Construction worker suicide rates are highest in the US, CDC study says

Males working in construction have the highest suicide rates in the country, according to a recent analysis by the Center for Disease Control and Prevention (CDC).
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Males working in construction have the highest suicide rates in the country, according to a recent analysis by the Center for Disease Control and Prevention (CDC).

Comparing the suicides of more than 22,000 people across 17 states in 2012 and 2015, researchers found males working in construction and extraction took their lives the most often, a rate of roughly 44 per 100,000 “civilian noninstitutionalized working persons” for construction workers and 53 per 100,000 for extraction workers.

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Men working in the arts, design, entertainment, sports, and media came in second — an increase of 47 percent during the years studied, according to the CDC. Installation, maintenance and repair rounded out the top three for males in 2015.

Comparatively, in 2015, women working in arts, design, entertainment, sports, and media had the highest suicide rates for females, while women in protective services came in second. The third were women who worked in health care support, according to the study.

“Among both males and females, the lowest suicide rate in 2015 was observed in Education, Training, and Library occupations,” the CDC reported.

The research comes adjacent to the rising suicide rates in the U.S. overall. The health agency announced in June the rates have been rising in “nearly every state,” with 25 states reporting a more than 30 percent increase during the study period.

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“Increasing suicide rates in the U.S. are a concerning trend that represent a tragedy for families and communities and impact the American workforce,” Deb Houry, the director of the CDC National Center for Injury Prevention and Control, said in an online statement. “Knowing who is at greater risk for suicide can help save lives through focused prevention efforts.”

The study Thursday is a correction to a similar 2016 study, which mistakenly included the misclassification of some workers as farmers instead of managers.

The Associated Press contributed to this report.

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Kevin Love Explains What it Feels Like to Deal With Anxiety

As a five-time NBA All Star and Olympic Gold Medal Winner, it’s safe to say that Kevin Love is doing something right. But the 30-year-old Cleveland Cavaliers player has insecurities like anyone else. For Love, these doubts are a source of anxiety.

“I [always] had this sense that I was doing something wrong,” he explains to MensHealth.com. “I never was. I just had that feeling for no reason.”

Earlier this year, Love discussed his anxiety in an open letter published in The Players Tribune. Love’s brave essay got a lot of positive attention. After all, it’s unfortunately rare that men—let alone professional athletes—speak so openly about their mental health.

“For 29 years, I thought about mental health as someone else’s problem,” he wrote. “To me, it was form of weakness that could derail my success in sports or make me seem weird or different.”

When he was younger, Love’s anxiety “manifested in so many different ways,” he explains. “The only thing I knew was to go somewhere and have a rage-type fit.”

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Love finally prioritized his mental health after a panic attack sidelined him during the middle of a game.

“I thought I was dying,” he says. “It was just an out-of-body crazy experience that I’d never had before.”

Now, the NBA star wants other guys to know their masculinity isn’t threatened by mental health issues. Love partnered with Schick Hydro and the Movember Foundation to create a series of “Locker Room Talk” videos about men’s health. In one episode, Love speaks with decorated Olympian Michael Phelps about his struggle with depression. Fans can donate to the campaign, which will fund various mental and physical health programs, and win the chance to meet Love before a game.

Schick Hydro Locker Room Talk

As for his own experience with anxiety, Love describes it as a “never-ending feeling in the pit of my stomach.”

“I just have this thing sitting here that just will not go away,” he says. “For better or worse, I think it will always be there.”

Through therapy, Love has found ways to manage this unease. The athlete finds relief by working out, playing basketball and meditating.

“I use Headspace quite a bit,” he says. According to Love, the app is easy to use and offers meditations that take less than five minutes.

Love also performs a technique where he tenses every part of his body and assesses how he’s feeling. Stress and anxiety build up in his extremities, particularly the feet, and he find that breathing into those areas is relaxing.

“I’ve really learned to breathe into my body,” he says. “It sounds funny.”

Even those who don’t experience anxiety can benefit from one of Love’s strategies: He takes a couple of minutes each day to think about how he’s feeling.

“Just do a self check,” he says. “I try to do that daily.”

And if you do experience anxiety, Love encourages professional treatment.

“It’s always worth a shot,” he says. “You have to look at it like you’re investing in yourself and your happiness.”

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration Treatment Referral Helpline at 1-800-662-HELP (4357).

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Rates of Mental Health Tx, Diagnosis Up for College Students

FRIDAY, Nov. 16, 2018 — From 2007 to 2017, there was an increase in the rates of mental health treatment and diagnosis among college students and a decrease in stigma, according to a study published online Nov. 5 in Psychiatric Services.

Sarah Ketchen Lipson, Ph.D., Ed.M., from the Boston University School of Public Health, and colleagues used 10 years of data from the Healthy Minds Study, which included 155,026 students from 196 campuses, to examine mental health service utilization by college students.

The researchers observed significant increases in the rates of mental health treatment and diagnosis. From 2007 to 2017, the rate of treatment increased from 19 to 34 percent, and an increase from 22 to 36 percent was seen in the percentage of students with lifetime diagnoses. Increases were also seen in depression and suicidality, while there was a decrease in stigma.

“We found that utilization increased substantially over the past decade, with much of this burden falling to campus counseling centers,” the authors write. “To better meet the mental health care demand from students and reduce strain on existing services, campuses may wish not only to expand capacity but also to increase the use of preventive and digital mental health services, such as those delivered via mobile apps.”

One author disclosed receiving consulting fees from Actualize Therapy.

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Posted: November 2018

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Hot bath may improve inflammation, metabolism: Study

A two-week treatment period in which the men participated in daily hot-water baths showed a reduction of fasting blood sugar and insulin levels as well as improved low-grade inflammation at rest.

Hot water bath may help in weight loss. (Source: File Photo)

If you are unable to exercise, a hot water treatment may help improve inflammation and blood sugar (glucose) levels, particularly in overweight men, suggests a new study.

Physical stress such as exercise can increase the level of an inflammatory chemical (IL-6), which activates the release of anti-inflammatory substances to combat unhealthily high levels of inflammation, known as chronic low-grade inflammation.

However, a hot-water immersion may “improve aspects of the inflammatory profile and enhance glucose metabolism in sedentary, overweight males and might have implications for improving metabolic health in populations unable to meet the current physical activity recommendations”, said researchers including Christof Andreas Leicht from the Loughborough University in the UK.


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For the study, published in the Journal of Applied Physiology, the team included a group of sedentary, overweight men who participated in both hot-water immersion and ambient room temperature (control) trials separated by at least three days.

In the hot water trial, the volunteers sat immersed up to their necks in 102-degree Fahrenheit water. The research team measured the men’s heart rate, blood pressure and body temperature every 15 minutes throughout both the control and immersion conditions. Blood samples were taken again two hours after each session.

The researchers found that a single hot-water immersion session causes the elevation of IL-6 levels in the blood and increased nitric oxide production, but did not change the expression of heat shock protein 72 — another protein suggested to be important for health.

However, a two-week treatment period in which the men participated in daily hot-water baths showed a reduction of fasting blood sugar and insulin levels as well as improved low-grade inflammation at rest.

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What is medicine?

Medicine aims to promote and maintain health and wellbeing.

Conventional modern medicine is sometimes called allopathic medicine. It involves the use of drugs or surgery, often supported by counseling and lifestyle measures.

Alternative and complementary types of medicine include acupuncture, homeopathy, herbal medicine, art therapy, traditional Chinese medicine, and many more.

Fields of medicine

Modern medicine has many fields and aspects. Here are some of them.

Clinical practice

A clinician is a health worker who works directly with patients in a hospital or other healthcare setting. Nurses, doctors, psychotherapists, and other specialists are all clinicians.

Not all medical specialists are clinicians. Researchers and laboratory workers are not clinicians because they do not work with patients.

The physician assesses the individual, with the aim of diagnosing, treating, and preventing disease using knowledge learned from training, research, and experiences, and clinical judgment.

Biomedical research

This area of science seeks ways to prevent and treat diseases that lead to illness or death.

Biomedical scientists use biotechnology techniques to study biological processes and diseases. They aim to develop successful treatments and cures.

Biomedical research requires careful experimentation, development, and evaluation. It involves biologists, chemists, doctors, pharmacologists, and others.

Medications

This field looks at drugs or medicines and how to use them.

Doctors and other health professionals use medications in the medical diagnosis, treatment, cure, and prevention of disease.

Surgery

Surgical procedures are necessary for diagnosing and treating some types of disease, malfomation, and injury. They use instrumental and manual means rather than medication.

A surgeon may carry out a surgical procedure to remove or replace diseased tissue or organs, or they may use surgery to remove tissue for biopsy. Sometimes, they remove unwanted tissue and then send it for diagnosis.

This includes any practice that aims to heal but is not part of conventional medicine. Techniques range widely. They include the use of herbs, manipulation of “channels” in the body, relaxation, and so on.

Alternative and complementary do not have the same meaning:

Alternative medicine: People use a different option from the conventional one, such as using relaxation measures to improve headaches, rather than pain relief medication.

Complementary medicine: People add another treatment option to a main treatment. For example, they may use relaxation as well as pain relief medication for a headache.

Alternative and complementary therapies are often based on traditional knowledge, rather than scientific evidence or clinical trials.

Examples include homeopathy, acupuncture, ayurveda, naturopathic medicine, and traditional Chinese medicine.

Clinical research

Researchers carry out investigations to find out which diseases are present, why they occur, what can treat or prevent them, what makes them more likely to happen, and many other aspects of health.

Clinical trials are one aspect of clinical research. They aim to find out if a therapy — often a drug — is safe and effective to use when treating a specific condition.

The most effective way to demonstrate the effectiveness of a drug or technique is to carry out a double-blind, random, long-term, large clinical human study.

In this type of study, researchers compare the effect of a therapy or drug in with either a placebo, no treatment, or another therapy or drug.

Psychotherapy

Counseling, cognitive behavioral therapy (CBT), and other forms of “talking cure” can be helpful for people with conditions that affect their mental health, ranging from depression to stress to chronic pain.

Anatomy: This is the study of the physical structure of the body.

Biochemistry: A biochemist studies chemical components and how they affect the body.

Biomechanics: This focuses on the structure of biological systems in the body and how they work, using a mechanical approach.

Biostatistics: Researchers apply statistics to biological fields. This is crucial for successful medical research and many areas of medical practice.

Biophysics: This uses physics, mathematics, chemistry, and biology to model and understand the workings of biological systems.

Cytology: This is a branch of pathology that involves the medical and scientific microscopic study of cells.

Embryology: This branch of biology studies the formation, early growth, and development of organisms.

Endocrinology: Scientists investigate hormones and their impact on the body.

Epidemiology: Researchers track the causes, distribution, and control of diseases in populations.

Genetics: This is the study of genes and their impact on health and the body.

Histology: This involves looking at the form of structures under the microscope. It is also known as microscopic anatomy.

Microbiology: This is the study of organisms that are too small to see with the naked eye, known as microorganisms. Aspects of microbiology include bacteriology, virology, mycology (the study of fungi), and parasitology.

Neuroscience: Neuroscientists study the nervous system and the brain and investigate diseases of the nervous system. Aspects of neuroscience include computational modeling and psychophysics. Some types of neuroscience are cognitive neuroscience, cellular neuroscience, and molecular neuroscience.

Nutrition: Nutritionists study how food and drink influence health, and how they can help treat, cure, and prevent different diseases and conditions.

Pathology: This is the study of disease. A pathologist often works in a laboratory, where they do tests — usually on a sample of blood, urine, or body tissue — to help diagnose diseases and conditions.

Pharmacology: This involves the study of pharmaceutical medications, or drugs, where they come from, how they work, how the body responds to them, and what they consist of.

Radiology: Radiologists use X-rays and scanning equipment during the diagnostic procedure, and sometimes as part of treatment, too.

Toxicology: A toxicologist studies poisons, what they are, what effects they have on the body, and how to detect them.

These are not all the aspects and fields of medicine. Many people work in patient transportation, dentistry, not to mention the many different specialties that physicians can choose to follow, such as emergency medicine.

Takeaway

For anyone who is considering medicine as a career, there are a wide variety of options.

Qualifications, aptitude, and preference will make a particular field more attractive or suitable to an individual.

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A hot bath can partially replace physical exercise

Treatment hot baths helps to reduce inflammation and blood sugar levels in people unable to perform physical exercise, according to a new study published in the Journal of Applied Psysiology.

The physical stress in the form of exercise can cause a transient increase in inflammatory markers. After a workout increases the level of interleukin 6 (IL-6) chemical substances associated with inflammation. In the process of so-called inflammatory response triggers the release of anti-inflammatory substances to counter the unhealthy high levels of inflammation, known as chronic nonspecific inflammation.

Recent studies have shown that the increase in body temperature enhances the inflammatory response and provides a basis for alternatives to the exercises that reduce non-specific inflammation in the body. Previous studies also found a link between the sharp increase in body temperature and the formation of nitric oxide, a substance which promotes blood flow and helps to carry the glucose throughout the body.

The researchers studied markers of inflammation, levels of sugar and insulin in the group of sedentary men with overweight. Participants volunteers were immersed in hot water or sitting for the same time at room temperature (control), between these two types of tests took place at least three days.

The researchers took blood samples before and after staying in the room at a temperature of 27C for 15 minutes. Then, participants either continued to sit in the room, or took a bath with hot water (39S) for 60 minutes, plunging neck-deep into the water. The researchers measured heart rate, blood pressure and body temperature every 15 minutes throughout the period of control and immersion. Blood samples were taken again two hours after each session.

The researchers found that one session of immersion in hot water causes an increase in levels of IL-6 in the blood and increases the production of nitric oxide, but does not change the expression of heat shock protein HSP72 (also important for health). However, a two-week period of treatment by daily hot baths showed a decrease in the level of fasting blood sugar and insulin levels, and reduced nonspecific inflammation at rest.

Men reported discomfort during immersion in hot water that could be associated with high water temperature or length of time in the tub. The researchers acknowledge that these conditions may impede alternative treatment of this kind. However, the positive results of inflammation reduction and the increase in insulin sensitivity suggests that immersion in hot water can improve aspects of the inflammatory profile and improve the metabolism of glucose in sedentary men who are overweight, and may have implications for improving metabolic health in a group of people unable to meet recommendations for physical activity.

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FDA Moves to Restrict Flavored E-Cig Sales, Ban Menthol Cigarettes

THURSDAY, Nov. 15, 2018 — The U.S. Food and Drug Administration said Thursday it will take steps to limit or ban access to flavored e-cigarettes, menthol cigarettes and flavored cigars.

The move against flavored e-cigarettes stops short of the full ban that had been expected from the agency. Instead, sales of these products — thought to be especially alluring to teens — will only be allowed in stores within special closed-off areas made inaccessible to minors, The New York Times reported.

More unexpected was the FDA’s proposed ban on menthol cigarettes and flavored cigars, products which have long been thought to disproportionately harm the health of black Americans.

The menthol ban still has regulatory hurdles to overcome, so removal of those products from the market could take two years, the Times noted.

Still, the move would come as a huge blow to the tobacco industry, since menthols make up more than a third of the cigarette market.

All three moves are aimed at curbing uptake of vaped and smoked nicotine by the young. More than 3.6 million Americans under the age of 18 now vape, the agency noted.

The announcements come after the leading vape maker, Juul Labs, announced Tuesday that it would voluntarily withdraw most flavors of its hugely popular vaping product from the marketplace.

Juul, which controls 70 percent of the e-cigarette market, has come under increasing pressure to do something about the surging popularity of its vaping devices among youth.

In a statement released Tuesday, Juul CEO Kevin Burns said, “Our intent was never to have youth use Juul. But intent is not enough. The numbers are what matter, and the numbers tell us underage use of e-cigarettes is a problem.”

And in a statement released Thursday, FDA Commissioner Dr. Scott Gottlieb noted that “almost all adult smokers started smoking when they were kids. Today, we significantly advance our efforts to combat youth access and appeal with proposals that firmly and directly address the core of the epidemic: flavors.”

Nevertheless, the decision to restrict but not ban flavored e-cigarettes came as a surprise, since leaked documents had suggested a full FDA ban was imminent. In the end, the complex legalities of imposing a ban may have meant drawn-out court battles, something the FDA may have wanted to avoid, legal experts told the Times.

Instead, Gottlieb said that within the next three months, e-cigarette manufacturers should remove the products from “where kids can access them and from online sites that do not have sufficiently robust age-verification procedures.”

Anti-smoking advocates expressed some disappointment at the FDA’s announcement, however.

“We commend the FDA for recognizing the grave threat posed by electronic cigarettes on our children, and for imposing restrictions on manufacturers,” Nancy Brown, CEO of the American Heart Association, said in a statement.

“With e-cigarette use having jumped by 78 percent among high school students and 48 percent among middle school students, the need for action is urgent,” she added. “But limiting the sale of e-cigarettes is not enough — the FDA should also remove flavored e-cigarettes from the market and prohibit companies from marketing their products in ways that appeal to kids.”

And Matt Myers, president of Campaign for Tobacco-Free Kids, wondered to the Times, “Does this mean a simple curtain with a sign like we used to see at the entrance to the pornography section of video stores?”

Lyle Beckwith, a spokesman for the National Association of Convenience Stores, said his group “will be reviewing the regulation and advising our members accordingly” as to how to best implement the new rules.

He noted that, according to his teenaged son, most minors already get their flavor pods from older youth, not convenience stores.

The FDA first began its crackdown on flavored e-cigarettes earlier this year, as the number of teens using the products reached epidemic proportions, the Times reported. By far, the leading vaping product is made by Juul, whose e-cigarette devices resemble small computer flash drives. Use of Juul has skyrocketed among teens over the past year.

Flavored versions of e-cigarettes — including chicken and waffles, rocket Popsicle and “unicorn milk” — have boosted sales among the young even further, experts contend.

“The availability of flavors in e-cigarettes is one of the top reasons that middle and high school students cite as their motivation for using e-cigarettes,” said Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y. “Young people are more likely to try flavored e-cigarettes and consider them less harmful than tobacco-flavored e-cigarettes.”

The vaping industry has countered that flavored e-cigarettes actually provide a potential health benefit, helping to encourage tobacco smokers to quit.

“Flavors are important for switching,” Dr. Moira Gilchrist, a scientist with Philip Morris International, said during a visit to Washington in October for an FDA public meeting. Phillip Morris hopes to market its IQOS heat-not-burn device in the United States in tobacco and menthol flavors.

“The focus should be on what is the right thing to do for the 40 million men and women in the United States who would otherwise continue to smoke cigarettes,” she said.

As for the ban on menthol cigarettes and flavored cigars — both highly favored by black Americans — challenges lie ahead. The U.S. tobacco industry has long fought hard against such a ban. But health advocates were heartened by the news.

“Studies show that menthol cigarettes increase initiation, especially among youth,” Brown noted. “Menthol also has a disproportionate impact on minorities including African-Americans, who favor menthol cigarettes and find them more difficult to successfully quit.”

Delmonte Jefferson, executive director of the National African American Tobacco Prevention Network, told the Times, “While we’re saddened by the number of lives lost and new smokers addicted over the past decade, we’re pleased that the FDA is moving in this direction.”

The group also praised the agency for taking on flavored cigars.

“Little cigars like Black & Milds and Swisher Sweets are heavily marketed to African Americans and are often cheaper in our neighborhoods,” said LaTroya Hester, a spokesman for the network. “A lot of young, black kids don’t know that cigarillos are just as dangerous, so hopefully this will send that message. This is a huge step in protecting their health. It’s about time our young people are prioritized.”

More information

The U.S. National Institute on Drug Abuse has more about e-cigarettes.

Posted: November 2018

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Syphilis is back: the disease makes it so tricky

The increase in the number of Syphilis infections in Germany is continuing. In the past year, nearly 7500 cases of the sexually transmitted disease were reported. Particularly in the big cities affected by the spread.

The Robert Koch Institute will examine Syphilis notifications since 2017 with an algorithm to avoid Multiple reporting of individual cases. In the current publication of the algorithm unit was applied also on figures of previous years, this can lead to deviations in comparison to older Reports.

This was an increase of 4.2 percent compared to the year 2016. In particular, in Berlin and Hamburg, ill, according to the report, in relation to the number of inhabitants above average, a lot of people.

Numbers continue to grow internationally

Since 2010, the RKI watch experts pay again a continuous increase of the case, are frequently affected gay men. In particular, in the 80s, the bacterial infection had been pushed back, with the spread of HIV/Aids and Safer Sex.

Meanwhile, a HIV-infection as a chronic disease treatable, if not curable. The return of Syphilis may have to do, according to the experts with a higher frequency of condom, abstinence from Sex among men. The come even with changing partners, it said, citing surveys.

The Syphilis Numbers rise internationally. In their report, the experts underline that measures for the prevention, diagnosis and therapy should be further developed. The increase is but in part also to better test offers. HIV-Infected were often diagnosed – probably because you receive a regular Screening is offered.

Early detection is only in a few patients

Often Syphilis usually has no symptoms. In other cases, a few days or weeks, and usually occurs after infection, an ulcer, for example, on the Penis that causes no pain. If left untreated, further symptoms can follow from a fever, fatigue, head, joint, muscle or lymph nodes pain and swollen up to the skin changes.

Years after the infection, some damage to the brain and the blood vessels are possible. Yet Syphilis is detected only in a fraction of the patients at an early stage.

Infection and incubation period

In General, the bacterial species Treponema palladium in unprotected sex will be transmitted, through the smallest of injuries to the skin and mucous membranes. In rare cases, Syphilis can be transmitted during pregnancy to the unborn child through the placenta.

The incubation period, the time from infection until the onset of the disease, depends on the number of ingested pathogens. In General, this period is 14 to 24 days.

First Symptoms: Primary Syphilis

The first stadium of a Syphilis (Lues I), is the primary Syphilis. After the incubation period, a painless dark or red spot or a hard nodule is formed at the location where the pathogens in the body. In men this is usually on the glans or foreskin, in women this Symptom usually occurs on the labia.

Within a few days, the nodules converts to a flat and pain-free ulcer. At the same time the neighboring lymph nodes swell. As these symptoms healed after four to six weeks by itself, is not recognized Syphilis in this stage often.

Secondary Syphilis: The Treponema pallidum spreads

If left untreated, the Treponema pallidum is spreading in the following four weeks by the blood in the body. The Phase of secondary Syphilis (Lues II) identifies various skin and mucosal changes. In addition, flu similar symptoms, such as fever, joint pain, swelling of the Lymph nodes.

After about ten weeks, the Patient gets a skin rash. It can also lead to hair loss. Especially in Places with strong sweat formation and in skin folds weeping pustules, which are called Condylomata lata. These are, if they crumble, very contagious. After about two to three months, all the skin lesions heal completely.

Latency Stage: Symptom Free Period

On the second stage, a symptom-free period usually follows. Up to five years, Syphilis can lie dormant in a standstill with no obvious symptoms. The risk of contagion decreases slowly with time.

In the case of about 30 to 40 percent of Patients symptoms of Syphilis do not show until after three to five years. In some cases, even after ten years. In other cases, it is a life-long-lasting stage of the disease without any external signs of the disease.

Tertiary stage: infestation of the muscles, skin and organs

When you break Through the latency time, the tertiary Syphilis (Lues III) begins. The Treponema palladium affects the organs, and destroyed muscles, and skin.

The pathogen spreads throughout the body and affects internal organs such as the stomach, liver, bones, muscles, and blood trails. It nodes, the harden is often rubber-like form. On the skin can form large ulcers that can also bone break.

Neurosyphilis: In the fourth stage, destruction of the brain

About 20 percent of the Affected ten to 20 years after the beginning of the Syphilis severe neurological symptoms. This final stage (Lues IV) is also called Neurosyphilis, as here, the nervous system, the brain and spinal cord are affected. The Neurosyphilis begins with inflammation of the meninges. It comes to vision problems. If left untreated, identify language problems, amnesia, dementia, and paralysis this Phase. The Neurosyphilis ends with death.

On the basis of the more Mature methods of treatment came for many decades and is increasingly rare in a fourth stage of Syphilis. In the last few years, the final stage, however, appears to be increasing. The reason for this is that a Lues-the disease meets seldom with HIV infection. Because HIV-positive syphilis patients are more likely to Lues IV.

The treatment of Syphilis

As Syphilis is treated primarily with Penicillin. Only in the case of Penicillin intolerance, it is the Dodge necessary, to other antibiotics. The dose and duration of treatment depend on the stage of the disease.

The earlier the treatment begins, the quicker a cure of the Syphilis may occur. Syphilis is among the reportable diseases. As soon as a doctor puts a Syphilis disease, he is obliged to send an anonymous message to the Robert-Koch-Institute. This allows for a good documentation of the disease and its expansion.

Breast Cancer Recurrence Rate Not Up With Autologous Fat Transfer

THURSDAY, Nov. 15, 2018 — For patients with breast cancer, reconstruction with autologous fat transfer (AFT) seems not to increase the rate of locoregional recurrence versus conventional breast reconstruction, according to a study published online Oct. 10 in JAMA Surgery.

Todor Krastev, M.D., Ph.D., from the Maastricht University Medical Center in the Netherlands, and colleagues matched 287 patients with 300 affected breasts receiving AFT between 2006 and 2014 to 300 nonexposed control patients based on age, type of oncologic surgery, tumor invasiveness, and disease stage. AFT patients were followed for a mean of 9.3 years, including 5.0 years following AFT; control patients were followed for a mean of 8.6 years after primary surgery.

The researchers identified eight locoregional recurrences in the treatment group and 11 among the control group, for an unadjusted hazard ratio of 0.63 (95 percent confidence interval, 0.25 to 1.60; P = 0.33). In relevant subgroups based on the type of oncologic surgery, tumor invasiveness, or pathologic stage, there were no increased locoregional recurrence rates. With respect to distant recurrences or breast cancer-specific mortality, no increased risks were detected with AFT.

“In line with reported rates from other published matched cohorts, there is no clinical evidence so far to suggest that AFT leads to increased rates of cancer relapse in patients with breast cancer,” the authors write.

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Posted: November 2018

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Why early diagnosis of autism should lead to early intervention

Research suggests children can be reliably diagnosed with autism before the age of two. It also shows that many of the behavioural symptoms of autism are present before the age of one.

These behaviours include decreased interest in social interaction, delayed development of speech and intentional communication, a lack of age-appropriate sound development, and unusual visual fixations.

Preliminary results of a study in the Wellington region indicate most children are diagnosed when they are around three years old. However, there is arguably little point of providing early diagnosis if it does not lead to evidence-based early intervention.

Early start

The Early Start Denver Model (ESDM) is a promising therapy for very young children (between one and five years) with, or at risk for, autism. ESDM uses play and games to build positive relationships in which the children are encouraged to boost language, social and cognitive skills.

Where ESDM differs most from traditional intervention is that behavioural teaching techniques are embedded within this play. This includes providing clear cues for a behaviour, and rewarding that behaviour. Parents, therapists and teachers can use ESDM techniques within the children’s play and daily routines to help them reach developmentally appropriate milestones.

For example, a child who does not yet talk, may be learning to reach for preferred items. A child who has a lot of language may be learning to answer questions like “what is your name?”.

Initial research conducted in the United States, where the model was developed, suggests that ESDM is particularly effective when implemented for more than 15 hours a week by trained therapists in the home environment.

Improved cognition in early childhood

The model was adopted in Australia where the government funds autism specific early childhood centres. Research conducted in these centres indicates that children receiving ESDM intervention from trained therapists show greater improvements in understanding and cognitive skills than children who were not receiving treatment.

In New Zealand there is no government funding for such therapy. As a result, the cost of providing this intensive level of early intervention is beyond the budget of most families. There is also a lack of trained professionals with the technical expertise to implement such therapies.

For these reasons, we are working with the Autism Intervention Trust and Autism New Zealand to develop a New Zealand-specific low-intensity approach to delivering ESDM. The team is using the research of what is effective overseas and is applying it within a New Zealand context.

Mainstream schooling

New Zealand takes an inclusive approach to education. The main goal of the research programme therefore is for children with autism and their families to receive support earlier so that they can get a better start in their development and go on to mainstream schools.

One project involves training kindergarten teachers in ESDM. Inclusion of ESDM strategies in kindergartens is the biggest unknown because there is little teacher training in New Zealand around how to best support children with autism in mainstream settings.

A second project involves providing parent coaching and then adding on a small amount of one-on-one therapy. This will provide some preliminary evidence as to whether adding a minimal amount of one-on-one therapy is any more beneficial that just coaching parents.

Each project involves examining specific measures of communication, imitation (a key early learning skill children with autism typically struggle with) and social engagement with others.

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