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[ { "answer_id": 9126, "body": "<p>The requirements for amino acids are <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK234922/table/ttt00008\" rel=\"noreferrer\">given here</a>. The relative ratio between the amino acids is also important here, it's no good getting a lot of one type if you miss out on another one, you need to get all of them in the right proportions and quantities. If you are into body building, you may need more than the RDA. To see if you're getting the right amount of the various essential amino acids from the foods you eat, you can <a href=\"http://nutritiondata.self.com\" rel=\"noreferrer\">use this website</a>. E.g. <a href=\"http://nutritiondata.self.com/facts/legumes-and-legume-products/4354/2\" rel=\"noreferrer\">for 100 grams split peas, mature seeds, cooked, boiled, without salt</a> we find:</p>\n\n<blockquote>\n <ul>\n <li><p>Tryptophan 93.0 mg </p></li>\n <li><p>Threonine 296 mg</p></li>\n <li><p>Isoleucine 344 mg </p></li>\n <li><p>Leucine 598 mg</p></li>\n <li><p>Lysine 602 mg </p></li>\n <li><p>Methionine 85.0 mg </p></li>\n <li><p>Cystine 127 mg </p></li>\n <li><p>Phenylalanine 384 mg </p></li>\n <li><p>Tyrosine 242 mg </p></li>\n <li><p>Valine 394 mg </p></li>\n <li><p>Arginine 744 mg </p></li>\n <li><p>Histidine 203 mg </p></li>\n <li><p>Alanine 367 mg </p></li>\n <li><p>Aspartic acid 984 mg </p></li>\n <li><p>Glutamic acid 1426 mg </p></li>\n <li><p>Glycine 371 mg </p></li>\n <li><p>Proline 344 mg </p></li>\n <li><p>Serine 367 mg</p></li>\n </ul>\n</blockquote>\n\n<p>Note that not all of these are the essential amino acids you really need, typical foods contain a lot more of the non-essential amino acid than the essential amino acids.</p>\n", "score": 6 }, { "answer_id": 9130, "body": "<p>You're not using protein as it is to maintain your body. It's first broken down to the individual amino acids, which your body can then use to build new stuff. </p>\n\n<p>If you're lacking one of the <a href=\"https://en.wikipedia.org/wiki/Essential_amino_acid\" rel=\"nofollow\">essential amino acids</a>, you can only build as much new protein until that runs out, and all the other amino acids are just excess. A protein that contains all the necessary amino acids is called a <a href=\"https://en.wikipedia.org/wiki/Complete_protein\" rel=\"nofollow\">complete protein</a>, and you could calculate the differences in the so-called <a href=\"https://en.wikipedia.org/wiki/Protein_Digestibility_Corrected_Amino_Acid_Score\" rel=\"nofollow\">quality of the protein</a>. </p>\n\n<p>A perfect protein (i.e. from egg/milk/soy) will contain amino acids in exactly the ratio you need, some protein contains so little of a certain amino acid that you'd need to eat twice as much of that protein (for example rice or peanuts).</p>\n\n<p>In your case, if beef is making you recover fastest, you'd need to eat 30*0.92/0.70 = 39g of peas for the same effect.</p>\n\n<p>You could get around this by combining different sources of protein. For example grains are limited in lysine, while beans are limited in cysteine/methionine. </p>\n", "score": 3 } ]

[ "diet" ]

[ { "answer_id": 9145, "body": "<p><strong>Menstrual blood is composed of a mixture of blood (blood cells), vaginal secretions, endometrial cells and inflammatory cells.</strong></p>\n\n<p><em>I have found no study investigating the change in colour of mentruation blood .</em></p>\n\n<p>However, the presence of endometrial cells (mucosa lining of the uterus) and necrotic cells (from the endometrium) is supposed to be highest during the first days of menstruation where the stratum functionalis gets cleaved from the stratum basalis in the endometrium.</p>\n\n<p>During the end of menstruation most of these cells have been expulsed and the new lining of the endometrial wall has developed, slowly \"covering\" previous bleeding vessels from the underlying mucosa. \nThis could possibly explain the change in colour you are mentionning. </p>\n\n<p>Some weeks ago, I have answered a question on the menstrual cycle including some points regarding the uterine wall and its changes during the cycle:\n<a href=\"https://health.stackexchange.com/questions/7303/how-does-my-body-know-how-long-a-month-is\">How does my body know how long a month is?</a></p>\n\n<p><em>Of course, these explanations apply to a \"physiological\" condition, and not to a pathological condition where things can be different.</em></p>\n\n<p><em>Sources:\nYang H, Zhou B, Prinz M, Siegel D. Proteomic Analysis of Menstrual Blood. Molecular &amp; Cellular Proteomics : MCP. 2012;11(10):1024-1035. doi:10.1074/mcp.M112.018390.</em></p>\n", "score": 8 } ]

[ "blood", "gynecology", "menstruation", "menstrual-cycle", "coloration-discoloration" ]

[ { "answer_id": 9168, "body": "<p><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK234935/\" rel=\"nofollow\">Recommended Dietary Allowances: 10th Edition</a></p>\n\n<blockquote>\n <p>A minimum average requirement for adults can be estimated under\n conditions of maximal adaptation and without active sweating...to 115\n mg of sodium or approximately 300 mg of sodium chloride per day. In\n consideration of the wide variation of patterns of physical activity\n and climatic exposure, a safe minimum intake [of sodium chloride]\n might be set at 500 mg/day [<strong>~200 mg sodium/day</strong>]</p>\n</blockquote>\n\n<p>So, for adults (young or old), the minimum requirement is about 200 mg (0.2 g) of sodium per day or even just about 100 mg (0.1 g) without active sweating.</p>\n", "score": 4 } ]

[ "salt" ]

[ { "answer_id": 9416, "body": "<p>To lose weight you need to consume less calories than you spend, but you know this. Cutting pops is a nice trick -- you can make it <strong>much easier</strong> if you cut it completely and cut other sugars too. As an alternative beverage, I recommend some mineral water that has a little bit sodium in it, which makes it more tasty than plain tap or bottled water. </p>\n\n<p>There are tricks how to <strong>get rid of sugar/food craving:</strong></p>\n\n<p><strong>1.</strong> If you crave for sugar, you <strong>remove all/most sugar and artificial sweeteners from your diet at once:</strong> pops, fruit juices, fruits, sweets, ice cream, chocolate...This can work easier if you also <strong>remove/limit other quickly absorbable carbohydrates,</strong> such as potatoes, white rice, pasta and white bread. So, you try to get used to whole-grain cereal products and vegetables (in short: foods high in dietary fiber). After this, in a short time (after few days of struggling) sugar craving can become much less intense. This is from my experience, but <a href=\"http://www.webmd.com/diet/features/13-ways-to-fight-sugar-cravings#1\" rel=\"nofollow\">others may tell you similar things</a> (WebMD).</p>\n\n<p><strong>2. Fast food</strong> can also cause food craving, probably because of quick and large surge of energy it provides. So, avoiding fast food can really make losing weight easier.</p>\n\n<p>To avoid depression from such diet, concentrate on your work goals and relationships that make you fulfilled. This requires some effort and can come with some <strong>emotional suffering,</strong> which, if associated with right goals, can be surprisingly <strong>healing</strong> for depression and anxiety.</p>\n\n<p>If not already, become more <strong>physically active.</strong> Something you can realistically adopt in your life style long-term. Walking, for example. This is not meant (only) to lose calories but to keep you mentally and physically fresh and less depressed.</p>\n", "score": 2 }, { "answer_id": 9434, "body": "<p>If giving up sweetened drinks is too difficult for you, then quit trying. Quit fighting a battle you're already convinced you're going to lose, because you will. One or two soft drinks per day isn't going to do you any great harm if you account for those calories. And after all, your prime objective here is to lose weight, right? Aside from the sugar and calories, there's nothing really terrible about soft drinks.</p>\n\n<p>A 12-ounce 7Up contains 140 calories. Adding 140-calories worth of exercise per day isn't difficult, even for someone who is \"badly overweight.\" For example, for a 300-pound person a <a href=\"http://caloriecontrol.org/healthy-weight-tool-kit/get-moving-calculator/\" rel=\"nofollow\">30-minute brisk walk burns 273 calories</a>, which is two 7Ups. If you do that walk and just have one 7Up per day instead of two, you'll begin to lose weight. </p>\n\n<p>If you've been sedentary a long time, then a 30-minute brisk walk might be too much. Fine, start out where you can. The first week make it 5 or 10 minutes -- whatever you can do. The next week add 5 minutes, and keep doing that until you're up to 30 minutes per day. From there you can either continue to add time, or pick up the pace, add some hills or stairs, etc.</p>\n\n<p>You'll lose weight, you'll improve your cardiovascular fitness, you'll feel better, you'll sleep better, and... you'll still get your daily 7Up fix. </p>\n\n<p>Also consider getting a wearable fitness monitor. They're a good way to keep track of your progress and they help keep you motivated. </p>\n", "score": 1 }, { "answer_id": 9414, "body": "<p>1.5 cans of 7up per day is around 22 pounds of fat in a year. Depending on how overweight you are, this might be the source of ALL your excess weight. Think about that. </p>\n\n<p>Still drinking 2 cans a week will just slow down your weightloss, and maybe save you a few weeks of discomfort (that's mostly psychological anyway). </p>\n\n<p>Calculation: \n<a href=\"http://www.myfitnesspal.com/food/calories/7-up-7-up-soda-12-oz-can-365658151?v2=false\" rel=\"nofollow\">140 kcal per can</a> * 1.5 = 210 kcal per day\n365 days per year * 210 kcal = 76650 kcal / year\n76650 kcal / <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376744/\" rel=\"nofollow\">3500 kcal per pound of bodyweight</a> = 21.9 pounds per year </p>\n", "score": 0 } ]

[ "diet", "weight", "overweight" ]

[ { "answer_id": 9436, "body": "<p>Blood donor restrictiction aims at preventing the transmission of the <strong>variant Creutzfeldt-Jakob disease</strong> (also known as Mad Cow Disease for a layperson), which is a prion disease that leads to irreversible neurodegeneration. Affected patients present with neurological and psychiatric symptoms and eventually die.</p>\n\n<p><em>Here some historical background to understand the rational behind the blood donor restrictions:</em></p>\n\n<p><strong>The first description of the vCJD in human occured in 1996</strong> and was quickly followed by more than 22 others mainly in the UK. Clinical symtoms varied from the previously known sporadic/familial/genetic Creutzfeld-Jakob diseases leading to the definition of a <strong>variant Creutzfeldt-Jakob disease</strong>. Additionally as most cases reported <strong>followed an epidemy of bovine spongiform encephalopathy (BSE) (the animal variant of the disease)</strong>, a direct link between the diseases (and an animal-human transmission) was made.</p>\n\n<p><em>The issues and the rational for blood donor restrictions:</em> </p>\n\n<ul>\n<li>Approximately <strong>50,000 infected cattle are estimated to have entered\nthe human food chain</strong></li>\n<li>at least <strong>five cases of transfusion transmission of vCJD have been reported in the UK</strong></li>\n<li>The <strong>limits of 1980 and 1996</strong> have been chosen because the first\ndescriptions of the BSE have been reported in the 80's. After 1996,\ndue to strict governmental regulations (such as the prohibition on\nruminant-derived proteins in feeds for all animals and poultry and\nthe banning of consumption of animals over the age of 30 months) a significant decline in BSE cases was noted, limiting the possibility of an animal-human transmission.</li>\n<li>the <strong>current prevalence of vCJD in the originally affected countries is unknown</strong> and hence makes it difficult to decide on the best approach. In the UK population some studies have suggested that it might be between 120 to 237 per million inhabitants but those values are highly debated (some suggesting it might be lower)</li>\n<li><strong>the incubation period of vCJD is long to very long</strong> (several years to decades) so people who are infected might be asymptomatic at the time they donate blood.</li>\n</ul>\n\n<p><strong>Blood donor restrictions vary between countries, some beeing more restrictive than others according to their respective public health policy.</strong></p>\n\n<p>Sources:\nBrown GH. Variant Creutzfeldt-Jakob disease. UpToDate. Sept 2016. <a href=\"https://www.uptodate.com/contents/variant-creutzfeldt-jakob-disease/print?source=see_link&amp;sectionName=Relationship%20with%20BSE&amp;anchor=H3\">https://www.uptodate.com/contents/variant-creutzfeldt-jakob-disease/print?source=see_link&amp;sectionName=Relationship%20with%20BSE&amp;anchor=H3</a></p>\n", "score": 5 } ]

[ "blood", "blood-donation" ]

[ { "answer_id": 9469, "body": "<p>I haven't been able to find anything useful about ginger, but I've found some publications about garlic and - to make long story short - there is lack of good quality evidence for its effectiveness. Some useful quotes are below.</p>\n\n<p>From \"<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928210/\" rel=\"nofollow\">Prevention and treatment of the common cold: making sense of the evidence</a>\" (2014):</p>\n\n<blockquote>\n <p>Studies of exercise, garlic, and homeopathy showed unclear evidence of benefit, whereas those of vitamin D and echinacea showed no evidence of benefit. (...) We did not identify any high-level evidence for garlic or probiotics in the treatment of the common cold.</p>\n</blockquote>\n\n<p>From \"<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25386977\" rel=\"nofollow\">Garlic for the common cold.</a>\" (2014):</p>\n\n<blockquote>\n <p>There is insufficient clinical trial evidence regarding the effects of garlic in preventing or treating the common cold. A single trial suggested that garlic may prevent occurrences of the common cold but more studies are needed to validate this finding. Claims of effectiveness appear to rely largely on poor-quality evidence.</p>\n</blockquote>\n\n<p>From \"<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23638928\" rel=\"nofollow\">Garlic in clinical practice: an evidence-based overview.</a>\" (2013):</p>\n\n<blockquote>\n <p>Garlic as a preventative or treatment option for the common cold or peripheral arterial occlusive disease or pre-eclampsia and its complications could not be recommended, as only one relatively small trial evaluated the effects separately. (...) Garlic might be effective in some areas of clinical practice, but the evidence levels were low, so further researches should be well designed using rigorous method to avoid potential biases.</p>\n</blockquote>\n\n<p>There is one newer and more positive clinical study about aged garlic extract (AGE), but this is still only a single trial, \"<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26764332\" rel=\"nofollow\">Aged Garlic Extract Modifies Human Immunity.</a>\" (2016):</p>\n\n<blockquote>\n <p>(...) although the number of illnesses was not significantly different, the AGE group showed reduced cold and flu severity, with a reduction in the number of symptoms, the number of days participants functioned suboptimally, and the number of work/school days missed. These results suggest that AGE supplementation may enhance immune cell function and may be partly responsible for the reduced severity of colds and flu reported. The results also suggest that the immune system functions well with AGE supplementation, perhaps with less accompanying inflammation.</p>\n</blockquote>\n", "score": 3 }, { "answer_id": 9470, "body": "<p>There seems to be lack of evidence about beneficial effects of <strong>ginger</strong> on common cold.</p>\n\n<p>According to <a href=\"http://www.webmd.com/vitamins-supplements/ingredientmono-961-ginger.aspx?activeingredientid=961\" rel=\"nofollow\">WebMD (info from Natural Medicines Comprehensive Database)</a>, there is <strong>insufficient evidence</strong> about the effect of ginger on common cold.</p>\n\n<p>The article on <a href=\"https://nccih.nih.gov/heatlh/flu/indepth\" rel=\"nofollow\">National Center of Complementary and Integrative Health</a> does not even mention ginger, while it mentions eventual effects of other herbs and remedies on common cold.</p>\n", "score": 2 } ]

[ "nutrition", "common-cold", "home-remedies" ]

[ { "answer_id": 10175, "body": "<p>I am not aware of any evidence based research looking at the efficacy of at home ear wax removal. In general the goal is not to make your ear canals 100% free of wax at the microscopic level. Rather, the goal is remove blockages and NOT damage the ear canal. The <a href=\"http://www.entnet.org/content/earwax-and-care\" rel=\"nofollow noreferrer\">American Academy of Otolaryngolgoy</a> recommends:</p>\n<blockquote>\n<p>Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide (available in most pharmacies) may also aid in the removal of wax.</p>\n<p>Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit...</p>\n</blockquote>\n", "score": 3 } ]

[ "hygiene", "audiology", "hearing-aids", "earwax", "hearing-impaired" ]

[ { "answer_id": 9590, "body": "<p>As an insomniac, I've looked into this myself, and found the following to be natural sleep-inducing foods (in no particular order): </p>\n\n<ul>\n<li><strong>Cherries</strong> -- The tarter, the better. They have melatonin!! And they are great for desert. </li>\n<li><strong>Chamomile Tea</strong> -- apparently it contains the chemical glycine, which helps relax muscles and nerves. </li>\n<li><strong>Honey</strong> -- the natural sugar of honey helps the insulin levels to raise quickly so the tryptophan (the chemical in Turkey that makes people sleepy after a Thanksgiving meal) can enter the brain easier and help you fall asleep! Plus... it goes well with the Chammomile Tea! </li>\n<li><strong>Almonds</strong> -- have lots of magnesium in it, and magnesium contributes to quality sleep. Also, try warm almond milk... </li>\n<li><strong>Walnut</strong>s -- Like cherries, walnuts, also are chalk full of melatonin. </li>\n<li><strong>Oatmeal</strong> -- Oats also have melatonin in them, but it also has B-6 in it which makes you relax as well. 2 components! </li>\n</ul>\n\n<p>Here's a few websites: </p>\n\n<p>16 foods that help you sleep: <a href=\"http://www.rd.com/health/beauty/foods-that-help-you-sleep/\" rel=\"noreferrer\">http://www.rd.com/health/beauty/foods-that-help-you-sleep/</a> </p>\n\n<p>9 foods that help you sleep better: <a href=\"http://www.prevention.com/food/foods-better-sleep\" rel=\"noreferrer\">http://www.prevention.com/food/foods-better-sleep</a> </p>\n\n<p>10 Foods that Make you Sleepy &amp; 10 Foods that Keep you up: <a href=\"http://www.goodhousekeeping.com/health/diet-nutrition/g796/sleep-inducing-foods/?slide=6\" rel=\"noreferrer\">http://www.goodhousekeeping.com/health/diet-nutrition/g796/sleep-inducing-foods/?slide=6</a> </p>\n\n<p>**Unlike Prince, I have not found tomatoes good for sleep. I finds tomatoes or tomato based foods to be too acidic for bed time and it gives me acid-reflux. But I guess it all depends on you and your body! </p>\n\n<p>Good Night! </p>\n", "score": 6 } ]

[ "sleep", "supplement", "home-remedies", "sleep-aids", "herbs" ]

[ { "answer_id": 10174, "body": "<p>The <a href=\"https://www.nidcd.nih.gov/health/hearing-aids#hearingaid_01\" rel=\"nofollow noreferrer\">NIDCD</a> defines a hearing aid as:</p>\n<blockquote>\n<p>A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one.</p>\n<p>A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.</p>\n</blockquote>\n<p>Things are a little messy because most people consider <a href=\"https://en.wikipedia.org/wiki/Ear_trumpet\" rel=\"nofollow noreferrer\">ear trumpets</a> as an early for of hearing aid despite being completely passive. Additionally, <a href=\"https://en.wikipedia.org/wiki/Bone-anchored_hearing_aid\" rel=\"nofollow noreferrer\">bone Anchored hearing aids</a> work in a totally different manner from most hearing aids. The <a href=\"http://earlens.com/\" rel=\"nofollow noreferrer\">earlens</a> is also pushing the boundaries of what a hearing aid is.</p>\n<p>The <a href=\"https://www.nidcd.nih.gov/health/cochlear-implants#a\" rel=\"nofollow noreferrer\">NIDCD</a> defines a cochlear implant as</p>\n<blockquote>\n<p>A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and understand speech in person or over the telephone.</p>\n</blockquote>\n<p><a href=\"http://american-hearing.org/disorders/hearing-aids/#aids\" rel=\"nofollow noreferrer\">Hearing aid indications</a> are generally <em>mild or moderate bilateral hearing loss, who has experienced a noticeable communication handicap</em>. There is a push now to fit hearing aids to anyone, especially children with communication difficulties (e.g., this <a href=\"http://www.audiology.org/news/amplification-normal-hearing-children-apd\" rel=\"nofollow noreferrer\">AAA report</a>).</p>\n<p><a href=\"https://www.advancedbionics.com/content/dam/ab/Global/en_ce/documents/libraries/Professional%20Library/AB%20Product%20Literature/System_Indications_Precautions/Indications_and_Contraindications.pdf\" rel=\"nofollow noreferrer\">Cochlear implant indications</a> are <em>postlingual onset of severe-to-profound, bilateral sensorineural hearing loss with limited benefit from appropriately fitted hearing aids</em>. These indications are also being pushed and cochlear implants are now used for individuals with <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185341/\" rel=\"nofollow noreferrer\">single-sided deafness</a> and <a href=\"http://www.cochlear.com/wps/wcm/connect/us/home/N6hybrid/index.html\" rel=\"nofollow noreferrer\">hybrid systems</a> are being used with individuals with residual low frequency hearing.</p>\n<p>As to whether you would want a hearing aid or cochlear implant is a deeply personal question. Those in <a href=\"https://en.wikipedia.org/wiki/Deaf_culture\" rel=\"nofollow noreferrer\">Deaf Culture</a> tend to be against auditory assistive devices. Hearing aids are low risk and have a limited commitment. Apart from money if you decide you do not like them, you have lost nothing. Cochlear implants are much more expensive, require surgery, and destroy all/most residual hearing. If you do not like the result of the cochlear implant, you cannot go back.</p>\n", "score": 2 } ]

[ "audiology", "hearing-impaired", "deaf", "hearing-aids" ]

[ { "answer_id": 9839, "body": "<p>There is a study that the amount of sleep is associated with the probability of getting infected by the common cold. The researchers attribute the finding to the impaired functioning of the immune system, when sleeping less. This may not answer your question directly, but it is related.</p>\n\n<blockquote>\n <p>Logistic regression analysis revealed that actigraphy-assessed <strong>shorter sleep duration was associated with an increased likelihood of development of a clinical cold</strong>. Specifically, <strong>those sleeping &lt; 5 h</strong> (odds ratio [OR] = 4.50, 95% confidence interval [CI], 1.08–18.69) <strong>or</strong> sleeping between <strong>5 to 6 h</strong> (OR = 4.24, 95% CI, 1.08–16.71) <strong>were at greater risk of developing the cold compared to those sleeping > 7 h per night</strong>; those sleeping 6.01 to 7 h were at no greater risk (OR = 1.66; 95% CI 0.40–6.95). This association was independent of prechallenge antibody levels, demographics, season of the year, body mass index, psychological variables, and health practices.</p>\n</blockquote>\n\n<p>(emphasis mine)</p>\n\n<p>The study identifies 6h of sleep as the threshold under which catching the infection becomes more likely. To try and explain this phenomenon, the researchers cite studies that have shown that lack of sleep can disturb the effectiveness of the immune system:</p>\n\n<blockquote>\n <p>Sleep, along with circadian rhythms, exerts substantial regulatory effects on the immune system.42,43 Circulating immune cells, including T and B cells, peak early in the night and then decline throughout the nocturnal hours moving out of circulation into lymphoid organs where exposure to virally infected cells occur.43–45 Studies employing experimental sleep loss also support functional changes relevant to host resistance. Sleep deprivation results in down regulation in T cell production of interleukin-219,44 and a shift away from T-helper 1 responses, marked by a reduction in the ratio of interferon-γ/IL-4 production.16 Sleep loss is associated with diminished proliferative capacity of T cells in vitro15 as well as modulation of the function of antigen presenting cells critical to virus uptake.46</p>\n</blockquote>\n\n<p>Source:</p>\n\n<p>Prather AA; Janicki-Deverts D; Hall MH, Cohen S. <a href=\"http://www.journalsleep.org/ViewAbstract.aspx?pid=30153\" rel=\"nofollow\">Behaviorally Assessed Sleep and Susceptibility to the Common Cold</a>. Sleep. 2015;38(9):1353-59</p>\n", "score": 2 }, { "answer_id": 9862, "body": "<p>Actually, resting does influence the recovery time of a common cold.</p>\n\n<p>It's one of the first pieces of advice you get when you're sick, but we can never stress it enough: give your body time to fight off the virus, and don't waste that energy elsewhere. A number of studies found that sleep deprivation results in poorer immune function. Not only do good sleep habits help you fight off a cold, but they will even increase your resistance to catching one in the first place. So, if you're sick, it's important to get plenty of rest—but don't neglect it when you're healthy either. Make sure this is quality sleep, too: drugs like NyQuil contain alcohol, and we already know what that does to your sleep cycle. You'll fall asleep quickly, but you won't get the deep sleep you need to get better</p>\n\n<p><a href=\"http://lifehacker.com/5686387/how-to-most-effectively-battle-the-common-cold\" rel=\"nofollow\">http://lifehacker.com/5686387/how-to-most-effectively-battle-the-common-cold</a></p>\n", "score": 0 } ]

[ "common-cold", "recovery" ]

[ { "answer_id": 17185, "body": "<p>I am answering this almost two years after it was asked, but I hope an answer can still be useful!</p>\n\n<p><strong>Hashimoto’s Disease</strong></p>\n\n<p>You are correct that <a href=\"https://emedicine.medscape.com/article/120937-overview#a4\" rel=\"nofollow noreferrer\">Hashimoto’s disease</a> (also known as Hashimoto’s thyroiditis) is the most common cause of hypothyroidism in those aged over six. In younger children hypothyroidism is most often congenital. So yes, you almost certainly have hypothyroidism due to Hashimoto’s disease.</p>\n\n<p>Hashimoto’s thyroiditis is an <a href=\"https://www.webmd.com/a-to-z-guides/autoimmune-diseases\" rel=\"nofollow noreferrer\">autoimmune disease</a>. This means that <em>something</em> triggers the immune system to produce antibodies that cross-react with normal parts of the body. People with Hashimoto’s disease can have antibodies in the blood to various components of the thyroid gland. The most common are <em>anti-thyroid peroxidase (anti-TPO) antibodies</em>. You may have had a blood test for this and you could certainly ask your family doctor or endocrinologist. Either way, the treatment is similar to other causes; namely replacement of thyroid hormones with <em>levothyroxine</em>.</p>\n\n<p><strong>Autoimmune disease in general</strong></p>\n\n<p>The origins of autoimmune disease seem to be a complex mix of genetic and environmental factors and possibly pathogens. Much autoimmune disease is due to various forms of immune <a href=\"https://en.m.wikipedia.org/wiki/Hypersensitivity\" rel=\"nofollow noreferrer\">hypersensitivity</a>. Specifically, Hashimoto’s thyroiditis is an example of <a href=\"https://en.m.wikipedia.org/wiki/Type_IV_hypersensitivity\" rel=\"nofollow noreferrer\">type 4 hypersensitivity</a> (along with coeliac disease and multiple sclerosis), while <a href=\"https://en.m.wikipedia.org/wiki/Type_I_hypersensitivity\" rel=\"nofollow noreferrer\">type 1</a> causes most allergies and anaphylaxis.</p>\n\n<p>A good example is autoimmune disease after infection by <a href=\"https://en.wikipedia.org/wiki/Group_A_streptococcal_infection\" rel=\"nofollow noreferrer\">Group A streptococcus</a> bacteria (a common cause of throat infections, skin infections, <a href=\"https://en.wikipedia.org/wiki/Scarlet_fever\" rel=\"nofollow noreferrer\">scarlet fever</a> etc). In some people, the antibodies that the body makes against streptococcus will cross-react with other body tissues and damage them, causing a number of conditions: </p>\n\n<ul>\n<li><a href=\"https://en.wikipedia.org/wiki/Rheumatic_fever\" rel=\"nofollow noreferrer\">Rheumatic fever</a> and rheumatic heart disease (<a href=\"https://en.m.wikipedia.org/wiki/Type_II_hypersensitivity\" rel=\"nofollow noreferrer\">type 2 hypersensitivity</a>)</li>\n<li><a href=\"https://en.wikipedia.org/wiki/Acute_proliferative_glomerulonephritis\" rel=\"nofollow noreferrer\">Glomerulonephritis</a> (<a href=\"https://en.m.wikipedia.org/wiki/Type_III_hypersensitivity\" rel=\"nofollow noreferrer\">type 3 hypersensitivity</a>)</li>\n<li><a href=\"https://www.psoriasis.org/about-psoriasis/types/guttate\" rel=\"nofollow noreferrer\">Guttate psoriasis</a></li>\n<li><a href=\"https://en.wikipedia.org/wiki/PANDAS\" rel=\"nofollow noreferrer\">Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)</a></li>\n</ul>\n\n<p>See <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK333434/\" rel=\"nofollow noreferrer\">this paper</a> for more information about autoimmunity after streptococcal infection. This is an example of <a href=\"https://en.m.wikipedia.org/wiki/Type_III_hypersensitivity\" rel=\"nofollow noreferrer\">type 3 hypersensitivity</a>.</p>\n\n<p><strong>Other Points</strong></p>\n\n<p>Various autoimmune diseases are associated with one another. Having one can make another more likely. For example, there is a link between <a href=\"https://en.wikipedia.org/wiki/Diabetes_mellitus_type_1\" rel=\"nofollow noreferrer\">type 1 diabetes</a> and autoimmune hypothyroidism. You mention that you may have lupus, which is also autoimmune. </p>\n\n<p>You also mention fibromyalgia. Currently, fibromyalgia is <em>not</em> thought to be an autoimmune condition. <a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/15082086/\" rel=\"nofollow noreferrer\">Proposals</a> of an autoimmune cause have not yielded evidence of this in research. It is likely to result from a complex interplay of internal and external factors with neurochemisty and neurophysiological processes. There is some overlap in symptoms, but this is not surprising as pain, stiffness, fatigue and low energy are some of the most common symptoms there are and can have many causes.</p>\n\n<p>I see from <a href=\"https://health.stackexchange.com/questions/9660/why-do-some-general-practioners-not-consider-fibromyalgia-as-a-genuine-real-aut\">another question</a> of yours that you had a bad experience with a general practitioner taking the very outdated view that fibromyalgia is not a real condition! It most certainly is real, even if not well understood yet, and can cause a lot of suffering. Whatever the underlying cause turns out to be (there may be several), it does not have to have an autoimmune origin to be real! :)</p>\n", "score": 7 } ]

[ "autoimmune-disease", "lupus", "hypothyroid", "tsh-levels", "hashimoto-thyroiditis" ]

[ { "answer_id": 18163, "body": "<blockquote>\n <p>When was congenital-analgesia (aka congenital insensitivity to pain), the inability to feel pain, clinically documented?</p>\n</blockquote>\n\n<p>It was first reported in 1932 in this paper:</p>\n\n<p>Dearborn, G. V. N. (1932). A case of congenital general pure analgesia. <em>Journal of Nervous and Mental Disease</em>, <em>75</em>, 612-615. <a href=\"http://dx.doi.org/10.1097/00005053-193206000-00002\" rel=\"noreferrer\">http://dx.doi.org/10.1097/00005053-193206000-00002</a></p>\n\n<p>However, I tried reading it, the print is very faded and near-impossible to read. </p>\n\n<blockquote>\n <p>How rare is it really?</p>\n</blockquote>\n\n<p>1 in 125 million</p>\n\n<p>From: \nDaneshjou, K. et al. (2012). Congenital insensitivity to pain and anhydrosis (CIPA) syndrome; a report of 4 cases. <em>Iranian Journal of Pediatrics</em>, <em>22</em>, 412–416.</p>\n\n<p>But in this paper on the epidemiology in Japan, it's estimated at 1 in 600,000–950,000</p>\n\n<p>From: \nHaga, N., Kubota, M., &amp; Miwa, Z. (2013). Epidemiology of hereditary sensory and autonomic neuropathy type IV and V in Japan. <em>American Journal of Medical Genetics Part A</em>, <em>161</em>, 871-874.</p>\n\n<blockquote>\n <p>Is it hereditary? Or just a sporadic fluke mutation?</p>\n</blockquote>\n\n<p>It's hereditary:</p>\n\n<p>Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV (HSAN IV)</p>\n\n<p>Kim, W., Guinot, A., Marleix, S., Chapuis, M., Fraisse, B., &amp; Violas, P. (2013). Hereditary sensory and autonomic neuropathy type IV and orthopaedic complications. <em>Orthopaedics &amp; Traumatology: Surgery &amp; Research</em>, <em>99</em>, 881-885.</p>\n\n<blockquote>\n <p>So what is the life expectancy of someone with congenital-analgesia?</p>\n</blockquote>\n\n<p>There's age distribution of the population in Japan:</p>\n\n<p><a href=\"https://i.stack.imgur.com/EeCat.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/EeCat.png\" alt=\"enter image description here\"></a></p>\n\n<p>It doesn't say life expectancy, but it seems that it won't be past 40 years.</p>\n", "score": 5 } ]

[ "life-expectancy", "history", "neuropathy", "pain-tolerance" ]

[ { "answer_id": 10005, "body": "<p>You are indeed correct! The origins and first usage of the word \"patient-zero\" was actually a total misinterpretation that was caught on quickly by the media, and has since been perpetuated henceforth. The <strong>phrase was coined in the early 1980's</strong> in reference to Gaëtan Dugas, who was erroneously identified as the cause of the AIDS outbreak. Your sources are correct in that new scientific evidence has since demonstrated that he didn't spread HIV, but the damage has been done, and his reputation has been tarnished.</p>\n\n<p>The \"Patient Zero\" reference has since been used in reference to Ebola, Avian Flu, Swine Flu, and Typhoid (this one retroactively). The more medically correct term is <strong>index-case.</strong></p>\n\n<p>Here are excerpts from a CNN article indicating the etymology of the \"Patient Zero\" and the usage of index cases: <a href=\"http://www.cnn.com/2016/11/08/health/patient-zero-history-super-spreaders/index.html\" rel=\"nofollow noreferrer\">http://www.cnn.com/2016/11/08/health/patient-zero-history-super-spreaders/index.html</a></p>\n\n<blockquote>\n <p>When a researcher's scrawling of the <strong>letter O was misinterpreted as\n a zero</strong> in reference to a HIV patient in the <strong>early 1980s, the\n provocative term \"patient zero\" was born.</strong></p>\n \n <p>\"Patient zero\" is still frequently used to describe <strong>index cases</strong> -- the\n first documented cases of a disease observed or reported to health\n officials.</p>\n</blockquote>\n\n<p>Here is another CNN article explaining the misinterpretation of the \"patient O\" and the clearance of Gaëtan Dugas as the cause for the AIDS outbreak: \n<a href=\"http://www.cnn.com/2016/10/27/health/hiv-gaetan-dugas-patient-zero/index.html\" rel=\"nofollow noreferrer\">http://www.cnn.com/2016/10/27/health/hiv-gaetan-dugas-patient-zero/index.html</a></p>\n\n<blockquote>\n <p>Dugas was placed near the center of this cluster, and the researchers\n identified him as patient O, an abbreviation to indicate that he\n resided outside California. However, <strong>the letter O was misinterpreted\n as a zero in the scientific literature.</strong> Once the media and the public\n noticed the name, the damage was done.</p>\n</blockquote>\n\n<p>Here is a list of other alleged \"patient-zeros\" or \"index cases\": <a href=\"http://www.cnn.com/2016/11/08/health/gallery/patient-zero-cases-history/index.html\" rel=\"nofollow noreferrer\">http://www.cnn.com/2016/11/08/health/gallery/patient-zero-cases-history/index.html</a> </p>\n", "score": 2 } ]

[ "terminology", "hiv", "epidemiology" ]

[ { "answer_id": 10032, "body": "<p>Short-Term Benefits</p>\n\n<ol>\n<li><p>Cold showers boost recovery after exercise: Athletes often take ice baths after vigorous training do reduce soreness. You don’t have to take it that far, but you can obtain a similar benefit with a quick cold shower after your training sessions.</p></li>\n<li><p>Cold showers increase mood and alertness: When cold water pours over your body, your breathing deepens in response to the shock of the cold (this is your body trying to keep you warm by increasing overall oxygen intake). Your heart rate will also increase, resulting in a rush of blood through your body that will help you get energized for the day.</p></li>\n</ol>\n\n<p>Long-Term Benefits</p>\n\n<ol>\n<li><p>Cold showers burn fat: There are two kinds of fat in your body: white fat and brown fat. White fat is the body fat we all know and struggle to get rid of. When we consume more calories than our body needs to function and we don’t burn those calories for energy, they are stored as white fat. Brown fat,\"the good fat\", is activated when we're exposed to extreme cold in order to generate energy and keep our body warm.Cold showers also speeds up your metabolic rate which helps to lose fat.</p></li>\n<li><p>Relieve depressive symptoms: \"A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature(e.g cold swim) and this lack of \"thermal exercise\" may cause inadequate functioning of the brain.</p></li>\n<li><p>Cold showers strengthen immunity and circulation: Remember how I mentioned that cold showers speed up your metabolic rate, which helps you lose fat? The increase of this rate activates your immune system, which releases virus-fighting white blood cells that will help you get sick less frequently. Cold showers also increase your overall blood circulation, which can help you avoid hypertension and the hardening of arteries.</p></li>\n</ol>\n\n<p>But still there are various temperature degrees of cold water that may harm the body while some relieves it. For more information about these temperature degrees, visit:</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/</a></p>\n\n<p>For more on the long and short term benefits, visit:</p>\n\n<p><a href=\"http://www.medicaldaily.com/benefits-cold-showers-7-reasons-why-taking-cool-showers-good-your-health-289524\" rel=\"nofollow noreferrer\">http://www.medicaldaily.com/benefits-cold-showers-7-reasons-why-taking-cool-showers-good-your-health-289524</a></p>\n\n<p><a href=\"http://www.lifehack.org/articles/lifestyle/surprising-benefits-cold-showers.html\" rel=\"nofollow noreferrer\">http://www.lifehack.org/articles/lifestyle/surprising-benefits-cold-showers.html</a></p>\n", "score": 2 } ]

[ "blood", "blood-circulation" ]

[ { "answer_id": 17931, "body": "<p><strong>What are effects of microdosing alcohol on the liver's ability to <em>metabolize toxins?</em></strong></p>\n\n<p>There seems to be no effect.</p>\n\n<p>Alcohol can induce the enzyme system CYP2E1 in the liver, which can speed up the metabolism of toxins thus making some more and others less toxic. But according to <a href=\"https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm\" rel=\"nofollow noreferrer\">niaaa.nih.gov</a>:</p>\n\n<blockquote>\n <p>...CYP2E1 only is active after a person has consumed <em>large</em> amounts of alcohol...</p>\n</blockquote>\n\n<p><strong>What are effects of microdosing alcohol on the <em>liver performance?</em></strong></p>\n\n<p>There seems to be no studies about the effects (beneficial or harmful) of microdosing alcohol (1-2 g alco/day) on liver function, but <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9726266\" rel=\"nofollow noreferrer\">light drinking</a> (up to 17 g alco/day) can show signs of impaired liver function, such as increased blood levels of the liver enzymes (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716536/\" rel=\"nofollow noreferrer\">PubMed</a>). </p>\n\n<hr>\n\n<p><strong>What is the relation between microdosing alcohol and <em>mortality?</em></strong></p>\n\n<p>In a systematic review of 87 studies including 3,998,626 individuals (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26997174\" rel=\"nofollow noreferrer\">PubMed, 2016</a>), no significant reduction in mortality risk was observed for low-volume drinkers (1.3-24.9 g ethanol/day) and occasional drinkers (&lt;1.3 g ethanol/day):</p>\n\n<blockquote>\n <p>...low-volume alcohol consumption has no net mortality benefit compared\n with lifetime abstention or occasional drinking.</p>\n</blockquote>\n\n<p>Another analysis of several surveys including 333,247 individuals (<a href=\"http://www.onlinejacc.org/content/70/8/913\" rel=\"nofollow noreferrer\">JACC, 2017</a>):</p>\n\n<blockquote>\n <p>Light and moderate alcohol intake [up to 2 drinks or 28 g ethanol/day]\n might have a protective effect on all-cause and cardiovascular\n disease-specific mortality in U.S. adults.</p>\n</blockquote>\n\n<p>According to both reviews, microdosing (consuming 1 g or similarly small amount of alcohol per day) is not associated with significantly lower mortality than abstention <em>(see the graph with a <a href=\"http://www.onlinejacc.org/content/70/8/913\" rel=\"nofollow noreferrer\">J-curve</a> in the 2nd review).</em></p>\n\n<hr>\n\n<p><strong>Can microdosing alcohol <em>improve your immunity</em> like antivenom can protect you against venom?</strong></p>\n\n<p>No, not likely. <a href=\"https://en.wikipedia.org/wiki/Mithridatism#In_practice\" rel=\"nofollow noreferrer\">Mithridatism - practice of protecting oneself against a poison by gradually self-administering non-lethal amounts (Wikipedia)</a>:</p>\n\n<blockquote>\n <p>...immunity generally is only possible with biologically complex types\n [usually proteins] which the immune system can respond to... In some\n cases, it is possible to build up tolerance against specific\n non-biological poisons. For some poisons, this involves conditioning\n the liver to produce more of the particular enzymes that deal with\n these poisons (for example alcohol).</p>\n</blockquote>\n\n<p>But, according to <a href=\"https://www.rcpe.ac.uk/sites/default/files/vol29_2.1_8.pdf\" rel=\"nofollow noreferrer\">rcpe.ac.uk, p. 140</a>, this increased liver alcohol clearance (alcohol tolerance) develops only after</p>\n\n<blockquote>\n <p>prolonged use of alcohol in <em>substantial</em> doses.</p>\n</blockquote>\n\n<p><strong>Concluding from studies that included larger amounts of alcohol, microdosing alcohol does not seem to have any significant beneficial or harmful effects on the liver, but there is a lack of direct evidence.</strong></p>\n", "score": 4 } ]

[ "alcohol", "liver", "metabolism", "toxins" ]

[ { "answer_id": 10228, "body": "<p>Drinking the appropriate amount of water is okay, but when it becomes excessive, then it could lead to some dangerous circumstances.</p>\n\n<p>The appropriate amount of water varies according to lifestyle. According to the popular 8 by 8 rule which says that one should drink eight glasses, each consisting of eight ounce of water, may not suit every individual. Says nutritionist Venu Adhiya Hirani, \"While the general belief is to drink eight to 10 glasses of water, it is advisable to drink 12 to 15 glasses of fluids which includes water, tea, buttermilk, soup, etc. This would amount to an intake of around 2.5 litres of fluids everyday.\"</p>\n\n<p>According to Krishnan, If you have a sedentary lifestyle and work in an air-conditioned environment where there is no scope for water loss via sweat, drinking more than 2 to 2.5 litres of water is not advisable. It will end up accumulating in your kidney and cause edema. For moderate workers like salespersons, who are required to do physical activity, it is important to drink around three litres of water.</p>\n\n<p>“It also depends on your size and weight, and also on your activity level and where you live,” Nessler says. “In general, you should try to drink between half an ounce and an ounce of water for each pound you weigh, every day.\" For example, if you weigh 150 pounds, that would be 75 to 150 ounces of water a day.</p>\n\n<p><a href=\"http://m.timesofindia.com/life-style/health-fitness/diet/Health-benefits-of-black-tea/articleshow/8508759.cms\" rel=\"nofollow noreferrer\">http://m.timesofindia.com/life-style/health-fitness/diet/Health-benefits-of-black-tea/articleshow/8508759.cms</a></p>\n\n<p><strong>Consequences of drinking excess water</strong></p>\n\n<p><strong>1. Causes Hyponatremia:</strong></p>\n\n<p>The sodium content in the blood influences the functioning of the electrolytes. These electrolytes are responsible for sending signals to the cells which control various operations of the body. When you consume too much water, the sodium levels in the blood decrease. This stops the electrolytes from sending signals to the cells.</p>\n\n<p><strong>2. Overburdens The Heart:</strong></p>\n\n<p>The heart performs the vital function of pumping blood through your entire body. When you consume too much of water, this increases the volume of blood inside your body. The increased blood volume causes unnecessary pressure on the blood vessels and the heart, leading to seizure in some cases.</p>\n\n<p><strong>3. Causes Damage To Glomeruli:</strong></p>\n\n<p>Glomeruli are capillary beds in our kidneys. They work as a filtering station to excrete excess water from the body. Too much of water can cause potential damage to this system, leading to serious health hazards. The kidneys have to work overtime to process all this unnecessary water that is beyond their normal filtering capacity (1000 ml per hour).</p>\n\n<p><strong>4. Causes Swelling Of Cells:</strong></p>\n\n<p>As your blood gets diluted due to excess water, the concentration of electrolytes in the blood becomes lower than that in the cells. To maintain a balance in the concentration of electrolytes in the blood and the cells, water begins to flow into the cells. This results in swelling of cells, which is a dangerous condition.</p>\n\n<p><strong>5. Causes Brain Edema:</strong></p>\n\n<p>This is the swelling of brain cells. It is as hazardous as it sounds. Most of the cells in our body have a lot of room to stretch out. But the flat bones in our skull do not leave much space for the brain cells to be accommodated freely. When excess water in the blood vessels starts seeping into the brain cells, it causes swelling in the cells of the brain. This leads to severe conditions that include coma, brainstem herniation, and respiratory attack.</p>\n\n<p><strong><em>Note:</em></strong> There has even been a <a href=\"http://www.telegraph.co.uk/news/uknews/2262683/Man-dies-after-drinking-10-litres-of-water-in-eight-hours.html\" rel=\"nofollow noreferrer\">report</a> of a man who died drinking 10 litres of water within eight hours.</p>\n", "score": 4 } ]

[ "side-effects", "water", "benefits", "body-temperature" ]

[ { "answer_id": 12862, "body": "<p>Skin wrinkles and creases are generally caused by <a href=\"http://www.webmd.com/beauty/cosmetic-procedures-collagen#1\" rel=\"nofollow noreferrer\">a breakdown of the collagen framework within the skin</a>.</p>\n\n<blockquote>\n <p>Collagen is a key part of your skin's structure. It forms a network of fibers within your skin that acts like a framework.</p>\n \n <p>In young skin, the collagen framework is intact and the skin remains moisturized and elastic. Over time, the support structure weakens and the skin loses its elasticity. The skin begins to lose its tone as the collagen support wears down.</p>\n</blockquote>\n\n<p>Regardless of age, men have a higher collagen density than women; this is the ratio of collagen to the thickness of the skin. Researchers believe that the higher collagen density accounts for why <a href=\"http://www.dermalinstitute.com/uk/library/17_article_Is_a_Man_s_Skin_Really_Different_.html\" rel=\"nofollow noreferrer\">women appear to age faster than men of the same age</a>.</p>\n\n<p>Both men and women lose about one percent of their collagen per year after their 30th birthday. For women, however, this escalates significantly in the first five years after menopause then slows down to a loss of two percent per year.</p>\n\n<p>Wrinkles and other signs of skin ageing <a href=\"http://www.webmd.boots.com/healthy-skin/guide/ageing-skin-do-you-look-older-than-you-should\" rel=\"nofollow noreferrer\">can be influenced by habits and behaviours during a person's life</a>. Avoiding some risk factors for premature skin ageing can help keep skin looking younger for longer.</p>\n\n<p>As well as smoking causing premature skin aging,</p>\n\n<blockquote>\n <p>Wrinkles at the corners of the eyes (crow's feet) or between the eyebrows (frown lines) are thought to be caused by small muscle contractions. Over a lifetime, habitual facial expressions like frowning, smiling or squinting leave their mark on our skin.</p>\n</blockquote>\n\n<p>The first link states that</p>\n\n<blockquote>\n <p>Using your facial muscles -- smiling, frowning, or squinting, for instance -- is part of expressing yourself. That's normal, but it does stress the collagen in your skin. Over time, that stress adds up and contributes to facial lines and wrinkles.</p>\n</blockquote>\n", "score": 4 }, { "answer_id": 15374, "body": "<p>As far as I know this was never under experimental laboratory conditions in humans. But there are some observational, correlational and theoretical studies and considerations to explain the phenomenon. There are two main factors to consider here: sex and gender.</p>\n\n<p>The gender part is that female members in our societies are hold to a different physical attractiveness standard, are judged differently, get a different form of attention; and draw a different kind of attention onto their own physical appearance; as evidenced by the original question where it mentions \"lipstick\". Men with wrinkles tend to be called \"looking interesting\" while female are often called to \"look old\". These are psychological and sociological factors that cannot be discarded, but there is a biological reason to which these gender aspects are only amplifying.</p>\n\n<p>Smoking has either very subtle differences regarding the over-all effects in male or female smokers or even the self-selection process in becoming a smoker presents a more fundamental confounding factor for observed differences:</p>\n\n<blockquote>\n <p><a href=\"https://doi.org/10.1016/0091-3057(91)90544-C\" rel=\"nofollow noreferrer\"><strong>Hormonal and subjective effects of smoking the first five cigarettes of the day: A comparison in males and females</strong></a> (1991)</p>\n</blockquote>\n\n<p>But the difference becomes readily apparent after the age of forty:</p>\n\n<blockquote>\n <p><a href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.85.1.78\" rel=\"nofollow noreferrer\"><strong>Facial wrinkling in men and women, by smoking status.</strong></a> (1995)<br>\n With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups, the increased risk of wrinkling was equivalent to about 1.4 years of aging.</p>\n</blockquote>\n\n<p>Taken together with the difference in collagen metabolism, already mentioned in <a href=\"https://health.stackexchange.com/a/12862/11231\">Chris answer</a>, where males and females differ from the start the difference in reaction is again amplified due to smoking:</p>\n\n<blockquote>\n <p><a href=\"https://academic.oup.com/asj/article/29/6/467/210050\" rel=\"nofollow noreferrer\"><strong>Perioral Wrinkles: Histologic Differences Between Men and Women</strong></a> (2009)<br>\n Women tend to develop more and deeper wrinkles in the perioral region than men. Although much is known about the complex mechanisms involved in skin aging, previous studies have described histologic differences between men and women with respect to skin aging only incidentally and have not investigated the perioral region.<br>\n <strong>Results:</strong> The female replicas showed more and deeper wrinkles than the male replicas (P &lt; .01). Histologic analysis revealed that the perioral skin of men displayed a significantly higher number of sebaceous glands (P = .000; 95% confidence interval [CI] 23.6–53.2), sweat glands (P = .002; 95% CI 2.1–8.1), and a higher ratio between vessel area and connective tissue area in the dermis (P = .009; 95% CI 0.003–0.021). The amount of hair follicles did not significantly differ between men and women, although the average number of sebaceous glands per hair follicle was greater in men (P = .002; 95% CI 0.33–1.28).<br>\n <strong>Conclusions:</strong> Women exhibit more and deeper wrinkles in the perioral region and their skin contains a significantly smaller number of appendages than men, which could be a feasible explanation for why women are more susceptible to development of perioral wrinkles.</p>\n</blockquote>\n", "score": 1 } ]

[ "smoking", "wrinkles", "gender-specific" ]

[ { "answer_id": 13553, "body": "<h1>Adverse effects of excessive caffeine intake</h1>\n\n<p>800 mg/day is well above the maximum recommended amount (1)(3). High doses of caffeine (>600 mg/day) can increase the risk of spontaneous abortion in women (2). Caffeine directly affects the heart. Side effects related to this becomes especially pronounced at higher doses, and can cause tachycardia, and arrythmias (5).</p>\n\n<p>Excessive caffeine consumption can result in severe psychological dependence and withdrawal (5).</p>\n\n<p>Caffeine use is associated with increased risk of developing anxiety disorders (4).</p>\n\n<p>Tolerance also develops with chronic caffeine consumption. Increased doses will be required to achieve the desired effects of enhanced concentration and reduction of fatigue (3).</p>\n\n<p>Moderate amounts (100-200 mg/day) however, have been demonstrated to be safe (3).</p>\n\n<h1>Treatment of ADHD with caffeine</h1>\n\n<p>There is some evidence to suggest that caffeine is an effective treatment for ADHD (5)(9). However, caffeine is not indicated for ADHD, and tolerance develops rapidly. </p>\n\n<h1>A Comparison of Stimulants</h1>\n\n<p>The drugs referenced interact with organisms in unique ways (i.e.: possess unique pharmacodynamics), and in turn, differ in their therapeutic effects, and side effects. The drugs also have varying pharmacokinetic profiles, meaning that they are absorbed, distributed, excreted, and metabolized differently in the body.</p>\n\n<h2>Caffeine</h2>\n\n<blockquote>\n <p>Caffeine is an antagonist at adenosine receptors 1 and 2A. This means\n it binds to said receptors without activating them. The presence of\n caffeine at the adenosine receptors prevents adenosine (an inhibitory\n neurotransmitter) from binding (and producing a response), thereby\n causing stimulation (1) . This activity also induces neurotransmitter\n release (2) .</p>\n</blockquote>\n\n<p>From <a href=\"https://health.stackexchange.com/questions/13299/mechanism-of-action-moa-of-caffeine/13468#13468\">Mechanism of action (MOA) of Caffeine</a>.</p>\n\n<p>Additionally, caffeine is a more mild CNS stimulant than the amphetamines (i.e.: methylphenidate and amphetamine). The amphetamines are a more effective treatment for ADHD than caffeine (10)</p>\n\n<h2>Methylphenidate (Ritalin, Concerta)</h2>\n\n<p>Methylphenidate is a reuptake inhibitor of dopamine (DA), and to a lesser but still marked degree, noradrenaline (NE) (6). This activity increases the effect of these neurotransmitters, resulting in a reduction of symptoms.</p>\n\n<h2>Amphetamine (Vyvanse, Adderall, Dexedrine)</h2>\n\n<p>Amphetamine is a releasing agent of DA, NE, serotonin (5-HT) (6).</p>\n\n<p>Side effects such as anorexia, weight loss, and nausea tend to occur more commonly with amphetamine than methylphenidate. (8)</p>\n\n<p>In regards to the therapeutic effect, there is no significant difference between methylphenidate and amphetamine overall (7).</p>\n\n<h1>References</h1>\n\n<ol>\n<li>Caffeine: How much is too much? <a href=\"http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20045678\" rel=\"noreferrer\">http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20045678</a></li>\n<li>Coffee <a href=\"http://lpi.oregonstate.edu/mic/food-beverages/coffee\" rel=\"noreferrer\">http://lpi.oregonstate.edu/mic/food-beverages/coffee</a></li>\n<li>Medicines in my Home Caffeine and Your Body <a href=\"https://www.fda.gov/downloads/UCM200805.pdf\" rel=\"noreferrer\">https://www.fda.gov/downloads/UCM200805.pdf</a></li>\n<li>Common Psychiatric Disorders and Caffeine Use, Tolerance,and Withdrawal: An Examination of Shared Genetic and Environmental Effects <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443633/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443633/</a></li>\n<li>Caffeine Psychological Effects, Use and Abuse <a href=\"http://orthomolecular.org/library/jom/1981/pdf/1981-v10n03-p202.pdf\" rel=\"noreferrer\">http://orthomolecular.org/library/jom/1981/pdf/1981-v10n03-p202.pdf</a></li>\n<li>Methylphenidate and dexmethylphenidate formulations for children with attention-deficit/hyperactivity disorder.</li>\n<li>Clinical Gains from Including Both Dextroamphetamine and Methylphenidate in Stimulant Trials <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842881/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842881/</a></li>\n<li>A post hoc comparison of the effects of lisdexamfetamine dimesylate and osmotic-release oral system methylphenidate on symptoms of attention-deficit hyperactivity disorder in children and adolescents. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23801529\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/23801529</a></li>\n<li>Tea consumption maybe an effective active treatment for adult attention deficit hyperactivity disorder (ADHD). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21277687\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/21277687</a></li>\n<li>Caffeine versus methylphenidate and d-amphetamine in minimal brain dysfunction: a double-blind comparison. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1096645\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/1096645</a></li>\n</ol>\n", "score": 8 } ]

[ "mental-health", "caffeine", "add-adhd", "stimulants", "amphetamine" ]

[ { "answer_id": 10900, "body": "<p>You express insight into your weaknesses in coping with stress, and a desire to build healthier coping mechanisms. A person does not need to be in the acute phase of a psychological problem to seek therapy for it.</p>\n\n<p><a href=\"https://www.apa.org/pubs/journals/features/amp-a0034569.pdf\" rel=\"noreferrer\">Prevention is part</a> of psychology.</p>\n\n<p>Even Wikipedia lists prevention in the definition of <a href=\"https://en.wikipedia.org/wiki/Applied_psychology#Clinical_psychology\" rel=\"noreferrer\">clinical psychology.</a></p>\n\n<p>In health fields, <a href=\"https://en.wikipedia.org/wiki/Preventive_healthcare#Levels_of_prevention\" rel=\"noreferrer\">primary prevention</a> tries to prevent something from happening the first time. <a href=\"https://en.wikipedia.org/wiki/Preventive_healthcare#Levels_of_prevention\" rel=\"noreferrer\">Secondary prevention</a> tries to prevent something from happening a subsequent time - as in your situation, where you identified that you've already experienced difficulties.</p>\n\n<p>But even if you had never experienced difficulties, seeking to improve one's own coping skills to prevent future problems is primary prevention - which is generally ENCOURAGED. I can't find Academy recommendations specifically for this, but many (if not all) of the 25+ therapists I've worked alongside in clinic encourage early/preventive counseling.</p>\n\n<p>Psychologists (PsyD or PhD) are not the only ones who do behavioral therapy, similarly trained therapists include MFT, MSW, LSW, etc. </p>\n\n<p>Lastly, and purely anecdotally, I will gladly disclose that I established a relationship with a therapist myself for preventive counseling a few times during these 7 years of medical training, and have found it to be extremely valuable when navigating the extreme stressors.</p>\n", "score": 5 } ]

[ "mental-health", "psychologist-psychology" ]

[ { "answer_id": 10594, "body": "<p>The fact of the matter is, regardless of the consumption method, a calorie is a calorie. The energy it takes to burn one liquid calorie equals exactly the same as that needed to burn one solid calorie. What throws some people off is the concept of caloric density. Foods that have high water content tend to have lower caloric density (think fruits and veggies), meaning a greater calorie to volume ratio. For example, to consume the same amount of calories you would get from one cup of raisins, you would need to eat nearly ten cups of grapes. What adds to this is that low caloric density foods tend to make you feel fuller faster because of their water content.</p>\n\n<p>This does not mean that simply consuming more liquid will make you want to eat less. Liquid calories may in fact be deceiving because beverages like sodas often contain a lot of calories but do little to satiate hunger. When studies compared food intake between one group given water to drink and the other given soda, there was little difference in the amount of solid calories they ate. However, even though both groups ate roughly the same amount of food, the group who drank the soda consumed more calories overall because of the beverage that accompanied their meal.</p>\n", "score": 1 } ]

[ "nutrition", "diet", "digestion" ]

[ { "answer_id": 15015, "body": "<p>In general: No. Having <a href=\"https://en.wikipedia.org/wiki/Helicobacter_pylori\" rel=\"nofollow noreferrer\">ulcers</a> does not protect you from catching the flu. But that &quot;no&quot; is an oversimplification. The devil is indeed in the details.</p>\n<p>The <a href=\"https://en.wikipedia.org/wiki/Innate_immune_system\" rel=\"nofollow noreferrer\">innate immune system</a> and the <a href=\"https://en.wikipedia.org/wiki/Adaptive_immune_system\" rel=\"nofollow noreferrer\">adaptive immune system</a> have to be considered. The reasoning given in the question is in principle largely only applicable to the innate system.\nThe adaptive immune system is highly specific. When there is a response to one virus then a different virus will be new to this system. That will result in that system having to start from scratch fighting it. To make matters more complicated, both systems interact and the above explanation is almost a grossly reduced picture of what <em>might</em> be going on.</p>\n<p>It depends on what an infection is, where it occurs, what is doing the infection etc. Some <a href=\"https://en.wikipedia.org/wiki/Attenuated_vaccine\" rel=\"nofollow noreferrer\">vaccines</a> are just a perfect fit for the description in question. But to &quot;improve resistance to coming infective disease&quot; would then have to be modified into &quot;improve resistance to coming infective disease <em>of the same or very similar kind</em>&quot;.</p>\n<p>Examples against &quot;one infection protects against a second&quot; are quite numerous:</p>\n<blockquote>\n<p><a href=\"https://en.wikipedia.org/wiki/Coinfection\" rel=\"nofollow noreferrer\">In microbiology, coinfection is the simultaneous infection of a host by multiple pathogen species. In virology, coinfection includes simultaneous infection of a single cell by two or more virus particles. An example is the coinfection of liver cells with Hepatitis B virus and Hepatitis D virus, which can arise incrementally by initial infection followed by superinfection.</a></p>\n<p><a href=\"https://en.wikipedia.org/wiki/Superinfection\" rel=\"nofollow noreferrer\">A superinfection is a second infection superimposed on an earlier one, especially by a different microbial agent of exogenous or endogenous origin, that is resistant to the treatment being used against the first infection. Examples of this in bacteriology are the overgrowth of endogenous Clostridium difficile which occurs following treatment with a broad-spectrum antibiotic, and pneumonia or septicemia from Pseudomonas aeruginosa in some immuno-compromised patients.</a></p>\n<p><a href=\"https://en.wikipedia.org/wiki/HIV_superinfection\" rel=\"nofollow noreferrer\">HIV superinfection (also called HIV reinfection) is a condition in which a person with an established human immunodeficiency virus infection acquires a second strain of HIV, often of a different subtype. The HIV superinfection strain (a recombinant strain) appears when a person becomes simultaneously infected by two different strains, allowing the two viruses to exchange genetic material, resulting in a new unique strain that can possess the resistances of both previous strains. This new strain co-exists with the two prior strains and may cause more rapid disease progression or carry multiple resistances to certain HIV medications.</a></p>\n</blockquote>\n<p>On the other hand, if you define <em>infection</em> as &quot;like, having bacteria&quot; then being infected by several of them does (or at least might) protect you. That is of course a philosophical stretch in definitions for most aspects of medicine. But there is some evidence of varying degrees for bacteria, fungi, <a href=\"https://en.wikipedia.org/wiki/Bacteriophage\" rel=\"nofollow noreferrer\">different</a> forms of <a href=\"https://www.biotechniques.com/news/Viruses-Join-the-FightAgainst-Cancer/biotechniques-365925.html\" rel=\"nofollow noreferrer\">viruses</a> and <a href=\"https://health.stackexchange.com/q/11724/11231\">parasites</a> infecting – or less stretchy: colonising – a host and having more beneficial than detrimental effects.</p>\n<p>That does not only involve pure infighting between those species. (Like beneficial microbiome species outcrowding the bad ones, or producing chemicals that are toxic to the unwanted invaders, or just good ones eating the bad ones.) There is also some spillover along the lines of reasoning in the question, for example:</p>\n<blockquote>\n<p><a href=\"http://www.cell.com/immunity/abstract/S1074-7613(17)30274-1\" rel=\"nofollow noreferrer\"><strong>An Ocular Commensal Protects against Corneal Infection by Driving an Interleukin-17 Response from Mucosal γδ T Cells</strong></a>\nMucosal sites such as the intestine, oral cavity, nasopharynx, and vagina all have associated commensal flora. The surface of the eye is also a mucosal site, but proof of a living, resident ocular microbiome remains elusive. Here, we used a mouse model of ocular surface disease to reveal that commensals were present in the ocular mucosa and had functional immunological consequences. We isolated one such candidate commensal, Corynebacterium mastitidis, and showed that this organism elicited a commensal-specific interleukin-17 response from γδ T cells in the ocular mucosa that was central to local immunity. The commensal-specific response drove neutrophil recruitment and the release of antimicrobials into the tears and protected the eye from pathogenic Candida albicans or Pseudomonas aeruginosa infection. Our findings provide direct evidence that a resident commensal microbiome exists on the ocular surface and identify the cellular mechanisms underlying its effects on ocular immune homeostasis and host defense.</p>\n</blockquote>\n", "score": 4 } ]

[ "infection", "immune-system", "infectious-diseases", "resistance", "filariasis" ]

[ { "answer_id": 10720, "body": "<p>Generally, Diabetes Mellitus is categorized into Type 1, Type 2 and Gestational diabetes.The type that you are concerned with is type 2 in which genetic factor plays a major role.</p>\n\n<blockquote>\n <p>Type 2 diabetes is a disease that is fundamentally caused by a mismatch between our genetic makeup and our lifestyle choices, namely diet and physical activity. Numerous genes have been identified as risk factors. Among them about 10 genes are thoroughly studied for their causative etiology. Variations in these genes confer some impairment in insulin secretion and/or utilization, glucose and/or lipid homeostasis.<a href=\"https://www.gbhealthwatch.com/science-portal-diabetes-genes.php\" rel=\"noreferrer\">Source</a></p>\n</blockquote>\n\n<p>Many cases of type 2 diabetes can be prevented, or the onset delayed, through positive lifestyle changes. It is estimated that the risk of developing type 2 diabetes can be reduced by up to 58% by maintaining a healthy weight, being physically active and following a healthy eating plan.\nThere are numerous ways of preventing the diabetes:</p>\n\n<ul>\n<li><p>Maintaining a healthy weight</p></li>\n<li><p>Regular physical activity</p></li>\n<li><p>Making healthy food choices</p></li>\n<li><p>Managing blood pressure</p></li>\n<li><p>Managing cholesterol levels</p></li>\n<li><p>Not smoking.</p></li>\n</ul>\n\n<p>Talking about exercise, it helps to decrease obesity, helps your body increase its sensitivity to insulin. Muscular activity induces glucose entry into muscle cells without the need for insulin. As such, exercise has insulin sparing effect.</p>\n\n<p>References &amp; Sources:</p>\n\n<p><a href=\"https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-prevention\" rel=\"noreferrer\">https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-prevention</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639\" rel=\"noreferrer\">http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639</a></p>\n\n<p><a href=\"https://www.diabetesaustralia.com.au/prevention\" rel=\"noreferrer\">https://www.diabetesaustralia.com.au/prevention</a></p>\n", "score": 6 }, { "answer_id": 10746, "body": "<p>I agree with CCR's answer, let me add that the type of exercise that burns the most energy are cardio exercises (like running, biking swimming). Strength exercise are also recommended for good health, having strong muscles brings additional health benefits. But you cannot replace the benefits of cardio exercise by doing only only bodybuilding. By burning a lot of energy (many hundreds of Kcal a day) you can eat a lot more without gaining weight, but what is then important is that you then eat a lot more healthy foods based on whole grains, brown rice and vegetables. Your intake of fibers will then be a lot larger. Fibers get converted to short-chained fatty acids (SCFA) by intestinal bacteria, and these SCFA are known to have important roles in preventing heart disease, certain cancers and diabetes.</p>\n\n<p>Now, when reading information about diabetes on the Internet, you need to keep in mind that the information you find is aimed at people who are lot older than you, who may already be coping with a lot of health problems, who reasonably would not be able to attain a fitness goal anywhere near to what you can attain. They have to focus a lot more on calorie restriction to lose weight. This is not recommended for young people who are healthy and who have a healthy weight, because this would make it more difficult for you to exercise, you'll feel tired and you won't recuperate as well. </p>\n", "score": 1 } ]

[ "prevention", "diabetes", "genetic-predisposition", "weightlifting" ]

[ { "answer_id": 11120, "body": "<p>The one thing I would add to your natural remedy is cranberry juice and/or dried cranberries. Countless studies have shown a correlation between cranberry consumption and renal health.</p>\n\n<p>I know for a fact cranberry consumption can help prevent kidney stones. I'm not sure about dissolving them, but it certainly won't hurt to add to your remedy list.</p>\n\n<p>Source: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14616463\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/14616463</a></p>\n", "score": 3 }, { "answer_id": 11124, "body": "<p>Once a stone is formed, to my knowledge, it will have to pass...I don't think that anything is available that will promote dissolving, if that is even possible. Certainly large fluid intake combined with medication that relaxes the ureters (like Tamulosin) has been found to be effective...also important is prevention, with various regimens depending on the actual composition of the stone, based on treating the underlying precipitators for stone formation...5mm is borderline but with Tamulosin + heavy floods intake, might just pass...</p>\n", "score": 0 } ]

[ "diet", "kidney-stones" ]

[ { "answer_id": 11236, "body": "<p><strong>Fever</strong> can be a result of many processes. In context of infectious diseases, the fever is triggered by substances released by the immune cells (substances such as interleukin-1 and -6).<br>\nAlso, pyrexia can be achieved by getting exogenous pyrogens, substances from the bacterial debris that can create the same response. Those substances then interact with one part of the brain that regulates the temperature.<br>\nThat part of the brain serves as a thermostat, meaning it sets the \"default\" body temperature higher in these states. By doing that, the body employs mechanisms to raise the temperature, which result with shaking of the muscles, increase in the metabolic rate, sweating etc. What is interesting is that often people with pyrexia or before the onset of pyrexia feel cold (the default temperature is set to higher point, so the organism feels the current temperature as low).<br>\nThe point of the fever in this context is not fully discovered, but there is evidence that it provides boost to the immune system production capabilities (increased production of cells to fight the infection etc.) and it might hamper the growth of some infectious organisms that are sensitive to temperature changes. </p>\n\n<p>To be hyperconcise - fever implies immune system activation against antigen OR presence of exogenous pyrogens released from some bacteria (not all bacteria). </p>\n\n<p>About failsafe mechanisms - the thermostat here is enough to coordinate between heat production and heat release. If the temperature goes above the \"default\", then the organism has many ways to release excess heat (sweating, inactivity, reducing of the metabolism etc.). </p>\n\n<p>Best reading on this topic - Guyton et Hall, Textbook of Medical Physiology 13th ed., ch. 74. </p>\n", "score": 6 } ]

[ "body-temperature", "fever", "triggers" ]

[ { "answer_id": 13687, "body": "<p>Stress and excitement both activate the sympathetic nervous system, so they can feel very physically similar (high heart rates, etc.) The main difference is in higher-level brain processing, where stress is subjectively perceived as negative and excitement as positive. Interestingly, there is a study that proposes \"anxiety reappraisal\" in which you tell yourself you're excited instead of nervous, to facilitate management of high-stress situations. See popular press coverage here: <a href=\"http://nymag.com/scienceofus/2016/03/youre-excited-not-nervous-you-just-keep-telling-yourself-that.html\" rel=\"nofollow noreferrer\">http://nymag.com/scienceofus/2016/03/youre-excited-not-nervous-you-just-keep-telling-yourself-that.html</a> and the original study by Alison Wood Brooks here: <a href=\"https://adobe99u.files.wordpress.com/2015/06/xge-a0035325.pdf\" rel=\"nofollow noreferrer\">https://adobe99u.files.wordpress.com/2015/06/xge-a0035325.pdf</a></p>\n", "score": 2 }, { "answer_id": 13040, "body": "<p>Although you do activate a lot of the same systems in both cases, I would think your biggest difference will be what <em>else</em> you activate when excited, which would be Dopamine, Oxytocin, Serotonin, Endorphins, etc. When you are stressed you will actually release cortisol which will inhibit excretion of other feel good chemicals. You may release the feel good ones when the stress has passed, depending on the type of stress (horrible daily grind of an awful job versus the stress of being chased by a hungry bear &amp; getting away). <a href=\"http://www.thepositivepsychologypeople.com/habits-of-a-happy-brain/\" rel=\"nofollow noreferrer\">http://www.thepositivepsychologypeople.com/habits-of-a-happy-brain/</a></p>\n\n<p>Most stress people feel in the modern developed world is more of a long term nagging sort, versus the survival level sort. That is also long &amp; drawn out in such a cases, versus excitement, which in intense feeling, is generally rather brief. You don't typically sustain the anxious level excitement that impacts eating, sleeping, etc longer term. You can experience all those for a fair amount of time though when in love. It would still then be coupled with positive chemicals versus the levels of cortisol &amp; such experienced when instead it's negative feelings you are experiencing with similar side effects.</p>\n", "score": 0 } ]

[ "stress", "anxiety-disorders", "loss-of-appetite", "shake-tremble-fidget", "neuroscience" ]

[ { "answer_id": 11334, "body": "<blockquote>\n <p>All models are wrong, but some are useful.</p>\n</blockquote>\n\n<p>The same is true for the body mass index. In general, people with a higher BMI have a higher chance of getting obesity-related illnesses than those with a BMI in the 18-25 range. But of course, there are exceptions like the one you mention. That's no reason to discard the entire BMI, because it does work in many cases. It's easier than other predictors (such as abdominal circumference).</p>\n\n<p>Another example would be age, as a predictor of mortality. It's safe to assume that in general, a 90-year-old would die sooner than a 25-year-old. But it's not true that no 25-year-olds die before any 90-year-old.</p>\n\n<p>For the second part of your question: obesity is defined as a BMI >30. In that sense, we can say that Heath would be obese. But once again, this \"label\" is not flawless. He's probably got a lower probability of getting obesity-related illnesses than someone with a BMI of 29.9 based entirely on a bad diet and lack of exercise. </p>\n\n<p>TL:DR; BMI isn't a flawless predictor, but it's ease-of-use causes it to still be used.</p>\n", "score": 6 }, { "answer_id": 11365, "body": "<p>Let's not conflate two different problems with BMI here. One the one hand you can have a low body fat percentage and still have a high BMI, but that only applies to body builders who exercise at a near professional level. Such a person will not get wrongly diagnosed by his or her doctor of being overweight. So, this shouldn't be a problem, however, as Carey Gregory points out, some insurance companies in the US make decisions about coverage and premiums purely based on BMI, which can lead to unjust decisions. A more practical problem with BMI is that it will underestimate the risk of cardiovascular problems and diabetes in people of certain ethnicities, particularly Asians. As <a href=\"http://www.who.int/nutrition/publications/bmi_asia_strategies.pdf\" rel=\"nofollow noreferrer\">recommended by the WHO</a>, Asians should keep their BMI below 23 kg/m^2.</p>\n\n<p>Then having cleared up these two real issues with the BMI, let's consider the context in which the argument for a fat tax and the denial of medical services are made in the sources quoted by the OP. The medical problem that at hand is that health problems caused by a poor diet combined with lack of exercise account for the lion's share of health care costs. The US is a special case where 50% of the health care costs is due to an inefficient system, in most other Western countries, the burden of health care costs to society is about 10% of GDP. But even that 10% of GDP is mostly due to people eating too much fat, salt and sugar and not doing enough exercise.</p>\n\n<p>The people who choose to eat too many Big Macs are not only making me pay for my health care, they are actually limiting my health care options. The health care industry is hard at work at fixing the bodies of people who through their own faults, have wrecked their bodies, therefore I don't have to count on being treated in an optimal way. If at age 90 I would need a new kidney, I will be rejected because of my age despite having the fitness of a 60 year old by that time. </p>\n\n<p>There are also costs for society outside of health care. Your car is <a href=\"https://www.youtube.com/watch?v=nj8-cGh9FsE&amp;feature=youtu.be&amp;t=1171\" rel=\"nofollow noreferrer\">significantly more expensive</a> because the workers at the factories where cars are made are not making the right lifestyle choices. If you buy a plane ticket, you're paying more because transporting heavier people requires more fuel, the costs are shared by all passengers; people only pay for their extra checked luggage above their allowance, not your checked fat. <a href=\"https://www.youtube.com/watch?v=BlILHQ0DXFA\" rel=\"nofollow noreferrer\">This has led to calls for the system to be modified</a>. The fat tax mentioned here is a fee that overweight people would have to pay. Contrast that with the notion of a \"fat tax\" in the source quoted by the OP. There it's about imposing a VAT on fat, which is a reasonable way to get the population to stick to a healthier lifestyle, thereby drastically reducing the costs incurred on society. </p>\n\n<p>In conclusion, while it may look like the BMIs of very muscular athletic people poses a problem with using the BMI, a closer examination of the relevant facts reveals that this is not a major problem. Rather, it are obese people whose BMIs do actually reflect their miserable physical state (and also people with a normal weight who eat an unhealthy diet) who are making everyone pay a hefty fat tax, and they are making the quality of the health care available for you a lot worse. Bureaucratic problems with athletic people having high BMIs are trivial to fix, unfair as such problems may look like, let's not forget that at age 80 you are not eligible for a heart transplant, no matter how well your medical prognosis is. How unfair is that?</p>\n", "score": 2 }, { "answer_id": 11350, "body": "<p>As well as any other measurements it doesn't say much on it's own. You need to use it along with other personal details (and measurements) to get some meaning of it. \nOne of the problems with BMI is that muscle weighs more than fat, so athletes (specially the ones that practise sports that rely on strength) tends to break the BMI meaning.\nIt work well in regular people with a normal bone-muscle-fat ratio.</p>\n", "score": 1 } ]

[ "body-fat", "body-mass-index-bmi", "procedure-purposes", "procedural-expectations", "obesity" ]

[ { "answer_id": 11778, "body": "\n\n<p>We don't know how risky aluminum is. <a href=\"https://skeptics.stackexchange.com/questions/18182/is-aluminum-in-pans-soda-cans-and-antiperspirants-correlated-to-alzheimers#18186\">(Source.)</a></p>\n\n<p>In Germany, the Federal Institute for Risk Assessment (BfR) wondered about kettles too.</p>\n\n<p>They wrote an article named <a href=\"http://www.bfr.bund.de/en/faqs_about_aluminium_in_food_and_products_intended_for_consumers-191148.html\" rel=\"nofollow noreferrer\">\"FAQs about aluminium in food and products intended for consumers\"</a>. I shall quote a bunch from that article; their final answer to your question is at the very end of my post.</p>\n\n<blockquote>\n <h3>What health risks does aluminium absorption pose?</h3>\n \n <p>Any assessment of the hazardous potential of aluminium focuses on its effects on the nervous system and the fact that it is toxic to reproduction (effects on fertility and unborn life) as well as the effects of aluminium on bone development.</p>\n \n <p>When aluminium is ingested with food, its acute toxicity is low. ... But even in healthy individuals, the light metal accumulates in the body in the course of a lifetime, especially in the lungs and the skeletal system.</p>\n \n <p>...</p>\n \n <h3>What quantities of aluminium can be absorbed ... without any health risks?</h3>\n \n <p>For oral intake from food, the European Food Safety Authority (EFSA) has derived a tolerable weekly intake (TWI) of 1 milligramme (mg) of aluminium per kilogramme of bodyweight.</p>\n</blockquote>\n\n<p>Finally, later in their article, they answer your question:</p>\n\n<blockquote>\n <h1>Can I continue to use aluminium cooking pots / pressure cookers?</h1>\n \n <p>Provided that they are coated, yes. If they are not, no salty or acidic foods such as apple purée, rhubarb or salted herring should be prepared or stored in such pots.</p>\n</blockquote>\n\n<p>So it sounds like they say you can continue to use your aluminum kettle.</p>\n", "score": 2 } ]

[ "water", "alzheimers", "healthy-cooking", "metal" ]

[ { "answer_id": 11468, "body": "<p>In general, anxiety can be handled with medications or with \"talking therapy\", of which there are many types. So far you have seen two doctors. </p>\n\n<p>One offered medication. You were concerned about depending on them rather than learning to handle situations yourself, and about possible side effects or damage to yourself from those pills. These are wonderful things to discuss with that doctor. You can ask about side effects, you can ask if the doctor thinks you need to be on the medications indefinitely or just while you learn to handle difficult situations, and so on. You can also ask about needing higher doses for more difficult situations. Once you thoroughly understand what the doctor is suggesting and why, and the benefits and risks of it, you can decide whether you want to take it and how you will know whether you want to keep taking it or not.</p>\n\n<p>One recommended just getting healthier overall. A great question to ask that doctor is why that might help? Perhaps you're sleeping very poorly. Perhaps some blood tests have shown you are suffering from deficiencies that might cause anxiety. You need a reason to believe that exercise and healthy food will help the anxiety, right? That said, living a healthy live often means living a happy life with less worry, so if you can afford (time and money) to walk more, spend time outside, eat fresh food you cooked yourself, and take up an active hobby, I would encourage you to do that as a good thing in itself that might happen to lower your panic situation too.</p>\n\n<p>In addition to asking more questions from the two doctors you've already spoken to, you can look into counseling or therapy. There are many kinds! <a href=\"https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy\" rel=\"nofollow noreferrer\">CBT</a> is often suggested for anxiety - rather than discussing your childhood and trying to find out why you react as you do, it focuses on teaching you specific skills for coping with things that distress you today. Many people learn what they need to learn from such counselling and then stop doing it. The Wikipedia article includes links to studies, including one specifically about adults with anxiety.</p>\n", "score": 4 }, { "answer_id": 11442, "body": "<p>If a doctor mentioned eating a healthier diet in relation to your problems then that suggests that your diet is pretty bad. We can't judge if that's the case, but if you are not eating well, e.g. lack of proteins in your diet, not enough calories etc., then that will affect your psychological well being. Your brain will hit the stress and anxiety button a lot sooner if your energy levels are low due to chronic malnutrition.</p>\n", "score": 1 } ]

[ "anxiety-disorders", "psychologist-psychology", "healthy-cooking", "panic-attack" ]

[ { "answer_id": 11426, "body": "<p>More dangerous than healthy teeth, but not impossible to live with. A cracked tooth has a higher risk of breaking, is less resistant to tooth decay, heat, cold, acid etc. The 2 most dangerous situations I can imagine:</p>\n\n<ul>\n<li>If the weakened tooth breaks apart, its parts can be as dangerous as shards of glass in the mouth.</li>\n<li>If the injury leads to osteomyelitis, it might require a surgery.</li>\n</ul>\n\n<p>I'm not a doctor, I'm just guessing: if your tooth is cracked, <strong>see your dentist ASAP</strong>, as each case is unique.</p>\n\n<p>(The photo in the question is my cracked tooth. I had an accident almost a year ago, landed my face on concrete, visited my dentist, used 25 g Elmex gel as she recommended. I still don't use this tooth, so fortunatelly it's still in its place and is painless.)</p>\n", "score": 5 } ]

[ "dentistry", "cracked-broken-tooth" ]

[ { "answer_id": 11471, "body": "<p><strong>What worked for me (and many others!) was exercise.</strong></p>\n\n<p>After trying many antidepressants, I tried running. What got me motivated was an old article that I read about a clinical trial done by the University of Wisconsin around 1980. (Sorry, I could not find it today). IIRC, half of the group was given Prozac with no exercise, and the other half ran but was not given any pills. At the end of 10 weeks, the runners were less depressed than the other group.</p>\n\n<p>After reading that, I decided to try running in the morning before work. I ran as far as I could until I was out of breath, and then walked back home. I made myself run a little further each time. One day, I could run much further; I didn't get out of breath, my legs just got tired. After only 6 weeks, I was amazed at how GOOD I felt! My depression and anxiety vanished. </p>\n\n<p>You get a <em>runner's high</em> when you get in shape. That's a well known benefit.</p>\n\n<p>Eventually, I regularly ran between 3 and 4 miles, 4 or 5 days a week after work. And I did that for several decades, before I slipped on some ice and injured my ankle and lower leg.</p>\n\n<p>Before you try it, <em>educate yourself</em>. You can injure your feet without the correct technique (such as stretching your leg muscles beforehand) and suitable running shoes (I used Nikes). See an appropriate physician and read some good running/jogging books first! And if you feel real pain, stop running and just walk that day.</p>\n\n<p>These days, I alternate walking with running. It does wonders for my mental health, as long as I can stay motivated. </p>\n", "score": 5 }, { "answer_id": 11476, "body": "<p>Definitely, exercise. Any form. Running is often mentioned because of \"runner's high,\" but I have bad knees so... I walk. I walk with earbuds and listen to my favorite music. I change where I walk and the music I listen to frequently. Then you have swimming, yoga, pilates, hit a handball at a wall, dance, martial arts, hiking, biking, climb a wall, all things you can do alone or with someone else.</p>\n\n<p>Brain exercise: Crossword puzzles, sudoku, quizzes, anything that make you think.</p>\n\n<p>Heart care: Practice at least one random act of kindness daily. </p>\n\n<p>Just move. Everything is okay.</p>\n\n<p><a href=\"https://i.stack.imgur.com/X2uKd.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/X2uKd.jpg\" alt=\"evom tsuj\"></a></p>\n", "score": 3 } ]

[ "brain", "depression", "music-therapy" ]

[ { "answer_id": 31072, "body": "<p>Yes, it is. It is common for CT and MR images to have a number of rows and columns equal to either 320 or 512.</p>\n<p>I suggest you to download the <a href=\"https://www.microdicom.com/downloads.html\" rel=\"nofollow noreferrer\">MicroDicom DICOM Viewer</a> to load and view your MR images. On the right hand corner of the user interface you will find a column which lists all the tags associated to the images. Among them, the <code>(0028, 0030) Pixel Spacing</code>attribute gives you the distance between the center of each pixel.</p>\n", "score": 1 } ]

[ "mri", "angular-spatial-resoluton", "dicom" ]

[ { "answer_id": 11542, "body": "<p>This is my personal preference, and I have asked both doctors and pharmacists about it. They all agree</p>\n\n<blockquote>\n <p><strong>If</strong> you are able to remember the names of the different ingredients, choose according to your symptoms, and manage different times frames (every 4 hrs for one; every 6 hrs for another) <strong>then</strong> taking individual ingredients is better.</p>\n</blockquote>\n\n<p>Why is it better? You won't be taking something you don't need, or more of something than you need. The risk is that you will mix things or take too much (you've dismissed these as not a worry) or that it will be too much hassle, while you're sick, to figure out what to take. People like the idea of \"take this, you'll feel better\" without a lot of thinking. </p>\n\n<p>I react poorly to antihistamines, so I take separate ingredients to give me control. This is now reasonably difficult, since buying decongestants without added ingredients keeps getting harder and harder. That's why I've asked doctors and pharmacists about my approach. Should I just give up and buy decongestants with acetaminophen in them already? But they all tell me I am actually doing it right, with the proviso that you have to be prepared to put in the mental effort to get all the doses right.</p>\n", "score": 3 }, { "answer_id": 11540, "body": "<p>This is a good question actually, and a few of my patients come and ask me this over the counter.</p>\n\n<p>There are a few reasons why manufacturers do this, but I'll mention 2 here:</p>\n\n<ol>\n<li><p><strong>For symptoms of the cold and flu, your symptoms may change from one symptom to another, even during the course of the cold or flu itself</strong>.<br>\nJust to give an example: It could start off with a runny nose and then proceed to a cough or a sore throat due to nasal drip.<br>\nHaving a combination product with multiple active ingredients will cover all basic symptoms, and help you get through the cold itself. Those drugs are a there in your system just in case those symptoms occur, so it's not a waste per say. </p></li>\n<li><p><strong>Cost</strong>:<br>\nIt costs less to have tablets/caps/liquid manufactured with multiple active ingredients than having one active ingredient per product.<br>\nThis cost would be reflected for the consumer who is buying this as well.\nIn regards to safety, there has been safety and efficacy research put into products which are placed on the market beforehand, and this is regulated by the FDA.<br>\nProducts are tested for their interactions as well. So it's reasonable to say that if they're already on the market, they would have underwent scrutiny and testing.</p></li>\n</ol>\n\n<p>Hope this helps.</p>\n\n<p>Source: I'm a pharmacist for 5 years. </p>\n", "score": 0 }, { "answer_id": 11551, "body": "<p>As echoed by others here, this is an excellent question and your conclusion is largely correct. For what it may be worth, I personally always ask my patients (after taking the entire history and doing the appropriate physical, of course), to summarize which of their symptoms are actually the most bothersome for them, and specifically treat those.</p>\n\n<p>The end result will very much vary depending on available formulations, cost of them (and whether the patient can actually afford them), among other things. I sometimes combine single-drugs (say Acetaminophen, Ibuprofen and an Antitussive), or I might combine something that has both Ibuprofen and an Decongestant with pure Acetaminophen, and so on and so forth.</p>\n\n<p>More often than not, as long as dosages and overlaps are kept in mind, it is possible to make MANY effective combinations of symptomatic treatment for a given situation. I dare say most physicians have a couple or more \"go-to\" combinations for similar situations, depending on some of the factors I've outlined above.</p>\n", "score": 0 } ]

[ "medications", "otc-over-the-counter" ]

[ { "answer_id": 11716, "body": "<h1>How can I deal with standing for long periods?</h1>\n\n<h2>I have an odd sensation, like pins and needles</h2>\n\n<p>The technical name for that kind of altered sensation is <a href=\"http://umm.edu/health/medical/ency/articles/numbness-and-tingling\" rel=\"nofollow noreferrer\">paraesthesia</a>. It can have a <a href=\"http://bestpractice.bmj.com/best-practice/monograph/1077/diagnosis/step-by-step.html\" rel=\"nofollow noreferrer\">number of causes</a>; so much so that if you are getting this and it's bothering you the usual response applies: <em>go and seek medical advice</em>.</p>\n\n<p>On the other hand, if you are still a bit reticent and want to try other things first, there are a number of options.</p>\n\n<h2>Stand right!</h2>\n\n<p>Postural problems <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3629399\" rel=\"nofollow noreferrer\">can cause nerve compression</a>. An <em>anterior pelvic tilt</em> is relatively common:</p>\n\n<p><img src=\"https://i.stack.imgur.com/XCwad.png\" height=\"300\"></p>\n\n<p><em>(credit: <a href=\"https://commons.wikimedia.org/wiki/File:PostureFoundationGarments04fig1.png\" rel=\"nofollow noreferrer\">Anonymous - Posture &amp; Foundation Garments</a>, public domain)</em></p>\n\n<p><em>Posterior</em> pelvic tilt can happen too:</p>\n\n<p><a href=\"https://i.stack.imgur.com/tS8AZ.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/tS8AZ.gif\" alt=\"posterior tilt\"></a></p>\n\n<p><em>(credit: <a href=\"https://spscgym.wordpress.com/2015/04/23/anterior-pelvic-tilt-lets-talk-about-your-curvy-low-back-and-forward-tipped-pelvis/\" rel=\"nofollow noreferrer\">SPSC Crossfit</a>)</em></p>\n\n<p>So if you are standing for long periods, make sure your posture is good:</p>\n\n<ul>\n<li>head level (not forward)</li>\n<li>chin parallel to ground</li>\n<li>chest high</li>\n<li>shoulders level and relaxed</li>\n<li>abdomen flat, held up and in</li>\n<li>lower back flat and tucked under</li>\n<li>legs straight, knees relaxed</li>\n<li>feet parallel, toes forward</li>\n</ul>\n\n<h2>Check your footwear</h2>\n\n<p>Related to the above, differences in footwear <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/pri.386/abstract\" rel=\"nofollow noreferrer\">may affect posture</a> (NB, small <em>n</em>). Interestingly, high-heels <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1910649\" rel=\"nofollow noreferrer\">may not be as bad as many think</a> in this area.</p>\n\n<p>The main point is to wear relatively 'neutral' footwear where possible; and support/take account of high/fallen arches if appropriate.</p>\n\n<h2>Take Breaks / Exercise</h2>\n\n<p>If you are able to take a break to sit down for a while, or at least move in a way that is different to how you stand, this movement can grant some relief.</p>\n\n<p>Squats (supported by a wall if needed), simple weight transfers - either leg-to-leg, or forefoot-to-hindfood - and pelvic tilting exercises can assist.</p>\n\n<p>This may be a point to ask a physiotherapist for advice (as below), as it is easier for someone else to observe your posture and where the sensation is; then make recommendations based on that!</p>\n\n<h1>Other Options</h1>\n\n<h3>Ask for Help</h3>\n\n<blockquote>\n <p>I don't want to bother my doctor with issues of no concern</p>\n</blockquote>\n\n<p>As a general point: if something is causing you issues, then it is of concern. You don't have to have to be terribly unwell to see a doctor! I understand where you are coming from, but if you are suffering as a result of something it may be worth running it past them.</p>\n\n<p>Alternatively, you could <strong>consult a physiotherapist</strong> for their opinion and suggestions for exercise. Here, it is possible to self-refer to physios (although there was a significant wait last time I used that service); but there are usually reasonably-priced private options too.</p>\n\n<h3>Use a Foam Roller</h3>\n\n<p>Since you asked for suggestions backed by personal experience and not just the usual sources, I would be remiss in not putting this forward. Anecdotally (<em>n=3</em>), using a foam roller has helped and given relief for back stiffness (with its attendant altered sensation) and pain. The <em>n</em>s in this case are myself, my father, and a close family friend.</p>\n\n<p>They are fairly simple things in and of themselves:</p>\n\n<p><a href=\"https://i.stack.imgur.com/5EBde.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/5EBde.jpg\" alt=\"foam roller\"></a>\n<em>(credit: self)</em></p>\n\n<p>and decent relief can be achieved by lying perpendicularly on top of them positioned near your power back, and rolling back and forth. More info can be found elsewhere.</p>\n\n<p><strong>Disclaimer</strong>: This is highly anecdotal and I haven't yet found good sources to back them up- but lots of (trendy) health mags like them. That might be a positive or a negative thing, depending on your perspective.</p>\n\n<h2>Further Disclaimer</h2>\n\n<p>If you start having significant other issues, like numbness, issues with continence, severe pain, weight loss or other <a href=\"http://www.gloshospitals.nhs.uk/en/Wards-and-Departments/Departments/Pain-Management/Different-Pains/Back-Pain-Draft/Red-Flags-in-Back-Pain/\" rel=\"nofollow noreferrer\">red flag symptoms</a>; <strong>definitely see a doctor</strong>!</p>\n\n<hr>\n\n<h1>Further reading:</h1>\n\n<ul>\n<li><a href=\"https://www.saintlukeshealthsystem.org/health-library/back-safety-basics-good-posture\" rel=\"nofollow noreferrer\">Good posture</a>, from St Luke's health System (others are similar)</li>\n<li><a href=\"http://www.mayoclinic.org/healthy-lifestyle/adult-health/multimedia/back-pain/sls-20076817\" rel=\"nofollow noreferrer\">Mayo Clinic's 'improve your posture'</a></li>\n<li><a href=\"https://www.ccohs.ca/oshanswers/ergonomics/standing/standing_basic.html\" rel=\"nofollow noreferrer\">Working while standing</a> information from CCOHS</li>\n</ul>\n\n<hr>\n\n<p><em>(note, this was written focusing on back pain which is not as relevant to OP, it is left in for others who find this answer who <strong>do</strong> have back pain)</em></p>\n\n<h3>Actually, I have pack pain too...</h3>\n\n<blockquote>\n <p>I feel like this is a general issue that many people have. </p>\n</blockquote>\n\n<p>You are so right.</p>\n\n<p>Back pain is a huge and varied subject. It is <em>extremely common</em>, and as such has a big impact on a great number of individuals but also society writ large- <a href=\"https://medlineplus.gov/backpain.html\" rel=\"nofollow noreferrer\">Medline claims that it is a condition \"affecting 8 out of 10 people at some point during their lives\"</a>. <a href=\"http://www.nhs.uk/news/2014/03March/Pages/Back-pain-leading-cause-of-disability-study-finds.aspx\" rel=\"nofollow noreferrer\">UK statistics are similar</a>.</p>\n\n<p>Given the problem you are having, you probably already knew that. You probably also know some of the recommendations for back pain, but they are worth restating, in brief:</p>\n\n<ul>\n<li>keep active; in general mobility helps back pain more than immobility</li>\n<li>try <a href=\"http://www.nhs.uk/Livewell/Backpain/Pages/low-back-pain-exercises.aspx\" rel=\"nofollow noreferrer\">exercises geared towards back pain</a></li>\n<li>anti-inflammatory painkillers may help; but if you have stomach issues or are going to be taking them longer-term the you definitely should have a conversation with your doctor about that</li>\n<li>hot and cold compression packs can give relief</li>\n</ul>\n\n<p>These ones are summarised from <a href=\"http://www.nhs.uk/conditions/back-pain/pages/introduction.aspx\" rel=\"nofollow noreferrer\">the NHS page on back pain</a>; but similar advice is available elsewhere. </p>\n", "score": 4 } ]

[ "back", "blood-circulation", "spine", "standing" ]

[ { "answer_id": 12428, "body": "<p>No individual food is \"not healthy\" it is your diet that overall is healthy or not. Using white flour instead of whole flour gives away a chance to eat some fibre. <a href=\"http://www.nhs.uk/chq/pages/1141.aspx?categoryid=51\" rel=\"noreferrer\">A page from the UK's NHS</a> explains how much fibre you need and the role it plays in health.</p>\n\n<p>In addition, your friends may object to wheat or flour (even whole wheat) because it is a carbohydrate. There is a popular belief that eating carbs will give you diabetes or cause you to gain weight. Refined carbohydrates, such as white flour, are considered even worse. The <a href=\"https://www.canada.ca/en/health-canada/services/nutrients/carbohydrates.html\" rel=\"noreferrer\">government of Canada advice</a> certainly doesn't say \"don't eat carbs\" but I am sure that will not stop your friends from telling you not to eat them.</p>\n\n<p>Diseases are not brought on directly by eating a specific food. Eating too much of one thing (especially if that leads to eating not enough of another) can, over time, contribute to the development of obesity, diabetes, heart conditions, and so on. A <a href=\"https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf\" rel=\"noreferrer\">huge UK report</a> concludes:</p>\n\n<blockquote>\n <p>the evidence from both prospective cohort studies and randomised controlled trials indicates that total carbohydrate intake appears to be neither detrimental nor beneficial to cardio-metabolic health, colo-rectal health and oral health. </p>\n</blockquote>\n\n<p>This includes sugars (also called simple carbohydrates) and starches (also called complex carbohydrates). It points out that sugars are linked to dental problems (cavities) and that eating unrefined grains (eg whole wheat, brown rice) is associated with a lower risk of diabetes and heart issues. It also emphasizes the importance of fibre. If you can't read the whole report, read pages 17 through 20 which are the recommendations.</p>\n\n<p>With all that in mind, if you eat plenty of fruits and vegetables you can eat a little white bread from time to time (especially homemade bread where you know exactly what's in it) without worrying. Consider learning how to make whole wheat bread as well: it is also tasty and chewy and you might like it a lot. Don't worry about your friends; there will always be people telling you that \"sugar is poison\" or \"we aren't designed to drink milk\" - get your dietary advice from informed sources and you will have more confidence in what you cook and eat.</p>\n", "score": 7 } ]

[ "diet", "refined-foods" ]

[ { "answer_id": 14284, "body": "<p>Yes. There are scientific reasons and treatments involving worms and allergies or other immune system disorders. But the results are not overly conclusive and still understudied.</p>\n<p>This is based on the so called <a href=\"https://en.wikipedia.org/wiki/Hygiene_hypothesis\" rel=\"nofollow noreferrer\">hygiene hypothesis</a> in immunology.</p>\n<p>Short version to this: our immune system evolved in a world full of dirt and germs where it had to be quite aggressive against all those threats and invasions in order to keep our ancestors alive. In recent years – since Leuwenhoek, Semmelweiss, Lister, Koch and Pasteur – we learned that and how germs could make us ill and tried to eradicate all of them. Or at least keep them away from us as to limit the danger of getting infections.</p>\n<p>That would theoretically translate into the very simple reasoning: Trying to eliminate all germs, or improving hygiene, ensures a much healthier population across the board. But the problem observed was that allergies were on the rise into previously unheard of dimensions despite the direct living environments getting cleaner and cleaner. That is, in modernised or Western societies allergies have become very widespread. In less developed nations the rise of allergies was seen as much less pronounced.</p>\n<p>The hypothesis is now that a lack of actual threats and &quot;proper training&quot; is directing the immune system to attack otherwise rather benign substances (like pollen) or even the own tissues (auto-immune disorders). Turning this process from its head back to its feet again it was then tried whether a deliberate infestation with once very common hookworms might alleviate the symptoms of sufferers. And apparently it sometimes did.</p>\n<p>Apart from currently being still <em>very</em> promising there are downsides to its applications. The effects seem to rely quite heavily on early childhood exposure and diminish with age. Having a worm is not much fun and of course, once the worms have &quot;modulated the immune system&quot; you have to get treatment to get rid of them again (which might cause an impressive range of side-effects on its own; <a href=\"https://www.drugs.com/sfx/vermox-side-effects.html\" rel=\"nofollow noreferrer\">example</a>).</p>\n<p>And while overuse of certain hygienic agents, like disinfectants and antibiotics, are certainly a problem, cutting back radically on hygiene or even to introduce deliberate infections of any kind seem like an easy inference – and a bat droppings crazy stupid one on top. It's complicated and we're still figuring out much of the basics.</p>\n<p>Good overviews are presented here: <a href=\"http://www.bbc.com/future/story/20130422-feeling-ill-swallow-a-parasite\" rel=\"nofollow noreferrer\">Worm therapy. Why parasites may be good for you</a> and <a href=\"http://sciencenotes.ucsc.edu/2014/pages/hookworm/hookworm.html\" rel=\"nofollow noreferrer\">Health by Hookworm</a> and <a href=\"https://www.theguardian.com/lifeandstyle/2010/may/23/parasitic-hookworm-jasper-lawrence-tim-adams\" rel=\"nofollow noreferrer\">Gut instinct: the miracle of the parasitic hookworm</a>.</p>\n<p>Although there were early speculations about this coming from Russian fringe doctors many decades ago and emerging in Western science in the seventies, the hypothesis really came into form with <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/\" rel=\"nofollow noreferrer\">Hay fever, hygiene, and household size</a> and took off after German reunification provided a really large quasi-experimental corroboration for it.</p>\n<p>Another word for this is <a href=\"https://en.wikipedia.org/wiki/Helminthic_therapy\" rel=\"nofollow noreferrer\">helminthic therapy</a>. This whole concept is now even largely superseded (or <a href=\"https://www.nature.com/articles/ni.3829\" rel=\"nofollow noreferrer\">refined</a>?) with the <a href=\"https://www.news-medical.net/health/Old-Friends-Hypothesis.aspx\" rel=\"nofollow noreferrer\">Old Friends hypothesis</a>, including bacteria and even viruses. This presents a much more <em>re</em>-balanced view of &quot;us&quot;– taking for example also our whole microbiome into consideration and not just a few &quot;key players&quot; like the hookworm in question.</p>\n<p>More up-to-date and in a more scientifically constructed wording than the gross oversimplifications above are these papers:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680069/\" rel=\"nofollow noreferrer\">Interactions between helminth parasites and allergy</a>(2009)</p>\n<blockquote>\n<p>Helminth infections have strong modulatory effects on anti-parasite inflammatory responses in the human host but it is not clear if helminths can affect allergic inflammatory responses to aero-allergens. Helminth infections have been associated with both a reduced prevalence and increased prevalence of atopy and atopic disease in different populations. The immune regulatory effects of tissue helminths are likely to be stronger than those of geo-helminths. Further research in prospective observational and intervention studies is required to address the question of causality. An understanding of the mechanisms by which helminth parasites modulate the host allergic inflammatory response may lead to the development of novel anti-inflammatory interventions. The demonstration of a causal association between some helminth parasites (particularly geo-helminths and toxocariasis that have a worldwide distribution) and an increased risk of asthma could lead to anthelmintic treatment programmes in populations considered to be at high risk.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025185/\" rel=\"nofollow noreferrer\">The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections</a>(2016)</p>\n<blockquote>\n<p>Current iterations of the hygiene hypothesis suggest an adaptive role for helminth parasites in shaping the proper maturation of the immune system. However, aspects of this hypothesis are based on assumptions that may not fully account for realities about human helminth infections. Such realities include evidence of causal associations between helminth infections and asthma or inflammatory bowel disease as well as the fact that helminth infections remain widespread in the United States, especially among populations at greatest risk for inflammatory and autoimmune diseases.</p>\n</blockquote>\n<p>That means that the parasites are well known to be able to modulate the immune system response. But this does not translate into proven, always beneficial effects. It can also go very wrong and actually worsen any associated condition. We do not know with certainty how the parasites do it. We do not know with certainty which parasites might be good or bad for what. We do not know with certainty if early exposure (at a young age), where the observed effects seem strongest, is necessary and therefor a treatment for adults much less effective. Having parasites is not very pleasant, just copying their mechanism looks much more promising.</p>\n<blockquote>\n<p>A recently emerged attractive alternative hypothesis to explain the rise of inflammatory diseases is a <a href=\"http://www.bmj.com/content/349/bmj.g5267\" rel=\"nofollow noreferrer\">“biome depletion” theory</a>. This suggests inflammatory disease may be due to a loss of species diversity or alteration of composition of the commensal microbiome within the human body.</p>\n<p>The immense conflicting data regarding the benefits versus harms of live helminths as a therapeutic modality to date warrants further questioning of the utility of additional human clinical trials. Therefore, directing future research and trials towards helminth-derived immunomodulatory molecules allows for safer and better-described therapies that could alleviate the suffering from autoimmune conditions without the commensurate risk of a parasite infection. Indeed, the aim of experimental animal models should be to develop novel treatments that mimic the effects of helminths without requiring the presence of parasites in the host.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374592/\" rel=\"nofollow noreferrer\">Human helminth therapy to treat inflammatory disorders – where do we stand?</a> (2015)</p>\n<blockquote>\n<p>Parasitic helminths have evolved together with the mammalian immune system over many millennia and as such they have become remarkably efficient modulators in order to promote their own survival. Their ability to alter and/or suppress immune responses could be beneficial to the host by helping control excessive inflammatory responses and animal models and pre-clinical trials have all suggested a beneficial effect of helminth infections on inflammatory bowel conditions, MS, asthma and atopy. Thus, helminth therapy has been suggested as a possible treatment method for autoimmune and other inflammatory disorders in humans.</p>\n</blockquote>\n<p>Especially in relation to asthma:\n<a href=\"https://autoimmunetherapies.com/candidate_diseases_for_helminthic_therapy_or_worm_therapy/asthma_helminthic_therapy.html\" rel=\"nofollow noreferrer\">Asthma &amp; Helminthic Therapy. Evidence for the use of helminthic therapy to treat Asthma</a>.</p>\n", "score": 4 } ]

[ "benefits", "asthma", "hookworm" ]

[ { "answer_id": 11997, "body": "<p>Yes. what you are describing sounds like microscopic hematuria (1). Sometimes red blood cells(RBC) are not numerous enough to be visible in urine. Yet, when tested, RBCs are detected.</p>\n\n<p>(1) <a href=\"http://www.nejm.org/doi/full/10.1056/NEJMcp012694\" rel=\"noreferrer\">http://www.nejm.org/doi/full/10.1056/NEJMcp012694</a></p>\n", "score": 5 }, { "answer_id": 14921, "body": "<p>The presence of blood in the urine is called <a href=\"https://en.wikipedia.org/wiki/Hematuria\" rel=\"nofollow noreferrer\">Hematuria</a>. It can be detected in the microscopic lab tests. Please contact a nephrologist doctor for quick treatment. </p>\n", "score": 0 } ]

[ "blood", "urine", "kidney" ]

[ { "answer_id": 12570, "body": "<p>Simply put, it doesn't.</p>\n\n<p>Breaking the word <strong>prosopagnosia</strong> down you end up with:</p>\n\n<p><strong>Prosop</strong> is rooted in Greek for face, and gnosis is knowledge (<strong>agnosia</strong> is therefore lack of knowledge, or ignorance, but not in a pejorative sense).</p>\n\n<p>There are tons of <a href=\"https://en.wikipedia.org/wiki/Agnosia\" rel=\"nofollow noreferrer\">agnosias</a>, which is defined as impairment of a single modality (like vision) from being able to process information correctly. As <a href=\"https://health.stackexchange.com/users/2833/bill-oertell\">Bill Oertell's answer</a> correctly points out, his pattern recognition skills are impaired visually and affects faces, birds, and I'm sure other similar objects. I'd imagine things with similar and subtle color changes (like hawks and human faces) cause issues.</p>\n\n<p>Further, something like dementia can impact facial recognition which is a subclass called developmental prosopagnosia, and that obviously carries a host of other impairments.</p>\n\n<p>Prosopagnosia is a disorder that can be caused by trauma, genetics from birth, and developmental conditions. It is a symptom, not a cause, and as such the cause will generally exhibit other symptoms as well.</p>\n", "score": 3 }, { "answer_id": 18986, "body": "<p>Face blindness is typically associated with a loss of \"map memory\" as well, an inability to memorize the layout of some place and find your way around.</p>\n\n<p>Oliver Sacks describes this:</p>\n\n<p><a href=\"https://www.newyorker.com/magazine/2010/08/30/face-blind\" rel=\"nofollow noreferrer\">https://www.newyorker.com/magazine/2010/08/30/face-blind</a></p>\n\n<p>I have both disabilities, apparently due to a case of polio at age 21 months.</p>\n\n<p>Oddly, the condition appears to affect \"formula memory\" in me, meaning I can't readily recall \"cookbook\" solutions to programming problems. Happily, this forces me to invent new solutions, and I've invented several in my career which were at least modestly notable.</p>\n", "score": 0 } ]

[ "neurology", "face" ]

[ { "answer_id": 12502, "body": "<p>The <a href=\"http://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/insomnia/FAQ-20057824\" rel=\"nofollow noreferrer\">Mayo Clinic</a> says, among other things:</p>\n\n<blockquote>\n <p>If you wake up and can't fall back to sleep within 20 minutes or so, get out of bed. Go to another room and read or do other quiet activities until you feel sleepy.</p>\n</blockquote>\n\n<p>Super thrilling and exciting work may not be the best choice. That said, I've been waking in the night lately and I found that doing a small nugget of work (most recently I changed a demo in an upcoming presentation, which took about half an hour) gives me a sense that I did something and earned a chance to relax. That was a better result than reading for an hour. I went back to sleep afterwards quite easily.</p>\n", "score": 2 }, { "answer_id": 12506, "body": "<p>Suppose that you also want to sleep better on the long term. Then that may require some lifestyle changes like exercising more. If waking up much earlier than usual and feeling that you just can't sleep more happens quite frequently, then you need to weigh your options such that sticking to your new routine is going to work the best. The problem with getting more exercise is that while <a href=\"https://well.blogs.nytimes.com/2013/08/21/how-exercise-can-help-us-sleep-better/?_r=0\" rel=\"nofollow noreferrer\">sleep is known to be affected by exercise</a>, it's not easy to get to sleep better by exercising more. You need to continue to exercise for a while to reap the benefits for sleep:</p>\n<blockquote>\n<p>But people with insomnia and other sleep disturbances tend to be “neurologically different,” Dr. Baron said. “They have what we characterize as a hyper-arousal of the stress system,” she said. A single bout of exercise on any given day “is probably not enough to overcome that arousal,” she explained. It could potentially even exacerbate it, since exercise is itself a physical stressor.</p>\n<p>Eventually, however, if the exercise program is maintained, Dr. Baron said, the workouts seem to start muting a person’s stress response. Her or his underlying physiological arousal is dialed down enough for sleep to arrive more readily, as it did in the 2010 experiment.</p>\n</blockquote>\n<p>We may get a better insight into insomnia by looking at populations were insomnia is rare. It turns out that many indigenous populations don't get the amount of sleep that is conventionally recommended, but they don't suffer from insomnia anywhere near the levels that's considered to be normal in Western societies. As <a href=\"http://news.nationalgeographic.com/2015/10/20151015-paleo-sleep-time-hadza-san-tsimane-science/\" rel=\"nofollow noreferrer\">pointed out here:</a></p>\n<blockquote>\n<p>Though the San, Tsimane, and Hadza often average less than seven hours of sleep, they seem to be getting enough sleep. They seldom nap, and they don’t have trouble dozing off. The San and Tsimane languages have no word for insomnia, and when researchers tried to explain it to them, “they still don’t seem to quite understand,” Siegel says.</p>\n</blockquote>\n<p>The Tsimane get far more exercise than most Westerners do. We can <a href=\"https://www.theguardian.com/society/2017/mar/17/tsimane-of-the-bolivian-amazon-have-worlds-healthiest-hearts-says-study\" rel=\"nofollow noreferrer\">read here:</a></p>\n<blockquote>\n<p>The Tsimane get a ton of exercise, Gurven says, but it's not really intense exercise. &quot;I think there's a general stereotype that if you're a hunter-gatherer and farmer, that you're exercising vigorously every day, like the equivalent of running a marathon, and that's not the case,&quot; Gurven says. &quot;It's really just that they're not sedentary.&quot;</p>\n<p>Instead the Tsimanes do a lot of walking — about 7 1/2 miles each day. And they're active for more than 90 percent of daylight hours. In contrast, Americans spend about half their waking hours sitting down.</p>\n</blockquote>\n<p>And they eat far less fat than we do:</p>\n<blockquote>\n<p>When you hear &quot;hunter-gatherer,&quot; people often think of the meat-packed paleodiet. But the Tsimane diet couldn't be further from that. More than 70 percent of their calories come from carbohydrates — ones that are packed with fiber, such as corn, cassava and plantains. The other 30 percent of the calories are split evenly between protein and fat.</p>\n</blockquote>\n<p>So, by changing your lifestyle by getting more exercise, eating healthier and getting a larger fraction of your calories from whole grain carbs, and by not focusing too much on getting 8 hours of sleep (6.5 hours may be enough), you'll likely end up sleeping better.</p>\n", "score": 2 } ]

[ "mental-health", "insomnia" ]

[ { "answer_id": 12545, "body": "<p>The glycemic index of rice varies quite a lot: according to <a href=\"http://www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods\" rel=\"nofollow noreferrer\">this link</a> from Harvard Medical School, from 38 for Parboiled rice to 72 for white rice. The latter is a rather high glycemic index. As a consequence, it may be that white rice at dinner releases glucose rapidly, and what is not needed then gets stored as fat. \nOf course, this depends on a number of factors, like how much rice do you eat, what sort of rice it is (there are many!), whether your dinner has been preceded or is followed by physical activity, and so on. Generally, I would reject the claim that eating rice during dinner is not good for one's health.</p>\n", "score": 3 } ]

[ "nutrition", "digestion", "supplement", "time-of-day", "meal" ]

[ { "answer_id": 12579, "body": "<h2>CRP</h2>\n\n<blockquote>\n <p>C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation throughout the body. It is one of a group of proteins called \"acute phase reactants\" that go up in response to inflammation.</p>\n</blockquote>\n\n<p>So, when there is an inflammation anywhere in your body, the amount of C-reactive protein in your blood will rise. </p>\n\n<p>The CRP test is a general test to check for inflammation in the body. It is not a specific test. That means it can reveal that you have inflammation somewhere in your body, but it cannot pinpoint the exact location.</p>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003356.htm\" rel=\"nofollow noreferrer\">Medlineplus.gov</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<ol>\n<li><p>For Inflammation:</p>\n\n<blockquote>\n <p>A test result showing a CRP level greater than 10 mg/L is a sign of serious infection, trauma or chronic disease, which likely will require further testing to determine the cause. </p>\n</blockquote></li>\n<li><p>For Heart Diseases</p>\n\n<blockquote>\n <p>If you're having an hs-CRP test to evaluate your risk of heart disease, there is a high risk if you have an hs-CRP level greater than 2.0 mg/L.</p>\n</blockquote></li>\n</ol>\n\n<p><em>Source: <a href=\"http://www.mayoclinic.org/tests-procedures/c-reactive-protein/basics/results/PRC-20014480\" rel=\"nofollow noreferrer\">MayoClinic.org</a></em></p>\n\n<hr>\n\n<h2>ESR</h2>\n\n<blockquote>\n <p>ESR stands for erythrocyte sedimentation rate. It is commonly called a \"sed rate.\" [...]\n This test can be used to monitor inflammatory diseases or cancer. <strong>It is not used to diagnose a specific disorder.</strong>\n <em>(Emphasis mine)</em></p>\n</blockquote>\n\n<p>Basically, they measure how long red blood cells (erythrocytes) take to travel down a thin tube.</p>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003638.htm\" rel=\"nofollow noreferrer\">Medlineplus.gov</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>Results from your sed rate test will be reported in the distance in millimeters (mm) that red blood cells have descended in one hour (hr). The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women. The upper threshold for a normal sed rate value may vary somewhat from one medical practice to another.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"http://www.mayoclinic.org/tests-procedures/sed-rate/details/results/rsc-20207039\" rel=\"nofollow noreferrer\">MayoClinic</a></em></p>\n\n<hr>\n\n<h2>AFP</h2>\n\n<blockquote>\n <p>An alpha-fetoprotein (AFP) blood test checks the level of AFP in a pregnant woman's blood. AFP is a substance made in the liver of an unborn baby (fetus). </p>\n</blockquote>\n\n<p>This is a very solid indication whether one is pregnant or not. It can also help to asses the health of the fetus.</p>\n\n<p>If one is not pregnant, it is highly probable that there are problems with the liver if a high amount of AFP can be found in the blood.</p>\n\n<p><em>Source: <a href=\"http://www.webmd.com/baby/alpha-fetoprotein-afp-in-blood\" rel=\"nofollow noreferrer\">WebMD</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>For women who aren’t pregnant as well as men, the normal amount of AFP is usually less than 10 nanograms per milliliter of blood. If your AFP level is unusually high but you aren’t pregnant, it may indicate the presence of certain cancers or liver diseases.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"http://www.healthline.com/health/alpha-fetoprotein#results5\" rel=\"nofollow noreferrer\">Healthline.com</a></em></p>\n\n<hr>\n\n<h2>CEA</h2>\n\n<blockquote>\n <p>The carcinoembryonic antigen (CEA) test measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially cancer of the large intestine (colon and rectal cancer). It may also be present in people with cancer of the pancreas, breast, ovary, or lung.</p>\n</blockquote>\n\n<p>This protein is usually only produced in the fetus, so a high level of CEA in the blood can be linked to cancer.</p>\n\n<p><em>Source: <a href=\"http://www.webmd.com/cancer/carcinoembryonic-antigen-cea\" rel=\"nofollow noreferrer\">WebMD</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>The normal range is 0 to 2.5 micrograms per liter (mcg/L). In smokers, the normal range is 0 to 5 mcg/L.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003574.htm\" rel=\"nofollow noreferrer\">Medlineplus.gov</a></em></p>\n\n<hr>\n\n<h2>WBC</h2>\n\n<p>The White Blood Cell Count (WBC) determines the amount of leukocytes, or white blood cells in your blood. </p>\n\n<p>The leukocytes play a vital role in your immune system. Generalized:</p>\n\n<blockquote>\n <p>These cells help fight infections by attacking bacteria, viruses, and germs that invade the body.</p>\n \n <p>Having a higher or lower number of WBCs than normal may be an indication of an underlying condition. A WBC count can detect hidden infections within your body and alert doctors to undiagnosed medical conditions, such as autoimmune diseases, immune deficiencies, and blood disorders. </p>\n</blockquote>\n\n<p>This is a standard part of any blood test. </p>\n\n<p><em>Source: <a href=\"http://www.healthline.com/health/wbc-count#overview1\" rel=\"nofollow noreferrer\">healthline.com</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>The normal number of WBCs in the blood is 4,500 to 11,000 white blood cells per microliter (mcL) or 4.5 to 11.0 x 10^9/L.</p>\n \n <p>Normal value ranges may vary slightly among different labs. Some labs use different measurements or may test different specimens. Talk to your doctor about your test results.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003643.htm\" rel=\"nofollow noreferrer\">Medlineplus.gov</a></em></p>\n\n<hr>\n\n<h2>RBC</h2>\n\n<blockquote>\n <p>An RBC count is a blood test that measures how many red blood cells (RBCs) you have.</p>\n \n <p>RBCs contain hemoglobin, which carries oxygen. How much oxygen your body tissues get depends on how many RBCs you have and how well they work.</p>\n</blockquote>\n\n<p>This is a standard part of any blood test.</p>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003644.htm\" rel=\"nofollow noreferrer\">Medlineplus.gov</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>A normal range in adults is generally considered to be 700,000 to 5.2 million red blood cells per microliter (mcL) of blood for men and 500,000 to 4.6 million red blood cells per mcL of blood for women. In children, the threshold for high red blood cell count varies with age and sex.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"http://www.mayoclinic.org/symptoms/high-red-blood-cell-count/basics/definition/SYM-20050858\" rel=\"nofollow noreferrer\">MayoClinic</a></em></p>\n\n<hr>\n\n<h2>Platelet Count</h2>\n\n<blockquote>\n <p>Platelets are parts of the blood that help the blood clot. They are smaller than red or white blood cells.</p>\n \n <p>The number of platelets in your blood can be affected by many diseases. Platelets may be counted to monitor or diagnose diseases, or to look for the cause of too much bleeding or clotting.</p>\n</blockquote>\n\n<p>This is a standard part of any blood test.</p>\n\n<p><em>Source: <a href=\"https://medlineplus.gov/ency/article/003647.htm\" rel=\"nofollow noreferrer\">Medlineplus.org</a></em></p>\n\n<p><strong>Test Results</strong></p>\n\n<blockquote>\n <p>A normal platelet count is between 150,000 and 450,000 platelets per microliter (one-millionth of a liter, abbreviated mcL). The average platelet count is 237,000 per mcL in men and 266,000 per mcL in women.</p>\n \n <p>A platelet count below 150,000 per mcL is called thrombocytopenia, while a platelet count over 450,000 is called thrombocytosis. Platelets seem to have a large backup capacity: blood typically still clots normally as long as the platelet count is above 50,000 per mcL (assuming no other problems are present). Spontaneous bleeding doesn’t usually occur unless the platelet count falls to 10,000 or 20,000 per mcL.</p>\n</blockquote>\n\n<p><em>Source: <a href=\"http://answers.webmd.com/answers/1198204/what-is-a-normal-platelet-count\" rel=\"nofollow noreferrer\">WebMD Answers</a></em></p>\n", "score": 7 } ]

[ "blood", "blood-tests", "gerd-acid-reflux" ]

[ { "answer_id": 12662, "body": "<p><a href=\"https://ndb.nal.usda.gov/ndb/foods/show/6195?n1=%7BQv%3D1%7D&amp;fgcd=&amp;man=&amp;lfacet=&amp;count=&amp;max=50&amp;sort=default&amp;qlookup=cocoa+powder&amp;offset=&amp;format=Full&amp;new=&amp;measureby=&amp;Qv=1&amp;ds=&amp;qt=&amp;qp=&amp;qa=&amp;qn=&amp;q=&amp;ing=\" rel=\"nofollow noreferrer\">Cocoa powder</a> is rich in the nutrients <a href=\"https://en.wikipedia.org/wiki/Human_iron_metabolism#Iron_overload\" rel=\"nofollow noreferrer\">iron</a>, <a href=\"https://en.wikipedia.org/wiki/Manganese#Biological_role\" rel=\"nofollow noreferrer\">manganese</a>, <a href=\"https://en.wikipedia.org/wiki/Magnesium_in_biology#Dietary_reference_intake\" rel=\"nofollow noreferrer\">magnesium</a>, and <a href=\"https://en.wikipedia.org/wiki/Phosphorus#Phosphorus_deficiency\" rel=\"nofollow noreferrer\">phosphorus</a>, and also contains significant amounts of <a href=\"https://en.wikipedia.org/wiki/Theobromine_poisoning\" rel=\"nofollow noreferrer\">theobromine</a> and <a href=\"https://en.wikipedia.org/wiki/Caffeine#Overdose\" rel=\"nofollow noreferrer\">caffeine</a>. Overdose information about many of these is hard to come by, but it looks like the limiting factor is going to be either iron or theobromine, with consumption of around 100-300g of cocoa powder being enough to cause symptoms.</p>\n\n<p>And as a side note, it appears that <a href=\"https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+7332\" rel=\"nofollow noreferrer\">theobromine has appetite-suppressing effects</a>.</p>\n", "score": 3 } ]

[ "nutrition", "food-safety", "overdose" ]

[ { "answer_id": 16135, "body": "<p>Fasting, at least in Islam, means no water intake during the fast. The Islamic purpose of not allowing even water is to <a href=\"http://aboutislam.net/counseling/ask-about-islam/no-water-fasting/\" rel=\"noreferrer\">remind one</a> that one should not take for granted the gifts of life. So, the purpose of the injunction is to remind you, and not to imperil your health. In the same way that the pillars of Islam have modifiers ( like not going to Mecca if your health is not strong enough ), then it seems clear that one should not fast when one is ill. And in the specific case of diarrhoea, then fluid loss can lead to hypovolaemia and renal failure.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2380138\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/2380138</a></p>\n", "score": 5 } ]

[ "risks", "fasting", "diarrhea", "dehydration" ]

[ { "answer_id": 12682, "body": "<p><a href=\"http://www.netwellness.org/question.cfm/64969.htm\" rel=\"nofollow noreferrer\">Fainting due to vaccination occurs only occasionally</a>, your immune system usually takes longer to react to viruses or bacteria (<a href=\"https://www.merriam-webster.com/dictionary/incubation%20period\" rel=\"nofollow noreferrer\">this is the incubation time of an illness</a>). 1 hour is a very unusual incubation time, furthermore the virus you get injected is not active anymore.</p>\n\n<p>It is therefore much more likely that a combination of anxiety and pain caused your <a href=\"http://www.webmd.com/brain/understanding-fainting-basics#1\" rel=\"nofollow noreferrer\">vasovagal reaction</a>.</p>\n\n<p>How to prevent this from happening the next time?</p>\n\n<ul>\n<li>You are warned and can prepare this time.<br>\nI would recommend sitting in a chair for roughly 30 minutes after you have received the injection so that your anxiety decreases. If you were to collapse in the chair, it will also prevent heavy injuries. Close your eyes and rest your head in your hands if you feel your blood pressure drop.</li>\n<li><a href=\"http://www.webmd.com/brain/understanding-fainting-prevention\" rel=\"nofollow noreferrer\">Do not hyperventilate!</a> <em>(I know, that's said easily)</em>: \n\n<ul>\n<li>Pay attention to your breath and focus on breathing in... and out.... and in</li>\n<li>Drinking a glass of water also helps me</li>\n</ul></li>\n<li>In General, drinking water and not being dehydrated will help. </li>\n<li>Bring chocolate with you. The sugar is a fast way for your brain to absorb energy.</li>\n<li>Have someone with you so that if you start to feel dizzy, they can help you and, if necessary, contact emergency services if you collapse.</li>\n</ul>\n\n<p>Apart from this, sedatives will help but I wouldn't recommend to use them.</p>\n\n<p>Have a nice trip! </p>\n", "score": 5 } ]

[ "blood-pressure", "injections", "typhoid" ]

[ { "answer_id": 14590, "body": "<p>Usually women get a period 2 weeks after ovulation. During menopause hormone levels fluctuate and ovulation may not occur regularly and periods are more spaced out or closer together, heavier or lighter. Some months women do not ovulate at all and don't have a period. There are two main hormones that regulate the lining of the uterus- estrogen (\"the fertilizer\") and progesterone (\"the lawn mower\"). During perimenopause women are still producing these two hormones but sometimes they aren't in the same proportion to each other as they were during younger years. If there's more estrogen than progesterone the lining of the uterus thickens and at some point it's shed (spotting) even if there isn't ovulation.</p>\n\n<p>To answer your question, spotting could be counted as a period if you are in perimenopause. However, if you haven't had ANY bleeding for 12 months and then have spotting you should check with your doctor.</p>\n", "score": 1 } ]

[ "menstruation" ]

[ { "answer_id": 13035, "body": "<h2>From the context of your question I would say no.</h2>\n<p>Increasing K+ intake is alright but completely eliminating Na+ from the diet would be a bad idea.</p>\n<p>In terms of the cardiovascular diseases like high blood pressure associated with high NaCl intake,cutting down NaCl from the diet(that is making the food less saltier) or increasing the dietary intake of K+ through K+ rich fruits or vegetables could prove to be extremely useful but replacing NaCl with KCl without recommendation could cause side effects.</p>\n<p>As we are aware that hypokalemia (low K+ in the blood) increases the risk but hyperkalemia (high K+ in the blood) too can cause the same.\n<a href=\"https://en.m.wikipedia.org/wiki/Cardiac_arrest\" rel=\"noreferrer\">Source</a></p>\n<h2>Why some salt substitutes are considered good</h2>\n<p>Salt substitutes having high quantities of K+ in the form of KCl and KI and little amount of Na+ are considered to be better than having only KCl as the main component.The former donot help to eliminate Na+ from the diet but helps to maintain a high proportion of K+ to a low proportion of Na+ also they are a source of iodine.</p>\n<p><a href=\"https://my.clevelandclinic.org/health/articles/salt-substitutes-heart-health\" rel=\"noreferrer\">Source</a></p>\n<h2>Reasons why the dietary recommendation for K+ is higher than Na+</h2>\n<p>The kidneys are very sensitive to high K+ in the blood and ECF thus efficiently excrete them.</p>\n<h2>Why not everybody should have a salt substitute.</h2>\n<p>People with renal disorders, hyperglycemia, neural disorders should be on a diet strictly prescribed by their physicians.\nThis is because renal disorders and hyperglycemia renders slight hyperkalimia. The nervous system relies totally on the balanced levels of K+ and Na+.\n<a href=\"https://en.m.wikipedia.org/wiki/Salt_substitute\" rel=\"noreferrer\">Source</a></p>\n<blockquote>\n<p>&quot;...People with kidney failure, heart failure, or diabetes should not use salt substitutes without medical advice. A manufacturer, LoSalt, has issued an advisory statement[6] that people taking the following prescription drugs should not use a salt substitute:amiloride, triamterene, Dytac, captopril&amp; other angiotensin-converting enzyme inhibitors, spironolactone, andeplerenone...&quot;</p>\n</blockquote>\n<h2>Further reading</h2>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692158/#__ffn_sectitle\" rel=\"noreferrer\">NCBI</a></p>\n<p>Dietary sources should prove to be a more better approach to increase K+ intake in a non-prescribed otherwise healthy indivitual.They include:</p>\n<blockquote>\n<p>&quot;... All meats (red meat and chicken) and fish such as salmon, cod, flounder, and sardines are good sources of potassium. Soy products and veggie burgers are also good sources of potassium.Vegetables including broccoli, peas, lima beans, tomatoes, potatoes (especially their skins), sweet potatoes, and winter squash are all good sources of potassium.Fruits that contain significant amounts of potassium include citrus fruits, cantaloupe, bananas, kiwi, prunes, and apricots. Dried apricots contain more potassium than fresh apricots.Milk, yogurt, and nuts are also excellent sources of potassium...&quot;\n<a href=\"https://medlineplus.gov/ency/article/002413.htm\" rel=\"noreferrer\">Source</a></p>\n</blockquote>\n", "score": 5 } ]

[ "blood-pressure", "sodium", "potassium", "rda-recommend-daily-allow" ]

[ { "answer_id": 13056, "body": "<p>This really isn't any different from asking if it is safe to share food with another person after watching them eat from the same bowl. If you have a weak immune system, as with anything else, it is probably better to not share saliva with pets or humans.</p>\n\n<p>Depending on your comfort zone, there shouldn't be any issues though if you wanted to continue eating. The only stopping factor is really if you find it unpleasant or not. I know plenty of people who share a glass of water with their pets, for me, I wouldn't cause I don't find it appealing.</p>\n\n<p>So in the end it's really a matter of choice to you, but it is worth noting if you have a weak immune system to not share saliva in general.</p>\n", "score": 3 } ]

[ "food-safety", "saliva", "zoonotic-diseases", "contaminate", "zoonotic-viruses" ]

[ { "answer_id": 13128, "body": "<p>Not towards the brain.</p>\n\n<p>Look at the two diagrams. The temporal artery is a branch of the external carotid artery that stays outside the skull. The internal carotid artery goes inside the skull. </p>\n\n<p><a href=\"https://i.stack.imgur.com/3ohX7.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/3ohX7.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>You couldn't compress the skull with sunglasses if you tried.</p>\n\n<p><a href=\"https://i.stack.imgur.com/lv0Nf.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/lv0Nf.jpg\" alt=\"enter image description here\"></a> </p>\n\n<p><a href=\"http://emedicine.medscape.com/article/1142908-overview\" rel=\"nofollow noreferrer\">MANY headaches are related to muscular/tendinous pain in the head and neck</a>, not the brain. Putting pressure on the temporal regions can cause pain in the muscles, and sustained pressure can cause spasms. Restricting the flow through the arteries of your face could in theory reduce flow to muscles of your scalp, causing pain and ischemia. It is less likely to be the cause of pain from sunglasses pressure, as there is lots of collateral blood flow, but not impossible.</p>\n\n<p>Note that transmitting any force through the actual skull via compression, which is a pretty solid bone, would take a great deal of pressure (orders of magnitude above what sunglasses are capable of) and would involve fracturing bone. Then you'd be looking at potential stroke/TBI symptoms. That is not happening to you.</p>\n\n<p>I am not going to discuss your symptoms of confusion, that starts down the path of individual medical advice. If you are concerned about any of your symptoms, see a doctor.</p>\n\n<p>Get some better sunglasses or fix the hinges.</p>\n", "score": 7 } ]

[ "blood-circulation", "glasses" ]

[ { "answer_id": 13275, "body": "<p>Thoughts about wanting to die or killing oneself do constitute <a href=\"https://www.cdc.gov/violenceprevention/suicide/definitions.html\" rel=\"nofollow noreferrer\">suicidal ideation.</a></p>\n\n<p><a href=\"http://www.dictionary.com/browse/ideation\" rel=\"nofollow noreferrer\">Ideation</a> is defined as</p>\n\n<blockquote>\n <p>the process of forming ideas or images.</p>\n</blockquote>\n\n<p>So that applied to suicide or wanting to die = suicidal ideation.</p>\n\n<p>That said, it doesn't mean that the individual is at immediate risk of completing suicide.</p>\n\n<p>Depression is common; 1/3 of human beings alive will have at least a short episode of depression at some time in their lives. Having passing thoughts about wanting to die (or not be alive) is not uncommon. </p>\n\n<p>Clinicians are now recommended to screen for depression/suicidality at all primary care visits due to how common and treatable it is. If someone replies \"yes\" to that question, additional questions are asked to characterize it.</p>\n\n<p>Reassuring factors that a person isn't at immediate risk of self-harm:</p>\n\n<ul>\n<li>Passive suicidal ideation means the individual is thinking about it like \"it'd be nice if I died\" or \"I'm ready for life to be over\" but without a desire or plan to actually commit suicide to achieve that.</li>\n<li>No plan of how they'd go about doing it.</li>\n<li>Protective factors and reasons for living like family, spiritual beliefs, goals.</li>\n</ul>\n\n<p>A person is <a href=\"https://www.health.harvard.edu/blog/suicide-often-not-preceded-by-warnings-201209245331\" rel=\"nofollow noreferrer\">more likely to follow through with suicide</a> if they have a plan of how to do it. Or <a href=\"https://www.hsph.harvard.edu/magazine/magazine_article/guns-suicide/\" rel=\"nofollow noreferrer\">access to a gun</a>. Or have tried before. So those are more red flags that this person may be at risk of harming themselves.</p>\n\n<p>In the case there's risk of immediate harm, a person needs to seek help or be involuntarily given help - ideally by a counselor or medical professional.</p>\n", "score": 2 } ]

[ "terminology", "symptoms", "depression", "psychiatrist-psychiatry", "suicide" ]

[ { "answer_id": 20194, "body": "<p>Certainly, headaches can be caused by a variety of smells, perfumes, paints, gasoline, bleach and yes, air fresheners.</p>\n\n<p>A study in 200 <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23832131\" rel=\"nofollow noreferrer\">migraine patients</a> showed perfumes were the first most common cause when headaches are attributed to odors (75%), followed by paints (42%), gasoline (28%) and bleach (27%)</p>\n", "score": 4 } ]

[ "headache", "migraine", "triggers", "smell" ]

[ { "answer_id": 18909, "body": "<p>Usually, protein supplements (e.g., whey protein) are used by athletes and body-builders.<br>\nBecause isometric exercise like body-building increases the diastolic blood pressure in short-term <a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/j.1751-7176.2010.00328.x\" rel=\"nofollow noreferrer\"><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/j.1751-7176.2010.00328.x\" rel=\"nofollow noreferrer\">1</a></a>, it is recommended to check for serum creatinine and Urea before supplementation (because it may accelerate renal function decline in people with mild renal insufficiency <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12639078\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12639078\" rel=\"nofollow noreferrer\">2</a></a>), along with check-ups every 6 months (it is my personal comment as a physician).<br>\nIt is all because there are some researches stating that high amount of Urea due to the intake of protein supplement may promote kidney damage by chronically increasing the glomerular pressure and hyperfiltration <a href=\"https://www.atiner.gr/presentations/Omar-Chebbo.pdf\" rel=\"nofollow noreferrer\"><a href=\"https://www.atiner.gr/presentations/Omar-Chebbo.pdf\" rel=\"nofollow noreferrer\">3</a></a> , <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15073493?dopt=Abstract\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15073493?dopt=Abstract\" rel=\"nofollow noreferrer\">4</a></a> ,<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602135/\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602135/\" rel=\"nofollow noreferrer\">5</a></a>. </p>\n\n<blockquote>\n <p>Even recommended doses of creatine monohydrate supplementation may cause kidney damage; therefore, anybody using this supplement should be warned about this possible side effect, and their renal functions should be monitored regularly<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421632/\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421632/\" rel=\"nofollow noreferrer\">6</a></a>. </p>\n</blockquote>\n\n<p>Toxic hepatitis is another rare side effects of supplementation for body-builders, which warrants these check-ups <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22809474\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22809474\" rel=\"nofollow noreferrer\">7</a></a>. </p>\n\n<p>However, it does not mean that high-protein intake necessarily damages the kidneys in all users <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1262767/\" rel=\"nofollow noreferrer\"><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1262767/\" rel=\"nofollow noreferrer\">8</a></a>. </p>\n\n<p>Furthermore, interactions with other drugs should be noticed if the users have underlying diseases or they use other medications.</p>\n", "score": 5 } ]

[ "nutrition", "prevention" ]

[ { "answer_id": 13400, "body": "<p>Not sure if this is what you are after but there is the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). The current one is ICD-10 <a href=\"http://www.who.int/classifications/icd/icdonlineversions/en/\" rel=\"noreferrer\">http://www.who.int/classifications/icd/icdonlineversions/en/</a></p>\n", "score": 5 } ]

[ "diagnosis", "medical-records" ]

[ { "answer_id": 13437, "body": "<p>Screening tests such as \"blood tests and imaging\" have two costs and one benefit:</p>\n\n<ul>\n<li>the cost (dollars and possible health problems) of the actual screening, which can in some cases be free</li>\n<li>the cost (dollars and possible health problems) of the followups required when the screening is positive</li>\n<li>the benefit of less people dying or their treatment being less expensive when things are found before there are symptoms.</li>\n</ul>\n\n<p>Obviously, deciding whether or not to screen will be different for every disease because each of these costs and benefits will be different for every disease. But it's really important to realize that screening brings false positives. These cause distress and anguish to people who believe they are dying and they cost a lot of money because the investigations required are expensive and intrusive.</p>\n\n<p>Recently Ontario has stopped recommending women do monthly breast self exams. These are free. However they do not save any lives. Women who actually have lumps find them without dutifully checking every month or week for them. But with the regular screening, many find things that are not cancers. They need to take time off work, get biopsies, which can be inconclusive, get scans, even have surgery to remove lumps so they can be sent to pathology, and so on. This costs a lot of money directly to the hospital and indirectly in people being off work. All this expense is pointless: there is no difference in survival rates between groups who do BSE and those who do not. They didn't even take into account the misery of thinking you have cancer when you don't.</p>\n\n<p>(A <a href=\"http://www.cbc.ca/news/health/breast-cancer-screening-guide-says-skip-exams-1.985763\" rel=\"noreferrer\">news article</a> about the changes, which also includes not having doctors do breast exams routinely if there are no symptoms, and not having mammograms before age 50. The <a href=\"https://canadiantaskforce.ca/guidelines/published-guidelines/breast-cancer/\" rel=\"noreferrer\">Task Force Guidelines</a> referred to in that article.) </p>\n\n<p>For screenings that are not just self-examination, consider also the radiation from scans, the chances of an allergic reaction to contrast dye, the chances of infection from a blood test, of catching an antibiotic-resistant infection while in the hospital recovering from having something removed, and so on. Both the screening and the procedures that happen when someone screens positive can hurt or kill people if you screen everyone, meaning millions of people.</p>\n\n<p>Finally, while it may seem logical to you that screenings like this would save lives by catching things earlier, there is very little evidence to support that. Our bodies actually destroy small cancers all the time: just because you see a small cancer on a scan doesn't mean the huge treatment machine has to swing into action. That is only needed when a small cancer demonstrates it's becoming a big cancer. And in the majority of cases, there are symptoms. These things get found.</p>\n", "score": 6 }, { "answer_id": 13443, "body": "<p>Great answer above. This is to add on to it:</p>\n\n<p>Making a decision on whether to recommend screening tests for the entire population is different from deciding whether to screen an individual patient. The <a href=\"https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions\" rel=\"noreferrer\">USPSTF uses panels of experts who employ extensive epidemiology and biostatistics and literature reviews to make those recommendations.</a> </p>\n\n<p>At the population level, things like cost-benefit analysis, how rare a condition is, how many you need to screen before you prevent 1 cancer, and risk (like what % of screening tests result in harmful outcomes) are extremely important. </p>\n\n<p>This is reflected in the Grades.</p>\n\n<p>Grade <strong>C</strong> recommendations = <strong>C</strong>onsider offer or provide this service for selected patients depending on individual circumstances.</p>\n\n<blockquote>\n <p>\"recommends selectively offering or providing this service to\n individual patients based on professional judgment and patient\n preferences. There is at least moderate certainty that the net benefit\n is small.\"</p>\n</blockquote>\n\n<p>Grade <strong>D</strong> recommendations = <strong>D</strong>iscourage the use of this service.</p>\n\n<blockquote>\n <p>The USPSTF recommends against the service. There is moderate or high\n certainty that the service has no net benefit or that the harms\n outweigh the benefits.</p>\n</blockquote>\n\n<p>At the individual level, like grade C, individual considerations must be taken into consideration. That is why it takes a clinician to discern whether or not to do a non-recommended screening test (or not do a recommended screening test).</p>\n\n<p>Also, <strong>once someone presents with a suggestive symptom, doing a test is not a considered a screening test but a diagnostic test.</strong> Once someone is extremely anemic, the appropriate workup for anemia isn't screening, it's diagnostic. The recommended workup steps for symptoms/signs/findings are established by consensus of experts based on research. That's another topic.</p>\n", "score": 6 } ]

[ "cancer", "blood", "prevention", "preventative-medicine" ]

[ { "answer_id": 13525, "body": "<p>In addition to the above, see this diagram. Your <strong>MIDDLE ear (highlighted in blue) connects to your sinus via the Eustachian tube</strong> (where it drains into the sinus cavity isn't showed). Your <strong>EXTERNAL ear canal</strong> is where the wax is, and it's <strong>separated from middle ear by the ear drum</strong> (TM). </p>\n\n<p><a href=\"https://i.stack.imgur.com/d4wRq.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/d4wRq.jpg\" alt=\"External/Middle/Inner Ear and Eustachian tube\"></a></p>\n\n<p>Also, many physicians advise <strong>not to use cotton tipped applicators in the canal;</strong> they tend to just pack wax deeper and cause it to become thicker/harder to remove, and also risk perforating the ear drum.</p>\n\n<p>FYI: It's also actually that <strong>nasal congestion and blocked Eustachian tubes can cause middle ear fluid or infections, not really the other way around.</strong> </p>\n\n<p>If nasal congestion persists, consider seeing a doctor for evaluation, as it may be allergic rhinitis or various other causes, which can cause middle ear effusions if untreated.</p>\n", "score": 4 }, { "answer_id": 13516, "body": "<p>It seems unlikely that ear wax could cause nasal congestion and restricted breathing, since in relatively healthy individuals, the ear canal is separated from the middle ear by the tympanic membrane (aka the ear drum). If the ear infection, or the Q-Tip, or however you \"flushed\" the middle ear, caused a perforation of the ear drum, lots of things could be going on.</p>\n", "score": 2 } ]

[ "breathing", "ear", "nasal-congestion" ]

[ { "answer_id": 13544, "body": "<p>That sounds a bit too broadly defined a question to answer with a general yes or no.</p>\n\n<p>Once a scar is formed it is difficult to <em>remove</em>, if not impossible. Cutting out scar tissue produces another scar. The outcome of this might be worse. </p>\n\n<p>Although quite promising, your second link qualifies: \"The skin healed <strong><em>almost without scarring</em></strong> […]\"</p>\n\n<p>Scar formation outcomes are largely determined by how the affected tissue came to be wounded and how it is treated immediately and long term afterwards.</p>\n\n<p>Already present scars may be treated, with surgery, chemicals, lasers, etc.\nThis is done mostly to 'improve' them, to make them smaller, less obvious, to camouflage them so to speak. Fresh scars will be more easily influenced than older ones.</p>\n\n<p>If this is the goal then there seem to be some options in that general direction:</p>\n\n<ul>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20354695\" rel=\"nofollow noreferrer\">Silicone-based scar therapy: a review of the literature.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24030657\" rel=\"nofollow noreferrer\">Silicone gel sheeting for preventing and treating hypertrophic and keloid scars.</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17312518\" rel=\"nofollow noreferrer\">Review of over-the-counter topical scar treatment products.</a></li>\n</ul>\n", "score": 1 } ]

[ "wound-care", "scar-tissue-scars" ]

[ { "answer_id": 16996, "body": "<p>If you take coffee daily, you no longer get a boost from it after about a week, but rather, you're just staving off the harsh withdrawal symptoms, not to mention over time it will physically change your brain <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3392208?dopt=Abstract\" rel=\"nofollow noreferrer\">to have more adenosine receptors</a> i.e., \"sleepiness receptors\". (Ramkumar V et al, J Clin Invest 82:242-247) in a process known as <a href=\"https://en.wikipedia.org/wiki/Downregulation_and_upregulation\" rel=\"nofollow noreferrer\">upregulation</a></p>\n\n<p>\"A <a href=\"https://lifehacker.com/5585217/what-caffeine-actually-does-to-your-brain\" rel=\"nofollow noreferrer\">1995 study suggests</a> that humans become tolerant to their daily dose of caffeine—whether a single soda or a serious espresso habit—somewhere between a week and 12 days. And that tolerance is pretty strong. One test of regular caffeine pill use had some participants getting an astronomical 900 milligrams (9 cups of coffee) per day, others placebos—found that the two groups were nearly identical in mood, energy, and alertness after 18 days. The folks taking the equivalent of nine stiff coffee pours every day weren't really feeling it anymore. They would feel it, though, when they stopped.</p>\n\n<p>\"You start to feel caffeine withdrawal anywhere from 12 to 24 hours after your last use. That's a big part of why that first cup or can in the morning is so important—it's staving off the early effects of withdrawal.\"</p>\n\n<p>Caffeine, the natural pesticide of bright red coffee berries, creates an emergency response in your body to fight it off (pooping, peeing, and adrenaline). It inherently doesn't give you energy or focus, but the adrenal side effect does. Studies show that people who have coffee 7 days in a row no longer receive any energy or focus benefits. At that point their brain has been sufficiently altered with new adenosine receptors that they are just at their baseline behavior. They found this was true with any caffeine amount, from 1 to 10 cups of coffee. The exception is after 10 cups is it just starts frying your brain. </p>\n\n<p>\"You might think all of this probably takes a while, but <a href=\"https://youarenotsosmart.com/2010/02/22/coffee/\" rel=\"nofollow noreferrer\">it takes about seven</a> days to become addicted to caffeine. Once addicted, you need more and more coffee to get buzzed as your brain gets covered in receptor sites. \"</p>\n\n<h2>Watch It</h2>\n\n<p><a href=\"https://www.youtube.com/watch?v=d_mvTTLz3U4\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=d_mvTTLz3U4</a></p>\n\n<p><a href=\"https://www.youtube.com/watch?v=yAMIQn78iAA\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=yAMIQn78iAA</a></p>\n\n<h2>Sources</h2>\n\n<p>Life Sciences Volume 36, Issue 24, 17 June 1985, Pages 2347-2358\nCaffeine tolerance: Behavioral, electrophysiological and neurochemical evidence\n Dorothy T.Chou Sukur Khan Jesse Forde Kenneth R. Hirsh\n<a href=\"https://www.sciencedirect.com/science/article/pii/002432058590325X\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/science/article/pii/002432058590325X</a></p>\n\n<p>Robertson D, Wade D, Workman R, Woosley RL, Oates JA. Tolerance to the humoral and hemodynamic effects of caffeine in man. Journal of Clinical Investigation. 1981;67(4):1111-1117.\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC370671/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC370671/</a></p>\n\n<p>\"Multiple components of the A1 Adenosine Receptor-Adenylate Cyclase System are Regulated in Rat Cerebral Cortex by Chronic Caffeine Ingestion.\" (Ramkumar V et al, J Clin Invest 82:242-247.) <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3392208?dopt=Abstract\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/3392208?dopt=Abstract</a></p>\n\n<p><a href=\"https://lifehacker.com/5585217/what-caffeine-actually-does-to-your-brain\" rel=\"nofollow noreferrer\">https://lifehacker.com/5585217/what-caffeine-actually-does-to-your-brain</a></p>\n\n<p><a href=\"https://youarenotsosmart.com/2010/02/22/coffee/\" rel=\"nofollow noreferrer\">https://youarenotsosmart.com/2010/02/22/coffee/</a></p>\n\n<p>\"Effects of chronic caffeine on brain adenosine receptors: Regional and ontogenetic studies\" (Paul J.Marangos, Jean-Philippe Boulenger, Jitendra Patel)\n<a href=\"https://www.sciencedirect.com/science/article/pii/0024320584902078\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/science/article/pii/0024320584902078</a></p>\n", "score": 2 } ]

[ "caffeine", "addiction", "medications", "drug-tolerance" ]

[ { "answer_id": 13567, "body": "<p>The major dietary causes are not enough water and not enough fibre. (See the Risk Factors section of this <a href=\"http://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/dxc-20252715\" rel=\"nofollow noreferrer\">Mayo Clinic article</a>, which focuses on medical causes of constipation.) There's nothing complicated about mystery little factors in your food that combine to create a problem. If you eat only white rice and meat for a meal, with no vegetables, then you are eating a lot less fibre than someone who added vegetables to that meal or who ate beans instead of meat.</p>\n\n<p>First thing to do if you're suffering constipation is to drink a lot more water. Second thing to do is add vegetables and legumes to your meals. There are things you can do beyond that, but they are not dietary and should probably be suggested by someone more familiar with your personal situation. More water and more fibre are generally a safe approach, so if you're sure your situation is caused by what you eat and drink, fix that.</p>\n\n<p>A note that if you are ill or are taking any medication, it's a whole different story and you shouldn't do anything (not even eating extra fibre) without discussing it with your doctor. </p>\n", "score": 5 } ]

[ "diet", "digestion", "constipation" ]

[ { "answer_id": 13609, "body": "<p>Your inner core is where majority of the Chronic LBP research supports working.</p>\n\n<p><strong>Inner Core</strong></p>\n\n<ul>\n<li>Transverse Abdominis </li>\n<li>Multifidus </li>\n<li>Diaphragm</li>\n<li>Pelvic Floor</li>\n</ul>\n\n<p><a href=\"https://i.stack.imgur.com/zBmmf.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/zBmmf.png\" alt=\"enter image description here\"></a></p>\n\n<hr>\n\n<p><strong>Transverse Abdominis Dysfunction</strong></p>\n\n<ul>\n<li><p>Numerous studies demonstrated timing and thickness change deficits in\nsubjects with LBP and athletes with groin pain</p></li>\n<li><p>When respiration is challenged, TrA is the first muscle recruited to\nassist with expiration</p></li>\n<li><p>Activation of TrA is preparatory, normally occurs before activation\nof primary mover and is not direction dependant.</p></li>\n</ul>\n\n<hr>\n\n<p><strong>There's no reason you can't work your glutes</strong> - research support this as well:</p>\n\n<blockquote>\n <p>EMG results demonstrated that subjects with chronic lower back pain had significantly\n higher levels of recruitment for the lower and upper gluteus maximus,\n hamstrings, and erector spinae muscles during rotation when compared\n to the control subjects</p>\n</blockquote>\n\n<hr>\n\n<p><strong>Supporting Research:</strong></p>\n\n<ul>\n<li><p><a href=\"http://journals.lww.com/spinejournal/Abstract/2006/12150/Low_Back_Pain_Patients_Demonstrate_Increased_Hip.18.aspx\" rel=\"nofollow noreferrer\">http://journals.lww.com/spinejournal/Abstract/2006/12150/Low_Back_Pain_Patients_Demonstrate_Increased_Hip.18.aspx</a></p></li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/</a></p></li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899579/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899579/</a> </p></li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805012/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805012/</a> </p></li>\n<li><p><a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141777\" rel=\"nofollow noreferrer\">http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141777</a></p></li>\n</ul>\n", "score": 3 } ]

[ "pain", "exercise", "lumbago-low-back-pain" ]

[ { "answer_id": 13627, "body": "<p>What is reported here about the \"wound care specialist\" sounds like being either badly phrased by the doctor or misunderstood, misremembered or phrased rather unluckily by the OP (no offence, just speculation).</p>\n\n<p>Whatever the reason for this unsatisfactory status of explanation: This treatment is likely not focused on the nitrate part of the formulation alone.</p>\n\n<p><a href=\"https://woundcareadvisor.com/how-to-apply-silver-nitrate/\" rel=\"noreferrer\"><em>Silver</em> nitrate</a> is likely <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22352216\" rel=\"noreferrer\">employed</a> to <a href=\"http://www.podiatrytoday.com/article/3156\" rel=\"noreferrer\">help with the healing process</a>. Quotes from the links:</p>\n\n<blockquote>\n <p>[#]\n Topical application of silver nitrate is often used in wound care to\n help remove and debride hypergranulation tissue or calloused rolled\n edges in wounds or ulcerations. It’s also an effective agent to\n cauterize bleeding in wounds. Silver nitrate is a highly caustic\n material, so it must be used with caution to prevent damage to healthy\n tissues.</p>\n \n <p>[#]\n Whether it is used as a topical ingredient or a dressing ingredient,\n the use of silver in treating wounds has been around for quite some\n time. Silver has an array of beneficial effects in promoting healing.</p>\n \n <p>[#]\n The use of silver nitrate application reduce dramatically the size of\n large wounds, which eventually healed, avoiding the patients to\n undergone surgery.</p>\n</blockquote>\n", "score": 5 }, { "answer_id": 13640, "body": "<blockquote>\n <p>“the wound has healed too much, and now it can’t heal anymore without knocking it back first.” I asked for more details and got a similar response back. </p>\n</blockquote>\n\n<p>Talking to patients is an art. This doctor lacks that art to some extent.</p>\n\n<p>Wounds left to heal on their own - without stitches - heal by <a href=\"http://woundeducators.com/three-types-of-wound-closure/\" rel=\"nofollow noreferrer\"><em>secondary intention</em></a>, that is, the wound fills in with a temporary tissue called granulation tissue. The best outcome is that enough granulation tissue is laid down to cover the wound, then, within the tissue, the normal components of skin, such as epithelial tissue and blood vessels grow.</p>\n\n<blockquote>\n <p>Epithelialization and neovascularization result from the increase in cellular activity. Stromal elements in the form of extracellular matrix materials are secreted and organized. This new tissue, called granulation tissue, depends on specific growth factors for further organization to occur in the completion of the healing process. This physiologic process occurs over several weeks to months in a healthy individual.</p>\n</blockquote>\n\n<p>However, this is somewhat of a \"dance\" dependent on how much of what kinds of signals the injured tissue sends out, and sometimes the granulation tissue grows too much, and actually impedes the process of epithelialization. In that case, the excess granulation tissue (or even all of it) needs to be removed so the process can start over (the process is dependent on the right amount of the right signals (e.g. growth factors). </p>\n\n<p>This is what was meant by the doctor.</p>\n\n<p>As to why silver nitrate was used, it destroys granulation tissue, but so does just picking it off and other methods.</p>\n\n<p>Your wound specialist really should have this talk down pat enough to give the answer in under a minute. But patients ask questions, and time is getting shorter and shorted for doctors to spend with patients (blame insurance companies for that.) So one way to save time is to avoid answering questions. You'll heal just as well without the information, but it doesn't engender much trust in the doctor.</p>\n\n<p>_{<a href=\"http://emedicine.medscape.com/article/1836438-overview\" rel=\"nofollow noreferrer\">Wound Closure Technique</a>}</p>\n", "score": 4 } ]

[ "wound-care" ]

[ { "answer_id": 13753, "body": "<p>Refer to the [Cochrane Systematic review] about this issue, available at [1]<a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002281.pub3/full#CD002281-tbl-0012\" rel=\"nofollow noreferrer\">http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002281.pub3/full#CD002281-tbl-0012</a></p>\n", "score": 4 } ]

[ "dentistry", "toothbrush" ]

[ { "answer_id": 13710, "body": "<p>It depends on the diet and the person. However, protein myths abound because people look at extreme ends of the scale, and assume that outlier needs are suitable for the masses.</p>\n<p>If you are looking for homeostasis and general maintenance, then the upper limit that has been shown in studies to be beneficial is 1.6g/kg/d, or about .73g/lb/day. 1g/lb/day is a little bit of overkill, but is an easy mark to remember. Where the outlier comes in is people using steroids for bodybuilding, which allows greater protein use than in a naturally training person.</p>\n<p>If you are looking for weight/fat loss with lean mass maintenance (i.e. losing as little muscle as possible while cutting calories), then a higher rate of protein intake is recommended to help make up for caloric deficits in carbohydrates. It is also noted that the higher the level of athlete, the <em>less</em> you need the protein (i.e. elite level athletes need less protein than beginners, as counterintuitive as that sounds).</p>\n<p>From a <a href=\"http://www.tandfonline.com/doi/full/10.1080/02640414.2011.619204?scroll=top&amp;needAccess=true\" rel=\"nofollow noreferrer\">meta analysis by Philips and Loon</a>:</p>\n<blockquote>\n<p>Our consensus opinion is that leucine, and possibly the other branched-chain amino acids, occupy a position of prominence in stimulating muscle protein synthesis; that protein intakes in the range of 1.3–1.8 g · kg−1 · day−1 consumed as 3–4 isonitrogenous meals will maximize muscle protein synthesis. These recommendations may also be dependent on training status: experienced athletes would require less, while more protein should be consumed during periods of high frequency/intensity training. Elevated protein consumption, as high as 1.8–2.0 g · kg−1 · day−1 depending on the caloric deficit, may be advantageous in preventing lean mass losses during periods of energy restriction to promote fat loss.</p>\n</blockquote>\n<p>That article is an excellent read, and contains many links and references to studies on various protein intakes for low to elite level athletes and body builders.</p>\n<p>From <a href=\"https://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/\" rel=\"nofollow noreferrer\">another very well written article</a>:</p>\n<blockquote>\n<p>To check if maybe there still isn't a slight benefit of going higher in protein that all these studies couldn't find, I co-authored a meta-analysis with some of the world's leading fitness researchers. We again a cut-off point at exactly 1.6g/kg/d beyond which no further benefits for muscle growth or strength development are seen.</p>\n<p>Based on the sound research, many review papers have concluded 0.82g/lb is the upper limit at which protein intake benefits body composition (Phillips &amp; Van Loon, 2011). This recommendation often includes a double 95% confidence level, meaning they took the highest mean intake at which benefits were still observed and then added two standard deviations to that level to make absolutely sure all possible benefits from additional protein intake are utilized. As such, this is already overdoing it and consuming 1g/lb ”˜to be safe' doesn't make any sense. 0.82g/lb is already very safe.</p>\n</blockquote>\n<p>Examining the article you link in the question, the end includes:</p>\n<blockquote>\n<p>Even though a higher protein intake can have health benefits for many people, it is not necessary for everyone.\n<strong>Most people already eat protein at around 15% of calories, which is more than enough to prevent deficiency</strong>.\nHowever, in certain cases, people can benefit from eating much more than that, or up to 25-30% of calories.</p>\n</blockquote>\n<p>(Emphasis mine)</p>\n<p>It then links to an article on &quot;how much protein you should be eating&quot;, which notes:</p>\n<blockquote>\n<p>A common recommendation for gaining muscle is 1 gram of protein per pound of body weight, or 2.2 grams of protein per kg.\nNumerous studies have tried to determine the optimal amount of protein for muscle gain and many of them have reached different conclusions.\nSome studies show that over 0.8 grams per pound has no benefit (13), while others show that intakes slightly higher than 1 gram of protein per pound is best (14).\n<strong>Although it's hard to give exact figures because of conflicting results in studies, 0.7-1 grams (give or take) per pound of body weight seems to be a reasonable estimate</strong>.</p>\n</blockquote>\n<p>(Emphasis mine)</p>\n<p>So while all the articles agree that a general intake of around 1g/lb/day is the upper limit of beneficial, they also agree that in specific diets and goals, increasing the amount of protein can aid in weight loss and lean mass retention. I believe that is the intent of your original article, despite the somewhat click bait title.</p>\n", "score": 4 }, { "answer_id": 13708, "body": "<p>Short answer yes, unless you have got any condition stopping you from doing so.<br>\nNow the long answer:\nProtein is the building block of the body. If we consider the human body as a huge network of interconnected chemical reactions, we can appreciate it a little better. Mostof chemical reactions in the body use enzymes as catalyst and most enzymes are proteins. A quick google search will provide you info on that matter.\nComing to topic at hand the protein RDA for a normal sedentary individual is <strong>0.8-1g/kg</strong>:\n <a href=\"https://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096\" rel=\"nofollow noreferrer\">https://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096</a> <br>\nThis value pales in comparison to the protein intake of athletes and especially body builders. As you increase your physical activity your body's demand for protein increases,as you're breaking down muscle to build more: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11023001?dopt=Abstract\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/11023001?dopt=Abstract</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21660839?dopt=Abstract\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/21660839?dopt=Abstract</a><br> This is the reason for the association of high intake of protein with physically active individuals. <br>\nFor someone doing moderate amounts of resistance training 1.6-2g/kg should be fine. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22150425\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/22150425</a> <br>High intensity strength training individuals have been reported to take around 3g/kg.\n<strong>For better explanation may I suggest this video</strong> <a href=\"https://www.youtube.com/watch?v=JeKn-ym6sgE\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=JeKn-ym6sgE</a></p>\n", "score": 1 } ]

[ "nutrition", "proteins", "public-health", "macronutrient" ]

[ { "answer_id": 13702, "body": "<p>Wrinkles are not directly proportional to age; people have different collagen properties. Some people wrinkle far earlier than others, and in different ways.</p>\n\n<p>But yes, <a href=\"http://www.mayoclinic.org/diseases-conditions/wrinkles/symptoms-causes/dxc-20265774\" rel=\"noreferrer\">smiling does promote wrinkles to some degree</a> due to repeated muscular contractions causing the same skin wrinkling pattern, but smiling also has <a href=\"https://www.psychologytoday.com/blog/cutting-edge-leadership/201206/there-s-magic-in-your-smile\" rel=\"noreferrer\">beneficial</a> and lasting <a href=\"http://www.neuropsychotherapist.com/the-neuroscience-of-smiling-and-laughter/\" rel=\"noreferrer\">neurobiological effects</a> that go far beyond the minimal superficial impact of slightly deeper wrinkles.</p>\n", "score": 9 } ]

[ "dermatology", "smile-smiling" ]

[ { "answer_id": 13776, "body": "<p>Try this:</p>\n\n<p>\"Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up\"</p>\n\n<p>Source - <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27331028\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/27331028</a></p>\n", "score": 1 } ]

[ "tendinopathy", "clinical-study", "rotator-cuff" ]

[ { "answer_id": 13761, "body": "<p>The statement quoted is actually contained under the heading: <blockquote>4.2: Is this really true? Surely people would investigate the safety, ethics, and efficacy of the products they buy.</blockquote>So this statement is not necessarily true or false; it is just one of the many statements in this heading that may or may not be so.<br><br>As to whether or not mouthwash may be effective, <a href=\"http://www.dentistryiq.com/articles/rdh/2002/03/studies-show-listerine-at-least-as-good-as-flossing.html\" rel=\"nofollow noreferrer\">this article</a> in DetistryIQ has this to say about Listerine:<blockquote>\"These findings support the benefit of adding an antiseptic mouthwash to a daily oral health care routine, especially for those patients who don't brush and floss properly,\" ...\"The findings, however, do not mean that flossing should be replaced with rinsing. I recommend that dentists and hygienists talk to their patients about what's best for their oral healthcare routine, and devise strategies to target difficult to reach areas that are susceptible to plaque accumulation and gingivitis.\"</blockquote><br>The ADA in <a href=\"http://www.ada.org/en/member-center/oral-health-topics/mouthrinse\" rel=\"nofollow noreferrer\">this article</a> also says:<blockquote>While not a replacement for daily brushing and flossing, use of mouthwash (also called mouthrinse) may be a helpful addition to the daily oral hygiene routine for some people.</blockquote>It also has some good information in it.<br><br>I could not find any reputable articles that made the claim in the OP's citation.</p>\n", "score": 4 } ]

[ "mouthwash" ]

[ { "answer_id": 13889, "body": "<p>It depends what your definition of <code>healthy</code> is really. If you're looking for something low calorie, I would suggest a large bowl of steamed vegetables. If you heavily season them avoiding salt if you can - think pepper and paprika, they are surprisingly delicious. </p>\n\n<p>Just cook frozen vegetables like brocoli, corn or peas in a bowl. You can buy them from any supermarket for super cheap, and the meal takes 5 mins in the microwave with basically no prep.</p>\n\n<p>10/10 healthy\n10/10 easy</p>\n", "score": 2 }, { "answer_id": 14626, "body": "<p>If you get hungry very fast, you are most likely not eating enough for your activity level or not getting the right nutrient ratios. Typically, if you up the protein and fiber content in your meals/snacks you'll be less hungry in general.</p>\n\n<p>If you feel you are eating enough, check on whether or not your hunger is \"real\". Sometimes things like not drinking enough water, too little sleep, etc. can trick you into thinking you are hungry, or, you may just wanting something to snack on out of boredom. If this is the case, good snacks may be food that are lower calorie but high in volume, like:</p>\n\n<ul>\n<li>Vegetables (and if you aren't a big fan, try adding some seasoning and roasting until crunchy)</li>\n<li>Apple slices, banana, berries</li>\n<li>Sunflower seeds (which take a while to eat shelled)</li>\n<li>Air popped popcorn</li>\n</ul>\n\n<p>For more nutrient dense snacks when you are truly hungry, find foods with a higher healthy fat content (will keep you focused and full) and a higher protein content (keeps you fuller longer), like:</p>\n\n<ul>\n<li>1oz of nuts (not strictly 1oz, but it is easy to overeat nuts)</li>\n<li>An egg or two on toast</li>\n<li>Banana or apple with peanut/nut butter and cinnamon</li>\n<li>Protein shake or bar</li>\n<li>Avocado on toast</li>\n<li>Veggies and hummus</li>\n<li>Grilled chicken</li>\n</ul>\n\n<p>And if you find that you are lacking energy to get through the day or that exercise is abnormally draining, you may want to add more carbohydrates, like:</p>\n\n<ul>\n<li>Bakes potato/Sweet potato</li>\n<li>Rice and beans</li>\n<li>Sprouted grain toast </li>\n<li>English muffin</li>\n</ul>\n\n<p>These are just some simple suggestions, but hopefully this helps!</p>\n", "score": 1 } ]

[ "nutrition", "diet", "snacks-snacking-snack" ]

[ { "answer_id": 14064, "body": "<p>In 2015-16, The Advisory Committee on Immunization Practices issued a report on <a href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm\" rel=\"noreferrer\">Prevention and Control of Influenza with Vaccines</a> that recommended that all children (under nine years old) should get <em>two doses</em> of flu vaccine the first year that they are vaccinated against the flu. The second flu shot — a <a href=\"https://www.merriam-webster.com/medical/booster%20dose\" rel=\"noreferrer\">booster dose</a>, improves the effectiveness of the flu vaccine in children. According to the <a href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm\" rel=\"noreferrer\">CDC</a>,</p>\n\n<blockquote>\n <p>In a study during the 2004–05 season of children aged 5–8 years who received IIV3 for the first time, the proportion of children with protective antibody responses was significantly higher after 2 doses than after 1 dose of IIV3 for each antigen (p = 0.001 for influenza A[H1N1]; p = 0.01 for influenza A[H3N2]; and p = 0 0.001 for influenza B) (138).</p>\n</blockquote>\n\n<p>The “interaction” you reference draws a correlation to <em>adaptive immunity</em> — the process in which the body develops antibodies against the virus. <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK21070/\" rel=\"noreferrer\">The adaptive immune system</a>, also called acquired immunity, uses specific antigens to strategically mount an immune response. The adaptive immunity is activated by exposure to pathogens (for example, the flu virus), and uses an <em>immunological memory</em> to learn about the threat and enhances the immune response accordingly. More specifically, the adaptive immune system relies on <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9107415\" rel=\"noreferrer\">B cells and T cells</a> to carry out its task.</p>\n\n<blockquote>\n <p>Evidence is reviewed that suggests that B cells essentially recognize antigen patterns, whereas T cells react against antigens newly brought into lymphoid tissues. </p>\n</blockquote>\n\n<p>Because the adaptive immune system can learn and remember specific pathogens, it can provide long-lasting defense and protection against recurrent infections. </p>\n", "score": 5 }, { "answer_id": 14010, "body": "<p>It's just empirical data <em>suggesting</em> that the weaker <a href=\"https://en.wikipedia.org/wiki/Immune_system\" rel=\"nofollow noreferrer\">immune system</a> of young humans is typically not 'yet <a href=\"https://en.wikipedia.org/wiki/Vaccine_efficacy\" rel=\"nofollow noreferrer\">finished</a>' reacting to the <a href=\"https://en.wikipedia.org/wiki/Vaccine\" rel=\"nofollow noreferrer\">vaccine</a> with <a href=\"https://en.wikipedia.org/wiki/Adaptive_immune_system\" rel=\"nofollow noreferrer\">building</a> <em>enough</em> anti-bodys (<a href=\"https://en.wikipedia.org/wiki/Immune_response\" rel=\"nofollow noreferrer\">and the rest</a>…) after just one <a href=\"https://en.wikipedia.org/wiki/Influenza_vaccine\" rel=\"nofollow noreferrer\">flu shot</a>. Being &quot;primed&quot; might be perceived as a popularising phrase but it is not that far off either. One shot was observed to be not as effective in the past while two were apparently seen as similar effective as compared to shots for people older than children.</p>\n<p>The relevant excerpt from the CDC for the upcoming season is really quite comprehensive and I cannot dump all the studies <em>they considered</em> in reaching this conclusion:\nFrom <a href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm#children_aged_6mths_8yrs\" rel=\"nofollow noreferrer\">Prevention and Control of Seasonal Influenza with Vaccines\nRecommendations of the Advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season</a>:</p>\n<blockquote>\n<p>Children aged ≥6 months typically develop protective levels of antibodies against specific influenza virus strains after receiving the recommended number of doses of seasonal IIV (101,105,131–134). Immunogenicity studies using the A(H1N1)pdm09 monovalent vaccine indicated that 80%–95% of vaccinated children developed protective antibody levels to the 2009 A(H1N1) influenza virus after 2 doses (135,136); response after 1 dose was 50% for children aged 6–35 months and 75% for those aged 3–9 years (137).</p>\n<p><strong>Studies involving seasonal IIV among young children have demonstrated that 2 vaccine doses provide better protection than 1 dose during the first season a child is vaccinated.</strong> In a study during the 2004–05 season of children aged 5–8 years who received IIV3 for the first time, the proportion of children with protective antibody responses was significantly higher after 2 doses than after 1 dose of IIV3 for each antigen (p = 0.001 for influenza A[H1N1]; p = 0.01 for influenza A[H3N2]; and p = 0 0.001 for influenza B) (138). <br>\n<strong>Vaccine effectiveness is lower among children aged &lt;5 years who have never received influenza vaccine previously or who received only 1 dose in their first year of vaccination than it is among children who received 2 doses in their first year of being vaccinated.</strong> <br>_{A retrospective study of billing and registry data among children aged 6–21 months conducted during the 2003–04 season found that although receipt of 2 doses of IIV3 was protective against office visits for ILI, receipt of 1 dose was not (139). Another retrospective cohort study of children aged 6 months through 8 years, the majority of whom received IIV3 (0.8% received LAIV3), also conducted during the 2003–04 season, found no effectiveness against ILI among children who had received only 1 dose (140). In a case-control study of approximately 2,500 children aged 6–59 months conducted during the 2003–04 and 2004–05 seasons, being fully vaccinated (having received the recommended number of doses) was associated with 57% effectiveness (95% CI = 28–74) against LCI for the 2004–05 season; a single dose was not significantly effective (too few children in the study population were fully vaccinated during the 2003–04 season to draw conclusions) (141).} <br> The results of these studies support the recommendation that all children aged 6 months–8 years who are being vaccinated for the first time should receive 2 doses separated by at least 4 weeks. [emphasis added]</p>\n</blockquote>\n<p>This might be visualised like in &quot;<a href=\"http://Efficacy%20of%20a%20single%20dose%20of%20live%20attenuated%20influenza%20vaccine%20in%20previously%20unvaccinated%20children:%20A%20post%20hoc%20analysis%20of%20three%20studies%20of%20children%20aged%202%20to%206%20years\" rel=\"nofollow noreferrer\">Efficacy of a single dose of live attenuated influenza vaccine in previously unvaccinated children: A post hoc analysis of three studies of children aged 2 to 6 years</a>&quot;:</p>\n<p><a href=\"https://i.stack.imgur.com/var1y.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/var1y.png\" alt=\"Kaplan-Meier curve for the time to first episode of culture-confirmed influenza illness in year 1 of the study by Bracco Neto et al among previously unvaccinated children aged ≥2 years. LAIV = live attenuated influenza vaccine.\" /></a></p>\n<p>This indicates that children are strictly speaking not <em>required</em> to be vaccinated two times, since a single flu shot also provides some significant protection. But a second vaccination likely increases the potential benefit substantially. That's why a second round is <em>recommended</em>.</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218633/\" rel=\"nofollow noreferrer\">Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 months to 8 Years Old during 2011–2012 and 2012–2013: The Importance of Two Priming Doses</a></p>\n<blockquote>\n<p>In conclusion, during 2011–12 and 2012–13, vaccination with IIV3 reduced the risk of outpatient medical visits for ARI associated with influenza virus infection by about half. Vaccinations received in previous seasons had preventive value in subsequent seasons in the form of residual protection for those who missed vaccination in and priming which boosted the benefit of IIV. <strong>Most notably, children primed with 2 doses of influenza vaccine in the previous same season appeared to enjoy even greater preventive benefit from IIV3 and may have reduced their risk of A(H3N2) illness by two-thirds.</strong></p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18022736\" rel=\"nofollow noreferrer\">Immunogenicity and reactogenicity of a trivalent influenza split vaccine in previously unvaccinated children aged 6—9 and 10—13 years</a></p>\n<blockquote>\n<p>Immunization of previously unvaccinated children against influenza is thought to require two doses of vaccine. There is currently no general consensus regarding the age cut-off for a two-dose vaccination regimen. <strong>A second vaccine dose in previously unvaccinated children appears advisable because of the limited immunogenicity of a single dose of influenza vaccine in young children. […] These recommendations are based on the premise that a significant proportion of these children are immunologically na ̈ıve…</strong></p>\n</blockquote>\n<p>Anyone who was exposed to the antigens of the viruses develops some residual immunity. This limited immunity further weakens over time since the viruses change so much and so rapidly. Thus people might require 'an update' to these antibody information for the immune system based on the 'currently trending' virus strains. Young children have a weaker adaptive immune response and <em>presumably</em> no residual immunity. Both points are thought to be addressed by the two vaccination regimes.</p>\n", "score": 2 } ]

[ "immune-system", "vaccination", "influenza" ]

[ { "answer_id": 14103, "body": "<h2>No, it doesn't</h2>\n<blockquote>\n<p>Vaccines contain the same antigens (or parts of antigens) that cause diseases. For example, measles vaccine contains measles virus. <strong>But the antigens in vaccines are either killed, or weakened to the point that they don’t cause disease. However, they are strong enough to make the immune system produce antibodies that lead to immunity.</strong> In other words, a vaccine is a safer substitute for a child’s first exposure to a disease. The child gets protection without having to get sick. Through vaccination, children can develop immunity without suffering from the actual diseases that vaccines prevent.</p>\n<p>^{<em>Source: <a href=\"https://www.cdc.gov/vaccines/vac-gen/howvpd.htm\" rel=\"nofollow noreferrer\">CDC.gov</a>, Emphasis Mine</em>}</p>\n</blockquote>\n<p>The effort it takes for the immune system to produce antibodies is so little your immune system should be able to cope with it, this is why multiple vaccinations can be received at the same time.</p>\n<blockquote>\n<p>A number of studies have been done to look at the effects of giving various combinations of vaccines, and when every new vaccine is licensed, it has been tested along with the vaccines already recommended for a particular aged child. <strong>The recommended vaccines have been shown to be as effective in combination as they are individually.</strong> Sometimes, certain combinations of vaccines given together can cause fever, and occasionally febrile seizures; these are temporary and do not cause any lasting damage. Based on this information, both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend getting all routine childhood vaccines on time.</p>\n<p>^{<em>Source: <a href=\"https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html\" rel=\"nofollow noreferrer\">CDC.gov</a>, <a href=\"http://www.nationalacademies.org/hmd/%7E/media/Files/Report%20Files/2003/Immunization-Safety-Review-Multiple-Immunizations-and-Immune-Dysfunction/MultImmSummaryFINAL.pdf\" rel=\"nofollow noreferrer\">Further Reading</a>, Emphasis Mine</em>}</p>\n</blockquote>\n<p>Furthermore, the Common Cold is usually not very straining on the immune system, and immunity to the influenza can take <a href=\"https://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm\" rel=\"nofollow noreferrer\">up to 2 weeks to develop</a>. Your immune system is handling so many infections at the same time, most of whose outbreaks never occur because the immune system is quick enough, a few killed antigens won't burden it much.</p>\n<p>If you still are in doubt, talk to your doctor.</p>\n<hr />\n<h2><a href=\"https://xkcd.com\" rel=\"nofollow noreferrer\">A little treat</a>:</h2>\n<p><a href=\"https://i.stack.imgur.com/21409m.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/21409m.png\" alt=\"enter image description here\" /></a></p>\n", "score": 5 } ]

[ "vaccination", "common-cold", "influenza" ]

[ { "answer_id": 14231, "body": "<p>Zinc oxide is an inorganic compound with the formula ZnO. ZnO is a white powder that is insoluble in water and is widely used as an additive in numerous materials and products including rubbers, plastics, ceramics, glass, cement, lubricants, foods, and as a sunblock. </p>\n\n<p>For material science applications, zinc oxide has a high <a href=\"https://www.britannica.com/science/refractive-index\" rel=\"noreferrer\">refractive index</a>, high <a href=\"http://www.dictionary.com/browse/thermal-conductivity\" rel=\"noreferrer\">thermal conductivity</a>, binding, antibacterial and UV-protection properties.</p>\n\n<p>Zinc oxide can be used in ointments, creams, and lotions to protect against <em>sunburn</em> and other damage to the skin caused by UV light. It is the broadest spectrum UVA and UVB absorber that is approved for use by the FDA and is completely <a href=\"https://www.merriam-webster.com/medical/photostable\" rel=\"noreferrer\">photostable</a>. As stated in an article titled ‘<a href=\"http://www.jaad.org/article/S0190-9622(99)70532-3/fulltext\" rel=\"noreferrer\">Microfine zinc oxide (Z-Cote) as a photostyable UVA/UVB sunblock agent</a>' the suitability of microfine zinc oxide as a broad-spectrum photo protective agent was assessed by examining the properties considered important in suncreens: <a href=\"https://www.britannica.com/science/attenuation-spectrum\" rel=\"noreferrer\">attenuation spectrum</a>, sun protection factor (SPF) contribution, photostability, and <a href=\"https://en.oxforddictionaries.com/definition/photoreaction\" rel=\"noreferrer\">photoreactivity</a>.</p>\n\n<blockquote>\n <p>Results: Microfine zinc oxide attenuates throughout the UVR spectrum, including UVA I. It is photostable and does not react with organic sunscreens under irradiation. Conclusion: Microfine zinc oxide is an effective and safe sunblock that provides broad-spectrum UV protection, including protection from long-wavelength UVA.</p>\n</blockquote>\n\n<p>In 1999, the FDA issued a notice of proposed rule making that amended the tentative final monograph (proposed rule) for over-the counter (OTC) sunscreen drug products. ‘<a href=\"https://www.fda.gov/ohrms/dockets/98fr/102298b.txt\" rel=\"noreferrer\">Sunscreen Drug Products for Over-the-Counter Human Use</a>' states the following:</p>\n\n<blockquote>\n <p>The agency discussed a study submitted to the Panel using zinc oxide alone and in combination with phenyl salicylate, another sunscreen ingredient (58 FR 28194 at 28213). The study was designed to measure the ability of zinc oxide (15 to 33.3 percent) to absorb ultraviolet (UV) radiation over a broad range of wavelengths.</p>\n</blockquote>\n\n<p>In the proposed rule, the agency also discussed the public health significance of ultraviolet A (UVA) radiation and the characteristics and proposed labeling of OTC sunscreen drug products that claim to provide protection from UVA radiation. One comment measured the spectral absorbance of three formulations: (1) 4 percent zinc oxide, (2) 25 percent zinc oxide, and (3) 2 percent oxybenzone.</p>\n\n<blockquote>\n <p>Albino hairless mouse stratum corneum/epidermis samples were prepared by mechanical removal of the dermis using a dulled razor\n blade. The samples were cut into 1-inch circles and maintained in a hydrated state by floating the samples (dermal side down) on a water bath. The absorbance of each skin sample was measured and recorded. Ten microliters (L) of sunscreen were applied to the skin substrate, allowed to dry for 15 minutes, and the absorbance measured. The absorbance of each sunscreen treated sample was subtracted from the absorbance of the skin (without sunscreen) to yield the absorbance of the sunscreen. Five replicate measurements for each sunscreen formula were averaged and plotted with standard deviations at each 10 nm.</p>\n</blockquote>\n\n<p>The spectral absorbance plots established that</p>\n\n<blockquote>\n <p>...zinc oxide has a relatively flat and broad absorbance curve from 250 nm through 370 nm with a sharp drop in absorbance beyond 370 nm and extending into the visible spectrum. Comparison of the measurements of the 4 percent zinc oxide with 25 percent zinc oxide showed that the magnitude of absorbance is related to the amount of zinc oxide in the formulation.</p>\n</blockquote>\n\n<p>These measurements adequately demonstrated that zinc oxide</p>\n\n<blockquote>\n <p>...absorbs radiation between 290 and 380 nm and, thus, support effectiveness.</p>\n</blockquote>\n\n<p>Another comment included the results of in vitro testing of a formulation containing 15 percent zinc oxide in a stable emulsion. The transmittance data supported the premise that </p>\n\n<blockquote>\n <p>...zinc oxide can protect against UV radiation, including both UVB and UVA.</p>\n</blockquote>\n\n<p>One comment included a spectral profile of attenuation for zinc oxide alone in a cosmetic formulation and from 1:1 and 3:1 combinations of zinc oxide and titanium dioxide. These spectral profiles of zinc oxide in various formulations demonstrated that</p>\n\n<blockquote>\n <p>...zinc oxide as a single ingredient can provide protection in both the UVB and UVA spectral regions.</p>\n</blockquote>\n\n<p>Recent scientific advances in understanding the photochemistry and photobiology of sunscreen drug products have raised many issues regarding sunscreen active ingredients, including zinc oxide and titanium dioxide. Because zinc oxide and titanium dioxide have many similar physical characteristics and may be used in combination in OTC sunscreen drug products, the following discussion addresses both ingredients.</p>\n\n<blockquote>\n <p>There has been renewed interest in using physical sunscreens, i.e., zinc oxide and titanium dioxide, in sunscreen formulations because these ingredients may confer protection for a broad range of the UV radiation spectrum. Some manufacturers have developed ultrafine forms of these ingredients in the range of 0.02 to 0.10 microns that are transparent on the skin, may offer both UVA and UVB protection, and are esthetically pleasing…</p>\n</blockquote>\n\n<p>Sunscreens have been generally classified as chemical (organic) or physical (inorganic) depending on whether they absorb specific UV radiation wavelengths or reflect and scatter UV radiation.</p>\n\n<blockquote>\n <p>Zinc oxide and titanium dioxide have been described as physical sunscreen ingredients that provide protection from UV radiation through reflection and scattering. However, new data and information indicate that they also absorb UV radiation as well as scatter visible light.</p>\n</blockquote>\n\n<p>Various authors have shown that these ingredients exhibit a semiconductor optical absorption gap meaning they absorb most radiation at wavelengths shorter than the gap (approx. 380nm) and scatter radiation at wavelengths longer than the gap.</p>\n\n<blockquote>\n <p>When zinc oxide and titanium dioxide are irradiated with light containing energy greater than the band gap (approximately 3 electron volts), an electron from the valence band can be excited to the conduction band, thus creating an electron-hole pair.</p>\n</blockquote>\n\n<p>There are many formulation variables that may affect the photocatalytic capability of zinc oxide and titanium dioxide.</p>\n\n<blockquote>\n <p>Such variables include mineral components, particle size, surface area, crystalline structure, particle coatings, pH of the medium, differences in the refractive index of the medium, and other components in the formulation.</p>\n</blockquote>\n\n<p>Although the FDA continues to evaluate data and information for the purpose of proposing a monograph method for determining UVA radiation protection, it nonetheless finds</p>\n\n<blockquote>\n <p>there is ample data demonstrating that zinc oxide provides protection against UVA radiation.</p>\n</blockquote>\n\n<p>As it relates to the frequency one should apply sunscreen, a common recommendation by many public health agencies is to reapply sunscreen every <em>two to three hours</em>. Is this recommendation effective in minimizing ultraviolet exposure of the skin during time in the sun? ’<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11712033\" rel=\"noreferrer\">When should sunscreen be applied?</a>’ studied how the time of sunscreen reapplication affects the solar ultraviolet exposure of the skin.</p>\n\n<blockquote>\n <p>A mathematical model was derived that took into account typical amounts of sunscreen application and sunscreen substantivity to determine how these factors, when combined with the time of sunscreen reapplication, influence the photoprotection provided by sunscreen during exposure for several hours around mid day in strong sunshine.</p>\n</blockquote>\n\n<p>Results of the study were as follows:</p>\n\n<blockquote>\n <p>Using a sunscreen that is readily removed from the skin achieves little in the way of sun protection, no matter when it is reapplied. For sunscreens that bind moderately or well to skin, typical of modern waterproof or water-resistant products, the lowest skin exposure results from early reapplication into the sun exposure period, and not at 2 to 3 hours, after initial application. Typically reapplication of sunscreen at 20 minutes results in 60% to 85% of the ultraviolet exposure that would be received if sunscreen were reapplied at 2 hours.</p>\n</blockquote>\n\n<p>The concluding statement advises sunscreen users </p>\n\n<blockquote>\n <p>…to apply sunscreen liberally to exposed sites 15 to 30 minutes before going out into the sun, followed by reapplication of sunscreen to exposed sites 15 to 30 minutes after sun exposure begins. Further reapplication is necessary after vigorous activity that could remove sunscreen, such as swimming, toweling, or excessive sweating and rubbing.</p>\n</blockquote>\n\n<p>Another abstract, ‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15767357\" rel=\"noreferrer\">A noninvasive objective measure of sunscreen use and reapplication</a>’, studied whether a noninvasive swabbing technique can detect sunscreen use for up to 6 hours, and whether the technique can detect reapplication of sunscreen. </p>\n\n<blockquote>\n <p>Thirty volunteer office workers were randomly assigned to have one of a variety of sunscreens applied using recommended application techniques, and half were randomly assigned to have sunscreen reapplied after 3 hours. Alcohol-based swabs were used to obtain a sample from participants' arm at 20 minutes, and hourly from 1 to 6 hours post-application. Absorption readings were analyzed using an UV-visible spectrophotometer…The “swabbing technique” was consistently able to distinguish the sunscreen from control swabs for up to 6 hours. The absorption readings between 20 minutes and 6 hours were significantly higher than control swabs. There were no differences between the group that had sunscreen reapplied and the group that did not.The swabbing technique was consistently able to distinguish the sunscreen from control swabs for up to 6 hours. The absorption readings between 20 minutes and 6 hours were significantly higher than control swabs. There were no differences between the group that had sunscreen reapplied and the group that did not.</p>\n</blockquote>\n\n<p>The study concluded with evidence indicating that the sunscreen swabbing technique is</p>\n\n<blockquote>\n <p>an effective noninvasive method for detecting a variety of sunscreen products in adults over a 6-hour period. No differences in absorption readings were found with sunscreen reapplication. This procedure will be a useful adjunct to other objective measures of sun protection and UV radiation exposure, resulting in a more accurate picture of the sun protection habits of individuals.</p>\n</blockquote>\n\n<p>Moreover, the Skin Cancer Foundation answers several relevant questions in an article titled ‘<a href=\"http://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-explained\" rel=\"noreferrer\">Sunscreens Explained</a>’. </p>\n\n<blockquote>\n <p>How much Sunscreen Should I Use and How Often Should I Put it On?\n To ensure that you get the full SPF of a sunscreen, you need to apply 1 oz – about a shot glass full. Studies show that most people apply only half to a quarter of that amount, which means the actual SPF they have on their body is lower than advertised. During a long day at the beach, one person should use around one half to one quarter of an 8 oz. bottle. Sunscreens should be applied 30 minutes before sun exposure to allow the ingredients to fully bind to the skin. Reapplication of sunscreen is just as important as putting it on in the first place, so reapply the same amount every two hours. Sunscreens should also be reapplied immediately after swimming, toweling off, or sweating a great deal.</p>\n</blockquote>\n\n<p>Finally, to address your question: “Why do I need to reapply a zinc sun blocker if it has not been exposed to sun or sweat?”; The International Agency for Research on Cancer’s ‘<a href=\"http://www.iarc.fr/en/publications/pdfs-online/prev/handbook5/index.php\" rel=\"noreferrer\">IARC Handbook of Cancer Prevention Volume 5</a>,’ explains in Chapter 6: <a href=\"http://www.iarc.fr/en/publications/pdfs-online/prev/handbook5/Handbook5_Sunscreens-6.pdf\" rel=\"noreferrer\">Other beneficial effects of sunscreens</a>, that there are other potential beneficial effects of sunscreens that are not related to the prevention of skin cancer include prevention of painful sunburns, photodamage and photoageing UVR-induced provocation of certain cutaneous diseases, and photoimmune suppression.</p>\n\n<blockquote>\n <p>Use of sunscreens can prevent skin diseases from progressing acutely after exposure to the sun; these diseases include cutaneous lupus erythematosus…and reactivation of herpes labialis… The other potential benefits of sunscreens are related to the type and duration of exposure to UVR. Prevention of photodamage and photoageing, which are related to cumulative exposure to UVR, in countries where solar irradiance is intense throughout the year requires daily, longterm sun protection… Prevention of acute flares of cutaneous diseases, which may be related to episodic exposure to UVR, requires anticipatory use of sun protection.</p>\n</blockquote>\n\n<p>Under certain circumstances, diseases of various etiologies can be aggravated by sunlight in people who on other occasions may react normally.</p>\n\n<blockquote>\n <p>These diseases include lupus erythematosus, lichen planus and herpes simplex. The disease most frequently recognized as requiring careful photoprotection from both UVB and UVA is lupus erythematosus in the discoid, systemic and subacute forms…The available evidence suggests that regular use of sunscreens reduces morbidity from both cutaneous and systemic lupus erythematous.</p>\n</blockquote>\n\n<p>Therefore, if you are unsure about whether it is necessary to wear sunscreen indoors, you may want to consider your medical history and potential predisposition toward developing a disease that may increase the need for more intensive \"sun-blocking\" protective measures. However, it is always advisable to consult with your primary care physician and/or dermatologist with any personal health-related questions or concerns.</p>\n", "score": 5 }, { "answer_id": 14217, "body": "<h2>TL;DR: No, sunscreen needs to be re-applied every 2 hours</h2>\n\n<hr>\n\n<h2>Your product is the same as SPF 30 sunscreen</h2>\n\n<blockquote>\n <p><strong>SPF is a measure of how much solar energy (UV radiation) is required to produce sunburn on protected skin (i.e., in the presence of sunscreen) relative to the amount of solar energy required to produce sunburn on unprotected skin.</strong> As the SPF value increases, sunburn protection increases.</p>\n \n <p>^{<em>FDA</em>: <strong><a href=\"https://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm106351.htm\" rel=\"nofollow noreferrer\">Sun Protection Factor (SPF)</a></strong>}</p>\n</blockquote>\n\n<p>This is irrelevant whether you apply sunscreen with an SPF of 30, or vanilla ice cream with an SPF of 30, or zinc sun block moisturiser with an SPF of 30. The FDA approves all 3 products, and the SPF value is an absolute, standardised value and does not depend on type of product.</p>\n\n<p>So, using a SPF 30 zinc sun blocker blocks equal amounts of UV radiation as a SPF 30 sunscreen. In fact, <a href=\"https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm#ingredients\" rel=\"nofollow noreferrer\">zinc oxide even is one of the multiple possible active ingredients in a sunscreen</a>, and yes, you are right, it is a physical blocker and therefore better than most sun screens as it protects from UVA and UVB also.</p>\n\n<h2>How long does an SPF 30 sunscreen protect my skin?</h2>\n\n<blockquote>\n <p>“<strong>If you’re in the sun, your sunscreen is good for a max of two hours</strong>, and depending on the sunscreen it might not even last that long,” Garner says. The skin literally “uses up” the active ingredient in the lotion over time, meaning it can’t do any more. </p>\n \n <p>^{<em>Laura Schoecker</em>. <strong><a href=\"https://www.huffingtonpost.com/2013/06/05/sunscreen-mistakes-tips_n_3377817.html\" rel=\"nofollow noreferrer\">8 Sunscreen Mistakes You’re Probably Making</a></strong>. HuffingtonPost. 2013}</p>\n</blockquote>\n\n<p>The FDA agrees:</p>\n\n<blockquote>\n <p>Reapply [sunscreen] <strong>at least every two hours, and more often if you’re swimming or sweating.</strong></p>\n \n <p>People should also be aware that no sunscreens are \"waterproof.” All sunscreens eventually wash off. Sunscreens labeled \"water resistant\" are required to be tested according to the required SPF test procedure. The labels are required to state whether the sunscreen remains effective for 40 minutes or 80 minutes when swimming or sweating, and all sunscreens must provide directions on when to reapply.</p>\n \n <p>^{<em>FDA</em>. <strong><a href=\"https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm\" rel=\"nofollow noreferrer\">Sunscreen: How to Help Protect Your Skin from the Sun.</a></strong>}</p>\n</blockquote>\n\n<p>However, this is the case with chemical sunblockers. Physical sunblockers do not get absorbed as easily by the skin (The swimming and sweating still holds, though):</p>\n\n<blockquote>\n <p>There are differences between the two main types of sunscreens: physical and chemical. <strong>A chemical sunscreen is absorbed by the skin.</strong> Sunlight is deactivated or degraded after contact with the organic chemicals contained in the sunscreen. Chemical sunscreens typically contain a range of ingredients like benzones, aminobenzoic acid and cinnamates that, together, protect against UVA and UVB.</p>\n \n <p>A physical block, in contrast, sits on the skin’s surface and contains inorganic compounds like titanium dioxide or zinc oxide that are not absorbed into the skin. In this case, light is either absorbed into sunblock material or reflected away from the skin, similar to a mirror or aluminum foil. <strong>Ingredients in physical sunblocks protect against both UVA and UVB and, because they are not absorbed into the skin</strong>, they are nonirritating and nonallergenic.</p>\n \n <p>^{<em>Dr. Doris J. Day</em>, <strong><a href=\"https://consults.blogs.nytimes.com/2009/06/10/what-to-look-for-in-a-sunscreen/\" rel=\"nofollow noreferrer\">What to Look for in a Sunscreen</a></strong>. New York Times. 2009}</p>\n</blockquote>\n\n<p>Nevertheless, both the FDA and multiple interviews with doctors I have seen encourage patients to use physical sun blockers and re-apply sunscreen every 2 hours. </p>\n\n<blockquote>\n <p><strong>Remember that sunscreen needs to be reapplied every two hours</strong>, or more frequently after swimming, heavy perspiration, or toweling off. Also remember, no matter how much sunscreen you apply, the SPF should be 15 or higher for adequate protection – and ideally 30 or higher for extended time spent outdoors.</p>\n \n <p>^{<em>Elizabeth Kale</em>, <strong><a href=\"http://www.skincancer.org/skin-cancer-information/ask-the-experts/how-much-sunscreen-should-i-be-using-on-my-face-and-body\" rel=\"nofollow noreferrer\">Ask The Epxert</a></strong>. Skin Cancer Foundation. 2010}</p>\n \n <p>In addition to sunscreens, <strong>sun smart behavior including avoiding the midday sun, staying in the shade when you can, and wearing a hat and sun protective clothing. Use an SPF of 15 or higher, and reapplying it every two hours or more often if you are swimming or sweating, is critical</strong>.</p>\n \n <p>^{<em>Dr. Doris J. Day</em>, <strong><a href=\"https://consults.blogs.nytimes.com/2009/06/10/what-to-look-for-in-a-sunscreen/\" rel=\"nofollow noreferrer\">What to Look for in a Sunscreen</a></strong>. New York Times. 2009}</p>\n</blockquote>\n\n<hr>\n\n<h2>Beware of a common misconception</h2>\n\n<p>I've read the claim on multiple, reputable websites that SPF multiplies the time you can normally stay in the sun without burns.</p>\n\n<blockquote>\n <p>Sunscreens provide protection by absorbing, reflecting or scattering the sun's rays. They may also contain chemicals that interact with the skin to protect it from UV rays. Sunscreens are rated according to their effectiveness by the sun protection factor (SPF). A product's SPF number helps determine how long the product will protect you before you need to re-apply it - how long you can stay in the sun without burning. For example, you may normally burn in 20 minutes. If you apply an SPF 15 sunscreen, you'll be protected for about 300 minutes, or five hours (SPF 15 x 20 minutes = 300 minutes). A person with lightly pigmented skin who burns in 10 minutes would be protected for only about two-and-a-half-hours with SPF 15 (SPF 15 x 10 minutes = 150 minutes).</p>\n \n <p>^{<em>American Skin Association</em>. <strong><a href=\"http://www.americanskin.org/resource/safety.php\" rel=\"nofollow noreferrer\">Sun Safety</a></strong>}</p>\n</blockquote>\n\n<p><strong>According to the FDA, this is a common misconception</strong>.</p>\n\n<blockquote>\n <p><strong>There is a popular misconception that SPF relates to time of solar exposure. For example, many consumers believe that, if they normally get sunburn in one hour, then an SPF 15 sunscreen allows them to stay in the sun 15 hours (i.e., 15 times longer) without getting sunburn. This is not true because SPF is not directly related to time of solar exposure but to amount of solar exposure.</strong> Although solar energy amount is related to solar exposure time, there are other factors that impact the amount of solar energy. For example, the intensity of the solar energy impacts the amount. </p>\n \n <p>^{<em>FDA</em>: <strong><a href=\"https://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm106351.htm\" rel=\"nofollow noreferrer\">Sun Protection Factor (SPF)</a></strong>}</p>\n</blockquote>\n", "score": 3 } ]

[ "lasting-effects-duration", "effectiveness", "zinc", "spf-sun-protection-factor", "sunscreen-sunblock" ]

[ { "answer_id": 14209, "body": "<h2>Unless you have risk factors, don't worry too much</h2>\n\n<blockquote>\n <p>Dr Gordon Guyatt, chair of the panel, said: \"There has been a significant push in health care to administer DVT prevention for every patient, regardless of risk.<br>\n <strong>\"As a result, many patients are receiving unnecessary therapies that provide little benefit and could have adverse effects.</strong>\"</p>\n \n <p>^{Stephen Adams: <strong><a href=\"http://www.telegraph.co.uk/news/health/news/9064474/DVT-risk-raised-by-sitting-in-the-window-seat.html\" rel=\"nofollow noreferrer\">DVT risk raised by sitting in the window seat</a></strong>. Telegraph.co.uk. 7. February 2012}</p>\n</blockquote>\n\n<p>Wearing GCS (graduated compression stockings) is actually discouraged for patients without risk factors. </p>\n\n<blockquote>\n <p>The panel noted that the <strong>absolute risk of developing a DVT or a resultant PE due to a long flight</strong> - collectively known as venous thromboembolism (VTE) - <strong>was \"very small</strong>\".<br>\n One person in 4,600 experiences a symptomatic VTE in a month following a flight of four hours or longer, and only a minority of those are serious.</p>\n \n <p>^{<em>ibid</em>}</p>\n</blockquote>\n\n<p>Basically, stay well hydrated, this will make you visit the toilet twice in 12 hours and you have the necessary movement.</p>\n\n<blockquote>\n <p>Get up and <strong>walk from time to time</strong>, <strong>flex your heels</strong>, however small the space you can always raise and lower your feet and <strong>exercise your calves</strong>. <strong>Stay well hydrated</strong>.</p>\n \n <p>^{<a href=\"http://www.telegraph.co.uk/news/health/news/10028503/Flight-socks-and-aspirin-wont-stop-blood-clots-says-professor.html\" rel=\"nofollow noreferrer\">Telegraph.co.uk</a>.<br>\n <strong>Note</strong>: The title is misleading: The article basically concludes that for patients <strong>without risk</strong> factors, flight socks and aspirin won't further decrease risk of the DVT. (<em>Prof Gradwell added that people most at risk from developing deep vein thrombosis (DVT) were those who have a predisposition to blood clots because of existing medical conditions.\n In these cases, individuals should consult their GPs, and might benefit from specially fitted compression stockings, or be told to take an extra dose of aspirin, he said.</em>)</p>\n</blockquote>\n\n<h2>If you do have risk factors, wear graduated compression stockings and do exercise your feat, and also consult your doctor</h2>\n\n<blockquote>\n <p>Fifty of 2637 participants with follow-up data available in the trials of wearing compression stockings on both legs had a symptomless DVT; three wore stockings, 47 did not (odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04 to 0.25, P &lt; 0.001; high-quality evidence). There were no symptomless DVTs in three trials. Sixteen of 1804 people developed superficial vein thrombosis, four wore stockings, 12 did not (OR 0.45, 95% CI 0.18 to 1.13, P = 0.09; moderate-quality evidence). </p>\n \n <p><strong>There is high-quality evidence that airline passengers similar to those in this review can expect a substantial reduction in the incidence of symptomless DVT</strong> and low-quality evidence that leg oedema is reduced if they wear compression stockings. Quality was limited by the way that oedema was measured. There is moderate-quality evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. We cannot assess the effect of wearing stockings on death, pulmonary embolism or symptomatic DVT because no such events occurred in these trials. Randomised trials to assess these outcomes would need to include a very large number of people.</p>\n \n <p>^{<em>Clarke, Mike J; Broderick, Cathryn; Hopewell, Sally; Juszczak, Ed; Eisinga, Anne:</em> <strong><a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004002.pub3/abstract;jsessionid=AA32A68747DC6724EC29491FAB67ECDC.f03t02\" rel=\"nofollow noreferrer\">Compression stockings for preventing deep vein thrombosis in airline passengers</a></strong>. Cochrane Database of Systematic Reviews. 2016,9. John Wiley &amp; Sons, Ltd CD004002 DOI: 10.1002/14651858.CD004002.pub3}</p>\n</blockquote>\n\n<p>If one has risk factors of DVT, wearing GCS stockings is encouraged.</p>\n\n<blockquote>\n <p><strong>For travelers on flights of 6 hours or more who have an increased risk for DVT/PE, the ACCP recommends frequent ambulation, calf muscle stretching, sitting in an aisle seat if possible, or the use of below-knee graduated compression stockings (GCS). For long-distance travelers who are not at increased risk for DVT/PE, the guidelines suggest against the use of GCS.</strong> In addition, the guidelines suggest against the use of aspirin or anticoagulant therapy to prevent DVT/PE in long-distance travelers. For travelers who are considered to be at particularly high risk for DVT/PE, the use of antithrombotic agents should be considered on an individual basis because the adverse effects may outweigh the benefits.</p>\n \n <p>“Symptomatic DVT/PE is rare in passengers who have returned from long flights; however the association between air travel and DVT/PE is strongest for flights longer than 8 to 10 hours,” said Dr. Crowther. “Most passengers who do develop a DVT/PE after long-distance travel have one or more risk factors.” </p>\n \n <p>^{<em>American College of Chest Physicians</em> <strong><a href=\"http://www.chestnet.org/News/Press-Releases/2012/02/ACCP-Antithrombotic-and-Economy-Class-Syndrome\" rel=\"nofollow noreferrer\">New DVT Guidelines: No Evidence to Support Economy Class Syndrome. Oral Contraceptives, Sitting in a Window Seat, Advanced Age, and Pregnancy Increase DVT Risk in Long-distance Travelers.</a></strong> February 7, 2012}}</p>\n</blockquote>\n\n<p>Furthermore, check with your doctor whether anticoagulants are an option.</p>\n\n<h2>TL;DR / Conclusion</h2>\n\n<p>Although I gave my best efforts, I have not found studies giving absolute numbers how much risk you are at without walking, with walking, without GCS, with GCS and so on.</p>\n\n<p><strong>But</strong>: DVT can get nasty in a worst-case-scenario. Getting up every four hours is not such bad an alternative to a bad case of DVT (however unlikely that is) and it’s not like one would enjoy a deep and healthy sleep in a small plane seat anyway. </p>\n\n<p>As for driving: Be the driver. This way, your feet get great exercise (if you’re not driving an automatic). Or play We Will Rock You every hour or so and stomp along. </p>\n", "score": 3 } ]

[ "travel", "thrombosis" ]

[ { "answer_id": 14346, "body": "<p>\"Luckily\" haemophilia only occurs in men*; women may be carrier of the disease but their bleeding tendency is in general less severe.</p>\n\n<p>However, haemophilia carriers and women with other bleeding disorders (such as von Willebrand disease or platelet problems, e.g. Glanzmann) may experience very heavy menstrual blood loss. In general the menstruation won't take more days, but the blood loss can be much more severe. This could lead to anaemia and <em>potentially</em> death.</p>\n\n<p>To minimise this blood loss, one could suppress the period (e.g. oral contraceptives or an intra-uterine device). Other options would be administration of the part that's missing or malfunctioning (clotting factor or platelets) or blood transfusion to treat anaemia.</p>\n\n<p>* based on the comments below I want to add that it is possible that a woman is a true haemophiliac, but that this is very rare. Haemophilia is an X-linked disorder; because men inherit XY one affected X chromosome will cause the disease. Women have XX, which means that they can \"compensate\" the effect of one affected X chromosome by the activity of the other X chromosome. She is then a carrier of the disease: there is a 50-50 chance of her son (to whom she gives one X) is a haemophiliac. A woman could inherit two affected X chromosomes if her father is a haemophiliac and her mother is a carrier (and inherits the affected X chromosome). This makes true haemophilia much more rare in women than in men.</p>\n", "score": 6 } ]

[ "blood", "female" ]

[ { "answer_id": 14501, "body": "<p><a href=\"https://link.springer.com/chapter/10.1007/978-3-642-83737-1_12?no-access=true\" rel=\"noreferrer\">Asthma can lead to shortage of breath and in severe cases to death by suffocation</a> (called <code>asthmatic asphyxia</code>). Failure of breathing inherently involves that the heart rate stops (called <code>cardiac arrest</code>).</p>\n<blockquote>\n<p>A victim who is unresponsive and not breathing normally is in cardiac arrest and requires CPR.</p>\n<p>^{European Resuscitation Council, <a href=\"https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7baf/573c781e5e61585a053d7bd1/files/S0300-9572_15_00327-5_main.pdf?\" rel=\"noreferrer\">New Guidelines 2015</a> p. 82}</p>\n</blockquote>\n<p>So, if the asthmatic victim did not breathe normally anymore (no regular breath in 10 seconds, <em>ibid</em>), they did everything right.</p>\n<p>Even if they weren't sure whether the patient was still breathing, they did everything right:</p>\n<p><a href=\"https://i.stack.imgur.com/SGXT0.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/SGXT0.png\" alt=\"enter image description here\" /></a></p>\n<p>^{Image Taken From European Resuscitation Council, <a href=\"https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7baf/573c781e5e61585a053d7bd1/files/S0300-9572_15_00327-5_main.pdf?\" rel=\"noreferrer\">New Guidelines 2015</a> p. 85}</p>\n", "score": 7 } ]

[ "asthma", "cpr", "cardiac-arrest" ]

[ { "answer_id": 14771, "body": "<p>Nonsteroidal Anti-Inflammatory Drugs (<strong>NSAIDs</strong>) are anti-inflammatory agents that are different structurally and mechanistically from the\nanti-inflammatory steroids. NSAIDS act by a competitive and reversible\nactive site inhibition of Cyclooxygenase (<strong>COX</strong>) enzyme.</p>\n\n<p>The inhibition of COX reduces the local synthesis of Prostaglandins (<strong>PGs</strong>) that include pro-inflammatory actions among the diverse physiological role for the PGs. The PG family is also associated with fever and the perception of pain that accounts for the antipyretic and analgesic\neffects of the NSAIDs.</p>\n\n<blockquote>\n <p>NSAIDs are prostaglandin inhibitors and prevent peripheral nociception\n by vasoactive substances such as prostaglandins and bradykinins. Most\n NSAIDs inhibit both COX-1, which produces prostaglandins that are\n believed to be cytoprotective of the stomach lining, and <strong>COX-2</strong>, which\n produces prostaglandins responsible for pain and <strong>inflammation</strong></p>\n</blockquote>\n\n<p><br/></p>\n\n<blockquote>\n <p>Given that glucocorticoids (or corticosteroids) modify the expression of so many genes, and\n that the extent and direction of regulation varies between tissues and\n even at different times during disease, you will not be surprised to\n learn that their anti-inflammatory effects are complex.</p>\n</blockquote>\n\n<hr>\n\n<p>Some studies¹indeed claim steriodal anti inflammatory drugs to be superior than NSAIDs, but strictly speaking it depends on the condition being managed (in that particular study its Rheumatoid arthritis).</p>\n\n<blockquote>\n <p>Corticosteroid drugs can relieve inflammation, and in high doses they\n have a dramatic effect on the symptoms of rheumatoid arthritis. They\n are used only temporarily, however, because of serious adverse effects\n during long‐term use. The review found that corticosteroids in low\n doses are very effective. They are more effective than usual\n anti‐arthritis medications (non‐steroidal anti‐inflammatory drugs, or\n NSAIDs)</p>\n</blockquote>\n\n<p>On the other hand, there seeemed to be no significant differences in their efficacy when managing inflammation after uncomplicated cataract surgery\n²:</p>\n\n<blockquote>\n <p>There was moderate-certainty evidence of no difference in mean cell\n value in the participants receiving an NSAID compared with the\n participants receiving a corticosteroid (mean difference (MD) -0.60,\n 95% confidence interval (CI) -2.19 to 0.99), and there was\n low-certainty evidence that the mean flare value was lower in the\n group receiving NSAIDs (MD -13.74, 95% CI -21.45 to -6.04).</p>\n</blockquote>\n\n<p>The major reason why the former are generally frowned upon as the mainstay of managing inflammatory conditions is perhaps their <strong>wide range of adverse effects</strong> with long term use.</p>\n\n<blockquote>\n <p>Low-dose glucocorticoid replacement therapy is usually without\n problems but serious unwanted effects occur with large doses or\n prolonged administration of glucocorticoids. The major effects are as\n follows:</p>\n \n <p>The adverse effects of the glucocorticoids include suppression of the\n pituitary–adrenal axis that requires dose tapering while withdrawing\n the drug. GI effects are also common adverse effects and may include\n peptic ulcer, GI hemorrhage, ulcerative esophagitis, and acute\n pancreatitis. Characteristic effects of glucocorticoids include weight\n gain, osteoporosis, hyperglycemia, acne, increased susceptibility to\n infection, and cushingoid “moon face” and “buffalo hump.” Other\n adverse effects include headache, vertigo, increased intraocular and\n intracranial pressures, muscle weakness, psychological disturbances,\n edema, and hypertension.</p>\n</blockquote>\n\n<hr>\n\n<p>Having said that, the general take home points are:</p>\n\n<ul>\n<li>NSAIDs are the agents of choice for the treatment of rheumatoid arthritis, osteoarthritis, and\nankylosing spondylitis.</li>\n<li><p>NSAIDs may also be used to relieve musculoskeletal pain, headache, and gouty arthritis.</p></li>\n<li><p>More specifically, glucocorticoids are useful for the <strong>last resort</strong> management of severe, disabling arthritis; severe allergic reactions; seasonal allergic rhinitis; bronchial asthma; chronic ulcerative colitis; rheumatic\ncarditis; nephrotic syndrome; collagen vascular disease; cerebral edema; and topically for inflammatory disorders.</p></li>\n</ul>\n\n<p>References</p>\n\n<ol>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010532/\" rel=\"nofollow noreferrer\">Corticosteroids versus placebo and NSAIDs for rheumatoid arthritis</a></p></li>\n<li><p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28670710\" rel=\"nofollow noreferrer\">Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery</a>. </p></li>\n<li>Rang and Dale Pharmacology 8th ed: Drugs affecting major organ systems.</li>\n</ol>\n", "score": 5 } ]

[ "anti-inflammatory" ]

[ { "answer_id": 14553, "body": "<p>They’re fastened together by blood vessels, nerves and most importantly, connective tissue, muscles and bones.</p>\n\n<p><a href=\"https://i.stack.imgur.com/JqLiw.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/JqLiw.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>^{Image Source: anatomyorgan.com}</p>\n\n<p><a href=\"https://i.stack.imgur.com/JJLAJ.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/JJLAJ.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>^{Image Source: <a href=\"https://www.britannica.com/science/abdominal-muscle\" rel=\"nofollow noreferrer\">Britannica</a>}</p>\n\n<p>The same holds true for other organs in the body, although the skin and the brain are slightly different cases.</p>\n\n<p>The brain does float around, albeit in the cerebrospinal fluid, and very rapid movements (like hitting the head) can cause the brain to clash against the skull, causing a <a href=\"https://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview\" rel=\"nofollow noreferrer\">concussion</a>.</p>\n\n<p><a href=\"https://i.stack.imgur.com/6WD78.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/6WD78.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>^{Image Source: <a href=\"https://upload.wikimedia.org/wikipedia/commons/6/6d/1317_CFS_Circulation.jpg\" rel=\"nofollow noreferrer\">Wikipedia</a>}</p>\n\n<p>The skin is a muscle itself, connected to other muscles and tendons and is also supported by the skeleton.</p>\n", "score": 5 } ]

[ "blood", "internal-organs" ]

[ { "answer_id": 15995, "body": "<p>Nothing much new.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775162/\" rel=\"nofollow noreferrer\">Potential Health Impacts of Hard Water (PubMed Central, 2013)</a></p>\n\n<blockquote>\n <p>Although, there is some evidence from epidemiological studies for a\n protective effect of magnesium or hardness on cardiovascular\n mortality, <strong>the evidence is being debated and does not prove causality.</strong>\n In spite of this, drinking-water may be a source of calcium and\n magnesium in the diet and could be important for those who are\n marginal for calcium and magnesium intake.</p>\n</blockquote>\n\n<p><a href=\"http://www.who.int/water_sanitation_health/dwq/chemicals/hardness.pdf\" rel=\"nofollow noreferrer\">The World Health Organization (2011)</a> mentions several studies, none of which found <strong>any causal relationship between water magnesium or calcium content or total hardness and cardiovascular health.</strong></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28151437\" rel=\"nofollow noreferrer\">Cardiovascular diseases and hard drinking waters: implications from a systematic review with meta-analysis of case-control studies (PubMed, 2017)</a></p>\n\n<blockquote>\n <p>Hard water consumption seems to be protective against CVD. However,\n the <strong>high heterogeneity and the existence of publication bias limits\n the robustness and generalizability of these findings.</strong></p>\n</blockquote>\n\n<p>Anyway, hard water may not contribute that much to your calcium and magnesium intake. 2 liters of <a href=\"https://www.water-research.net/index.php/water-treatment/tools/hard-water-hardness\" rel=\"nofollow noreferrer\">hard water</a> (an average daily requirement) will likely contain only about 100 mg of calcium (<a href=\"http://lpi.oregonstate.edu/mic/minerals/calcium\" rel=\"nofollow noreferrer\">Recommended Daily Allowance is 1,000 mg/day</a>) and 50 mg of magnesium (<a href=\"http://lpi.oregonstate.edu/mic/minerals/magnesium\" rel=\"nofollow noreferrer\">RDA = 400 mg/day</a>).</p>\n", "score": 2 } ]

[ "water", "cardiology", "minerals" ]

[ { "answer_id": 14975, "body": "<p>Using these \"visuals\" is mostly a way for <em>you</em> to better understand and present the situation and condition of the patient. These preparations should help you to have everything ready and accessible when asked for by your doctor.</p>\n\n<p>The first problem with these pictures is indeed that they are a first draw and that they might get streamlined into a cleaner illustration. That means having printed text in a consistent design.</p>\n\n<p>The anatomical aspects are only helpful to you, an analog watch seems unnecessary, so from an cognitive ergonomics perspective (your UX part) I'd separate this onto the left side of a two facing pages design.</p>\n\n<p>It depends on many different things how well this will go: first thing to consider is the practitioner you visit and her preferences. Some really do not like being buried in details while others delight in as much detail as is possible and really devour files and information presented <em>in that style</em>.</p>\n\n<p>Prepare two identical brochures. One for you, one to present the doctor. She may then chose to use it or to ignore it and you can still refer to it in your answers to the anamnestic questions she will have on top of what you present to her.</p>\n\n<p>That <em>style</em> is the key part here:</p>\n\n<p>Doctors are trained to make the best of their and your time to cut to the chase efficiently and effectively. Taking a <a href=\"https://en.wikipedia.org/wiki/Medical_history\" rel=\"nofollow noreferrer\">medical history</a> and proceeding to <a href=\"https://en.wikipedia.org/wiki/Diagnosis\" rel=\"nofollow noreferrer\">diagnosis</a> to arrive at a possible treatment.</p>\n\n<p>The doctor chooses to read through the stuff you have prepared not only based on her preferences, but also on the current situation and setting. But further, how well presented your info is. That means two different but interconnected things:</p>\n\n<ol>\n<li>Follow the guidelines other <a href=\"https://www.google.de/search?q=example%20medical%20history%20form\" rel=\"nofollow noreferrer\">doctors or institutions use</a> in what to include, when to include and where to include it in the flow of information.</li>\n<li>Choose a consistent layout with a clear hierarchy of information to present (headlines, paragraphs etc.; aim for minimalism).</li>\n</ol>\n\n<p>One <a href=\"https://en.wikipedia.org/wiki/Medical_history#Process\" rel=\"nofollow noreferrer\">example</a> is in the Wikipedia article, since it is not really suited to this case, there are <a href=\"https://www.hopkinsmedicine.org/psychiatry/specialty_areas/moods/patient_information/docs/Pt_medi_history_form.doc\" rel=\"nofollow noreferrer\">others</a> to orient your file design and content on. Another might go as follows:</p>\n\n<blockquote>\n <ul>\n <li><strong>S</strong> Symptoms: especially pain and discomfort. \n When did it start, what hurts, where does it hurt, how did it proceed, how long, how intense did it hurt etc. <br></li>\n <li><strong>A</strong> Allergies: known, confirmed or suspected<br></li>\n <li><strong>M</strong> Medications: This includes really everything he takes or took: prescribed meds as well as self-chosen over the counter meds, supplements, unusual dietary habits or ingredients. These need to be clearly listed in one place, possibly ordered in tables if they are many. Every medication, every supplement, herb, vitamin, mineral. (Everything that has an effect likely has side effects and maybe interactions.)<br>\n <br></li>\n <li><strong>P</strong> Patient's history: Prior illnesses and conditions, previous diagnosis or treatments. For example hypertension, diabetes, operations etc. \n <br></li>\n <li><strong>L</strong> Last…: meals, hospitalisation, episode of illness etc.<br></li>\n <li><strong>E</strong> Event: What is new, what changed, what happened recently to arrive at the current situation<br></li>\n <li><strong>R</strong> Risks: known problems likely to occur but not listed above.</li>\n </ul>\n</blockquote>\n\n<p>The written information is absolutely king and if it is presented well, everybody (including you, when asked by the doctor for just one specific thing) should be able to skip those parts that may be currently irrelevant. Be consistent in how you compile these things. </p>\n", "score": 5 } ]

[ "medical-records" ]

[ { "answer_id": 15117, "body": "<p>Let's assume that the person inherits their A version of their ABO gene from their father. This means that they inherited their B version of their ABO gene from their mother. Now mother apparently tests O, which means that she can only donate an O gene to her offspring, unless she has a non-functional H gene. People with non-functional H genes will test as O blood type even if they're actually A or B type. </p>\n\n<p>The child then gets a functional H gene from the other parent and this then exposes the A or B gene from the mother. </p>\n\n<p>What actually happens is that the A or B gene code for proteins that turn the H protein into A or B, and if the H gene is defective, the A or B proteins can't be made and so the blood type appears as O. <a href=\"http://genetics.thetech.org/ask/ask413\" rel=\"nofollow noreferrer\">http://genetics.thetech.org/ask/ask413</a></p>\n\n<p>Another possiblity is a mutation. </p>\n\n<p><a href=\"https://i.stack.imgur.com/ceqq7.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/ceqq7.gif\" alt=\"enter image description here\"></a></p>\n\n<p>But you're much more likely to mutate from O to A rather than to B as the former pair only has one base difference between them. The O type is likely a nonsense mutation from A. <a href=\"http://genetics.thetech.org/ask/ask181\" rel=\"nofollow noreferrer\">http://genetics.thetech.org/ask/ask181</a></p>\n", "score": 1 } ]

[ "blood", "blood-tests" ]

[ { "answer_id": 24372, "body": "<h2><strong>Edited</strong></h2>\n<p>From the therapeutic point of view escitalopram and citalopram are the same; the difference between them resides on the isomers, pharmacologically citalopram is named as R,S-citalopram and escitalopram is named as S-citalopram.</p>\n<blockquote>\n<p>citalopram and escitalopram are selective serotonin reuptake inhibitors (SSRIs) and widely used antidepressants. Citalopram is a racemic mixture, whereas escitalopram is its S-enantiomer. Both agents have similar profiles of clinical efficacy and side effects. <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/2771\" rel=\"nofollow noreferrer\">PubChem</a></p>\n</blockquote>\n<p><a href=\"https://i.stack.imgur.com/KHJV3.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/KHJV3.gif\" alt=\"citalopram vs escitalopram\" /></a></p>\n<blockquote>\n<p>Binding of R‐citalopram at the allosteric site on the 5‐HT transporter decreases the time that S‐citalopram occupies the primary site. <a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-7843.2006.pto_295.x\" rel=\"nofollow noreferrer\">article</a></p>\n</blockquote>\n<p>Since citalopram is a racemic mixture and being S-citalopram the active ingredient, one might attempt to think that escitalopram that only has S-citalopram to be better or superior, when in fact, in terms of <strong>efficiency</strong> they are completely the same with escitalopram being prescribed with half the dosage of the citalopram for the same therapeutic effect, but the efficiency remains the same. In terms of <strong>potency</strong>, escitalopram, indeed, is far much potent than citalopram for that same reason.</p>\n<blockquote>\n<p>Presently, the claims about clinically relevant superiority of escitalopram over citalopram in short-to-medium term treatment of major depressive disorder are not supported by evidence <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829184/\" rel=\"nofollow noreferrer\">other article</a></p>\n</blockquote>\n<p><a href=\"https://i.stack.imgur.com/Abu8Q.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Abu8Q.png\" alt=\"image\" /></a></p>\n<p>As one can see, the SERT occupancy is practically the same for 5 mg of escitalopram that corresponds to 10 mg of citalopram and also identical for 10 mg of escitalopram that corresponds to 20 mg of citalopram.</p>\n<hr />\n<p>Once R‐citalopram can act with a similar mechanism as a competitive antagonist in this case, it is important to remember that those don't affect the Emax, what just happens is that more concentration is needed to achieve the same effect; also, toxicologically, it is possible to exist some differences that might be interesting to note and those be a choice factor between one and the other, however therapeutically there are none, because -kinetically they are very well studied and design to have a proportional response.</p>\n<hr />\n<p>Without excluding your research, when we take a closer look, we read things <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413963/\" rel=\"nofollow noreferrer\">like</a></p>\n<blockquote>\n<p>A pooled analysis from 4 trials showed a significant superiority of escitalopram versus citalopram,9 and this has been confirmed in a direct comparison of escitalopram and citalopram in severely depressed patients.23</p>\n</blockquote>\n<p>and then we go to articles 9 and 23, and not surprisingly the metrics that they used to use the word [superior] and better &quot;efficacy&quot; was based on MADRS (Montgomery-Asberg Depression Rating Scale) furthermore article 23 aims to conclude this</p>\n<blockquote>\n<p><a href=\"https://journals.lww.com/intclinpsychopharm/Abstract/2005/05000/Prospective,_multicentre,_randomized,_double_blind.2.aspx\" rel=\"nofollow noreferrer\">The MADRS</a> score decreased more in the escitalopram than in the citalopram arm (–22.4±12.9 versus –20.3±12.7; P&lt;0.05)</p>\n</blockquote>\n<p>and by those two points they won the champions league and conclude superiority :) and the story is all the same in all the reports they cite, for instance</p>\n<blockquote>\n<p><a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1742-1241.2005.00440.x\" rel=\"nofollow noreferrer\">There was</a> a significant difference in response between escitalopram and citalopram (56 vs. 41%, respectively, p = 0.007)</p>\n</blockquote>\n<p>Everytime based upon a metrics of MADRS and in this case with a difference of 15%, which is something... but still it doesn't seem enough to call it superior or that has a better efficacy.</p>\n<p>Personally I wouldn't go from there, these metrics are very easy to hack and the results are not so upfront as they state.</p>\n<p>Regarding your main question &quot;Why does anybody still prescribe Citalopram with Escitalopram available&quot;, I'd give you that, is a good question, if I might say so, they both have equivalent efficiencies; with escitalopram being more potent than citalopram; and of course we can't exclude the fact that all the data suggests that the response from escitalopram (based upon the MADRS metrics point of view) is at least slightly better than citalopram, with that being said, that doesn't mean citalopram is obsolete, it can still be a choice of treatment, however if we exclude pharmacoeconomic factors and other realms of realities such as publicity and commissions, that is a very difficult question to answer, because we can choose between one and the other: with one having a slightly better response than the other (according to MADRS metrics), it's a dilemma.</p>\n<p>In my opinion they both do the job, if one does it one week earlier or if there is a difference between them of 2 points according to the MADRS protocol, they still are quite equivalent.</p>\n", "score": 1 } ]

[ "medications", "prescription" ]

[ { "answer_id": 15112, "body": "<p><strong>Quality of Evidence</strong>\nFirst off, I'd be careful with the sources you are citing-- one of them is an opinion letter in a journal, and two are studies in rats.</p>\n\n<p>When looking at studies, the best evidence is that with patient-centered outcomes (5). Increased dentate gyrus neurogenesis or HGH production are interesting results, but it's unclear that those translate into meaningful benefits for you. The papers that are worth changing your daily habits for are the ones that look at endpoints that are meaningful to you: weight loss, increased survival, improved memory, etc. While you can theorize a link between neurogenesis or HGH and a meaningful outcome, science is full of theoretical connections that turned out not to exist in real life.</p>\n\n<p><strong>Evidence for Intermittent Fasting In Humans</strong>\nThere is not yet great evidence on the topic, as you mentioned, but there is a decent review published in 2014 comparing calorie restriction (CR) diets with intermittent fasting or alternate day fasting (IF/ADF) diets. It concludes (emphasis mine):</p>\n\n<blockquote>\n <p>Results reveal <strong>superior decreases in body weight by CR</strong> vs IF/ADF\n regimens, yet <strong>comparable reductions in visceral fat mass</strong>, fasting\n insulin, and insulin resistance. None of the interventions produced\n clinically meaningful reductions in glucose concentrations. Taken\n together, these <strong>preliminary findings show promise for the use of IF\n and ADF as alternatives to CR for weight loss and type 2 diabetes risk\n reduction</strong> in overweight and obese populations, but <strong>more research is\n required</strong> before solid conclusions can be reached.</p>\n</blockquote>\n\n<p>So while intermittent fasting may not cause as much weight loss as a typical diet, it seems to be similarly good at eliminating fat.</p>\n\n<p>There are several studies out there that look at intermittent fasting and weight loss, but they all have small sample sizes (n&lt;110) and most of them involve women only, so it's hard to extrapolate much from them. However most of them say that the two dietary approaches seem to be similar in terms of weight loss (2-4).</p>\n\n<p>Overall, it looks like intermittent fasting has comparable effects on weight and blood sugar as traditional calorie-restrictive diets.</p>\n\n<p>References:</p>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S193152441400200X\" rel=\"noreferrer\">Review of Intermittent Fasting Effects on Diabetes and Weight Loss</a></p>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/0002934394903026\" rel=\"noreferrer\">Year Long Weight Loss In Overweight Women</a></p>\n\n<p><a href=\"https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-11-98\" rel=\"noreferrer\">Intermittent Fasting and Weight Loss In Obese Women</a></p>\n\n<p><a href=\"https://www.nature.com/articles/ijo2010171\" rel=\"noreferrer\">Intermittent vs. Calorie Restriction Diets in Young Overweight Women</a></p>\n\n<p><a href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1207437\" rel=\"noreferrer\">Patient-Centered Outcomes</a></p>\n", "score": 5 } ]

[ "diet", "weight-loss", "metabolism", "fasting", "autophagy" ]

[ { "answer_id": 15290, "body": "<h1>Evidence for early exposure to peanuts is good; other evidence is mixed</h1>\n<h2>Evidence for beneficial introduction of peanuts in early life</h2>\n<p>The second paper you mention is the <a href=\"https://waojournal.biomedcentral.com/articles/10.1186/s40413-015-0076-x\" rel=\"nofollow noreferrer\">LEAP trial</a>. This went beyond the previous advice which said that children were less likely to develop allergies if exposed to peanuts early; they had enough evidence to make a positive recommendation:</p>\n<blockquote>\n<p>Existing guidelines pertaining to the early introduction of complementary foods have indicated that the introduction of highly allergenic foods, such as peanut, need not be delayed past 4 or 6 months of life.</p>\n<p>...</p>\n<p>There is now scientific evidence (Level 1 evidence from a randomized controlled trial) that healthcare providers should recommend introducing peanut-containing products into the diets of “high-risk” infants early on in life (between 4 and 11 months of age) in countries where peanut allergy is prevalent because delaying the introduction of peanut can be associated with an increased risk of peanut allergy.</p>\n</blockquote>\n<p>in 2017 this was codified <a href=\"https://www.niaid.nih.gov/diseases-conditions/guidelines-clinicians-and-patients-food-allergy\" rel=\"nofollow noreferrer\">into a recommendation by the National Institutes of Health</a>. From the <a href=\"https://www.niaid.nih.gov/sites/default/files/peanut-allergy-prevention-guidelines-parent-summary.pdf\" rel=\"nofollow noreferrer\">addendum for parents</a>:</p>\n<blockquote>\n<p>Guideline 1 recommends that if your infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), <strong>he or she should have peanut-containing foods introduced into the diet as early as 4 to 6 months of age</strong>.</p>\n<p>Guideline 2 suggests that if your infant has mild to moderate eczema, he or she <strong>may have peanut-containing foods introduced into the diet around 6 months of age to reduce the risk of developing peanut allergy</strong>.</p>\n<p>Guideline 3 suggests that if your infant has no eczema or any food allergy, <strong>you can freely introduce peanut-containing foods into his or her diet</strong>.</p>\n</blockquote>\n<p>Though it is suggested to &quot;[c]heck with your infant’s healthcare provider before feeding your infant peanut-containing foods.&quot;</p>\n<p>These recommendations were contemporaneously reported <a href=\"https://www.theguardian.com/society/2017/jan/05/babies-peanut-allergies-health-guidelines\" rel=\"nofollow noreferrer\">in mainstream press</a>.</p>\n<h2>Evidence for exposure to other allergens early in life</h2>\n<p>This is tricker to answer as there hasn't been a single focused study with evidence comparable to LEAP.</p>\n<h3>Asthma</h3>\n<p>One study looked at 514 children between birth and 24 months, and <a href=\"http://thorax.bmj.com/content/64/4/353#ref-1\" rel=\"nofollow noreferrer\">concluded that those who are exposed to &quot;spores and pollen in the first 3 months of life are at increased risk of early wheezing&quot;</a>.</p>\n<p>Similarly, there may be some correlation between early sensitivity to house dust mite (HDM) &amp; grass pollen and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/6640888\" rel=\"nofollow noreferrer\">month of birth due to seasonal variations</a>. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1514665\" rel=\"nofollow noreferrer\">Asthma itself seems to vary by month of birth</a>.</p>\n<p>However, it is important to note that these relations don't necessarily imply that early exposure causes the sensitisation- as ever, <em>correlation does not equate to causation</em>.</p>\n<h3>Sensitisations or Tolerance</h3>\n<p>A <a href=\"http://users.unimi.it/minucci/Molecular%20Immunology%20Module2017-18/Allergic%20diseases/Early%20life%20factors%20that%20affect%20allergy%20development%20(allergy%20review)%20(1).pdf\" rel=\"nofollow noreferrer\">2017 review on the subject of allergy development</a> (<strong>PDF</strong>) is more equivocal:</p>\n<blockquote>\n<p>It is becoming increasingly clear that antigen exposures during the first few years of life are unique in their capacity to either elicit allergic sensitization or result in tolerogenic responses.</p>\n</blockquote>\n<p>It has been proposed that <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24560412\" rel=\"nofollow noreferrer\">cutaneous exposure (through the skin) is more likely to result in <em>sensitisation</em></a>; whereas oral exposure is more associated with a <a href=\"https://www.nature.com/articles/mi20124\" rel=\"nofollow noreferrer\">development of tolerance</a>.</p>\n<p>Interestingly, it would seem that cutaneous exposure to peanuts -- for example peanut dust entering via break in skin -- can drive intestinal sensitivity and perhaps <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15969667\" rel=\"nofollow noreferrer\">prevent oral tolerance</a>.</p>\n<h3>Prenatal exposure</h3>\n<p>While not technically in the scope of your question, there is interest in what\neffect <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2753947/\" rel=\"nofollow noreferrer\">prenatal exposure</a> -- positive and negative -- can have on allergy development.</p>\n<h1>Pets</h1>\n<p>Evidence here is inconclusive as well. Some studies show a benefit to early exposure, while others link it with the development of an allergy. A <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783630/\" rel=\"nofollow noreferrer\">2009 review discusses the evidence</a>.</p>\n<blockquote>\n<p>Over the past decades, numerous studies have investigated the role of pet exposures in relation to atopy, but the published findings have been inconsistent and sometimes conflicting. Although there is growing evidence that exposure to pets may protect against development of atopic outcomes, the protective effects have not been replicated in all studies.</p>\n</blockquote>\n<p>Since then, there has been further evidence on both sides, for example a <a href=\"https://jamanetwork.com/journals/jamapediatrics/fullarticle/2467334\" rel=\"nofollow noreferrer\">large Swedish study which showed that animal exposure could be protective against asthma development</a> (reported in <a href=\"http://www.bbc.co.uk/news/health-34697408\" rel=\"nofollow noreferrer\">mainstream press</a>); wile another study from Finland concluded that pet exposure was <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25735463\" rel=\"nofollow noreferrer\">associated with a higher incidence of pet allergy</a>.</p>\n", "score": 2 }, { "answer_id": 15297, "body": "<h2>Peanuts and Peanut Allergies</h2>\n\n<p>It was advised that Peanuts were not to be eaten during pregnancy due to possible allergy issues, <a href=\"https://www.nhs.uk/conditions/pregnancy-and-baby/foods-to-avoid-pregnant/#peanuts\" rel=\"nofollow noreferrer\">but it is no longer the case</a>.</p>\n\n<blockquote>\n <p>You can eat peanuts or food containing peanuts, such as peanut butter, during pregnancy, unless you're allergic to them or a health professional advises you not to.</p>\n \n <p>You may have heard peanuts should be avoided during pregnancy. This is because the government previously advised women to avoid eating peanuts if there was a history of allergy – such as asthma, eczema, hay fever and food allergy – in their child's immediate family.</p>\n \n <p>This advice has now changed because the latest research has shown no clear evidence that eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.</p>\n</blockquote>\n\n<p>For peanut allergies, there is a therapy called Probiotic and Peanut Oral ImmunoTherapy (PPOIT) and <a href=\"http://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30041-X/fulltext\" rel=\"nofollow noreferrer\">a study published in The Lancet Child &amp; Adolescent Health</a> suggests that it can help for upto 4 years (Hsiao et al., 2017)</p>\n\n<blockquote>\n <p>48 (86%) of 56 eligible participants were enrolled in the follow-up study. Mean time since stopping treatment was 4·2 years in both PPOIT (SD 0·6) and placebo (SD 0·7) participants. Participants from the PPOIT group were significantly more likely than those from the placebo group to have continued eating peanut (16 [67%] of 24 vs one [4%] of 24; absolute difference 63% [95% CI 42–83], p=0·001; number needed to treat 1·6 [95% CI 1·2–2·4]). Four PPOIT-treated participants and six placebo participants reported allergic reactions to peanut after intentional or accidental intake since stopping treatment, but none had anaphylaxis.</p>\n</blockquote>\n\n<h2>Other Allergies</h2>\n\n<p>As stated in my comment a while ago, there was an article I saw about allergies in general, which stated that there seems to be a rise in the numbers of people suffering from allergies and there is a <a href=\"https://en.wikipedia.org/wiki/Hygiene_hypothesis\" rel=\"nofollow noreferrer\">hypothesis that this is due to the sterility of the environment compared to the past</a>. I cannot find the article I was thinking of, but the linked Wikipedia page provides information on this with citations.</p>\n\n<blockquote>\n <p>In medicine, the hygiene hypothesis is a hypothesis that states a lack of early childhood exposure to infectious agents, symbiotic microorganisms (such as the gut flora or probiotics), and parasites increases susceptibility to allergic diseases by suppressing the natural development of the immune system. In particular, the lack of exposure is thought to lead to defects in the establishment of immune tolerance.</p>\n \n <p>The hygiene hypothesis has also been called the \"<a href=\"https://en.wikipedia.org/wiki/Biome\" rel=\"nofollow noreferrer\">biome</a> depletion theory\" and the \"lost friends theory\" ^[1].</p>\n \n <p>...</p>\n \n <p>Although the idea that exposure to certain infections may decrease the risk of allergy is not new, Strachan was one of the first to formally propose it, in an article published in the British Medical Journal in 1989. ^[21]</p>\n \n <p><strong>Citations</strong></p>\n \n <p>[1] William Parker (2010-10-13). <a href=\"http://evmedreview.com/?p=457/\" rel=\"nofollow noreferrer\">\"Reconstituting the depleted biome to prevent immune disorders\"</a>. The Evolution &amp; Medicine Review.</p>\n \n <p>[21] Strachan, D. P. (1989). <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109\" rel=\"nofollow noreferrer\">\"Hay fever, hygiene, and household size\"</a>. BMJ. 299 (6710): 1259–60. doi:<a href=\"https://doi.org/10.1136/bmj.299.6710.1259\" rel=\"nofollow noreferrer\">10.1136/bmj.299.6710.1259</a>. PMC <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109\" rel=\"nofollow noreferrer\">1838109</a> Freely accessible. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2513902\" rel=\"nofollow noreferrer\">2513902</a></p>\n</blockquote>\n\n<p>The thing with these hypotheses, as indicated in the Wikipedia page, is that</p>\n\n<blockquote>\n <p>[with reducing modern practices of cleanliness and hygiene, there is] a significant amount of evidence that it would increase the risks of infectious diseases. ^[8]</p>\n \n <p>[8] Stanwell-Smith R, Bloomfield SF, Rook GA. (2012). <a href=\"http://www.ifh-homehygiene.org/best-practice-review/hygiene-hypothesis-and-its-implications-home-hygiene-lifestyle-and-public-0\" rel=\"nofollow noreferrer\">\"The hygiene hypothesis and its implications for home hygiene, lifestyle and public health\"</a>. International Scientific Forum on Home Hygiene.</p>\n</blockquote>\n\n<h3>Biological Basis</h3>\n\n<blockquote>\n <p>Allergic conditions are caused by inappropriate immunological responses to harmless antigens driven by a T_H2-mediated immune response, T_H2 cells produce interleukin 4, interleukin 5, interleukin 6, interleukin 13 and predominantly immunoglobulin E. Many bacteria and viruses elicit a T_H1-mediated immune response, which down-regulates T_H2 responses.<br>(<a href=\"https://en.wikipedia.org/wiki/Hygiene_hypothesis#Biological_basis\" rel=\"nofollow noreferrer\">Source</a>)</p>\n</blockquote>\n\n<h3>Epidemiological evidence</h3>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Hygiene_hypothesis#Epidemiological_evidence\" rel=\"nofollow noreferrer\">Epidemiological data supports the hygiene hypothesis</a></p>\n\n<blockquote>\n <p>Studies have shown that various immunological and autoimmune diseases are much less common in the developing world than the industrialized world and that immigrants to the industrialized world from the developing world increasingly develop immunological disorders in relation to the length of time since arrival in the industrialized world.^[11] This is true for asthma^[40] and other chronic inflammatory disorders.^[5]</p>\n \n <p>...</p>\n \n <p>In developed countries where childhood diseases were eliminated, the asthma rate for youth is approximately 10%. In the 19th century, hay-fever, an easily recognisable allergy, was a very rare condition.^[42]</p>\n \n <p><strong>Citations</strong></p>\n \n <p>[5] Rook, G. A. W.; Lowry, C. A.; Raison, C. L. (2013). \"Microbial 'Old Friends', immunoregulation and stress resilience\". Evolution, Medicine, and Public Health. 2013: 46–64. doi:<a href=\"https://doi.org/10.1093/emph/eot004\" rel=\"nofollow noreferrer\">10.1093/emph/eot004</a></p>\n \n <p>[11] Okada, H.; Kuhn, C.; Feillet, H.; Bach, J. -F. (2010). \"The 'hygiene hypothesis' for autoimmune and allergic diseases: An update\". Clinical &amp; Experimental Immunology. 160: 1–9. doi:<a href=\"http://doi.org/10.1111/j.1365-2249.2010.04139.x\" rel=\"nofollow noreferrer\">10.1111/j.1365-2249.2010.04139.x</a></p>\n \n <p>[40] Gibson, Peter G.; Henry, Richard L.; Shah, Smita; Powell, Heather; Wang, He (2003). \"Migration to a western country increases asthma symptoms but not eosinophilic airway inflammation\". Pediatric Pulmonology. 36 (3): 209–15. doi:<a href=\"http://doi.org/10.1002/ppul.10323\" rel=\"nofollow noreferrer\">10.1002/ppul.10323</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12910582\" rel=\"nofollow noreferrer\">12910582</a></p>\n \n <p>[42] Blackley CH (1873) Experimental Researches on the Causes and Nature of Catarrhus Aestivus (Hay-fever and Hay-asthma) (Baillière Tindall and Cox, London).</p>\n</blockquote>\n\n<h2>Treatments</h2>\n\n<p>As with Peanut Allergies, <a href=\"https://en.wikipedia.org/wiki/Allergen_immunotherapy\" rel=\"nofollow noreferrer\">Allergen Immunotherapy, also known as <strong>desensitisation</strong> or <strong>hypo-sensitisation</strong>, is a medical treatment for some types of allergies</a>.</p>\n\n<blockquote>\n <p>Immunotherapy involves exposing people to larger and larger amounts of allergen in an attempt to change the immune system's response.^[1]</p>\n \n <p>Meta-analyses have found that injections of allergens under the skin are effective in the treatment in allergic rhinitis in children^[3][4] and in asthma.^[2] The benefits may last for years after treatment is stopped.^[5] It is generally safe and effective for allergic rhinitis, allergic conjunctivitis, allergic forms of asthma, and stinging insects.^[6] The evidence also supports the use of sublingual immunotherapy against rhinitis and asthma, but it is less strong.^[5] In this form the allergen is given under the tongue and people often prefer it to injections.^[5] Immunotherapy is not recommended as a stand-alone treatment for asthma.^[5]</p>\n \n <p><strong>Citations</strong></p>\n \n <p>[1] <a href=\"https://web.archive.org/web/20160909195614/http://www.niaid.nih.gov/topics/allergicDiseases/Pages/allergen-immunotherapy.aspx\" rel=\"nofollow noreferrer\">\"Allergen Immunotherapy\"</a>. April 22, 2015. Archived from <a href=\"http://www.niaid.nih.gov/topics/allergicdiseases/Pages/allergen-immunotherapy.aspx\" rel=\"nofollow noreferrer\">the original</a> on 9 September 2016. Retrieved 15 June 2015.</p>\n \n <p>[2] Abramson, MJ; Puy, RM; Weiner, JM (4 August 2010). \"Injection allergen immunotherapy for asthma\". The Cochrane Database of Systematic Reviews (8): CD001186. doi:<a href=\"https://doi.org/10.1002%2F14651858.CD001186.pub2\" rel=\"nofollow noreferrer\">10.1002/14651858.CD001186.pub2</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20687065\" rel=\"nofollow noreferrer\">20687065</a>.</p>\n \n <p>[3] Penagos, M; Compalati, E; Tarantini, F; Baena-Cagnani, R; Huerta, J; Passalacqua, G; Canonica, GW (August 2006). \"Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials\". Annals of Allergy, Asthma &amp; Immunology. 97 (2): 141–8. doi:<a href=\"https://doi.org/10.1016%2FS1081-1206%2810%2960004-X\" rel=\"nofollow noreferrer\">10.1016/S1081-1206(10)60004-X</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16937742\" rel=\"nofollow noreferrer\">16937742</a>.</p>\n \n <p>[4] Calderon, MA; Alves, B; Jacobson, M; Hurwitz, B; Sheikh, A; Durham, S (24 January 2007). \"Allergen injection immunotherapy for seasonal allergic rhinitis\". The Cochrane Database of Systematic Reviews (1): CD001936. doi:<a href=\"https://doi.org/10.1002%2F14651858.CD001936.pub2\" rel=\"nofollow noreferrer\">10.1002/14651858.CD001936.pub2</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17253469\" rel=\"nofollow noreferrer\">17253469</a>.</p>\n \n <p>[5] Canonica GW, Bousquet J, Casale T, Lockey RF, Baena-Cagnani CE, Pawankar R, Potter PC, Bousquet PJ, Cox LS, Durham SR, Nelson HS, Passalacqua G, Ryan DP, Brozek JL, Compalati E, Dahl R, Delgado L, van Wijk RG, Gower RG, Ledford DK, Filho NR, Valovirta EJ, Yusuf OM, Zuberbier T, Akhanda W, Almarales RC, Ansotegui I, Bonifazi F, Ceuppens J, Chivato T, Dimova D, Dumitrascu D, Fontana L, Katelaris CH, Kaulsay R, Kuna P, Larenas-Linnemann D, Manoussakis M, Nekam K, Nunes C, O'Hehir R, Olaguibel JM, Onder NB, Park JW, Priftanji A, Puy R, Sarmiento L, Scadding G, Schmid-Grendelmeier P, Seberova E, Sepiashvili R, Solé D, Togias A, Tomino C, Toskala E, Van Beever H, Vieths S (December 2009). <a href=\"https://web.archive.org/web/20111112132041/http://www.worldallergy.org/publications/slit-wao-pp_final.pdf\" rel=\"nofollow noreferrer\">\"Sub-lingual immunotherapy: World Allergy Organization Position Paper 2009\"</a> (PDF). Allergy. 64 Suppl 91: 1–59. doi:<a href=\"https://doi.org/10.1111%2Fj.1398-9995.2009.02309.x\" rel=\"nofollow noreferrer\">10.1111/j.1398-9995.2009.02309.x</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20041860\" rel=\"nofollow noreferrer\">20041860</a>. Archived from <a href=\"http://www.worldallergy.org/publications/slit-wao-pp_final.pdf\" rel=\"nofollow noreferrer\">the original</a> (PDF) on 2011-11-12.</p>\n \n <p>[6] Rank, MA; Li, JT (September 2007). \"Allergen immunotherapy\". Mayo Clinic Proceedings. 82 (9): 1119–23. doi:<a href=\"https://doi.org/10.4065%2F82.9.1119\" rel=\"nofollow noreferrer\">10.4065/82.9.1119</a>. PMID <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17803880\" rel=\"nofollow noreferrer\">17803880</a>.</p>\n</blockquote>\n\n<h2>References</h2>\n\n<p>Hsiao, K. et al. (2017) <em>Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomised, double-blind, placebo-controlled trial</em>. The Lancet Child &amp; Adolescent Health, 1(2): pp. 97—105<br>DOI: <a href=\"https://doi.org/10.1016/S2352-4642(17)30041-X\" rel=\"nofollow noreferrer\">10.1016/S2352-4642(17)30041-X</a></p>\n", "score": 2 } ]

[ "allergy" ]

[ { "answer_id": 15248, "body": "<blockquote>\n <p>What would be medical advantages? </p>\n</blockquote>\n\n<p>There are several problems with what you're asking. It has to do with how you're framing the issue. But rather than get into a more convoluted point, I'll just answer your question:</p>\n\n<ol>\n<li>Reduced psychosocial well-being</li>\n<li>Longer term scarring </li>\n</ol>\n\n<p>Maybe that matters to you, maybe it doesn't. For some people it can impact their life in a significant way, leading to depression, etc. Then again, the retinoid treatments for acne can also lead to depression or worse.</p>\n\n<p>\"Remaining a virgin at age 40\" may not have an ICD-10 code, but it doesn't mean it's not a risk factor of acne worthy of attenuating.</p>\n\n<blockquote>\n <p>Such as avoiding risk for infections, or other?</p>\n</blockquote>\n\n<p>No, quite the opposite is possible:</p>\n\n<blockquote>\n <p><a href=\"https://jamanetwork.com/journals/jamadermatology/fullarticle/398804\" rel=\"nofollow noreferrer\">https://jamanetwork.com/journals/jamadermatology/fullarticle/398804</a></p>\n \n <p><strong>Antibiotic Treatment of Acne May Be Associated With Upper Respiratory\n Tract Infections</strong></p>\n \n <p><strong>Objective</strong> To determine if the long-term use of antibiotics for the treatment of acne results in an increase in either of 2 common\n infectious illnesses: upper respiratory tract infections (URTIs) or\n urinary tract infections.</p>\n \n <p><strong>Design</strong> Retrospective cohort study.</p>\n \n <p><strong>Setting</strong> General Practice Research Database of the United Kingdom, London, England, from 1987 to 2002.</p>\n \n <p><strong>Patients</strong> Patients with a diagnosis of acne.</p>\n \n <p><strong>Main Outcome Measure</strong> The onset of either a URTI or a urinary tract infection.</p>\n \n <p><strong>Results</strong> Of 118 496 individuals with acne (age range, 15-35 years) who were identified in the General Practice Research Database, 84 977\n (71.7%) received a topical or oral antibiotic (tetracyclines,\n erythromycin, or clindamycin) for treatment of their acne and 33 519\n (28.3%) did not. Within the first year of observation, 18 281 (15.4%)\n of the patients with acne had at least 1 URTI, and within that year,\n the odds of a URTI developing among those receiving antibiotic\n treatment were 2.15 (95% confidence interval, 2.05-2.23; P&lt;.001) times\n greater than among those who were not receiving antibiotic treatment.\n Multiple additional analyses, which were conducted to show that this\n effect was not an artifact of increased health care–seeking behavior\n among our cohorts, included comparing the cohorts of patients with\n acne with a cohort of patients with hypertension and the likelihood of\n developing a urinary tract infection.</p>\n \n <p><strong>Conclusions</strong> Patients with acne who were receiving antibiotic treatment for acne were more likely to develop a URTI than those with\n acne who were not receiving such treatment. The true clinical\n importance of our findings will require further investigation.</p>\n</blockquote>\n", "score": 3 } ]

[ "dermatology" ]

[ { "answer_id": 15275, "body": "<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", "score": 4 }, { "answer_id": 15322, "body": "<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", "score": 2 } ]

[ "symptoms" ]

[ { "answer_id": 18056, "body": "<p>The research into last year's flu season puts the blame on egg-based vaccine production.</p>\n\n<p>Reference:\n<a href=\"https://www.vox.com/science-and-health/2018/2/1/16960758/flu-vaccine-effectiveness\" rel=\"nofollow noreferrer\">https://www.vox.com/science-and-health/2018/2/1/16960758/flu-vaccine-effectiveness</a></p>\n\n<p>Researchers guess at the dominant flu strains well before flu season starts, then grow the strains in chicken eggs - an outdated process that takes weeks.</p>\n\n<p>Additionally, H3N2 (influenza A and the dominant strain last year) is infamous for rapid mutation. Often, the dominant strain can mutate after the previously mentioned researchers' guess has been finalized and the vaccine is queued for mass production. Also reported in the Vox article: 33% combined vaccine effectiveness in H3N2 seasons, vs. slightly over 50% when influenza B dominated and 67% in H1N1 (swine flu) seasons.</p>\n\n<p>Another problem the article mentions with growing flu vaccines in chicken eggs: H3N2 viruses mutate to get better at infecting the eggs, which means that even if you guess at the correct strain and grow it in eggs, the output vaccine isn't guaranteed to have the same structure (and therefore won't be as effective as expected).</p>\n\n<p>Why is the industry still using eggs?</p>\n\n<p>2 reasons, again mentioned in the Vox article: The industry is already optimized and built around the egg-based workflow (economy of scale) - and more modern approaches (cell-based and recombinant) are far more expensive. Additionally, more research is needed to determining if the cell-based and recombinant approaches produce a more reliable vaccine.</p>\n\n<p>In a summary answer to your question, it would appear to be \"no\", due to the egg-based mutation mentioned above. The Vox article also mentions abysmal protection rates in that season's vaccine against the dominant H3N2 strain, as low as 17% reported in Canada.</p>\n", "score": 3 } ]

[ "vaccination", "influenza" ]

[ { "answer_id": 28990, "body": "<p>If a drug produces noticeable side effects, it is likely that studies will suffer from an unblinding effect which will cause overstatement of efficacy of the drug. This is because in a properly blinded study, the placebo effect is the same<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130397/#s2title\" rel=\"nofollow noreferrer\">*</a> for both the active drug and the placebo, so we can calculate the true efficacy by <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130397/#s2title\" rel=\"nofollow noreferrer\">subtracting*</a></strong>. Unblinding causes the placebo effect to increase in the treatment group (due to increased certainty that they're receiving the active drug).</p>\n<p><a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0895435616303080\" rel=\"nofollow noreferrer\">Active placebos</a> could be used to mimic side effects and reduce risk of unblinding. Antidepressants, for example, show reduced effect in <a href=\"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/metaanalysis-of-trials-comparing-antidepressants-with-active-placebos/1222DAAE4794E07C1D38A70D8D557945\" rel=\"nofollow noreferrer\">studies that use an active placebo</a>.</p>\n<p>Surveys could be done of patient and provider so you could verify the validity of the blinding using the correlation between the patient taking the drug and <em>belief</em> that the patient is taking the drug.</p>\n<p>Neither of those things are commonly done.</p>\n", "score": 4 } ]

[ "clinical-study" ]

[ { "answer_id": 15343, "body": "<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", "score": 3 }, { "answer_id": 15337, "body": "<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", "score": 0 } ]

[ "digestion", "bacteria", "disinfection", "flora" ]

[ { "answer_id": 15347, "body": "<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", "score": 6 }, { "answer_id": 17616, "body": "<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", "score": 3 } ]

[ "depression", "cognitive-science", "psychiatrist-psychiatry", "behavior" ]

[ { "answer_id": 15459, "body": "<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", "score": 4 }, { "answer_id": 15460, "body": "<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", "score": 2 } ]

[ "vaccination", "pneumonia" ]

[ { "answer_id": 15548, "body": "<p><strong>Short answer</strong></p>\n\n<p>Sometimes (and yes, deafening has been used as a treatment for some patients).</p>\n\n<p><strong>Tinnitus has multiple causes</strong></p>\n\n<p>Although the mechanisms of tinnitus are not completely understood, many forms of sustained tinnitus are <em>not</em> caused by activity in hair cells. Rather, the causes involve auditory brain regions beyond the inner ear, likely due to those circuits no longer receiving the input they used to receive after damage to the cochlea.</p>\n\n<p>Hearing damage in certain frequencies both kills the hair cells (causing deafness) and also induces tinnitus. Therefore, deafness as a cure for tinnitus seems not only undesirable but quite counterproductive in those cases.</p>\n\n<p>In contrast, cochlear implants have in some cases reduced tinnitus, and this is effectively the opposite solution: restoring some version of lost hearing, rather than removing what remains.</p>\n\n<p><strong>Deafening can be a cure for peripheral (originating in the ear) tinnitus</strong></p>\n\n<p>Some forms of tinnitus seem to have a peripheral origin. For example, tinnitus may occur when there is a selective loss of outer but not inner hair cells in a region of the cochlea. In this context, lesioning those inner hair cells could possibly solve the problem, while also deafening the patient at those frequencies. I am unaware, however, of a surgical procedure that can successfully produce such a selective lesion (please comment if anyone knows differently).</p>\n\n<p>Curing tinnitus by lesioning the auditory nerve (thereby deafening the patient) <em>can</em> cure tinnitus in some patients. However, deafening a patient is a rather severe course of action.</p>\n\n<p><strong>Summary</strong></p>\n\n<p>In summary, tinnitus refers to a spectrum of conditions, and depending on the causes in a particular patient, completely different courses of action may be appropriate. Deafening can cure tinnitus in some intractable cases, but is completely inappropriate in others.</p>\n\n<hr>\n\n<p><strong>References</strong></p>\n\n<p><em>Arts, R. A., George, E. L., Stokroos, R. J., &amp; Vermeire, K. (2012). cochlear implants as a treatment of tinnitus in single-sided deafness. Current opinion in otolaryngology &amp; head and neck surgery, 20(5), 398-403.</em></p>\n\n<p><em>Baguley, D. M. (2002). Mechanisms of tinnitus. British medical bulletin, 63(1), 195-212.</em></p>\n\n<p><em>Baguley, D. M., &amp; Atlas, M. D. (2007). Cochlear implants and tinnitus. Progress in brain research, 166, 347-355.</em></p>\n\n<p><em>Hesse, G. (2016). Evidence and Lack of Evidence in the Treatment of Tinnitus. Laryngo-rhino-otologie, 95, S155-91.</em></p>\n\n<p><em>Jackson, P. (1985). A comparison of the effects of eighth nerve section with lidocaine on tinnitus. The Journal of Laryngology &amp; Otology, 99(7), 663-666.</em></p>\n\n<p><em>Pulec, J. L. (1995). Cochlear nerve section for intractable tinnitus. Ear, nose, &amp; throat journal, 74(7), 468-470.</em></p>\n", "score": 7 } ]

[ "hearing", "ear", "tinnitus", "cure", "deaf" ]

[ { "answer_id": 15678, "body": "<p>It simply means visually exposing the tissues the surgeon needs to operate on. For example, if the surgeon needs to cut or suture inside one of the chambers and it's full of blood, they would be unable to see the tissue they're working on; therefore, they <em>expose the surgical field</em> by aspirating (suctioning out) the blood blocking their view.</p>\n\n<p><a href=\"https://medical-dictionary.thefreedictionary.com/surgical+field\" rel=\"noreferrer\">https://medical-dictionary.thefreedictionary.com/surgical+field</a></p>\n", "score": 5 } ]

[ "surgery", "cardiology", "heart" ]

[ { "answer_id": 16268, "body": "<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", "score": 3 }, { "answer_id": 16259, "body": "<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", "score": 2 }, { "answer_id": 16275, "body": "<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", "score": 2 } ]

[ "water" ]

[ { "answer_id": 16331, "body": "<p>The relationship between thyroid function and body weight is bidirectional and complex. </p>\n\n<p>It is known for decades, if not centuries, that cretinism (only in the end of the 19th century to be associated to hypothyroidism) may be accompanied by weight gain and that thyrotoxicosis may result in weight loss. As early as in 1835 Robert J. Graves described that ladies affected by goitre and palpitations (probably due to hyperthyroidism resulting from the disease which is now named after him) were remarkably thin [2]. Five years later the German physician Karl von Basedow described the same condition, where a lady suffering from goitre, Exophthalmos and palpitations had severely emaciated [3]. In 1883 the swiss surgeon Theodor Kocher described weight gain after total thyroidectomy [4]. Ten years later, in 1893 William Ord described rapid weight loss, after myxoedematous patients were set on treatment with thyroid extreact [5].</p>\n\n<p>Today it is known that over one third of hypothyroid infants have a birth weight greater than the ninetieth percentile [6, 7]. However, an “atypical” form of hypothyroidism may be associated to low birth weight [8]. Of course, weight gain in hypothyroidism isn’t restricted to infants, but common in adults, too. Hypothyroidism is assumed to contribute 2.5 to 5 kg (5 to 10 pounds) to body weight [9]. </p>\n\n<p>On the other hand, changes in body weight may also result in changes of thyroid function. A number of studies, as recently extensively reviewed [10, 11], described elevated TSH levels and increased total step-up deiodinase activity in patients with weight gain. These changes were reversible after weight loss [12]. On the other hand, low T3 syndrome is a well-known consequence of anorexia and starvation [13, 14].</p>\n\n<p>Probably, these changes represent adaptive responses of pituitary-thyroid axis to type 1 or type 2 allostasis, respectively [15]. The observed mechanisms may contribute to some kind of autoregulation of weight in conditions of changing supply with energy.</p>\n\n<p><a href=\"https://i.stack.imgur.com/oTLCo.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/oTLCo.jpg\" alt=\"Autoregulation of weight in obesity [Chatzitomaris et al. 2017, CC BY license]\"></a></p>\n\n<p>To use thyroid hormones as an adjunct treatment in obesity is strongly discouraged, since cardiovascular side effects may be significant [16].</p>\n\n<p><strong>References</strong></p>\n\n<p>1: <a href=\"https://www.frontiersin.org/articles/10.3389/fendo.2017.00163/full\" rel=\"noreferrer\">https://www.frontiersin.org/articles/10.3389/fendo.2017.00163/full</a></p>\n\n<p>2: Graves RT. Lecture XII. in: Clinical Lectures. 1835 25-43.</p>\n\n<p>3: von Basedow K. Exophthalmos durch Hypertrophie des Zellgewebes in der Augenhöhle. Wochenschrift für die gesammte Heilkunde. 1840 13:197-228.</p>\n\n<p>4: Kocher T. Ueber Kropfexstirpation und ihre Folgen. Archiv für klinische Chirurgie. 1883 29:254-335.</p>\n\n<p>5: Ord WM, White E. Clinical Remarks on Certain Changes observed in the Urine in \nMyxoedema after the Administration of Glycerine Extract of Thyroid Gland. Br Med \nJ. 1893 Jul 29;2(1700):217. PMID: 20754379; PMCID:\nPMC2422016. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20754379\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/20754379</a> <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422016/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422016/</a> </p>\n\n<p>6: LaFranchi SH. Hypothyroidism. Pediatr Clin North Am. 1979 Feb;26(1):33-51.\nPMID: 460987. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/460987\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/460987</a></p>\n\n<p>7: Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010\nJun 10;5:17. doi: 10.1186/1750-1172-5-17. PMID: 20537182; \nPMCID: PMC2903524. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20537182/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/20537182/</a> <a href=\"http://dx.doi.org/10.1186/1750-1172-5-17\" rel=\"noreferrer\">http://dx.doi.org/10.1186/1750-1172-5-17</a></p>\n\n<p>8: Mandel SJ, Hermos RJ, Larson CA, Prigozhin AB, Rojas DA, Mitchell ML. Atypical\nhypothyroidism and the very low birthweight infant. Thyroid. 2000\nAug;10(8):693-5. PMID: 11014314. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11014314\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/11014314</a></p>\n\n<p>9: American Thyroid Association: Thyroid &amp; Weight. 2016. <a href=\"https://www.thyroid.org/wp-content/uploads/patients/brochures/Thyroid_and_Weight.pdf\" rel=\"noreferrer\">https://www.thyroid.org/wp-content/uploads/patients/brochures/Thyroid_and_Weight.pdf</a></p>\n\n<p>10: Pacifico L, Anania C, Ferraro F, Andreoli GM, Chiesa C. Thyroid function in\nchildhood obesity and metabolic comorbidity. Clin Chim Acta. 2012 Feb\n18;413(3-4):396-405. doi: 10.1016/j.cca.2011.11.013. \nPMID: 22130312. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22130312\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/22130312</a> <a href=\"http://dx.doi.org/10.1016/j.cca.2011.11.013\" rel=\"noreferrer\">http://dx.doi.org/10.1016/j.cca.2011.11.013</a></p>\n\n<p>11: Fontenelle LC, Feitosa MM, Severo JS, Freitas TE, Morais JB, Torres-Leal FL,\nHenriques GS, do Nascimento Marreiro D. Thyroid Function in Human Obesity:\nUnderlying Mechanisms. Horm Metab Res. 2016 Dec;48(12):787-794. \nPMID: 27923249. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27923249\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/27923249</a></p>\n\n<p>12: Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010 Mar\n25;316(2):165-71. doi: 10.1016/j.mce.2009.06.005. \nPMID: 19540303. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19540303\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/19540303</a> <a href=\"http://dx.doi.org/10.1016/j.mce.2009.06.005\" rel=\"noreferrer\">http://dx.doi.org/10.1016/j.mce.2009.06.005</a></p>\n\n<p>13: Rothenbuchner G, Loos U, Kiessling WR, Birk J, Pfeiffer EF. The influence of\ntotal starvation on the pituitary-thyroid-axis in obese individuals. Acta\nEndocrinol Suppl (Copenh). 1973;173:144. PMID: 4542076. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/4542076\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/4542076</a></p>\n\n<p>14: Portnay GI, O'Brian JT, Bush J, Vagenakis AG, Azizi F, Arky RA, Ingbar SH,\nBraverman LE. The effect of starvation on the concentration and binding of\nthyroxine and triiodothyronine in serum and on the response to TRH. J Clin\nEndocrinol Metab. 1974 Jul;39(1):191-4. PMID: 4835133. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/4835133\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/4835133</a></p>\n\n<p>15: Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood \nA, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic\nFeedback Control to Conditions of Strain, Stress, and Developmental Programming. \nFront Endocrinol (Lausanne). 2017 Jul 20;8:163. doi: 10.3389/fendo.2017.00163.\nPMID: 28775711; PMCID:\nPMC5517413. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28775711\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/28775711</a> <a href=\"http://dx.doi.org/10.3389/fendo.2017.00163\" rel=\"noreferrer\">http://dx.doi.org/10.3389/fendo.2017.00163</a></p>\n\n<p>16: Krotkiewski M. Thyroid hormones in the pathogenesis and treatment of obesity. \nEur J Pharmacol. 2002 Apr 12;440(2-3):85-98. PMID: 12007527. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12007527\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/12007527</a></p>\n", "score": 8 } ]

[ "weight", "thyroid" ]

[ { "answer_id": 16484, "body": "<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", "score": 4 }, { "answer_id": 16494, "body": "<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", "score": 4 }, { "answer_id": 16503, "body": "<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", "score": 2 } ]

[ "sex", "hiv", "sti", "epidemiology" ]

[ { "answer_id": 18583, "body": "<p>For starters, make sure you or someone close by is calling for an ambulance, because you need that more advanced help started in your direction ASAP. </p>\n\n<p>Get the person out of the heat, into air conditioning or at least out of the sun. If there are no air conditioned areas close by then shade is next best. Get them undressed if possible, soak them with cold water. If you're alone, you may not want to just place them in a cold bath, covering them with sheets soaked in cold water would be helpful. If they are still conscious and able to tolerate it, you may place them in a cool bath or shower. If they are still conscious and able to safely swallow, you may give them cold water to sip (not gulp, you don't want them vomiting). </p>\n\n<p>Let's discuss what heat stroke is... Signs and symptoms of heatstroke as presented by the Mayo Clinic include a rectal temperature of 104 degrees Fahrenheit or higher, altered mental status, nausea, decreased sweating and rapid heart rate. </p>\n\n<p>For a complete list of signs and symptoms, see this link from <a href=\"https://www.mayoclinic.org/diseases-conditions/heat-stroke/symptoms-causes/syc-20353581\" rel=\"nofollow noreferrer\">The Mayo Clinic</a>.</p>\n\n<p>For diagnosis and treatment information for heatstroke, visit this link from <a href=\"https://www.mayoclinic.org/diseases-conditions/heat-stroke/diagnosis-treatment/drc-20353587\" rel=\"nofollow noreferrer\">The Mayo Clinic</a>.</p>\n\n<p>If you would like an in-depth read on the history of heatstroke, risk factors, causes, in-hospital treatment of it and a variety of additional information on it, see this link from <a href=\"https://www.nursingcenter.com/journalarticle?Article_ID=593951&amp;Journal_ID=230572&amp;Issue_ID=593907\" rel=\"nofollow noreferrer\">Lippincott Nursing Center</a>. The link goes to a continuing education article on heat stroke for nurses. In my personal opinion, this is the most informational article of the three I shared. However, it is wordy and a rather lengthy read. </p>\n\n<p>Hope this helps! </p>\n", "score": 5 } ]

[ "first-aid", "body-temperature" ]

[ { "answer_id": 16531, "body": "<p>Permanent loss of memory seems only occur in the memory of the treatment and events leading up to the treatment.</p>\n<blockquote>\n<p>The results indicated that ECT can initially disrupt recall of events that occurred many years previously, but recovery of these memories was virtually complete by seven months after treatment. It was also clear that persisting memory loss for information acquired only a few days before treatment can occur. For information acquired one to two years prior to treatment, recovery was substantial, but the results suggested that some memory problems might persist for events that occurred during this time period.</p>\n<p>^{Squire LR, Slater PC, Miller PL. <strong><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7458573?report=abstract\" rel=\"nofollow noreferrer\">Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up.</a></strong> Arch Gen Psychiatry. 1981}</p>\n</blockquote>\n<p>This study comes to the same conclusion:</p>\n<blockquote>\n<p>Our results are consistent with the possibility that ECT as currently practiced does not cause significant lasting retrograde amnesia, but that amnesia is mostly temporary and related to the period of impairment immediately following ECT.</p>\n<p>^{Martijn Meeter, Jaap M.J. Murre, Steve M.J. Janssen, Tom Birkenhager, W.W. van den Broek,\n<strong><a href=\"https://www.sciencedirect.com/science/article/pii/S0165032711000802\" rel=\"nofollow noreferrer\">Retrograde amnesia after electroconvulsive therapy: A temporary effect?</a></strong>,\nJournal of Affective Disorders,\nVolume 132, Issues 1–2,\n2011}</p>\n</blockquote>\n<p>The following extract from <em>The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging</em> suggests that almost all patients in fact do experience retrograde amnesia, but the severity differs and can be assessed with a Mental State Exam which should be conducted prior:</p>\n<blockquote>\n<p><strong>Following ECT, patients also display retrograde amnesia.</strong> Deficits in the recall of both personal (autobiographical) and public information are usually evident, and the deficits are typically greatest for events that occurred temporally closest to the treatment</p>\n</blockquote>\n<p>Below is a link to the full text.</p>\n<blockquote>\n<p>^{<strong><a href=\"https://www.ect.org/resources/apa/\" rel=\"nofollow noreferrer\">The Practice of Electroconvulsive Therapy:\nRecommendations for Treatment, Training and Privileging\nSecond Edition (Completely Revised)</a></strong>, Section 5}</p>\n</blockquote>\n", "score": 5 } ]

[ "neurology", "psychologist-psychology", "psychiatrist-psychiatry" ]

[ { "answer_id": 16661, "body": "<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", "score": 6 }, { "answer_id": 16664, "body": "<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", "score": 4 }, { "answer_id": 17911, "body": "<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", "score": 2 }, { "answer_id": 17913, "body": "<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", "score": 2 } ]

[ "medications" ]

[ { "answer_id": 16691, "body": "<p>I have found a couple of papers which debunk this myth. The links here go directly to free PDF copies and there are DOI links in the references in case the PDF links die.</p>\n\n<p>The most recent paper I can find at the moment is by <a href=\"http://www.academia.edu/download/43189354/Combined_vaccines_are_like_a_sudden_ons20160229-3560-1cbx2wu.pdf\" rel=\"noreferrer\">Hilton, et al. (2006)</a>.</p>\n\n<blockquote>\n <p>The recent controversy surrounding the safety of the measles, mumps, and rubella vaccine (MMR) has heightened parents’ concerns about the safety of vaccines, and led some to believe that giving vaccines in a combined form may ‘overload’ children's immune systems. However, to date no studies have been published examining how British parents conceptualise the notion of ‘immune-overload’ or how they relate this concept to their own children. Eighteen focus groups were conducted with parents between November 2002 and March 2003. <strong>[....]</strong> We conclude that although there is no scientific evidence that supports parents’ fears about combined vaccines causing ‘immune-overload’, policy makers need to recognise these concerns if they are to successfully persuade parents that combined vaccines are safe.</p>\n</blockquote>\n\n<p>There is also <a href=\"http://pediatrics.aappublications.org/content/109/1/124.full-text.pdf\" rel=\"noreferrer\">Offit, et al. (2002)</a>.</p>\n\n<blockquote>\n <p>Recent surveys found that an increasing number of parents are concerned that infants receive too many vaccines. Implicit in this concern is that the infant’s immune system is inadequately developed to handle vaccines safely or that multiple vaccines may overwhelm the immune system. In this review, we will examine the following: 1) the ontogeny of the active immune response and the ability of neonates and young infants to respond to vaccines; 2) the theoretic capacity of an infant’s immune system; 3) data that demonstrate that mild or moderate illness does not interfere with an infant’s ability to generate protective immune responses to vaccines; 4) how infants respond to vaccines given in combination compared with the same vaccines given separately; 5) data showing that vaccinated children are not more likely to develop infections with other pathogens than unvaccinated children; and 6) the fact that infants actually encounter fewer antigens in vaccines today than they did 40 or 100 years ago.</p>\n</blockquote>\n\n<p>In summary, they said</p>\n\n<blockquote>\n <p>Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or “use up” the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment. By providing protection against a number of bacterial and viral pathogens, vaccines <strong>prevent</strong> the “weakening” of the immune system and consequent secondary bacterial infections occasionally caused by natural infection.</p>\n</blockquote>\n\n<h2>References</h2>\n\n<p>Hilton, S., Petticrew, M., &amp; Hunt, K. (2006). Combined vaccines are like a sudden onslaught to the body's immune system’: parental concerns about vaccine ‘overload’ and ‘immune-vulnerability’. <em>Vaccine</em>, 24(20), 4321-4327.<br>DOI: <a href=\"https://doi.org/10.1016/j.vaccine.2006.03.003\" rel=\"noreferrer\">10.1016/j.vaccine.2006.03.003</a><br>PDF: <a href=\"http://www.academia.edu/download/43189354/Combined_vaccines_are_like_a_sudden_ons20160229-3560-1cbx2wu.pdf\" rel=\"noreferrer\">http://www.academia.edu/download/43189354/Combined_vaccines_are_like_a_sudden_ons20160229-3560-1cbx2wu.pdf</a></p>\n\n<p>Offit, P. A., Quarles, J., Gerber, M. A., Hackett, C. J., Marcuse, E. K., Kollman, T. R., ... &amp; Landry, S. (2002). Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system?. Pediatrics, 109(1), 124-129.<br>DOI: <a href=\"https://doi.org/10.1542/peds.109.1.124\" rel=\"noreferrer\">10.1542/peds.109.1.124</a><br>PDF: <a href=\"http://pediatrics.aappublications.org/content/109/1/124.full-text.pdf\" rel=\"noreferrer\">http://pediatrics.aappublications.org/content/109/1/124.full-text.pdf</a></p>\n", "score": 6 } ]

[ "immune-system", "vaccination", "clinical-study" ]

[ { "answer_id": 16806, "body": "<p><em>Neuroscience is complex; this is a simplification. To summarize: yes, breathing techniques and other meditation and biofeedback methods have been shown to be effective for reducing anxiety and panic, as has been cognitive behavioral therapy. Psychotherapy is a critical part of treatment of anxiety disorders. Some people benefit from medications like SSRIs as well. BUT because anxiety might be a symptom of a medical condition, it's important to see a doctor to be formally diagnosed, and receive individualized treatment recommendations.</em></p>\n\n<p>Generalized anxiety disorder is, at its root, over-activity of the sympathetic nervous system. It is when the normal human \"fight or flight\" response is extended and/or exaggerated. Panic attacks occur when that gets stuck in a positive feedback loop. </p>\n\n<p>Physical symptoms of anxiety or panic are due to this sympathetic hyper-activation: increased heart rate, blood pressure, respirations, alertness, sensory awareness (including pain), sweating, speed of reaction, gastrointestinal upset, etc. It helps to understand that anxiety and panic disorders develop more frequently in people who have experienced severe traumatic stressors, especially during childhood, during which their neurological system becomes conditioned to overreact. During \"fight or flight\" much of our mental processing gets caught up in the limbic system (center of emotion) rather than engaging the frontal cortex (center of logical reasoning), which is why anxiety can impair clarity of thought, decision-making, and memory.</p>\n\n<p>Deep breathing, mediation, and certain biofeedback techniques can activate the parasympathetic nervous system, thereby decreasing sympathetic tone. With practice it can interrupt even the positive feedback loop of panic. This not only reduces the physical symptoms, it allows our frontal cortex to engage in processing input and thoughts more logically. The long term impact of these techniques can be profound. </p>\n\n<p>Resources below are as a supplement for professional evaluation and treatment. </p>\n\n<p>References</p>\n\n<ul>\n<li><a href=\"https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response\" rel=\"nofollow noreferrer\">Harvard patient education on relaxation techniques for anxiety</a></li>\n<li><a href=\"https://www.webmd.com/balance/stress-management/stress-relief-breathing-techniques#1\" rel=\"nofollow noreferrer\">WebMD information on deep breathing exercises</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/\" rel=\"nofollow noreferrer\">Example of many studies on effects of diaphragmatic breathing on mood and attention</a></li>\n<li><a href=\"https://www.psychologytoday.com/us/blog/in-practice/201607/breathing-techniques-anxiety\" rel=\"nofollow noreferrer\">PsychologyToday on breathing techniques</a></li>\n<li><a href=\"https://www.sciencedirect.com/science/article/pii/S000632230101157X\" rel=\"nofollow noreferrer\">One of many papers</a> looking at adverse childhood events as risk factors for anxiety, depression, PTSD</li>\n</ul>\n\n<p>Resources</p>\n\n<ul>\n<li>Individual therapy (<a href=\"http://www.nbcc.org/Search/CounselorFind\" rel=\"nofollow noreferrer\">search for therapist in the USA</a>)</li>\n<li>Free app <strong><a href=\"https://www.traumaresourceinstitute.com/ichill-app/ichill-app-1\" rel=\"nofollow noreferrer\">iChill</a></strong> developed by the Trauma Resrouce Institute</li>\n<li><a href=\"http://www.seattlechildrens.org/clinics-programs/biofeedback/resources/\" rel=\"nofollow noreferrer\">Seattle Children's Hospital resources for breathing techniques</a></li>\n<li>Book <strong>Transforming Anxiety</strong> by Childre (HeartMath Institute)</li>\n</ul>\n", "score": 2 } ]

[ "breathing", "stress", "anxiety-disorders" ]

[ { "answer_id": 17492, "body": "<blockquote>\n <p>If an injection seems especially painful or if blood or clear fluid is seen after withdrawing the needle, the patient should apply pressure for 5–8 s without rubbing. Blood glucose monitoring should be done more frequently on a day when this occurs. If the patient suspects that a significant portion of the insulin dose was not administered, blood glucose should be checked within a few hours of the injection. If bruising, soreness, welts, redness, or pain occur at the injection site, the patient’s injection technique should be reviewed by a physician or diabetes educator. Painful injections may be minimized by the following:</p>\n \n <ul>\n <li><p>Injecting insulin at room temperature.</p></li>\n <li><p>Making sure no air bubbles remain in the syringe before injection.</p></li>\n <li><p>Waiting until topical alcohol (if used) has evaporated completely before injection.</p></li>\n <li><p>Keeping muscles in the injection area relaxed, not tense, when injecting.</p></li>\n <li><p>Penetrating the skin quickly.</p></li>\n <li><p>Not changing direction of the needle during insertion or withdrawal.</p></li>\n <li><p>Not reusing needles.</p></li>\n </ul>\n \n <p>Insulin may be injected into the subcutaneous tissue of the upper arm and the anterior and lateral aspects of the thigh, buttocks, and abdomen (with the exception of a circle with a 2-inch radius around the navel). Intramuscular injection is not recommended for routine injections. <strong>Rotation of the injection site is important to prevent lipohypertrophy or lipoatrophy. Rotating within one area is recommended (e.g., rotating injections systematically within the abdomen) rather than rotating to a different area with each injection. This practice may decrease variability in absorption from day to day.</strong> Site selection should take into consideration the variable absorption between sites. The abdomen has the fastest rate of absorption, followed by the arms, thighs, and buttocks. Exercise increases the rate of absorption from injection sites, probably by increasing blood flow to the skin and perhaps also by local actions. Areas of lipohypertrophy usually show slower absorption. The rate of absorption also differs between subcutaneous and intramuscular sites. The latter is faster and, although not recommended for routine use, can be given under other circumstances (e.g., diabetic ketoacidosis or dehydration).</p>\n \n <p>^{American Diabetes Association\n Diabetes Care. <strong><a href=\"http://care.diabetesjournals.org/content/25/suppl_1/s112.full\" rel=\"nofollow noreferrer\">Insulin Administration</a></strong>. 2002 Jan; 25(suppl 1): s112-s115.} </p>\n</blockquote>\n\n<hr>\n\n<p>Apart from this, I can only tell you that I've been predominantly taught to do subcutaneous injections with either insulin or heparin in the abdomen, though with no particular reasoning. </p>\n", "score": 1 } ]

[ "pain", "injections", "shoulder", "thigh" ]

[ { "answer_id": 16871, "body": "<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", "score": 7 }, { "answer_id": 17878, "body": "<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", "score": 3 }, { "answer_id": 19000, "body": "<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", "score": 1 } ]

[ "type-2-diabetes", "cure" ]

[ { "answer_id": 17726, "body": "<p>Heave menstruation can be a pathology, which is called menorrhagia.</p>\n\n<p>There is a multitude of medication available:</p>\n\n<ul>\n<li>NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).</li>\n<li>Tranexamic acid (Lysteda) only needs to be taken during the menstrual phase.</li>\n<li>Oral contraceptives can help regulate menstrual cycles apart from being birth control.</li>\n<li>The hormone progesterone can help correct hormone imbalance and thus reduce menorrhagia.</li>\n<li>Intrauterine devices can release a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.</li>\n</ul>\n\n<p>^{<a href=\"https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834\" rel=\"nofollow noreferrer\">Source: MayoClinic.org</a>, <a href=\"https://emedicine.medscape.com/article/255540-treatment\" rel=\"nofollow noreferrer\">MedScpae.com</a>}</p>\n\n<p>However, this is something to consult a gynaecologist with. Menorrhagia can also lead to anaemia (a decrease of red blood cells in the blood), if the body can't keep up with the heavy bleeding. </p>\n", "score": 2 } ]

[ "menstrual-cycle", "menstruation", "uterus" ]

[ { "answer_id": 16948, "body": "<p><a href=\"https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance\" rel=\"noreferrer\">This page from the NIH</a> has a lot of relevant information about lactose intolerance.</p>\n\n<p>There are several standard diagnostic tests for lactose intolerance, but your physician might ask you to try eliminating dairy from your diet before you receive any of those tests. If avoiding lactose alleviates your symptoms, you've potentially treated your primary lactose intolerance successfully. If you feel somewhat better but still experience classic GI problems (bloating, diarrhea), you might be lactose intolerant secondary to a <a href=\"http://www.airitilibrary.com/Publication/alDetailedMesh?DocID=09647058-201512-201512310024-201512310024-s9-s13\" rel=\"noreferrer\">different illness</a> like Crohn's disease or celiac disease. Keep in mind, lactose intolerance is caused by the lack of an enzyme (lactase) in your body, so lactose can't be digested – a milk allergy is your body generating an immune response to certain milk proteins, but doesn't suggest any enzymatic deficit.</p>\n\n<p>Usually, your physician will perform a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175689/#Sec3title\" rel=\"noreferrer\">hydrogen breath test</a> to confirm a lactose intolerance diagnosis. When you're missing the lactase enzyme, you can't digest lactose (which means you can't absorb lactose, since it's \"too big\" pre-digestion – this and energy release are the goals of catabolism). This results in lactose sitting around post-consumption (there are no enzymes available to cleave it for transport), where it starts to ferment in your gut microbiota. Bacterial digestion like this makes degradation products like methane, carbon dioxide, and <em>hydrogen</em> (this is where the name \"hydrogen breath test\" comes from), and we can measure these gases as they rise to escape from your GI tract. A basic schematic:</p>\n\n<p><a href=\"https://i.stack.imgur.com/y1OIx.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/y1OIx.jpg\" alt=\"Hydrogen breath test\"></a></p>\n\n<p>Some people <a href=\"http://iopscience.iop.org/article/10.1088/1752-7155/7/2/024001/meta\" rel=\"noreferrer\">don't exhibit conventional responses</a> to the hydrogen breath test, so a methane breath test or combination test might be more reliable. Alternatively, <a href=\"https://www.tandfonline.com/doi/abs/10.3109/00365529409091742\" rel=\"noreferrer\">fecal pH tests</a> can be used to show GI irregularities like lactose intolerance (malabsorption makes your stool acidic). More invasive techniques like <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/1173735\" rel=\"noreferrer\">blood glucose monitoring</a> or even <a href=\"http://pediatrics.aappublications.org/content/118/3/1279.short\" rel=\"noreferrer\">intestinal biopsy for disaccharidase quantitation</a> can be employed, although the general patient population is well-suited for noninvasive tests like those that require only spent breath or stool and pH paper.</p>\n", "score": 6 } ]

[ "allergy", "stomach", "test", "lactose-intolerant", "lactase" ]

[ { "answer_id": 16975, "body": "<blockquote>\n <p>I'm writing a story, in which the detective will recognize a prescription for the victim is for relief of some genetic condition. </p>\n</blockquote>\n\n<p>You wanted to be realistic: In the autopsy report (after any murder, they usually cut the corpse open and search for clues - and for causes of death), the genetic condition would have usually shown. </p>\n\n<p>Usually, diseases/conditions do not have an identifiable prescription. As an example, Crohn's Disease (a genetic condition) is treated with antibiotics and prednisone, a combination that could also be applied for COPD, laryngitis, thyroiditis etc. </p>\n\n<blockquote>\n <p>I'm looking for some genetic condition that both mother and father could have that would express itself differently in the child. I've done a lot of research, but search engines weren't made for this sort of question, and deadlines approach. I've discovered codominant genetic expressions, which seem to fit the bill, but the only examples I can find (in humans) are AB blood type and Sickle Cell Anemia, neither of which will work in the narrative. Perhaps I'm barking up the wrong tree.</p>\n</blockquote>\n\n<p>Neither of which are expressed differently though. In the case of SCA, both carriers are either unaffected or show the same symptoms. I have yet to encounter a disease that can manifest itself entirely differently. </p>\n\n<p><a href=\"https://i.stack.imgur.com/1DxYA.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/1DxYA.png\" alt=\"enter image description here\"></a>\n^{Source: <a href=\"https://en.wikipedia.org/wiki/Sickle_cell_disease\" rel=\"nofollow noreferrer\">Wikipedia</a>}</p>\n\n<p>Furthermore, two people having the same genetic disease does not inevitably make them closely related. It'd have to be a really rare one for the detective to conclude that (to everybody's surprise, so no other likeliness etc.). Today, DNA tests are performed routinely for suspects, and any unknown relationship between father and suspect (daughter) would have presented itself there.</p>\n", "score": 4 } ]

[ "genetics", "blood-type", "carrier-genetic", "recessive-gene" ]