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[ { "answer_id": 30805, "body": "<p>Here is a potential option that should at least be better than nothing and not particularly risky.</p>\n<p><strong>Required supplies:</strong></p>\n<ul>\n<li>Iodized salt</li>\n<li>High concentration ethanol (&gt;90%)</li>\n<li>Filter</li>\n</ul>\n<p><strong>Principle:</strong></p>\n<p>Iodized salt contains <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-iodide#section=Solubility\" rel=\"nofollow noreferrer\">potassium iodine</a> which has a solubility of 2g / 100g in ethanol. <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-chloride#section=Solubility\" rel=\"nofollow noreferrer\">Sodium chloride</a> is less soluble at 0.07 g / 100 g.</p>\n<p><strong>Method:</strong></p>\n<ol>\n<li>Mix salt and ethanol. Use the minimum amount of ethanol required to wet the salt - the salt won't fully dissolve.</li>\n<li>Filter the result and collect the liquid.</li>\n<li>(Optional) Heat to evaporate the alcohol.</li>\n<li>Dilute with water and consume.</li>\n</ol>\n<p><strong>Acquired dose and safety:</strong></p>\n<p>For 1 kg of salt, the amount of potassium iodine separated by this method is probably less than 10 mg. This is far less than the recommended 130 mg dose for radiation emergencies, but more than the 0.2 mg normal daily intake from food. As the goal is to make more normal Iodine-127 than radioactive Iodine-131 available to the body, this will be partially effective.</p>\n<p>All the source materials are safe for human consumption, so the downsides are the same as for drinking a salty cocktail.</p>\n", "score": 3 }, { "answer_id": 30839, "body": "<p>Based on <a href=\"https://www.who.int/water_sanitation_health/publications/iodine-02032018.pdf?ua=1\" rel=\"nofollow noreferrer\">WHO report: Iodine as drinking-water disinfectant</a> page 19, common 10% (often labeled 100 mg/mL) povidone-iodine solution can be used as drinking water disinfectant. The recommended amount for killing pathogens is 0.35 - 0.70 mL / liter and results in 4-8 mg / liter of residual iodine after 30 minutes.</p>\n<p>The same report also considers the safety of iodine in drinking water, with iodine concentrations up to 10 mg / liter and timespans of up to several years. Long term incidence of thyroid abnormalities was increased for higher dosages. Acute effects occurred at dosages of more than 1000 mg per day.</p>\n<p>If povidione-iodine disinfectant is available, adding 10 milliliters (2 teaspoons) to 1 liter of water and waiting 30 minutes provides the 130 mg dose that is recommended for adults after a radiation emergency. And if the drinking water source is not clean, this has the extra benefit of killing most bacteria and viruses.</p>\n", "score": 2 } ]

[ "emergency", "thyroid", "radiation", "iodine", "alternative-medicine" ]

[ { "answer_id": 30858, "body": "<p>Providing an accurate measurement of how long it would take for death to occur after cessation of insulin in an individual who intrinsically makes <em>no</em> insulin is not feasible. This is because such a medical research study would be ethically unacceptable. Any researcher would be obligated to provide insulin.</p>\n<h4>Natural History of Lack of Insulin</h4>\n<p>However, you are absolutely correct that individuals with type 1 diabetes cannot simply &quot;take better care of themselves&quot; to avoid their insulin requirement. Autoimmune destruction of the insulin-producing beta cells of the pancreas prevent the individual from making endogenous insulin. As Yukdin (2000. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/10752719/\" rel=\"nofollow noreferrer\">10752719</a>) notes:</p>\n<blockquote>\n<p>Three quarters of a century after its discovery, insulin is not routinely available in many parts of the developing world. ... In consequence, the life expectancy of a child with newly diagnosed type 1 diabetes in much of sub-Saharan Africa may be as short as 1 year.</p>\n</blockquote>\n<p>Thus, even the early &quot;honeymoon phase&quot;, lack of access to insulin is routinely fatal.</p>\n<h4>Residual Insulin Secretion Decreases Over Time</h4>\n<p>In reality, however, individuals with type 1 diabetes come to clinical attention once pancreatic insulin secretion reaches a critical non-zero threshold. As Steele and colleagues (2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/14747294/\" rel=\"nofollow noreferrer\">14747294</a>) note:</p>\n<blockquote>\n<p>With time, all individuals with type 1 diabetes are thought to lose insulin production.</p>\n</blockquote>\n<p>Here is a graph from their paper showing decreased insulin production following diagnosis.</p>\n<p><img src=\"https://ada.silverchair-cdn.com/ada/content_public/journal/diabetes/53/2/10.2337_diabetes.53.2.426/2/zdb0020410060002.jpeg\" alt=\"Graph of decreasing insulin secretion after diagnosis\" />\n^{Figure 2 from (Steele <em>et al</em> 2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/14747294/\" rel=\"nofollow noreferrer\">14747294</a>) available <a href=\"https://diabetesjournals.org/diabetes/article/53/2/426/11480/Insulin-Secretion-in-Type-1-Diabetes\" rel=\"nofollow noreferrer\">here</a>.}</p>\n<p>Thus, how long an individual could survive is likely also correlated to their residual insulin secretion which may be present many years after their diagnosis.</p>\n<p>Interestingly, a randomized controlled trial of exercise intervention (one type of &quot;taking care of yourself&quot;) among newly diagnosed patients with type 1 diabetes found no significant effect on residual insulin production (Narendran <em>et al</em> 2017. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/28905421/\" rel=\"nofollow noreferrer\">28905421</a>).</p>\n<h4>Results of Abrupt Cessation of Insulin</h4>\n<p>However, an interesting study by Keller and colleagues (1993. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/8421367/\" rel=\"nofollow noreferrer\">8421367</a>) does provide us a window into what the natural history might look like. In their study, they reviewed cases of prisoners in the New York City prison system who were not provided access to their life-saving insulin therapy. Here is an excerpt of a table from the study:</p>\n<div class=\"s-table-container\">\n<table class=\"s-table\">\n<thead>\n<tr>\n<th style=\"text-align: left;\">Variable</th>\n<th style=\"text-align: right;\">Mean ± SD (Range)</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"text-align: left;\">Number of participants</td>\n<td style=\"text-align: right;\">34</td>\n</tr>\n<tr>\n<td style=\"text-align: left;\">Number of days since insulin</td>\n<td style=\"text-align: right;\">3.4 ± 3.3 (1-21)</td>\n</tr>\n<tr>\n<td style=\"text-align: left;\">Serum glucose (mmol/L)</td>\n<td style=\"text-align: right;\">27.5 ± 10.0 (11.9-47.2)</td>\n</tr>\n<tr>\n<td style=\"text-align: left;\">Serum glucose (mg/dL)</td>\n<td style=\"text-align: right;\">495 ± 180 (215-850)</td>\n</tr>\n<tr>\n<td style=\"text-align: left;\">Serum bicarbonate (mmol/L)</td>\n<td style=\"text-align: right;\">14.4 ± 6.2 (3.1-30.0)</td>\n</tr>\n<tr>\n<td style=\"text-align: left;\">Mean arterial pH</td>\n<td style=\"text-align: right;\">7.28 ± 0.10 (6.99-7.47)</td>\n</tr>\n</tbody>\n</table>\n</div>\n<p>As you can see, in an average of just 3 and a half days, the prisoners were ill enough for hospitalization, many of them critically.</p>\n<h4>Cause of Death in Untreated Type 1 Diabetes</h4>\n<p>The life threatening complications of untreated diabetes are <a href=\"https://en.wikipedia.org/wiki/Diabetic_ketoacidosis\" rel=\"nofollow noreferrer\">diabetic ketoacidosis</a> and <a href=\"https://en.wikipedia.org/wiki/Hyperosmolar_hyperglycemic_state\" rel=\"nofollow noreferrer\">hyperosmolar hyperglycemic state</a>. These conditions result in hyperglycemia, ketone production, elevated plasma osmolality, sodium and potassium derangements, and proinflammatory state. With modern therapy, the ultimate cause of death is most frequently cerebral edema (Lizzo <em>et al</em> 2021. NBK <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK560723/\" rel=\"nofollow noreferrer\">560723</a>). However, historically, vascular thrombosis and hypovolemic shock were also felt to be important causes of mortality (Clements and Vourganti 1978. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/102504/\" rel=\"nofollow noreferrer\">102504</a>)</p>\n<h4>Conclusion</h4>\n<p>Overall, patients with type 1 diabetes and no endogenous insulin production definitively require insulin therapy to sustain life. They will require hospitalization in approximately 3 and a half days on average. How long they might survive after the onset of diabetic ketoacidosis or hyperosmolar hyperglycemic state is difficult to determine and likely varies due to the variety of underlying pathologies which might result in mortality and potentially the degree of residual insulin secretion.</p>\n", "score": 4 } ]

[ "diabetes", "type-1-diabetes", "insulin" ]

[ { "answer_id": 30881, "body": "<p>This is more of a partial answer than a full answer.</p>\n<p>First, it would be useful to understand the typical amount of time an MRI scanner is in service. A report from the European Society of Radiology suggests the typical MRI scanner has a useful lifetime of 8-12 years based on usage (2014. PMCI <a href=\"https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4195838/\" rel=\"nofollow noreferrer\">4195838</a>).</p>\n<p>Some potentially useful data to address this question comes from a 2019 study of prostate MRI quality performed by Burn and colleagues (PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/31296337/\" rel=\"nofollow noreferrer\">31296337</a>). They found the following effect of scanner age:</p>\n<blockquote>\n<p>Effect of scanner age</p>\n<p>The influence of scanner age on image quality was assessed by comparing the two groups: MRI performed on scanners &lt;7 years old (54 patients) and MRIs performed on scanners ≥7 years old (40 patients) and dichotomising image quality into diagnostic (image quality score ≥3) and non-diagnostic (score ≤2). For T2W, 80% were diagnostic in the newer scanner group, compared to 53% in the older scanner group (odds ratio 3.5, range 1.4–8.8, p=0.006). For DWI for the newer scanner group, 81% were diagnostic and in the older scanner group, 80% were diagnostic (odds ratio=1.2, range 0.3–5.9, p=0.8). The relationship between scanner age for each site and mean T2W overall quality score is shown in Fig 6, demonstrating an inverse correlation.</p>\n</blockquote>\n<p><img src=\"https://els-jbs-prod-cdn.jbs.elsevierhealth.com/cms/attachment/7c599667-6086-4956-84d6-0ce113efef79/gr6.jpg\" alt=\"Graph of negative linear relationship between scanner age in years (range 0 to 14 years) and &quot;mean T2W score per site&quot;\" /><br>^{Figure 6 from (Burns <em>et al</em> 2019. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/31296337/\" rel=\"nofollow noreferrer\">31296337</a>) available <a href=\"https://www.clinicalradiologyonline.net/article/S0009-9260(19)30223-5/fulltext\" rel=\"nofollow noreferrer\">here</a>.}</p>\n<p>This seems to suggest higher quality images from younger scanners, at least for particular <a href=\"https://radiopaedia.org/articles/mri-pulse-sequences-1?lang=us\" rel=\"nofollow noreferrer\">pulse sequences</a>.</p>\n<p>However, it is important to recognize that younger scanners are by definition <strong>newer models</strong>, and thus may have new and improved imaging algorithms. Indeed Burns and colleagues note this:</p>\n<blockquote>\n<p>This clearly brings into focus the quality of the technique, particularly outside large academic centres and <strong>without access to latest-generation high-quality MRI systems</strong> and with limited scanner time.</p>\n</blockquote>\n<p>So it is likely that at least some of this effect is based on the generation of the scanner, but it is still possible that there is some degradation of image quality over time.</p>\n<p>Unfortunately, the authors do not discuss further. A paper by Giganti and colleagues mention the study but unfortunately do not provide additional insight (2022. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/34233502/\" rel=\"nofollow noreferrer\">34233502</a>)</p>\n<blockquote>\n<p>Another important aspect that should be taken into account is scanner age. Although this requires more investigation, Burn and colleagues have shown a significant difference in the quality of prostate MRI at a 7-year cut-off for scanner age and this is something that will need to be explicitly addressed in the next iteration of the PI-RADS recommendation.</p>\n</blockquote>\n<p>To directly answer your question, we would need to assess image quality of scans taken from the same scanner over many years. However, I was unable to find any such study.</p>\n", "score": 4 } ]

[ "mri" ]

[ { "answer_id": 30913, "body": "<p><a href=\"https://www.cdc.gov/coronavirus/2019-ncov/lab/naats.html\" rel=\"nofollow noreferrer\">Viral nucleic acid amplification tests</a> use real time PCR to detect viral genomic material. If the genetic material is present, a reaction will occur that generates fluorescence. If sample produces a reaction that reaches a specified fluorescence <strong>&quot;threshold&quot;</strong> by a predetermined cycle, it will be deemed positive.</p>\n<p>The cycle at which a reaction reaches the threshold, is the <a href=\"https://publichealthproviders.sccgov.org/sites/g/files/exjcpb951/files/Documents/FAQs-CT-values-from-covid-19-PCR-tests.pdf\" rel=\"nofollow noreferrer\"><strong>cycle threshold (CT) value</strong></a>.</p>\n<p>If we plot the fluorescent signal generated during the reaction against the number of cycles, it generally follows a sigmoid curve.</p>\n<p>Consider this hypothetical plot:\n<a href=\"https://i.stack.imgur.com/SWfS3.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/SWfS3.png\" alt=\"enter image description here\" /></a>\n^{Source: Ian Campbell}</p>\n<p>As we can see, the black sample fluorescence line crosses the orange threshold line during the 20th cycle. It doesn't happen at the exact beginning of the cycle, but about two thirds of the way through it.</p>\n<p>In this case the CT value (dashed blue line) is 20.63.</p>\n<p>The reality is that the precision of this value is meaningless, as variability in sample preparation and stochasticity lead to much more difference than a 100th of a cycle.</p>\n<p>For more precision, dilution experiments can be performed, but these aren't really necessary / feasible in a clinical testing scenario. See <a href=\"https://www.bio-rad.com/webroot/web/pdf/lsr/literature/Bulletin_5279.pdf\" rel=\"nofollow noreferrer\">this guide</a> from a real-time PCR thermocycler vendor for more.</p>\n", "score": 4 } ]

[ "covid-19", "coronavirus", "pcr" ]

[ { "answer_id": 31191, "body": "<p><a href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/outcome\" rel=\"nofollow noreferrer\">&quot;Outcome&quot;</a> in medical research is also sometimes called an &quot;endpoint&quot; and in a statistics class you might have heard it called the &quot;dependent variable&quot;. It's the thing you measure to find out whether the thing you're studying is having an effect. An outcome should be operationally defined, so if you want to know whether yellow jelly beans cause cancer, your outcome might be &quot;cancer incidence within 1 year of eating a yellow jelly bean&quot;.</p>\n<p>The study you link to is a systematic <a href=\"https://en.wikipedia.org/wiki/Meta-analysis\" rel=\"nofollow noreferrer\">meta-analysis</a>. Meta-analysis is a family of statistical techniques to combine research results from multiple studies. Every study makes some estimates of the effect being measured, and these effects are never absolutely precise, they have some uncertainty around them, sometimes expressed with a confidence interval/credible interval. That doesn't mean that studies are wrong if different studies find a slightly different answer, it just means you need a way to decide what the best estimate is if you have a bunch of different estimates. Meta-analysis is the way you do this quantitatively.</p>\n<p>When you do a meta-analysis, you have to decide what you're looking for. That means identifying both <em>exposures</em> and also outcomes that are relevant to your study; also other aspects like who is the studied population (adults? kids? receiving care in France? tea-drinkers?). For example, do you want to do your meta-analysis about all jelly beans, or just the yellow ones? Do you want to know if yellow jelly beans cause cancer, or heart disease, or tooth decay? Or do you want to know if they cause increased mortality by any cause? Whatever your goals are, you have to define them somehow so you know what studies to include. You can't really combine the estimates of cancer incidence with the incidence of tooth decay, or you'll get a mashup that's not interpretable - how is an estimate of the incidence of &quot;cancer or tooth decay&quot; at all more useful than knowing the two separately?</p>\n<p>For your specific study, they identified <a href=\"https://www.who.int/publications/i/item/9789240046429\" rel=\"nofollow noreferrer\">a range of outcomes they were interested in</a>:</p>\n<ul>\n<li><p>measures of adiposity (e.g. body weight, body mass index [BMI], overweight/obesity, fat and\nlean mass);</p>\n</li>\n<li><p>type 2 diabetes and pre-diabetes (incidence and intermediate markers of glycaemic control);</p>\n</li>\n<li><p>cardiovascular diseases (incidence and intermediate markers, such as blood pressure and\nlipids);</p>\n</li>\n<li><p>cancer;</p>\n</li>\n<li><p>dental caries;</p>\n</li>\n<li><p>chronic kidney disease;</p>\n</li>\n<li><p>eating behaviour (e.g. appetite, satiety, energy intake);</p>\n</li>\n<li><p>sweet preference (e.g. subjective measures, sugars intake);</p>\n</li>\n<li><p>neurocognition;</p>\n</li>\n<li><p>mood and behaviour; and</p>\n</li>\n<li><p>asthma and allergies (for children only).</p>\n</li>\n</ul>\n<p>Okay, forget everything I said, they literally have both <em>cancer</em> and <em>tooth decay</em> (dental caries) on the list! Or at least, they're interested in both, but not because they're going to combine them, they're just looking at a lot of different things at once, doing a bunch of separate meta-analyses together. So they're going to find all the studies that measured adiposity (e.g., BMI) and combine those estimates together, all the studies that measured diabetes and combine those together, all the studies that measured cancer and combine those together, etc.</p>\n<p>However, they're not looking at <em>everything</em>. Specifically, &quot;variation in faecal microbiota composition&quot; isn't on their list. So, when they went to collect a bunch of useful studies to address their wide goal of estimating everything from cancer to dental caries, they still found some studies that were out of scope with their original analysis plans, and they had to set those studies aside because the study didn't have an <em>outcome</em> that was <em>on their list of outcomes of interest</em>: that study has <em>no outcome of interest</em>.</p>\n", "score": 4 } ]

[ "who-world-health-org", "microbiology", "sweeteners" ]

[ { "answer_id": 31271, "body": "<p>As you have hopefully learned in class, fluid homeostasis in the human vascular system is a balance between two major forces. The hydrostatic pressure and the osmotic pressure.</p>\n<p><a href=\"https://i.stack.imgur.com/Yu8wT.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/Yu8wT.png\" alt=\"Image demonstrating major net forces in capillary fluid homeostasis\" /></a>\n^{Source: Ian Campbell CC-BY SA 4.0.}</p>\n<p>As the <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK541067/\" rel=\"noreferrer\">StatPerls on colloid osmotic pressure</a> notes:</p>\n<blockquote>\n<p>Blood pressure within a capillary (approximately 36 mmHg), referred to as the capillary hydrostatic pressure, constitutes an outward filtration force from the plasma space to the interstitium. The opposing force, meaning the hydrostatic pressure exerted by the interstitium towards the capillary is normally close to zero, making it non-contributory to net fluid movement across capillary membranes</p>\n</blockquote>\n<p>The authors continue to discuss osmotic pressure:</p>\n<blockquote>\n<p>The major reabsorptive force in this system comes from the colloid osmotic pressure within the capillary, normally around 24 mmHg</p>\n</blockquote>\n<p>In an excellent review about albumin, Fanali and colleague provide some interesting facts about this vitally important protein (2011 PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/22230555/\" rel=\"noreferrer\">22230555</a>):</p>\n<blockquote>\n<p>[Albumin] makes up 50% of the protein present in the plasma of normal healthy individuals, is the main determinant (80%) of plasma oncotic pressure... Albumin is predominantly an interstitial protein with concentration of about 3 × 10⁻⁴ M and a total mass of approximately 160 g. ... The concentration in the plasma is about 7 × 10⁻⁴ M and the intravascular mass is about 120 g. Albumin circulates from the blood across the capillary wall into the interstitial compartments, including cerebrospinal fluid, and returns to the blood through the lymphatic system with a circulation half-life of approximately 16 hours.</p>\n</blockquote>\n<p>In simplistic terms, the osmotic pressure is due mostly to two effects (Michelis et al 2016. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959682/\" rel=\"noreferrer\">4959682</a>):</p>\n<ol>\n<li>Solute concentration contributed by the protein itself (ie <a href=\"https://en.wikipedia.org/wiki/Van_%27t_Hoff_equation\" rel=\"noreferrer\">van Hoff effect</a>)</li>\n<li>The <a href=\"https://en.wikipedia.org/wiki/Gibbs%E2%80%93Donnan_effect\" rel=\"noreferrer\">Gibbs-Donnan effect</a></li>\n</ol>\n<p>Fanali <em>et al</em> explain:</p>\n<blockquote>\n<p>Albumin is responsible for 80% of the oncotic pressure of plasma (25–33 mm Hg). ... About two thirds of this pressure is represented by the simple osmotic pressure, to which albumin contributes disproportionately because its molecular mass of 67 kDa is lower than that of the average of the plasma globulins, about 170 kDa (Peters, 1996). The other third arises from the Donnan effect essentially due to albumin and its low isoelectric point, which gives to the protein a global negative charge at physiological pH (Figge et al., 1991, Peters, 1996). However, albumin is also the predominant protein in the interstitium, contributing to the interstitial colloid osmotic pressure.</p>\n</blockquote>\n<p>Michelis and colleagues expand on the second effect:</p>\n<blockquote>\n<p>[Albumin's] negative charge also plays a role in colloid osmotic pressure maintenance, by attracting cations such as sodium (Na+) and causing water molecules to shift across the semi-permeable capillary membrane into the intravascular space.</p>\n</blockquote>\n<h5>OK, but how does this <em>actually work</em>?</h5>\n<p>I am not an expert in osmosis, but it seems that the answer is &quot;no one knows for sure&quot;.</p>\n<p>A very interesting manuscript by Borg (2003. <a href=\"https://doi.org/10.48550/arXiv.physics/0305011\" rel=\"noreferrer\">arXiv:physics/0305011</a>) presents a number of competing theories of osmosis. However, none of them are able to fully explain how this process actually works.</p>\n<p>As Professor Borg notes:</p>\n<blockquote>\n<p>Many of the &quot;explanations&quot; for osmosis try to explain osmosis in terms of a single mechanism, such as diffusion due to a presumed water-concentration gradient. None of the mechanisms considered seem as such to be instrumental in making the osmosis happen.</p>\n</blockquote>\n", "score": 5 } ]

[ "physiology", "homework" ]

[ { "answer_id": 31359, "body": "<p>From <em>Chauhan, V. M., Zhang, H., Dalby, P. A., &amp; Aylott, J. W. (2020). Advancements in the co-formulation of biologic therapeutics. Journal of Controlled Release, 327, 397-405.</em>:</p>\n<blockquote>\n<p>Co-formulation can be considered as the purist view of a combination therapy and can be described as consisting of more than one drug substance in a single formulation, with the intention of delivering multiple therapeutic agents at the same time for maximum therapeutic benefit</p>\n</blockquote>\n<p>Co-formulated in the context of a therapeutic drug/treatment means that two or more components are part of the same combined treatment, for example existing in the same pill or solution for injection. In this form, they are not separable.</p>\n<p>It's not clear to me that this is specifically what the chart you linked means, though, rather they are saying that some treatment options have not been compared independent of the others, but were always given together within trials. That might be better described as &quot;co-administered&quot;.</p>\n<p>From the context of the flow chart, it is not immediately clear to me which specific combinations they are referring to.</p>\n", "score": 8 }, { "answer_id": 31370, "body": "<blockquote>\n<p><strong>There is currently no evidence available on the effectiveness of concurrent use of monoclonal antibodies or antivirals for Covid-19, except when co-formulated.</strong></p>\n</blockquote>\n<p>As they have used <strong>or</strong>, I think they are trying to say that no evidence is available for taking two different antivirals together(except the co-administered Nimratrelvir/Ritonavir) or two different monoclonal antibodies together except when they are co-formulated i.e. Evusheld.</p>\n<p>A similar type of wording is used by them in the sourced page below, from where I think they have created the flowchart.</p>\n<blockquote>\n<p>The concurrent use of two or more monoclonal antibodies should be avoided except where co-formulated.</p>\n</blockquote>\n<p><strong>Source:</strong>\n<a href=\"https://covid19evidence.net.au/#living-guidelines\" rel=\"nofollow noreferrer\">https://covid19evidence.net.au/#living-guidelines</a>\n(See Evusheld section)</p>\n", "score": 1 } ]

[ "covid-19", "terminology", "antibodies", "antivirals" ]

[ { "answer_id": 31740, "body": "<p>It has to do with different mechanism of action of both substances. Both calcium channel blockers and beta blockers are used to lower blood pressure, but the ways, how the hypotensive effect is achieved, are different.</p>\n<p>As a first approximation, the arterial blood pressure <em>P_A</em> evolves with</p>\n<p><em>P_A</em> = <em>P_V</em> + <em>R</em> * <em>dV</em>/<em>dt</em>,</p>\n<p>where <em>P_V</em> is central venous pressure, <em>R</em> is total peripheral resistance and <em>dV</em>/<em>dt</em> is cardiac output.</p>\n<p>Calcium channel blockers have vasodilatory action, i.e. they lower <em>R</em>. Beta-blockers act mainly on the heart so that they decrease <em>dV</em>/<em>dt</em>. Both mechanisms lower blood pressure, but the ways are different.</p>\n<p>Different are also their side effects. Beta-blockers may lead to bradycardia (and other problems), and calcium channel blockers increase the hydrostatic pressure in the precapillary circulation, thereby permitting fluid shifts into the interstitial compartment. Beta-blockers have even a slight vasoconstrictor effect.</p>\n<p>This is the reason why patients on calcium channel blockers are more prone to oedema than persons on beta-blockers.</p>\n<p><strong>References</strong></p>\n<ol>\n<li><p>Sica D. Calcium channel blocker-related periperal edema: can it be resolved? J Clin Hypertens (Greenwich). 2003 Jul-Aug;5(4):291-4, 297. doi <a href=\"https://doi.org/10.1111/j.1524-6175.2003.02402.x\" rel=\"noreferrer\">10.1111/j.1524-6175.2003.02402.x</a>. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/12939574/\" rel=\"noreferrer\">12939574</a>.</p>\n</li>\n<li><p>Makani H, Bangalore S, Romero J, Htyte N, Berrios RS, Makwana H, Messerli FH. Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate--a meta-analysis of randomized trials. J Hypertens. 2011 Jul;29(7):1270-80. doi <a href=\"https://doi.org/10.1097/hjh.0b013e3283472643\" rel=\"noreferrer\">10.1097/HJH.0b013e3283472643</a>. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/21558959/\" rel=\"noreferrer\">21558959</a>.</p>\n</li>\n</ol>\n", "score": 5 } ]

[ "medications", "heart" ]

[ { "answer_id": 31802, "body": "<p>Short answer - no, the mRNA vaccines specifically don't only work for a short period of time. Natural infection and all vaccines of different types against SARS-CoV-2 all produce similar durations of immunity.</p>\n<p>Longer answer:</p>\n<p>Generally speaking we can expect the immunity from a vaccine to last approximately long as the immunity following a natural infection, though there are some exceptions to this, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326260/\" rel=\"noreferrer\">where vaccination (not via mRNA) results in shorter protection than natural infection for pertussis</a>¹ . In the case of infection with SARS-CoV-2, the natural immunity induced by the infection results in protective levels of antibodies for about 6 months to a year and similar time-frames for vaccines of any sort against SARS-CoV-2.</p>\n<p>I found a relatively <a href=\"https://www.pnas.org/doi/10.1073/pnas.2204336119\" rel=\"noreferrer\">recent paper in PNAS</a>² (highly respected journal), that states (emphasis mine):</p>\n<blockquote>\n<p>Peak antibody levels elicited by messenger RNA (mRNA) vaccines mRNA-1273 and BNT1262b2 exceeded that of natural infection and are expected to typically yield more durable protection against breakthrough infections <strong>(median 29.6 mo; 5 to 95% quantiles 10.9 mo to 7.9 y)</strong> than natural infection <strong>(median 21.5 mo; 5 to 95% quantiles 3.5 mo to 7.1 y)</strong>. Relative to mRNA-1273 and BNT1262b2, viral vector vaccines ChAdOx1 and Ad26.COV2.S exhibit similar peak anti-S IgG antibody responses to that from natural infection and are projected to yield lower, shorter-term protection against breakthrough infection <strong>(median 22.4 mo and 5 to 95% quantiles 4.3 mo to 7.2 y; and median 20.5 mo and 5 to 95% quantiles 2.6 mo to 7.0 y; respectively)</strong>.</p>\n</blockquote>\n<p>From this you can see that the durations of protection are similar in length between the various vaccine types and similar to natural infection.</p>\n<p><a href=\"https://theconversation.com/how-long-does-protective-immunity-against-covid-19-last-after-infection-or-vaccination-two-immunologists-explain-177309\" rel=\"noreferrer\">The Conversation</a> has a nice layman's explanation of how this all works and why infection and vaccinations don't typically produce different durations of immunity,</p>\n<p>1:Leung T, Campbell PT, Hughes BD, Frascoli F, McCaw JM. Infection-acquired versus vaccine-acquired immunity in an SIRWS model. Infect Dis Model. 2018 Jun 15;3:118-135. doi: 10.1016/j.idm.2018.06.002. PMID: 30839933; PMCID: PMC6326260.</p>\n<p>2:Townsend JP, Hassler HB, Sah P, Galvani AP, Dornburg A. The durability of natural infection and vaccine-induced immunity against future infection by SARS-CoV-2. Proc Natl Acad Sci U S A. 2022 Aug 2;119(31):e2204336119. doi: 10.1073/pnas.2204336119. Epub 2022 Jul 15. PMID: 35858382; PMCID: PMC9351502.</p>\n", "score": 9 } ]

[ "vaccination", "mrna" ]

[ { "answer_id": 31892, "body": "<p>These are incidence rates. They basically report the number of occurrences over a specific period &quot;at risk&quot; using the following formula.</p>\n<p>Number of new cases of disease during specified time interval <strong>divided by</strong> Summed person-years of observation or average population during time interval.</p>\n<p><a href=\"https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section2.html\" rel=\"noreferrer\">This CDC page</a> points out a few things to note regarding person-years</p>\n<ul>\n<li>Person-time has one important drawback. Person-time assumes that the probability of disease during the study period is constant, so that 10 persons followed for one year equals one person followed for 10 years. Because the risk of many chronic diseases increases with age, this assumption is often not valid.</li>\n<li>Long-term cohort studies of the type described here are not very common. However, epidemiologists far more commonly calculate incidence rates based on a numerator of cases observed or reported, and a denominator based on the mid-year population. This type of incident rate turns out to be comparable to a person-time rate.</li>\n<li>Finally, if you report the incidence rate of, say, the heart disease study as 2.5 per 1,000 person-years, epidemiologists might understand, but most others will not. Person-time is epidemiologic jargon. To convert this jargon to something understandable, simply replace “person-years” with “persons per year.” Reporting the results as 2.5 new cases of heart disease per 1,000 persons per year sounds like English rather than jargon. It also conveys the sense of the incidence rate as a dynamic process, the speed at which new cases of disease occur in the population.</li>\n</ul>\n<p>So, where you asked</p>\n<blockquote>\n<p>Does 35 per 100 person-years mean the recurrence is 35% or something else?</p>\n</blockquote>\n<p>35 per 100 person-years means <strong>among the cohort studied</strong>, there were 35 cases per 100 people per year. If there were 1000 people in the cohort, you would expect, <strong>on average</strong>, 350 cases per year <strong>among those 1000 people</strong>.</p>\n<p>You could take another 1000 people and get a different average because as previously highlighted in the CDC page</p>\n<blockquote>\n<p>the risk of many chronic diseases increases with age,</p>\n</blockquote>\n<h2>Example provided at <a href=\"https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section2.html\" rel=\"noreferrer\">this CDC page</a> with additional pointers added</h2>\n<p>Investigators enrolled 2,100 women in a study and followed them annually for four years to determine the incidence rate of heart disease. After one year, none had a new diagnosis of heart disease, but 100 had been lost to follow-up. After two years, one had a new diagnosis of heart disease, and another 99 had been lost to follow-up. After three years, another seven had new diagnoses of heart disease, and 793 had been lost to follow-up. After four years, another 8 had new diagnoses with heart disease, and 392 more had been lost to follow-up.</p>\n<p>The study results could also be described as follows:</p>\n<p><strong>Number of new cases of the disease</strong><br>\nNo heart disease was diagnosed at the first year. Heart disease was diagnosed in one woman at the second year, in seven women at the third year, and in eight women at the fourth year of follow-up.</p>\n<p><strong>Person-years of observation</strong><br>\nOne hundred women were lost to follow-up by the first year, another 99 were lost to follow-up after two years, another 793 were lost to follow-up after three years, and another 392 women were lost to follow-up after 4 years, leaving 700 women who were followed for four years and remained disease free.</p>\n<p>Calculate the incidence rate of heart disease among this cohort. Assume that persons with new diagnoses of heart disease and those lost to follow-up were disease-free for half the year,\nand thus contribute ½ year to the denominator.</p>\n<ul>\n<li><p>Numerator = number of new cases of heart disease\n= 0 + 1 + 7 + 8 = 16</p>\n</li>\n<li><p>Denominator = person-years of observation<br><br>\n= (2,000 + ½ × 100) + (1,900 + ½ × 1 + ½ × 99) + (1,100 + ½ × 7 + ½ × 793) +\n(700 + ½ × 8 + ½ × 392)<br><br>\n= 6,400 person-years of follow-up</p>\n</li>\n</ul>\n<p>or</p>\n<ul>\n<li><p>Denominator = person-years of observation<br><br>\n= (0 × 0.5) + (1 × 1.5) + (7 × 2.5) + (8 × 3.5) + (100 × 0.5) + (99 × 1.5) + (793 × 2.5) +\n(392 × 3.5) + (700 × 4)<br><br>\n= 6,400 person-years of follow-up</p>\n</li>\n<li><p>Person-time rate = Number of new cases of disease or injury during specified period Time each person was observed, totalled for all persons<br><br>\n= 16 ⁄ 6,400<br>\n= .0025 cases per person-year<br>\n= 2.5 cases per 1,000 person-years</p>\n</li>\n</ul>\n", "score": 7 } ]

[ "terminology", "research" ]

[ { "answer_id": 32387, "body": "<p>The units might actually have been <code>mGy•cm^2</code> (rather than <code>mGy/cm^2</code>). This is the dose (in Grays) multiplied by the area it is administered over and is known as the <strong><a href=\"https://en.m.wikipedia.org/wiki/Dose_area_product\" rel=\"nofollow noreferrer\">Dose Area Product</a></strong>. This is used as it correlates well with the actual dose delivered to the patient and can easily be measured (or closely approximated) using an ionisation chamber in the path of the beam. For example, a 5x5cm x-ray field with an entrance dose of 1 mGy will have a DAP of 25 mGy•cm^2.</p>\n<p>The <strong><a href=\"https://remm.hhs.gov/gray_definition.htm#:%7E:text=gray%20(Gy)%3A,Joule%2Fkilogram%20%3D%20100%20rad.\" rel=\"nofollow noreferrer\">Gray (Gy)</a></strong> is a (relatively) new international system (SI) unit of radiation dose, expressed as absorbed energy per unit mass of tissue.</p>\n<p>The SI unit &quot;gray&quot; has replaced the older &quot;rad&quot; designation. 1 Gy = 1 Joule/kilogram = 100 rad.</p>\n<p>The gray is useful clinically and is the main unit used when planning radiotherapy in radiation oncology (a total dose is given in Grays, and administered in multiple <em>fractions</em> to mimimise toxicity.</p>\n<p>Although the gray can be used for any type of ionising radiation, it does not account for biological effects. This is where sieverts are used. The dose in gray is multiplied by a factor depending on the radiation.</p>\n<p>I found <a href=\"https://www.dosewizard.com/2011/08/dose-area-product-dap.html?m=1\" rel=\"nofollow noreferrer\">this converter</a> to convert DAP in Gy•cm^2 into sieverts, based on the type of x-ray examination, though it does not have dental x-rays!</p>\n", "score": 1 } ]

[ "dentistry", "medical-imaging", "radiation" ]

[ { "answer_id": 28, "body": "<p>Like many medications you want to use the amount necessary, no more, no less. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18674453\">Contact dermatitis has been caused by Neosporin</a> (and similar products). I would mention a few particular reasons:</p>\n\n<ol>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21247665\">Topical antibiotics can contribute to medication resistant germs</a>, and having goop sliding out of a bandage and onto non-injured areas of your skin serves no beneficial purpose but does increase medication resistance. </p></li>\n<li><p>The more you expose yourself to Neosporin-esque products, the higher your rates for <a href=\"http://my.clevelandclinic.org/health/diseases_conditions/hic_Contact_Dermatitis\">contact dermatitis</a>. </p></li>\n<li><p>The effect of having a gooey half-Neosporin / half-body-fluid ooze coming out of your bandage isn't going to help anything, will weaken the bandage, and is spreading its little cocktail all over your skin.</p></li>\n</ol>\n\n<p>In short it's pretty common to always use the smallest amount of pharmacology to achieve whatever ends. The more medicine you use, the greater the chance of side effects and the greater their impact will be.</p>\n", "score": 8 } ]

[ "wound", "dermatology" ]

[ { "answer_id": 428, "body": "<p>The penetration is limited, therefore it's less risky than a steroid injection which carries a higher risk of tendon rupture^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15069146\" rel=\"nofollow\">(1)</a>}.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10372854\" rel=\"nofollow\">Study</a> conclusion from 1999 (<a href=\"http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.17.3136&amp;rep=rep1&amp;type=pdf\" rel=\"nofollow\">PDF</a>) by <a href=\"http://en.wikipedia.org/wiki/Southern_Medical_Journal\" rel=\"nofollow\">SMJ</a> was:</p>\n\n<blockquote>\n <p>Iontophoresis using sterile water or corticosteroid resulted in minimal or no biochemical and histologic changes in the tendon compared with injection of either substance. The method of corticosteroid delivery may be as important as the actual drug effects on the biomechanical and histologic properties of tendons.</p>\n</blockquote>\n", "score": 1 } ]

[ "tendons", "dexamethasone", "iontophoresis" ]

[ { "answer_id": 159, "body": "<p>It does differ from country to country. For example, in France (As I'm sure you are aware), if a person <em>fails</em> to render assistance to a person in danger then they can by held liable. This falls under the \"duty to rescue\" concept.</p>\n\n<p>Here in the United States (and elsewhere), this is covered by something called the \"<a href=\"http://en.wikipedia.org/wiki/Good_Samaritan_law\">Good Samaritan Law</a>\", which is intended to remove the fear of litigation preventing someone from aiding another in times of distress.</p>\n\n<p>However, it is not a blanket immunity from someone suing. One of the concepts that I was taught when I was a first responder and ER medic in the Armed Forces, is that you are pretty much safe if you act in a manner consistent with either your own training or the training of the general person on the street.</p>\n\n<p>While it is not a guarantee, if you stick within the scope of your training and provide assistance, then you should pretty much be protected. You may still be sued, as there is no bar against a lawsuit being brought, but the Samaritan concept should protect you.</p>\n\n<p>Note, this is not something that covers everything. For example, I was trained and certified in starting IV fluids. US protocol, however, provides that this can only be done when there is contact with a medical control available, and transport to a facility. If I came upon a hiking accident and whipped out an IV, I could still be held liable since that is out of protocol, and I would be considered to be acting outside the scope of common practice.</p>\n\n<p>If you are traveling, your best bet is to look up the laws of emergency responders in the country you are going to. In some countries if it becomes known that you have the certification and you passed by an accident, you can then be held liable and possibly removed from certification because you failed in your duty to act.</p>\n", "score": 9 } ]

[ "first-aid" ]

[ { "answer_id": 254, "body": "<p>We ice injuries like tendinitis because they reduce the pain and inflammation. Ice does not actually fix your tendinitis, it just makes it easier to deal with. The reason it is recommended that you ice immediately after you see symptoms of tendinitis is so you can relieve the pain quicker. Icing after a few days will probably be little less effective (the tendon will have also healed a bit naturally, so the difference will be less), but if you can get rid of the pain and reduce the inflammation earlier, why wouldn't you? This is more of logic thing rather than a scientific study. </p>\n\n<p>Also, if you do wait a few days before doing anything, apply heat as it will increase blood flow to the injury, allowing it to heal faster.</p>\n\n<hr>\n\n<p><a href=\"https://www.painscience.com/articles/icing.php\" rel=\"nofollow\">^{Pain Science - Icing for Injuries, Tendinitis, and Inflammation}</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/tendinitis/expert-answers/tendinitis/faq-20057872\" rel=\"nofollow\">^{Mayo Clinic - Which is better for relieving tendinitis pain — ice or heat? (Expert Answer)}</a></p>\n", "score": 3 }, { "answer_id": 486, "body": "<p>Clinical studies indicate that icing is helpful and offer symptomatic relief for tendinopathies even though the reason of its action is not yet fully understood. It is thought that ice causes vasoconstriction and address the abnormal neovascularization of the tendon tissue^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20086639\" rel=\"nofollow\">2000</a>, <a href=\"http://www.massagebyjoel.com/downloads/OveruseTendinosis-PhysSptsmed.pdf\" rel=\"nofollow\">PDF</a>}.</p>\n\n<p>Usually it's advised to use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon^{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/\" rel=\"nofollow\">2008</a>}. However it's hard to say if ice has any long-term beneficial effect on tendinosis, but it's an excellent form of pain control (as long you won't \"ice burn\" from too much ice).</p>\n\n<p>Icing is most effective shortly after symptoms appear in the immediate period following an injury, because it reduces the blood flow and provide temporary pain relief (similar to ice massage therapy). It can also help to reduce swelling and inflammation.</p>\n\n<p>See also:</p>\n\n<ul>\n<li><a href=\"http://www.tendinosis.org/current.shtml\" rel=\"nofollow\">Current Treatments for tendinosis (ISTS 2012)</a> at Tendinosis</li>\n<li><a href=\"http://orthopedics.about.com/cs/sprainsstrains/ht/iceinjury.htm\" rel=\"nofollow\">How To Ice An Injury</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/\" rel=\"nofollow\">Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters</a></li>\n</ul>\n", "score": 2 } ]

[ "tendinitis", "cryotherapy" ]

[ { "answer_id": 260, "body": "<p>As I mentioned in <a href=\"https://health.stackexchange.com/a/254/26\">this answer</a>, icing is not meant to heal tendinopathy. It is supposed to be a painkiller. It can have some effects that may feel like they are fixing the problem though. The cold ice forces blood vessels to contract which can help reduce the inflammation. This might be considered healing, but the tendinopathy is still there, until the tendon heals itself.</p>\n", "score": 4 } ]

[ "tendinopathy", "cryotherapy" ]

[ { "answer_id": 296, "body": "<p>As you grow older, your tendons become more rigid and brittle. This is probably because of decrease in the water content of tendons, which is one of the reasons why tendons are flexible. This decrease in water content makes your tendons stiffer and weaker. They also become less tolerable of stress. This causes you to be more prone to tendon injuries, which can then lead to tendinitis.</p>\n\n<hr>\n\n<p>^{<a href=\"http://orthoinfo.aaos.org/topic.cfm?topic=A00191\" rel=\"nofollow\">Effects of Aging</a>}</p>\n\n<p>^{<a href=\"http://www.merckmanuals.com/home/bone_joint_and_muscle_disorders/biology_of_the_musculoskeletal_system/effects_of_aging_on_the_musculoskeletal_system.html\" rel=\"nofollow\">Effects of Aging on the Musculoskeletal System</a>}</p>\n", "score": 4 } ]

[ "tendons", "aging" ]

[ { "answer_id": 3593, "body": "<p>\"Rheumatism\" isn't one disease. It's not even a set of closely related diseases, it's just a name for anything affecting the joints <strong>and/or</strong> connective tissue. As such, there is a wide range of illnesses and causes for these illnesses. </p>\n\n<p>What most people mean when they say rheumatism is arthritis, which is yet another word for a wide range of illnesses, though at least a more narrow one for ones affecting the joints. Most prominent among those diseases are <strong>osteoarthritis</strong> and <strong>rheumatoid arthritis</strong>. </p>\n\n<p><strong>Osteoarthritis</strong> is also known as \"degenerative arthritis\". As the name says, it is a degenerative disease, the primary cause is damage from mechanical stress, whether from repetitive movement or mechanical injury. It is not caused by getting cold.</p>\n\n<p>However, people with arthritis often feel worse when experiencing high humidity combined with low barometric pressure. </p>\n\n<p><strong>Rheumatoid arthritis</strong> has a very different cause - it is an autoimmune disorder where the immune system attacks the joints and as a response, the joint capsule swells. While autoimmune diseases are still being understood, they often have a genetic and an environmental component. This environmental component can be an infection, which <em>could</em> coincide with someone getting very cold. This connection is very weak at best, though. </p>\n\n<p>However, proving a negative is hard, so there is no evidence that windy or wet weather can't cause arthritis. However, when looking at epidemiological data for rheumatoid arthritis </p>\n\n<blockquote>\n <p>The incidence appears to be highest in Pima Indians (5.3%) and Chippewa Indians (6.8%), and lowest in people from China and Japan (0.2%-0.3%) </p>\n</blockquote>\n\n<p>As I understand it, Japan actually has a \"rainy season\" for several weeks a year. </p>\n\n<p>Is it impossible that some form of arthritis (which is the umbrella term for a wide range of diseases) often appears in regions where it is windy? No, of course not. But this belief has all the marks of confirmation bias - if you live in a wet and windy climate, you get wet or cold a lot without suddenly developing joint pain. However, the one time it does happen, it's the weather's fault... And because high humidity makes osteoarthritis worse, that might be the first time someone really notices their condition. </p>\n\n<p><strong>Sources and further reading</strong></p>\n\n<p><a href=\"http://www.ajmc.com/journals/supplement/2012/ACE006_12dec_RA/ACE006_12dec_Gibofsky_S295to302/\" rel=\"nofollow\">Overview of Epidemiology, Pathophysiology, and Diagnosis of Rheumatoid Arthritis</a></p>\n\n<p><a href=\"http://www.arthritis.org/about-arthritis/types/osteoarthritis/causes.php\" rel=\"nofollow\">Causes of osteoarthritis</a></p>\n\n<p><a href=\"http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/causes.php\" rel=\"nofollow\">Causes of rheumatoid arthritis</a></p>\n\n<p><a href=\"http://www.ajmc.com/journals/supplement/2012/ACE006_12dec_RA/ACE006_12dec_Gibofsky_S295to302/\" rel=\"nofollow\">Overview of Epidemiology, Pathophysiology, and Diagnosis of Rheumatoid Arthritis</a></p>\n\n<p><a href=\"http://www.arthritis.org/living-with-arthritis/pain-management/tips/weather-pain.php\" rel=\"nofollow\">Weather and osteoarthritis</a></p>\n", "score": 3 } ]

[ "traditional-medicine", "folk-medicine", "arthritis" ]

[ { "answer_id": 24500, "body": "<p>With the COVID-19 pandemic some new attention has come to mask wearing pressure injuries. On a very general level, pressure injuries happen mostly to immobilized patients or those with sensitive skin, such as early borns or babies.</p>\n<p>That said and as an aside there is the NPIAP which is a society exclusively concerned with pressure induced injuries: <a href=\"https://npiap.com/\" rel=\"nofollow noreferrer\">https://npiap.com/</a></p>\n<p>I couldn't find any specific information the referred mask model, however, here are some general guidelines issued by the NPIAP to prevent pressure injuries. They include</p>\n<ul>\n<li>relieve pressure when possible</li>\n<li>reduce pressure intensity when possible</li>\n<li>avoid moist (softened) skin</li>\n<li>avoid friction</li>\n</ul>\n<p>Pressure is defined by force exerted on an area, therefore it may also be a good idea to increase the area therefore reducing the force applied to the area.</p>\n<p>For COVID-19 there is also a position paper on N95 masks: <a href=\"https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf\" rel=\"nofollow noreferrer\">https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf</a></p>\n<p>There is some more information on prevention and some general information on therapy for pressure injuries here: <a href=\"https://www.uofmhealth.org/health-library/abp5591\" rel=\"nofollow noreferrer\">https://www.uofmhealth.org/health-library/abp5591</a>\nThese are not specific to masks and involve recommendations such as rotation the places where pressures is applied; this is mostly applicable to immobilized patients. For these patients rotation of their bodies so that the body weight pressured is applied to different regions of the body can be beneficial. A takeaway may be to try applying pressure to different areas of the face, such as using different models of masks over time. A strategy with stenomasks may be to have at least two different models so that they can be worn alternately.</p>\n<p>As for the quality of air: I assume the air surrounding you when wearing the masks is relatively clean and breathable to begin with (otherwise a different kind of mask may be necessary). As far as depletion of oxygen and enrichment with carbon-dioxide goes, I assume that the stenomask will have to have passed some testing that will prevent CO2-intoxication when used for prolonged time. There may be some information on this in the masks' manual. If someone has a link to that, feel free to post it in the comments.</p>\n", "score": 1 } ]

[ "air-quality" ]

[ { "answer_id": 470, "body": "<p>In order to understand this claim you have to first understand what causes car sickness in the first place. What is basically happening is the motion you sense with your inner ear is different from the motion you are visualizing. This is easily caused by motions that you sense with your body that you can't see with your eyes or that you can't anticipate. This is most common in cars when people are doing other activity while riding in them such as readying a book or playing on an electronic device. It is generally not an issue for the driver since they are in control and able to anticipate everything.</p>\n\n<p>As to your question the there really isn't any difference in the motion of an automatic car and a manual car as when driven properly there will be no noticeable changes in motion when shifting gears. I would chalk that site up to an advertisement for selling cars with an automatic transmission as it just seems to talk about how an automatic transmission is better then a manual. </p>\n\n<p>If you look around online you will find claims that both an automatic and a manual are better for preventing carsickness.</p>\n\n<p>As a side note there is talk about how driver less cars might make carsickness worse for some people as it will take away the advantages that are gained from driving.</p>\n\n<p><a href=\"http://www.medicinenet.com/motion_sickness_sea_sickness_car_sickness/article.htm\" rel=\"nofollow\">http://www.medicinenet.com/motion_sickness_sea_sickness_car_sickness/article.htm</a></p>\n", "score": 3 } ]

[ "nausea" ]

[ { "answer_id": 611, "body": "<p>Yes, typhoid is most certainly contagious. Indeed, one of the major figures in the history of public health, Mary Mallon (aka <a href=\"http://en.wikipedia.org/wiki/Typhoid_Mary\">Typhoid Mary</a>) is associated with this disease.</p>\n\n<p>The only known hosts for <em>Salmonella typhi</em>, the causal organism for typhoid fever, are <a href=\"http://iai.asm.org/content/70/5/2249\">humans and higher primates</a>, so it is <em>definitely</em> spread from person to person. This is primarily through the \"<a href=\"http://www.who.int/water_sanitation_health/diseases/typhoid/en/\">fecal-oral route</a>\", wherein water or food contaminated with the bacteria from an infected individual's intestinal track is then ingested, proliferates, and causes illness.</p>\n\n<p>In terms of preventing its spread, because of it's fecal-oral transmission route, the major methods are personal hygiene and sanitation. Hand washing, <a href=\"http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/\">avoiding high risk foods</a> (those that cannot be peeled, cooked throughly, etc.) are the usual steps to avoid enteric pathogens of all sorts. There is also a vaccine available, though it is not routinely administered in the <a href=\"http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/\">United States</a> nor heavily pushed by the <a href=\"http://www.who.int/water_sanitation_health/diseases/typhoid/en/\">WHO</a> except in cases of \"prolonged exposure to potentially contaminated food and water in high-risk areas\", and does not provide complete protection.</p>\n", "score": 6 } ]

[ "infection", "typhoid" ]

[ { "answer_id": 1368, "body": "<p>I will answer to each element of your quesiton separatly:</p>\n\n<p>Calculus (Tarter) is calcified bio-film and plaque that is stuck on the surfaces of your teeth. Inside are bacterias, dead or alive, along with their byproducts (and their toxins) that irritate the gums, which may eventually cause an immune response in the gums that will lead to a recession.</p>\n\n<p>Therefore, <strong>scaling (removing) the \"half\" that is above</strong> the gums will do <strong>little or nothing</strong> to improve your situation, especially if there is anything left behind, bellow the gums.</p>\n\n<p><strong>The same can be said of any mouthrinces</strong> and other products you might try. They will hardly have any effect on the surfaces of the teeth above the gum line, due to the relatively short amount of time most people keep mouthrince in their mouth, the slow diffusion of the active ingredients across the calculus. It will not even reach below the gums wont remove/dissolve sub-gingival plaque or calculus. </p>\n\n<p>On the other hand, if you chose to attempt to perform scaling deeper with picks, you risk <strong>damaging your gums</strong>, especially since the \"picks\" will be pointed towards your gums, and you will eventually slide them too far and therefore damage even more the soft tissues that surround and support your tooth, potentially accelerating the recession, or worsening the inflamation.</p>\n\n<p>Dentists and hygienists use <strong>scalers and curettes</strong>, which cause minimal damage to the gums if used properly. Do not attempt to use them at home, on yourself, if you don't know what you are doing or lack good dexterity and technique. There are numerous videos on YouTube about how to use them.</p>\n\n<p>Needless to say, if you have access to a hygienist, a dentist or periodontist (dentist that specializes in the treatment of gums) you will be in good hands.</p>\n", "score": 3 } ]

[ "dentistry" ]

[ { "answer_id": 854, "body": "<p>When the body is exposed to hot temperatures, the normal response of the body is dilation of the peripheral blood vessels so that the heat energy in the blood can be released into the external environment, increasing the rate at which the body cools down.</p>\n\n<p>This dilatation also leads to decreased peripheral vascular resistance (blood pooling in the extremities, for instance), and thus a decrease in blood pressure. Thus if one already suffers from low blood pressure, exposure to hot environments may temporarily exacerbate the problem.</p>\n\n<p><a href=\"http://www.colorado.edu/eeb/courses/1230jbasey/abstracts%202007/17.htm\" rel=\"nofollow\">http://www.colorado.edu/eeb/courses/1230jbasey/abstracts%202007/17.htm</a></p>\n", "score": 3 } ]

[ "blood-pressure", "blood" ]

[ { "answer_id": 1827, "body": "<p>First of all, there is a <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611484/pdf/586_2001_Article_230.pdf\" rel=\"nofollow\">weak correlation between posture and pain.</a></p>\n\n<p>Secondly, working on long term activation may hurt (as in pain) your back. \nIf you find that a certain posture is good <strong>for you</strong> try to sets of time in which you are in that posture. </p>\n\n<p>Remmember: your best posture is your next posture. </p>\n", "score": 2 } ]

[ "back" ]

[ { "answer_id": 878, "body": "<p>The anesthetics used for the root canal are not very long lasting. An example of the longer-acting local anesthetics is Bupivacaine. The average half-life of Bupivacaine Hydrochloride in adults is 2.7 hours (that is, within 2.7 hours, half of the total dose absorbed is metabolized. In people with liver or renal failure, it may be longer, as it is metabolized by the liver.</p>\n\n<p>While various factors may increase or decrease the half-life of bupivacaine, it is exceedingly unlikely that there will be any bupivicaine left in her system a week from having a root canal, let alone a month.</p>\n\n<p>Of course, the exact drug(s) used by her dentist may differ.</p>\n\n<p>_{<a href=\"http://www.lb7.uscourts.gov/documents/Bupivacaine.pdf\">Bupivacaine</a>}</p>\n", "score": 7 } ]

[ "dentistry", "obstetrics" ]

[ { "answer_id": 1593, "body": "<p>I've actually had to look up this procedure first. From what I've read in <a href=\"http://hairremoval.about.com/od/threading/a/threading101.htm\" rel=\"nofollow noreferrer\">this article</a> the procedure itself seems sanitary.</p>\n<p>Still our skin surface contains bacteria. When the hair is removed, the bacteria can enter through the pilo-sebaceuous duct.</p>\n<p><img src=\"https://i.stack.imgur.com/51GJ8.jpg\" alt=\"enter image description here\" /></p>\n<p>Image source: <a href=\"http://www.aknicare.co.uk/science.php\" rel=\"nofollow noreferrer\">http://www.aknicare.co.uk/science.php</a></p>\n<p>This is why it would be good to <strong>disinfect the skin prior to the procedure.</strong> The choice of antiseptic will depend on your skin sensitivity. 70% ethanol is a very effective antiseptic, but if you have sensitive skin (and the area above the mouth is sensitive in its own right) then ethanol can cause irritation.</p>\n<p>Another, somewhat milder antiseptic is boric acid, but if it is absorbed and has systemic effects it can be toxic. This is why its use in cosmetic products has been restricted in the UK. (Martindale: The Complete Drug Reference, 34th edition) This is why (if you chose to use it) it should be used on intact skin only. (An aside: The use in children under 3 years of age is now forbidden. This is because children have more permeable skin, and absorption is more likely than in adults.)</p>\n<p>You can always ask your pharmacist or dermatologist to recommend you an antiseptic that would be good for you to use on this sensitive area.</p>\n<p><strong>After the procedure</strong> you can use a bit of talc powder to lessen the irritation.</p>\n<p>From Martindale: The Complete Drug Reference:</p>\n<blockquote>\n<p>Purified talc is used in massage and as a dusting powder to allay irritation and prevent chafing. It is usually mixed with starch, to increase absorption of moisture, and zinc oxide. Talc used in dusting powders or as talc poudrage should be sterilised.</p>\n<p>Inhalation of talc can cause respiratory irritation; prolonged exposure may produce pneumoconiosis.</p>\n</blockquote>\n<p>Because the area is right under your nose, you should just be careful not to inhale talc when you apply it, and you can apply a thin layer (there is no need for a thick layer). The microbiological quality of talc powder is very important, so make sure to purchase a reliable brand.</p>\n", "score": 2 } ]

[ "dermatology" ]

[ { "answer_id": 962, "body": "<p>I might hazard a guess that \"don't put pressure on your liver\" means don't take medications that might tax the liver, or drink alcohol, etc. I don't <em>think</em> they meant \"don't squeeze the liver.\"</p>\n\n<p>However, if they did mean that, it would be my recommendation that she sleep in the left lateral decubitus position.</p>\n\n<p><img src=\"https://i.stack.imgur.com/dVUti.jpg\" alt=\"enter image description here\"></p>\n\n<p>Since the liver is on the right side, lying on her left side with the head of the bed slightly elevated will exert the least amount of pressure on the liver. Probably the next best thing would be on her back with the head of the bed slighty elevated.</p>\n\n<p>I did find one paper addressing the position of the body in the treatment of various illnesses, calling the role of position in treatment \"postural medicine\". Much of this is common sense (that is, experience has taught us as much) but some of it is new to me. </p>\n\n<p><a href=\"http://www.medicinabiomolecular.com.br/biblioteca/pdfs/Doencas/do-1170.pdf\" rel=\"nofollow noreferrer\">The role of body position and gravity in the symptoms and treatment of various medical diseases</a>. </p>\n", "score": 1 } ]

[ "sleep", "liver", "position" ]

[ { "answer_id": 14679, "body": "<p>One of the low-fat diet risks include poor brain function, because the brain basically requires a high amount of cholesterol, which can be reduced by low levels of healthy fats in the ration. Here's some more information about <a href=\"https://www.smartpillwiki.com/how-to-improve-short-term-memory-definition-causes-symptoms/\" rel=\"nofollow noreferrer\">short term memory loss</a> and some <a href=\"https://draxe.com/15-brain-foods-to-boost-focus-and-memory/\" rel=\"nofollow noreferrer\">foods should be included in the diet</a> to prevent it.</p>\n\n<p>Connection between memory loss and nutrition:</p>\n\n<blockquote>\n <p>Another cause of this problem is when you have a deficiency of certain vitamins in the body. If you don’t eat well then this can lead to deficiency of certain nutrients in the body such as vitamins that play a major role in keeping your brain in good health.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15673620\" rel=\"nofollow noreferrer\">Serum cholesterol and cognitive performance in the Framingham Heart Study</a></p>\n\n<blockquote>\n <p>Lower naturally occurring TC levels are associated with poorer performance on cognitive measures, which place high demands on abstract reasoning, attention/concentration, word fluency, and executive functioning.</p>\n</blockquote>\n", "score": 3 } ]

[ "diet" ]

[ { "answer_id": 1018, "body": "<p>Actually, sunflower oil is very high in omega 6 and poor in omega 3 which isn't a good thing considering that the body needs a good balance between omega 6 and omega 3 to be healthy, and most modern food is way too high in omega 6.</p>\n\n<p>In my opinion there aren't good oils and bad oils, it's all a matter of balance. I personally use olive oil for hot dishes, and colza oil for salads and stuff... most of the time. But you still can try and pick most of the oils if you feel curious (I think that palm oil is the only vegetable oil which isn't good for health even if used just a little).</p>\n\n<p>Sources</p>\n\n<ul>\n<li><p><a href=\"http://authoritynutrition.com/optimize-omega-6-omega-3-ratio/\" rel=\"nofollow\">How to Optimize Your Omega-6 to Omega-3 Ratio</a></p></li>\n<li><p><a href=\"http://health.usnews.com/health-news/blogs/eat-run/2014/01/03/the-shocking-truth-about-sunflower-oil\" rel=\"nofollow\">The Shocking Truth About Sunflower Oil</a></p></li>\n</ul>\n", "score": 3 } ]

[ "nutrition", "cooking", "oil" ]

[ { "answer_id": 1025, "body": "<p>According to this <a href=\"http://web.archive.org/web/20150225220724/http://discovery.yukozimo.com/who-discovered-brain-cancer/\" rel=\"nofollow noreferrer\">source</a> and <a href=\"https://en.wikipedia.org/wiki/Timeline_of_brain_cancer\" rel=\"nofollow noreferrer\">this</a>, brain cancer was first discovered in 1873 and brain tumor before that. We can't say for sure when the first case of brain tumor occurred because it may have been originated in the prehistoric times. Since no data was recorded in those times, it isn't certain to say when and where the first case of brain tumor occurred.</p>\n\n<blockquote>\n <p>It’s not that hard to answer the question of who discovered brain cancer – this breakthrough is credited to Gupta Longati, a Russian scientist, who discovered the disease in 1873.</p>\n</blockquote>\n", "score": 2 } ]

[ "cancer", "brain", "history" ]

[ { "answer_id": 1045, "body": "<p>No, products that comply with FDA guidelines are not tested before being offered to the public for sale.</p>\n\n<p>It is impossible - literally* - to test every batch of ice cream, spinach, frozen hamburger, etc. that is shipped out to supermarkets for sale. The FDA relies on the good intentions of the manufacturer to follow its guidelines and results of evaluations. If they do not, they are held responsible for damages inflicted on the public, as well as punitive damages and fines.</p>\n\n<p>In the example of ice cream, the FDA has guidelines for the facilities that produce the product based on years of studies and experience. They include cleaning recommendations, temperatures at certain stages, the amount of time the product must spend at certain temperatures, etc. The facilities are inspected routinely, and when a product ends up contaminated, the FDA does a new inspection and reviews the previous inspections for evidence that previous recommendations were ignored, or might have prevented what occurred. In other words, it's a continuous process that relies on the manufacturer to keep in compliance with FDA guidelines. Facilities that don't comply face recalls, fines, and ultimately closure.</p>\n\n<p>The Blue Bell Ice Cream Listeria outbreak is a good case study in the process. The process can be <a href=\"http://www.foodsafetynews.com/2015/05/fda-posts-blue-bell-inspection-reports-from-2007-2014/#.VWCn9qbqmto\" rel=\"nofollow\">examined here</a> and by following the links within. </p>\n\n<p>*The costs would be prohibitive to test for every possible pathogen and contaminant.</p>\n", "score": 5 } ]

[ "food-safety" ]

[ { "answer_id": 1097, "body": "<blockquote>\n <p>[I] was wondering if I were to go to the GP now is there any way they could tell that I was sick these last couple of days through some kind of blood test or something? </p>\n</blockquote>\n\n<p>\"Food poisoning\" covers a vast number of illnesses, and whether it is detectable after your recovery depends on what type of illness caused it. For example, if your gastroenteritis was caused by a norovirus (formerly called Norwalk virus, the most common cause of food poisoning), a blood test for IgM (Immunoglobulin M) to the virus, indicating a recent illness, might be positive.</p>\n\n<p>However, diagnosing after the fact in a short term and self-limiting illness like norovirus infection is harder than diagnosis during the illness (which requires just a small stool sample), unless the pathogen is known with certainty, and even then, there may not be a residual response to test.</p>\n\n<p>Clearly, you will be paying for a large number of tests with only a chance that one of them will come up positive.</p>\n\n<p>In terms of getting a doctor's note, it's best if you a) have a prior relationship with the physician, b) call him while you're sick (not after) or c) see a health care provider, go to the school health clinic, a walk-in clinic, or something similar.</p>\n\n<p>Writing a note after the fact is a tricky area ethically. Many doctors who know and trust their patients will do it without hesitation. But I can understand others simply refusing the request for a post-illness work-up (which might be negative regardless) on the basis of cost and questionable need.</p>\n\n<p>Or to use a medical metaphor, an ounce of prevention is better than a pound of cure.</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC85428/\" rel=\"nofollow\">Antibody Test To Detect Genogroup II Norwalk-Like Virus Infection</a>}<br>\n_{<a href=\"http://reference.medscape.com/medline/abstract/22354525\" rel=\"nofollow\">Assessment of a rapid immunochromatographic test for the diagnosis of norovirus gastroenteritis.</a>}</p>\n", "score": 4 } ]

[ "food-poisoning" ]

[ { "answer_id": 1082, "body": "<p>There is nothing very scientific about measuring a blister; measure it just as you would a mole.</p>\n\n<p>With a ruler held above or next to it, note it's length and it's width, and it's general shape.</p>\n\n<p>Blisters from burns or friction or do not tend to \"grow\" once the damage to the epidermis is finished (The skin is cooled down or the shoe comes off). They may become more tense, but that doesn't change their length and width.</p>\n\n<p>Blisters from a process that separates the epidermis in an ongoing manner (e.g. an autoimmune reaction such as bullous pemphigoid or a drug reaction) or from a slow-acting contact irritant (e.g. poison ivy), etc., may grow. </p>\n\n<p>If you have blisters from an unknown source, you should see a physician.</p>\n", "score": 3 } ]

[ "dermatology" ]

[ { "answer_id": 1131, "body": "<p>A vegan diet is based only on vegetal foods. If we analyze the amino acid content of different food protein sources (animal and plant proteins), <strong>lysine</strong> is consistently at a much lower concentration in all major plant-food protein groups than in animal foods (<a href=\"http://www.sciencedirect.com/science/article/pii/S0065242309470070\" rel=\"nofollow\" title=\"biomarkers\">1</a>, <a href=\"http://ajcn.nutrition.org/content/59/5/1203S.short\" rel=\"nofollow\" title=\"young pellet\">2</a>). Lysine is one of the essential amino acids, thus lysine is most likely to be the first limiting amino acid in diets that are based\npredominantly on cereal grains (<a href=\"http://ajcn.nutrition.org/content/59/5/1203S.short\" rel=\"nofollow\" title=\"young pellet\">2</a>).</p>\n\n<p>For this reason the American Dietetic Association, in its 2009 position paper on vegetarian diets, recommends an increase of consumption of <strong>beans and soy products</strong> in order to satisfy the essential amino acids requirements in vegan diets (<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19562864\" rel=\"nofollow\" title=\"ADA pos\">3</a>).</p>\n", "score": 4 }, { "answer_id": 16479, "body": "<p>All essential amino acids originate from plants (and microbes), and all plant proteins have all essential amino acids. Eating a whole food plant-based diet also known as a proper vegan diet or a proper plant-based diet, one can obtain absolutely all essential amino acids. Furthermore, our body has an amino acid reservoir from which it daily sends about 90 grams of amino acids to combine with amino acids from a meal and synthesize complete protein. (<a href=\"https://nutritionfacts.org/video/the-protein-combining-myth/\" rel=\"nofollow noreferrer\">1</a>) Even a banana has all essential amino acids. (<a href=\"https://tools.myfooddata.com/protein-calculator.php?food1=9040&amp;serv1=100g&amp;food2=0&amp;serv2=0&amp;food3=0&amp;serv3=0&amp;food4=0&amp;serv4=0&amp;food5=0&amp;serv5=0&amp;food6=0&amp;serv6=0&amp;food7=0&amp;serv7=0&amp;food8=0&amp;serv8=0&amp;food9=undefined&amp;serv9=undefined&amp;food10=0&amp;serv10=0\" rel=\"nofollow noreferrer\">2</a>)</p>\n\n<p>Being deficient of essential amino acids on a proper plant-based diet where one daily consumes foods from each category such as whole grains, legumes, fruits, nuts, and green leafy vegetables is unheard of.</p>\n\n<p>People who are deficient in essential amino acids are also deficient in other nutrients and people who are deficient are likely either starving or in war zones.</p>\n", "score": 2 } ]

[ "nutrition", "vegetarianism", "proteins", "amino-acids" ]

[ { "answer_id": 1182, "body": "<p>There hasn't been any conclusive clinical studies that have found that vibrating belts, or any vibration exercise for that matter, can definitely help promote weight loss. Sadly, most studies have been done on full body vibration training, so some of the references I point to may not be specifically about vibration belts, but the mechanisms of each method are basically the same.</p>\n\n<p>A review of several studies^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22092513\" rel=\"nofollow\">1</a>} on vibration exercise in general, including the use of vibration belts, found that vibration exercise was not very efficient in burning fat. It wasn't found to be very good at promoting weight loss or changing the body composition at all (ie: building muscle). One study did show possible signs that vibration exercise and vibration belts can burn fat, but overall, the rate at which fat is burned at when using a vibration belt or other form of vibration exercise is low. There are some possible benefits of vibration exercise, such as higher oxygen intake. This review did not provide fully conclusive results, though.</p>\n\n<p>Another review of many studies on whole-body vibration training^{<a href=\"http://www.nutricionhospitalaria.com/pdf/6656.pdf\" rel=\"nofollow\">2</a>} found similar results, though they did point more in the favor of vibration exercise having benefits. The review states in its conclusion that:</p>\n\n<blockquote>\n <p>[Whole-body vibration training] appears to be associated with three pathways involved in weight loss: inhibition of adipogenesis and reduction of fat mass, increased energy expenditure, and increase in muscle mass. After analysing the literature, none of the results for the proposed pathways are consistent, and indeed are often contradictory.</p>\n</blockquote>\n\n<p>This review shows more positive results than the other review I mentioned that vibration training may promote weight loss, especially when used in conjunction with other exercises meant to help you lose weight. Vibration exercise does appear to be safe, though, so it can be used with a weight loss diet and exercises to help promote weight loss. Though this review was about whole-body vibration training, vibration belts work in a similar fashion, so it is likely that vibration belts may produce similar results.</p>\n\n<hr>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22092513\" rel=\"nofollow\">1: Is vibration exercise a useful addition to a weight management program?</a>}</p>\n\n<p>^{<a href=\"http://www.nutricionhospitalaria.com/pdf/6656.pdf\" rel=\"nofollow\">2: Whole-body vibration training as complement to programs aimed at weight loss</a>}</p>\n", "score": 3 } ]

[ "weight" ]

[ { "answer_id": 1212, "body": "<p>The first ingredient is water; the second ingredient is a detergent (milder than SLS). The next ingredients are Shea Butter and sunflower seed oil (good for the skin), then a humectant (attracts moisture from the air to the skin), then another surfactant/detergent - very, very mild, then a thickener/foam enhancer (people don't like to wash up with stuff that doesn't make bubbles), then <strong>Allantoin</strong>, one of my all-time favorite ingredients for skin care, then the rest are in amounts at or under 1% and are mostly to increase shelf life/prevent bacteria from growing in the product.</p>\n\n<p>If that doesn't seem like an answer to you, I'll put it in plain English, but first an aside.</p>\n\n<p>The Romans (well, <em>maybe</em> limited to the middle class and up), who had soap to wash garments with, did not use soap on their skin. Instead, they bathed in hot water, then were coated with an infused olive oil (say, lavender), then the oil was scraped from their skin with a scraper, taking away the old and (?)foul smelling, and leaving behind some of the nicer, new stuff. A couple of additional steps and they were clean. That was good skin care.</p>\n\n<p>No one today washes that way. It would be prohibitively expensive and time consuming. By habit, many people would not feel clean, either, because they equate \"bubbles\" with \"clean\".</p>\n\n<p>Your Cetaphil is trying to do that - replace oil removed with oil deposited - while still foaming and acting as a wash, which people expect.</p>\n\n<blockquote>\n <p>Is it because, in general, it still remove your skin oil? Therefore, after all I still need to apply moisturizer. In that case, what is the different to use normal soap and then use moisturizer after that?</p>\n</blockquote>\n\n<p>First, soap and detergent are different things. I'll assume you mean soap.</p>\n\n<p>A very high quality soap (which you can't buy commercially) will attempt to do the same thing by <em>superfatting</em> the soap using oils with a great skin care profile: Jojoba oil, Macademia Nut oil, Shea butter, Cocoa butter, etc. to the point of almost not foaming (no bubbles). You would find the Cetaphil and the soap would leave you feeling about the same.</p>\n\n<p>Regualar soap strips the skin of all fats and sweat, dirt, etc. Then you replace the oils stripped with new oils and the other ingredients in your moisturizer.</p>\n\n<p>Does it matter? You can answer that yourself. In one scenario, you strip your skin of oils then add them back. In another, you have some good oils on your skin and you add to that. Which sounds healthier for your skin?</p>\n\n<p>_{If you wonder why I am so opinionated on the matter, it's because I used to make skin care products for health care professionals, who often developed nasty hand dermatitis from hospital supplied skin cleansers. When my husband developed a rash that wouldn't go away - winter or summer, on vacation, using other soaps, etc., - and under a dermatologist's care for two years, biopsied twice and using steroids and other topical meds, I decided I could do better. I learned everything I could about skin health, and made some wonderful soaps and lotions that cured my husband's and others' dermatological problems. I studied skin care for about six years, and made products for five, always improving my formulas. In that very narrow area, I'd pit my knowledge against any but the best dermatologist's. In every country I've visited, their most expensive soaps are no where close to mine. They might be quadruple-milled, but they still are basically oil-stripping soaps.}</p>\n", "score": 4 } ]

[ "dermatology", "oil-of-skin", "moisturize", "soap" ]

[ { "answer_id": 4274, "body": "<p>Results on this are mixed. For instance, Reference 1 states that there is no correlation, whereas, Reference 2 states that their results \"suggest that the overall IQ of the children exposed to high fluoride levels in drinking water and hence suffering from dental fluorosis were significantly lower than those of the low fluoride area.\"</p>\n\n<p>I think the New Zealand study explains these finding quite nicely: \"Associations between very high fluoride exposure and low IQ reported in previous studies may have been affected by confounding, particularly by urban or rural status.\"</p>\n\n<p>Reference 3 concludes \"children who live in a fluorosis area have five times higher odds of developing low IQ than those who live in a nonfluorosis area or a slight fluorosis area.\"</p>\n\n<p>Due to the sheer amount of mixed findings on this topic, I cannot answer your question with an iota of certainty. I could most certainly give you my <em>opinion</em>, however, it is hardly relevant ;) .</p>\n\n<p><strong>References</strong></p>\n\n<ol>\n<li>(No correlation) Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24832151\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pubmed/24832151</a></li>\n<li>(Correlation) Relationship Between Dental Fluorosis and Intelligence Quotient of School Going Children In and Around Lucknow District: A Cross-Sectional Study. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/26673535\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pubmed/26673535</a></li>\n<li>(Correlation) Fluoride and children's intelligence: a meta-analysis, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18695947/\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pubmed/18695947/</a></li>\n</ol>\n", "score": 6 }, { "answer_id": 14540, "body": "<p>As the saying goes, anything is a poison, it's the dose that matters. Short summary, the new 2015 US PHS standard (0.7 mg/L) or even the old one (0.7-1.2 mg/L) are below the doses at which negative effects were observed in China (2.5-4.1 mg/L), and the evidence from there is not of high quality, even though there's one meta-analysis of it. (As a cautionary tale on inferring from low quality evidence, <a href=\"https://skeptics.stackexchange.com/a/20353/29579\">the first meta-analysis of homeopathy found positive results</a>, latter ones which filtered out low-quality studies were more skeptical.)</p>\n\n<p>But back to fluoride, what did the United States Public Health Service (PHS), actually <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547570/\" rel=\"nofollow noreferrer\">decide in 2015</a>?</p>\n\n<blockquote>\n <p>For these community water systems that add fluoride, PHS now recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L). In this guidance, the optimal concentration of fluoride in drinking water is the concentration that provides the best balance of protection from dental caries while limiting the risk of dental fluorosis. The earlier PHS recommendation for fluoride concentrations was based on outdoor air temperature of geographic areas and ranged from 0.7–1.2 mg/L. </p>\n</blockquote>\n\n<p>As for neurotoxicity, this was PHS's review of the new evidence:</p>\n\n<blockquote>\n <p>IQ and other neurological effects.\n The standard letters and approximately 100 unique responses expressed concern about fluoride's impact on the brain, specifically citing lower IQ in children. Several Chinese studies considered in detail by the NRC review reported lower IQ among children exposed to fluoride in drinking water at mean concentrations of 2.5–4.1 mg/L—several times higher than concentrations recommended for community water fluoridation.[81–83] The NRC found that “the significance of these Chinese studies is uncertain” because important procedural details were omitted, but also stated that findings warranted additional research on the effects of fluoride on intelligence.[6]</p>\n \n <p>Based on animal studies, the NRC committee speculated about potential mechanisms for nervous system changes and called for more research “to clarify the effect of fluoride on brain chemistry and function.” These recommendations should be considered in the context of the NRC review, which limited its conclusions regarding adverse effects to water fluoride concentrations of 2–4 mg/L and did “not address the lower exposures commonly experienced by most U.S. citizens.”[6] A recent meta-analysis of studies conducted in rural China, including those considered by the NRC report, identified an association between high fluoride exposure (i.e., drinking water concentrations ranging up to 11.5 mg/L) and lower IQ scores; study authors noted the low quality of included studies and the inability to rule out other explanations.[84] A subsequent review cited this meta-analysis to support its identification of “raised fluoride concentrations” in drinking water as a developmental neurotoxicant.[85]</p>\n \n <p>A review by SCHER also considered the neurotoxicity of fluoride in water and determined that there was not enough evidence from well-controlled studies to conclude if fluoride in drinking water at concentrations used for community fluoridation might impair the IQ of children. The review also noted that “a biological plausibility for the link between fluoridated water and IQ has not been established.”[79] Findings of a recent prospective study of a birth cohort in New Zealand did not support an association between fluoride exposure, including residence in an area with fluoridated water during early childhood, and IQ measured repeatedly during childhood and at age 38 years.[86]</p>\n</blockquote>\n\n<p>From the actual <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265943/\" rel=\"nofollow noreferrer\">New Zealand study</a> we find out they used a simiar standard as the US, albeit slighly lower at 0.7-1 mg/L, and no effect on IQ was noticeable at this level of exposure.</p>\n\n<p>And the stated reason for lowering the PHS standard in 2015 to just 0.7mg/L was based on risk of fluorosis</p>\n\n<blockquote>\n <p>Although not fully generalizable to the current U.S. context, these findings, along with findings from the 1986–1987 survey of U.S. schoolchildren, suggest that the risk of fluorosis can be reduced and caries prevention maintained toward the lower end (i.e., 0.7 mg/L) of the 1962 PHS recommendations for community water fluoridation.</p>\n</blockquote>\n\n<p>and lack of need for the higher value (1.2 mg/L)</p>\n\n<blockquote>\n <p>Recent data do not show a convincing relationship between water intake and outdoor air temperature. Thus, recommendations for water fluoride concentrations that differ based on outdoor temperature are unnecessary.</p>\n</blockquote>\n", "score": 4 }, { "answer_id": 5329, "body": "<p>There are <a href=\"http://fluoridealert.org/studytracker/?effect=brain-2&amp;sub=&amp;type=&amp;start_year=&amp;end_year=&amp;show=10&amp;fulltext=&amp;fantranslation=\" rel=\"nofollow noreferrer\">over 300 studies</a> have found that fluoride is a neurotoxin (a chemical that can damage the <a href=\"http://fluoridealert.org/issues/health/brain/\" rel=\"nofollow noreferrer\">brain</a>). </p>\n\n<p>According to <a href=\"https://www.epa.gov/chemical-research/toxicity-forecasting\" rel=\"nofollow noreferrer\">EPA</a> scientists (United States Environmental Protection Agency), there is substantial evidence that fluoride is neurotoxin^{<a href=\"http://www.fluoridealert.org/wp-content/uploads/epa_mundy.pdf\" rel=\"nofollow noreferrer\">2009</a>}. They based their conclusion on studies showing that fluoride exposure during pregnancy can damage the brain which was consistent with three other studies from China which found that the brain of the human fetus can be significantly damaged by the mother’s high fluoride intake (safe dose for preventing this effect is not yet known).</p>\n\n<p><a href=\"http://www.fluoridealert.org/wp-content/uploads/epa_mundy.pdf\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/coT9Hl.jpg\" alt=\"EPA.gov - Chemicals with substantial evidence of developmental neurotoxicity\"></a></p>\n\n<p>Further more, the National Research Council (NRC) expressed concern about fluoride’s possible contribution to dementia and \"it is apparent that fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means\"^{<a href=\"http://fluoridealert.org/studies/brain06/\" rel=\"nofollow noreferrer\">2006</a>}.</p>\n\n<blockquote>\n <p>It is apparent that fluorides have the ability to interfere with the functions of the brain. (National Research Council, 2006)</p>\n</blockquote>\n\n<p>A more recent “meta-analysis” of 27 cross-sectional studies performed by <a href=\"http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/\" rel=\"nofollow noreferrer\">Harvard researchers</a>, did a systematic review of children exposed to fluoride in drinking water (mainly from China), which suggested that children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas (an average IQ decrement of about seven points in children exposed to higher fluoride concentrations)^{<a href=\"http://ehp.niehs.nih.gov/1104912/\" rel=\"nofollow noreferrer\">2012</a>}.</p>\n\n<blockquote>\n <p>Some studies suggested that even slightly increased fluoride exposure could be toxic to the brain. </p>\n</blockquote>\n\n<p>In March of 2014, The Lancet medical journal published a review of <a href=\"http://fluoridealert.org/wp-content/uploads/grandjean-20141.pdf\" rel=\"nofollow noreferrer\">neurobehavioral effects of developmental toxicity</a>, which concluded that fluoride is one of only 11 chemicals that is known to damage the developing brain and it is capable of causing widespread brain disorders such as autism, attention deficit hyperactivity disorder, learning disabilities, and other cognitive impairments. In most cases the damage is often <strong>untreatable</strong> and <strong>permanent</strong>^{<a href=\"http://fluoridealert.org/news/fluoride-newly-identified-as-dangerous-to-brains/\" rel=\"nofollow noreferrer\">2014</a>}. According to this, fluoride is classified as <strong>dangerous</strong> to developing brains.</p>\n\n<p>In a bulletin posted on the <a href=\"http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/\" rel=\"nofollow noreferrer\">Harvard School of Public Health website</a>, Grandjean notes that:</p>\n\n<blockquote>\n <p>Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain. The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.</p>\n</blockquote>\n", "score": 3 } ]

[ "mental-health", "lasting-effects-duration", "cognitive-science", "fluoride", "iq-intelligence" ]

[ { "answer_id": 1371, "body": "<p>Apparently the body does remove mercury naturally:</p>\n\n<blockquote>\n <p>Sixty days after the amalgam removal, the Hg levels in blood, plasma, and urine had declined to approximately 60% of the pre-removal levels. [...] After removal, there was a considerable decline in the Hg levels of blood, plasma, and urine, which slowly approached those of subjects without any history of amalgam fillings.</p>\n</blockquote>\n\n<p>-- Sandborgh-Englund G1, Elinder CG, Langworth S, Schütz A, Ekstrand J. - <em><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9539465\" rel=\"nofollow\">Mercury in biological fluids after amalgam removal</a></em> - J Dent Res. 1998 Apr;77(4):615-24.</p>\n", "score": 4 } ]

[ "blood" ]

[ { "answer_id": 1422, "body": "<p>It is not possible to tell what actions led to the thigh infection, because there are multiple possible actions that could.</p>\n\n<p>Explanation: Close bodily contact of any kind can transmit herpes. That is, the virus jumps from an infected person to another person by close bodily contact (i.e. rubbing of some type). </p>\n\n<p>If someone was engaged in a sexual act with you and rubbed an infected part of their skin on your thigh, then, yes, your infection would be considered a sexually transmitted infection. </p>\n\n<p>If your lesion is reasonably far from the genital area, however, it's more likely to be an instance of herpes gladiotorum, which is a sports disease, not a sexual disease. Wrestlers, rugby players (in a scrum), and so on, engage in very close physical contact, and this can lead to spread of herpes from one person to another through a non-sexual route.</p>\n\n<p>As a child, you may not have been playing rugby, but you might have been wrestling with an infected friend, or the friend may have bit you on the thigh, or who knows what. Where your friend got infected, or how, is of lesser importance.</p>\n\n<p>If it has not come back since the original appearance, I would not worry about it. Could you as a child really tell a herpes vesicle from a bug bite? Could you as an adult?</p>\n", "score": 1 } ]

[ "dermatology", "diagnostics", "herpes", "sti" ]

[ { "answer_id": 1588, "body": "<p>There are several reasons why we can't specify the range here on Health SE, especially for anti-TPO Ab.</p>\n<ul>\n<li><strong>The test method</strong></li>\n</ul>\n<p>Antibodies are proteins, produced by our immune system. Determining the concentration of a specific protein is somewhat more difficult than determining the concentration of a smaller molecule. Still, there are various methods for this - for antibodies those are mostly immunological assays.</p>\n<p>If you test the same sample with various methods, you could get different results.</p>\n<p>From <a href=\"https://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test/#is\" rel=\"nofollow noreferrer\">Lab Tests Online</a>:</p>\n<blockquote>\n<p>The sensitivity and specificity of thyroid antibody testing is improving but is still not as good as health practitioners would like it to be. All of the thyroid antibody tests have changed over time. This is part of the reason that the tests have historically acquired many different names. <strong>There are also many distinct methodologies and each has different reference (normal) ranges.</strong> If someone is having serial testing done for monitoring purposes, it is best to have test done by the same laboratory each time, using the same methodology.</p>\n</blockquote>\n<p>How can you trust these tests if they give different results? Each test method has to be <a href=\"http://www.fda.gov/ScienceResearch/FieldScience/ucm171877.htm\" rel=\"nofollow noreferrer\">validated</a> and standardised. This means that various parameters (that have been determined as important) are checked for each method against a standard or a referent method. The important thing is that one interprets the value obtained by testing a certain sample by a certain method by comparing it to the <strong>referent range for that method</strong>.</p>\n<ul>\n<li><strong>Demographics</strong></li>\n</ul>\n<p>From the same source:</p>\n<blockquote>\n<p><em>Reference values are dependent on many factors, including patient age, sex, sample population, and test method, and numeric test results can have different meanings in different labs.</em></p>\n<p><em>For these reasons, you will not find reference ranges for the majority of tests described on this web site. The lab report containing your test results should include the specific reference range for your test(s).</em></p>\n</blockquote>\n<p>This is pretty straight forward. E.g. if there are variations between sexes, the lab report should come with two referent ranges (one for each sex), and specify which is which. Sample population is also important, and some referent ranges are defined for the majority population living in a certain area.</p>\n<ul>\n<li><strong>The units</strong></li>\n</ul>\n<p>If somebody told me that their body temperature is 97 degrees, I'd say that's impossible. This is because I'm used to Celsius scale, where water boils at 100 degrees Celsius. In fact, <a href=\"http://www.unit-conversion.info/temperature.html\" rel=\"nofollow noreferrer\">this calculator</a> shows that 97.16 degrees Fahrenheit corresponds to 36.2 degrees Celsius, which is within normal body temperature range. Same goes for determining concentration - there are many &quot;types&quot; of concentrations (molar, mass, etc.) and each of these can be expressed in various units. Furthermore, the amount/level of the tested parameter doesn't have to be a concentration at all.</p>\n<p><strong>Conclusion 1</strong>: If you have your test results, they should have come with units and reference ranges (usually written in a column at the right of the report). If you don't have these, it might be a good idea to contact the test lab if possible and inquire for details.</p>\n<ul>\n<li><strong>Interpretation</strong></li>\n</ul>\n<p>If the results are not within the reference range, this can mean a number of things. It might imply that there is an underlying condition causing this. For thyroid, the values of TSH and anti-TPO Ab can point to several, very different conditions. You shouldn't try to discern these on your own - even if you have referent ranges. This is what doctors are for. You should not expect a physician to interpret these results via phone or e-mail, because <strong>laboratory tests are just one part of making a correct diagnosis.</strong> Other parts include: anamnesis, family anamnesis (medical history of your relatives), physical examination and possibly (but not necessarily) imaging methods, such as ultrasound.</p>\n<p>What's more, even within a certain referent range, for some hormones it depends very much on your age e.g. in which part of the interval are the &quot;ideal&quot;, i.e. optimal values.</p>\n<p><strong>Conclusion 2</strong>: Leave the interpretation and the diagnosis to your doctor.</p>\n<hr />\n<p>Suggested reading: <a href=\"https://labtestsonline.org/understanding/features/ref-ranges/\" rel=\"nofollow noreferrer\">Reference Ranges and What They Mean</a></p>\n<hr />\n<p>An aside: determining TSH values is more straightforward, but still various sources give different referent ranges: <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/003684.htm\" rel=\"nofollow noreferrer\">1</a>: 0.4 - 4.0 mIU/L and <a href=\"http://www.endocrineweb.com/conditions/thyroid/thyroid-function-tests\" rel=\"nofollow noreferrer\">2</a>: 0.5-6 uU/ml.</p>\n", "score": 5 } ]

[ "endocrinology", "autoimmune-disease", "thyroid", "thyroperoxidase-tpo" ]

[ { "answer_id": 1581, "body": "<p>Calorie restriction is a complex phenomenon as the effects can vary depending on how much you restrict calories to when you restrict them. You can do daily calorie restriction, or you can restrict your calories with fasting in various intermittent fasting protocols. </p>\n\n<p>For the benefits of restricting calories, there seems to be several studies showing benefits in longevity and health. However, the fact that restricting calories will in most cases lead to weight loss, it is hard to determine whether it is the restriction itself that has benefits (and the hormonal changes that occur in the body due to restriction) or simply from the weight loss itself. </p>\n\n<p>This study, which is done on rodents, show that there are changes on the cellular level that can increase the lifespan of rodents: <a href=\"http://www.sciencedirect.com/science/article/pii/S1357272502000389\" rel=\"nofollow\">http://www.sciencedirect.com/science/article/pii/S1357272502000389</a></p>\n\n<p>This study shows that several age-related diseases can decrease with long-term calorie restriction. However, this study discusses the effects it has on yeast, worms, flies and rodents, and links these hypothetically to primates: <a href=\"http://www.nature.com/nrm/journal/v6/n4/abs/nrm1616.html\" rel=\"nofollow\">http://www.nature.com/nrm/journal/v6/n4/abs/nrm1616.html</a></p>\n\n<p>This is a similar study as the one above. It discusses studies done on yeast, worms, flies, rodents, and some primates (the Rhesus monkey) and draws conclusions from those studies to humans: <a href=\"http://www.sciencedirect.com/science/article/pii/S0047637405000874\" rel=\"nofollow\">http://www.sciencedirect.com/science/article/pii/S0047637405000874</a></p>\n\n<p>This study is similar to the one above: <a href=\"http://www.sciencedirect.com/science/article/pii/S0092867405001030\" rel=\"nofollow\">http://www.sciencedirect.com/science/article/pii/S0092867405001030</a></p>\n\n<p>I find the conclusion of the last study to be of interest:</p>\n\n<blockquote>\n <p>CR has long been recognized for its ability to extend mammalian life\n span and to mitigate disease processes in many tissues. Humans have\n not fully harvested the benefits from the regimen, in part because of\n the extreme difficulty in complying with the regimen.</p>\n</blockquote>\n\n<p>Long term calorie restriction is very difficult for humans, and since we cannot do lab studies on humans, it is very hard to determine the long term effects of CR. However, there are several studies that seem to indicate that intermittent fasting (IF) can produce similar results as CR, and that IF can be much easier for humans to maintain in the long term. Since IF is not the topic of this question I will not link to studies.</p>\n", "score": 4 } ]

[ "nutrition" ]

[ { "answer_id": 1575, "body": "<p>There are many facts to consider in answering the question, but in effect, yes, one can calculate the chances. Things to consider:</p>\n\n<ul>\n<li>type of condom</li>\n<li>correct usage of condom</li>\n<li>point in the menstrual cycle</li>\n</ul>\n\n<p><strong>Condom type</strong></p>\n\n<p>Latex condoms are somewhat more effective than polyurethane condoms, mostly due to breakage and slippage. However, since in your scenario the condom doesn't break (and we assume it didn't slip), breakage or slippage would not be a problem in the calculations. For this scenario, we'll use the effectiveness of a latex condom.</p>\n\n<p><strong>Correct usage</strong></p>\n\n<p>Male condoms remain a highly effective contraceptive method when used correctly. Latex condoms are 98% effective, meaning that two out of 100 women correctly using male condoms as a means of contraception will become pregnant <strong>in one year</strong>. Use of out-of-date condoms, spermicidal jelly or the wrong kind of lubricant with latex condoms, etc. decreases the efficacy of condoms. In this scenario, we'll assume a not-expired condom, applied properly (not applied and taken off and reapplied, or used more than once, etc.) (Please note, however, it only takes one \"successful\" mating to become pregnant.)</p>\n\n<p><strong>The menstrual cycle</strong></p>\n\n<p>A menstrual cycle begins on the first day of your period and ends the day before the next period begins. Most women will experience some variation in the length of cycles throughout their lives; normally, though, a cycle is between 21 and 35 days. </p>\n\n<p>Ovulation usually occurs about 14 days before the next cycle begins, but it can vary. If you have a short cycle (say, 24 days) and your bleeding lasts 5 days, this means you likely ovulate around day 10; add one day for every day that your cycle is longer (so in a 35 day cycle, you will likely ovulate on day 21.) Pregnancies occur within a 6 day fertile window. This “fertile window” is comprised of the five days before ovulation and the day of ovulation itself. Sex must occur on one of these days (and, yes, it can be only once. It makes no difference if it's the first time or the 50th.) This is because sperm can live for up to five days, traveling to meet the ovulated egg. </p>\n\n<blockquote>\n <p>Overall, an estimated 2% of women were in their fertile window by the fourth day of their cycle and 17% by the seventh day (based on 213 women). This percentage peaked on days 12 and 13, when 54% of women were in their fertile window. If ovulation was delayed, women reached their fertile days much later. Among women who reached the fifth week of their cycle, 4-6% were in their fertile window.</p>\n</blockquote>\n\n<p>This graph shows the probability of women being in their fertile window on a specific day in their cycle.</p>\n\n<p><img src=\"https://i.stack.imgur.com/BwiRy.gif\" alt=\"enter image description here\"></p>\n\n<p>If a woman has a 28 day cycle (the most common), and stops bleeding on day five, on day 6, there is a less than 20% chance that of her being in her fertile window.</p>\n\n<p><strong>What it boils down to</strong></p>\n\n<p>Even with ejaculation, a latex condom used correctly is between 98% and 99% effective (odds of pregnancy: .02); if the woman has a 28 day cycle, the odds of being in her window of fertility on day 6 is ~15% (.15). Doing the math, .15 x .02 = .0003, which means she has <strong>at most</strong> a 3 in 10,000 chance of becoming pregnant from this interaction. Because of the lack of ejaculation, the chance is reduced by a factor of 10 (to account for sperm in the pre-ejaculate), so the chance is approximately 3 in 100,000. </p>\n\n<p>That is a very small chance of being pregnant. As a way to put that into perspective, that is only (roughly) 15 times more likely than a person's chance of being killed by an asteroid. </p>\n\n<p>Though the chance is very small, it is not zero. For this reason, one can take a urine test to reassure oneself as soon as the 28th day.</p>\n\n<p>_{Read the information in the references below to learn how to keep yourself safe while having sex.}</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Nonlatex+vs.+latex+male+condoms+for+contraception%3A+a+systematic+review+of+randomized+controlled+trials.\" rel=\"noreferrer\">Nonlatex vs. latex male condoms for contraception: a systematic review of randomized controlled trials.</a>}<br>\n_{<a href=\"http://www.nhs.uk/conditions/contraception-guide/pages/male-condoms.aspx\" rel=\"noreferrer\">Condoms</a>}<br>\n_{<a href=\"http://www.bmj.com/content/321/7271/1259.short\" rel=\"noreferrer\">The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study</a>} </p>\n", "score": 8 } ]

[ "obstetrics", "contraception" ]

[ { "answer_id": 1592, "body": "<p>You have three separate issues here; I'll focus on how they affect bacteria in the gut. First, are different yet similar bacteria better or worse for people? Clearly yes; with various types of <a href=\"http://www.mayoclinic.org/diseases-conditions/e-coli/basics/definition/con-20032105\" rel=\"nofollow\"><em>Escherichia coli</em></a> being common and usually benign inhabitants, but <em>E. coli O157:H7</em> causing severe problems.</p>\n\n<p>Second, can directed evolution coax a bad type of bacteria into being a less harmful type? Also clearly yes: this is being done all the time in the biofuels industry to create bacteria with specific abilities to break down and reform materials into fuel.</p>\n\n<p>Third, can such improved bacteria be used to crowd out the bad bacteria? Again, yes: <em>Clostridium difficile</em> is (see the name) a difficult-to-control gut inhabitant. Classic treatment with antibiotics has not been very effective, but transplanting good gut flora with <a href=\"http://www.mayoclinic.org/medical-professionals/clinical-updates/digestive-diseases/quick-inexpensive-90-percent-cure-rate\" rel=\"nofollow\">fecal microbiota transplantation</a> (FMT) seems to be very effective in the limited studies so far.</p>\n\n<p>The trouble is when you want to combine them all. FMT is still controversial, because it's difficult to control exactly what gets transplanted, and we don't completely (or even mostly) understand the functionality of the gut biota. What if a transplant recipient goes downhill in an unexpected way: was it the fault of the transplant? It may be tough to tell, but lawyers could make enormous amounts of money on the question. Now, if you're working with a <strong>designed</strong> bacteria, the consequences could be even harder to predict, and the legal fault could be even clearer. (Plus there's the \"ick\" factor of poop transplantation.)</p>\n\n<p>To summarize, the basic idea is good, but the proof is in the implementation. </p>\n", "score": 2 }, { "answer_id": 1596, "body": "<p>Yes.</p>\n\n<p>In principle, this is what happens with any vaccine using an <a href=\"http://vaccine-safety-training.org/live-attenuated-vaccines.html\" rel=\"nofollow\">\"attenuated\"</a> virus or bacteria - they have been directed through essentially forced evolution to lose some of their properties that effect virulence - how sick they make you when you get infected.</p>\n\n<p>Some examples of this include the <a href=\"http://www.cdc.gov/flu/about/qa/nasalspray.htm\" rel=\"nofollow\">influenza nasal spray vaccine</a> or the type of <a href=\"http://www.polioeradication.org/Polioandprevention/Thevaccines/Oralpoliovaccine(OPV).aspx\" rel=\"nofollow\">polio vaccine</a> used in developing countries. These are both viral examples, but bacterial examples exist, including tuberculosis.</p>\n\n<p>In a grander sense outside vaccination research, this is theoretically possible, but has some complications. The first is whether or not you can actually get attenuation. There are some microbes (norovirus and <em>C. difficile</em> come to mind) that are very hard to culture, so this kind of directed evolution is difficult. And, if successful, you'd have to reintroduce them in a setting where the \"full strength\" microbes exist, and if those full strength microbes have a selective advantage in the environment, the engineered strains are unlikely to be successful in the long term.</p>\n", "score": 0 } ]

[ "infection", "bacteria", "virus", "resistance" ]

[ { "answer_id": 10959, "body": "<p>You seem to be on a great track. I think you're doing all the right things.</p>\n\n<p>Regarding cinnamon pills: I have indeed read studies regarding cinnamon curbs blood sugar by lowering insulin resistance. Just be aware that it is a warming herb/spice so if you are someone that finds themselves just a bit too hot all the time, this will exacerbate that.</p>\n\n<p>Lastly, here are some other natural remedies that could work, with some support from science:</p>\n\n<ol>\n<li><p>Coptis extract (called Huang Lian in Chinese): Lengthy studies have shown that Coptis extract has antibacterial, antiviral, and anti-inflammatory properties and protect against diabetes, heart disease, and some forms of cancer very well. (source: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609856/\" rel=\"nofollow noreferrer\">[US National Library of Medicine National Institutes of Health</a>)</p></li>\n<li><p>Gynostemma Pentaphyllum Herbal Tea: Gynostemma has been shown in a study to decrease insulin resistance significantly (Source: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20213586\" rel=\"nofollow noreferrer\">US National Library of Medicine National Institutes of Health</a>) </p></li>\n</ol>\n\n<p>Note: I work with a new shop that addresses health concerns, including diabetes: <a href=\"https://rootandspring.com/collections/internal-health/diabetes\" rel=\"nofollow noreferrer\">rootandspring.com</a> and I'm also one of the authors for rootandspring.com, which believes and carries in both these products. </p>\n", "score": 3 } ]

[ "diabetes", "natural-remedy", "type-2-diabetes", "blood-sugar", "glycated-hemoglobin-hba1c" ]

[ { "answer_id": 1612, "body": "<p>More or less: Yes.</p>\n\n<p>Acute and chronic are ways to classify diseases according to duration.</p>\n\n<p><strong><a href=\"http://medical-dictionary.thefreedictionary.com/acute+illness\">Acute</a>*</strong>:</p>\n\n<blockquote>\n <p><em>Acute Illness (1) Any illness that develops quickly, is intense or severe and lasts a relatively short period of time.\n (2) Any condition—e.g., infection, trauma, fracture—with a short (often less than 1 month) clinical course. Acute illnesses usually respond to therapy; a return to a state of complete—pre-morbid—health is the norm.</em></p>\n</blockquote>\n\n<p>from: Segen's Medical Dictionary. © 2012 Farlex via The Free Dictionary</p>\n\n<p><strong><a href=\"http://www.viha.ca/phc_cdm/cdm/what_is_chronic_disease.htm\">Chronic</a></strong>:</p>\n\n<blockquote>\n <p><em>Chronic diseases are different. They usually develop slowly, last a long time, and are often progressive and incurable. For many chronic diseases, there is no cure. The long-term effects of a chronic illness may be difficult to predict.</em></p>\n</blockquote>\n\n<p>from: Island health</p>\n\n<p>Note that most, but not all chronic illnesses are incurable. Also, although the illness is present all the time, the symptoms don't have to be. The time periods (which can be quite long) when the person doesn't have symptoms and feels well is called remission. When the symptoms appear this is called exacerbation or relapse. Many chronic illnesses that can't be cured can be well-managed and the consequences can be mitigated.</p>\n\n<p>There are other categories between chronic and acute:</p>\n\n<p><a href=\"http://medical-dictionary.thefreedictionary.com/subacute\">subacute</a> - which can refer to duration (between acute and chronic, but closer to acute), to severity (often duration and severity combined: moderate) or it is sometimes used to denote a condition in a person who appears to be clinically well (although there are better terms for this, IMO).</p>\n\n<p>subchronic - usually longer than acute, but limited in time (duration of illness is for about a year).</p>\n\n<p>Subacute and subchronic (along with acute and chronic) are also used in toxicology to refer to classification of toxicity according to duration of exposure.</p>\n\n<hr>\n\n<p>There is no universal duration time for all illnesses, which would serve as the limit based on which the illness would be acute or chronic. The duration based on which conditions are classified often vary across different fields of medicine (i.e. different organs/organ systems). Consider these two examples:</p>\n\n<blockquote>\n <p><em>Acute sinusitis - Duration of illness less than 3 weeks.</em></p>\n \n <p><em>Sub acute sinusitis - Duration of illness ranging between 3-6 weeks.</em></p>\n \n <p><em>Recurrent sinusitis - Recurrent sinusitis with disease free periods in-between attacks.</em></p>\n \n <p><em>Chronic sinusitis - Duration of illness is more than 6 weeks</em></p>\n</blockquote>\n\n<p>from: <a href=\"https://books.google.rs/books?id=YwSuBQAAQBAJ&amp;pg=PA130&amp;dq=illness+classification+according+to+duration&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=illness%20classification%20according%20to%20duration&amp;f=false\">Role of Imaging in Rhinology</a> edited by Geetha Ramamoorthy</p>\n\n<blockquote>\n <p><em>Cases of low back pain can be classified according to duration as follows:</em></p>\n \n <p><em>Acute: less than 6 weeks</em></p>\n \n <p><em>Subacute: between 6 and 12 weeks</em></p>\n \n <p><em>Chronic: more than 12 weeks</em></p>\n</blockquote>\n\n<p>from: <a href=\"https://books.google.rs/books?id=G7uXK9Z2TSoC&amp;pg=PA688&amp;dq=classification+of+diseases++%22according+to+duration+%22&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=classification%20of%20diseases%20%20%22according%20to%20duration%20%22&amp;f=false\">Integrative Medicine</a> by David Rakel</p>\n", "score": 6 } ]

[ "terminology" ]

[ { "answer_id": 1943, "body": "<p>I found these water injectors on Amazon which squirt a thin stream of water for several dozen seconds and have a curved tip that can reach back into the crevices of tonsils. I was able to remove several of the tonsilliths. The tips are slightly rough but I suppose they can be cut or filed. Shining a flashlight with the other hand lets you see what you are doing. I had hoped for a vacuum solution but this seems to work for less money. Just take a deep breath and hold your breath while doing it.</p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/B007Y8230G\" rel=\"nofollow\">http://www.amazon.com/gp/product/B007Y8230G</a></p>\n", "score": 1 } ]

[ "dentistry", "otolaryngology" ]

[ { "answer_id": 3874, "body": "<p>Surprisingly, it might not always be necessary, </p>\n\n<p>However, to make one thing clear, if we are talking about caries, the tooth is not merely decayed, it is infected by bacteria. </p>\n\n<blockquote>\n <p>Dental decay is due to the irreversible solubilization of tooth mineral by acid produced by certain bacteria that adhere to the tooth surface in bacterial communities known as dental plaque.</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK8259/\" rel=\"nofollow\">Microbiology of Dental Decay and Periodontal Disease</a> (chapter of \"Medical Microbiology\") </p>\n\n<p>There are multiple studies on what happens if not all of the infection is removed prior to tooth filling. For example <a href=\"http://link.springer.com/article/10.1007/s00784-006-0033-8\" rel=\"nofollow\">The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14–18 months</a></p>\n\n<blockquote>\n <p>Interference in environmental conditions by partial dentine caries removal and tooth sealing arrests lesion progression, suggesting that complete dentine caries removal is not essential to control caries progression.</p>\n</blockquote>\n\n<p>This suggests that as soon as the tooth is sealed, the infection doesn't spread deeper. One meta study reached the conclusion:</p>\n\n<blockquote>\n <p>Based on reviewed studies, incomplete caries removal seems advantageous compared with complete excavation, especially in proximity to the pulp. However, evidence levels are currently insufficient for definitive conclusions because of high risk of bias within studies.</p>\n</blockquote>\n\n<p><a href=\"http://jdr.sagepub.com/content/92/4/306.short\" rel=\"nofollow\">Incomplete Caries Removal: A Systematic Review and Meta-analysis</a></p>\n\n<p>However, until this proves to be a very clear benefit with good evidence, the recommendation will be to remove the complete infection, for fear of it spreading deeper under the filling and/or the tooth <a href=\"http://jdr.sagepub.com/content/89/11/1270.short\" rel=\"nofollow\">getting weaker</a>. Especially for not very deep infections, removing it all may be simpler and need less follow-up. </p>\n", "score": 2 } ]

[ "dentistry" ]

[ { "answer_id": 3577, "body": "<p>The answer to your specific question in particular, is rather indefinitive. </p>\n\n<p>However, when a the bean/extract of the <a href=\"https://en.wikipedia.org/wiki/Coffea_canephora\" rel=\"noreferrer\">Coffea canephora plant</a> is used in a strong brew of black coffee it was shown to significantly defend the teeth from bacteria upon exposure! \n<a href=\"http://www.webmd.com/oral-health/guide/dental-health-cavities\" rel=\"noreferrer\">Cavities</a>, are caused by bacteria!</p>\n\n<p>The conclusion of this <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24909065\" rel=\"noreferrer\">study</a> clearly shows that the very high polyphenol content, in the bean/extract from the coffee plant caused the bacterial cells to burst or lyse. Further more, there is evidence that it <em>may</em> aid strengthening of the teeth as, when the bacteria lyse calcium is released into the medium. </p>\n\n<p>Additionally, a study in the same agenda proves that the high caffiene content in the Robusta bean, from the Coffea canephora plant, contributes to the ability of the bean to cause an <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11853508\" rel=\"noreferrer\">antiadhesive effect</a> in the saliva, preventing the bacteria from initially adhering to the host i.e. the tooth, and hence preventing the receptors on your tooth surface from communicating with the bacterial cells that cause decay/cavities (Streptococcus mutans). Bacterial cells have no vision, they arrive at their destination per say, by cell signalling so, interfering with the receptor sites on your teeth means that they have a loss of direction.</p>\n\n<p>When the bacteria do successfully attach to the teeth they <a href=\"https://en.wikipedia.org/wiki/Cell_signaling\" rel=\"noreferrer\">signal</a> other bacterial cells causing colonization on the enamel surface. From there on they synthesize sucrose and henceforth, <a href=\"http://www.nhs.uk/Conditions/Dental-decay/Pages/Causes.aspx\" rel=\"noreferrer\">produce acid</a> as a waste product causing; erosion; decay; cavities. </p>\n", "score": 5 } ]

[ "nutrition", "dentistry", "oral-health" ]

[ { "answer_id": 1712, "body": "<p><a href=\"http://www.nlm.nih.gov/medlineplus/magazine/issues/winter11/articles/winter11pg12.html\" rel=\"nofollow\">National Institutes of Health (NIH) Medline Plus</a> website has the same recommendations as the FDA, broken down by age, sex, and pregnancy status. They cite the 2010 Institute of Medicine (IOM) report <a href=\"http://iom.nationalacademies.org/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx\" rel=\"nofollow\">Dietary Reference Intakes for Calcium and Vitamin D</a> which is very comprehensive and can be downloaded for free.</p>\n\n<p>The report says that: </p>\n\n<blockquote>\n <p>mean calcium absorption (also referred to as “fractional calcium absorption,” which is the percentage of a given dose of calcium that is absorbed) in men and non-pregnant women—across a wide age range— has been demonstrated to be approximately 25 percent of calcium intake</p>\n</blockquote>\n\n<p>However, calcium absorption or bioavailability depends on many factors such as: age, sex, pregnancy, metabolic status (such as obesity), Vitamin D intake (promotes absorption), phytic acid and oxalic acid intake (inhibits absorption), amount of calcium intake itself, etc. See p. 38 of the IOM report</p>\n\n<p>In addition, some things increase <em>elimination</em> of calcium from the body and can also reduce absorption, such as: alcohol, caffeine, and high protein consumption. <a href=\"https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#en1\" rel=\"nofollow\">See the NIH Office of Dietary Supplements</a> page for calcium for more.</p>\n\n<p>Lastly but importantly, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854910/table/tbl1/\" rel=\"nofollow\">this 2010 article in American Journal of Clinical Nutrition</a> directly discusses your question concerning how biovailability is taken into account when establishing Dietary Reference Intakes. For calcium, it says the dietary factors considered were phytate and\noxalate intake (both of which inhibit absorption). </p>\n", "score": 2 } ]

[ "nutrition", "calcium" ]

[ { "answer_id": 1716, "body": "<p>The use of ear buds in it of itself is probably not harmful.</p>\n\n<p>The physical shape and the effort used to place the ear buds can be potential areas of abuse.\nHowever, what has the most real-world potential of being harmful to your ear is most likely what comes out of those ear buds. \nE.g. ear buds are being used to listen to very loud music/sounds.</p>\n\n<blockquote>\n <p>With extended exposure, noises that reach a decibel level of 85 can\n cause permanent damage to the hair cells in the inner ear, leading to\n hearing loss. Many common sounds may be louder than you think…</p>\n \n <ul>\n <li>A typical conversation occurs at 60 dB – not loud enough to cause damage. </li>\n <li>A bulldozer that is idling (note that this is idling, not actively bulldozing) is loud enough at 85 dB that it can cause permanent damage\n after only 1 work day (8 hours). </li>\n <li>When listening to a personal music system with stock earphones at a maximum volume, the sound generated can reach a level of over 100 dBA,\n loud enough to begin causing permanent damage after just 15 minutes\n per day! </li>\n <li>A clap of thunder from a nearby storm (120 dB) or a gunshot (140-190 dB, depending on weapon), can both cause immediate damage.</li>\n </ul>\n</blockquote>\n\n<p>Long term use of ear buds can also cause sensitivity in and around your ear, causing some pain when touched or upon pressure. The size and shape of the ear buds would help to mitigate this, but not everyone's ears are the same exact size and shape.</p>\n", "score": 1 } ]

[ "side-effects", "hearing", "instruments" ]

[ { "answer_id": 1753, "body": "<p>First, let me say that I highly doubt your assertion that workouts make you more likely to get ill than someone who \"just goes to the office &amp; back each day.\" I don't know what you base that assertion on and I think you're 100% wrong until you can provide evidence to support it. Working out and staying fit have the exact opposite effect, if anything. Why are you even doing it if you think being fit makes you sick?</p>\n\n<p>That said, it is true that you touch a lot of surfaces at a gym that many other people touch, and that does indeed open a pathway to infection. I don't know that you touch more surfaces than an office worker does, but for the sake of argument let's suppose you do. </p>\n\n<p><a href=\"http://health.universityofcalifornia.edu/2012/12/13/cold-supplements-from-airborne-to-zinc/\" rel=\"nofollow\">There are many well known prevention strategies</a>, and quite frankly few of them that are actually known to work involve supplements, vitamins or anything else you have to pay for. Most mainly involve soap.</p>\n\n<p>In my personal experience, which comes with significant scientific backing, two simple things will prevent more upper respiratory infections than anything else you can do:</p>\n\n<p>1) <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16553905\" rel=\"nofollow\">Wash your hands -- well and often</a>. And since you can't do that as often as you should, <a href=\"http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html\" rel=\"nofollow\">carry a bottle of alcohol hand sanitizer</a> in your car, your purse, or wherever you'll actually have it when you need it. Use it whenever you leave a public place. And in the gym, use the sanitizer they (should) have all over the place.</p>\n\n<p>2) <a href=\"http://www.cdc.gov/features/rhinoviruses/\" rel=\"nofollow\">Do not ever touch your eyes, nose or mouth with your fingers</a>. No, not ever, not even once. When your eye itches, rub it with a tissue or even your sleeve if that's all you've got. Use napkins or tissues or sleeves or as the absolute last choice, <em>the back</em> of your hand if you must touch your face. Just never touch mucous membranes with bare fingers.</p>\n\n<p>Do those two things, then put your wallet back in your pocket at the vitamins and supplements store, and enjoy your freedom from upper respiratory tract infections.</p>\n", "score": 2 } ]

[ "treatment", "disease" ]

[ { "answer_id": 1793, "body": "<p>I found three well conducted (randomized trial) studies on this topic. Synthesis seems to be that HEPA results to significant reduction in the particulate matter in the air but the objective effects on health remains to be shown.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25896330\" rel=\"nofollow\">Study 1</a>:</p>\n\n<p>HEPA filtration resulted to better air quality. In subjects exposed to traffic-related matter, use of HEPA resulted to lower level of C-reactive protein indicating less intensive systemic inflammation. No effect was when examining subjects exposed to woodsmoke matter.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515693/\" rel=\"nofollow\">Study 2:</a></p>\n\n<p>Subjects were exposed to traffic-realted particles and use of HEPA filtration had no effect on blood pressure, level of C-reactive protein, fibrinogen or tumor necrosis factor alpha-receptor.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893545/\" rel=\"nofollow\">Study 3:</a></p>\n\n<p>Investigators examined subjects exposed to \"regular\" indoor air. HEPA filtration had no effect on microvascular and lung function or the biomarkers of systemic inflammation.</p>\n\n<hr>\n\n<p>My personal opinion is that I strongly believe that use of HEPA filtration has beneficial health effects IF one is subjected to particulate-matter (like traffic induced). The theory is quite solid: we reduce the bad, potentially carcinogenic particulate matter in the air which we breath daily. </p>\n\n<p>As so, it is very reasonable to assume that intervention has it´s advantages. What they are, remains to be shown. It should be noted that these studies mentioned investigate only the short term effects. It reasonable to assume that long-term effects are evident (lung cancer, chronic bronchitis, COPD etc.)</p>\n", "score": 3 }, { "answer_id": 1788, "body": "<p>Not knowing about HETA air filters some general information: Small particles in air may cause cancer or other lung diseases, but preferably when inhaled in large amounts for a long time(>10 years). In regions of low small-particle-pollution you won't need any air filter, in regions with high pollution this may cause health damage. (<a href=\"http://www.who.int/mediacentre/factsheets/fs313/en/\" rel=\"nofollow\">http://www.who.int/mediacentre/factsheets/fs313/en/</a>) In a highly polluted area (like the air is \"grey\") a filter wouldn't be a bad idea, I would use one. In a low polluted area it won't be too effective. Also, as I assume the place you use it is not air-thight it wont have full effect. Assuming you are 12h/day at home I would be impressed if it has more that 20%-30% effect on your day-intake of PM.</p>\n\n<p>So to answer you question (I did not find numbers, but look at the WHO link above): It may have an significant positive impact to your health in high polluted regions. Many (non published) studies tried to prove that things like this work in low polluted regions but never got significant.</p>\n", "score": 1 } ]

[ "air-quality" ]

[ { "answer_id": 1787, "body": "<p>Basically every movement you make uses energy. The exercice on your photo defenitly uses a moderate amount of energy depending on speed and time you workout. Simplified your lymph moves with every movement, not only when you use your strength; in a healthy body(no heart or vessel disease) it actually moves without any movement. The white blood cells need no movement to 'escape blood vessel', but true, your immune system works better with proper lymph drainage. (simplified) </p>\n\n<p>To answer your question: In assumption you are a 'typical' more or less healthy person, yes, it will be good to exercise (not because of lymph movement though). Every workout you make, even if it is just going round for an hour, cycling or anything else, will improve your health. </p>\n\n<p>Note that 'too much' may do more harm than good.</p>\n", "score": 1 } ]

[ "exercise", "immune-system" ]

[ { "answer_id": 1988, "body": "<p>A list of foods rich in vitamin B3 (niacin) is available <a href=\"http://www.dietitians.ca/Your-Health/Nutrition-A-Z/Vitamins/Food-Sources-of-Niacin.aspx\" rel=\"nofollow\">here</a>. Although meats are the richest source, those are often not soft to chew. However, if you look at that table you'll see that it shouldn't be difficult to consume the RDA even on a vegetarian diet.</p>\n", "score": 2 } ]

[ "nutrition", "micronutrients" ]

[ { "answer_id": 12863, "body": "<p>Skin wrinkles 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>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\n<p><strong>If your lips are pursed whilst you are consuming the lozenge, then over time, wrinkles will form just like they would with other facial movements</strong></p>\n", "score": 1 } ]

[ "smoking", "nicotine", "wrinkles" ]

[ { "answer_id": 4128, "body": "<p>Endorphins are neuropeptides that can bind to opioid receptors, thus exerting an analgesic effect in the brain. You mention a counterpart, which is a badly defined concept in this context. There are other substances that can bind to these opioid receptors (opiods, for one :-)) and substances that can block opioid receptors without triggering them, like naloxone and naltrexone. Those are called opioid antagonist and for example used for treating substance dependence. They don't cause pain, though. </p>\n\n<p>Pain is transmitted in the body through neurons the same way other signals are transmitted. The difference to other signals is in how the brain interprets these signals. If they are coming from pain receptors (nociceptors), they are interpreted as pain. There is no special neurotransmitter for pain, though as all signal transmission, there isn't just one. Pain transmission is also relatively slow compared to some other neuronal activity, having to do with the mixture of neurotransmitter and the way nocireceptors are structured. </p>\n\n<p>For example, for pain generated by heat exposure:</p>\n\n<blockquote>\n <p>The nociceptive axons, (...) begin to discharge only when the strength of the stimulus (a thermal one in the example in Figure 10.1) reaches high levels; at this same stimulus intensity, other thermoreceptors discharge at a rate no different from the maximum rate already achieved within the nonpainful temperature range, indicating that there are both nociceptive and nonnociceptive thermoreceptors.</p>\n</blockquote>\n\n<p>Basically, in this case there are two signals being transmitted, one normal temperature signal and one pain signal. </p>\n\n<p>Stress is not a signal that is transmitted through any pathway in the human body. With high stress levels come changes in brain chemistry, for example in cortisol and adrenaline levels, but again, these aren't exactly counterparts of endorphins. </p>\n\n<p><em>Sources</em></p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104618/\" rel=\"nofollow\">Understanding Endorphins and Their Importance in Pain Management</a> </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21916528\" rel=\"nofollow\">Mechanisms of pain transmission and pharmacologic management</a></p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK10965/\" rel=\"nofollow\">Nociceptors</a></p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19630726\" rel=\"nofollow\">Opioid antagonists for pharmacological treatment of alcohol dependence - a critical review</a></p>\n", "score": 1 } ]

[ "pain", "neurology", "endocrinology", "nervous-system" ]

[ { "answer_id": 1964, "body": "<p>There may be some benefit in using anti-bacterial soaps in more clinical settings where people already have compromised immune systems, but most of the research points to there being no real benefits to using anti bacterial soaps.</p>\n\n<p>Soap works by reducing the surface tension of the oils and dirt on skin, allowing them to be washed away with water. All soaps achieve this. Anti bacterial soaps add agents such as <a href=\"https://en.wikipedia.org/wiki/Triclosan\">triclosan</a> to kill surface bacteria. While it does achieve these aims, it also kills beneficial bacteria that reside on the skin, and has not been proven in studies to reduce infection rates. The US based FDA has <a href=\"http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm\">also raised questions about it</a> increasing bacterial resistance, as well as higher exposure levels than actually reported.</p>\n\n<p>So while there may be beneficial uses in clinical settings, in general for the home, using warm/hot soap and water, combined with <a href=\"http://www.cdc.gov/features/handwashing/\">a good technique</a> for handwashing should be sufficient.</p>\n", "score": 5 } ]

[ "soap" ]

[ { "answer_id": 5081, "body": "<p>The disease associated with low cortisol is known as <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199610173351607\" rel=\"nofollow noreferrer\">adrenal insufficiency</a> (so-called because the <a href=\"http://www.endocrineweb.com/endocrinology/overview-adrenal-glands\" rel=\"nofollow noreferrer\">adrenal glands</a> are responsible for <a href=\"https://en.wikipedia.org/wiki/Cortisol\" rel=\"nofollow noreferrer\">cortisol</a> production). Morning cortisol is not a definitive test for the diagnosis of adrenal insufficiency.¹ That is because cortisol varies according to a circadian rhythm (i.e. with your body's sleep-wake cycle). </p>\n\n<p><img src=\"https://i.stack.imgur.com/alThh.png\" alt=\"caption\"></p>\n\n<p>The x axis represents time across a 24h day.² The transition from dark yellow to light yellow indicates the habitual wake time. The y axis shows plasma cortisol level.</p>\n\n<p>The OP mentioned <a href=\"https://health.stackexchange.com/questions/1968/should-chronic-low-cortisol-be-treated-if-the-patient-has-no-symptoms#comment9767_1968\">in comments</a> that this value was obtained four hours prior to his habitual wake time. As shown on the graph above, this is predictably a trough (i.e. low point) in serum cortisol. On the other hand, the \"normal\" range is likely calibrated for the <em>peak</em> level. (This test is supposed to be done shortly after waking, approximating the peak.) The fact that a value below the normal range was obtained is predictable. </p>\n\n<p>For this reason, a confirmatory test is required to make the diagnosis of adrenal insufficiency. This generally involves administration of <a href=\"https://en.wikipedia.org/wiki/Adrenocorticotropic_hormone\" rel=\"nofollow noreferrer\">ACTH (adrenocorticotropic hormone)</a> &ndash; the physiologic stimulator of cortisol production &ndash; and assaying cortisol levels at fixed intervals afterward to evaluate for an adequate rise. Only after inadequate adrenal response is demonstrated can the diagnosis be made.³ </p>\n\n<p>In direct response to the OP's questions, then:</p>\n\n<blockquote>\n <p>It is normal to treat low cortisol levels....? </p>\n</blockquote>\n\n<p>No, except in exceptional circumstances, a confirmatory test is required before treatment. </p>\n\n<blockquote>\n <p>It is normal to treat...without symptoms?</p>\n</blockquote>\n\n<p>The <a href=\"http://www.niddk.nih.gov/health-information/health-topics/endocrine/adrenal-insufficiency-addisons-disease/Pages/fact-sheet.aspx\" rel=\"nofollow noreferrer\">symptoms of adrenal insufficiency are notoriously vague</a>, and the OP indicates that there actually was some complaint prompting the testing. Inadequate treatment of adrenal insufficiency can go unnoticed until a stressor triggers a life-threatening condition known as <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000357.htm\" rel=\"nofollow noreferrer\">adrenal crisis</a>. If a true inadequate response to ACTH is demonstrated, this should be treated. </p>\n\n<blockquote>\n <p>Is it normal to not do it any further screening of possible causes (my doctor didn't)?</p>\n</blockquote>\n\n<p>It is standard to follow a low cortisol level with a ACTH stimulation test. On the other hand, if this is only mildly below the reference range of your lab, given the likelihood that what has actually been measured is closer to a trough than a peak cortisol level, one could imagine a scenario where it might be reasonable to drop it. In addition to the reference range, the details of the presenting complaint and any physical exam or laboratory abnormalities would be necessary to make a decision in that regard. This part is beyond the scope of Health.SE.</p>\n\n<hr>\n\n<p>_{\n1. A normal value, on the other hand, can <em>rule out</em> the condition.<br>\n}</p>\n\n<p>_{\n2. Note that the numbers are arbitrary; <em>circadian</em> time is not equal to <em>clock</em> time even if they do correspond in an individual accustomed to waking at 0800.\n} </p>\n\n<p>_{\n3. As with most things in life, it's actually more complicated. It's possible to have <em>secondary</em> adrenal insufficiency (where the problem involves the brain's production of ACTH) and still \"pass\" an ACTH stim. test if the condition is of recent onset and the adrenals have not yet atrophied. \n} </p>\n\n<hr>\n\n<p>_References</p>\n\n<p>_{\nNicola Neary and Lynnette Nieman. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928659/\" rel=\"nofollow noreferrer\"><em>Adrenal Insufficiency- etiology, diagnosis and treatment</em></a> Curr Opin Endocrinol Diabetes Obes. 2010 Jun; 17(3): 217–223.\n} </p>\n\n<p>_{\nMark S. Rea et al. <a href=\"http://www.hindawi.com/journals/ije/2012/749460/\" rel=\"nofollow noreferrer\"><em>Relationship of Morning Cortisol to Circadian Phase and Rising Time in Young Adults with Delayed Sleep Times</em></a> International Journal of Endocrinology, 2012.\n}</p>\n", "score": 9 } ]

[ "endocrinology", "topical-cream-gel", "cortisol", "asymptomatic" ]

[ { "answer_id": 2001, "body": "<p>I should look at the actions of American Psychiatric Assocation (APA) (<a href=\"http://roundtable.menloschool.org/issue10/3_Taylor_MS_Roundtable10_Fall_2011.pdf\" rel=\"nofollow noreferrer\">1</a>).</p>\n\n<blockquote>\n <p>Although American homosexuals today are still struggling for equal\n rights, no shift has been more drastically beneficial for the status\n of homosexuality than its declassification as a mental illness. The\n American Psychiatric Association’s Board of Trustees passed this\n groundbreaking decision unanimously on December 15, 1973, and\n subsequently released a statement that rejected legal discrimination\n on the basis of sexual orientation. In the publication of its\n monumental decision to remove homosexuality from the Diagnostic and\n Statistical Manual of Mental Disorders (DSM), the board cited “review\n of evidence[,]...changing social norms and growing gay-rights\n activism.”</p>\n</blockquote>\n\n<p>And indeed, Medicine has a dark history when homosexuality was regarded as mental illness. </p>\n\n<p><a href=\"http://collections.nlm.nih.gov/catalog/nlm:nlmuid-26520130R-bk\" rel=\"nofollow noreferrer\">Classification of diseases as adopted by the Massachusetts General Hospital (1919)</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/dVBw5.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/dVBw5.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>In the <a href=\"http://collections.nlm.nih.gov/catalog/nlm:nlmuid-58010590R-bk\" rel=\"nofollow noreferrer\">military medicine</a> in the year 1949 homosexuality was classified under \"psychopathy\".</p>\n\n<p><a href=\"https://i.stack.imgur.com/72Ujf.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/72Ujf.jpg\" alt=\"enter image description here\"></a></p>\n\n<p><a href=\"https://openlibrary.org/books/OL5604593M/Noyes&#39;_modern_clinical_psychiatry.\" rel=\"nofollow noreferrer\">A \"modern\" perspective</a> in 1968 was to consider pedophilia as a subtype of homosexuality.</p>\n\n<p><a href=\"https://i.stack.imgur.com/AQfHB.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/AQfHB.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>Another <a href=\"https://openlibrary.org/books/OL5704106M/Modern_perspectives_in_world_psychiatry.\" rel=\"nofollow noreferrer\">\"modern\" perspective</a> in 1971 considered LSD as a \"treatment\" for homosexuality.</p>\n\n<p><a href=\"https://i.stack.imgur.com/Vu5y4.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Vu5y4.jpg\" alt=\"enter image description here\"></a> </p>\n\n<p>So, yes, things were slightly different back in the days.</p>\n", "score": 6 } ]

[ "history", "icd-intrntl-classif-disea" ]

[ { "answer_id": 3684, "body": "<p>Yes, or at least waterproof enough to bath and swim while wearing it. </p>\n\n<p>According to the <a href=\"https://www.arhp.org/Publications-and-Resources/Patient-Resources/fact-sheets/Contraceptive-Patch\" rel=\"nofollow\">Association of Reproductive Health Professionals</a>:</p>\n\n<blockquote>\n <p>You can wear the patch while bathing, showering, swimming, and exercising</p>\n</blockquote>\n\n<p>And <a href=\"http://www.nhs.uk/conditions/contraception-guide/pages/contraceptive-patch.aspx\" rel=\"nofollow\">the NHS</a>:</p>\n\n<blockquote>\n <p>You can wear the patch in the bath, in the swimming pool and while playing sports</p>\n</blockquote>\n\n<p>And according to the review <a href=\"http://www.researchgate.net/publication/276966686_Transdermal_EthinylestradiolNorelgestromin\" rel=\"nofollow\">Transdermal ethinylestradiol/norelgestromin: a review of its use in hormonal contraception</a>. </p>\n\n<blockquote>\n <p>During three efficacy studies in which more than 70 000 patches were used (7-day duration of application), 1.8% were replaced because of complete detachment and 2.9% for partial detachment. Neither living in a humid climate nor physical activity, including exercise, heat, <strong>humidity, and water immersion</strong>, seemed to affect patch adhesion</p>\n</blockquote>\n\n<p>If the patch detaches, it needs to be replaced, but water immersion such as bathing and swimming does not appear to significantly increase the risk of it happening. Water immersion also <a href=\"http://www.sciencedirect.com/science/article/pii/S0015028201032617\" rel=\"nofollow\">doesn't reduce the hormone uptake of the patient</a></p>\n", "score": 1 } ]

[ "contraception" ]

[ { "answer_id": 3886, "body": "<p>I only looked for studies on the effect of exercise, there may be more in regards to dietary changes. </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587394/\" rel=\"nofollow\">The impact of brief high-intensity exercise on blood glucose levels</a> is a review article analysing several articles on this subject, with studies in both patients with and without diabetes. </p>\n\n<p>One looked at two weeks of exercise:</p>\n\n<blockquote>\n <p>Two weeks of sprint interval training increased insulin sensitivity up to 3 days postintervention</p>\n</blockquote>\n\n<p>Original study: <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20547683\" rel=\"nofollow\">Short-term sprint interval training increases insulin sensitivity in healthy adults but does not affect the thermogenic response to beta-adrenergic stimulation</a></p>\n\n<p>Others looked at single training sessions of high intensity interval training (HIIT):</p>\n\n<blockquote>\n <p>low volume SIT with as little as 7.5 minutes of high-intensity exercise per week may be a time-efficient exercise strategy to help control blood glucose in diabetic patients and improve insulin sensitivity in nondiabetic adults.</p>\n</blockquote>\n\n<p>However, this is a brief effect:</p>\n\n<blockquote>\n <p>it is [...] uncertain if any improvements in blood glucose achieved by a brief intervention would be sustained over a longer period</p>\n</blockquote>\n\n<p>But there does seem to be a short-term effect for training at high intensities that does not need to be sustained for long - typical exercise duration in these studies was a couple of sprints at a few minutes of high intensity training per session plus warm up. </p>\n", "score": 1 } ]

[ "diabetes" ]

[ { "answer_id": 7240, "body": "<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16028436\" rel=\"nofollow\">This '05 study</a> found a positive effect from exercise. Here middle aged (>45y) subjects with chronic idiopathic constipation had their Rome symptoms (straining, hard stools, and incomplete evacuation) improved by a 30 min cardio workout and 11 minute home programe. </p>\n\n<p>On the other hand, this <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9824122\" rel=\"nofollow\">'98 study</a> found there was little or no positive effect on patients with the same diagnosis, this study however, was smaller and of shorter duration.</p>\n\n<p>However, I could find no study in favor (or against) of exercise helping <em>occasional</em> constipation. It is in the nature of this condition hard to gather subject for a controlled study, and we can assume the clinical support will stay at anecdotal level for some time being.</p>\n\n<p>As exercise a lot of other benefits, it should in worst case be a harmless recommendation. Best case there is some effect that is not yet clinically documented.</p>\n", "score": 1 } ]

[ "exercise", "digestion" ]

[ { "answer_id": 3091, "body": "<p>There are many reasons why fried food can be harmful. The chief reason is related to the oil content in these foodstuffs.</p>\n\n<ol>\n<li>It has high oil content which may not be good if consumed in large amounts. Fried food cannot be tolerated by people who have undergone gall bladder removal.</li>\n<li>Oils are heated at high temeperatures and in many fried-food outlets (or in general practice), reheated many times. This leads to some chemical reactions, some of which include cracking of the hydrocarbon chains and isomerization. These reactions can produce carcinogenic substances (<a href=\"http://dx.doi.org/10.1017/S0007114510002229\">Srivastava et al. 2010</a>).</li>\n<li>Oil vapours from these food can also cause respiratory distress in some people, especially asthmatics. </li>\n</ol>\n", "score": 6 } ]

[ "nutrition", "gastroenterology" ]

[ { "answer_id": 4253, "body": "<p>There isn't much literature on this, so my best guess might have to suffice. </p>\n\n<p>OCD is on the anxiety spectrum of disorders. Vortioxetine is ineffective for GAD and therefore may not help remediate OCD symptoms.</p>\n\n<p><strong>Edit</strong></p>\n\n<p>Upon doing more research, I found evidence that both supports Vortioxetine as a treatment for GAD, and evidence that claims it is equivalent to placebo. Talk about confusing! </p>\n\n<p>In regards to OCD, Reference 5 states that their evidence suggests newer \"agents (ADs) should be tested more comprehensively.\". It doesn't state that any of the newer antidepressants (which includes Vortioxetine) were ineffective. Based on Vortioxetine's mixed results for GAD, and the very vague and tentative for OCD, Vortioxetine is possibly an effective treatment for OCD.</p>\n\n<p><strong>References</strong></p>\n\n<ol>\n<li>(Against) A randomized, double-blind, fixed-dose study comparing the efficacy and tolerability of vortioxetine 2.5 and 10 mg in acute treatment of adults with generalized anxiety disorder., <a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/24424707/?i=4&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/m/pubmed/24424707/?i=4&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]</a></li>\n<li>(Against) A randomised, double-blind, placebo-controlled, duloxetine-referenced study of the efficacy and tolerability of vortioxetine in the acute treatment of adults with generalised anxiety disorder, <a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/24341301/?i=5&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/m/pubmed/24341301/?i=5&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]</a></li>\n<li>(For) Vortioxetine, a multimodal antidepressant for generalized anxiety disorder: a systematic review and meta-analysis., <a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/25851751/?i=2&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/m/pubmed/25851751/?i=2&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]</a></li>\n<li>(For) Vortioxetine (Lu AA21004) in generalized anxiety disorder: results of an 8-week, multinational, randomized, double-blind, placebo-controlled clinical trial, <a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/22898365/?i=14&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/m/pubmed/22898365/?i=14&amp;from=vortioxetine%20anxiety&amp;sort=[relevance]</a></li>\n<li>An updated review of antidepressants with marked serotonergic effects in obsessive-compulsive disorder., <a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/24766145/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/m/pubmed/24766145/</a></li>\n</ol>\n", "score": 3 } ]

[ "medications", "mental-health", "antidepressants", "obsessive-compulsive" ]

[ { "answer_id": 4353, "body": "<p>First, a correction. ADHD is NOT caused by a dopamine deficiency. It is way more complex than that, but i won't go into detail here. The best treatments for ADHD alter dopamine activity (and they are very effective), but that doesn't mean the cause for ADHD is a dopamine deficiency.</p>\n\n<p>So the question is how vortioxetine can help in ADHD. Well, the short answer is that one major part of ADHD (the \"look-a-squirrel-forget-what-you-were-doing part\") is working memory. Vortioxetine has been shown to have positive effects on working memory, at least in depressed patients. It wouldn't be too far out to assume it could have similar effects for ADHD-patients.</p>\n\n<p>The long answer is that <strong>different neurotransmitter systems are interconnected</strong>, so that increasing signaling in one can increase or decrease signaling in another. It gets even more complex when you add receptor subtypes to the picture. Serotonin has 14 receptor subtypes that we know of, with different roles and effects. Then add that the same neurotransmitter on the same receptor has different functions depending on where it is located in the body or brain. Now you have a nice, complex picture.</p>\n\n<p>Vortioxetine activates 5-HT1A (serotonin 1A), which increases dopamine signaling in the prefrontal cortex and deactivates 5-HT1B, which also increases dopamine signaling in the PFC (same neurotransmitter, same location, different receptor, opposite effect). It also deactivates 5-HT3 and 5-HT7, both of which have effects that strengthen signaling in the PFC (through the serotonin, noradrenalin and glutamate systems). All of these effects could be relevant for improving ADHD-symptoms.</p>\n\n<p>So that's how it could help in ADHD.</p>\n", "score": 3 } ]

[ "medications", "mental-health", "adhd", "antidepressants" ]

[ { "answer_id": 3119, "body": "<p>I checked literature on this and found that following general measures are helpful to prevent acute mountain sickness, high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE):</p>\n\n<ul>\n<li>These conditions generally occur at altitudes higher than 2500 meters. Beyond that, one should not ascend more than 300-500 meters per day.</li>\n<li>Slow ascent, e.g. traveling by road or rail, will increase time for acclimatization and reduce risk of mountain sickness.</li>\n<li>Taking rest and avoiding exercise for first 2-3 days. </li>\n<li>High carbohydrate diet may be helpful</li>\n<li>One should avoid alcohol and sedatives</li>\n</ul>\n\n<p>Following medicines have been shown to reduce the risk and are generally recommended for persons who are susceptible (e.g. those who suffered such episodes on their previous visits to high altitudes):</p>\n\n<ul>\n<li>Acetazolamide</li>\n<li>Nifedipine</li>\n<li>Dexamethasone</li>\n<li>Tadalafil, sildenafil</li>\n<li>Other drugs which have been used are bosentan and inhaled salmeterol. </li>\n</ul>\n\n<p>Above medicines should be started one day prior and continued for 2-3 days after reaching high altitude.</p>\n\n<p>If acute mountain illness does occur, following measures are useful to treat these conditions:</p>\n\n<ul>\n<li>Rest</li>\n<li>Oxygen</li>\n<li>Hydration</li>\n<li>Hyperbaric bag or chamber</li>\n<li>Drugs listed above can be used for treatment also. Dexamethasone is especially useful for high altitude cerebral edema while nifedipine is most commonly used for high altitude pulmonary edema. Nitric oxide (NO) and oxygen - nitric oxide mixture inhalation have also been shown to be helpful.</li>\n<li>Descent to lower altitude is most important if symptoms do not resolve quickly.</li>\n<li>Frusemide (or Furosemide), the classical drug for pulmonary congestion, has limited usefulness in treatment of high altitude pulmonary edema. It may cause hypovolemia (reduced blood volume) and hypotension (fall in blood pressure). </li>\n</ul>\n\n<p>Some References:</p>\n\n<ul>\n<li><p><a href=\"http://emedicine.medscape.com/article/300716-overview\" rel=\"nofollow\">http://emedicine.medscape.com/article/300716-overview</a></p></li>\n<li><p><a href=\"http://cardiovascres.oxfordjournals.org/content/72/1/41\" rel=\"nofollow\">http://cardiovascres.oxfordjournals.org/content/72/1/41</a></p></li>\n</ul>\n", "score": 4 } ]

[ "brain", "lungs", "heart-disease", "edema" ]

[ { "answer_id": 3218, "body": "<blockquote>\n <p>Do the antimicrobial properties of honey counteract the probiotic properties of yogurt?</p>\n</blockquote>\n\n<p>It appears not to. Studies using 5% (w/w) clover honey had no effect on Steptococcus thermophilus, Lactobacillus delbrukeii subsp bulgaricus and probiotics Lactobacillus acidophilus and Bifidobacterium bifidum.</p>\n\n<p>You are correct that honey has been found to have antimicrobial properties against a wide range of pathogens. However, these studies are done for the scenario of using undiluted honey as a wound dressing. For example, from a recent study:</p>\n\n<blockquote>\n <p>For at least 2700 years, honey has been used by humans to treat a variety of ailments <em>through topical application</em>, but only recently have the antiseptic and antimicrobial properties of honey been discovered. ...Clinical studies have demonstrated that application of honey to severely infected cutaneous wounds rapidly clears infection from the wound and improves tissue healing. </p>\n</blockquote>\n\n<p>The broad-spectrum antimicrobial properties of honey are confirmed but the exact mechanism is unclear; it could be due to the acidity, honey's osmotic effect, presence of bacteriostatic and bactericidal factors (hydrogen peroxide, antioxidants, lysozyme, polyphenols, phenolic acids, flavonoids, methylglyoxal, and bee peptides), etc. </p>\n\n<p>From a review atricle,</p>\n\n<blockquote>\n <p>A bacterial level greater than 10⁵ organisms per gram of wound tissue has been found to have a deleterious effect on wound healing in surgical and chronic wounds. [This article discusses] the inherent complexities of the clinical use of medical-grade honey... and to select clinical entities in patients who may benefit from treatment with medical-grade honey, using the evidence indicators such as the Cochrane reviews.</p>\n</blockquote>\n\n<p>Studies have demonstrated that the antibacterial properties of honey are more complex than just high sugar content alone (which decreases tissue fluid to which it is applied, inhibiting bacterial growth.) As referred to above, honey contains an enzyme that converts glucose to hydrogen peroxide, an antibacterial agent. Also, as you mentioned, the antibacterial properties of honey appear to vary depending on the floral source. </p>\n\n<blockquote>\n <p>Honey derived from Leptospermum trees (manuka) or Echium vulgare bush (viper's bugloss) showed antibacterial properties independent of hydrogen peroxide. It is believed that another, yet undiscovered, component of honey is responsible for the antibacterial properties.</p>\n</blockquote>\n\n<p>As mentioned above, phenols are significant:</p>\n\n<blockquote>\n <p>Antioxidant potential was dependent of honey extract concentration and the results showed that dark honey phenolic compounds had higher activity than the obtained from clear honey.</p>\n</blockquote>\n\n<p>There have been interesting studies of susceptibility of food-borne pathogen to honey, or potential for treatment of stomach ulcers with honey, but these are <em>in vitro</em> </p>\n\n<blockquote>\n <p>Assessment of the minimum inhibitory concentration by inclusion of manuka honey in the agar showed that all seven isolates tested had visible growth over the incubation period of 72 h prevented completely by the presence of <strong>5%</strong> (v/v) honey. </p>\n</blockquote>\n\n<p>Even in vitro, significant minimum inhibitory concentration started at about 9%, and against some organisms, 25%.</p>\n\n<p>One paper isolating methylglyoxal (MGO) (and other agents) found Manuka (Leptospermum scoparium) honey had very high amounts of MGO, up to 100-fold higher compared to conventional honeys. </p>\n\n<blockquote>\n <p>Whereas most of the honey samples investigated showed no inhibition in dilutions of 80% (v/v with water) or below, the samples of Manuka honey exhibited antibacterial activity when diluted to 15–30%, which corresponded to MGO concentrations of 1.1–1.8 mM. This clearly demonstrates that the pronounced antibacterial activity of New Zealand Manuka honey directly originates from MGO.</p>\n</blockquote>\n\n<p>All this is to say concentration (as well as the source of the honey) matters. If one of the most consistently antibacterial honeys (manuka)has to be present in concentrations of at least 15% to be significantly antibacterial in vitro, unless you're chugging manuka honey, I don't <em>think</em> it will have a deleterious effect on your intestinal flora.</p>\n\n<p>_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2621.2001.tb16134.x/abstract\" rel=\"nofollow\">Growth and Acid Production by Lactic Acid Bacteria and Bifidobacteria Grown in Skim Milk Containing Honey</a>}\n_{<a href=\"http://journals.lww.com/americantherapeutics/Abstract/2014/07000/Antimicrobial_Properties_of_Honey.13.aspx\" rel=\"nofollow\">Antimicrobial Properties of Honey</a>}<br>\n_{<a href=\"http://journals.lww.com/aswcjournal/Fulltext/2011/01000/Use_of_Honey_in_Wound_Care__An_Update.11.aspx\" rel=\"nofollow\">Use of Honey in Wound Care: An Update</a>}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0278691508005607\" rel=\"nofollow\">Antioxidant and antimicrobial effects of phenolic compounds extracts of Northeast Portugal honey</a>}<br>\n_{<a href=\"http://jrs.sagepub.com/content/87/1/9.short\" rel=\"nofollow\">Susceptibility of Helicobacter Pylori to the Antibacterial Activity of Manuka Honey</a>}<br>\n_{<a href=\"http://www.biomedcentral.com/1472-6882/9/34/\" rel=\"nofollow\">The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey</a>}<br>\n_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1002/mnfr.200700282/abstract\" rel=\"nofollow\">Identification and quantification of methylglyoxal as the dominant antibacterial constituent of Manuka (Leptospermum scoparium) honeys from New Zealand</a>} </p>\n", "score": 2 } ]

[ "diet", "digestion", "stomach" ]

[ { "answer_id": 3440, "body": "<blockquote>\n <p>Once hemostasis was achieved, the hemispherectomy cavity was copiously irrigated until the fluid was crystal clear. While keeping the cavity dry, a layer of Gelfoam and Surgicel was placed over the residual raw surface. This allows these materials to adhere and, hopefully, form the basis of an adhesive layer that will preclude subsequent hemorrhage.<strong>We have discovered no adverse effects from leaving the hemispherectomy cavity unfilled with saline</strong>. The dura was closed in a water-tight fashion and was not stitched medially to the falx and tentorium or laterally to the inner table of the skull. <strong>Eventually the hemispherectomy cavity fills with CSF</strong></p>\n</blockquote>\n\n<p><a href=\"http://www.c3.hu/~mavideg/jns/642696june1.html\" rel=\"nofollow\">Hemispherectomy: a hemidecortication approach and review of 52 cases </a></p>\n\n<p>The <a href=\"http://www.surgeryencyclopedia.com/Fi-La/Hemispherectomy.html\" rel=\"nofollow\">Encyclopedia of Surgery </a> also does not mention the cavity being filled during surgery. </p>\n\n<p>The hemisphere that is left does not move towards the center, as can be seen in MRI scans, for example in this paper: <a href=\"http://www.thetp.org/article/view/3760/5032\" rel=\"nofollow\">Hemispherectomy in the treatment of seizures: a review</a></p>\n", "score": 3 } ]

[ "brain", "neurology", "csf-cerebrospinal-fluid" ]

[ { "answer_id": 3283, "body": "<p>I checked myself and found that yes, prediabetes is also a risk factor for coronary heart disease.</p>\n\n<p>Prediabetes is the condition when fasting blood sugar is 100-125 mg/dl or 2 hour blood sugar is 140-200 mg/dl (more than 125 fasting or >200 after 2 hours will be diagnostic of diabetes).</p>\n\n<p>A number of longitudinal studies have shown that prediabetes is associated with increased risk of coronary heart disease which may cause angina, heart attack and sudden death.</p>\n\n<p>Hence, lifestyle modification is advised to all persons with prediabetes. These include regular exercise, maintaining ideal body weight, stopping smoking, keeping blood cholesterol and blood pressure under control.</p>\n\n<p>Persons who have other risk factors of coronary heart disease also, such as high blood pressure, obesity, increased blood lipids etc, may also be treated with metformin, a commonly used drug for control of diabetes.</p>\n\n<p>These interventions reduce the risk of progression to diabetes and occurrence of its complications including coronary heart disease.</p>\n\n<p>Some also recommend use of aspirin and/or statins for persons at high risk for coronary heart disease.</p>\n\n<p>Reference: <a href=\"http://care.diabetesjournals.org/content/30/3/753.full.pdf+html\" rel=\"noreferrer\">http://care.diabetesjournals.org/content/30/3/753.full.pdf+html</a></p>\n", "score": 5 } ]

[ "diabetes", "heart-disease" ]

[ { "answer_id": 3282, "body": "<p>The FDA requires labeling of prescription medications. Pharmacies will often attach a label on the bottle for patient-dependent behaviors. Therefore the easiest way (in the US) to tell if you need to take a medication with food or on an empty stomach is by reading the prescription bottle:</p>\n\n<p><a href=\"https://i.stack.imgur.com/HJCCJ.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/HJCCJ.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>A patient can also ask for a <em>package insert</em>, which will contain much more information.</p>\n\n<p>For OTC medications, a readable label is also required with quite a lot of the necessary information.</p>\n\n<p>However, supplements are not governed by the FDA, therefore, the makers are under no obligation to include pertinent information, relying on the consumer to know the particulars for that supplement.</p>\n\n<p>The only practical way to know whether your particular supplement should be taken with food is to look up that information yourself. </p>\n\n<p>In the case of glutathione, for example, a reliable source of information will be hard to find, because anyone can make any claim about a supplement and often will (for monetary gain.)</p>\n\n<p>Even so, there exist some resources, such as Examine.com and PubMed. From PubMed:</p>\n\n<blockquote>\n <p>Research suggests that glutathione is not orally bioactive, and that very little of oral glutathione tablets or capsules is actually absorbed by the body.</p>\n</blockquote>\n\n<p>So it doesn't seem to matter if it's on an empty or full stomach.</p>\n\n<p>From Examine.com:</p>\n\n<blockquote>\n <p>There is, currently, no known benefit of orally ingested glutathione that cannot be more readily mimicked by supplementation of N-acetylcysteine and couldn't theoretically be aided by a high protein diet including dietary sources rich in L-cysteine (whey protein).</p>\n</blockquote>\n\n<p>However, for <a href=\"http://examine.com/supplements/n-acetylcysteine/\" rel=\"nofollow noreferrer\">N-Acetylcysteine</a>, Examine.com gives this advice:</p>\n\n<blockquote>\n <p>Does Not Go Well With\n - Activated charcoal (may reduce absorption of N-acetylcysteine)</p>\n</blockquote>\n\n<p>as well as a lot of other information.</p>\n\n<p>Examine.com is an interesting and promising site, but its editors aren't donating their time for the love on mankind only. It is a for profit company, but one that at least makes use of easily available scientific research. </p>\n\n<p>This should not be seen as an endorsement. As the disclaimer on that site states:</p>\n\n<blockquote>\n <p>Examine.com is intended to be used for educational and information purposes only. Examine.com and its Editors do not advocate nutritional supplementation over proper medical advice or treatment and this sentiment will never be expressed through pages hosted under Examine.com. If using any pharmaceuticals or drugs given to you by a doctor or received with a prescription, you must consult with the doctor in question or an equally qualified Health Care Professional prior to using any nutritional supplementation. If undergoing medical therapies, then consult with your respective Therapist or Health Care Professional about possible interactions between your Treatment, any Pharmaceuticals or Drugs being given, and possible nutritional supplements or practices hosted on Examine.com. (Etc.)</p>\n</blockquote>\n\n<p><strong>TL;DR:</strong> You're pretty much on your own as applies to this.</p>\n\n<p>_{<a href=\"http://www.fda.gov/Drugs/ResourcesForYou/ucm163354.htm\" rel=\"nofollow noreferrer\">Drug Interactions: What You Should Know</a>}<br>\n_{<a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/124886#section=Top\" rel=\"nofollow noreferrer\">glutathione at PubMed</a>}<br>\n_{<a href=\"http://examine.com/supplements/glutathione/\" rel=\"nofollow noreferrer\">Glutathione at Examine.com</a>}</p>\n", "score": 4 } ]

[ "supplement" ]

[ { "answer_id": 3441, "body": "<p>Yes, blood viscosity changes with altitude. \nThis is a study in rats where the control group was kept at normal altitude and the test group at simulated 5500 meters. </p>\n\n<blockquote>\n <p>Besides, RBC counts, hematocrit, <strong>whole blood viscosity</strong>, erythrocyte aggregation index of hypoxia model rats were all notably higher than those of normal control rats respectively.</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/6465620/\" rel=\"nofollow\">Changes in the rheologic properties of blood after a high altitude expedition</a>\nThe effects you are describing is called \"high altitude deterioration\" (HADT) and in patients with this, blood viscosity is one of the symptoms. </p>\n\n<blockquote>\n <p>but other indicators including the <strong>blood viscosity</strong>, hematocrit, hemoglobin concentration and heart rate were higher in patients with HADT</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/26439041\" rel=\"nofollow\">The study of prevalence rate, and clinical characteristics of high altitude deterioration</a></p>\n\n<p>This study was only in old women, but nevertheless I will include it here:</p>\n\n<blockquote>\n <p>It is found that the correlation between geographical factors and the normal reference value of whole blood viscosity (230s(-1)) of old women is quite significant (F=30.137, P=0.000).</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/24120566/\" rel=\"nofollow\">Normal reference value of whole blood viscosity (230s(-1)) of old women and geographical factors</a></p>\n\n<p>Most relevant to your question, this was a small study on mountaineers to Mount Everest:</p>\n\n<blockquote>\n <p>In blood samples collected immediately after return, alterations of some haemorheologic parameters were observed in comparison with baseline values, and namely an <strong>increase in relative blood viscosity</strong>, fibrinogen and erythrocyte filtration time along with a fall in platelet count</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/6465620/\" rel=\"nofollow\">Changes in the rheologic properties of blood after a high altitude expedition</a></p>\n\n<p>Making the connection to vascular problems:</p>\n\n<blockquote>\n <p>Increased viscosity is associated with aging, obesity, carotid intima-media thickness, metabolic syndrome, hypertension, diabetes, <strong>ischemic heart disease, and stroke</strong></p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/m/pubmed/23988733\" rel=\"nofollow\">Increased whole blood viscosity is associated with silent cerebral infarction</a></p>\n", "score": 3 } ]

[ "blood-circulation", "heart-attack", "altitude-sickness" ]

[ { "answer_id": 3234, "body": "<p>Each state should have their own licensing board, that may or may not have a search function to verify a licensure.</p>\n\n<p>As an experiment, I went to the <a href=\"https://www.bon.texas.gov/forms/apninq.asp\" rel=\"noreferrer\">Texas website</a> and entered the name of a nurse practitioner that I gathered off of the internet, and it came back with a verification of their initial licensure, how long it was good for, and the recognized level of accreditation.</p>\n\n<p>Your own state should have a way to verify all licensed medical practitioners in the state.</p>\n", "score": 5 } ]

[ "practice-of-medicine", "health-education", "medical-training", "qualifiy-certify", "nurse-practitioner" ]

[ { "answer_id": 3261, "body": "<p>First, I want to agree with <a href=\"https://health.stackexchange.com/a/3257/1312\">@anongoodnurse</a></p>\n\n<p>There is <a href=\"http://news.sciencemag.org/health/2015/04/fda-takes-new-look-homeopathy\" rel=\"nofollow noreferrer\">debate and mixed views</a> inside the \"Western Medical Community\" which is a vast, vast group of people.</p>\n\n<p>I wanted to expand on that by pointing out the US government has put a <a href=\"https://en.wikipedia.org/wiki/National_Institutes_of_Health\" rel=\"nofollow noreferrer\">National Institute of Health</a> center together to study what is academically known as \"<a href=\"https://en.wikipedia.org/wiki/Alternative_medicine\" rel=\"nofollow noreferrer\">complementary and alternative medicine (CAM)</a>.\" CAM is basically a catch all for what may be a homeopathic or traditional medicine in any particular location, but paired with modern scientific thinking. The name of the NIH center is the \"<a href=\"https://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Integrative_Health\" rel=\"nofollow noreferrer\">National Center for Complementary and Integrative Health</a>.\"</p>\n\n<p>I think a very <a href=\"https://nccih.nih.gov/research/blog/niche\" rel=\"nofollow noreferrer\">approachable editorial</a> on what exactly they do was written by a previous deputy director. They represent a growing field of research that applies rigorous logic and scientific testing to alternative medicines. In other words, they use \"traditional medicines\" as a starting point to drive new modern interventions.</p>\n\n<p>The general premise goes something like this:</p>\n\n<p>1) Community A has traditionally used [Plant/Intervention] B to address disease or symptoms X, Y, and Z.</p>\n\n<p>2) Some aspect of B may infact be pharmacologically/physiologically active.\n[Note the null hypothesis can also be, and often is, true; that B provides no benefit over placebo or sham operation.]</p>\n\n<p>3) Break down B into it's molecular or procedural components B[1,2,..n]</p>\n\n<p>4) Compare B components to known interventions to make educated guesses as to what really is going on. </p>\n\n<p>5) Test basic components of B, B as a whole, and mixtures of B components (derived from educated guess) to address X, Y, Z, preferably in an <a href=\"https://en.wikipedia.org/wiki/Model_organism\" rel=\"nofollow noreferrer\">animal model</a> first.</p>\n\n<p>6) Refine positive results into traditional medicine drug/intervention M</p>\n\n<hr>\n\n<p><strong><a href=\"https://en.wikipedia.org/wiki/Cannabis\" rel=\"nofollow noreferrer\">Cannabis</a> provides a good example of how this can be done.</strong></p>\n\n<p>NOTE: I make no stance on the legalization of cannabis in the US for recreational use, and could see it go either way. I think that a honest conversation about medical vs recreational use should be had, and that medical uses should not drive something that is desired for recreational uses. Please don't derail this post on merits or demerits of cannabis use.</p>\n\n<hr>\n\n<p>The study of cannabis lead to the discovery of <a href=\"https://en.wikipedia.org/wiki/Tetrahydrocannabinol\" rel=\"nofollow noreferrer\">THC</a> the principal psychoactive component of cannabis. This lead to the discovery of medical benefits of THC, and the ability for physicians to use THC in drug form dronabinol (brand name Marinol).</p>\n\n<p>In our example cannabis would be our [Plant B], nausea and loss of appetite our symptoms X-Y, <a href=\"https://en.wikipedia.org/wiki/Cannabinoid\" rel=\"nofollow noreferrer\">cannabinoids</a> our components of B, and Marinol the final drug produced M.</p>\n\n<hr>\n\n<hr>\n\n<p><strong>I include the following note/disclaimer because 1) it shows my point of view on the question asked, and 2) it will hopefully cut of some comments I suspect are likely to come from such a post.</strong></p>\n\n<p>As I'm sure it will come up, it certainly could be true that additional cannabinoids will come up to be medically significant, perhaps in certain combinations, and that may require inhalation as a delivery route. I'm happy for that research to be conducted, and I wait to see what comes out as scientifically valid. </p>\n\n<p>I note that burning and inhaling of a raw plant, with all the chemicals that are produced in the process, is not something I would recommend to any patient. That goes from tobacco, to cannabis, to grass clippings. We have nebulizers to aerosol drugs that need to be inhaled.</p>\n\n<p>This is where taking traditional medicine as a start, and then advancing it to \"Western Medicine\" comes in. The scientific method has born out in pharmacology, and needed active ingredients from plants/animals can be identified, derived, purified, and normalized so that they can be safely and consistently applied in \"Western Medicine\" (which can be called \"traditional\" by the people practicing it). </p>\n", "score": 7 }, { "answer_id": 3257, "body": "<blockquote>\n <p>My question is, how does scientific community view traditional medicine?</p>\n</blockquote>\n\n<p>There is no single view of traditional medicine within a large community. There are some who investigate, some who incorporate traditional medicine into their practices, and some who eschew it. Most simply don't know about it.</p>\n\n<p>_{<a href=\"http://www.nature.com/ncb/journal/v1/n1/abs/ncb0599_60.html\" rel=\"noreferrer\">Indirubin, the active constituent of a Chinese antileukaemia medicine, inhibits cyclin-dependent kinases</a>}<br>\n_{<a href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.92.10.1582\" rel=\"noreferrer\">A Public Health Agenda for Traditional, Complementary, and Alternative Medicine</a>}</p>\n", "score": 5 } ]

[ "traditional-medicine" ]

[ { "answer_id": 3286, "body": "<p>The quantitive figures for Vitamin A overdose are well established, and widely published.</p>\n\n<p>The RDI in the United States (Different countries may have different values) is 900 micrograms for men, and 700 micrograms for females. 900 micrograms is approximately 3000 IU.</p>\n\n<p>The acute toxic dose of vitamin A is 25,000 IU/kg, and the chronic toxic dose is 4000 IU/kg every day for 6-15 months.</p>\n\n<p>A 1/2 cup of raw carrots contains about 9000 IU of Vitamin A. So if you are a 154 lb man, (70 kg), your toxic dose of Vitamin A is 1,750,000 IU, or right around 98 full cups of carrots for a toxic dose, or 15 cups a day for 6-16 months. I think you are perfectly fine eating two large carrots a day.</p>\n\n<p><a href=\"https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/\" rel=\"nofollow\">https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/</a></p>\n\n<p><a href=\"http://emedicine.medscape.com/article/819426-overview\" rel=\"nofollow\">http://emedicine.medscape.com/article/819426-overview</a></p>\n", "score": 4 } ]

[ "nutrition", "micronutrients" ]

[ { "answer_id": 3596, "body": "<p>Yes, it looks like they do. Within certain limits, though and with the limitation that only small pilot studies have been done. \nA study assessing the the results of such a device in 15 men found that </p>\n\n<blockquote>\n <p>After 6 months the mean gain in length was significant, meeting the goals of the effect size, at 2.3 and 1.7 cm for the flaccid and stretched penis, respectively. No significant changes in penile girth were detected. </p>\n</blockquote>\n\n<p><a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2008.08083.x/full\" rel=\"nofollow\">A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’</a></p>\n\n<p>There is one meta study on the subject (a study looking at and summarizing other studies) that says </p>\n\n<blockquote>\n <p>In conclusion, penile extenders appear to be an effective treatment for patients who complain of ‘short penis’. The application of such devices can be recommended in all patients regardless of the penile length, because of the low risk of complications</p>\n</blockquote>\n\n<p><a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2010.09647.x/full\" rel=\"nofollow\">Non-invasive methods of penile lengthening: fact or fiction?</a></p>\n\n<p>There's links to the original studies in that review. </p>\n\n<p>Both studies are from the British Journal of Urology, which seems like a decently trustworthy journal and nothing in the papers stood out to me as unreasonable. The usual warnings apply, though: talk to you doctor about your plans and have one supervise the process if you both decide this is the best course of action for you. </p>\n\n<p>So, yes, preliminary research seems like they have some effect (1 to 2 centimeters) <strong>if used as advised</strong>. </p>\n", "score": 4 } ]

[ "penis" ]

[ { "answer_id": 3887, "body": "<p>These are called <a href=\"https://en.wikipedia.org/wiki/Random_glucose_test\" rel=\"nofollow\">random glucose tests</a>, and they, too, can be used to check for diabetes and pre-diabetes. Because the meal before the test is not standardized the range is quite large, but that doesn't mean they don't have any diagnostic value. </p>\n\n<p>An abnormal result will probably mean a <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/003482.htm\" rel=\"nofollow\">fasting glucose test is then ordered</a>. So why not do that in the first place? Without knowing the story of the pictured result, probably because diabetes diagnosis wasn't the point of the blood tests, and the glucose test was just one of several tests. In that case, doctors might decide it's unnecessary to tell the patient not to eat just because of that one test. Especially if the blood drawing doesn't take place in the morning. </p>\n", "score": 2 } ]

[ "blood-tests" ]

[ { "answer_id": 3463, "body": "<p><code>Diastolic Murmur [heard maximally at the] Right Lower Sternal Border</code></p>\n\n<p>This is not the most typical description of any murmur, but it can be consistent with aortic regurgitation. Note that this patient had two murmurs described. In addition to DM/RLSB, he had a SEM = <code>systolic ejection murmur</code> (SEM). Both were described as II/IV intensity (read: <em>two out of six</em>), indicating a murmur that was faint but could be heard without difficulty.*</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK346/\" rel=\"nofollow\">This is a good review</a> on diastolic murmurs, usually considered to be an indicator of pathology. In contrast, <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK345/\" rel=\"nofollow\">systolic murmurs</a> are at times consistent with normal physiology.</p>\n\n<hr>\n\n<p>_{\n* Traditionally. Modern cardiologists tell me that those of us not trained in the good-ole’-days of cardiac auscultation tend to experience difficulty up to a higher threshold of intensity.\n}</p>\n", "score": 3 } ]

[ "terminology" ]

[ { "answer_id": 3484, "body": "<p>It is prudent to obtain imaging studies to evaluate the relationship of the cyst with the urethra.</p>\n\n<p>Imaging studies are often done by radiologists, though some urologists do some imaging studies as well. Imaging studies include voiding cystourethrograms, MRIs, ultrasounds, etc. From <a href=\"http://link.springer.com/referenceworkentry/10.1007%2F978-3-642-13327-5_208\" rel=\"nofollow\">Penile Lumps</a>: </p>\n\n<blockquote>\n <p>imaging is often required to confirm the diagnosis.</p>\n</blockquote>\n\n<p>From <a href=\"http://onlinelibrary.wiley.com/doi/10.1046/j.1442-2042.2000.00219.x/full\" rel=\"nofollow\">Epidermoid cyst of the penis: A case report and review of the literature</a></p>\n\n<blockquote>\n <p>The differential diagnosis of cystic structures in the genital region includes an extensive range of conditions. Among the more serious diseases, urethral diverticula and urethrocutaneous fistula are important, but can usually be ruled out by both physical examination and the conditions evident upon voiding. <em>When the diagnosis remains questionable, a voiding cystourethrogram should be obtained</em>.</p>\n</blockquote>\n\n<p>The above prove nothing, really, because we can't know the precise reason for your urologist wanting to directly examine the urethra (I presume the first cystoscopy was for the same reason?) However, <strong>you should be able to ask your doctor any questions you have</strong>.</p>\n\n<p>If all they want to do is have a look at the urethra (for whatever reason), it's completely reasonable that they stick to the area around the cyst. If they're looking for a connection between the urethra and the cyst, a VCU would seem to be a more prudent choice.</p>\n\n<p><em>It is hard to code for a partial procedure</em> (e.g. a look at only part of the <a href=\"https://books.google.com/books?id=zRuMBgAAQBAJ&amp;pg=PA697&amp;dq=coding+for+distal+urethroscopy&amp;hl=en&amp;sa=X&amp;ved=0CCcQ6AEwAGoVChMI1cGdhJjUyAIVhXs-Ch2OPQ6p#v=onepage&amp;q=coding%20for%20distal%20urethroscopy&amp;f=false\" rel=\"nofollow\">urethra</a>), and therefore difficult to charge the patient/their insurance. There is no code for \"distal urethroscopy\". As crass as it may sound, that might be the reason for the stated desire to do a cystoscopy.</p>\n\n<p>It's your body to defend against what might be an unnecessary procedure. If you don't get a satisfactory answer, a second opinion may be in order.</p>\n\n<p>If a urologist could answer this question, that would be terrific.</p>\n", "score": 2 } ]

[ "urology", "urethra" ]

[ { "answer_id": 11272, "body": "<p>The internet is overflowing with information regarding probiotics, and since these products are not registered as drugs and are widely sold as nutritional supplements, it might be hard to \"separate the wheat from the chaff\".</p>\n\n<p>I found <a href=\"http://link.springer.com/article/10.1007%2Fs12664-015-0547-6\" rel=\"nofollow noreferrer\">this review</a> which seems pretty comprehensive, and extracted some key concepts that may answer your question (they will be italicized hereinafter). First, some basic terminology is in order:</p>\n\n<ol>\n<li><strong>Microbiota</strong> - this is a general name for a \"community\" (for lack of a better word) of different types of microorganisms. Specifically, the <a href=\"https://en.wikipedia.org/wiki/Human_microbiota\" rel=\"nofollow noreferrer\">human microbiota</a> is the entire community of microbial organisms that inhabit the human body. See <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426293/\" rel=\"nofollow noreferrer\">this text</a> for elaboration.</li>\n<li><strong>Microbiome</strong> - this is a general name for the collection of genes of a certain microbial community. The human microbiome is the collection of genes of the human microbiota, and is the subject of an extensive study due to the potential health benefits its manipulation may provide.</li>\n<li><strong>Gut microbiota</strong> - this should be clear already... this is the entire microbial community that resides in the digestive system. It is also called '<a href=\"https://en.wikipedia.org/wiki/Gut_flora\" rel=\"nofollow noreferrer\">gut flora</a>'. This concept is not unique to humans, so we will refer to the human gut microbiota from now on.</li>\n<li><strong>Probiotics</strong> - as ProfK correctly noted in his comment, probiotics is the commonly used name for the content of \"good bacteria\", which are essentially the same bacteria that naturally inhabit our digestive system (specifically the colon), in the form of a commercial product.</li>\n</ol>\n\n<p>Regarding your first question - <strong>What are the bacteria in your large intestine doing that benefits health/immunity?</strong>:</p>\n\n<p><em>Gut bacteria use mostly fermentation to generate energy, converting sugars in part to short-chain fatty acids (SCFA) that are used by the host as an energy source. The main end-products are acetate, propionate, and butyrate. SCFA help increase gut motility, decrease gut pH, and provide energy for commensal bacteria. Besides SCFA, a number of amino acids that are indispensable to humans are provided by commensal bacteria. It has been well established that some microbial species may be responsible for the synthesis of vitamins like biotin, phylloquinone, and vitamin K, and deficiencies may directly or indirectly be associated with reduction in abundance of specific components of the gut microbiome. The gut microbiota also plays an important role in preventing comorbidities and infection in addition to influencing mood regulation, obesity, diabetes, insulin resistance, and cognition.</em></p>\n\n<p>Regarding your title question - <strong>How do probiotics work?</strong> - I will only cite this short paragraph: <em>Probiotics can act through multiple mechanisms to affect the health of the host. They can transform dietary components into bioactive molecules, modulate the microbiota, or interact directly with the host immune or nervous system.</em><br>\nPlease see the section on mechanism for a deeper explanation and specific examples for probiotic mechanisms.</p>\n\n<p>Final point: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=probiotics%20benefits\" rel=\"nofollow noreferrer\">many studies</a> show all kinds of health benefits associated with probiotics in different states of disease. They cannot be covered here, but the review I cited can be a pretty good starting point. One of the main uses of probiotics is following (or together with) an antibiotic treatment, in order to replace some of the gut flora that might be destroyed by the antibiotics - antibiotics do not differentiate between \"good\" and \"bad\" bacteria, and some research (e.g. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26645894\" rel=\"nofollow noreferrer\">this study</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24291194\" rel=\"nofollow noreferrer\">this study</a>) indicates that taking probiotics close to an antibiotic treatment may help to restore the gut flora (which has a significant role in the human body as discussed earlier) faster and help to overcome the bacterial infection better and faster.</p>\n", "score": 4 } ]

[ "digestion", "bacteria", "probiotics", "gut-microbiota-flora" ]

[ { "answer_id": 3683, "body": "<blockquote>\n <p>My understanding is that quadrivalent flu shots are designed to build immunity to 4 flu virus strains, while trivalent flu shots are designed to build immunity to 3 flu virus strains. Is this accurate?</p>\n</blockquote>\n\n<p>Yes. </p>\n\n<blockquote>\n <p>For years, flu vaccines were designed to protect against three different flu viruses (trivalent). This included an influenza A H1N1 virus, an influenza A H3N2 virus and one B virus. Experts had to choose one B virus, even though there are two very different lineages of B viruses that both circulate during most seasons. This meant the vaccine did not protect against the group of B viruses not included in the vaccine. Adding another B virus to the vaccine aims to give broader protection against circulating flu viruses.</p>\n</blockquote>\n\n<p>The quadrivalent flu vaccine is also just as safe as the trivalent one. </p>\n\n<blockquote>\n <p>Studies have shown that vaccines made to protect against four flu viruses have a safety profile similar to seasonal flu vaccines made to protect against three viruses, with similar—mostly mild—side effects</p>\n</blockquote>\n\n<p><a href=\"http://www.cdc.gov/flu/protect/vaccine/quadrivalent.htm\" rel=\"nofollow\">Source for both quotes: CDC page on quadrivalent flu vaccine</a></p>\n\n<p>Now why would people choose the trivalent one? </p>\n\n<p>For one, the quadrivalent flu vaccine is more expensive. According to the <a href=\"http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/\" rel=\"nofollow\">CDC</a> the difference is more than 50 percent. This probably means there is a market for it, so it still gets produced.</p>\n\n<p>Also, some patients (and some doctors) will be cautious about anything they perceive as new and \"untested\" and thus prefer the old one for a few more years. That's another reason to still produce and ship the trivalent flu vaccine. </p>\n\n<p>If the quadrivalent flu vaccine is not available (for example because not enough was ordered), taking the trivalent flu vaccine is recommended over waiting:</p>\n\n<blockquote>\n <p>Don’t delay getting a flu vaccine if you cannot locate a quadrivalent vaccine. The important thing is to get vaccinated against influenza. </p>\n</blockquote>\n\n<p><a href=\"http://www.cdc.gov/flu/protect/vaccine/quadrivalent.htm\" rel=\"nofollow\">Source: CDC</a></p>\n", "score": 3 } ]

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

[ { "answer_id": 14673, "body": "<p>These findings are largely correct. We do not necessarily need <em>newer</em> findings to confirm that. If you look back a few years and consider one of largest experiments in this regard it becomes clear that this is not ideal but possible. The Irish have survived as long as they had enough potatoes available. </p>\n\n<blockquote>\n <p>[…] [the Irish Potato Famine, because about two-fifths of the population was solely reliant on this cheap crop for a number of historical reasons.]<a href=\"https://en.wikipedia.org/wiki/Great_Famine_(Ireland)\" rel=\"nofollow noreferrer\">1</a></p>\n</blockquote>\n\n<p>Potatoes alone have no fat soluble Vitamins A, D, and no B12. While D might not be a problem in central latitudes because humans may synthesise adequate amounts of this vitamin through sun exposure alone, vitamin A and B12 must be acquired from other sources. The amounts of biotin and of calcium in potatoes is equally quite low. Potatoes are also quite low in essential fatty acids and overall fat content. The protein content is of relatively good quality but with comparably low digestibility and mass. </p>\n\n<p>These deficiencies of potatoes are very well balanced when the diet also contains cow's milk, since <a href=\"https://en.wikipedia.org/wiki/Milk#Nutritional_value\" rel=\"nofollow noreferrer\">it provides all of these \"missing ingredients\" that are generally recognised as essential.</a></p>\n\n<p>Otherwise the potato is quite unusual in its measured content of nutrients:</p>\n\n<blockquote>\n <p><strong>Carbohydrates:</strong>\n Potato carbohydrates may be classified as starch, non-starch polysaccharides, and sugars.</p>\n</blockquote>\n\n<p>What potatoes are best known for: source of energy in the form of starch.</p>\n\n<blockquote>\n <p><strong>Lipids:</strong>\n The lipid content of potato is low. Galliard (1973) found 0.08 to 0.13% (FWB) in 23 varieties. This range is too low to have any nutritional significance but contributes towards potato palatability (Kiryukhin &amp; Gurov, 1980), enhances tuber cellular integrity and resistance to bruising and plays a part in reducing enzymic darkening in tuber flesh (Mondy &amp; Mueller, 1977).</p>\n \n <p><strong>Organic acids:</strong>\n The major organic acids identified in the potato are citric and malic acids (Jadhav &amp; Andrew, 1977; Bushway et ai, 1984). Others present are oxalic and fumaric (Bushway et al., 1984), chlorogenic and phosphoric (Schwartz et aL, 1962), as well as ascorbic, nicotinic and phytic acids, amino acids and fatty acids. All these contribute to flavour and help to buffer the potato sap (the pH of the tuber is 5.6 to 6.2); the level of some, especially that of malic acid, can be used to indicate tuber maturity. Ascorbic and nicotinic acids influence directly, and phytic acid indirectly, tuber nutritional value (see pp. 45 and 49).</p>\n</blockquote>\n\n<p>Phytic acid is an anti-nutrient that diminishes the value of the potato and everything eaten with it. Other problematic substances found in potatoes are lectins, glycoalkaloids and proteinase inhibitors.</p>\n\n<blockquote>\n <p><strong>Pigments:</strong> Anthocyanin pigments in the periderm and peripheral cortex produce totally or partly pigmented skins in potatoes. In some South American varieties, the pigment is so dark that tubers may appear black and others dark purple.</p>\n</blockquote>\n\n<p>These secondary nutrients are often touted as very healthy constituents in potatoes. Whether they are or not, in commercially grown potatoes they are almost absent.</p>\n\n<blockquote>\n <p>Potato flesh may be white or various shades of yellow, depending upon the variety. Yellow coloration is generally due to presence of carotenoid pigments. The major carotenoid identified in 13 German varieties was violaxanthin, followed by lutein and lutein-5,6-epoxide and, in lower concentrations, by neoxanthin A and neoxanthin (Iwanzik et al., 1983); beta-carotene was detected in only trace amounts or was totally absent. One cultivar had an intense yellow flesh colour, but a relatively low level of carotenoids. It is therefore possible that, in some varieties, the yellow colour is due to other, unidentified, pigments as well as to carotenoids. In some places (e.g. Peru) yellow-fleshed varieties are highly prized and command higher prices than those with white flesh.</p>\n</blockquote>\n\n<p>Varieties differ substantially in their contents. Growing and harvesting conditions influence their value, as do factors like freshness, storage conditions, and how they are prepared and eaten. Most of the most important nutrients are present in potatoes. There may very well be other nutrients missing for something approaching anything like an 'optimal diet', but potatoes already offer a large chunk of what a human typically needs.</p>\n\n<blockquote>\n <p><strong>Vitamins:</strong>\n Potatoes are substantial sources of several vitamins: ascorbic acid (vitamin C) and the B vitamins thiamin (B1), pyridoxine (B6) and niacin. Riboflavin (B2), folic acid and pantothenic acid are also present. Small amounts of vitamin E have been reported (Paul &amp; Southgate, 1978). Biotin is present in traces. The vitamin A precursor beta-carotene is absent or present only in trace amounts.\n Factors affecting contents\n Values can vary considerably, as the ranges, determined by different authors, shown in Table 2.10 demonstrate, but relatively little work has been carried out to determine the sources of variation. Different methods of analysis can lead to varying results: Finglas &amp; Faulks (1984, 1985) attributed differences in their determined values for thiamin, niacin, riboflavin and total folate from those previously reported for the potato in food composition tables to analytical methods that were more reproducible than those used earlier.\n The thiamin content of potatoes depends upon variety (Swaminathan &amp; Pushkarnath, 1962; Leichsenring et al., 1951) and location of growth (Leichsenring et al., 1951). Tubers from loamy soil contained more thiamin than tubers from sandy soil, and thiamin content is greatly increased by nitrogen fertilization (Augustin, 1975).</p>\n \n <p>However, although the potato has been shown to be a source of good-quality protein, to have a favourable ratio of protein calories to total calories and to be an important source of vitamins and minerals, its overall value in the diet nowadays is generally greatly underestimated.</p>\n \n <p><strong>Energy value:</strong>\n The potato has a lower average carbohydrate content than do other roots and tubers, and also a comparable fat content (Table 2.2). Raw potato has a somewhat lower average energy content than other raw roots and tubers with 335 kJ (80 kcal) per 100 g. However, the large variation in tuber DM content produces a range of energy contents also, e.g. 264 to 444 kJ (63 to 106 kcal) per 100 g was found for the energy values of North American commercial varieties (Toma et al., 1978fl). The energy content of raw potato is considerably less than that of raw cereals and legumes; however, when cooked, the latter staples absorb large quantities of water, which changes their composition significantly. The potato, when boiled in its skin, retains its energy value almost unaltered. A fairer comparison of the potato and the cereals or legumes, therefore, is either on a dry, raw basis or on a cooked, 'as eaten', basis. […] Bread and tortillas, however, provide substantially more energy than cooked potatoes. […] The potato's low energy density (energy content per gram of food) is advantageous when potatoes are included (without added fat or energy- rich sauces) in diets of the developed world, where obesity, as a state of malnutrition, is found increasingly. In parts of the developing world where diets are energy deficient, this attribute may be a disadvantage, particularly in the diet of infants and small children, whose digestive systems cannot cope with large intakes. Too much potato would be needed to supply all the energy requirements of small children, so they need an energy-rich supplement. […] Although adults would also have to consume large quantities to meet all their daily energy needs, their digestive systems have a greater capacity. Up to 4.5 kg per capita were consumed daily in Ireland in the seventeenth to nineteenth century (Pimental et al., 1975). This would have provided approximately 15.06 MJ (3600 kcal) and 94 g of total protein.</p>\n \n <p><strong>Dietary fibre:</strong>\n Boiled potato flesh has a dietary fibre content similar to that of cooked white rice and a much lower content than that of boiled green plantains or of boiled Phaseolus beans. Potatoes cooked as french fries or chips are a more concentrated source of fibre (Table 2.8). It can be calculated that 100 g of boiled potato supply 1.0, 0.7, and 0.5 times the fibre that can be found in a 35 g 'medium' slice of white, brown or wholemeal bread, respectively; a 25 g packet of chips supplies 1.9,1.4 and 1.0 times the respective bread fibre contents.\n There is no recommended daily allowance (RDA) for dietary fibre at present. It has been suggested (Brodribb, 1983) that about 40 g/day should be consumed to maintain correct colonic function. Recently an ad hoc working party of the NACNE (National Advisory Committee on Nutrition Education, 1983) recommended an increase in British dietary fibre intake to 30 g per person per day. When potatoes are consumed in quantity on a regular basis, they make a significant contribution to dietary fibre intake. At present, for example, fresh potatoes contribute 15% of the dietaryfibreintake in British households and rank as a primary source (Finglas &amp; Faulks, 1985).</p>\n \n <p>At present, potato may be seen from the tables to compare favourably on a raw basis with all the listed staples and vegetables in terms of thiamin, riboflavin and niacin, and with most of the vegetables in pyridoxine and pantothenic acid contents. It has a much lower biotin content than the other vegetables, but it may be a comparatively richer source of folic acid than was previously thought. Fresh potatoes may contain 30 mg or more of ascorbic acid per 100 g when newly harvested, with an average value of 20 mg/100 g, although values decline when potatoes are stored, cooked or processed.</p>\n \n <p><strong>Comments on protein contribution from potatoes:</strong>\n Potato protein is of sufficiently high quality for maintenance purposes in adult man and for growth of infants and children. The relatively low digestibility of potato protein is a disadvantage when potatoes are used for feeding to children; potatoes have to be consumed in large quantities to satisfy both protein and energy requirements, a characteristic they share with other root and tuber staples. Potatoes are rarely consumed as the sole source of N in the diets of either adults or children, but it is clear that they can make a valuable contribution to the protein content and quality of a mixed diet, provided present levels of protein in potato are maintained.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://pdf.usaid.gov/pdf_docs/PNABD047.pdf\" rel=\"nofollow noreferrer\">Jennifer A. Woolfe,: \"Potato in the human diet\", Cambridge University Press: Cambridge, New York, 1987.</a></p>\n\n<p>Returning to the Irish experiment with John Reader: <a href=\"https://en.wikipedia.org/wiki/The_Propitious_Esculent\" rel=\"nofollow noreferrer\">\"Potato. A History of the Propitious Esculent\"</a>, Yale University Press: New Haven, London, 2008: </p>\n\n<blockquote>\n <p>\"I have heard [the potato] stigmatized as being unhealthy, and not sufficiently nourishing for the support of hard labour; but this opinion is very amazing in a country, many of whose poor people are as athletic in their form, as robust, and as capable of enduring labour as any upon earth. When I see the people of a country, in spite of political oppression, with well-formed vigorous bodies, and their cottages swarming with children; when I see their men athletic and their women beautiful, I know not how to believe them subsisting on an unwholesome food.\"<br></p>\n</blockquote>\n\n<p>This quotes an English survey of the time. While these observations seem to be the result of relatively subjective impressions, there are quite some numbers to back that up:</p>\n\n<blockquote>\n <p>The population of Ireland more than doubled between 1687 and 1791, rising from 2.16 million to 4.75 million. During the fifty years from 1791 to 1841 another 3.4 million were added, taking the population to 8.15 million. Another 1.75 million emigrated to North America, Scotland, England and even Australia during the same period, which brings the total born in Ireland to nearly 10 million — almost a five-fold increase in 154 years (1687 to 1841). ‘Probably in no other western country has so rapid a rate of natural increase been so long sustained,’ writes the historian Kenneth H. Connell. </p>\n</blockquote>\n", "score": 4 } ]

[ "nutrition" ]

[ { "answer_id": 11054, "body": "<p>In my experience keeping your nose blown (or even rinsed out) prevents a secondary infection in your throat. Whatever you don't blow out of your nose dribbles down the back of your throat and bacteria get happy there and give you a sore throat. This is technically a different second infection but most people will treat it as a single long cold that \"moved down\" as it progressed. </p>\n\n<p>There was a <a href=\"http://www.theglobeandmail.com/life/nose-blowing-may-prolong-the-common-cold/article4211818/\" rel=\"nofollow noreferrer\">study</a> that suggested nose blowing would put mucus and bacteria up into the sinuses and result in a secondary infection there, but all the nose blowing was done by people lying on their backs, which doesn't seem super representative. To be on the safe side, blow as gently as possible, and keep in mind your own tendency to get a sore throat after a cold or to get a sinus infection after a cold.</p>\n", "score": 1 } ]

[ "common-cold", "nose", "mucus-phlegm", "nasal-congestion", "nose-blowing" ]

[ { "answer_id": 3674, "body": "<p>Humans have been spending hours per day immersed in sea water without harm since before recorded history. Many sportsmen, professional divers, and fishermen still do. Other than the mild drying effects salt water has on the skin, I can find no documentation of harm from exposure to it. </p>\n\n<p>What else might be in the water can only be revealed by laboratory testing. If you want to be sure the water is free of harmful contaminants, you'll need to have it tested. Never a bad idea with well water.</p>\n", "score": 2 } ]

[ "water", "salt", "bath" ]

[ { "answer_id": 3651, "body": "<p>Currently, there is no definitive way to predict maximum heart rate for a single individual. There are formulae that can give an approximation, but about the only way to get a good estimate on a personal level is to do a maximal treadmill test with monitoring.</p>\n\n<p>As far as the 220-age, that is a bad myth, and wasn't based on a study, but simple observation of 11 different references of both published and unpublished research. This <a href=\"https://www.cyclingfusion.com/pdf/220-Age-Origins-Problems.pdf\" rel=\"nofollow\">PDF writeup goes through the history</a> of the 220-age origins, and gives some alternate ways to calculate maxHR. However, especially for exercise science, the margin for error is still too large for clinical use, although it may have slightly better use in a non clinical exercise setting.</p>\n", "score": 4 }, { "answer_id": 3655, "body": "<p>Many recommend the target to be 70-85% of (220-age) value, rather than value itself. See <a href=\"http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887?pg=2\" rel=\"nofollow\">Mayo Clinic site</a> and <a href=\"http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/Target-Heart-Rates_UCM_434341_Article.jsp#.Vj7Oo2Meuu1\" rel=\"nofollow\">American Heart Association page</a>. Moreover, trained athletes often have slower heart rates than those who are sedentary. Hence, slower heart rates are often sign of good exertional ability. Some drugs like beta-blockers slow the heart rate and prevent it from reaching target rate on exercise. </p>\n\n<p>Heart rate checking during exercise is more of a value for persons at extremes of exercise abilities, i.e. those who may be just starting an exercise program and those taking part in competitive athletics. Most other persons can simply exercise to the level that causes <a href=\"http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887?pg=2\" rel=\"nofollow\">some breathlessness and sweating</a> and that is not causing excessive exhaustion, breathlessness or chest pain. </p>\n", "score": 1 } ]

[ "heart-disease", "exercise" ]

[ { "answer_id": 3699, "body": "<p><strong>Tetanus Vaccine</strong>\nIf you get a tetanus shot every five years you are good to go. The recommended dose of tetanus toxoid (vaccine) is every ten years but since: </p>\n\n<blockquote>\n <p>In a small percentage of individuals, antitoxin levels fall below the minimal protective level before 10 years have elapsed, to ensure adequate protective antitoxin levels, persons who sustain a wound that is other than clean and minor should receive a tetanus booster if more than 5 years have elapsed since their last dose</p>\n</blockquote>\n\n<p>(Taken from <a href=\"http://cdc.gov/vaccines/pubs/pinkbook/index.html\">http://cdc.gov/vaccines/pubs/pinkbook/index.html</a> chapter on tetanus) </p>\n\n<p>As for your <strong>wounds</strong>, it is better to wash them with simple soaps and water and leave them to heal without band-aids. The principle is: use solutions that do not cause further damage to the skin and that can be applied to clean most residues and dead tissue with mechanic force rather than chemical action. The most used in Hospital settings is saline solution (H2O plus NaCl at 0.9&amp;), we use it with a syringe so the water comes with pressure. </p>\n\n<p>Here are the general recommendations for wound management/treatment: </p>\n\n<blockquote>\n <ul>\n <li>Apply direct pressure to any bleeding wound, to control hemorrhage. Tourniquets are rarely indicated since they may reduce tissue\n viability.</li>\n <li>Examine wounds for gross contamination, devitalized tissue, and\n foreign bodies.</li>\n <li>Remove constricting rings or other jewelry from injured body part.</li>\n <li>Cleanse the wound periphery with soap and sterile water or available\n solutions, and provide anesthetics and analgesia whenever possible.</li>\n <li>Irrigate wounds with saline solution using a large bore needle and syringe. If unavailable, bottled water is acceptable.</li>\n <li>Leave contaminated wounds, bites, and punctures open. Wounds that are sutured in an unsterile environment, or are not cleansed,irrigated, and debrided appropriately, are at high risk for infection due to contamination. Wounds that are not closed primarily (sutured) because of high risk of infection should be considered for delayed primary closure by experienced medical staff using sterile technique.</li>\n <li>Remove devitalized tissue and foreign bodies prior to repair as they may increase the incidence of infection</li>\n <li>Clip hair close to the wound, if necessary. Shaving of hair is not\n necessary, and may increase the chance of wound infection.</li>\n <li>Cover wounds (other than contaminated wounds, bites, and punctures) with dry dressing; deeper wounds may require packing with saline soaked gauze and subsequent coverage with a dry bulky dressing.</li>\n </ul>\n</blockquote>\n\n<p><em><a href=\"http://emergency.cdc.gov/disasters/emergwoundhcp.asp\">http://emergency.cdc.gov/disasters/emergwoundhcp.asp</a></em></p>\n", "score": 6 } ]

[ "first-aid" ]

[ { "answer_id": 4638, "body": "<p>In my experience with one brand of monitors we tend to set multiple levels of severity of alarms at different volumes. The third tier alarms will be quite quiet and usually reflect a problem with monitoring (ie lead fallen off). The second tier are usually low-moderate volume and persistent. This would indicate an abnormal value that the patient condition has changed and needs attention. The first tier alarms are critical changes that are life-threatening and require immediate attention.</p>\n\n<p>This first tier alarm is heard by all staff in the unit and can prompt other staff that there may be a need for assistance with that patient.</p>\n\n<p>Further to this is the code alarm. This is activated by the nurse and indicates that assistance IS required.</p>\n\n<p>I'm sure that not having adequate response to a cardiac arrest has more deleterious outcomes than loud alarms.</p>\n", "score": 1 } ]

[ "sleep", "hospital", "icu-intensive-care-unit" ]

[ { "answer_id": 7526, "body": "<p>Here are some resources and books you can use but before that check out <a href=\"http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/default.htm\" rel=\"nofollow\">FDA</a> ,<a href=\"http://www.radiologyeducation.com/\" rel=\"nofollow\">radiologyeducation.com</a>, <a href=\"https://www.med-ed.virginia.edu/courses/rad/\" rel=\"nofollow\">virginia.edu</a> , <a href=\"http://www.emory.edu/X-RAYS/Guide/ICQF.htm\" rel=\"nofollow\">emory.edu</a> and <a href=\"http://www.sprawls.org/ppmi2/IMGCHAR/\" rel=\"nofollow\">sprawls.org</a> i think they can pretty much give you the information you want.</p>\n\n<p>For fundamental information and physic of radiography ( which i think is the answer to your question) :</p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/1401871941\" rel=\"nofollow\">Principles of Radiographic Imaging: An Art and a Science</a></p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/0781785693\" rel=\"nofollow\">Review of Radiologic Physics</a></p>\n\n<p><a href=\"https://www.amazon.co.uk/Essential-Physics-Medical-Imaging/dp/0781780578\" rel=\"nofollow\">The Essential Physics of Medical Imaging</a></p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/0521519152\" rel=\"nofollow\">Fundamentals of Medical Imaging</a>\n<a href=\"http://rads.stackoverflow.com/amzn/click/1439058725\" rel=\"nofollow\">Principles Radiographic Imaging Science</a></p>\n\n<p><a href=\"http://www.springer.com/us/book/9781461409441\" rel=\"nofollow\">Radiology Fundamentals</a></p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/1608311937\" rel=\"nofollow\">Radiobiology for the Radiologist</a></p>\n\n<p>For MRI i recommend :</p>\n\n<p><a href=\"https://www.amazon.co.uk/MRI-Practice-Catherine-Westbrook/dp/1444337432\" rel=\"nofollow\">MRI in Practice</a></p>\n\n<p>For PET scan :</p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/1441908048\" rel=\"nofollow\">Basics of PET Imaging: Physics, Chemistry, and Regulations</a></p>\n\n<p>CT scan :</p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/0781777518\" rel=\"nofollow\">Computed Tomography for Technologists</a></p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/1904798810\" rel=\"nofollow\">Step by Step Ct Scan</a></p>\n\n<p><a href=\"http://rads.stackoverflow.com/amzn/click/1416000305\" rel=\"nofollow\">Fundamentals of Body Ct</a></p>\n\n<p>If you need other sources you can see <a href=\"https://www.bookdepository.com/category/1384/Medical-Imaging\" rel=\"nofollow\">bookdepository</a> and <a href=\"http://www.amazon.co.uk/lm/R2HHXT9A0744MB\" rel=\"nofollow\">amazon</a> I hope that i helped.</p>\n", "score": 4 } ]

[ "medical-device", "medical-imaging" ]

[ { "answer_id": 3840, "body": "<p>Sleep and general anaesthesia share a few similarities, but also have differences. From what I have read, they are sufficiently different that comparing anaesthesia to a certain sleep phase doesn't make sense. \nI recommend reading <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390788/\" rel=\"nofollow\">General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis</a>, which I found trying to answer a different question I had myself. Here are a few quotes related to your questions, but it's really all quite interesting. </p>\n\n<blockquote>\n <p>The EEG patterns and other features of general anesthesia generally differ from those of sleep</p>\n</blockquote>\n\n<p>These patterns are shown in figure 1.</p>\n\n<blockquote>\n <p>There is similarity between the EEG patterns seen in slow-wave sleep and those seen in phase 2 of the maintenance period of general anesthesia</p>\n</blockquote>\n\n<p>Phase 2 and phase 3 are the phases the actual surgery is performed in. \nFor example, a difference between anaesthesia and sleep is muscle tone:</p>\n\n<blockquote>\n <p>in contrast to the drug-induced atonia described above, rigidity and spasticity are typically seen in patients who are in a coma or a vegetative state, and muscle tone is preserved during slow-wave sleep</p>\n</blockquote>\n\n<p>Generally it appears that anaesthesia is closer to being in a coma than to being asleep. </p>\n\n<blockquote>\n <p>confusion arises because anesthesiologists use the term sleep as a nonthreatening description of general anesthesia when speaking with patients. A level of general anesthesia appropriate for surgery is not sleep but rather a coma. However, like sleep, general anesthesia is reversible and can allow dreaming</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390788/\" rel=\"nofollow\">General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis</a> (I recommend the Introduction and Implications sections) </p>\n\n<p>Anaesthesia is not necessarily restful, they can cause a symptom called \"rebound REM sleep\" where patients need more sleep following anaesthesia because anaesthesia isn't like sleeping:</p>\n\n<blockquote>\n <p>REM sleep rebound after exposure to volatile anesthetics suggests that these volatile anesthetics do not fully substitute for natural sleep</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178044/\" rel=\"nofollow\">Rapid eye movement sleep debt accrues in mice exposed to volatile anesthetics</a></p>\n", "score": 3 } ]

[ "sleep", "anesthesia" ]

[ { "answer_id": 3859, "body": "<p>Disclaimer: I am not a doctor, do not take this as medical advice.</p>\n\n<p>Basic first aid for 2nd/3rd degree burns (<a href=\"https://play.google.com/store/books/details?id=p1yU5No0xq0C&amp;source=productsearch&amp;utm_source=HA_Desktop_US&amp;utm_medium=SEM&amp;utm_campaign=PLA&amp;pcampaignid=MKTAD0930BO1&amp;gl=US&amp;gclid=CIGSgYmyrskCFRaeNwodS5oDBQ&amp;gclsrc=ds\" rel=\"nofollow\">source</a>, <a href=\"http://rads.stackoverflow.com/amzn/click/1616690178\" rel=\"nofollow\">source</a>) is to:</p>\n\n<ul>\n<li>Cool the burn with clean, cool water. Avoid ice and don't cool off extensive burns (>20% of body surface) because of the risk of hypothermia.</li>\n<li>Remove clothing/jewelry from affected areas.</li>\n<li>Keep the skin clean and dry.</li>\n<li>Cover with a clean, dry dressing, preferably sterile and non-stick.</li>\n<li>Avoid popping blisters unless they are infected.</li>\n</ul>\n\n<p>You'll notice the word \"clean\" in there a lot, and that's because the biggest danger with a severe burn is <strong>infection</strong>. Burned skin loses its defense against bacteria, so keeping the wound clean will be your primary concern. In an apocalyptic scenario, without proper antibiotics, infections can easily turn deadly through <a href=\"http://emedicine.medscape.com/article/168402-overview\" rel=\"nofollow\">septic shock</a>. </p>\n\n<p>The use of antibiotic ointments on severe burns is controversial. Some handbooks recommend Silvadene cream, but others discourage putting any ointment on the wound.</p>\n\n<p>Definitive treatment in normal circumstances would include <a href=\"http://www.advancedtissue.com/understanding-debridement-important-part-wound-healing/\" rel=\"nofollow\">surgical debridement</a> and skin grafts, but neither is likely to be practical in an apocalyptic situation. Without proper supplies and training, you'd probably do more harm than good. <a href=\"http://www.medscape.com/viewarticle/554795_1\" rel=\"nofollow\">Larval therapy</a> is an option, but eeew!</p>\n\n<p>The <a href=\"http://rads.stackoverflow.com/amzn/click/0988872536\" rel=\"nofollow\">Survival Medicine Handbook</a> has a whole chapter on natural burn remedies, from vinegar to honey and cotton-ash paste. It's too much to summarize here, but the book is a great resource for apocalyptic fiction writers.</p>\n\n<p>A suture won't take the place of a skin graft, and in fact can compound the risk of infection.</p>\n", "score": 4 } ]

[ "blood" ]

[ { "answer_id": 11239, "body": "<p>First I should clarify this - prediabetic range can mean two things: impaired fasting glycemia (IFG) or impaired glucose tolerance (IGT). Both of these two tell us that a person is at risk of developing diabetes mellitus type-2. IFG means that you have higher glucose in your blood while fasting ; IGT means that your organism cannot reduce the glucose levels after sugar intake as fast as it should because the insulin response is weak in comparison to a healthy body. </p>\n\n<p>Second, it i possible to have hypoglycemia and pre-diabetes. There are few common scenarios: one group of the people with pre-diabetes are using medications that lower their blood glucose as therapy (hypoglycemia can occurr as a side-effect, although rare); also, it is possible that people that do not have good glucose regulation (prediabetes) to fall into hypoglycemia if they abuse alchocol (especially if they mix it with medications that can lower the blood sugar levels). </p>\n", "score": 1 } ]

[ "blood", "diabetes", "sugar", "pre-diabetes", "hypoglycemia" ]

[ { "answer_id": 3868, "body": "<p>People who have had toxoplasmosis are not barred from donating blood (at least in the places I checked). While toxoplasmosis during pregnancy is dangerous for the embryo/fetus, if they don't have lasting damage from it, that person is just like any other person who once had toxoplasmosis, of which there are many (in some countries up to 80 percent of people are immune because they had toxoplasmosis at one time). </p>\n\n<p>People with a currently active infection would probably be sent away, but since toxoplasmosis infection usually presents like a generic mild infection (muscle ache, mild temperature) and isn't tested for, that's no different than sending away someone with a cold. </p>\n\n<p>When in doubt, ask the place where you are donating. </p>\n\n<p>Sources:</p>\n\n<p><a href=\"http://www.cdc.gov/parasites/toxoplasmosis/disease.html\" rel=\"nofollow\">CDC on toxoplasmosis</a></p>\n\n<p><a href=\"http://www.redcrossblood.org/donating-blood/eligibility-requirements/eligibility-criteria-alphabetical-listing\" rel=\"nofollow\">Red Cross blood donation eligibility requirements</a></p>\n\n<p><a href=\"https://my.blood.co.uk/Knowledgebase\" rel=\"nofollow\">NHS blood donation services Knowledgebase</a></p>\n", "score": 1 }, { "answer_id": 3869, "body": "<p>First, it'll be necessary to know if only the mother was infected during pregnancy, or if the parasite responsible for toxoplasmosis (<em>Toxoplasma gondii</em>) was really transmitted to the foetus. This was possibly done during pregnancy via amniocentesis.</p>\n\n<p>If the person was infected in utero, then they are likely to carry the parasite, although they won't necessarily express symptoms. This can be verified by a specialized blood test (specific IgM and IgG antibodies will be searched).</p>\n\n<p>Toxoplasmosis can be transmitted via blood donation. People who have been infected by toxoplasmosis are however eligible for blood donation, but they must give this information to the blood center as their blood will be specifically not given to people with immune deficiency (who could then be severely infected by the parasite).</p>\n\n<p>These rules can vary from country to country. Be sure to check with the closest blood center.</p>\n\n<p>Sources : <a href=\"https://books.google.fr/books?id=THHv3HKKifUC&amp;pg=PA66&amp;lpg=PA66&amp;dq=blood%20donation%20toxoplasmosis&amp;source=bl&amp;ots=Ww2pa_Eb-W&amp;sig=XJOQ3MuOv5oslxXKHapDTRloiCE&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwi6_c_X7LDJAhUHWhoKHWSOB04Q6AEIRTAE#v=onepage&amp;q=blood%20donation%20toxoplasmosis&amp;f=false\" rel=\"nofollow\">recommendations on blood donations from the Pan American Health Organization</a>\n<a href=\"http://www.bloodjournal.org/content/37/4/388.long?sso-checked=true\" rel=\"nofollow\">Transmission of toxoplasmosis by blood donation described in 1970</a></p>\n", "score": 1 } ]

[ "blood", "blood-donation", "toxoplasmosis" ]

[ { "answer_id": 3935, "body": "<p>There's a number of medical reasons to take the pill other than preventing pregnancy : </p>\n\n<ul>\n<li>Regulating menstruation to avoid having irregular, overly frequent, overly abundant or painful periods, as well as premenstrual syndrome</li>\n<li>Endometriosis</li>\n<li>Polycystic ovary syndrome</li>\n<li>Acne</li>\n</ul>\n\n<p><a href=\"http://youngwomenshealth.org/2011/10/18/medical-uses-of-the-birth-control-pill/\" rel=\"nofollow\">Source</a></p>\n\n<hr>\n\n<p>Edited because I did in fact understood birth control pills and not prenatal supplementation.</p>\n\n<p>As a vitamin supplementation, it could in theory be used by people who lack certain nutrients, namely folic acid and iron (iron deficiency in particular is common in people who are menstruating). However, the Mayo Clinic doesn't recommend it:</p>\n\n<blockquote>\n <p>However, if you're not pregnant and not planning to become pregnant, high levels of certain nutrients over a long period of time may actually be more harmful than helpful.</p>\n</blockquote>\n\n<p><a href=\"http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/prenatal-vitamins/faq-20057922\" rel=\"nofollow\">Source</a> </p>\n", "score": 5 }, { "answer_id": 4276, "body": "<p>For most people, no. </p>\n\n<p>Prenatal vitamins usually contain folate acid, some also contain B12, iodine, and/or vitamin D. For deficiencies in the last three, usually, special supplements will be given. </p>\n\n<p>However, certain medications actually mess with the foliate cycle in the body, and require patients to take supplemental folic acid. One of those is <a href=\"http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/disease-modifying-drugs/methotrexate-side-effects.php\" rel=\"nofollow\">methotrexate</a>. Some doctors prescribe higher dose folic acid to be taken once weekly, others recommend just taking a folic acid supplement daily - which are usually marketed as prenatal vitamins. Patients taking that often enjoy the irony of taking prenatal vitamins alongside a medication that is actively harmful to a pregnancy.</p>\n\n<p>So it's rare, but possible. </p>\n", "score": 1 } ]

[ "medications", "obstetrics", "supplement" ]

[ { "answer_id": 11099, "body": "<p>I am a trained first aider.</p>\n\n<p>I note that this question was asked a long time ago and has never been answers.</p>\n\n<p>The majority of ID/Health alert lockets should indeed be waterproof (this would either the case or the information it contains). Otherwise, it's pretty much useless.</p>\n\n<p>First aiders are trained to look for lockets that have the \"snake on a pole\" or \"SOS\" design prominently in view. Anything over-stylised would be easily overlooked. I guess it might well be obvious, but the information held within an SOS locket needs to be updated as soon the information changes, or it becomes illegible.</p>\n\n<p>I'd also go for a bracelet - as a male first aider, I wouldn't be comfortable looking into a woman's cleavage for a pendant.</p>\n\n<p>Obviously, the key thing is that people who are commonly around you (friends/co-workers) should be aware of your condition and any likely conditions you might have. Background information really does help a first aider, even if they do need to put a little work into confirming what's actually happening.</p>\n", "score": 2 }, { "answer_id": 11119, "body": "<p>[<strong>SOLVED_EasilyAccessibleStandardLogoNoGlitter</strong>]</p>\n\n<p>What ever makes the <em>responder</em> identify the situation quickly enough will help in the worst case scenario or for an emergency. So, for my question what type of accessory would make it easier to identify this particular type of situation? <strong>Ideally a bracelet is the best option</strong>. Otherwise, if a bracelet can't be worn then it would be appropriate to use a necklace instead.</p>\n\n<p>Just make sure the I.D.'s design isn't straying too far away from how medical logos are displayed. Since we are talking about a standard procedure the medical logo (<em>or the Snack-on-a-Pole / SOS</em>) must be visible to any peripheral vision.</p>\n\n<p>Thanks to @PETE, I was now able to understand the <strong>importance of speed</strong> to acknowledge responders to take the appropriate action for person(s) in danger. This is because they were able to locate the information needed as-fast-as-possible without any fuss or delay.</p>\n\n<p>Now, I just wonder if people ever considered using a Tattoo for this case....</p>\n", "score": 0 }, { "answer_id": 21597, "body": "<p>For people within the United States, there are a number of options for diabetes, especially insulin-dependent diabetes. There are a number of options include custom dog tags, shoe tags, necklaces and bracelets from cheap stainless steel options up to ordering custom engraved options from Tiffany. There are also off-the-shelf options online, at pharmacies and on websites like Amazon that say, Type 1 Diabetes - Insulin Dependent, and are necklaces, bracelets and even a wide variety of silicon bracelets. T1D is universally understood, so anything that can have a monogram would work. </p>\n\n<p>It's now 2020, and the other options emerge if you are on a CGM and/or pump. Those need to be noted, especially if you are passed out and medical professionals need to remove hardware for scans. Especially with the CGMs, there are SOS and medical emergency options with the devices that collect the output that data. The Apple Watch and/or phone have that information available readily for medical professionals. EHR data can also be pulled into the health app for these devices as well. So information that should be available is:</p>\n\n<p>Diagnosis: T1DM\nMedications: Insulin Dependent, Glucagon kit, xyz...\nMedical Devices: CGM, Insulin Pump, etc.\nEmergency Contact: ICE - Name - Phone Number\nMedical Data Source: EHR, Endo, Hospital Group, etc. \nAllergies: Food, Meds, Additives to Meds\nOther Medical Conditions and Meds</p>\n\n<p>I hope that helps you live safe and well with T1D! </p>\n", "score": 0 } ]

[ "diabetes", "type-1-diabetes", "clothes", "public-awareness" ]

[ { "answer_id": 3949, "body": "<p>In general, no.</p>\n\n<p>A <a href=\"https://en.wikipedia.org/wiki/Ketogenic_diet\">ketogenic diet</a> is one where carbohydrates are eliminated and protein is restricted, to force the body to obtain its energy from the metabolism of fatty acids and ketone bodies, rather than the normal method of glucose metabolism. It is used primarily to treat otherwise-intractible epilepsy, and to a lesser extent, to deal with certain metabolic disorders.</p>\n\n<p>Long-term side effects of the diet in children include <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19064531\">poor bone development</a>, <a href=\"http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet\">stunted growth, and kidney stones</a>. In short, it's not something you should be subjecting a child to without a strong medical reason to do so, under the supervision of a doctor.</p>\n", "score": 12 }, { "answer_id": 3959, "body": "<p>Your have three questions in one now:</p>\n\n<ul>\n<li>Is a ketogenic diet appropriate for a one year old? </li>\n<li>Is a carbohydrate reduced diet appropriate for a one year old? </li>\n<li>Is milk really necessary for a one year old, or can I replace it with something else? </li>\n</ul>\n\n<p><strong>Milk</strong></p>\n\n<p>Milk is a very obvious nutritional choice for a small child. You mention that your child has been drinking formula so far, so the switch to cow milk makes sense. Milk is an excellent source of calcium, which kids need a lot of to promote growth. In many countries, it is also fortified with vitamin D, which enhances calcium absorption. </p>\n\n<p>The <a href=\"http://www.aafp.org/afp/2006/1101/p1527.html\">Guidelines of the American family physicians</a> recommends two or three servings (cups = approximately 600 milliliters in total) per day, to get around 700 milligrams of calcium. Except for fortified foods, <a href=\"http://nof.org/articles/886\">dairy really is a very good source for calcium</a></p>\n\n<p>Can it be replaced? Sure. There's children who are lactose tolerant or get eczema, for example, who can't have milk. Should you, with no physical reason to? I'd say no. For one thing, getting enough calcium without dairy really isn't all that easy, especially for a one year old. Two cups of milk are much easier to get into a toddler than 350 grams of broccoli. </p>\n\n<p>Also, for the purpose of reducing carbohydrates, reducing milk intake is a weird choice. That 600 milliliters of milk has about 30 grams of lactose (the only carbohydrate in milk). That 350 grams of broccoli to replace it has about 25. Complex carbs instead of a disaccaride, but if you are concerned about carbohydrates, milk is just really not a bad choice anyway. </p>\n\n<p><strong>Carbohydrate-reduced diet</strong></p>\n\n<p>I don't think anyone would tell you to give your daughter pasta, rice, and nothing else. A child's diet should be balanced, so of course she can have lots of other things - vegetables, meat, etc. Without knowing what exactly you mean with a diet low in carbohydrates, it's hard to say for sure, though. </p>\n\n<p><strong>Ketogenic diet</strong></p>\n\n<p>Someone else already linked to the study <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19064531\">Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet</a>. The important part here is that this occurred even despite the children receiving calcium and vitamin D supplements and reducing their medication. </p>\n\n<blockquote>\n <p>This study describes progressive loss of BMC in both the whole body and spine in children with IE treated with KD. These findings persisted after correction for both age and height. The decline in BMC occurred despite prescribed vitamin D and calcium supplementation and with a reduction in the number of AEDs used.</p>\n</blockquote>\n\n<p>Most studies are of course done in kids with epilepsy - deviating from the recommended diet for children in such an extreme way is only done in studies where the benefits may outweigh the risks. Everything else is not defendable in front of an ethics committee. </p>\n\n<p>However, in these studies, epileptic children on such a diet are compared to epileptic children on a normal diet. Differences between the groups are thus attributed to the diet. </p>\n\n<p>Other problems associated with ketogenic diets in children are <a href=\"http://link.springer.com/article/10.1007/s004670000443\">kidney stones</a>. </p>\n\n<p>Even in epileptic children, the ketogenic diet, despite its success, is only recommended <a href=\"http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet\">after several medication options fail</a> and includes regular checkups with a medical professional. </p>\n\n<p>I think it helps to remember what ketogenesis <em>is</em> - fatty acid breakdown it order to get the body the energy it needs. That breakdown can lower the pH in the blood, leading to keto acidosis, which is dangerous. In a child, with a low body mass and a high energy need because of growth, this at least sounds very dangerous. </p>\n\n<p>In summary, <strong>do not</strong> do this unless necessary. There is potentially no benefit at all, and a risk a parent should not be take on without medical need and supervision. </p>\n", "score": 8 }, { "answer_id": 3955, "body": "<p>I highly advise against such a restrictive and one-sided diet for a child! For children a balanced diet is important both for their physical and mental development. This means that malnutrition can cause permanent damage to both the mental and physical health of children.\nSee for example <a href=\"http://www.biomedcentral.com/content/pdf/1744-9081-4-31.pdf\" rel=\"noreferrer\">this research article</a> describing cognitive and physical retardation as a results of protein malnutrition in children. In contrast, the effects of malnutrition in adults are much less severe and more easily reversed.</p>\n\n<p>A ketogenic diet puts particular stress on the neural development (and the brain as a whole), because neurons mainly metabolise glucose. Quoting <a href=\"https://en.wikipedia.org/wiki/Brain\" rel=\"noreferrer\">the Wikipedia article about the brain</a>: The brain typically gets most of its energy from oxygen-dependent metabolism of glucose. This is also the reason why a ketogenic diet is used to treat some forms of epilepsy, because there the energy deprivation helps reduce the chance of the neurons firing too much and causing a seizure.\nThe effect of a ketogenic diet is again particularly strong in children because they use up to 40% of their total energy for the brain, while an adult uses only 20% of their energy for the brain. </p>\n\n<p>Finally, it is simply impossible to properly compensate for a one-sided diet with food supplements. Very often, the uptake of a mineral or vitamin critically depends on the food that we eat together with the nutrient. Evolution has simply not prepared us for the uptake of pure nutrients in the form of pills! Examples where we know these relationships are:</p>\n\n<ul>\n<li>Vitamin E can only be taken up together with fatty food.</li>\n<li>Calcium can only be integrated into bones well if there is no shortage of vitamins D and/or K</li>\n<li>Zinc can only be absorbed well together wit protein.</li>\n<li>And many more (both known and unknown)...</li>\n</ul>\n", "score": 6 } ]

[ "nutrition", "diet", "pediatrics" ]

[ { "answer_id": 3967, "body": "<p>This question already has a longer answer on our sister site, Biology Stackexchange. In summary, this is normal. </p>\n\n<p>I will quote from the answer of <a href=\"https://biology.stackexchange.com/users/8517/mike-taylor\">Mike Taylor</a>. The complete answer is a bit longer. </p>\n\n<blockquote>\n <p>This is natural phenomenon called the nasal cycle. It is discussed in this paper by <a href=\"http://www.ijpp.com/IJPP%20archives/1994_38_2/133-137.pdf\" rel=\"nofollow noreferrer\">Telles et al. (1994)</a>, among many others. The nostrils are used on an alternating cycle of about 2-3 hours, controlled by the <a href=\"http://www.ndrf.org/ans.html\" rel=\"nofollow noreferrer\">autonomic nervous system</a>. If you notice alternating congestion, that also seems to be coupled to the nasal cycle (Hasegawa and Kern <a href=\"http://europepmc.org/abstract/MED/609283\" rel=\"nofollow noreferrer\">1977</a>, <a href=\"http://europepmc.org/abstract/MED/635366\" rel=\"nofollow noreferrer\">1978</a>).</p>\n \n <p>The nasal cycle is a natural ultradian cycle (see <a href=\"http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1163\" rel=\"nofollow noreferrer\">here</a> and <a href=\"http://sequencewiz.org/wp-content/uploads/2014/08/Lateralized-rhythms-of-the-central-and-autonomic-nervous-systems.-D.-Shannahoff-Khalsa.pdf\" rel=\"nofollow noreferrer\">here</a>. Not only is it present in humans, the nasal cycle has been observed in rats, rabbits, domestic pigs, cats and dogs (see references in <a href=\"http://erj.ersjournals.com/content/9/2/371.full.pdf\" rel=\"nofollow noreferrer\">Eccles 1996</a>]). Thus, the nasal cycle may at least be a feature of mammals but it may be a feature of other bilateral animals that use nostrils for respiration. In addition, the nasal cycle may be an artifact of the evolution of bilateral symmetry in animals, and how the autonomic nervous system operates between the two sides. </p>\n \n <p>The autonomic nervous system controls the nasal cycle. The autonomic nervous system has two divisions, the sympathetic nervous system and the parasympathetic nervous system. Interestingly, these two divisions show a lateralized ultradian rhythm <a href=\"http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1163\" rel=\"nofollow noreferrer\">(Shannahoff-Khalsa 2007)</a>. This means that the parasympathetic nervous system dominates one side of the body and the sympathetic nervous system dominates the other side of the body. The two systems later switch dominate sides. This dominance swithcing back and forth between the parasympathetic and sympathetic happens with a regular rhythmic cycle every few hours. As it happens, this switching between sides correlates very well with the nasal cycle <a href=\"http://sequencewiz.org/wp-content/uploads/2014/08/Lateralized-rhythms-of-the-central-and-autonomic-nervous-systems.-D.-Shannahoff-Khalsa.pdf\" rel=\"nofollow noreferrer\">(Shannahoff-Khalsa 1991)</a>. When the parasympathetic-sympathetic systems switch sides, so do the nostrils. This is also associated with a switch in EEG activity between the two brain hemispheres <a href=\"http://europepmc.org/abstract/MED/6874437\" rel=\"nofollow noreferrer\">(Werntz et al. 1983)</a>.</p>\n \n <p>Therefore, the nasal cycle may not have a specific function, adaptive or otherwise. Instead, it could result from dominance of the parasympathetic system. Whichever side is dominated by the parasympathetic system will have the primary nostril in use for respiration. However, others have argued that the nasal cycle does provide a function. For example, <a href=\"http://erj.ersjournals.com/content/9/2/371.full.pdf\" rel=\"nofollow noreferrer\">Eccles (1996)</a> argued that the nasal cycle may function as a respiratory defense mechanism. They found that the rate of cycling increases when nasal infection is present in the nose. They argue that the congestion-decongestion helps generate \"plasma exudate\" (nasal fluids derived from blood plasma) which may help remove bacteria and viruses.</p>\n \n <p>The nasal cycle is an interesting phenomenon but whether it evolved as an adaptation (such as a mechanism proposed by Eccles et al. (1996) or is simply an artifact of the operation of the autonomic nervous system may never be known for sure.</p>\n</blockquote>\n\n<p>Original question: <a href=\"https://biology.stackexchange.com/questions/21216/why-do-i-only-breathe-out-of-one-nostril\">Why do I only breathe out of one nostril?</a></p>\n", "score": 3 } ]

[ "nose" ]

[ { "answer_id": 3968, "body": "<p>Smith-Lemli-Opitz syndrome is a genetic condition that only occurs if <em>both parents</em> are carriers of the mutation. For each chromosome that isn't a sex chromosome, we get one copy from each parent, so we have two copies of every gene. The \"autosomal recessive pattern\" means that the condition is not linked to the sex chromosomes (autosomal) and only occurs in people who have two copies (recessive), one from each parent. </p>\n\n<p>The parents, as carriers, themselves don't have any symptoms because they have a \"healthy\" copy of the gene in addition to the mutated gene. In a combination such as that, the risk of a subsequent child showing the syndrome is 25 percent, inheriting the mutation from both parents. 25 percent of children will get two \"healthy\" copies, and 50 percent will get one healthy and one mutated copies, and thus be carriers themselves. </p>\n\n<p>I have included a link explaining this kind of inheritance at the end. </p>\n\n<p>As for Diane-35, it is an oral contraceptive. Oral contraceptives do not cause genetic mutations, either in the mother or the fetus. </p>\n\n<p>Sources:</p>\n\n<p><a href=\"http://ghr.nlm.nih.gov/condition/smith-lemli-opitz-syndrome\">Smith-Lemli-Opitz syndrome</a> (already linked in the question, included here for completeness) </p>\n\n<p><a href=\"http://www.mayoclinic.org/autosomal-recessive-inheritance-pattern/img-20007457\">Autosomal recessive inheritance pattern</a></p>\n\n<p><a href=\"http://kintalk.org/genetics-101/\">Genetics 101</a> with some more detailed explanation of the genetics </p>\n", "score": 6 }, { "answer_id": 3969, "body": "<p>The following is of course, in case the diagnosis is confirmed.</p>\n\n<p>SLO is an autosomal recessive pathology, which means <strong>both parents are carrier</strong> of one mutated allele of the DHCR7. They do not express the pathology because the other allele isn't mutated and this allows for a normal function of the DHCR7 gene. </p>\n\n<p>This also means there is nothing that can be done about it. A birth-control pill doesn't have any impact on mutations or the genes in general, so no, it can't be due to drugs.</p>\n\n<p><a href=\"https://i.stack.imgur.com/TH0uC.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/TH0uC.png\" alt=\"enter image description here\"></a></p>\n\n<p>Each time this couple has a child, there is a 25% risk the child will have SLO syndrome. Because this is a high probability, they can be offered early prenatal diagnosis (so that if there's an abortion, it can be done early in the pregnancy) or pre-implantation genetic diagnosis (by selecting healthy embryos in vitro).</p>\n\n<p>Edit: @YviDe answered first, but since I wrote this I'm keeping it for the \"what to do for future pregnancies\" part.</p>\n\n<p>Image credit: <a href=\"https://en.wikipedia.org/wiki/File:Autorecessive.svg#/media/File:Autorecessive.svg\" rel=\"nofollow noreferrer\">Wikipedia User CBurnett</a> (own work in Inkscape) - CC BY-SA 3.0</p>\n", "score": 6 } ]

[ "obstetrics", "congenital", "enzyme" ]

[ { "answer_id": 8980, "body": "<p>You asked:</p>\n<blockquote>\n<p>if one has the options of packing the food cold and microwaving it later at work versus packing it hot in a thermos and keeping it hot all the way until lunch, which option is <strong>healthier</strong>?</p>\n</blockquote>\n<p>I'm not able to answer your question in regard to nutrients and vitamins, but I might have something to share about what is healthier in another aspect. It seems that it is important to keep food either in very low or very high temperatures to prevent bacterias from growing. See this quote from &quot;<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164089/\" rel=\"nofollow noreferrer\">Temperature of Foods Sent by Parents of Preschool-Aged Children</a>&quot; (2011):</p>\n<blockquote>\n<p>Biological hazards, especially bacteria, are found everywhere, including most foods, and multiply rapidly when exposed to warm moist conditions. Control of the temperature of food is an important way to prevent bacteria from growing and possibly causing foodborne illness. Bacteria are preserved in a state of suspended animation when refrigerated or frozen and most are killed when food is heated to an internal temperature &gt;74°C (165.2°F). <strong>Keeping foods &gt;60°C (140°F) or &lt;4°C (39.2°F) is critical in the prevention of foodborne illness</strong>.</p>\n<p><strong>Foods left in the temperature zone of 4°C (39.2°F) to 60°C (140°F) for &gt;2 hours are unsafe to consume and must be discarded</strong> because of the production of heat-resistant toxins by bacteria that can cause foodborne illness.</p>\n</blockquote>\n", "score": 1 }, { "answer_id": 9345, "body": "<p>The main short-term detrimental effect of heating on nutrients occurs during cooking. Keeping the food warm for several hours would further destroy some nutrients but to a lower extent.</p>\n\n<p>The only essential nutrients that can be partially destroyed (30-50%) by heating are vitamins (mainly B vitamins and vitamin C) (<a href=\"http://nutritiondata.self.com/topics/processing\" rel=\"nofollow\">nutritiondata.self.com</a>). Minerals are not destroyed, but some of them can leak out of foods during cooking in water. Carbohydrates, proteins and fats can change during heating but are not \"destroyed\" in the nutritional sense.</p>\n\n<p>On the linked website, there is a table that shows how food processing (freezing, drying, cooking, draining and reheating) affects vitamins. Keeping food in a thermo is similar to reheating, during which additional 30-50% of vitamins B and C can be destroyed (at temperatures expected in your flask probably less than 30%).</p>\n\n<p>In summary:</p>\n\n<ul>\n<li>Cooked and cooled food would retain more vitamins than food kept warm for several hours.</li>\n<li>A more important issue is an increased risk of bacterial overgrowth and food poisoning from a food that was kept warm for several hours. </li>\n</ul>\n", "score": 1 } ]

[ "nutrition" ]

[ { "answer_id": 12365, "body": "<p>I think alcohol is better than peroxide for the reasons stated above. </p>\n\n<p>Nevertheless, from an evidence stand-point, there is no really strong evidence for basically any solution over the other or even for whether to clean or not clean wounds.</p>\n\n<p>Personally (and what is preferred by most in daily practice and generally recommended in guidelines as well) is cleaning with a running solution (either isotonic saline or water) as it's believed that the largest part of the cleaning is actually done by mechanically pushing the germs off the wounded region.</p>\n\n<p><a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003861.pub3/abstract\" rel=\"nofollow noreferrer\">The effects of water compared with other solutions for wound cleansing</a></p>\n", "score": 2 } ]

[ "first-aid", "wound-care", "wound", "hydrogen-peroxide", "rubbing-alcohol-isopropyl" ]

[ { "answer_id": 10434, "body": "<p>To remove the sealant, <a href=\"http://jada.ada.org/article/S0002-8177(16)30473-1/fulltext\" rel=\"nofollow noreferrer\">probably the most effective way to protect the teeth from caries</a>, you need to reapply an acid or remove the superficial sealed enamel. In both cases you will loss more healthy enamel than sealant. </p>\n\n<p>So, I <strong>would not</strong> reccomend to remove a sealant from a sealed tooth, instead, I would <strong>reccomend to re-seal</strong> any partial loss sealed tooth to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19149298\" rel=\"nofollow noreferrer\">avoid the risk of caries</a>. </p>\n\n<p>By the way, the sealants work creating a barrier between the surface of tyour tooth and the acid that generates the sugar that you drink/eat and is metabolized by normal bacteria living in our mouth. </p>\n", "score": 4 } ]

[ "dentistry", "removal", "enamel" ]

[ { "answer_id": 4993, "body": "<p>A few countries have large long-term databases and studies based on this data:</p>\n\n<ul>\n<li><p><a href=\"http://link.springer.com/article/10.1007/BF02185763\" rel=\"nofollow\">The heritability of human longevity: A population-based study of 2872 Danish twin pairs born 1870–1900</a> </p></li>\n<li><p><a href=\"http://biomedgerontology.oxfordjournals.org/content/53A/6/M441.short\" rel=\"nofollow\">The Effect of Genetic Factors for Longevity: A Comparison of Identical and Fraternal Twins in the Swedish Twin Registry</a> </p></li>\n</ul>\n\n<p>There are also lots of review articles on the subject, for example <a href=\"http://rstb.royalsocietypublishing.org/content/366/1561/35\" rel=\"nofollow\">Genomics of human longevity</a>.</p>\n\n<p>Most of the studies seem to show an impact of about <strong>20 to 33 percent from genetics</strong>, for example from the first study:</p>\n\n<blockquote>\n <p>The heritability of longevity was estimated to be 0.26 for males and 0.23 for females</p>\n</blockquote>\n\n<p>and the second:</p>\n\n<blockquote>\n <p>Over the total age range examined, a maximum of around one third of the variance in longevity is attributable to genetic factors, and almost all of the remaining variance is due to nonshared, individual specific environmental factors. </p>\n</blockquote>\n\n<p>and the review:</p>\n\n<blockquote>\n <p>Heritability studies comparing the concordance of lifespan in monozygous and dizygous twins estimated a 25–30% genetic contribution to human lifespan variation</p>\n</blockquote>\n\n<p>Basically, this means that they compared identical to fraternal twins, and found that the variability in lifespan between identical twins was less than that of fraternal twins. When also taking into account that fraternal twins share an average of 50% of their genetic material, the influence of genetics appears to be around a quarter to a third. The second paper I linked to above has some explanations on how they calculate this and what the numbers mean. </p>\n\n<p>Drawing conclusions from twin studies to the overall role of genetics is not a completely exact science¹, but this is probably the closest we can get to putting a number on this, I think. </p>\n\n<p>_{1) There may be other reasons for this, for example identical twins choosing to lead similar lifestyles more often. This is mentioned in the second paper: \"It is possible, for example, that this difference in risk is attributable to more similar environmental circumstances of MZ [identical] than of DZ [fraternal] pairs, rather than to their differences in genetic similarity.\"}</p>\n", "score": 2 } ]

[ "lifestyle", "statistics", "research", "life-expectancy" ]