Health Risks of Tattooing and Ear or Body Piercing

Tattooing and ear/body piercing are increasingly popular among Canadians. These procedures, however, may increase the risk of contracting a number of serious blood-borne diseases.

Background

Tattoos and ear/body piercings are very popular, especially among those aged 18 to 22. Between 73 and 83 percent of women in the U.S. have had their ears pierced. An American university survey in 2001 found that 51 percent of students had piercings and 23 percent had tattoos. U.S. studies show that the number of women with tattoos quadrupled between 1960 and 1980. The number of tattooing and piercing shops in Canada has increased dramatically in the last few years.

Health Risks of Tattooing and Ear/Body Piercing

Skin and mucous membranes in the mouth and nose protect you from many infections. Both tattooing and ear/body piercing procedures involve piercing the skin or mucous membrane with a needle or other sharp instrument.

Unless the needles are new, sterilized for each treatment and properly handled by the practitioner, instruments can be contaminated with the infected blood or bodily fluids of another person.

You may also have bacteria or viruses present on your skin that can enter your body and cause infection when your skin is pierced. Practitioners who do the tattooing and piercing are also at risk of becoming infected through accidental cuts and punctures.

It is possible to transmit viral infections such as hepatitis B, hepatitis C, Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and herpes through tattooing and piercing, as well as bacterial skin infections such as Streptococcus and Staphylococcus.

Minimizing your Risk

The best protection against disease and infection is to carefully choose where you obtain your tattoo or piercing. Here is a list of conditions on which to base your decision:

-- The work area is clean and brightly lit.

-- The shop uses instruments that are easily cleaned and sterilized, such as stainless steel.

-- Tattooing is done with sterile needles in a tattoo machine that has been wiped with alcohol after each use and covered with new disposable plastic.

-- Ear piercing is done with a sterile needle or a gun that has a disposable sterile cartridge to holds the studs.

-- Tattoo and piercing needles are new and sterile for each treatment. They should never be reused.

-- Those performing the procedure have clean working habits, including washing their hands before and after procedures, after handling contaminated items, before opening and handling sterile supplies, and before putting on and after removing their gloves.

-- Practitioners wear medical gloves during the procedures.

-- The shop has a "clean zone" and a "dirty zone." The procedure should be done in the clean zone where only sterilized packages and clean equipment are kept and used. The dirty zone is the contaminated area where there is a washing sink and holding basin for disinfecting implements.

-- Work surfaces are made of smooth and non-porous materials.

-- All surfaces are cleaned with a solution of bleach and water.

-- The shop has a sterilizing machine, preferably a steam sterilizer, and test strips are used to indicate whether the machine is operating correctly.

-- Waste is disposed of properly, with blood-contaminated waste placed in plastic bags and tied before being added to the regular waste.

-- Sharp implements used to pierce the skin are put into puncture-resistant containers.

-- Oral and written instructions are given to clients for personal care after the procedure.

You can minimize your own risk of infection by taking these precautions:

-- Choose a good professional practitioner who has been trained.

-- Ask the practitioner if she or he follows the Infection Control Guidelines for tattooing and ear/body piercing.

-- Never tattoo or pierce skin that has a cut or break, pimples, warts, or other abnormalities.

-- Make sure the practitioner disinfects the skin area using a skin antiseptic before the procedure.

-- Wash your hands thoroughly before you apply lotions or ointments to the tattooed or pierced area after the procedure or when rotating the jewelry, as directed by the practitioner. If you are concerned that the tattoo or piercing is infected, contact your doctor or local health unit.

-- Hepatitis B vaccine will help protect you from hepatitis B, but there is no vaccine for hepatitis C or HIV.

Health Canada's Role

Working in partnership with the provincial and territorial governments, Health Canada has created Infection Control Guidelines for tattooing and ear/body piercing. These guidelines were developed for practitioners of tattooing and ear/body piercing by representatives from industry, health services, and Health Canada's Centre for Infectious Disease Prevention and Control.

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All About Careers in Nutrition UK

NUTRITION is the study of nutrients in food, how the body uses nutrients, and the relationship between diet, health and disease. Nutritionists create and apply scientific knowledge to promote an understanding of the effects of diet on health and wellbeing of humans and animals.

Most of the major food manufacturers and retailers employ nutritionists and food scientists and opportunities also exist in journalism, government, research, health promotion and education, at home and abroad.

There is also a variety of food-orientated careers within the related field of food science and technology. Nutritionists also work in emergency relief or development projects in low income countries. In relation to the latter, information on opportunities and advice on training courses and the personal skills and qualities required can be found at www.ihe.org.uk.

The Nutrition Society is the learned society in Britain for nutritionists. Members of the Society can apply for registration, which requires a degree level qualification in nutrition (or a related subject) plus a minimum of 3 years professional experience as a nutritionist. Registered individuals can be recognised by the letters RNutr after their name.

Associate registration is available for graduates who are in the process of gaining sufficient experience to apply for full registration. Specialist registration in public health nutrition (RPHNutr) is also available via the Society. The registers can be found on the Society's website, www.nutsoc.org.uk, which is also a source of information on job vacancies.

PUBLIC HEALTH NUTRITION

PUBLIC HEALTH NUTRITION is the application of the science of nutrition for the benefit of the population as a whole, or sub-sections of the population. It encompasses promotion of good health through nutrition and the primary prevention of diet-related illness in the population.

Although an important facet of public health nutrition is establishing the relationships between nutrition and health or disease risk at a research level, equally important is nutrition-related health promotion. This includes the type of work conducted by many of the nutritionists working in the food industry and related trade associations, government, health promotion, and by dietitians working in the community.

In December 1997, the Nutrition Society launched a scheme to register individuals qualified in public health nutrition. Registration usually requires a degree in human nutrition plus a minimum of three years relevant post-graduate experience in public health nutrition. Individuals achieving registration are known as Registered Public Health Nutritionists (RPHNutr).

Associate registration is available for graduates who are in the process of gaining sufficient work experience to apply for full registration. The Nutrition Society is also beginning to accredit degree courses in public health nutrition so that this career path can be selected from the outset. Several such courses now exist and details can be obtained from the Nutrition Society (www.nutsoc.org.uk/courses).


DIETETICS

DIETETICS is the application of the science of nutrition to the construction of diets and the selection and preparation of foods, in health and disease. A dietitian will have undertaken training in a hospital as part of his/her course and is specially trained to give practical advice to individuals about their diets. Many dietitians are employed in the NHS, and they work with both healthy and sick people, as well as their families. With patients who need special diets, dietitians use their scientific knowledge to provide practical information that is appropriate to the patient's medical history and lifestyle.

These days a considerable proportion of dietitians spend some or all of their time working in the community rather than in a hospital. Many of these are eligible to apply for registration in public health nutrition as well as being state registered dietitians (SRD). In the community, the dietitian's work is more about health education, although many also run clinics in doctors' surgeries for people who need specialist dietary counselling. Dietitians also work in research, the food industry, government, the media and education. Information about freelance dietitians is available from the British Dietetic Association.

It is necessary to have a degree (BSc or MSc) in nutrition and dietetics to work as a dietitian. The British Dietetic Association has a leaflet called Puzzled about qualifying as a Dietitian? that provides information on degree course entry requirements (its website is www.bda.uk.com).

What is the difference between nutritionists' and dietitians' qualifications?

Dietetics involves the application of nutrition science and so all dietetic courses must include the study of nutrition. However, not all nutrition courses include dietetics and lead to a qualification in dietetics, which is required to work in hospital as a dietitian. If you want to become a dietitian, you must graduate from a course approved by the Dietitians' Board of the Council for Professions Supplementary to Medicine (contact www.bda.uk.com).

GETTING STARTED: LOOKING FOR A CAREER IN NUTRITION AND DIETETICS

UNDERGRADUATE COURSES The usual way of starting a career in nutrition is to study for a degree in nutrition and/or dietetics at a University. Chemistry and/or biology are generally required, if you did not study science at school, you may be able to enter university after successfully completing a science access course. Information about entry requirements is available via university prospectuses and Course Leaders or Admissions Tutors. Also, the UCAS (Universities and Colleges Admissions Service) provides information on the many varied courses that now exist (www.ucas.co.uk). A summary of available courses is listed below. Your careers advisor should also be able to provide advice and information.

Universities and colleges that run BSc courses in nutrition and/or dietetics (courses marked with an asterisk lead to state registration in dietetics)

The Robert Gordon University, Aberdeen www.rgu.ac.uk
Nutrition and Dietetics with State Registration in Dietetics* (4 years)
Nutrition

University of Wales Institute, Cardiff, www.cardiff.ac.uk.
Applied Human Nutrition
Human Nutrition and Dietetics*

Coventry University, www.coventry.ac.uk
Dietetics*

Queen Margaret University College, Edinburgh, www.qmuc.ac.uk
Dietetics* (4 years)
Human Nutrition
Public Health Nutrition

Glasgow Caledonian University, www.caledonian.ac.uk
Human Nutrition and Dietetics*

Leeds Metropolitan University, www.lmu.ac.uk
Dietetics*

Liverpool John Moores University, www.livjm.ac.uk
Nutrition

King's College London (University of London), www.kcl.ac.uk
Nutrition
Nutrition and Dietetics (4 years)*

University of Greenwich, London, www.gre.ac.uk
Human Nutrition
Human Nutrition with European Studies

University of North London, www.unl.ac.uk
Human Nutrition
Human Nutrition and Dietetics (4 years)*

South Bank University, London www.sbu.ac.uk
Bioscience (Nutrition)

University of Westminster, London www.wmin.ac.uk
Health Sciences: Nutritional Therapy
Human Nutrition
Human Nutrition (with a foundation year) (4 years)

University of Luton, www.luton.ac.uk
Nutrition
Public Health Nutrition

The Manchester Metropolitan University, www.mmu.ac.uk
Human Nutrition
Human Nutrition (with a foundation year) (4 years)

University of Nottingham, www.nottingham.ac.uk
Nutrition
Nutrition (with state registration in dietetics)*
(4 years, undergraduate masters level)

Oxford Brookes University, www.brookes.ac.uk
Public Health Nutrition

Sheffield Hallam University, www.shu.ac.uk
Public Health Nutrition (subject to validation)

University of Southampton, www.som.soton.ac.uk
Nutritional Sciences

University of Surrey, www.surrey.ac.uk
Nutrition (3 or 4 years)
Nutrition with a Foundation year (4 or 5 years)
Nutrition/Dietetics (4 years)*

Roehampton University of Surrey, www.roehampton.ac.uk
Nutrition and Health

Kingston University, Surrey, www.kingston.ac.uk
Nutrition
Nutrition (with a foundation year) (4 years)

University of Ulster, Northern Ireland www.ulst.ac.uk
Human Nutrition (opportunity to specialise in public health nutrition, 4 year, this route is accredited by the Nutrition Society)

Postgraduate Diploma Courses in Dietetics are run at:

Kings College London, www.kcl.ac.uk
(15-month course for applicants with a BSc in Nutrition or equivalent, leads to a postgraduate diploma)

Leeds Metropolitan University, www.LMU.ac.uk
(2 years, full time course, postgraduate diploma)

University of Wales Institute, Cardiff, www.uwic.ac.uk
(2 years, full time course, postgraduate diploma)

University of Ulster, Coleraine, Northern Ireland, www.ulst.ac.uk
(2 years, full time course, MSc or postgraduate diploma)

Postgraduate Courses

Once you have a degree, it is possible to take a masters degree (MSc), which typically take 12-18 months to complete, or to study for a doctorate (PhD), which takes a minimum of 3 years.

A masters degree in nutrition is a means by which you can change careers if your BSc is in a subject other than nutrition, or by which you can specialise, e.g. by taking a postgraduate course in public health nutrition or sports science.

To undertake a PhD, it is necessary to have been awarded a very good BSc (first class or upper second (2i) class honours) or to have a MSc in the subject, together with funding that is typically in the form of a research grant.

Postgraduate (MSc) taught courses and opportunities to study for a PhD focusing on nutrition are offered at:

University of Aberdeen, www.abdn.ac.uk
Human Nutrition and Metabolism MSc (1 year)
International Nutrition MSc (1 year)
MSc/PhD by research (with Rowett Research Institute)

The Robert Gordon University, Aberdeen, www.rgu.ac.uk
Nutrition PhD/MPhil by research
PGDip/MSc (part-time, subject to validation)

Queen Margaret University College, Edinburgh www.qmced.ac.uk
Public Health Nutrition MSc 45 weeks (full or part-time)
PgCert, PgDip,
MPhil/PhD by research

University of Glasgow, www.gla.ac.uk
Human Nutrition MSc/Diploma (1 year)
Human Nutrition PhD and MPhil by research
Clinical Nutrition MSc/Diploma (medical graduates only) (2 years)

University of Huddersfield, www.hud.ac.uk
Nutrition and Food Management MSc (1 year)
PhD and MPhil by research

University of Keele, www.keele.ac.uk
Health, Population and Nutrition in Developing Countries MBA (1 year)

University of London, King's College, www.kcl.ac.uk
Human Nutrition MSc (1 year) or Diploma (7 months)
PhD by research

London School of Hygiene and Tropical Medicine, University of London www.lshtm.ac.uk Public Health Nutrition MSc (1 year full time, 2 years part time) (accredited by the Nutrition Society)
MPhil/PhD/DrPH

University of Westminster, London, www.wmin.ac.uk
Public Health (Food & Nutrition) MSc 1-2 PgDiploma, PgCert
Nutrition & Healthcare MSc 1-2 PgDiploma, PgCert
MPhil/PhD by research

University of Newcastle upon Tyne, Human Nutrition Research Centre, www.ncl.ac.uk
Human Nutrition PhD/MPhil by research

University of Nottingham, www.nottingham.ac.uk
Nutritional Biochemistry (Human) MSc (1 year)
PhD/MPhil by research

Oxford Brookes University, Centre for the Science of Food and Nutrition, www.brookes.ac.uk
Human Nutrition MPhil/PhD by research

University of Sheffield, www.shef.ac.uk MMed Sci in Human Nutrition (part or full time)
Diploma in Human Nutrition (full time) MPhil/ PhD in Human Nutrition

University of Southampton, www.wom.soton.ac.uk
Public Health Nutrition MA (Accredited by the Nutrition Society)
PhD/MPhil by research

University of Surrey, www.surrey.ac.uk
Human Nutrition MPhil/PhD by research
Nutritional Medicine MSc (2-6 years) (Also diploma and certificate) Part-time modular training.

University of Surrey, Roehampton Institute London www.roehampton.ac.uk
Clinical Nutrition MSc/Diploma (part or full-time)
Nutrition, Brain & Behaviour MSc/Diploma

University of Ulster www.ulst.ac.uk
Human Nutrition MSc (1 year) PgDiploma (9 months)
MRes (1 year) MPhil/DPhil by research

Other opportunities

Some other universities and colleges offer courses such as food science, biochemistry, sports science, home economics, and food technology that include modules/joint courses in nutrition. These include: University of Bradford, Chester College, University of Greenwich, University of Huddersfield, University of Lincolnshire and Humberside, Liverpool John Moores University, University of Newcastle-upon-Tyne, Roehampton Institute, University of Teeside. More details can be found in the UCAS Handbook, or on its website, www.ucas.co.uk

Also, the Open University has modules on food and health. Contact: The Centre For Continuing Education, The Open University, PO Box 118, Milton Keynes MK7 6A.

There are no correspondence courses in Dietetics although some colleges and universities are developing study routes, which offer flexibility, including part time courses. Please contact the colleges and universities directly about these.

BSc Courses in Animal Nutrition

University of Central Lancashire, www.uclan.ac.uk
Animal Production and Nutrition

Harper Adams University College, www.harper-adams.ac.uk
Animal Nutrition

University of Leeds, www.leeds.ac.uk
Animal Nutrition and Physiology

For more information

Consult appropriate university and college guides for information on specific courses and entry requirements, which vary considerably.

For the addresses of universities offering courses that lead to registration in dietetics, see www.ucas.co.uk. For more information on dietetics, write to the British Dietetic association at: BDA, 7th Floor, Elizabeth house, 22 Suffolk Street, Birmingham B1 1LS, enclosing a large stamped self-addressed envelope (website: http://www.bda.uk.com).

Information on nutrition courses is also available from the Nutrition Society's website: www.nutsoc.org.uk.

For further information about opportunities in food science contact The Institute of Food Science and Technology, 5 Cambridge Court, 210 Shepherds Bush Road, London W6 7NJ (www.ifst.org.uk).

Depending on your specific interests, it may also be worth contacting the Institute of Consumer Sciences, 21 Portland Place, London, W1B 1PY (www.institute-consumer-sciences.co.uk)

Funding

Many local authorities assist students resident in their areas. In Scotland you should apply to the Scottish Education Department and in Northern Ireland to the local Education and Library Board. All students may apply for student loans.

What about non-degree courses?

A number of NVQ, SVQ and HND courses include some basic nutrition, e.g. courses in catering, retailing or hospitality. Although, these types of courses are useful for people with a general interest in the subject, who wish to know more about basic nutrition for their personal interest, these courses are NOT designed to train participants to give detailed and evidence-based dietary advice. Furthermore, these and other non-degree courses are not recognised by the Nutrition Society or Dietitians Board as being of sufficient depth to provide the basis for a career in nutrition or dietetics. However, in the context of the National Grid for Learning, (S)NVQs can be a route of entry into higher education (e.g. the undergraduate courses listed previously), provided the particular course has been judged to be acceptable as an access course that shows general readiness for study. The same applies to some diplomas in the private sector (see below).

There are a number of private colleges and institutes that do not have Privy Council approval to award degrees, which offer courses in nutrition. These courses are not controlled by the Qualifications and Curriculum Agency and the Quality Assurance Agency that oversee courses offered in the public sector, and so it is difficult to assess what standard is achieved. These courses can be expensive and the qualifications obtained may be of limited value as they are not recognised by the professional organisations that represent the interests of conventionally trained nutritionists and dietitians, or by the majority of would-be employers of nutritionists/ nutrition scientists and dietitians.

Who's who in Nutrition

The British Dietetic Association

The British Dietetic Association (BDA) was formed in 1936 and incorporated in 1947. It is the professional association for qualified dietitians in the UK, and a condition of full membership is the holding of a recognised dietetic qualification. The BDA is represented on Functional Council, Professional and Technical Staffs 'A' of the Whitley Councils for the Health Service (Great Britain). This body negotiates salaries and conditions within the National Health Service. Members of the association serve on the Council for Professions Supplementary to Medicine and the Dietitians Board thereof, the body granting statutory registration to qualified dietitians, which is now compulsory for employment in the National Health Service.

The BDA has a commitment to assist its members to uphold the highest standard of professionals practice. The Continued Professional Development (CPD) policy adopted by the profession in May 1998, sets out the main principles of CPD; identifies the steps to be taken prior to engagement in CPD activity; provides guidance on the completion of a Personal Development Plan and gives examples of CPD activities.

The British Dietetic Association, 5th Floor Charles House, 148/9 Great Charles Street Queensway, Birmingham, B3 3HT; tel: 0121 200 8080; website: www.bda.uk.com; email: info@bda.uk.com

The Nutrition Society

The Nutrition Society was established in 1941"to advance the scientific study of nutrition and its application to the maintenance of human and animal health". It is the largest learned society for nutrition in Europe. Membership is worldwide but most members live in Europe. Membership is open to those with a genuine interest in the science of human or animal nutrition. Full details of membership and application forms are available via the Society's website www.nutsoc.org.uk.

The Society publishes four major international scientific journals and is currently producing a series of textbooks on nutrition. Full details of the Society's publishing division, including electronic access to sample copies of the journals, are available via the website.

The Society works for professional development in nutrition for members, to recognise and encourage appropriate standards of training in nutrition. The Society offers professional qualifications to nutritionists through a number of registration schemes, the details of which can be found at www.nutsoc.org.uk. The Society also organises an accreditation scheme for courses in Public Health Nutrition. Three courses have been accredited to date.

The Nutrition Society, 10 Cambridge Court, 210 Shepherds Bush Road, London, W6 7NJ; tel: 020 7602 0228; website: www.nutsoc.org.uk; email: office@nutsoc.org.uk

Links

Nutrition Society www.nutsoc.org.uk
British Dietetic Association www.bda.uk.com
Institute of Biology www.iob.org
UCAS (Universities and Colleges Admissions Service) www.ucas.co.uk
National Sports Medicine Institute www.nsmi.org.uk
International Health Exchange www.ihe.org.uk
IFST Careers site www.foodtechcareers.org

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Sex between Doctor and Patient is fine, say 40% of Medical Students

A new study has revealed that 40% of medical students think that sex between doctor and patient is OK. In the UK, the General Medical Council prohibits any kind of sexual relationship to develop between doctors and their patients.

Researchers from the University of Glasgow, Scotland, asked 62 students whether they would accept a dinner invitation from a patient if they were practising as a GP on a remote Scottish island. 60% said they wouldn't, while 40% said they would. In fact, the 40% said they would seek a relationship in that case (remote Scottish island).

Students gave various reasons for the decision. Some said that living in a remote Scottish island would mean finding a partner might be quite difficult. Others said it would be easy to pursue a relationship if the patient changed doctors (changed practice).

In this survey, the students had to imagine the patient in question was coming to the end of lengthy treatment. They had to imagine that the doctor and patient both belonged to a bird watching club - the doctor being a new member. The patient, on making the invitation, made it clear that he/she wished to pursue a relationship with the doctor.

First, second and third year students were asked this question. The 60%-40% ratio remained pretty constant throughout those years.

You can read about this survey in the Journal of Medical Ethics.

The main reason the 60% said no was ethical. They thought a relationship would undermine the doctor-patient relationship.

According to recent US research, 10% of American doctors have had a sexual experience with one or more patients.

The Scottish researchers said they hoped their findings would lead to more discussions on the subject of doctor patient relationships.

In the UK any doctor who has sex with a patient will be investigated and may face a disciplinary hearing.

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Laptop computers Lower Sperm Counts and increase Infertility Risk for Men

Men and teenage boys should think twice before placing a laptop computer on their laps as they can lower sperm counts and reduce your chances of fathering a child. If you are male, thinking about having a family, or even a decade away from planning a family, you may be better off placing your laptop on a desk.

The increasing popularity of laptop computers (LC), coupled with existing evidence that elevated scrotal temperature can result in sperm damage, prompted researchers from the State University of New York at Stony Brook to undertake the first study into the effect of heat from LC on scrotal temperature.

The findings are reported in Europe's leading reproductive medicine journal Human Reproduction[1]. They show that using an LC on the lap increased the left scrotal temperature by a median 2.6°C and the right by a median 2.8°C. Several previous studies have shown that increases in testicular or scrotal temperatures of between 1°C and 2.9°C are associated with a sustained and considerable negative effect on spermatogenesis and fertility.

Lead researcher Dr Yefim Sheynkin, Associate Professor of Urology and Director, Male Infertility and Microsurgery at the University, said: "By 2005, there will be 60 million laptop computers in use in the USA and a predicted 150 million worldwide. Continued improvements in power, size and price of LC have favoured their increased use in younger people and laptop sales now exceed those of desktop computers."

With the exception of an anecdotal report of genital burns, the effect of portable computers on scrotal temperature when they are used on the lap was not known, he said.

"Laptops can reach internal operating temperatures of over 70°C. They are frequently positioned close to the scrotum, and as well as being capable of producing direct local heat, they require the user to sit with his thighs close together to balance the machine, which traps the scrotum between the thighs."

The researchers worked with 29 healthy volunteers aged 21 to 35, measuring scrotal temperatures with and without laptops. Two one-hour sessions of scrotal temperature measurements were performed on different days in the same room with a median room temperature of 22.28°C. The men were dressed in the same casual clothing for each session and sessions with and without LC were conducted at the same time of the day. Body temperature was taken by mouth beforehand and each volunteer spent 15 minutes standing in the room to adjust to room temperature before being seated. A non-working LC was placed on the lap so that the volunteer could adopt the right position to balance the laptop, then removed, and the seating position held for one hour, with scrotal temperature being measured every three minutes. The same procedure was repeated for one hour, with the same baselines controls, but this time with a working laptop. The temperature of the bottom surface of the LC was also measured at intervals.


"We found that scrotal temperatures rose by 2.1°C when the men sat with their thighs together, which is necessary to keep LC on the lap. But, the rise was significantly higher when the LC were used - 2.8°C on the right side and 2.6°C on the left," said Dr Sheynkin. " It shows that scrotal hyperthermia is produced by both special body posture and local heating effect of LC."

The median surface temperature of Pentium 4 computers used increased from nearly 31°C at the start of the experiment to nearly 40°C after one hour.

Dr Sheynkin said: "The body needs to maintain a proper testicular temperature for normal sperm production and development (spermatogenesis). Portable computers in a laptop position produce scrotal hyperthermia by both the direct heating effect of the computer and the sitting position necessary to balance the computer. The magnitude of scrotal hyperthermia associated with abnormal spermatogenesis is unclear. But, previous studies suggest that 1°C above the baseline is the possible minimal thermal gradient capable of inhibiting spermatogenesis and sperm concentration may be decreased by 40% per 1°C increment of median daytime scrotal temperature.

"We don't know the exact frequency and time of heat exposure capable of producing reversible or irreversible changes in spermatogenesis. Studies have shown significant but reversible changes after short-term heating. However, LC produce significant repetitive transient scrotal hyperthermia for years, and insufficient recovery time between heat exposures may cause irreversible or partially reversible changes in male reproductive function."

Dr Sheynkin said his team now planned further studies to evaluate the heating effect of LC on testicular function and sperm parameters. For now, he did not know an exact time for safe use. However, their study showed that within the first 15 minutes of use scrotal temperatures increased by 1°C, so it did not take long to reach a point that may affect testicular function. Also, frequent use may cause intermittent temperature rises, which could significantly increase a single heating effect.

"Until further studies provide more information on this type of thermal exposure", he said, "teenage boys and young men may consider limiting their use of LC on their laps, as long-term use may have a detrimental effect on their reproductive health."

Dr Sheynkin added that two LC brands were tested randomly to avoid criticism that brands may differ. "All laptop computers generate significant heat due to the increasing power requirements of computer chips. New laptops with higher power requirements may produce even more heat. So far, computer fans and 'heat sinks' are not sufficient. It's possible that external protective devices could somewhat help, but it is essential to confirm their protective effect in a clinical study to prevent commercial advertising and use of inefficient and useless products." (ends)

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Ancient Roman Skin Cream Gave Women Beautiful Complexion

Ancient Roman women had beautiful skin, apparently, they had a foundation skin cream which until recently, no one knew how to reproduce. Researchers at the University of Bristol, UK, have recreated the 2000 year old cosmetic skin cream.

They managed to do this because an original was discovered in perfect condition during an archaeological excavation in London.

During the Roman Empire, Roman women in London used to use this foundation cream. The cream is made of refined animal fat, starch and tin.

When you apply it to your face you have a smooth, white powdery texture - probably due to the starch, say the researchers.

Romans loved white faces. Tin, say the researchers, was a better option than lead, because tin is not toxic. Lead had been a popular ingredient for cosmetics throughout history.

The original cream was found in its metal container in perfect condition.

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Many Teen Girls Experience Headache, Stomach Ache, Back Pain And Fatigue

Complaints of headache, stomach ache, back pain and morning fatigue are common among United States adolescent girls, according to an article in the August issue of The Archives of Pediatrics & Adolescent Medicine, a theme issue on mental health and one of the JAMA/Archives journals.

According to information in the article, symptoms such as these are commonly reported among children and adolescents, and girls are at a greater risk of having more than one of these symptoms at the same time. Chronic pain may have long-term effects and negatively affect school attendance, relationships and developmental experiences, the article states.

Reem M. Ghandour, M.P.A., of the Health Resources and Services Administration (HERSA), Rockville, Md., and colleagues investigated the prevalence, frequency and co-occurrence of headache, stomachache, backache and morning fatigue among a nationally representative sample of 8,250 girls in grades six through ten between 1997 and 1998 (representing the 10,360,601 girls nationwide in grades six through ten).

The researchers found that "Among U.S. adolescent girls, 29.1 percent experience headaches, 20.7 percent report stomachaches, 23.6 percent experience back pain, and 30.6 percent report morning fatigue at the rate of more than once a week," and that co-occurrence of more than one the symptoms is common.

The researchers also found that among girls who experienced headaches more than once a week, 53.3 percent also reported stomach pain more than once a week, and 74.3 percent reported morning fatigue more than once a week. Alcohol use, caffeine intake and smoking were strongly associated with all symptoms, while parent and teacher support appeared to protect girls from these symptoms.

"Somatic complaints of headache, stomachache, backache, and morning fatigue are common among U.S. adolescent girls," the authors write. "These findings suggest that effective clinical treatment may require comprehensive assessment of all female adolescents presenting with seemingly isolated somatic complaints to accurately identify and treat both the presenting symptom and any related conditions."

"While linkages may be drawn between selected complaints and other biological functions such as menstruation, most of these complaints seem to be associated more strongly with social, environmental, and behavioral risk factors such as perceived social support and alcohol and caffeine consumption," the researchers conclude.

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Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesia

Extrapyramidal Side Effects and Tardive Dyskinesia. Would You Recognize Them If You See Them?

Anti-emetic, anti-spasmodic and prokinetic medications commonly used in gastroenterology are neuroleptics, a class of drugs which includes anti-psychotics used for schizophrenia.

These medications are capable of causing serious and potentially permanent side effects. The manifestation of neuroleptic drug side effects may range from dramatic and debilitating to very subtle. It has been demonstrated repeatedly that these side effects often go unrecognized.

Doctors prescribing prokinetics, anti-emetics and anti-spasmodics need to be able to recognize these side effects. A full description of the most common movement side effects and the corresponding medical term is included as a resource list for professionals and patients.

BACKGROUND

Any drug capable of causing Extra Pyramidal Side effects (EPS) and Tardive Dyskinesia (TD) is by definition a neuroleptic, Latin for "seize the neuron." It is widely assumed that only patients who are being treated for psychiatric disorders such as schizophrenia are at risk for neuroleptic side effects, yet several gastroenterology drugs have the same side effect profile as Thorazine. Patients taking these medications need to be monitored carefully to prevent potentially irreversible side effects.

Psychiatrists have long been trained to recognize the signs and symptoms of EPS and TD and a great deal of physician education has been aimed at them, yet it has been well documented that they often miss the symptoms. In some studies, experts in the field pick up twice as many cases of tardive as newly trained psychiatrists.

Most other physicians have never been trained to recognize the many different manifestations of EPS and TD. These conditions can be particularly difficult to recognize in children, even for those with specific training.

The relationship between neuroleptic medications and movement disorders is extremely complex and confusing. A neuroleptic may cause movement symptoms in a patient, but the same drug can also temporarily suppress the symptoms or delay the onset of symptoms for the same patient. Symptoms often first appear during withdrawal of the medication. Movement symptoms can occur spontaneously, but they are often clearly induced by medication. The best way to avoid permanent movement disorders is to use neuroleptics very cautiously and to monitor patients closely for emerging symptoms.

TERMINOLOGY

There are two major classifications of movement disorders, dystonias and dyskinesias. There are also two time frames used to classify the onset of symptoms. Dystonias are spasms of individual muscles or groups of muscles. They can be sustained or intermittent, sudden or slow, painful or painless. They can affect any of the body's voluntary muscles including those of the vocal cords. The movements of dystonias can appear very bizarre and deliberate but are involuntary.
Dyskinesias are involuntary, often hyperkinetic movements of various types that have no purpose and are not fully controllable by the patient. Some are random, some rhythmic, most are very odd looking and socially stigmatizing.

They can affect the ability to initiate or stop a movement as in Parkinson's. They can affect the smooth movement of a joint resulting in a jerky articulation. Abrupt and seemingly violent movements of a limb are common as are gyrations of any body part. Tics and involuntary vocalizations are related to dyskinesias.

Extrapryramidal Side Effects (EPS) describes movement side effects that begin during the early phases of treatment with a neuroleptic drug. Early onset symptoms tend to resolve quickly and completely when the patient is weaned from the offending medication(s). The word refers to symptoms originating in a specific part of the brain that refines and modulates movement.

Tardive Dyskinesia/Dystonia (TD) simply means late onset of the same EPS movement side effects.

They can appear after months of trouble free treatment, or they can begin to appear as the dose is lowered or the drug is withdrawn. Symptoms generally appear shortly after drug withdrawal although they can appear months later. The previous cut off of three months post withdrawal is now being questioned.

Tardive reactions may resolve quickly, but these late reactions are more likely to be persistent or permanent.

Symptoms that persist for six to twelve months are considered to be permanent although they may diminish slightly over the course of several years. Masking is the term used to describe the ability of the drug to cover the toxic symptoms it is producing.

EPIDEMIOLOGY

Studies of movement symptoms in patients taking neuroleptics for schizophrenia show prevalence rates ranging from .5% to nearly 70%. Studies examining this wide range of published prevalence rates show the discrepancies are most likely due to the skill of the observer. Movement disorders caused by motility and antispasmodic medications in the treatment of gastrointestinal diseases are widely believed to be rare.

This assumption is probably dangerous and inaccurate. Small studies of metaclopramide in particular show EPS and TD in up to 30% of patients. Given the devastating and potentially permanent nature of TD, extreme care should be taken to use neuroleptic drugs only when absolutely necessary and in the lowest doses possible.

RISK FACTORS

Most risk assessment studies on EPS and TD have been conducted in patients with schizophrenia. In these patients, TD is associated with older age, higher medication doses and longer treatment periods; i.e. total exposure. Females also appear to be a higher risk.

Concomitant treatment with any additional drugs capable of causing neuroleptic side effects is likely to increase the risk of EPS and TD. This includes both traditional antipsychotics and the newer, "atypical" antipsychotics which still carry some risk. Substances as common as alcohol and cold medications have some risk of TD and EPS. Caution is needed as well with patients taking anticonvulsants, antihistamines, barbiturates or antidepressants as some drugs in these categories have a high risk of EPS and TD.

Underlying "soft neurological" factors or mental retardation are significant risk factors in the development of TD.

Many experts caution that tapering down to drug free periods a few times a year is necessary to ascertain whether a patient has "covert" symptoms that are being masked by the continuing use of the drug. Other experts believe that this cycling on and off for "drug holidays" can provoke a tardive reaction and is an additional risk factor.

RECOGNIZING SIDE EFFECTS OF NEUROLEPTICS

Movement symptoms may be so subtle that a psychiatrist or neurologist who specializes in movement disorders may be the only expert to pick them up. But in many unfortunate patients, the symptoms are visible from blocks away.

Movement symptoms are generally not present during sleep, can worsen with stress, and patients can often suppress these symptoms for a short period of time through intense concentration. Movement symptoms may be present uniformly throughout the day, or they may have a diurnal pattern.

Some specific movement symptoms are more troublesome during resting and abate during voluntary movement. Other specific symptoms are only problematic during voluntary movement.

Movement symptoms can wax and wane over time and deliberate provocation may be necessary to elicit the symptom in a clinical setting. This is typically done by distracting the patient with conversation or asking them to perform a mental task, such as math, that requires intense concentration.

Tongue and facial symptoms are often the first to appear and a thorough neurological exam involves careful observation of the tongue in the mouth and sticking out. EPS and TD can mimic disorders such as Parkinson's Disease, Tourette's Syndrome, Huntington's Chorea, tics, cerebral palsy, stroke and hyperactivity.

They are often mistaken for psychiatric disturbances and patients may be shunned. During episodes of dystonia, opposing muscles that should relax contract. This can result in a limb that appears distorted. One of the most common manifestations is an ankle that twists and won't bear weight. In some cases, muscle groups that should be uninvolved in the activity being attempted will get involved. The result can be shoulders that swing violently during walking or an entire arm and shoulder that cramp and contort while the hand is holding a pen. In some instances, the opposing hand/arm/shoulder may also contort in a perverse sympathy.

Some patients find quirky tricks that can short circuit a dystonia or dyskinesia. For example, a few patients with torticollis find that stroking their jaw or touching the back of the head can stop the muscle spasms. A case report describes one patient with a severe gait disturbance who found that tossing a small object from hand to hand allowed him to walk more normally. For this reason, patients should be asked about any odd mannerisms.

In addition to causing movement disorders, neuroleptics used in gastroenterology are capable of causing a host of other symptoms that may not be automatically connected with the drug: drooling, autonomic instability, depression, cognitive slowing, confusion, flat affect, agitation, restlessness, irritability, headaches, disordered thinking, memory changes, altered sensations or perceptions, word retrieval problems, and many others.

Localized Symptoms

Neck/spine symptoms
Associated movement symptoms
Muscle spasms of the neck (cervical) which pull the head to the side (torticollis), forward and down (antecollis), or up (retrocollis) are often painful. An extreme bending at the waist is rare (Pisa Syndrome or pleurothotonus). The most extreme form of back arching can bring the entire body off the bed except the back of the head and the heels (opisthotonus). Pelvic rocking or gyrations (axial hyperkinesia) may appear to be self stimulating or sexual in nature. Jacknifing refers to abrupt bending at the waist.

Gait/walking disorder
Associated movement symptoms
A disorganized walk (ataxia) may be as subtle as a foot rolling in occasionally, or as dramatic and absurd as a Monty Python routine. The patient may appear clumsy, stumbling, clomping or drunk. An inability to start walking as if glued to the floor and then an inability to stop, or a shuffling walk are characteristic of tardive Parkinsonism.

Oral facial symptoms
Associated movement symptoms
Oral-mandibular/buccal-lingual symptoms include chewing motions (sometimes called 'Wrigley Sign'), biting with nose wrinkling ('Rabbit Syndrome'), tongue probing in the cheek ('Bon Bon Sign'), grimacing, pouting and repetitive swallowing. The jaw may open or shut or lock (trismus/lockjaw) making eating difficult. The tongue may protrude rapidly ('Fly Catcher') or hang flaccidly (tonic). The patient may make sucking/kissing/smacking/clicking noises. The patient may bite their own cheeks or tongue. Eyebrows may raise ('Spock eyebrows') or lower making the person appear haughty or angry. Symptoms confined to the lower face may be called Miege's Syndrome. Tooth grinding (bruxism) may occur during sleep. Some symptoms can be aborted by touching the lips or other tricks. Some patients with tardive Parkinsonism lack facial expressions (mask-like facies) and they may drool.

Finger movements
Associated movement symptoms
Finger movements often resemble playing 'Air Guitar', 'Air Piano' or a particular movement called 'milkmaid grip'. Writer's cramp is a severe spasm of the entire hand or arm. The opposing arm may also cramp. This is more than fatigue and may be induced by fine motor activities other than writing. 'Pill rolling' finger movements (rubbing the thumb and fingers in a motion similar to the gesture meaning 'money') are more common in drug-induced Parkinsonism.

Limb symptoms
Associated movement symptoms
Flailing movements involving a whole limb may appear combative like a punch or karate kick (ballismus), or may appear like raising a hand to ask a question. This is one of the few movements that occur during sleep. Some patients with tardive Parkinsonism have limb movements that are jerky and have a ratchet-like quality (cog wheel rigidity).

Eye symptoms
Associated movement symptoms
Blinking of both eyelids (blepharospasms) may be so severe that the patient is legally blind. The eyes may be rolled in any direction (oculogyric crisis).

Vocalizations, breathing, swallowing
Associated movement symptoms
Vocal tics such as grunting, throat clearing, swearing (coprolalia), and echoing words or sounds (echolalia) are possible. The vocal cords may spasm (dysphonia) making the voice choppy, quavery, breathy or cause a hoarse sounding noise when breathing in (stridor). The vocal cords may clamp shut (Laryngospasm/obstructive apnea/dysepnea). The speech may be slurred (dysarthria) or have a quality normally associated with brain damage (bulbar). Swallowing may be uncoordinated (dysphagia).

MONITORING MOVEMENT SYMPTOMS

The Abnormal Involuntary Movement Scale, (AIMS) is available online and provides one quick and systematic way to assess a variety of common movement symptoms. This scale is not useful for distinguishing between the many types of movement disorders and it cannot distinguish drug induced symptoms from spontaneous ones. Several other scales are commonly used and a full discussion of their merits and proper uses can be found in "Assessment of drug-related movement disorders in schizophrenia." Since different clusters of symptoms can suggest different treatments, a full exam by a movement specialist may be desired.

TREATMENT

Treatment of movement side effects that appear early during treatment (EPS) is generally accomplished by slowly withdrawing the drug or lowering the dose.

When the drug is being used to treat a major psychiatric illness such as schizophrenia, withdrawal of the drug may not be feasible. Anticholinergic medications may be helpful in EPS, but generally are not. Beta blockers have also been tried.

Treatment of late onset (TD) movement symptoms and syndromes can be much more complex. Withdrawal of the drug may need to be undertaken very slowly and drugs to counteract the symptoms may be tried. Unfortunately, anticholiergic drugs are generally not as helpful with late onset symptoms and may occasionally cause paradoxical exacerbation. Consultation with a movement disorders specialist may be helpful and in complex cases referral may be necessary.

The long list of drugs that may be used to reduce TD symptoms attests to the difficulty in treating this iatrogenic disease. Many cases of TD do not respond well to currently available treatments and there are many new treatments being investigated including vitamins that act as free radical scavengers. Vitamin E and vitamin B6 have both shown benefit in preventing the development of TD although they have not been effective in treating the disorder once it has developed.

Research is being conducted on the use of branch chain amino acids.

PEDIATRIC CONSIDERATIONS:

Recognition of movement side effects in children is particularly problematic. Infants are more likely to have boxing arm movements, cycling leg movements or generalized hypertonia, all of which are uncommon in adults.

A gait disturbance may not be apparent in a child who is just learning to walk. Motor restlessness in a pre-schooler can look like urinary urgency. Early onset EPS or TD can look like cerebral palsy. How do you distinguish between biting due to a dystonia and a temper tantrum?

Back and neck arching in an infant may be due to pain, an infantile spasm, a seizure, acid reflux induced Sandifer Syndrome or dystonia. A pediatric movement disorders specialist may need to examine the child in order to make a definitive diagnosis.

Non-movement side effects of neuroleptics are also more difficult to recognize in children. Small children can't tell us that they have a headache, that they are having memory trouble, that their senses are not functioning correctly, or that they are suffering from a mood change. How do you distinguish hormonal changes of puberty from the hormonal changes (gyncomastia, amenorrhea) due to prolactin fluctuations caused by a neuroleptic? How do you distinguish druginduced muscle pain (arthralgia) from the pain of the disease you are treating? How do you recognize psychosis, dementia or even a sleep disorder in a baby?

There is a wide range of developmental levels within the range of "normal" making subtle deficits difficult to spot. One author (Anderson) recently met a toddler who was believed to be profoundly retarded while on metaclopramide. His "intractable seizures" stopped the day after withdrawal and he was walking and talking after several months of intense therapy (personal communications with parents and doctor).

To further complicate matters, children metabolize many drugs differently. Children have an undeveloped blood-brain barrier which can leave them more susceptible to CNS involvement where none would be expected in an adult. Children with acute illness or dehydration seem to be at additional risk for dystonias.

Many common medications can exacerbate neuroleptic side effects. In addition, pediatric formulations of some drugs contain alcohol which can exacerbate or precipitate movement symptoms and many other side effects.

Of particular concern is the alcohol in pediatric ranitidine. One of the side effects of ranitidine is an interference with the normal clearance of alcohol that can magnify the effects of the alcohol by a factor of ten.

Children and the elderly are recognized to be at additional risk of EPS and TD from neuroleptics used for psychiatric illnesses. It is reasonable to assume that they are at increased risk when using neuroleptics for gastrointestinal ailments. The lack of recognition means that any estimates about the rarity of side effects are suspect. A few pediatric gastroenterologists no longer use neuroleptics for just this reason.

LEGAL CONSIDERATIONS

There have been many lawsuits filed by patients experiencing TD. The Journal of the American Academy of Psychiatry and the Law and the Journal of Clinical Psychiatry have both printed review articles describing the many legal issues raised. Acording to "Tardive Dyskinesia: Tremors in Law and Medicine," most suits have alleged malpractice but there have also been suits alleging failure to obtain written informed consent, torts violations, failure to monitor, inappropriate reassurance that the TD/EPS symptoms were not drug related, failure to follow standards of care, failure to refer to a neurologist, product liability, etc.

Institutionalized psychiatric patients have filed suits alleging civil rights violations. This article is written jointly by a forensic psychiatrist and an attorney. It summarizes the circumstances, arguments and rulings from dozens of individual cases and is available online. "Update on Legal Issues Associated with Tardive Dyskinesia," a section of a the Journal of Clinical Psychiatry Supplement on TD, contains a history of the use of neuroleptics and is more medically oriented. It explains concepts such as determining when the statute of limitations clock is likely to start in language accessible to doctors.

It gives practical guidelines for physicans who want to avoid lawsuits. The author explains that, "In determining causation, the law is more interested in the straw that broke the camel's back than in all the straws already piled on its back." He includes a quote from a 1984 article; "The impending flood of tardive dyskinesia litigation has begun. I think that there is an enormous backlog of cases that is going to plague us for years." He also warns that the pendulum is swinging in the direction of trying to link all movement disorders to neuroleptics.

Indeed, there are now class action law suits for patients who took metaclopramide and were damaged.

General Symptoms

Akathisia
An inner feeling of restlessness, which compels the patient to pace, march, fidget or wiggle although some patients are able to sit still. In infants, this is more likely to look like air boxing or air cycling. Restlessness may manifest as insomnia. It may be perceived as an uncomfortable inner vibration. Patients may call akathisia anxiety.

Chorea/choreic
Dance-like movements of any body part or the whole body.

Myoclonus/ myoclonic
Involuntary movements that are sudden and violent in appearance as if struck by lightening or hit by an invisible assailant.

Tics
Gilles de la Tourette Syndrome may be drug induced.

Vermicular/ atheoid
Worm-like writhing movement of any body part or the entire body.

Bradykinesia
Slowing of voluntary movements (bradykinesia) can affect any body part or the whole body. In rare cases there can be a complete lack of movement (akinesia).

Resting Tremor
Shaking of a resting limb or tongue that tends to subside during deliberate movements. The opposite of alcohol induced tremors which are worse during intentional movement.

Neuroleptic Malignant Syndrome
The most dangerous side effect of anti-psychotics is Neuroleptic Malignant. This Syndrome potentially fatal reaction is characterized by "lead pipe rigidity," high fever, dehydration, sweating, elevated blood pressure, fast heart rate and respiration, agitation, elevated white blood cell count, difficulty swallowing and autonomic instability.

Paroxysmal
Very abrupt movements

RECOMMENDATIONS

To avoid EPS and potentially irreversible TD, neuroleptics must be used at the lowest possible doses, for the shortest possible duration, only when clearly indicated and when there is no safer alternative. Patients should be monitored closely and frequently for emerging symptoms using standardized movement rating scales. Possible side effects should be fully disclosed via written informed consent documents and the doctor should initiate an ongoing dialog about this topic with the patient. The doctor should consider alerting family members since they often become aware of movement disorders before the patient does.

Resources

Journal of Clinical Psychiatry, 2000, Volume 62, Supplement 4, "Update on Tardive Dyskinesia" contains 9 articles (57 pages) on aspects of TD. CME credit is available. This supplement includes the article, "Update on Legal Issues Associated with Tardive Dyskinesia." The supplement may be ordered on line at http://www.psychiatrist.com/order.htm

Psychotropic Drug Directory, 2001, Stephen Bazire and William Benfield Jr., Quay Books, Mark Allen Publishing. This book contains a full list of drugs capable of causing movement disorders, mood disorders, sleep disorders, etc., (Chapters 5.8-5.9) with citations for each entry. It also has a section on the treatment of movement disorders (Chapters 1.20-1.22) with citations to relevant articles for each entry. Order online at http://www.markallengroup,com/quaybooks

"Tardive Dyskinesia: Tremors in Law and Medicine," Neil S. Kaye, MD, FAPA, and Thomas J. Reed Esquire. Journal of the American Academy of Psychiatry and the Law, 1999; Volume 25, No 2. Viewable online at http://www.courtpsychiatrist.com/tardive.html

Details of pediatric hypertonia symptoms are available in "Classification and Definition of Disorders Causing Hypertonia in Childhood," Pediatrics, 2003: Vol 11, No 1. Available in PDF format online at http://pediatrics.aappublications.org/cgi/reprint/111/1/e89.pdf

"Assessment of drug-related movement disorders in schizophrenia," Maurice Gervin and R.E. Thomas Barnes Advances in Psychiatric Treatment, 2000; 6: 332-341. This article contains a discussion of several movement rating scales and reviews methods of conducting them that can reduce the variability of the results. Available online at http://apt.rcpsych.org/cgi/content/full/6/5/332

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Causes Of Back Pain & How To Treat Back Pain

Many people experience neck and back discomfort at sometime in their lives. Problems can occur suddenly after an accident or injury, or may occur as the result of a slow, gradual process due to lack of exercise or poor posture. Incorrect posture throws the head forward and puts a tremendous amount of stress on the muscles in the back of the neck and upper shoulders.

Muscles in this position maintain a constant state of contraction, resulting in injury and subsequent discomfort. Poor sleeping habits, poor work habits, and tension can all contribute to this problem. While tension is not often the primary cause of back and neck pain, it can certainly worsen pain and make you more prone to injury.

Also, failure to exercise opposing muscle groups can also result in neck and shoulder pain. The imbalance of muscle strength can cause chronic or sporadic tension and tightness in these areas.

Some other specific conditions that can lead to muscle deterioration and pain may include a sedentary lifestyle, obesity, and general lack of muscular tone.

A healthy, pain-free neck also depends on the condition of your upper back. Because the neck and upper back share the same muscles, the strength and flexibility of the shoulders and upper back muscles are important for keeping the neck balanced.

Pain is also generated when muscles go into spasm. While such a spasm may occur as a protective reflex, it intensifies discomfort by reducing circulation and setting up an inflammatory response.

Stress of any kind, physical or emotional, may cause spasms in underexercised muscles. Lastly, pressure or "pinching" of the nerves in the spine can cause severe pain that can radiate (travel) down the back and leg.

SERIOUS SYMPTOMS

While dull aches can be annoying and even ignored, severe pain or pain accompanied by other symptoms may indicate a serious underlying disease that requires medical attention. If you have any of the following symptoms associated with pain in your neck or back, you are urged to seek medical assistance:

-- Fever - May indicate an infection.

-- Frequent, painful or bloody urination - May indicate a kidney problem.

-- Leg pain traveling down to or below the knee - May indicate a possible disc problem.

-- Numbness, tingling, weakness or loss of bladder or bowel control - May indicate a nerve or disc problem.

-- Persistent pain that hasn't improved and can not be relieved - May indicate a serious back disorder or injury.

SEEKING HELP

If you have any of the symptoms listed above or have other concerns about your neck or back, you are encouraged to consult with a medical provider. Evaluation of your problem may include a discussion and review of your medical history, a physical examination and diagnostic tests.


To be a better health care consumer, you should prepare for your appointment in advance. You may want to make a written, chronological history of your problem with accurate descriptions of your symptoms. You may also want to prepare a list of questions in advance. By letting your provider know you have prepared these, it may help ensure that you have an exchange of communication and that all of your concerns and questions are addressed.

Your provider should let you know the advantages and disadvantages of all recommended tests, procedures and treatments and give you an idea (or prognosis) of outcomes, especially if extensive drug therapy, physical therapy or surgery may be required. If your provider refers you for tests or additional consultation, you should also be aware of the financial obligations you may incur. Talk with the provider's office or your insurance company, if you have coverage, about filing a claim or payment expectations.

SELF-CARE

Self-care and treatment can be responsibly done under the consultation of a medical provider. The following are some safe and effective methods, but remember, if your back still hurts after a week of self-treatment, seek medical advice.

Application of heat or ice

Apply heat and/or ice in a way that makes you most comfortable. To relieve initial pain, you may want to apply ice packs wrapped in towels for 10 minutes every two hours for the first one or two days. Then you may apply heat or ice. Always make sure you have a cloth of some type between your skin and the ice, to prevent freezing the skin and frostbite. It is not recommended that you lie on an ice pack. Since back sprains and strains don't usually cause much swelling, some people find moist heat, such as a hot shower, tub bath, wet towels, or hot water bottle, to be more effective than ice. Limit heat to 15-20 minutes every few hours. Too much heat can make you feel drained and tired, rather than relaxed.

Massage

Massage helps increase the blood flow to your muscles, improves muscle tone and helps your muscles to relax. Classes are often offered for massage training and there are resources such as books and handouts available to teach proper massage technique.

Medication

Pain relievers, such as acetaminophen, ibuprofen and aspirin can help reduce pain. Be aware that products such as these can cause stomach irritation for some people. Take all medications in the dosages and time schedules recommended on the label.

Rest

Try to lie comfortably in a well-supported bed. The best position for your back is on your side with the knees bent. A pillow between the knees may also help increase comfort. Another good resting position is on your back with a pillow underneath your knees. Lying on your stomach or flat on your back with your legs straight out are not recommended positions.

Exercise

Once your pain subsides, do the exercises provided by your healthcare provider or visit www.spineuniverse.com. A bit of initial discomfort is normal, but if you avoid exercise for too long, your muscles will stiffen and weaken and may cause you more problems in the future. If you experience any significant pain, stop immediately and seek medical attention. Gradually increase the amount, intensity and frequency of exercise as tolerated. Do not perform any exercise with pain that is increasing or not improving.

Stress and Tension Management

Techniques, such as progressive muscular relaxation, exhalation breathing, meditation and guided imagery can help create a more relaxed body that is receptive to healing. You might want to seek out a class or book on one of these topics. Soothing music played on a stereo or radio and resting your body and mind may also be beneficial.

Recreational Activities

Some activities can be helpful in toning and stretching muscles while reducing the possibility of further injury. Swimming, walking, and water walking are recommended. Conversely, some activities can cause problems if done before symptoms are gone and strength, flexibility and conditioning are restored. Avoid tennis, golf, bowling, racquetball, diving, high-impact aerobics, and other activities that combine sudden bending and twisting.

SUMMARY

You are not alone if you suffer from back and neck pain and related problems. Restoring your body to optimal conditioning with proper exercise and prevention measures will help ensure an active life. Consultation with a medical provider may be necessary for some individuals.

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How do Women Feel After an Abortion?

It is normal for a woman to experience a range of emotions after an abortion, such as relief, sadness, happiness and feelings of loss. Each woman is unique. Many women feel that they have made the right decision after having an abortion. For some women, however, abortion can raise negative emotional responses including grief, guilt, anger, shame and regret. Understanding your emotions can help you begin to let go of any pain and start to heal. It is important to recognize your feelings and to take good care of yourself if you are experiencing difficulty. The following information may be helpful if you are experiencing emotional distress after an abortion.

What kinds of things might contribute to a woman feeling distress after an abortion?

-- Hormones are changing back to their pre-pregnancy state after an abortion. This chemical change can make a woman feel sad and emotional.

-- A woman is more likely to feel negative emotions if she felt pressured into having an abortion by someone else, instead of making her own decision.

-- Some women don't receive much support from their friends or family.

-- Social stigmas about abortion can make it difficult for women to share their experience and make them feel isolated.

-- Some women might feel judged.

-- Some women fear that they might never again be able to get pregnant. However, abortion does not interfere with your future fertility.

-- Sometimes the couple relationship is stressed or undermined by the crisis of an unplanned pregnancy. In these circumstances, women may feel abused and/or abandoned.

Any time you make a difficult life decision, it is natural to have second thoughts. Allowing yourself to express any negative feelings that you may be having will help to diminish their impact. Sometimes reading about other women's experiences can be reassuring and may make your own feelings more clear. You can find the stories of several women who have had abortions at: http://www.peaceafterabortion.com/stories.html

Is it normal to feel depressed after an abortion?

Approximately 5% to 30% of women report feelings of regret, anxiety, guilt, mild depression and other negative emotions. If your feelings are overwhelming or persistent, you should consult a professional therapist.

It is rare for a woman to become clinically depressed after having an abortion. There are some risk factors that can contribute to the risk of clinical depression after abortion, such as if the woman has a previous history of depression. Depression is a very serious illness. It is extremely important that you seek help from a professional such as a doctor, counsellor or therapist.

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What is Asthma? How Do You Get Asthma? How Long Does Asthma Last?

Asthma is a long-lasting (chronic) disease of the lungs and airways (bronchi) that affects 5 people in every 100. In children, this figure is higher and rising.

Asthma is characterised by attacks of breathlessness, tight chest, wheezing and coughing which are caused by the airways becoming narrowed and inflamed. Some people may have these symptoms all of the time and others may be normal between attacks.

How do you get asthma?

Asthma can arise at any age, but why some people have the disease and others don't is not known. People with asthma have airways that are more sensitive than normal.

• Doctors know, however, that asthma can sometimes run in families.


• Asthma attacks can be set off by many different things, these are called triggers. Examples include cold air, vigorous exercise and stress.


• These triggers may also include 'allergens'. These are present in the environment and contain chemicals that trigger allergic reactions.


• Allergens include, for example, pollen, animal danders, house dust, pollution, some foods, perfumes and cigarette smoke.


• Allergens cause the lining of the airways to become swollen and inflamed. It produces extra mucus and the muscles of the airways tighten. There is then less room for the air to pass in and out.


• Attacks may be more frequent or severe in people who have a chest infection.

How serious is asthma?

Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening. Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling. In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.

How long does asthma last?

Asthma attacks come and go, with wide variation in the symptoms at different times. Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days. Some children grow out of asthma and some people are only affected at different times of the year. However, the period of time during which people may have asthma attacks can last for many years or throughout life.

How is asthma treated?

Asthma is not so much "treated" as it is "controlled". As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.

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Wonder pill, Rimonabant, makes you lose body weight and keep it off

An experimental wonder drug, Rimonabant, helps you lose weight, quit smoking and it also helps protect your heart. Trials have shown that 33% of people on Rimonabant lost 10% of body weight and kept their weight down for two years - this is a record, no other diet drug has managed to keep a person's weight down for so long.

The second 33% lost 5% of body weight and kept it down.

As well as keeping you lean, the drug also helps you quit the smoking habit. This will be of great interest for many smokers who are afraid to give up because they say they will put on loads of weight if they do (young female smokers worry about this the most).

The findings of this trial were presented at the American Heart Association conference, New Orleans, USA.

Study leader, Dr. Xavier Pi-Sunyer, said "People were able to quit and stay off cigarettes significantly better on rimonabant and also not gain all that weight that generally happens when you quit smoking."

Dr. Xavier Pi-Sunyer works at St Luke's Roosevelt Hospital, New York.

There are nerve receptors that exist in the brain and fat cells. These receptors tell the body to overeat (and intake nicotine). Rimonabant blocks the signals these receptors give out - it stops them from telling us to overeat. Overeaters and addicted smokers have very active receptors of this kind.

By blocking the signals, the overeater or nicotine addict does not have the same urge to eat or smoke. There is no other drug like it - one that helps you stop smoking and overeating.

If approved, makers Sanofi-Aventis hope to have the drug on the market next year. Rimonabant will have the brand name 'Acomplia'. Sanofi-Aventis are hopeful the drug will be approved.

The present study looked mainly at the drug's effect on body weight over a period of two years. Other studies will look more closely at Rimonabant's effectiveness at helping people quit smoking. Smaller studies have indicated the drug is very good at helping addicted smokers kick the habit.

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Organic foods in relation to nutrition and health key facts

This factsheet is a summary of an article published in "Coronary and Diabetic Care in the UK 2004" by the Association of Primary Care Groups and Trusts (UK). It was written by James Cleeton, Policy Projects Co-ordinator at the Soil Association.

The article concluded that a predominantly organic diet:

- reduces the amount of toxic chemicals ingested;

- totally avoids GMOs [genetically modified organisms];

- reduces the amount of food additives and colourings;

- increases the amount of beneficial vitamins, minerals, EFAs [essential fatty acids] and antioxidants consumed;

- appears to have the potential to lower the incidence of common conditions such as cancer, coronary heart disease, allergies and hyperactivity in children.

1) PESTICIDES

The routine use of synthetic pesticides is not allowed under organic standards. Currently, over 400 chemicals can be regularly used in conventional farming to kill weeds, insects and other pests that attack crops. For example, Cox's apples can be sprayed up to 16 times with 36 different pesticides. 7 Only four chemicals are allowed in restricted circumstances under Soil Association standards.

"Organic food contains fewer residues of pesticides used in conventional agriculture, so buying organic is one way to reduce the chances that your food contains these pesticides" (Sir John Krebs, Chair, Food Standards Agency, Cheltenham Science Festival debate, 5th June 2003).

"Consumers who wish to minimise their dietary pesticide exposure can do so with confidence by buying organically grown food" (Baker et al 2002).

Organophosphates

The most dangerous chemicals used in farming such as organophosphates [pesticides] have been linked with a range of conditions such as cancer, decreasing male fertility, foetal abnormalities, chronic fatigue syndrome in children and Parkinson's disease. 8,9 Pesticide residues have been ranked among the top three environmental cancer risks by the American Government. 10

Pesticide residues in food

In recent years, UK Government research has consistently found pesticide residues in a third of food, including residues of more than one chemical in apples, baby food, bread, cereal bars, fresh salmon, lemons, lettuces, peaches, nectarines, potatoes and strawberries. 11 Not all foodstuffs are checked; instead a small number of different products is tested every 3 months and the results published by the Pesticide Safety Directorate (PSD).

Residues of multiple pesticides: the cocktail effect


After pressure from NGOs [non-governmental organisations] such as the Soil Association, the PSD has begun testing for multiple pesticide residues in its samples because evidence suggests that when acting in combination, harmful effects of pesticide residues may be increased. The Government has recognised that "ignoring the cocktail effects during risk assessment will lead to significant under-estimations of risk".12

Combinations of low-level insecticides, herbicides and nitrates have been shown to be toxic at levels that individual chemicals are not.13 - 16 It is clearly an enormous task to test all possible combinations of the 400 permitted pesticides currently in use. It is clear that not enough is known about how combinations of pesticides affect our health, and the Government's Committee on Toxicity has expressed disquiet about the risks involved.17

Pesticides and cancer

Women with breast cancer are five to nine times more likely to have pesticide residues in their blood than those who do not.18 Previous studies have shown that those with occupational exposure to pesticides have higher rates of cancer.19 - 21 The apparent link between hormone dependent cancers, such as those of the breast and prostate, may be via endocrine disrupting chemicals [compounds that artificially affect the hormone system] such as 2,4D and Atrazine (both herbicides, now banned or about to be banned). The Royal Society [the UK's main scientific organisation] recommends that human exposure to EDCs (especially during pregnancy) should be minimised on grounds of prudence.63

Effects of pesticides on children

Children may be particularly susceptible to pesticide residues as they have a higher intake of food and water per unit of body weight than adults and their relatively immature organ systems may have limited ability to detoxify these substances.22

In a study of children aged 2 -4 living in Seattle, concentrations of pesticide residues up to six times higher were found in children eating conventionally farmed fruit and vegetables compared with those eating organic food.23 Whilst the presence of pesticide residues in children eating conventional food has been confirmed, the full effect of such pesticides are unknown.

2) FOOD ADDITIVES

Food colourings and additives can cause a range of health problems in adults and children. For example, tartrazine (the yellow food colouring E102) and other additives have been linked to allergic reactions, headaches, asthma, growth retardation and hyperactivity in children.24 - 27

Although around 300 additives are permitted in conventional food only 30 are allowed under Soil Association standards. Some additives found in organic food are added for legal reasons including iron, thiamine (vitamin B) and nicotinic acid (vitamin B3) in white flour, and various vitamins and minerals in different types of baby foods. All artificial colourings and artificial sweeteners are banned in organic food.

Specific ingredients and additives not allowed in organic food are monosodium glutamate, aspartame, phosphoric acid and hydrogenated fats. In each case their use has been banned because of evidence that they can be damaging to health. For example, hydrogenated fats (also known as trans fats) have been directly linked with increased rates of heart disease, cancer and skin disease. 28,29,30,31 The FSA [Food Standards Agency] acknowledges that they have no known nutritional benefits and increase the risk of coronary heart disease. The FSA website advises that people should try to cut down their consumption of hydrogenated fat. 32

3) GENETICALLY MODIFIED ORGANISMS

Genetically modified organisms are banned from organic food.

The potential health effects of GM foods are unknown. Michael Meacher the former Minister for the Environment recently stated that "We have had no systematic clinical or biochemical trials of the effects on human beings of eating GM food".

A paper in Nutrition and Health 33 supports Mr Meacher's position. The authors state that there have only been ten published studies of the health effects of GM food and that the quality of some of these was inadequate. Over half were done in collaboration with companies (fully or partially), and these found no negative effects on body organs. The others were done independently and looked more closely at the effects on the gut lining; in several, evidence of harmful effects were found which remain unexplained. 33

Similar effects on the gut lining were found in an unpublished animal feeding study on a GM tomato. In addition, a study by Newcastle University sponsored by the FSA found that the transgenes [genetically modified organisms] transfer into gut bacteria at detectable levels after only one GM meal. The health effects of these transgenes are unknown and until they have been properly tested people are, in our opinion, wise to avoid eating GM food.

4) ESSENTIAL VITAMINS AND MINERALS

UK and US government statistics indicate that levels of trace minerals in fruit and vegetables fell by up to 76% between 1940 and 1991. 34,35 In contrast there is growing evidence that organic fruit and vegetables generally contain more nutrients than non-organic food.

The Soil Association conducted a systematic review of the evidence comparing the vitamin and mineral content of organic and conventionally grown food. It was found that, on average, organic food contains higher levels of vitamin C and essential minerals such as calcium, magnesium, iron and chromium. 36

An independent review of the evidence found that organic crops had significantly higher levels of all 21 nutrients analysed compared with conventional produce including vitamin C (27% more), magnesium (29% more), iron (21% more) and phosphorous (14% more). Organic spinach, lettuce, cabbage and potatoes showed particularly high levels of minerals. 37

5) ANTIOXIDANTS

A high antioxidant intake has been shown to be associated with a reduced incidence of coronary heart disease and some cancers. Such antioxidants include certain vitamins (vitamin E and beta-carotene) and substances known as phenolics. Researchers have recognised the growing concern that levels of some phenolics may be lower than is optimal for human health in conventionally grown foods. 38Phenolics are generated by a plant when attacked by pests.

Generally, organic crops are not protected by pesticides and research has shown that organically produced fruit contains higher levels of phenolic compounds than conventionally grown fruit. 38,39 Danish researchers have found that organic crops contain 10% to 50% more antioxidants than conventional crops. 40

6) ESSENTIAL FATTY ACIDS

The essential fatty acids (EFA), omega 3 and conjugated linoleic acid (CLA) play an essential role in metabolism [chemical changes which take place in our bodies to utilise food and eliminate waste materials] and especially in the prevention of coronary heart disease and high blood pressure 41,42,43. Omega 3s also reduce the risk of neurological disorders including depression 44,45,46 and ADHD (Attention Deficit Hyperactivity Disorder) in children 47,48,49,50, 51,52. Furthermore, CLA has been demonstrated to help prevent cancer and degenerative changes in the walls of the arteries 53,54 enhance growth promotion and reduce body fat 54, 55, 56.

Forage based diets [a diet based on fresh or dried food as opposed to processed feed] form the basis of organic livestock production systems and have the potential to decrease saturated fat concentrations and to increase the concentrations of omega-3 57, 58 and CLA 59,50,61 in beef. Milk taken from animals fed on a forage-based diet also display improved levels of EFAs, including CLA and omega 3. 61, 62

7) ALLERGIES

In a study of Swedish children, the prevalence of atopic disorders [allergies] from two different groups of children was measured. The study compared 295 children aged 5 - 13 years from two anthroposophic schools [schools with an alternative approach to education] with 380 children from two neighbouring state schools. The anthroposophical school children ate a predominantly organic diet, used antibiotics restrictively, had few vaccinations and their diet usually contained live lactobacilli [a friendly bacteria found in the upper intestinal tract of humans and in some yoghurts and in unpasteurised milk]. It was found that the anthroposophic way of life is associated with a lowered prevalence of atopy in children. 4

The reduced incidence of atopic disorders is likely to be the result of a combination of lifestyle differences between the two groups of children so that the contribution of organic food consumption is unclear. However, consumption of organic food is the single most common factor unifying the anthroposophic children.

8) FERTILITY

A steady deterioration in male reproductive health has been reported throughout Europe. Sperm concentrations have declined and abnormalities in sperm development have been recorded.

Danish research compared the sperm density of members of an organic farming association (OFA) with that of three different occupational groups and found that that the former had significantly higher sperm counts 2. This research was corroborated in 1996 when members of another Danish OFA were compared with a control group of 797 healthy men. It was found that "sperm concentration was higher among men eating organically produced food" 3.

"A biological plausible hypothesis has suggested that man-made chemicals act as endocrine disrupters (EDC) resulting in altered development of the reproductive tract causing the observed effects"5. A number of pesticides regularly used in conventional agriculture are known to be EDCs. Therefore, if an individual's diet does not contain pesticide residues, it can be hypothesised that the above abnormalities of sperm would be less likely.

9) POSITION OF THE FOOD STANDARDS AGENCY AND THE GOVERNMENT

The Food Standards Agency responded to the Soil Association's report "Organic farming, food quality and human health' (2001) by stating that:

On the basis of current evidence, the Agency's assessment is that organic food is not significantly different in terms of food safety and nutrition from food produced conventionally. 1

The Government has taken a more open-minded view. At a meeting between members of the Government's Organic Action Plan and the FSA, the then Organic Farming Minister, Elliot Morley, suggested to the FSA that:

"while the FSA is clear that all conventionally produced food is safe, the FSA could also recognise that some consumers want less pesticide residues, less use of veterinary medicines, no routine use of antibiotics, and no use of GM ingredients, and that in all these areas organic food delivers what the consumers want."

At that time, Sir John Krebs the Chair of the FSA, was unwilling to change its stance on organic food. However, in recent months Sir John has endorsed one of the organic sector's findings, namely that organic food contains less pesticide residues.

"Organic food contains fewer residues of pesticides used in conventional agriculture, so buying organic is one way to reduce the chances that your food contains these pesticides" (Sir John Krebs, Cheltenham Science Festival debate, 5th June 2003).

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What Is Flatulence? What Causes Flatulence (Farting)?

Though you might not think it, we each have an average of 14 occurrences of flatulence per day. For an excessive amount of daily flatulence, there can be many reasons. These include:

• Smoking
• Lactose intolerance
• Eating certain foods
• Swallowing too much air
• An overabundance of bacteria in the colon

How Can I Control Flatulence?

Controlling ordinary flatulence is basically a matter of watching how you eat and what you eat. You may wish to monitor your intake of high-fibre foods such as cabbage, corn, and beans to determine which may be causing a problem. Substituting the problem food for other high-fibre foods such as bran may lessen the problem.

Beans are famous for their wind-inducing properties. However, they are less likely to lead to flatulence if they are soaked overnight along with a couple of tablespoons of vinegar. They should be then be drained and rinsed before cooking in fresh water.

Eating slowly and chewing food for longer allows the enzymes in saliva to break the food down before it enters the stomach and digestive tract.

The more that food is chewed, the more it is broken down for the digestive system. What's more, swallowed air is a prime cause of flatulence, and careful chewing avoids the swallowing of air that occurs when food is eaten too quickly.

Some processed food items contain ingredients, such as sweeteners or preservatives that can induce wind, especially:

• Dietetic foods
• Sugarfree sweets and chewing gum
• Fizzy drinks
• Whole grains and bran

When Should I Consult My Doctor About Flatulence?

Excessive flatulence may be a symptom of a serious health problem such as:

• Appendicitis
• Gallstones
• Stomach ulcers
• Irritable bowel syndrome (IBS)

If you suspect that you may be suffering from any of these ailments, you should consult your GP.

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