Smoking during pregnancy is associated with an increased risk of placentalabruption, a potentially life-threatening condition for both the mother and fetus.
With placental abruption, the placenta detaches from the uterus wall priorto birth, resulting in severe bleeding. Depending on the degree ofdetachment, up to 40 percent of affected infants die.
Dr. Cande V. Ananth, from the Robert Wood Johnson Medical School, NewBrunswick, New Jersey, and Dr. Sven Cnattingius, from the KarolinskaInstitute in Stockholm, investigated whether the effect of maternal smokingon abruption risk is restricted to the pregnancy during which the mothersmokes or whether subsequent pregnancies may be affected as well.
According to the findings, smoking during pregnancy raised the risk ofabruption during that pregnancy but seemed to have little impact on the riskin future pregnancies.
Regardless of smoking status, having one abruption greatly increased therisk of another abruption. In women with a prior abruption, the likelihoodof having another was increased 5.3-fold for nonsmokers and 10.9-fold forsmokers compared with women with no history of abruption.
These findings further reinforce the message that women should reducesmoking during pregnancy. [Am J of Epid]
Senin, 21 Juli 2008
Sabtu, 19 Juli 2008
Choosing a Physician
What is a family physician?
A family physician is a doctor who takes care of your whole family. Familyphysicians create caring relationships with patients and their families.They really get know their patients. They listen to them and help them makethe right health care decisions.
What do family physicians do?
Family physicians take care of the physical, mental, and emotional health oftheir patients and their families. They know how your family's healthhistory can affect you. They are trained to care for you through all thestages of your life.
Family physicians are trained in all areas of medicine. They diagnose andtreat the full range of problems people bring to their doctors. They knowwhen to treat you, and when to bring in another specialist you can trust.
What kind of training do family physicians have?
Family physicians must know the most current treatments and technologies.Only family physicians train in real practice settings, treating patients inthe office, the hospital, and at home. Family physicians also continue toeducate themselves. This allows them to apply the latest medicalbreakthroughs to the everyday care of their patients.
I don't have any health problems. Why do I need a family physician?
Family physicians are specially trained in preventive medicine. They believethat preventing a health problem is better than having to overcome one. Theyhelp you make the right health choices to keep you and your family healthy.
How do I find a family physician?
If you are looking for a family physician, try talking to your friends andfamily. Once you have the names of a few doctors, call their offices to getmore information. Some things that you should ask include:
A family physician is a doctor who takes care of your whole family. Familyphysicians create caring relationships with patients and their families.They really get know their patients. They listen to them and help them makethe right health care decisions.
What do family physicians do?
Family physicians take care of the physical, mental, and emotional health oftheir patients and their families. They know how your family's healthhistory can affect you. They are trained to care for you through all thestages of your life.
Family physicians are trained in all areas of medicine. They diagnose andtreat the full range of problems people bring to their doctors. They knowwhen to treat you, and when to bring in another specialist you can trust.
What kind of training do family physicians have?
Family physicians must know the most current treatments and technologies.Only family physicians train in real practice settings, treating patients inthe office, the hospital, and at home. Family physicians also continue toeducate themselves. This allows them to apply the latest medicalbreakthroughs to the everyday care of their patients.
I don't have any health problems. Why do I need a family physician?
Family physicians are specially trained in preventive medicine. They believethat preventing a health problem is better than having to overcome one. Theyhelp you make the right health choices to keep you and your family healthy.
How do I find a family physician?
If you are looking for a family physician, try talking to your friends andfamily. Once you have the names of a few doctors, call their offices to getmore information. Some things that you should ask include:
- Do they accept your insurance?
- What are the office hours?
- What hospital does the doctor use?
Once you find a doctor who meets your needs, schedule an appointment so thatyou can meet and talk to the doctor. During the appointment, make sure:
- You're comfortable talking to the doctor
- The doctor answers all your questions
- The doctor explains things so that you can understand
- You had enough time to ask all your questions
Remember, it takes time to build a relationship with your doctor. (AAFP)
Rabu, 16 Juli 2008
The Common Cold: What You Should Know
What is a cold?
A cold is a common illness that can be caused by many viruses. It can bepassed easily from one person to another.
If you have a cold, your throat may be sore or scratchy. After a couple ofdays, you may have a runny or stuffy nose and a cough that lasts about aweek. The mucus from your runny nose might be yellow or green for a fewdays. Some people have a fever and muscle aches in the first few days.Sometimes, you can have more serious symptoms like an ear infection, sinusinfection, or pneumonia.
Colds do not cause serious health problems for most people. But they cancause problems for people who smoke, people whose bodies can't fightinfection, and people who have lung problems.
What should I do if I have a cold?
Usually, you don't have to do anything. Most colds don't cause seriousproblems.
There is no medicine to cure a cold, but over-the-counter medicine mighthelp you feel better. These medicines may not be good for young children andolder adults. Some may have bad side effects. Ask your doctor what medicineis best for you or your child.
How do I know if I have a cold and not something worse?
If your symptoms are normal for a cold and you've been around people withcolds, you probably have a cold and not something more serious. See yourfamily doctor if you have:
A cold is a common illness that can be caused by many viruses. It can bepassed easily from one person to another.
If you have a cold, your throat may be sore or scratchy. After a couple ofdays, you may have a runny or stuffy nose and a cough that lasts about aweek. The mucus from your runny nose might be yellow or green for a fewdays. Some people have a fever and muscle aches in the first few days.Sometimes, you can have more serious symptoms like an ear infection, sinusinfection, or pneumonia.
Colds do not cause serious health problems for most people. But they cancause problems for people who smoke, people whose bodies can't fightinfection, and people who have lung problems.
What should I do if I have a cold?
Usually, you don't have to do anything. Most colds don't cause seriousproblems.
There is no medicine to cure a cold, but over-the-counter medicine mighthelp you feel better. These medicines may not be good for young children andolder adults. Some may have bad side effects. Ask your doctor what medicineis best for you or your child.
How do I know if I have a cold and not something worse?
If your symptoms are normal for a cold and you've been around people withcolds, you probably have a cold and not something more serious. See yourfamily doctor if you have:
- symptoms that are worse than those of a normal cold or that haven't gottenbetter in 10 days
- a high fever
- an earache that gets worse
- a headache or pain in your face or eyes
- a stiff neck
- shortness of breath
- sleepiness or confusion
- a health problem that makes it more likely that you will have problemswith a cold (for example: asthma and other lung diseases or a disease thataffects how your body fights infection) (AAFP)
Corneal Abrasions
What is a corneal abrasion?
A corneal abrasion is a cut or scratch on your cornea. The cornea is theclear, protective window at the front of your eye. It lies directly over thecolored part of your eye (called the iris).
What can cause a corneal abrasion?
Many things can cause a corneal abrasion, such as sand, dust, dirt, wood ormetal shavings that get in your eye. The cornea can also be scratched by afingernail, a tree branch or a contact lens. Rubbing your eyes very hard isanother way that an abrasion can occur. Sometimes, if a corneal abrasionhasn't healed properly, it can come back weeks or months after the originalinjury. In some people, the outer layers of the cornea are weak. Thesepeople may get a corneal abrasion for no apparent reason.
How do I know if I have a corneal abrasion?
The cornea is very sensitive, and a corneal abrasion is usually quitepainful. You may feel like you have sand or grit in your eye. You may noticetears or blurred vision, or your eye may look red. You may also notice thatlight hurts your eye. Some people get a headache when they have a cornealabrasion.
What do I do if I get something in my eye?
If you think something has gotten into your eye, first try to wash out theeye by splashing clean water into it. Your workplace may have an eye rinsestation for this purpose. Sometimes, blinking or pulling the upper eyelidover the lower eyelid may remove a particle from under the eyelid. Avoidrubbing your eye. If you or someone else notices something on the white partof your eye, use a soft tissue or cotton swab to gently lift it out of theeye. Don't try to remove something that is directly over the cornea--thismight cause more serious damage. If you can't remove the particle or ifthere doesn't seem to be anything in your eye, call your doctor.
What will my doctor do for a corneal abrasion?
Your doctor will examine your eye for any damage or particles that may betrapped under your eyelid. A yellow-orange dye may be placed on your eye tohelp your doctor see the abrasion. Your doctor will probably treat theabrasion with eye drops or ointment. Most small abrasions heal within one tothree days. You may need to return to your doctor for another exam the nextday.
What if I wear contact lenses?
If you wear contact lenses, you need to be especially careful with a cornealabrasion because you have a higher risk of infection. Your doctor may tellyou not to wear your contact lenses for a few days if you're treating youreye with medicine.
How can I prevent corneal abrasion?
Take the following steps to help prevent corneal abrasions:
A corneal abrasion is a cut or scratch on your cornea. The cornea is theclear, protective window at the front of your eye. It lies directly over thecolored part of your eye (called the iris).
What can cause a corneal abrasion?
Many things can cause a corneal abrasion, such as sand, dust, dirt, wood ormetal shavings that get in your eye. The cornea can also be scratched by afingernail, a tree branch or a contact lens. Rubbing your eyes very hard isanother way that an abrasion can occur. Sometimes, if a corneal abrasionhasn't healed properly, it can come back weeks or months after the originalinjury. In some people, the outer layers of the cornea are weak. Thesepeople may get a corneal abrasion for no apparent reason.
How do I know if I have a corneal abrasion?
The cornea is very sensitive, and a corneal abrasion is usually quitepainful. You may feel like you have sand or grit in your eye. You may noticetears or blurred vision, or your eye may look red. You may also notice thatlight hurts your eye. Some people get a headache when they have a cornealabrasion.
What do I do if I get something in my eye?
If you think something has gotten into your eye, first try to wash out theeye by splashing clean water into it. Your workplace may have an eye rinsestation for this purpose. Sometimes, blinking or pulling the upper eyelidover the lower eyelid may remove a particle from under the eyelid. Avoidrubbing your eye. If you or someone else notices something on the white partof your eye, use a soft tissue or cotton swab to gently lift it out of theeye. Don't try to remove something that is directly over the cornea--thismight cause more serious damage. If you can't remove the particle or ifthere doesn't seem to be anything in your eye, call your doctor.
What will my doctor do for a corneal abrasion?
Your doctor will examine your eye for any damage or particles that may betrapped under your eyelid. A yellow-orange dye may be placed on your eye tohelp your doctor see the abrasion. Your doctor will probably treat theabrasion with eye drops or ointment. Most small abrasions heal within one tothree days. You may need to return to your doctor for another exam the nextday.
What if I wear contact lenses?
If you wear contact lenses, you need to be especially careful with a cornealabrasion because you have a higher risk of infection. Your doctor may tellyou not to wear your contact lenses for a few days if you're treating youreye with medicine.
How can I prevent corneal abrasion?
Take the following steps to help prevent corneal abrasions:
- Wear protective eye goggles when you're around machinery that causesparticles of wood, metal or other materials to fly into the air (such as achainsaw or a sandblaster)
- Cut infants' and young children's fingernails short
- Trim low-hanging tree branches
- Use care when putting in contact lenses (AAFP)
Contraceptive Injections
Two contraceptive formulations are available as injections. Each is injectedby a health care practitioner into a muscle of the arm or buttocks, and eachis very effective as a contraceptive.
Medroxyprogesterone acetate, a progestin, is injected once every 3 months.Medroxyprogesterone acetate can completely disrupt the menstrual cycle.About one third of women using this contraceptive have no menstrual bleedingduring the 3 months after the first injection, and another third haveirregular bleeding and spotting for more than 11 days each month. After thiscontraceptive is used for a while, irregular bleeding occurs less often.
After 2 years, about 70% of the women have no bleeding at all. When theinjections are discontinued, a regular menstrual cycle resumes in about halfof the women within 6 months and in about three fourths within 1 year.
Fertility may not return for up to a year after injections are discontinued.Side effects include a slight weight gain and a temporary decrease in bonedensity. Bones usually return to their previous density after the injectionsare discontinued. Medroxyprogesterone acetate does not increase the risk ofdeveloping any cancer, including breast cancer. It greatly reduces the riskof developing uterine (endometrial) cancer. Interactions with other drugsare uncommon.
The other formulation is a once-a-month injection. It contains estrogen anda much smaller amount of medroxyprogesterone acetate than the injectionsgiven every 3 months. Consequently, bleeding usually occurs regularly about2 weeks after each injection is given, and bone density does not decrease.Because the dose of medroxyprogesterone acetate is lower, fertility returnsmuch more rapidly after the injections are discontinued. [Merck]
Medroxyprogesterone acetate, a progestin, is injected once every 3 months.Medroxyprogesterone acetate can completely disrupt the menstrual cycle.About one third of women using this contraceptive have no menstrual bleedingduring the 3 months after the first injection, and another third haveirregular bleeding and spotting for more than 11 days each month. After thiscontraceptive is used for a while, irregular bleeding occurs less often.
After 2 years, about 70% of the women have no bleeding at all. When theinjections are discontinued, a regular menstrual cycle resumes in about halfof the women within 6 months and in about three fourths within 1 year.
Fertility may not return for up to a year after injections are discontinued.Side effects include a slight weight gain and a temporary decrease in bonedensity. Bones usually return to their previous density after the injectionsare discontinued. Medroxyprogesterone acetate does not increase the risk ofdeveloping any cancer, including breast cancer. It greatly reduces the riskof developing uterine (endometrial) cancer. Interactions with other drugsare uncommon.
The other formulation is a once-a-month injection. It contains estrogen anda much smaller amount of medroxyprogesterone acetate than the injectionsgiven every 3 months. Consequently, bleeding usually occurs regularly about2 weeks after each injection is given, and bone density does not decrease.Because the dose of medroxyprogesterone acetate is lower, fertility returnsmuch more rapidly after the injections are discontinued. [Merck]
What's a Fart?
P.U.! What's that smell? How can your body make something so stinky?Farts - also called flatus (say: flay-tus) or intestinal (say:in-tes-tuh-null) gas - are made of, well, gas!
When you eat, you don't swallow just your food. You also swallow air, whichcontains gases like nitrogen (say: ny-truh-jen) and oxygen (say:ahk-sih-jen) . Small amounts of these gases travel through your digestivesystem as you digest your food. Other gases like hydrogen (say:hy-droh-jen) , carbon dioxide (say: kar-bon dy-ahk-side, the gas that makessoda fizzy), and methane (say: meth-ain) are made when food is broken downin the large intestine. All of these gases in the digestive system have toescape somehow, so they come out as farts!
Gases are also what can make farts smell bad. Tiny amounts of hydrogen,carbon dioxide, and methane combine with hydrogen sulfide (say: suhl-fide)and ammonia (say: uh-mow-nyuh) in the large intestine to give gas its smell.Phew!
All people fart sometimes, whether they live in France, the Fiji islands, orFresno, California! If you have a dog, you may have even been unlucky enoughto have heard (or smelled) Fido farting. Intestinal gas is totally normal,and it's very rare for farting to be a sign that something is wrong in the body.
If you want to be less farty, try cutting back on foods like beans, onions,and fried foods. These can release larger amounts of gas as they break downin your body. If you have a lot of gas after you eat ice cream, yogurt, ormilk, talk to your parent about it - your body may have a difficult timedigesting the natural sugar called lactose, which is found in dairy foods.And don't forget that farting can sometimes be your body's sign that it'stime to take a trip to the bathroom.
The bathroom is also a good place to go if you're feeling particularly gassybecause it's not polite to fart in social settings, like in class or at thedinner table (Yuck!). But don't worry if this happens accidentally. Justremember to say "excuse me!" [AAFP]
When you eat, you don't swallow just your food. You also swallow air, whichcontains gases like nitrogen (say: ny-truh-jen) and oxygen (say:ahk-sih-jen) . Small amounts of these gases travel through your digestivesystem as you digest your food. Other gases like hydrogen (say:hy-droh-jen) , carbon dioxide (say: kar-bon dy-ahk-side, the gas that makessoda fizzy), and methane (say: meth-ain) are made when food is broken downin the large intestine. All of these gases in the digestive system have toescape somehow, so they come out as farts!
Gases are also what can make farts smell bad. Tiny amounts of hydrogen,carbon dioxide, and methane combine with hydrogen sulfide (say: suhl-fide)and ammonia (say: uh-mow-nyuh) in the large intestine to give gas its smell.Phew!
All people fart sometimes, whether they live in France, the Fiji islands, orFresno, California! If you have a dog, you may have even been unlucky enoughto have heard (or smelled) Fido farting. Intestinal gas is totally normal,and it's very rare for farting to be a sign that something is wrong in the body.
If you want to be less farty, try cutting back on foods like beans, onions,and fried foods. These can release larger amounts of gas as they break downin your body. If you have a lot of gas after you eat ice cream, yogurt, ormilk, talk to your parent about it - your body may have a difficult timedigesting the natural sugar called lactose, which is found in dairy foods.And don't forget that farting can sometimes be your body's sign that it'stime to take a trip to the bathroom.
The bathroom is also a good place to go if you're feeling particularly gassybecause it's not polite to fart in social settings, like in class or at thedinner table (Yuck!). But don't worry if this happens accidentally. Justremember to say "excuse me!" [AAFP]
Sabtu, 12 Juli 2008
Sexually Transmitted Infections in Pregnancy
At the beginning of pregnancy, your family doctor will test you for sexuallytransmitted infections (STIs) that could hurt you or your baby. These testsare very important.
What tests will I have?
At the first visit, your family doctor may do a Pap smear to check forcervical cancer and signs of human papillomavirus (HPV) infection. Yourfamily doctor may also test for chlamydia (kluh-MID-ee- uh) and gonorrhea(gah-nuh-REE- uh). These tests may be repeated near the end of yourpregnancy.
Your blood will be tested for syphilis (SIFF-uh-liss) , hepatitis B, and HIV(the virus that causes AIDS). The family doctor will check your skin forsigns of herpes.
Why do I need these tests?
You can have many of these infections without having symptoms. Theseinfections can be passed on to your baby, and some of them can cause you togo into labor early.
What if I have an infection?
Chlamydia, gonorrhea, and syphilis can be treated with antibiotics.Medicines can help keep your baby from getting herpes and HIV viruses. Ifyou have hepatitis B, your baby can be given medicine at birth to keep himor her from getting the disease.
Your sex partner may also need to be treated for some infections (forexample, chlamydia and gonorrhea) so you don't get the infection back. Youshould not have sex with your partner until your partner has been treated, too.
How can I protect myself?
The safest way is to have only one sex partner, and for your partner not tohave sex with anyone else. Condoms give you some protection. You shouldalways use condoms if you have more than one partner or if your partner mayhave other partners. [AAFP]
What tests will I have?
At the first visit, your family doctor may do a Pap smear to check forcervical cancer and signs of human papillomavirus (HPV) infection. Yourfamily doctor may also test for chlamydia (kluh-MID-ee- uh) and gonorrhea(gah-nuh-REE- uh). These tests may be repeated near the end of yourpregnancy.
Your blood will be tested for syphilis (SIFF-uh-liss) , hepatitis B, and HIV(the virus that causes AIDS). The family doctor will check your skin forsigns of herpes.
Why do I need these tests?
You can have many of these infections without having symptoms. Theseinfections can be passed on to your baby, and some of them can cause you togo into labor early.
What if I have an infection?
Chlamydia, gonorrhea, and syphilis can be treated with antibiotics.Medicines can help keep your baby from getting herpes and HIV viruses. Ifyou have hepatitis B, your baby can be given medicine at birth to keep himor her from getting the disease.
Your sex partner may also need to be treated for some infections (forexample, chlamydia and gonorrhea) so you don't get the infection back. Youshould not have sex with your partner until your partner has been treated, too.
How can I protect myself?
The safest way is to have only one sex partner, and for your partner not tohave sex with anyone else. Condoms give you some protection. You shouldalways use condoms if you have more than one partner or if your partner mayhave other partners. [AAFP]
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