By John Whitesides
WASHINGTON (Reuters) - The U.S. Congress has started work on a broad overhaul of the healthcare system in a rare spirit of optimism, but brewing battles over its cost, scope and structure could still scuttle hopes for a solution.
From President Barack Obama's declaration that "the stars are aligned" on healthcare to a recent cost-cutting pledge by a half-dozen industry groups, momentum has built steadily on an issue that has eluded consensus for decades.
The first test comes in a few weeks when Congress unveils legislation, launching months of expected wrangling over the specifics of tax hikes, spending cuts and the government's role in a revamp that could cost as much as $1.5 trillion.
"It's true that the planets are aligned for healthcare as never before, but there are still big obstacles," said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group.
"We are about to enter a very different stage of the debate once everyone sees the specifics and how it will be paid for," he said. "Getting a comprehensive agreement is a high hill to climb. We have failed many times."
The push for reform is still haunted by the most spectacular of those failures, the collapse of the Hillary Clinton-led effort in 1994. But analysts say Obama so far has avoided some of the pitfalls that doomed that plan.
Obama has pursued a more open approach than Clinton in developing the legislation, which he hopes will curb costs and expand coverage to many of about 46 million uninsured Americans.
He asked congressional leaders to put together the bill, rather than presenting it to them as a finished package, and brought to the table many of the groups like insurers who helped kill the Clinton plan.
Congressional leaders have backed a quick timetable for approval, limiting time for opposition to mount. The first proposal will be unveiled in the next few weeks and Obama wants to sign a final bill before the end of the year.
'TACTICALLY SUPERIOR'
"The whole approach has been eminently superior, tactically, to 1994," said Ed Howard, executive vice president of the Alliance for Health Reform, a non-partisan health policy education group.
Obama has a strong political hand after a decisive White House win in November over Republican John McCain, and has large majorities of fellow Democrats in both houses of Congress to work with.
Obama and McCain backed dramatically different approaches to healthcare reform. But the issue rarely won the spotlight in a 2008 campaign dominated early by the debate over wars in Iraq and Afghanistan and late by the collapsing economy.
Since then, the economic pain of the recession has strengthened the drive for reform, spotlighting worries about spiraling costs and bolstering Obama's argument that reform is vital to an economic cure.
"The status quo has been shown to be unsustainable right before our eyes," said Len Nichols, director of the Health Policy program at the New America Foundation. "Healthcare is an economic issue again. How do you go out there and tell people we will not do anything about this?"
But economic concerns will fuel what is likely to be the biggest battle over the plan: How much will it cost and how is it paid for?
OPPOSITION EXPECTED
Lawmakers have floated a variety of possible tax proposals to help pay for covering the uninsured. Nearly any tax hike will run into opposition from interest groups, and many could drain public support.
"A lot of middle-income people who have insurance are probably going to read an article soon saying they are going to have to pay a lot more for this at a time when they are economically hurting," said Bob Blendon, a health policy and political analysis professor at Harvard University.
"And they are going to say, 'That's not what I mean by health reform'," he said.
Republican opponents have been slow to organize and uncertain how to proceed as they search for the proper way to frame their warnings that Obama's approach could reduce choice and lead to a government-run healthcare system.
"We're dealing with shadows. No one knows what is going to be in the bill so it's impossible to assess," said Gary Ferguson, a Republican pollster who specializes in healthcare.
The leader of the first organized campaign against the overhaul is Rick Scott, a multimillionaire ousted as head of the huge healthcare firm Columbia/HCA during a fraud investigation that eventually led to $1.7 billion in judgments against the company.
But the insurance industry, which helped kill the Clinton plan, could still spring to life if the legislation includes a public insurance plan favored by Obama and many Democrats that would help cover the uninsured and create competition for private insurers.
Opponents say it could drive companies out of business. But Blendon said given the economy, it will be easier to find a compromise on the issue of a public plan than on the money.
"Because of the problem of finding the money to pay for it, the bill could wind up being more modest in the beginning or it could be phased in over a longer period of time," he said.
"There are so many options here. The one option Obama can't accept is to go back to Democrats and say 'I couldn't get a bill passed.'"
Tuesday, June 23, 2009
Philippines closes Congress after H1N1 virus death
MANILA, June 23 (Reuters) - The Philippines closed down the lower house of Congress for five days on Tuesday and sent about 3,000 workers home after cases of influenza A (H1N1) were reported in the offices, officials said.
A 49-year-old woman who died last week from symptoms exacerbated by the flu was a staff member on a congressional committee, said Ramon Roque, a doctor and deputy secretary-general of the House of Representatives.
The legislature is not currently in session.
Roque said the House was taking steps to clean and sanitise the offices to prevent the spread of the virus as well as prepare the facility for the resumption of sessions and the president's state of the nation speech next month.
The health department said 28 more positive influenza A (H1N1) virus cases were reported on Tuesday, bringing the total number of new flu virus cases in the country to 473 and one reported death.
Health Secretary Francisco Duque said about 85 percent of the new flu virus cases in the country had recovered, but more schools have suspended classes due to a rising number of cases on campuses.
Nearly 30 universities, some state colleges and elementary schools have been closed for up to 10 days since the flu virus first surfaced in the country on May 21. (Reporting by Manny Mogato; Editing by Raju Gopalakrishnan)
A 49-year-old woman who died last week from symptoms exacerbated by the flu was a staff member on a congressional committee, said Ramon Roque, a doctor and deputy secretary-general of the House of Representatives.
The legislature is not currently in session.
Roque said the House was taking steps to clean and sanitise the offices to prevent the spread of the virus as well as prepare the facility for the resumption of sessions and the president's state of the nation speech next month.
The health department said 28 more positive influenza A (H1N1) virus cases were reported on Tuesday, bringing the total number of new flu virus cases in the country to 473 and one reported death.
Health Secretary Francisco Duque said about 85 percent of the new flu virus cases in the country had recovered, but more schools have suspended classes due to a rising number of cases on campuses.
Nearly 30 universities, some state colleges and elementary schools have been closed for up to 10 days since the flu virus first surfaced in the country on May 21. (Reporting by Manny Mogato; Editing by Raju Gopalakrishnan)
Monday, April 13, 2009
Sympton of Femail Hair Loss
A widening of the part or a decrease in pony tail width is usually the most noticeable sign that hair loss is occurring. Hairs tend to be miniaturized or of various lengths and diameters in the affected area. An abnormally high number of hairs found on brushes or combs, pillows or in the shower drain may be the first noticeable indicators of the condition. However, female pattern hair loss may not be visually identifiable in an affected area until significant thinning or hair loss has occurred.
Hair loss is not usually a cause for concern. However, it can be an early sign of certain diseases (e.g., diabetes, lupus, hypothyroidism, hyperthyroidism). Hair loss may also develop as the result of poor nutrition (e.g., iron deficiency), skin damage or as a side effect of certain medications. Women who are troubled by their hair loss should consult a dermatologist, especially if the condition is accompanied by other symptoms such as itching or skin irritation.
The article reprinted from http://digghealth.com/sympton-femail-hair-loss/ In most cases of female pattern hair loss, the hairlines at the front and back of the head remain intact. As opposed to the “bald spot” or receding hairline that commonly distinguishes men with hereditary hair loss, women typically experience an overall thinning of the hair just behind the frontal hairline or middle scalp area and extending back to the crown (top of the head).The article reprinted from http://digghealth.com/sympton-femail-hair-loss/
Hair loss is not usually a cause for concern. However, it can be an early sign of certain diseases (e.g., diabetes, lupus, hypothyroidism, hyperthyroidism). Hair loss may also develop as the result of poor nutrition (e.g., iron deficiency), skin damage or as a side effect of certain medications. Women who are troubled by their hair loss should consult a dermatologist, especially if the condition is accompanied by other symptoms such as itching or skin irritation.
The article reprinted from http://digghealth.com/sympton-femail-hair-loss/ In most cases of female pattern hair loss, the hairlines at the front and back of the head remain intact. As opposed to the “bald spot” or receding hairline that commonly distinguishes men with hereditary hair loss, women typically experience an overall thinning of the hair just behind the frontal hairline or middle scalp area and extending back to the crown (top of the head).The article reprinted from http://digghealth.com/sympton-femail-hair-loss/
Tuesday, January 13, 2009
Prevention cancer， what we should eat vegetables?
Cancer cases around us in the frequent occurrence of aggressive treatment is the best approach। But in everyday life a little attention to diet, can prevent cancer happen? The answer is yes। Here I will give you some vegetables can prevent cancer, according to their own taste preferences often selective eat something, you can achieve the role of cancer prevention. Concanavalin Suitable for esophageal and gastric cardia, gastric cancer patients with nausea hiccup when eating, there are only uh Jiangqi effect। Concanavalin inquiry old civil commonly used powder, 30 grams each to eat, and Japan served 2 or 3 times, every 30 days for a course of treatment. Lumbar pain of kidney cancer, the public has 50 grams of beans with a knife, with one kidney, kidney soup into taking it in 1 day at times served.
Bean Alias beans. Suitable for leukemia, nasopharyngeal cancer, thyroid cancer, osteosarcoma, malignant mole, chorionic epithelial cancer, breast cancer, cervical pain, ovarian pain, testicular cancer, colorectal cancer patients to eat. This is because the seeds of sugar bean protein, trypsin inhibitor, and red blood cells containing the human body has a strong activity in PHA, as a result of PHA have a certain anti-cancer effect, and there is, the cancer patients should eat more. Bean sprouts Is a good anti-cancer vegetables, not only because of its nutrient-rich, containing a large number of anti-cancer effect of the amount of vitamin C and carotene. More importantly, Levin sprouts contain an enzyme, can block the carcinogenic nitrosamines in the body's synthesis. At the same time, bean sprouts in chlorophyll, cellulose can also control a number of colorectal cancer and other cancer, cancer patients eat bean sprouts, the promotion of nutrition, disease control the development of certain benefits. Kelp Chinese traditional medicine, the sea with Huatan, Ruanjian, Sanjie role, is commonly used in Chinese medicine to treat cancer drugs, more should be used on the gall tumor, sputum of nuclear and other, which is equivalent to modern medicine said thyroid, esophagus, stomach, breast, lymph system benign or malignant tumors, cancer is always an ideal anti-cancer food, suitable for thyroid cancer, lung cancer, breast cancer, esophageal cancer, cardiac cancer, uterine cancer, malignant lymphoma patients take. Porphyra Cold, sweet salty, there Qingre, Ruanjian, Huatan function is ideal for cancer patients anti-cancer food, suitable for brain tumors, breast cancer, thyroid cancer, malignant lymphoma, and a variety of tumors with lymph node metastasis regular use, which inhibit tumor growth, narrow the masses to ease the development of the disease have a certain effect. Seaweed Modern pharmacological studies confirmed that the algae have a certain anti-cancer function, is also a kind of anti-cancer anti-cancer food, traditional Chinese medicine that cold seaweed can Ruanjian, Sanjie, Xiaotan, suitable for head and neck, thyroid, digestive tract, lungs and lymph System of people taking a variety of malignant tumors. Usually associated with kelp with food, more appropriate. Auricularia Sexual-ping, sweet, can Yiqi, Yangyin. Modern study found that black fungus in the body contains a polysaccharide with a certain degree of anti-cancer activity. This role is not to direct inhibition of cancer or destroy cancer cells, but by increasing the body's immunity to cancer, and this is what Chinese medicine uphold effect. Therefore, suitable for various types of cancer Auricularia patients and radiotherapy, chemotherapy or postoperative physical infirmity are edible. White fungus Sexual-ping, sweet light, there Ziyin, Moistening Lung, Yangwei, Sheng Jin function is a kind of anti-cancer nutritional Fuzheng tonic. Modern pharmacological studies have shown that tremella can promote the transformation of lymphocytes in the body, improve immune function. Tremella polysaccharides on anti-tumor cells have a certain extent, on the various types of cancer patients and chemotherapy and radiotherapy after the weak, and is particularly suitable. Hericium erinaceus Or Hericium is a nutritious edible fungi, suitable for various types of cancer patients, especially the consumption of the digestive system cancer patients. Hericium erinaceus is not only nutritious, it contains polysaccharides, peptide on the cancer cells have a stronger inhibitory effect, at the same time enable the body protein composition of any significant increase, resulting in the interferon, and enhance the anti - cancer effects. Therefore, cancer patients often eat Hericium erinaceus helps increase the body's immune globulin, to enhance lymphocyte transformation rate, or mention of white blood cells, enhancing immune function, play a role in cancer prevention of cancer. Flammulina According to Japanese scholars, Flammulina mushrooms contain a Su-Park, which Park Su-mushroom can effectively inhibit tumor growth, with obvious anti-cancer effect. Japan's Nagano is the production of Flammulina a place where most residents in the county is often taken as a result of this edible fungus and rarely get cancer, the region of tumor incidence was significantly lower than other regions. Can be seen in patients with various types of cancer Flammulina is an ideal food. Volvacea Cold, sweet, can Qingre Yangyin Shengjin. In addition it is rich in vitamin C has a good effect against cancer, the straw mushroom fruiting bodies also contains a heterologous protein, also has a certain anti-cancer effect. Suitable for various types of cancer patients use can enhance the body's anti-cancer ability to treat cancer. Ostreatus In recent years, China's medical workers found that ostreatus is also a kind of anti-cancer food, it has a direct role in cancer prevention of cancer, and suitable for stomach cancer, nasopharyngeal cancer, cervical cancer patients to take. To some extent, can stabilize the patient's condition, control of cancer development, and reduce the postoperative metastasis and recurrence. Commonly known as mushrooms. The United States, Japan scientific staff, in the mushrooms found in a 1,3-β-glucosidase by the anti-cancer tests showed that cancer patients treated with this material, can enhance the body's ability to inhibit cancer, strengthen the anti-cancer role. China's pharmaceutical workers also found that mushrooms contained Lentinan to enhance the effectiveness of anti-cancer drugs, though not directly kill the tumor cells, but can stimulate the reticuloendothelial system. Therefore, various types of cancer patients, fresh mushrooms, can improve their immune function and anti-cancer ability to enhance the radiotherapy and chemotherapy efficacy, the prevention of chemotherapy after radiotherapy-induced leukopenia. Persist after the operation and long-term consumption mushrooms, the prevention of cancer recurrence and metastasis is also quite beneficial. Fish maw Also known as isinglass, white fish. Sexual-ping, sweet, can Bushen, Yijing, reduces swelling,
"Compendium of Materia Medica," said it "casual blood stasis, swelling drug." "Common medicinal animals" in the description: "test governance malignant: dry fish 40 grams, 40 grams subsoil kitchen, a total of inquiry, Japan for 3 times 10 grams." Inner Mongolia civil governance gastric esophageal cancer, useful to Shannon fried fish cakes, crushed, 5 grams per serving, the Japanese way to serve 3 times.Yellow peas Commonly known as Chinese cabbage, winter people to eat one of the main vegetable. Detoxification with the exception of heat, Tom Lee gastrointestinal effect. Modern view that there are anti-cancer effect of Chinese cabbage, Chinese cabbage This is because contains trace elements copper, can inhibit the body's absorption of carcinogenic nitrosamines and synthesis. Therefore, cancer patientsquite appropriate. Cauliflower Modern scientists have discovered, cauliflower and other vegetables in the cabbage, which contains a variety of indole derivatives, these substances can increase the body of carcinogens benzene and methyl anthraquinone Benzopyrene resistance, which has anti-cancer effects. Therefore, cancer patients should eat it. In addition, cancer patients may also wish to eat escargot, loach, Coelomactra antiquata, Yangmei, onions, horse teeth vegetables, onions, water spinach, Malange first, chrysanthemum brain, winter bamboo shoots, Chinese wolfberry head, Sargassum, bird's nest, Adenophora, American ginseng , Astragalus, duck, carp, silver fish, mackerel, blood, kidney, sponge gourd, snake melon, Chinese cabbage, amaranth, Chrysanthemum, celery, wild rice stem, olives, loquat, orange cake and grapes.
Spicy foods can fight cancer！
Spicy food is a favorite of many people, but also cancer cell's "enemies." The University of Nottingham academics through research opened a spicy foods to kill cancer cells secret. Researchers in human lung cancer cells and pancreatic cancer medium was tested and found, Mexico pepper capsaicin to attack inside the mitochondria (the energy source of cells) caused the death of cancer cells. Capsaicin molecule belongs to the family, as well as aldehyde Fangcao adhesion to the protein inside the mitochondria of cancer cells, the trigger apoptosis (cell by environmental stimulation in gene regulation under the phenomena generated by natural death) also will not hurt the surrounding healthy cells. Principal investigator Dr. Tracy Timothy description: "When these compounds the core of the tumor cells to launch attacks, we believe that all cancers have been found the Achilles heel of the fundamental. Biochemical structure of mitochondria of cancer cells differ from healthy cells. This is Health of cancer cells and to the natural weaknesses
Drink green tea will be fasting renal injury！
The role of green tea's health has been well-known, and along with the international role of green tea health care more and more in depth study, green tea seems to have become a lot of people choosing health care choice. Many people throughout the day is a teacup chain, green tea nothing, am I get up there were some people who drink a cup of green tea as a habit. But the national Tea Quality Supervision and Testing Center, an associate research fellow-remind: fasting drink green tea, on the adverse gastrointestinal health. Some people say that green tea is not the result of fermentation of tea, fresh leaves retained more of a natural material, which the tea polyphenols, caffeine could retain more than 85% of the fresh leaves, green tea ingredients, for anti-aging, anti-cancer, cancer, sterilization, anti-inflammatory effects, such as indeed, is unmatched by other tea. However, it is these natural ingredients, if the fasting state of drinking, will have a negative impact on the human body. Fasting, the tea will be part of active substance of the protein binding with the stomach, stimulate the formation of the stomach, easy to伤胃. In addition to gastrointestinal would stimulate, fasting tea will make digestive juice was watered down, affecting digestion. At the same time, when fasting, tea, some material easily be too much to absorb, such as caffeine and fluoride. Caffeine cause some people appear palpitation, dizziness, hands and feet can not afford, trance-like symptoms such as mind, medically known as the "tea drunk" phenomenon. Once the tea drunk phenomenon occurs, you can eat a piece of candy or drink a cup of sugar, these symptoms can be eased and disappeared. If fluoride accumulation in the body too much, it may lead to intestinal diseases, the impact of renal function. Suffering from stomach, duodenal ulcer in the elderly, fasting should not drink more green tea, the tannin in tea can stimulate the gastrointestinal mucosa, causing illness, but also may cause indigestion or constipation.
Brain tumor will to infect ?
Comparing the incidence of brain tumors in general, and some families have several generations of the occurrence of brain tumors. I have encountered Grandpa. Granddaughter suffering from the same type of brain tumor, the treatment of patients hospitalized at the same time. So many people ask me this question, "Will brain infection?" Can say with certainty that brain tumors and cancer is not contagious. The concept of infection, simply put, is a disease from a person through some sort of way to spread to another person। Transmission must have three conditions: the source of infection, transmission and the susceptible population, these are three indispensable. The clinical data demonstrated that brain tumor patients is not in itself the source of infection. Experts done this kind of experiment, from cancer patients to remove the cancerous tissues directly planted in another person, who did not survive growth. Although certain types of cancer that occurs with certain viruses, such as: cervical cancer, nasopharyngeal cancer, leukemia, but still could not confirm HIV infection in some way will certainly have some kind of cancer is.
People suffering from the same family of brain tumor, brain tumor can only show that there are family genes, especially astrocytoma (glioma) of the same family, a higher rate of incidence। But note that there is not a family in patients with brain tumors, the next generation or the generation after next on some people will be suffering from brain tumor. Because the formation of brain tumors for many reasons, the current view that the occurrence of induced brain tumor factors: genetic factors, physical factors, chemical factors and tumorigenic virus and so on.
The world's brain is not as infectious diseases, treated patients did not take as infectious diseases such as quarantine measures. Neurosurgery or oncology health care workers, and their incidence of tumors than the general population is not high. Animal experiments also proved that the cancer of animals and long-term health of animals together, through repeated observation and inspection, had not been seen in any transmission phenomenon. Should remind you that we have family and friends had brain tumor, do not worry about infection, but should be more with them, and resolve the mental pressure of patients, to encourage patients to active treatment. Dedication to patients a warm and caring, so that patients can help improve the early resumption.
People suffering from the same family of brain tumor, brain tumor can only show that there are family genes, especially astrocytoma (glioma) of the same family, a higher rate of incidence। But note that there is not a family in patients with brain tumors, the next generation or the generation after next on some people will be suffering from brain tumor. Because the formation of brain tumors for many reasons, the current view that the occurrence of induced brain tumor factors: genetic factors, physical factors, chemical factors and tumorigenic virus and so on.
The world's brain is not as infectious diseases, treated patients did not take as infectious diseases such as quarantine measures. Neurosurgery or oncology health care workers, and their incidence of tumors than the general population is not high. Animal experiments also proved that the cancer of animals and long-term health of animals together, through repeated observation and inspection, had not been seen in any transmission phenomenon. Should remind you that we have family and friends had brain tumor, do not worry about infection, but should be more with them, and resolve the mental pressure of patients, to encourage patients to active treatment. Dedication to patients a warm and caring, so that patients can help improve the early resumption.
Best Jiannao campaign - skipping
Do not think that skipping is a leg and foot exercise and has nothing to do with the brain. In fact, research shows that: Jiannao skipping is the best sport! Skipping when in order to lower limb after bouncing and action-oriented leg, arm swing at the same time, while the waist with the upper and lower extremities activities twist, abdominal muscle contraction in order to help put the legs. At the same time, skipping when breathing deepened, thoracodorsal, the Ministry of all the diaphragm and respiratory muscles are related to participate in the activities. Therefore, rope skipping, the brain in a highly excited state, often for such training, can increase the vitality of nerve cells and is conducive to improve the thinking ability. Learn from Chinese medicine acupuncture meridians, the skipping of the body meridians have a stimulating effect। Skipping when绳头hand, constant rotation will be able to stimulate acupuncture points the palm of your hand with the fingers, hands and thus clear the meridians, so that the hands, upper limb Department of the six meridians blood flow Chang lost in the brain. In addition the body meridians beginning and ending at 6 feet, rope skipping can promote limbs six meridians of the blood circulation. Therefore, the skipping can pass by the active, so as to achieve Xingnaojing, Jiannao role.
In her spare time to find a little place where you jump rope skipping, this is truly a good sport and physical Jiannao.
In her spare time to find a little place where you jump rope skipping, this is truly a good sport and physical Jiannao.
Children of the diagnosis and treatment of hydrocephalus
Children with hydrocephalus of inspection and diagnosis Inspection of the suspicious features of the early patients, measuring the size of the skull, including the circumference, diameter and inter-ear diameter. Normal neonatal head circumference 33 ~ 35cm. Before the skull in 9 to 18 months between the closure, after fontanelle closed six weeks after birth, the data for reference. To further confirm the diagnosis, understanding the existence of hydrocephalus, as well as the nature and extent of inspection can be carried out as follows: 1. Skull X-ray; 2. Cranial CT scanning; if necessary, magnetic resonance imaging can be used for the head (MRI). More than 20 years ago, the head ultrasound and angiography ventricle is extremely popular; now been replaced by CT and MRI. Some important parameters should be obtained: the size of head circumference, brain cortex thickness, Intraventricular pressure (normal infant water for 50 ~ 60mm), lumbar puncture manometry, cerebrospinal fluid dynamics inspection . Typically, intraventricular expansion is hydrocephalus. If the fourth ventricle of normal size, only supratentorial ventricles symmetry expansion, for obstructive hydrocephalus diagnostic gold standard. If the fourth ventricle, third ventricle, lateral ventricles are expanded, consideration should be given to traffic hydrocephalus.
The treatment of children with hydrocephalus, is divided into non-surgical treatment and surgery. Non-surgical treatment for drug therapy, such as mannitol, intravenous quickly to the entry; furosemide, improve water exclusion from the urine volume; acetazolamide to inhibit the emergence of cerebrospinal fluid. Non-surgical treatment for palliative care, are generally used for mild hydrocephalus. If the result is poor, they are advised to take early surgery. The essence of surgery is excluded from the re-establishment of cerebrospinal fluid pathways. Theoretically points: cerebrospinal fluid shunt surgery; cerebrospinal fluid fistula by history, the existence of multiple bypass surgery procedure, all requiring shunt placement in vivo, such as ventriculoperitoneal shunt surgery, is about to cerebrospinal fluid through the ventricular system, the inflow to be absorbed into the abdominal cavity; addition In addition, transverse sinus ventriculoperitoneal shunt, ventricular atrial shunt, ventriculoperitoneal shunt on. Because of severe damage, the current inherited retained surgical procedures to ventriculoperitoneal shunt surgery. Cerebrospinal fluid ostomy surgery, refers to the ventricular system and the brain pool system of communication, so that cerebrospinal fluid from the ventricle into the brain pool system has been absorbed, such as the commonly used PEG endplate, in the third ventricle endplate fistulation Department will introduce a saddle cerebrospinal fluid on cisternography system. At present, the use of intraventricular endoscopic technology, ostomy surgery, has become a fashion, such as intraventricular endoscopic third ventricle at the end of surgery, such as leak-made, which greatly raised the level of minimally invasive surgery.
The treatment of children with hydrocephalus, is divided into non-surgical treatment and surgery. Non-surgical treatment for drug therapy, such as mannitol, intravenous quickly to the entry; furosemide, improve water exclusion from the urine volume; acetazolamide to inhibit the emergence of cerebrospinal fluid. Non-surgical treatment for palliative care, are generally used for mild hydrocephalus. If the result is poor, they are advised to take early surgery. The essence of surgery is excluded from the re-establishment of cerebrospinal fluid pathways. Theoretically points: cerebrospinal fluid shunt surgery; cerebrospinal fluid fistula by history, the existence of multiple bypass surgery procedure, all requiring shunt placement in vivo, such as ventriculoperitoneal shunt surgery, is about to cerebrospinal fluid through the ventricular system, the inflow to be absorbed into the abdominal cavity; addition In addition, transverse sinus ventriculoperitoneal shunt, ventricular atrial shunt, ventriculoperitoneal shunt on. Because of severe damage, the current inherited retained surgical procedures to ventriculoperitoneal shunt surgery. Cerebrospinal fluid ostomy surgery, refers to the ventricular system and the brain pool system of communication, so that cerebrospinal fluid from the ventricle into the brain pool system has been absorbed, such as the commonly used PEG endplate, in the third ventricle endplate fistulation Department will introduce a saddle cerebrospinal fluid on cisternography system. At present, the use of intraventricular endoscopic technology, ostomy surgery, has become a fashion, such as intraventricular endoscopic third ventricle at the end of surgery, such as leak-made, which greatly raised the level of minimally invasive surgery.
Children with hydrocephalus: the causes and diagnosis
The causes of children with hydrocephalus and crimes against
Hydrocephalus on the pathology and imaging, means the brain is full of single or multiple cerebrospinal fluid expansion of the ventricles, काउसिंग space thinning to reduce the cerebral cortex, the brain function of growth restriction। Hydrocephalus diverse reasons, such as intraventricular choroid plexus of normal production and secretion of cerebrospinal fluid, and blocked the flow of cerebrospinal fluid and become obstructive hydrocephalus; such as the normal flow of cerebrospinal fluid, and subarachnoid adhesions, occlusion, with the result that can not be arachnoid granulations the cerebrospinal fluid into the large intracranial venous system - sagittal sinus, and then back to the absorption of cerebrospinal fluid caused by obstacles to the formation of the so-called traffic hydrocephalus; so brain tissue due to ischemia or hemorrhage, appeared to soften in the recovery of the pathological changes shrinkage of brain tissue, resulting passive ventricle expansion, saying compensatory hydrocephalus।
More than can be seen in children, but especially in obstructive hydrocephalus most common. Multi-path in the cerebrospinal fluid circulation, the emergence of congenital deformity obstruction, or after the nature of inflammation, hemorrhage adhesion obstruction, or obstruction of tumor formation. Clinical epidemiological investigation found that in 5 years of age infants, the midbrain dysplasia or divide caused by the formation of hydrocephalus, the most common. These children, because no accurate self-report symptoms, together with the parents of neglect, often Imaging it has been more severe hydrocephalus, and few have been discovered in a timely diagnosis. As the national economy in recent years, large industrialized development, adverse environmental factors constitute the main reason for children with hydrocephalus, such as the gestation period of pregnant women and infants direct contact with chemicals, radioactive elements, the abuse of antibiotics, as well as pregnant women to use abortion drug to fetal medicine, are caused by newborns, infants, toddlers, the incidence of hydrocephalus increased year by year.
Infants with congenital hydrocephalus more than a few weeks after birth signs emerged, showing more of the same age as the head children increases, parents will find a little attention; also have children with birth abnormalities of the big head on. Generated as a result of hydrocephalus and to exclude the loss of balance, hydrocephalus increasing oppression of brain tissue, hydrocephalus oppression by the brain tissue, may turn out to oppression skull. As a result of fetal, neonatal, infant, or child care than the bone of the skull soft suture is not closely connected, or fontanelle has not yet closed, may result in compensatory increase skull to alleviate the intracranial pressure, alleviate symptoms in children. Adult hydrocephalus, usually head size is fixed and can not be compensatory increased intracranial pressure, it showed headache, nausea, vomiting, vision loss, and even the occurrence of epilepsy. It can be said that children with hydrocephalus and more signs show the appearance of change; adult hydrocephalus, more performance for the symptoms of intracranial hypertension. Children with severe hydrocephalus, large head, showing the characteristic shape, that is, its prominent forehead forward the development of eyes downward pressure on the ball, caused by the uppersclera eyes, "Levy was the sunset." Before the skull to expand and increase tension, other fontanelle can also be expanded, skull suture separation, scalp vein. Hydrocephalus occurs in children with head to the extreme limit the expansion of compensatory, but also the performance of the performance of intracranial hypertension: severe headache, frequent vomiting; and even epilepsy, quadriplegia, coma; long-term past, associated with compression of optic nerve atrophy can be induced blindness. Nystagmus, seizures also common. Also often accompanied by mental changes and mental disorders. A very small number of children with hydrocephalus, in the development of its own after a certain period of time to stop, the skull is no longer continue to increase, not in the increased intracranial pressure, known as the "static hydrocephalus." Early detection, timely diagnosis, appropriate surgery, on children with hydrocephalus is extremely important to save the children is a key factor in the quality of life. This is children with parents, from pregnancy, टी Pu, as well as the subsequent rearing period, in health awareness has put forward higher requirements. Careful observation, consulting physicians, early detection is an important measure of the disease.
Hydrocephalus on the pathology and imaging, means the brain is full of single or multiple cerebrospinal fluid expansion of the ventricles, काउसिंग space thinning to reduce the cerebral cortex, the brain function of growth restriction। Hydrocephalus diverse reasons, such as intraventricular choroid plexus of normal production and secretion of cerebrospinal fluid, and blocked the flow of cerebrospinal fluid and become obstructive hydrocephalus; such as the normal flow of cerebrospinal fluid, and subarachnoid adhesions, occlusion, with the result that can not be arachnoid granulations the cerebrospinal fluid into the large intracranial venous system - sagittal sinus, and then back to the absorption of cerebrospinal fluid caused by obstacles to the formation of the so-called traffic hydrocephalus; so brain tissue due to ischemia or hemorrhage, appeared to soften in the recovery of the pathological changes shrinkage of brain tissue, resulting passive ventricle expansion, saying compensatory hydrocephalus।
More than can be seen in children, but especially in obstructive hydrocephalus most common. Multi-path in the cerebrospinal fluid circulation, the emergence of congenital deformity obstruction, or after the nature of inflammation, hemorrhage adhesion obstruction, or obstruction of tumor formation. Clinical epidemiological investigation found that in 5 years of age infants, the midbrain dysplasia or divide caused by the formation of hydrocephalus, the most common. These children, because no accurate self-report symptoms, together with the parents of neglect, often Imaging it has been more severe hydrocephalus, and few have been discovered in a timely diagnosis. As the national economy in recent years, large industrialized development, adverse environmental factors constitute the main reason for children with hydrocephalus, such as the gestation period of pregnant women and infants direct contact with chemicals, radioactive elements, the abuse of antibiotics, as well as pregnant women to use abortion drug to fetal medicine, are caused by newborns, infants, toddlers, the incidence of hydrocephalus increased year by year.
Infants with congenital hydrocephalus more than a few weeks after birth signs emerged, showing more of the same age as the head children increases, parents will find a little attention; also have children with birth abnormalities of the big head on. Generated as a result of hydrocephalus and to exclude the loss of balance, hydrocephalus increasing oppression of brain tissue, hydrocephalus oppression by the brain tissue, may turn out to oppression skull. As a result of fetal, neonatal, infant, or child care than the bone of the skull soft suture is not closely connected, or fontanelle has not yet closed, may result in compensatory increase skull to alleviate the intracranial pressure, alleviate symptoms in children. Adult hydrocephalus, usually head size is fixed and can not be compensatory increased intracranial pressure, it showed headache, nausea, vomiting, vision loss, and even the occurrence of epilepsy. It can be said that children with hydrocephalus and more signs show the appearance of change; adult hydrocephalus, more performance for the symptoms of intracranial hypertension. Children with severe hydrocephalus, large head, showing the characteristic shape, that is, its prominent forehead forward the development of eyes downward pressure on the ball, caused by the uppersclera eyes, "Levy was the sunset." Before the skull to expand and increase tension, other fontanelle can also be expanded, skull suture separation, scalp vein. Hydrocephalus occurs in children with head to the extreme limit the expansion of compensatory, but also the performance of the performance of intracranial hypertension: severe headache, frequent vomiting; and even epilepsy, quadriplegia, coma; long-term past, associated with compression of optic nerve atrophy can be induced blindness. Nystagmus, seizures also common. Also often accompanied by mental changes and mental disorders. A very small number of children with hydrocephalus, in the development of its own after a certain period of time to stop, the skull is no longer continue to increase, not in the increased intracranial pressure, known as the "static hydrocephalus." Early detection, timely diagnosis, appropriate surgery, on children with hydrocephalus is extremely important to save the children is a key factor in the quality of life. This is children with parents, from pregnancy, टी Pu, as well as the subsequent rearing period, in health awareness has put forward higher requirements. Careful observation, consulting physicians, early detection is an important measure of the disease.
Monday, January 12, 2009
Should a TV Doctor Be Surgeon General?
The news that the television doctor and neurosurgeon Sanjay Gupta is being considered for the post of U.S. surgeon general has prompted a mixed reaction on health and science blogs and other sites. Here’s a sampling:
KevinMD.com: The doctor blogger calls it a “bold pick” but asks whether “this a case of style over substance.”
THDblog: The Technology, Health and Development blog says, “Public health needs a rock star.”
Terra Sigillata: Science blogger Abel notes that “literally millions of Americans already trust him for health care information,” adding that “Gupta has also been on-site for several of the most challenging medical emergencies the U.S. has faced in recent years, most significantly the aftermath of Hurricane Katrina in New Orleans.” But fellow blogger Jake at Pure Pedantry says Dr. Gupta has waffled on issues like vaccines and autism under the guise of journalistic fairness — something he can’t do as surgeon general.
Center for Science in the Public Interest: Director Michael Jacobson says: “It has been a long time since we’ve had a surgeon general who had a major national impact, such as Dr. C. Everett Koop, who took on the tobacco industry. Certainly no one could accuse any surgeon general in the last eight years of tackling tough health problems.”
GetBetterHealth.com: Dr. Val says, “I don’t think he has the gravitas or appropriate experience for the role of Surgeon General of the United States.” She cites an unidentified source close to the nomination proceedings who says, “It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.”
Gawker.com: The gossip site points out that Dr. Gupta was voted one of People Magazine’s Sexiest Men Alive in 2003. “Obviously Dr. Quinn, Medicine Woman, is the big loser here,” says Gawker.
According to Dr. Gupta’s bio provided by CNN, he regularly performs surgery at Emory University Hospital and Grady Memorial Hospital, where he serves as associate chief of neurosurgery. Before joining CNN, Gupta was a fellow in neurosurgery at the University of Tennessee’s Semmes-Murphy clinic, and before that, the University of Michigan Medical Center. In 1997, he was chosen as a White House Fellow — one of only 15 fellows appointed.
KevinMD.com: The doctor blogger calls it a “bold pick” but asks whether “this a case of style over substance.”
THDblog: The Technology, Health and Development blog says, “Public health needs a rock star.”
Terra Sigillata: Science blogger Abel notes that “literally millions of Americans already trust him for health care information,” adding that “Gupta has also been on-site for several of the most challenging medical emergencies the U.S. has faced in recent years, most significantly the aftermath of Hurricane Katrina in New Orleans.” But fellow blogger Jake at Pure Pedantry says Dr. Gupta has waffled on issues like vaccines and autism under the guise of journalistic fairness — something he can’t do as surgeon general.
Center for Science in the Public Interest: Director Michael Jacobson says: “It has been a long time since we’ve had a surgeon general who had a major national impact, such as Dr. C. Everett Koop, who took on the tobacco industry. Certainly no one could accuse any surgeon general in the last eight years of tackling tough health problems.”
GetBetterHealth.com: Dr. Val says, “I don’t think he has the gravitas or appropriate experience for the role of Surgeon General of the United States.” She cites an unidentified source close to the nomination proceedings who says, “It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.”
Gawker.com: The gossip site points out that Dr. Gupta was voted one of People Magazine’s Sexiest Men Alive in 2003. “Obviously Dr. Quinn, Medicine Woman, is the big loser here,” says Gawker.
According to Dr. Gupta’s bio provided by CNN, he regularly performs surgery at Emory University Hospital and Grady Memorial Hospital, where he serves as associate chief of neurosurgery. Before joining CNN, Gupta was a fellow in neurosurgery at the University of Tennessee’s Semmes-Murphy clinic, and before that, the University of Michigan Medical Center. In 1997, he was chosen as a White House Fellow — one of only 15 fellows appointed.
Doctors’ Favorite Medical Web Sites
Health writers often suggest Web sites and strategies for finding the best doctor. But what do doctors think about all this advice?
In today’s “Doctor and Patient” column, Dr. Pauline W. Chen talks to other doctors about the best way to find a doctor you trust, and the best places to research health information.
Many of the doctors I spoke to or exchanged e-mail with made commonsense suggestions that were not unexpected. They urged patients to find out which doctors their closest friends really like, to ask a prospective doctor questions like how much experience he or she has with a specific condition or operation, and to make sure that as a patient you feel part of a shared decision-making process and comfortable saying how you feel, or that you don’t understand or that you respectfully disagree.
But many of the physicians also shared links to valuable Web sites, several of which I was unfamiliar with. All the sites are free to the public and accessible to anyone with an Internet connection. When I looked at these sites while writing this column, I became really excited as a patient about the amount of information available.
For a complete lists of the various Web sites suggested by doctors, click here to read Dr. Chen’s full column, “In Search of a Good Doctor.” And then join the discussion below.
In today’s “Doctor and Patient” column, Dr. Pauline W. Chen talks to other doctors about the best way to find a doctor you trust, and the best places to research health information.
Many of the doctors I spoke to or exchanged e-mail with made commonsense suggestions that were not unexpected. They urged patients to find out which doctors their closest friends really like, to ask a prospective doctor questions like how much experience he or she has with a specific condition or operation, and to make sure that as a patient you feel part of a shared decision-making process and comfortable saying how you feel, or that you don’t understand or that you respectfully disagree.
But many of the physicians also shared links to valuable Web sites, several of which I was unfamiliar with. All the sites are free to the public and accessible to anyone with an Internet connection. When I looked at these sites while writing this column, I became really excited as a patient about the amount of information available.
For a complete lists of the various Web sites suggested by doctors, click here to read Dr. Chen’s full column, “In Search of a Good Doctor.” And then join the discussion below.
When it comes to breasts – three’s a crowd?
While many men and women have strong opinions about the size of breasts, most would agree the number of their breasts— two— is fine. Unfortunately, for those with polymastia, that’s not always the case. Sometimes referred to as accessory breasts, polymastia is the presence of supernumerary (extra) breasts on the human body. The extra breast tissue can appear in many forms, everything from a third nipple (the most common condition, referred to as polythelia) to a fully-formed — and fully-functional breast — in some unusual location. It can also present itself as a breast with a nipple but no areola, a breast with an areola but no nipple, or just a small lump of breast tissue with neither nipple nor areola. According to a recent article in The American Surgeon, it’s not as rare as you might think. The condition occurs in up to 6 percent of the general population, although it is commonly misdiagnosed, usually as lipoma, a benign tumor composed of fat cells. In a few cases, supernumerary breasts can be diagnosed with breast cancer. Women report a much higher rate of polymastia and polythelia than men, but there have been several reported cases of men with accessory breast tissue. Extra nipples are more common.
Declining Car Risk for Older Drivers
Drivers over 70 are keeping their licenses longer and driving more than earlier generations, a trend that has led to dire predictions about car accident risks for aging baby boomers.
But new research from the Insurance Institute for Highway Safety should ease those fears. It shows that fatal car accidents involving older drivers have actually declined markedly in the past decade.
“It’s not what people had expected to see,” said Anne T. McCartt, senior vice president for research at the insurance institute. “There were some studies, including our own research, that had predicted older driver crashes would become a bigger and bigger problem.”
Compared with middle-aged drivers (age 35 to 54), drivers 75 or older have far higher death rates per mile traveled. (So do drivers under 20.) Death rates jump markedly after age 80. But that does not necessarily mean that older people are worse drivers or that they are far more likely to crash.
Car fatalities involving young people are almost entirely explained by the fact that they have more accidents than experienced drivers. But while crash rates are slightly higher for older people, most of their increased risk for a fatal car accident is explained by the fact that they tend to be more frail. Older drivers are more likely to suffer a severe injury, particularly to the chest, or other medical complications.
But fatalities per capita among older people have decreased 35 percent since 1975 and are now at their lowest level. And while fatal crashes are declining over all, the rates for older driving deaths are falling the fastest. Between 1997 and 2006, the annual decline in fatal crash rates was 0.18 fewer fatal crashes per 100,000 middle-aged licensed drivers. By comparison, the annual decline for drivers age 70 to 74 was 0.55 fatal crashes per 100,000 licensed drivers, and for those over 80 it was 1.33.
Older drivers are also less likely to cause drunken driving accidents. In 2007, just 6 percent of drivers 70 and older who died in crashes had blood-alcohol levels above the legal limit. The figure for fatally injured drivers age 16 to 59 was 41 percent.
The insurance institute is conducting further research to determine why the risks appear to be going down for older drivers. It may be that today’s older drivers are simply in better physical and mental shape than their counterparts a decade ago, so they are not only less likely to make a driving mistake, but also less frail and better able to survive injuries.
It may also be that driving patterns among older adults have changed, leading to more highway driving, which is safer than driving on local roads. Older drivers may be more likely than in the past to wear a seat belt or to drive a safer car.
Research suggests education campaigns have increased awareness about older driving risks.
Researchers from Johns Hopkins recently reported results of the Salisbury Eye Evaluation and Driving Study (Seeds for short), which looked at vision, cognition and health changes among 1,200 licensed drivers age 67 to 87. The study, published in the journal Investigative Ophthalmology & Visual Science, found that after a year 1.5 percent of the drivers had given up driving on their own, and 3.4 percent more had voluntarily restricted their driving because of declining vision.
“We’re intent on doing research to try to figure out why we’re seeing this,” Dr. McCartt said. “It’s certainly a possibility that older drivers compared to 10 or 20 years ago are in better condition in various ways.”
But new research from the Insurance Institute for Highway Safety should ease those fears. It shows that fatal car accidents involving older drivers have actually declined markedly in the past decade.
“It’s not what people had expected to see,” said Anne T. McCartt, senior vice president for research at the insurance institute. “There were some studies, including our own research, that had predicted older driver crashes would become a bigger and bigger problem.”
Compared with middle-aged drivers (age 35 to 54), drivers 75 or older have far higher death rates per mile traveled. (So do drivers under 20.) Death rates jump markedly after age 80. But that does not necessarily mean that older people are worse drivers or that they are far more likely to crash.
Car fatalities involving young people are almost entirely explained by the fact that they have more accidents than experienced drivers. But while crash rates are slightly higher for older people, most of their increased risk for a fatal car accident is explained by the fact that they tend to be more frail. Older drivers are more likely to suffer a severe injury, particularly to the chest, or other medical complications.
But fatalities per capita among older people have decreased 35 percent since 1975 and are now at their lowest level. And while fatal crashes are declining over all, the rates for older driving deaths are falling the fastest. Between 1997 and 2006, the annual decline in fatal crash rates was 0.18 fewer fatal crashes per 100,000 middle-aged licensed drivers. By comparison, the annual decline for drivers age 70 to 74 was 0.55 fatal crashes per 100,000 licensed drivers, and for those over 80 it was 1.33.
Older drivers are also less likely to cause drunken driving accidents. In 2007, just 6 percent of drivers 70 and older who died in crashes had blood-alcohol levels above the legal limit. The figure for fatally injured drivers age 16 to 59 was 41 percent.
The insurance institute is conducting further research to determine why the risks appear to be going down for older drivers. It may be that today’s older drivers are simply in better physical and mental shape than their counterparts a decade ago, so they are not only less likely to make a driving mistake, but also less frail and better able to survive injuries.
It may also be that driving patterns among older adults have changed, leading to more highway driving, which is safer than driving on local roads. Older drivers may be more likely than in the past to wear a seat belt or to drive a safer car.
Research suggests education campaigns have increased awareness about older driving risks.
Researchers from Johns Hopkins recently reported results of the Salisbury Eye Evaluation and Driving Study (Seeds for short), which looked at vision, cognition and health changes among 1,200 licensed drivers age 67 to 87. The study, published in the journal Investigative Ophthalmology & Visual Science, found that after a year 1.5 percent of the drivers had given up driving on their own, and 3.4 percent more had voluntarily restricted their driving because of declining vision.
“We’re intent on doing research to try to figure out why we’re seeing this,” Dr. McCartt said. “It’s certainly a possibility that older drivers compared to 10 or 20 years ago are in better condition in various ways.”
A Pediatrician’s View of Rude Children
Do good manners make a difference to a child’s health? Writing in Tuesday’s Science Times, pediatrician Dr. Perri Klass believes they do.
The conversations that every pediatrician has, over and over, about “limit setting” and “consistently praising good behavior” are conversations about manners. And when you are in the exam room with a child who seems to have none, you begin to wonder what is going on at home and at school, and questions of family dysfunction or neurodevelopmental problems begin to cross your mind.
Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child’s manners were a perfectly appropriate topic to raise at a pediatric visit.
“It has a huge impact on people’s lives — why wouldn’t you bring it up?” she said. “Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy’s purse and take things out?”
Dr. Howard suggested that the whole “manners” concept might seem a little out of date — until you recast it as “social skills,” a very hot term these days. Social skills are necessary for school success, she pointed out; they affect how you do on the playground, in the classroom, in the workplace.
To read more about what a child’s manners mean to the pediatrician, read the full article, “Making Room for Miss Manners Is a Parenting Basic.” And then join the discussion below.
What do you think? Should a pediatrician comment on a child’s manners?
The conversations that every pediatrician has, over and over, about “limit setting” and “consistently praising good behavior” are conversations about manners. And when you are in the exam room with a child who seems to have none, you begin to wonder what is going on at home and at school, and questions of family dysfunction or neurodevelopmental problems begin to cross your mind.
Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child’s manners were a perfectly appropriate topic to raise at a pediatric visit.
“It has a huge impact on people’s lives — why wouldn’t you bring it up?” she said. “Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy’s purse and take things out?”
Dr. Howard suggested that the whole “manners” concept might seem a little out of date — until you recast it as “social skills,” a very hot term these days. Social skills are necessary for school success, she pointed out; they affect how you do on the playground, in the classroom, in the workplace.
To read more about what a child’s manners mean to the pediatrician, read the full article, “Making Room for Miss Manners Is a Parenting Basic.” And then join the discussion below.
What do you think? Should a pediatrician comment on a child’s manners?
Will Drivers Ever Give Up Cellphones?
Recently while driving from New York to Pennsylvania, I suddenly realized I had taken the wrong exit for the New Jersey Turnpike.
For me it was a startling mistake that had me going north instead of south, and added at least a half hour to my commute. It had happened while I was talking to a friend on the phone. Even though I had been using a headset and had both hands on the wheel, I still made an important driving error.
Beyond my driving mistake, there are plenty of data to show that cell phone conversations and driving don’t mix. My Well column in Tuesday’s Science Times explores the science of cell phones and driving, and helps explain why even hands-free cellphone use takes a toll on your driving ability. Now the National Safety Council has called for a total ban on cellphone use while driving.
Read the full story, “A Problem of the Brain, Not the Hands: Group Urges Phone Ban for Drivers,” and then join the discussion below. Are you willing to give up your hands-free cell phone calls during your driving time?
For me it was a startling mistake that had me going north instead of south, and added at least a half hour to my commute. It had happened while I was talking to a friend on the phone. Even though I had been using a headset and had both hands on the wheel, I still made an important driving error.
Beyond my driving mistake, there are plenty of data to show that cell phone conversations and driving don’t mix. My Well column in Tuesday’s Science Times explores the science of cell phones and driving, and helps explain why even hands-free cellphone use takes a toll on your driving ability. Now the National Safety Council has called for a total ban on cellphone use while driving.
Read the full story, “A Problem of the Brain, Not the Hands: Group Urges Phone Ban for Drivers,” and then join the discussion below. Are you willing to give up your hands-free cell phone calls during your driving time?
Making Room for Miss Manners Is a Parenting Basic
For years, I took care of a very rude child. When he was 3, I called him rambunctious — and I talked to his mother about “setting limits.” At 4, I called him “demanding.” At 5, he was still screaming at his mother if she didn’t do what he wanted, he still swatted me whenever I tried to examine him, and his mother asked me worriedly if I thought he was ready for kindergarten.
I could go on (he didn’t have an easy time in school), but it would sound like a Victorian tale: The Rude Boy. I never used the word “rude” or even “manners” when I spoke to his mother. I don’t describe my patients as rude or polite in the medical record. But I do pass judgment, and so does every pediatrician I know.
It’s always popular — and easy — to bewail the deterioration of manners; there is an often quoted (and often disputed) story about Socrates’ complaining that the young Athenians have “bad manners, contempt for authority.” Sure, certain social rubrics have broken down or blurred, and sure, electronic communication seems to have given adults as well as children new ways to be rude. But the age-old parental job remains.
And that job is to start with a being who has no thought for the feelings of others, no code of behavior beyond its own needs and comforts — and, guided by love and duty, to do your best to transform that being into what your grandmother (or Socrates) might call a mensch. To use a term that has fallen out of favor, your assignment is to “civilize” the object of your affections.
My favorite child-rearing book is “Miss Manners’ Guide to Rearing Perfect Children,” by Judith Martin, who takes the view that manners are at the heart of the whole parental enterprise. I called her to ask why.
“Every infant is born adorable but selfish and the center of the universe,” she replied. It’s a parent’s job to teach that “there are other people, and other people have feelings.”
The conversations that every pediatrician has, over and over, about “limit setting” and “consistently praising good behavior” are conversations about manners. And when you are in the exam room with a child who seems to have none, you begin to wonder what is going on at home and at school, and questions of family dysfunction or neurodevelopmental problems begin to cross your mind.
Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child’s manners were a perfectly appropriate topic to raise at a pediatric visit.
“It has a huge impact on people’s lives — why wouldn’t you bring it up?” she said. “Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy’s purse and take things out?”
Dr. Howard suggested that the whole “manners” concept might seem a little out of date — until you recast it as “social skills,” a very hot term these days. Social skills are necessary for school success, she pointed out; they affect how you do on the playground, in the classroom, in the workplace.
We also think of social skills as a profound set of challenges that complicate the lives of children — and adults — on what is now called the autism spectrum. Children with autism, whether mild or severe, have great difficulty learning social codes, deciphering subtle body language or tone of voice, and catching on to the rules of the game.
Therapy for these children can include systematic training in social skills, sometimes using scripts for common human interactions. And one lesson, Dr. Howard said, “is that you can teach this stuff, and we maybe aren’t teaching it as well as we should be to children who are developing normally.”
And of course, one of the long-term consequences of being a rude child is being a rude adult — even a rude doctor. There are bullies on the playground and bullies in the workplace; it can be quite disconcerting to encounter a mature adult with 20 or so years of education under his belt who still sees the world only in terms of his own wants, needs and emotions: I want that so give it to me; I am angry so I need to hit; I am wounded so I must howl.
I like Miss Manners’ approach because it lets a parent respect a child’s intellectual and emotional privacy: I’m not telling you to like your teacher; I’m telling you to treat her with courtesy. I’m not telling you that you can’t hate Tommy; I’m telling you that you can’t hit Tommy. Your feelings are your own private business; your behavior is public.
But that first big counterintuitive lesson — that there are other people out there whose feelings must be considered — affects a child’s most basic moral development. For a child, as for an adult, manners represent a strategy for getting along in life, but also a successful intellectual engagement with the business of being human.
I did not enjoy visits with my rude patient. Despite his generally good health and his normal developmental milestones, I couldn’t help feeling that the adult world had failed to guide and protect him. He was loud and demanding and insistent, but one of his basic needs had not been met: no one had taught him manners.
As a pediatrician, I worry about the trajectories of children’s growth and development: measuring a baby’s head size, weighing a toddler, asking about the language skills of a preschooler. Manners are another side of the journey every child makes from helplessness to autonomy. And a child who learns to manage a little courtesy, even under the pressure of a visit to the doctor, is a child who is operating well in the world, a child with a positive prognosis.
I could go on (he didn’t have an easy time in school), but it would sound like a Victorian tale: The Rude Boy. I never used the word “rude” or even “manners” when I spoke to his mother. I don’t describe my patients as rude or polite in the medical record. But I do pass judgment, and so does every pediatrician I know.
It’s always popular — and easy — to bewail the deterioration of manners; there is an often quoted (and often disputed) story about Socrates’ complaining that the young Athenians have “bad manners, contempt for authority.” Sure, certain social rubrics have broken down or blurred, and sure, electronic communication seems to have given adults as well as children new ways to be rude. But the age-old parental job remains.
And that job is to start with a being who has no thought for the feelings of others, no code of behavior beyond its own needs and comforts — and, guided by love and duty, to do your best to transform that being into what your grandmother (or Socrates) might call a mensch. To use a term that has fallen out of favor, your assignment is to “civilize” the object of your affections.
My favorite child-rearing book is “Miss Manners’ Guide to Rearing Perfect Children,” by Judith Martin, who takes the view that manners are at the heart of the whole parental enterprise. I called her to ask why.
“Every infant is born adorable but selfish and the center of the universe,” she replied. It’s a parent’s job to teach that “there are other people, and other people have feelings.”
The conversations that every pediatrician has, over and over, about “limit setting” and “consistently praising good behavior” are conversations about manners. And when you are in the exam room with a child who seems to have none, you begin to wonder what is going on at home and at school, and questions of family dysfunction or neurodevelopmental problems begin to cross your mind.
Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child’s manners were a perfectly appropriate topic to raise at a pediatric visit.
“It has a huge impact on people’s lives — why wouldn’t you bring it up?” she said. “Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy’s purse and take things out?”
Dr. Howard suggested that the whole “manners” concept might seem a little out of date — until you recast it as “social skills,” a very hot term these days. Social skills are necessary for school success, she pointed out; they affect how you do on the playground, in the classroom, in the workplace.
We also think of social skills as a profound set of challenges that complicate the lives of children — and adults — on what is now called the autism spectrum. Children with autism, whether mild or severe, have great difficulty learning social codes, deciphering subtle body language or tone of voice, and catching on to the rules of the game.
Therapy for these children can include systematic training in social skills, sometimes using scripts for common human interactions. And one lesson, Dr. Howard said, “is that you can teach this stuff, and we maybe aren’t teaching it as well as we should be to children who are developing normally.”
And of course, one of the long-term consequences of being a rude child is being a rude adult — even a rude doctor. There are bullies on the playground and bullies in the workplace; it can be quite disconcerting to encounter a mature adult with 20 or so years of education under his belt who still sees the world only in terms of his own wants, needs and emotions: I want that so give it to me; I am angry so I need to hit; I am wounded so I must howl.
I like Miss Manners’ approach because it lets a parent respect a child’s intellectual and emotional privacy: I’m not telling you to like your teacher; I’m telling you to treat her with courtesy. I’m not telling you that you can’t hate Tommy; I’m telling you that you can’t hit Tommy. Your feelings are your own private business; your behavior is public.
But that first big counterintuitive lesson — that there are other people out there whose feelings must be considered — affects a child’s most basic moral development. For a child, as for an adult, manners represent a strategy for getting along in life, but also a successful intellectual engagement with the business of being human.
I did not enjoy visits with my rude patient. Despite his generally good health and his normal developmental milestones, I couldn’t help feeling that the adult world had failed to guide and protect him. He was loud and demanding and insistent, but one of his basic needs had not been met: no one had taught him manners.
As a pediatrician, I worry about the trajectories of children’s growth and development: measuring a baby’s head size, weighing a toddler, asking about the language skills of a preschooler. Manners are another side of the journey every child makes from helplessness to autonomy. And a child who learns to manage a little courtesy, even under the pressure of a visit to the doctor, is a child who is operating well in the world, a child with a positive prognosis.
The Wet Way to Lose Weight
Ever hear that water can help you lose a few extra pounds?
It can—if you eat foods that contain a lot of water, like fruits and veggies. In a University of Tokyo study, women who ate high-water-content foods had lower body mass indexes and smaller waistlines. Researchers speculate that the water in these foods may fill you up so you eat less. Make the strategy work for you by adding more of these in-season fruits and veggies—each is at least 90% water—to your meals.
It can—if you eat foods that contain a lot of water, like fruits and veggies. In a University of Tokyo study, women who ate high-water-content foods had lower body mass indexes and smaller waistlines. Researchers speculate that the water in these foods may fill you up so you eat less. Make the strategy work for you by adding more of these in-season fruits and veggies—each is at least 90% water—to your meals.
GP in hours triage
NHS Direct has developed a service that improves patient access to same day appointments in Cheshire.
This assists GPs in managing their same day appointment system and home visiting service, both of which place pressure on their clinical time.
NHS Direct, together with the staff from the primary care centre, work efficiently to ensure that referrals to the GPs for same day appointments and home visits are from patients who have a true medical need.
Where patients can safely be treated through self care, NHS Direct nurses work with them to ensure they are supported to look after themselves in their own home.
Through this process, those patients who truly need to the see their GP can access a same day appointment and receive appropriate treatment.
Feedback from both patients and professionals has been positive since the start of the scheme. Additionally, by improving access to this primary care centre over time, there will also be a reduction in emergency admissions. This demonstrates that NHS Direct can successfully contribute within this area.
This assists GPs in managing their same day appointment system and home visiting service, both of which place pressure on their clinical time.
NHS Direct, together with the staff from the primary care centre, work efficiently to ensure that referrals to the GPs for same day appointments and home visits are from patients who have a true medical need.
Where patients can safely be treated through self care, NHS Direct nurses work with them to ensure they are supported to look after themselves in their own home.
Through this process, those patients who truly need to the see their GP can access a same day appointment and receive appropriate treatment.
Feedback from both patients and professionals has been positive since the start of the scheme. Additionally, by improving access to this primary care centre over time, there will also be a reduction in emergency admissions. This demonstrates that NHS Direct can successfully contribute within this area.
GP out of hours triage
Primary Care Trusts (PCTs) are responsible for making sure all patients can access out of hours care.
Some PCTs may provide this healthcare themselves, while others commission other organisations to provide out of hours services on their behalf. This creates slightly different services across the country.
NHS Direct provides some out of hours services, and completes the call answering and clinical assessment for patients who use the service.
This provides callers with prompt access to healthcare and assessments, and refers patients to a range of appropriate partner organisations depending on their clinical need.
Where patients are referred for face to face care, their call details are passed electronically to our partner organisation who will arrange the next stage of clinical care.
All elements of our service comply with the national standards for out of hours care. This ensures that patients accessing their out of hours GP service are answered and assessed effectively.
Meeting these standards makes NHS Direct a safe and reliable provider of out of hours care. Additionally NHS Direct can extend this standard of care to provide Single Point of Access (SPA) schemes. Following the recent Darzi reviews, clinical professionals and commissioners are seeking services that provide one point of contact where information and signposting can be delivered safely and consistently.
NHS Direct has developed significantly in recent years and is equipped and capable to provide this patient focused service.
Some PCTs may provide this healthcare themselves, while others commission other organisations to provide out of hours services on their behalf. This creates slightly different services across the country.
NHS Direct provides some out of hours services, and completes the call answering and clinical assessment for patients who use the service.
This provides callers with prompt access to healthcare and assessments, and refers patients to a range of appropriate partner organisations depending on their clinical need.
Where patients are referred for face to face care, their call details are passed electronically to our partner organisation who will arrange the next stage of clinical care.
All elements of our service comply with the national standards for out of hours care. This ensures that patients accessing their out of hours GP service are answered and assessed effectively.
Meeting these standards makes NHS Direct a safe and reliable provider of out of hours care. Additionally NHS Direct can extend this standard of care to provide Single Point of Access (SPA) schemes. Following the recent Darzi reviews, clinical professionals and commissioners are seeking services that provide one point of contact where information and signposting can be delivered safely and consistently.
NHS Direct has developed significantly in recent years and is equipped and capable to provide this patient focused service.
Dental Care
Primary Care Trusts (PCTs) have been responsible for commissioning primary dental care services in their local area since April 2007.
Several PCTs have also commissioned NHS Direct to help them provide this service to dental patients. Together, NHS Direct and PCTs provide access and support to dental services, including an out of hours service, and emergency dental service.
There are five NHS Direct centres located around the country providing this service. They combine specialist local knowledge, professional support, and health expertise to provide two levels of dental care services to PCTs.
These services are:
call streaming, and
dental call streaming and nurse assessment.
Call streaming
NHS Direct uses a dedicated telephone number to receive calls for the commissioned dental service. Calls are then assessed by NHS Direct health advisors using special dental streaming guidelines developed by NHS Direct. Using these clinical assessment techniques, patients can be effectively directed to emergency or routine dental care.
Dental call streaming and nurse assessment
In addition to dental call streaming, NHS Direct can provide detailed dental nurse assessment.
Adding this level of assessment provides patients with self care advice, pain relief and support with oral hygiene which reduces the demand on emergency dental services.
Several PCTs have also commissioned NHS Direct to help them provide this service to dental patients. Together, NHS Direct and PCTs provide access and support to dental services, including an out of hours service, and emergency dental service.
There are five NHS Direct centres located around the country providing this service. They combine specialist local knowledge, professional support, and health expertise to provide two levels of dental care services to PCTs.
These services are:
call streaming, and
dental call streaming and nurse assessment.
Call streaming
NHS Direct uses a dedicated telephone number to receive calls for the commissioned dental service. Calls are then assessed by NHS Direct health advisors using special dental streaming guidelines developed by NHS Direct. Using these clinical assessment techniques, patients can be effectively directed to emergency or routine dental care.
Dental call streaming and nurse assessment
In addition to dental call streaming, NHS Direct can provide detailed dental nurse assessment.
Adding this level of assessment provides patients with self care advice, pain relief and support with oral hygiene which reduces the demand on emergency dental services.
Latest news
Welcome to our new वेबसाइट
4 November 2008
Welcome to NHS Direct’s new website! It has been redesigned to reflect our new ‘look’.
The site continues to promote the health services available from NHS Direct and provides detailed corporate information.
NHS Direct and NHS Choices
The other piece of good news is that we’ve joined forces with NHS Choices to provide health information on www.nhs.uk. So you can now access all NHS online health information on one website.
By integrating the online services of NHS Direct and NHS Choices, the NHS will have the most comprehensive online health information service available anywhere.
Our services
NHS Direct will continue to provide the telephone service on 0845 4647, providing health advice and information 24/7.
All NHS Direct website health content will also be available on NHS Choices, including the following popular services:
Self-help guide – provides you with quick and easy ways of checking your symptoms and deciding whether you need to seek health advice.
Health encyclopaedia - provides reliable information on more than 800 conditions and treatments.
Common health questions – allows you to obtain answers to topical and frequently asked health questions.
Online enquiry service – you can submit and receive answers to non-emergency health questions.
The self-help guide and online enquiry service will also continue to be delivered and made available here on the NHS Direct website.
4 November 2008
Welcome to NHS Direct’s new website! It has been redesigned to reflect our new ‘look’.
The site continues to promote the health services available from NHS Direct and provides detailed corporate information.
NHS Direct and NHS Choices
The other piece of good news is that we’ve joined forces with NHS Choices to provide health information on www.nhs.uk. So you can now access all NHS online health information on one website.
By integrating the online services of NHS Direct and NHS Choices, the NHS will have the most comprehensive online health information service available anywhere.
Our services
NHS Direct will continue to provide the telephone service on 0845 4647, providing health advice and information 24/7.
All NHS Direct website health content will also be available on NHS Choices, including the following popular services:
Self-help guide – provides you with quick and easy ways of checking your symptoms and deciding whether you need to seek health advice.
Health encyclopaedia - provides reliable information on more than 800 conditions and treatments.
Common health questions – allows you to obtain answers to topical and frequently asked health questions.
Online enquiry service – you can submit and receive answers to non-emergency health questions.
The self-help guide and online enquiry service will also continue to be delivered and made available here on the NHS Direct website.
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