ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: FEEDBACK

Sunday, January 16, 2011 10:23

In assisting the alcoholic to “see” what is going on, the counselor’s observation skills pay off. The alcoholic has a notoriously warped perception of reality. The ability of the counselor to “merely” provide accurate feedback to the client, giving specific descriptions of behavior, of what the client is doing, is very valuable. The alcoholic has lost the ability for self-assessment. It is quite likely that any feedback from family members has also been warped and laced with threats, so that it is useless to the alcoholic. In the counseling situation, it may go like this: “Well, you say things are going fine. Yet, as I look at you, I see you fidgeting in your chair, your voice is quivering, and your eyes are cast down toward the floor. For me, that doesn’t go along with someone who’s feeling fine.” Period. The counselor simply reports the observations. There is no deep interpretation. There is no attempt to ferret out hidden unconscious dynamics. The client is not labeled a liar. Your willingness and ability to simply describe what you see is a potent therapeutic weapon. The alcoholic can begin to learn how he does come across, how others see him. Thus, your use of observation serves to educate the client about himself
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DESCRIBING ALLERGY

Sunday, December 26, 2010 10:22
Posted in category Allergies

This broad knowledge is a good start but hardly sufficient to solve the problems of allergy. The allergy specialists find that the information about it is still incomplete.
There is a relationship between immunity and allergy. In immunity a foreign substance called an antigen stimulates the formation inside us of an antibody to combat it. Allergy is usually considered to be an undesirable manifestation of the antigen-antibody reaction.   When a foreign substance gains entrance to the tissues, the cells in turn produce an antibody against it. Where there is allergy the antibody in some manner attaches to certain tissue cells and renders them sensitive to further contact with the inciting antigen. After an appropriate interval, if contact with the foreign substance again occurs, some irritating substances, the chief one being called histamine, are liberated. These are thought to be directly responsible for the allergic signs and symptoms.
The human afflictions which are described as allergic would not seem to be due to the emotions but there are evidently two schools of thought as to the degree of relationship.
I have a friend who specializes in allergy and who describes himself as way out on the left. He thinks that the emotions play a small part. A woman has lived in the city all her life and has hardly laid eyes on a field of grain. Yet a series of tests show that her severe allergy is due to buckwheat. Further investigation shows that her husband is a furrier and uses buckwheat flour in his work. An asthmatic boy is sent west to school as his physician has a hunch that family difficulties are mostly responsible. The scheme works beautifully and he is entirely free of his asthma. Later on he feels that he needs more room furnishings and among other things a feather pillow comes on. Immediately his asthma returns. With thorough investigation undoubtedly most cases of allergy can be shown to have a physical basis. But they certainly can be aggravated by the emotions, or helped by a proper frame of mind. Most patients who go to a distant allergy clinic with buoyant spirit receive temporary relief.   Unfortunately a good many later backslide.
Anyway, whether allergy is a manifestation of the immunity reaction, or is associated with the emotions, or, as is presumably the case, is related to both of these, it seems safe to say that it is a condition of unusual or exaggerated specific susceptibility to a substance which is harmless in similar amounts for the majority of people. There is good evidence that it is a familial trait or, in ordinary language, that it runs in families. Likewise, it usually represents an ingrown constitutional defect, which means that you are just built that way. No matter how well you are doing at any one time, you may have recurrences of different clinical varieties.   These may involve skin, bronchi, nose, and intestinal tract. It may show as arthritis and trouble in the connective tissue, or, in fact, in about any part of the body. However, it should be stated that a majority of allergic individuals, whose allergies have been properly handled, become completely symptom-free and live normal, happy lives.
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TRUE CHILDHOOD ALLERGIES

Sunday, December 19, 2010 10:21
Posted in category Allergies

Many childhood illnesses are falsely attributed to allergies, particularly to certain foods such as dairy products. However, skin rashes are rarely caused by food allergies, although true contact dermatitis may occur if children come into contact with certain plants or chemicals, and allergic reactions can occur in response to insect bites and even sunlight.

Plant allergies
Plant allergies can produce a severe, even life-threatening dermatitis. Children who are allergic to rhus trees, for example, may develop significant swelling of the face, mouth, eyelids and throat. Grevillea, chrysanthemums, daisies, oleander and primula can all produce an allergic reaction. This may occur as a rash on the face or arms, or as a blistering eruption. These decorative, rapidly growing plants are becoming increasingly popular in school yards, parks and gardens. If a child does become allergic to a plant, he or she must avoid it at all costs as more severe reactions may occur with subsequent contact.

Insect bites
Insect bites in children commonly produce itchy lumps. The first time a child suffers from insect bites an allergic reaction can occur because his or her immune system has not previously been exposed to the insect protein. As children get older, their immune systems become ‘hardened’ and they develop tolerance to insect bites.
Severe, even life-threatening reactions can occur in response to wasp, bee and mosquito bites. These insects may also carry serious infections such as Ross River virus and malaria.

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MENOPAUSE IN WOMEN’S LIFE

Sunday, December 12, 2010 10:19
Posted in category Women's Health

The menopause is frequently accompanied, we don’t quite understand why, by sudden slight disturbances of the circulation, called vasomotor symptoms. A wave of heat passes over the entire body, and is often followed by a profuse sweating. There may occasionally be a sense of violent heart-beating, almost a feeling of suffocation. These symptoms may be disconcerting but they have no special importance. One cannot be too exact about how long they will continue.
A woman told me that she had been having “hot flashes” for fifteen years. The modern use of hormones at the time of the menopause may prolong the period of symptoms. Since the ovary is one of the many glands of internal secretion which work together in sexual matters, when it stops functioning, the whole system is put out of balance and adjustments have to be made. The adjustments may not take place if ovarian extracts are supplied. Undoubtedly the judicious use of hormonal therapy may at times be well worth while. The great trouble is that it is frequently overdone and over prolonged.
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ЛЕЧЕНИЕ АТОПИЧЕСКОГО ДЕРМАТИТА

Sunday, November 21, 2010 9:24
Posted in category Allergies
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Наиболее эффективным методом лечения атопического дерматита является устранение причинно-значимого аллергена из питания и окружения больного. Назначаются диеты с выключением причинно-значимых аллергенов. В особенности важно выключить из питания больного так называемые облигатные аллергены: рыбу, икру, яйца, цельное молоко, мед, орехи, цитрусовые и др. Исключить контакты с животными и бытовыми аллергенами.
По показаниям и после определения и выявления аллергенов проводится специфическая гипосенсибилизация (введение больному аллергена, вызвавшего данное заболевание, что приводит к снижению чувствительности организма в результате нормализации обмена веществ) пищевыми или бытовыми аллергенами.
Часто назначаются антигистаминные препараты (димедрол, пипольфен, супрастин и др.), оказывающие противозудное действие и улучшающие, как правило, сон больных, что важно для предотвращения расчесывания кожи во сне. Применяются продолжительные курсы лечения задитеном (кетотифеном).
Кортикостероидные гормоны внутрь и в инъекциях в настоящее время применяются лишь в тяжелых случаях. Обычно их применяют местно, недлительно, во время обострения процесса (гидрокортизоновая мазь, лоринден, флуцинар, фторокорт, аэрозоли, содержащие кортикостероидные гормоны).
Большое значение для больного имеет одежда. С местами поражения могут контактировать только хлопчатобумажные ткани. Следует бороться с потливостью, так как выделение пота резко усиливает зуд, избегать слишком частого мытья горячей водой и мылом пораженной кожи. Мыть кожу следует не чаще 1-2 раз в неделю, теплой водой, с употреблением лишь детского мыла.
Заболевание имеет благоприятный для жизни прогноз, но течение его может быть очень длительным с чередованием периодов ухудшения и улучшения.

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TRIALS ON EVENING PRIMROSE OIL AND MS (MULTIPLE SCLEROSIS)

Wednesday, September 15, 2010 12:45
Posted in category General Health
During the 1970s many patients with MS began to take evening primrose oil, without the oil ever having been tested in a trial. Then in 1978 a trial took place in Newcastle, conducted by Professor David Bates and others.
The researchers divided 116 people with MS into four groups. One group was given evening primrose oil (Naudicelle), six capsules a day; one group was given olive oil in capsules; one group was given ‘Flora’ to eat as a spread; and one group was given another spread. No one knew what he or she was taking.
At the end of the two years, there was no significant difference between any of the groups, as measured by the Kurtzke disability scale.
Of all the groups, those who did best were the ones who took the sunflower seed oil spread ‘Flora’. The duration and severity of their attacks were less severe. In this group, the amount of linoleate in their blood went up from 28% before the trial started to 39% at the end of the trial.
Professor Bates came to the conclusion that the amount of polyunsaturates taken has to be enough to affect plasma levels. Only when this level has been achieved does the PUFA have an effect on the severity and duration of relapses.
At the time, the results of this trial were taken to prove that evening primrose oil does not work for MS. But this is not a correct or fair assessment at all, and in fact the results of this Newcastle trial were later re-analyzed by a Canadian doctor by the name of Robert Dworkin. Some years later after the Newcastle study, Dr Dworkin looked closely at its results, but he also pooled these results together with results from two other trials, one jointly in London and Belfast (Millar and others) and one in Ontario.
What Dr Dworkin found was extremely important: patients who had very low levels of disability at the start of the trial, who took polyunsaturates, did not get worse in a two-year period.
This was indeed a crucial discovery – the length of time that a patient had had MS made a difference to the outcome of the trials. The newly-diagnosed, who were 0-2 on the Kurtzke disability scale at the start of the trials, were the ones who showed little change or deterioration by the end of the trial. This applied only to the group which had been treated with PUFAs.
The conclusion from this is that treatment with PUFAs helps to stabilize MS in the recently diagnosed who have no real disability.
So in fact the Newcastle study – far from showing the ineffectiveness of evening primrose oil and other polyunsaturates for MS – does the opposite. But it does show that someone with MS does need to take a certain amount of linoleate for it to be effective.
The trial results do show that six capsules of evening primrose oil on their own, without any additional intake of linoleic acid, is not enough to affect plasma levels of linoleate. The answer, surely, is to take eight to 12 capsules of evening primrose oil a day, plus use sunflower seed oil spread and a cooking oil high in linoleic acid.
Some people have also criticized this particular trial on other scores. Firstly, there was no advice given about cutting down on saturated fats in the diet. (Saturated fats are thought to compete with polyunsaturated fats.) Secondly, the Naudicelle capsules used at that time had orange and black coloured shells which used the dye tartrazine. It is known that tartrazine interferes with fatty acid metabolism. Since then, evening primrose oil capsules have been produced in clear gelatin shells, with none of the same problems.
It is a pity that no one has conducted another trial with evening primrose oil taking all these factors into consideration. Since there has been no scientific evidence in favour of evening primrose oil as a therapy for MS, it is not prescribable on the NHS and has to be bought from chemists or health food shops, or by mail order from the manufacturers. Many people with MS find evening primrose oil too expensive to buy so don’t take it at all.
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CHLAMYDIA

Wednesday, September 15, 2010 12:41
Posted in category General Health
Chlamydia is probably the most frequent cause of sexually transmitted disease in Australia today. Amongst men this very small bacteria produces Non Specific Urethritis (NSU). In women chlamydia causes Pelvic Inflammatory Disease (PID), infertility and ectopic pregnancies. Chlamydia can also cause infections in the eye and other organs.
Approximately 300,000 Australian women are at risk of infertility as a result of silent chlamydia infection. Most are not even aware they have the disease. When infection affects men they get some burning with the passage of urine and a slight penile discharge. Women receive no such warning and unless contacted by a treated partner, they receive no notice of the unpleasant complications to come.
Chlamydiae are sensitive to antibiotics such as the Tetracyclines, Bactrim and Erythromycin. Because these small bacteria live and reproduce inside the human host cells, long courses of antibiotics are necessary. Two weeks is the minimum period for treatment. Sometimes chlamydia finds a home in deeper tissues of the body and like herpes become difficult to eradicate. Recurrence appears in up to 15 percent of the treated population.
Home Remedies
Chlamydia means that condoms are the rule until there is some certainty that a sexual relationship is one on one. Chlamydia infection is silent in women, those with a history of frequent sexual activity with multiple partners should have a test for chlamydia when ever they present for a pap smear. A swab of the cervix and an anti cancer smear are easily done at the same time. Chlamydia is also detectable through the use of a blood test.
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HEALTH CARE OF OLDER PEOPLE: WHEN TO CHOOSE A GERIATRIC SPECIALIST

Tuesday, June 1, 2010 13:43
Posted in category General Health
As long as you select someone who seems aware of your needs, your physician need not have formal training in geriatrics. If you have several disabling conditions or are in your eighties or beyond and need to change doctors, however, it makes sense to search out a geriatric specialist. If a doctor has been recommended as specializing in geriatrics, find out exactly what training he or she has had. Ask about plans to take the newly developed licensing examination in the field.
If you live in an urban area, explore the possibility of getting care from a hospital-based geriatric service. Geriatric services offer state-of-the-art team care for disabled older people-workers from a variety of disciplines collaborate to keep people functioning independently. If this type of service is available, the care is likely to be excellent. You will be surprised at the attention and the sensitivity to your needs. People committed to geriatrics are a special breed; they combine technical skill with heart. When necessary, they are even happy to make house calls.
Another alternative you may have is a freestanding geriatric center. To understand what services this type of institution can provide, let’s examine the offerings of one – the Metropolitan Jewish Geriatric Center in Brooklyn, New York.
The Metropolitan Jewish Geriatric Center provides what it calls an “umbrella approach” to geriatric care, addressing the full spectrum of needs of older people who are having some trouble functioning independently. It offers inpatient services and a variety of outpatient programs. There is long-term home health care for people who are housebound: all the nursing, rehabilitation, and medical services of a nursing home are offered in a patient’s own home. There is the day hospital, a center open from nine to five offering activities, meals, nursing, and rehabilitation. There is the hospice program for people who are terminally ill. (Hospices minister to dying patients and their families, offering counseling and treatment directed toward pain control and comfort rather than cure. To enter this program, now covered by Medicare, a person must be judged as having no more than six months to live and must be willing to abandon curative treatments.) There also is an Emergency Alarm Response System (EARS). For a small monthly charge a subscriber’s telephone is hooked up to a central switchboard. Someone calls daily to check in. If there is no answer, a neighbor comes by to check. The older person living alone has the comfort of knowing help will arrive in a medical emergency.
There also is Elderplan, an HMO specifically for people over sixty-five. By paying a fixed sum, enrollees are entitled to all the outpatient services the center offers plus traditional medical and hospital care and care in a nursing home.
Except for Elderplan, all the programs offered at this geriatric center are now available in many communities. They are components of what is called a continuum of care. They exist to prevent nursing-home placement, to keep people with disabilities functioning in the community.
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GENERAL HEALTH

HEALTH CARE FOR OLDER PEOPLE: THE HMO ALTERNATIVE

Tuesday, June 1, 2010 13:42
Posted in category General Health
Increasingly, rather than selecting a private doctor, you may have another choice – joining a health maintenance organization or HMO. Rather than paying a physician for each appointment, if you join an HMO you pay a fixed sum in advance that entitles you to almost all (or all) of your medical care: checkups and routine care, laboratory tests, the services of specialists, hospitalization costs. There are two major types of HMOs – group practice and individual practice.
Group-practice HMOs provide all their outpatient services at a centrally located health facility, usually staffed by primary-care doctors, specialists (e.g., in eye care, hearing, surgery, gynecology), and additional personnel such as technicians and nurses. The clinic offers laboratories, X-ray services, a pharmacy, and perhaps ambulatory surgical care. On enrolling, a subscriber selects one of the primary-care doctors as a personal physician who is responsible for coordinating care. On routine visits patients may see a specially trained nurse practitioner.
Individual-practice HMOs provide primary care in the private offices of doctors under contract to the HMO. Joining this type of HMO may make getting to the doctor easier if you choose someone with an office near your home, but you may not receive the wide range of services you would get by joining a group-practice HMO.
A major advantage of joining an HMO is more financial peace of mind. Your medical bill is already paid. There are no large out-of-pocket expenses you might abruptly incur. There also is no economic deterrent to calling the doctor if you are ill, since visiting four times a month costs no more than once a month. And because HMOs have to operate within a fixed budget, they have an incentive to deliver services in an economical fashion. Studies show that, on average, people who use HMOs spend less for health care.
Does this emphasis on efficiency lead to poorer service? Although doctors opposed to HMOs reason that a system where people are paid beforehand no matter what they do offers a built-in incentive to provide minimal, cursory care, the reverse seems to be true. When researchers at Johns Hopkins Medical School reviewed the literature comparing HMO care with traditional fee-for-service care, nineteen studies showed that HMOs provided better care, a handful found the two types of care comparable, and only one or two found HMO care inferior.
On the other hand, the serious drawback to joining an HMO is the lack of freedom. HMO subscribers must use a certain hospital; when they need a specialist, they must visit someone under contract to the HMO. Many people decide against joining because they are not prepared to give up the right to go to the doctor or hospital of their choice.
Furthermore, only a fraction of HMOs accept Medicare. (Some HMOs not under contract to Medicare provide what is called Medicare “wraparound,” offering coverage for current subscribers, who then become eligible for Medicare.) Probably in part because of this, only a small minority of the elderly are enrolled in HMOs.
If you are interested in an HMO and able to enroll, use the same considerations in evaluating it as you would in selecting a private physician: cost (Does the HMO accept Medicare? How expensive is joining? What services are covered?); accessibility (How easy is it to get there? Will a doctor see you promptly if you are ill?); quality (Is the clinic overcrowded and unattractive? Are the doctors on the staff well qualified? What is the affiliated hospital like?).
James Doherty of the Group Health Association of America, a national organization of HMOs, also suggests finding out if the HMO is “federally qualified.” Federally qualified HMOs are approved by the Health Care Financing Administration. Your state insurance department will also have information about the quality of a prospective HMO.
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GENERAL HEALTH

NORMAL SLEEP PATTERNS: INFANCY

Thursday, May 21, 2009 6:58
Posted in category General Health

The sleeping pattern begins to change in the first 6 months. This is a time of considerable irregularity, as babies’ neurological systems mature at different rates, but in early infancy sleeping patterns tend to coincide with feeding times — that is, babies wake to feed.

By 6 weeks of age, babies are awake for longer periods during the day, as they begin to take an increasing interest in their environment and interact with their care-givers. By 6 months their sleep is less linked to feeding patterns. Rather than sleeping for most of the time, they are awake for longer periods and seem to have several naps during the day. Some infants, to the great delight of their parents, are already sleeping through the night.

Between 6 months and 1 year of age, sleep patterns change considerably. The typical baby will sleep 10-12 hours at night and have two naps during the day. A greater number of babies sleep right through the night. Some may wake several times but will often go back to sleep with a minimum of fuss. This is also the time when they begin to establish more regular and predictable patterns of sleep and feeding and playing. There is still variation, depending on temperament and other factors. This is also the time when patterns are easily disrupted by illness. Many sleep problems have their genesis during this period, with parents unwittingly interfering with their babies’ sleep cycles, for example waking him for a feed. It is important that your baby be allowed to develop his own sleep patterns with minimal parental interference.

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