Guns and health

Guns and health - People choose to possess weapons for several reasons: hunting, shooting, picking ... The number one reason is for protection now. 

As physicians, we also care about your protection. Our mission is to treat the disease, promote quality of life and prevent injury and death. Health and safety issues are discussed confidentially, without prejudice. We asked to depression, domestic violence, and drugs.

We make recommendations on the practice of safe sex and the use of seat belts. But some believe that doctors should not talk about guns. In fact, Florida has passed legislation restricting such discussion. But weapons will affect health and safety.

In the US, the number of deaths by firearms continues to increase (currently at about 33,000 per year, far more than any other developed country per capita) and is expected to exceed the death of motor vehicles in 2015. It is the second cause of death among children.

Death by association 

Weapons have been successfully used in self-defense. But the reality is that owning a gun is associated with an increased risk of injury or death family. Manslaughter and suicide attempts or completed are far superior to the use of firearms in self-defense. 

In fact, more households have guns in a particular state, most firearm deaths there - even after adjusting for crime, unemployment, urbanization, alcohol and poverty. 

And which is intended to be protected can be a threat. In an unauthorized entrance examination in homes, 1.5% of reported cases with a gun to defend himself, but twice that of the loss of his gun the intruder.

Moreover, most homicides (54%) are committed by someone known to the victim and another 25% were for the family, especially with firearms. When you have access to firearms in the house, the risk of dying from domestic violence of women quintupled.

Suicides 

As the possession of weapons has increased, so has the number of suicides. Two-thirds of gun deaths are suicides. However, firearms owners have more mental health problems, depression or suicidal thoughts than those without weapons. The problem is more easily accessible. Nobody thinks it could happen to them or their families, but many suicide attempts are unexpected and done on impulse.

Damage to children

Children also use weapons to commit suicide; 82% of suicides involving firearms in the house, most of the time stored unlocked. When suicide attempt, 90% of children do when firearms are used, compared to 5% by other means. It is difficult to prevent because young people often act impulsively and may have signs such as suicidal thoughts. 

Children often accidentally thrown by a friend or a brother. We think we know our children - but do not underestimate the secrets they keep. One study found that parents often mistakenly believe that their children had never handled their weapons. One third of children said otherwise.

Choose wisely

Weapons are your good choice. But know that even weapons can protect, chances are higher that they will hurt those who intend to keep. Education and commitment can help us work toward acceptable means to stem the rising tide of deaths related to firearms. That's why I'm going to talk to my patients the security of firearms.

What can you do?

       * If you plan to bring a weapon, consider the real risks for you and your family. If there is a history of domestic violence, or if someone in your family suffers from depression, consider removing any weapon.

       * If you choose to have a gun, keep it locked. Although this will not eliminate all risks, arms locked away will probably be less prone to theft and curious children. The Bureau of Justice estimated that firearms were stolen 1.4 million between 2005 and 2010, mainly domestic burglaries. 

       * If you decide to have a gun, store it with the button and ammunition separately. Explore the latest features and new technologies unlocked scanning and storage of fingerprints gun safety locks.

       * Before your child goes to a playdate, consider asking parents if they have a weapon, and if they are stored safely. This may be difficult at first. One day it might come as easy as asking about food allergies and safety seats for carpooling.

       * Talk to your children about what to do if they find a gun, or if your friend wants to show a weapon. Advise them, "Do not touch the gun, immediately leave the area and tell an adult."

       * Research on Firearms Support injuries so we can better understand the problem and find solutions. Research on the prevention of firearm injuries CDC stopped after funding was excluded for nothing interpreted as promoting stricter laws on weapons.
By: Wynne Armand,MD

 

Read More

What happens when you faint?

What happens when you faint? - You were watching the news on CNN recently, when the anchor Poppy Harlow collapsed during a live? She spoke in a graphic on the screen at the time, over a period of 10 seconds or more, his speech was halting and paste - and then there was silence.

With the schema in the approval rate of President Obama is on the screen, the issue moved to a commercial.

After a brief stuffed CNN colleague, Ms. Harlow, who is pregnant, has reappeared and assured his audience that was fine.

She explained that she was a little hot, fainted briefly, and now it felt good. She closed the show and quickly informed his doctor. Soon after, she tweeted that she and her baby were fine. The video series was widely distributed. It is not every day that you can see (or hear) someone low on live television. But have you ever wondered exactly what is fainting?

Fainting is not just one thing

As the term is commonly used, fainting is a sudden and temporary loss of consciousness. The medical term is "syncope" which comes from "syncope" Greek meaning "contraction" or "cut". 

It is an appropriate term because syncope occurs due to a sudden reduction of blood flow to the brain. Syncope is common: nearly a third of people report having at least one episode of loss of consciousness during his lifetime. 

But while "fading" is commonly used to describe people in good health low may be due to a number of conditions, ranging from harmless to life threatening.

Some of the most common causes of fainting include:

    * Vasovagal syncope. The name of the report refers to increased activity of the vagus nerve which signals the heart to slow down and blood vessels ("vasopressin") to open. This combination of effects results in a drop in blood pressure and too little blood flow to the brain.

The sight of blood or emotional or physical stress are common triggers of this condition. Straining during defecation or even strong cough can also cause vasovagal syncope. And therefore can a hot or a sense of panic or claustrophobia.

   * Abnormal heart rhythm. If the heart rate is significantly slower or faster, blood pressure and fainting can fall may follow. Among the many triggers an abnormal heart rhythm are heart disease itself, certain medications, or an overactive thyroid gland.

    * Orthostatic hypotension. This term means a drop in blood pressure that develops during the movement of the supine to standing or sitting. Dehydration, medication or drugs (including alcohol) and blood loss are common culprits underlying. The condition also becomes more common with age.

There are many other causes of fainting, such as blood sugar or seizures. But in many cases you can not find the cause. 

Although nearly 75% of people who do not have anything serious vanish as the cause, it is important to have controls to ensure that you are in that 75%. And even when he did not find anything serious, many people get injured if they fall when they lose consciousness.

People who lost consciousness and occupations involving passengers or heavy machinery operation may be recommended to restrict activities that could themselves or others at risk if they are still missing. 

Pregnancy is another condition that can make it more likely fainting. Blood vessels tend to dilate during pregnancy and blood pressure is usually on the low side. Not much to drop enough to cause fainting blood pressure.

When fainting is fashionable 

In some circumstances, fainting in a specific signal - "fade" or "fail" - has become a cultural expectation. For example, it was common for aristocratic women of Victorian England for a low particularly dramatic moment.

Examples abound of "hysterical fainting" where a lot of people close to each other begins to fail due to a common illness or exposure to a toxin or even a curse. And then there is the game we played in the gentle district intentionally: we breathe deeply and rapidly for some time and then hold our breath and push. It has never worked for me - which is fortunate, because it can be dangerous.

The bottom line 

The circumstances of the disappearance of Poppy Harlow - a warm atmosphere under the studio lights, pregnancy and stressful job - seem more than enough to trigger an episode of fainting. But it was the right thing to be checked by your doctor. In fact, perhaps the only surprise of fainting - including recent event Poppy Harlow in the air - is that this does not happen more often. 
By: Robert Shmerling, M.D.  

Read More

The truth about altruism

The truth about altruism - Credit people like Eleanor Roosevelt asking, "When will our consciences grow so tender that we will act to prevent human misery rather than avenge it?" Unfortunately, tenderness is not a characteristic of all human consciousness. So the violence continues, often rationalized as revenge in response to the misery of others.

While altruism is often understood as rooted in tenderness, scientific research suggests otherwise. Rather, altruism may have evolved with the desire to condemn and even punish those who act solely in their own interests. We can be motivated to do good, to avoid being rejected by our community.

The function of altruism

These impulses to act for the good may have helped our early ancestors enforce social norms, in an earlier era formal laws, contracts and courts have forced cooperation.

A few years ago, an international group of researchers led by anthropologist Joseph Henrich from Emory University in Atlanta, tested this theory. They created three experimental games and they played with people who lived in Africa, South America, New Guinea, the South Pacific and the US Midwest.

In these games, players were anonymous to each other. All received real money (or "game") to operate:

        *  The dictator Thurs. The player to decide how much your participation to give the player B. Player B must accept any amount offered. If player A is stingy, no fault.
 
        *  The ultimatum game. Player A decides how much to share with the player B. Player B, before hearing the amount, deciding which offer is acceptable. If B rejects A's offer, both players receive nothing.
 
        *  The third game of repression. Player A decides how much to share with the player B. Player C is given an independent participation. If C feels was too stingy A, C can be punished by reducing the benefits of, but C should pay part of their participation for the privilege. 

The interest dictates that all players must have all the money they receive, because it is a time that the anonymous meeting and reputation does not matter.

In fact, the interest does not govern the results. Few have acted purely selfish. Overall, there was an almost universal to act altruistically and share the trend of play.

Player A is usually offered something that the player B and frequently gave media. In the third game of the punishment, Player C was generally willing to sacrifice some money to punish selfishness. A player, when you know that the punishment was possible, tended to be more generous.

Since Player A has more stingy, most players have chosen to punish him if they were the target of selfishness A player or just a spectator. Local customs affect the amount of trade and the punishment threshold.

Human values and standards

The studies do not show whether it was induced by a desire for revenge or feelings of envy or competition. In any case, people can be more generous when they expect to be punished by selfishness which is outside the cultural norm or when behaving fairly is a high value of the community.

What this means for Eleanor Roosevelt's desire for a tender of universal human consciousness? Human beings with a greater capacity for altruism may have had a survival advantage in primitive societies. 

But it was the people who were good with a spear and had a talent for looking for food or agriculture. In evolutionary terms, being the time both strong and selfless seems to be the winning combination. 

If it is pure altruism, Heinrich study provides no evidence. But it supports the idea that even if we are being "unselfish", we serve our own interests.

Mrs. Roosevelt could argue that society becomes more bearable when people feel good to be kind and generous, rather than the harsh and unforgiving heart. And if I could look around today, she would probably not think of tenderness flourished worldwide since his death in 1962.

But it can be encouraged to know about research showing "altruism" or consciousness as a natural emergent property of human societies. We humans seem to have the ability to play clean, though we sometimes fear of punishment that can help us do that.

By: Michael Craig Miller,M.D.

Read More

Computer guided CBT may improve treatment of depression?

Computer guided CBT may improve treatment of depression? - In the United States, depression is the leading cause of disability, but only 21% of patients diagnosed with major depression receive treatment that meets the guidelines of the American Psychiatric Association. 

Of people seeking treatment for depression who would be treated with psychotherapy Live outnumber those who would be treated with drugs three to one, but those who often want to live not a therapy they receive. 

Access to psychotherapy is limited by the number of professionals from the region itself, the cost and logistics - not to mention the stigma. And when people receive the therapy, therapists can not provide care based on evidence.

One way to get high quality psychotherapy to people in need is to automate and computerize the treatment process and provide via websites and applications. This could provide guidelines on the basis of everyone, everywhere, at any time, at a low cost treatment. 

Stand-alone computerized cognitive behavioral therapy (CBT) has been found to be effective for treating depression, and is now available in a few entities. But it remains unclear how much, if anything, CCTB improve the treatment of depression in primary care, so that a group of UK researchers recently tested the benefits of adding CCTB to standard treatment. 

They randomly assigned 691 people with depression in three different groups. One group received standard care, and the others received standard care plus a two CCTB programs online.

CCTB over standard care for depression 

Consequently, the standard treatment of depression in primary care in the UK is pretty good. Citizens are routinely offered antidepressants, psychotherapy, and access to community mental health teams, psychologists, psychiatrists and counselors - a range of both rare resources available in primary care practices in the United States. 

There was a lot of crossover between the study groups. In the group "standard of care", 19% ended up using CBT although they are not specifically assigned to this treatment. Between 77% and 84% of the three groups used to treat depression and drugs "Live" mental health specialists were seen by 17% annually and 24% of the other group CARE. 

In this context - with many participants CCTB groups also receive specialized mental health treatment and 19% of the group receiving the usual practice CBT-- no significant differences in treatment outcomes of depression. However, the United States, the results might have been different, given the limited resources of mental health in most established primary care clinics. 

It would be more interesting and more importantly, know the advantage of using CCTB for patients receiving no more - without drugs and without access to specialists in mental health. It is for these patients that CCTB might be most beneficial.

Challenges to get people to use CCBT to treat depression 

The two sites of the CCBT has been tested in previous clinical trials, and both have proven to be effective treatments - but they are only useful if people use them. Although both independent sites CCTB were designed to be used on 6 or 8 "sessions", most people only used once or twice, although the study provided reminder calls to participants. 

People with depression may experience fatigue, impaired concentration, and feelings of hopelessness. Make websites use systematic CCTB on your own schedule is a challenge - even if these programs could be useful in the end. More structure may be needed to keep people using CCTB.

What is the take home? The biggest challenge is not building a CBT program that works; He built one that people will use. Just as you need to entertain while educating before CBT program must be extremely involving users - and provide immediate value of the first session. 

And while the concept of treatment anywhere, anytime is attractive, confident people to plan CCTB themselves in their own time, in their own homes, can lead to high levels of downhill; after all, you can always get around to it later. 
By: James Cartreine, Phd.

Read More

Only overwork dying young

Only overwork dying young - Billy Joel was on to something. As the singer suggested in "Movin 'Out" working too hard can really give you a "heart-DCA crisis ..." And, as a recent study has also shown, stroke can be an even bigger problem than to a heart attack in people who are overworked. 

For the study, researchers at University College London compile data on the relationship between working hours and the risk of heart attack by more than 600,000 workers, and similar data on the risk of stroke more than 500,000 workers.

They adjusted their data to compensate for differences due to health behaviors of individual workers, such as smoking, alcohol consumption and physical activity, and also adjusted for the presence of other cardiac risk factors, such as high blood pressure, diabetes and high cholesterol.

They found that those who worked more than 55 hours per week had an increased risk of suffering a heart attack by 13% and were 33% more likely to suffer a stroke compared to those who have worked 35-40 hours a week.

The high risk of heart attack with more hours of work was only seen among workers with low socio-economic status. The risk of heart attack in high-wage workers who worked long hours was similar to that of high-wage workers who had normal working hours. The risk of stroke was higher among those who worked long hours, regardless of their socioeconomic status.

Why overwork and cardiovascular risk are related is not entirely clear. Hormonal factors, such as high levels of hormones "stress" such as cortisol and adrenaline, may be involved. Overwork and stress at work are also associated with many cardiac risk factors.

Those who work long hours tend to have unhealthy lifestyles, with less exercise, the worst regimes, and increased consumption of alcohol and snuff. Type 2 diabetes is more common among workers with low socioeconomic status who work long hours, but not workers with a high socioeconomic level working similar hours.

Metabolic syndrome, a set of cardiovascular risk factors, including high blood pressure, high triglycerides, low levels of good cholesterol, high blood sugar and abdominal obesity "apple shape", is associated with a stressful job.

Death from overwork in Asia

In more developed countries, overdrive is not considered a public health problem. However, death from overwork is quite common in Japan there is a word for it: karoshi. Japanese, or employee, company workers have a tradition of job security for life. 

Unfortunately for them, the decline is expected to enter additional long hours without pay. The work addiction is so bad that the Japanese government has considered imposing a mandatory annual leave of five days. 

In China, death from overwork, known as guolaosi name, is also said to be widespread. A tobacco epidemic is probably a major contributing factor; 63% of middle-aged men in East Asia are regular smokers.

Staying healthy at work 

A number of strategies can help you avoid work habits that are bad for your health:

     *  Eat well and avoid "tension".
     *  Avoid sugary drinks and salty snacks in vending machines; bring a lot of nuts, fruits and vegetables of the house instead.

     *  Integrating physical activity into your workflow: hurry up the stairs instead of taking the elevator, or walking in an office colleagues for a while face rather than an email exchange.

     *  Prolonged sitting is associated with increased mortality from any cause; try to work whenever possible.

     * Joke; the mood is associated with better cardiovascular health and increased labor productivity.
     *  Make sure your major cardiac risk factors such as pressure and sugar levels in the blood and blood cholesterol are under good control. 

And if you're the boss, remember that a low stress, positive work environment is not only good for the health of employees, it is also good for business.
By: John Ross, MD,FIDSA

 

Read More

Adolescents with optimistic friends can have better emotional health

Adolescents with optimistic friends can have better emotional health - Pediatricians and child behavior specialists who work with adolescents know that adolescence is an important time for social growth.

However, these years can be fraught with anxiety for parents of teenagers. How will you know if your teenager Moody is to be with the right people?

What friends could be a bad influence? How can you help your child develop healthy relationships? 

Recent research has addressed some aspects of these issues. A study entitled "Dissemination of healthy humor in social networks of adolescents" published this year in the Proceedings of the Royal Society of London, examined whether a teenager whose friends have a healthy atmosphere is less likely to be depressed.

He also discussed how emotionally healthy friends affect the recovery of adolescent depression. Basically, the researchers wanted to know: is a contagious good mood?

The study involved nearly 3,000 teenagers. Each study volunteers carried out two surveys, six months apart, in which he or she up to five male and five female friends listed. Then each teenager was monitored over time to see how it changes your mood. 

One of the interesting things about this study is that the researchers define depression as a behavior, not necessarily as a disease that we can get. This allowed them to make them slightly different from previous studies looking at the same statistical analysis of things, and discovered the potential power of positive thinking friends. 

The researchers found that have a social network of friends with a healthy atmosphere cut the likelihood of developing depression half of teenagers over a period of 6-12 months. It has also significantly improved the chances of recovery from depression in adolescents who have had it.

Although the data do not show a cause and direct effect, this study suggests that having friends with healthy mood can reduce the risk of depression and make it a little easier to recover from depression if it product.

Surprising findings in the survey on social networks

This study is a good example of a recent trend in epidemiology - the use of data on the social network from person to learn about this person. This research has led to many interesting discoveries, and given really is a whole new area of research.  

A 2007 study in the New England Journal of Medicine was one of the first of its kind. It has been shown that obese people who had friends and relatives were themselves more likely to be obese. 

Since then, additional research has studied how social networks influence the risk of developing the individual (or avoid) specific health conditions such as obesity, smoking and depression.

The results of these studies are sometimes surprising, giving valuable information to the new medical community. For example, I conducted a study in 2011 called me "The influence of social networks on patients' attitudes towards the type II diabetes." When I began this research, it is assumed that patients are less concerned about having diabetes, if several friends and family members had diabetes. 

I had imagined that these patients might have become so used to the idea that diabetes disease seems common and almost normal. But in fact, my team found the opposite! patients with a higher prevalence of diabetes within their social networks worried over their disease. This unexpected result gave me information that helped me take better care of my patients.

Using network data to improve the mental health of your child

This type of research is not only useful for doctors, but also provides important for anyone trying to improve their own health or that of informing the family of one. 

The study on the positive mood in the social networks of adolescents suggests that parents may be able to reduce their chances of developing adolescent depression - or improve your mood or depression if she has - just promote and support emotionally healthy friendships with their peers.

With much controversy over the use of antidepressants in adolescents, the results are, as they can give parents a simple way to promote the emotional health and well-being in their teens - no drugs involved.
By: Nandini Mani, MD

Read More