaders may be chosen to convey topics with which they are familiar. During this meeting, it is important to solicit the input of the community. Identify their needs and begin to prioritize how those needs will be met. 

This meeting will be an opportunity to develop an awareness of how important the projects are to the community, how to actualize them and also an opportunity to learn about the strengths and resources of the community. It will be important to define mutual goals and develop a plan as to how to reach these goals. This will include organizing individuals to work together and coordinate services. 

Various people in the community have different capabilities and these capabilities must be factored into action plans and considered when defining goals of a meeting. Community leaders and project workers should ask themselves, ‘What can we reasonably expect to achieve at the end of this meeting?

4.    Develop ongoing ways to communicate
Once goals have been defined and a plan has been developed, it will be important to identify ongoing ways to communicate. Rather than having large meetings, cluster meetings of project staff, community leaders and community members working on similar tasks are more manageable and efficient. The groups should begin team building with all team members (project staff, community leaders and community members). It is vital that marginalized and vulnerable people are included in these teams. Mediation with the community may be required for them to ‘allow’ marginalized or isolated members of their community to participate in a team. 

Work in small teams that include affected people as well as outside helpers. Team leaders should meet daily for sharing of information, planning and coordination. Not all teams will be required for all emergency response projects. Some people may be a member of more than one team.

Important Teams in Community Mobilization for Self-financed Projects
Logistics
  • Transport people to work locations;
  • Transport supplies to work sites when needed;
  • Transport extra supplies to warehouse.
Communication
  • Tell the story of the projects to potential donors;
  • Tell the story of the response to the church;
  • Take pictures of the work;
  • Get the story to the press – church, local, national;
  • Can be done by someone who is older, disabled, not able to do heavy work.
     
Accounts/ Finance
  • Keep clear accounts of all money coming in for the projects ;
  • Keep clear record of donors;
  • Account for all money spent.  Show receipts for each expenditure;
  • Can be done by someone older, disabled or not able to do heavy work,;
  • Should be done by a team of local and outside people to increase trust.
     
Project manager
  • Assess the requirements of a specific project in the larger projects;
  • Plan for equipment, supplies and people needed;
  • Request equipment, supplies and people through the coordinator and daily meetings;
  • Plan the steps to complete the task.  Monitor budget and activity plans;
  • Work with the team to complete the task;
  • Communicate with the Coordinator throughout the process.
     
Supply manager
  • Keep a constant inventory of supplies available for the projects;
  • Prepare supplies for delivery to sites;
  • Purchase supplies requested if approved by coordinator and finance;
  • Should be trustworthy and a good organizer.
     
Tool manager
  • Care for tools that are available for use on the projects;
  • Sign tools out for projects and sign them back in when returned;
  • Make sure that tools are working and in good repair;
  • Can be done by someone not able to go out to work at sites.
     
Volunteer coordinator
  • Recruit people for emergency response (community members, outside helpers);
  • Keep track of people, skills and availability;
  • Contact people for jobs as needed;
  • Thank volunteers for helping;
  • Can be done by someone who is not able to do heavy work;
  • Should be a person who is calm and gracious.
     
Kitchen
  • Provide coffee, tea, refreshments for workers;
  • Depending on the projects, provide meals for workers, or local community if needed;
  • Can be asked to provide emergency meals;
  • Can be done by local volunteers or a local business that is willing to cooperate;
  • Should be included in coordination meetings for best results.
     
Pastoral Care team
  • Provide comfort and hope;
  • May pray with and for the needs of people;
  • Answer questions that arise from the project, such as why there are tragedies;
  • Keep company with those in distress;
  • May provide worship or prayer meeting for workers at beginning or end of day;
  • Can be done by a pastor / priest or someone they appoint.
Psychosocial team
  • Provide psychological ‘first aid’ to victims or workers as needed;
  • Organize community meetings to assist in support and problem solving at community level;
  • Can organize activities for children or people who are displaced;
  • Work as advocates for people’s emotional and social needs;
  • Support families as they plan their next steps.
     
Team co-ordinator(s)
Designate team coordinators to be responsible for the following:
  • Make it possible for teams to do their work;
  • Facilitate communication between work teams – meetings, messages, reports;
  • Manage conflicts – mediate;
  • Manage power struggles – recognise;
  • Care for staff, volunteers;
  • Ensure openness and transparency;
  • Be an obliging leader.

Wednesday, 7 May 2014

Treatments of Syphilis



When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. If you're allergic to penicillin, your doctor will suggest another antibiotic.


A single injection of penicillin can stop the disease from progressing if you've been infected for less than a year. If you've had syphilis for longer than a year, you may need additional doses.

Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you're treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.

The first day you receive treatment you may experience what's known as the Jarisch-Herxheimer reaction. Signs and symptoms include fever, chills, nausea, achy pain and headache. This reaction usually doesn't last more than one day.

Treatment follow-up

After you're treated for syphilis, your doctor will ask you to:
  • Have periodic blood tests and exams to make sure you're responding to the usual dosage of penicillin
  • Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured
  • Notify your sex partners so that they can be tested and get treatment if necessary
  • Be tested for HIV infection