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   Jul 27

SPINAL CORD INJURY TREATMENT: ASSISTIVE DEVICES TECHNOLOGY

The term “assistive devices technology” refers to the range of tools used by disabled people to interact more effectively with the environment. In the broadest sense, assistive devices include braces, splints, canes, crutches, walkers, wheelchairs, reachers, grab bars, powered hospital beds, communication systems, and even personal computers. Advances in assistive devices technology have a huge impact on the lives of individuals with spinal cord injuries.
One critical area is wheelchair design. For an individual who spends much of the day in a wheelchair, the characteristics of that chair are critically important. The chair must be comfortable, lightweight, sturdy, and maneuverable. For individuals with quadriplegia, a power wheelchair is often necessary. Sophisticated control devices have been developed for individuals with injuries of the upper cervical spinal cord, who may have difficulty controlling a power wheelchair. These devices include modified joystick controls, “sip and puff” controls, tongue switches, head controls, and chin controls.
A particular problem for people with quadriplegia is performing the pressure releases necessary to prevent decubitus ulcers – many find these difficult or even impossible to perform independently. Sophisticated power wheelchairs often can perform automated pressure releases. The entire positioning system of the chair can tilt backward, under the control of a small accessible switch: the seat, backrest, headrest, and leg-rests all tip backward, taking the weight of the body off the sitting surface. This restores blood flow to the skin under the buttocks and prevents skin breakdown.
Another important area of assistive devices technology is the environmental control unit. This device enables a severely physically disabled individual to control electronic devices in the environment, such as lighting, telephones, radios, televisions, air conditioners, and computers. A key element of an environmental control unit is the interface with the user, which may be a simple on/off switch or a complex, sophisticated, personal computer with specialized software. The environmental control unit interfaces with the appliances or devices in the environment by direct wiring or by remote control using radio waves or infrared light.
After some research, Bella, who has incomplete C4 quadriplegia, has acquired a variety of technological innovations that let her manage her life more independently. In her bedroom she has a portable heater with a timer that turns the heat on and off during the night, and a fan with the same features. Her speakerphone picks up automatically on the third ring and hangs up automatically when the other person hangs up. An X-10 internal board on her computer links to addressable electrical boxes that control lights, stereo, TV, VCR, electrical doors, bells and buzzers, and appliances throughout the house.
A final important area of assistive devices technology is augmentative communications, electronic and mechanical devices that enable individuals with speech and language impairments to have spoken or written communication. Augmentative communication has limited applicability for spinal cord injury, because most individuals with paraplegia or quadriplegia have no difficulty speaking and understanding speech. However, some individuals who require long-term use of a mechanical ventilator are unable to speak independently and can benefit from augmentative communications systems.
A related communication technology is the voice-activated computer, which can be useful for people with limited hand function.
Pauline, whose job involves writing long reports, used to rely on hired stenographers to transcribe her dictations after her C4-5 injury. She now uses a voice-activated computer. This evolving technology is becoming less costly and more effective. Pauline also uses a voice-activated switch for the call-light in her nursing-home room. This allows her to communicate easily with nursing staff when she needs assistance. Previously, she had to shout down the hall because she couldn’t turn on the light switch. This has changed everything from her sleeping habits to her personality says Pauline.
*156/156/5*
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   Jul 17

OTHER CAUSES OF LUNG CANCER

Ideas about the cause of lung cancer have been so dominated by recognition of the effect of smoking for the last forty years that it is sometimes easy to forget that there may be other important causal factors and that lung cancer still occurs in non-smokers. The effect of smoking is so strong that it can be quite difficult to unravel other causes, because the presence of a few smokers in any group will so alter the statistics. However, there are undoubtedly other factors at work in the development of lung cancer and many of them can now be judged.
Cooking with a Wok and Rape-seed Oil. Among women who do not smoke lung cancer is commonest in the Chinese. The risk is quite substantial: between two and three times greater than the risk in white women and Japanese women. The effect is observed whether the Chinese live in Shanghai, Hong Kong or Hawaii, and it is limited to women – Chinese non-smoking men have the same chance of lung cancer as a non-smoking white man.
A probable explanation for this observation was unravelled by Gao and colleagues in 1987. It seems that very-nigh-temperature cooking using some kinds of oil in a wok, and presumably inhaling the burnt chemicals given off, may be a factor in lung cancer. The comparison was made between Chinese women who cooked with rape-seed oil and noted irritation of their eyes when they were cooking and those who never had such irritation and used only soya-bean oil. The difference in lung cancer risk was threefold. Studies in the laboratory show that the fumes from rape-seed oil are more capable of altering DNA (being mutagenic) than are those from soya-bean oil, to the story seems to add up.
This effect is considerably greater than the effect of passive smoking but has not attracted so much attention. Fortunately simple precautions can be taken; improved ventilation in East-era kitchens might well be achieved without great coat.
*42\194\4*
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   Jul 05

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: IMPROVING YOUR ACTIVITY LEVEL – HOW TO JUDGE THE INTENSITY OF YOUR EXERCISE

The intensity level of your exercise should be strenuous enough that you feel you are working, but it need not be exhausting. Exercise physiologists describe exercise intensity in terms of percentage of maximal exercise capacity; the recommend an intensity of 50 to 80 percent of your maximal exercise capacity. You can determine the intensity of your exercise by counting your pulse, using a perceived exertion scale, or using the “talk test.”
Many people exercising on own use their own use their pulse rate to deter whether their exercise is intense enough. Ask your doctor to suggest an appropriate target heart rate for during exercise. The harder you exercise, the higher your heart rate or pulse rate climbs.
Your maximal heart rate decreases with age and is affected by cardiovascular disease and some cardiovascular medications. Regular exercise does not influence your maximal heart rate. Some people with very irregular heart  rates cannot use the heart rate method to monitor their exercise intensity.
*313\252\8*
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   Jun 24

CHONDROITIN SULFATE AND OSTEOARTHRITIS

Since osteoarthritis is a disease where cartilage is gradually damaged, a simplistic approach to treating it might involve gnawing the ends of bones, thereby ingesting cartilage or its constituents in the hope of strengthening and nourishing joint tissue. Although it’s hard to believe that such an approach could really work, recent evidence suggests that one of the main ingredients of cartilage – chondroitin sulfate – not only reduces the symptoms of arthritis, but may slow the progression of the disease as well.
Chondroitin sulfate (kon-DROIT-uhn) is widely used in Europe for the treatment of arthritis – so widely, in fact, that in a recent editorial in the prestigious Journal of Rheumatology, chondroitin sulfate and its chemical cousins were described as “some of the most widely used therapies in osteoarthritis”. However, in Europe chondroitin sulfate is primarily used in a form that can be injected straight into arthritic joints. Injectable chondroitin sulfate is not widely available in the United States, but oral chondroitin sulfate has recently become extremely popular as a form of self-treatment for arthritis.
There is now reasonably good evidence that chondroitin, like glucosamine, can significantly reduce the pain experienced with osteoarthritis. Furthermore, recent studies suggest that chondroitin can slow the usual progressive worsening of osteoarthritis. Remember, this same benefit has been proposed for glucosamine too. However, with glucosamine, this exciting possibility is mostly hypothetical. For chondroitin, there is actually some direct evidence to turn to.
*39/306/5*
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   Jun 11

COPING WITH SEIZURES AND EPILEPSY: WHAT DO YOU TELL YOUR CHILD?

Be truthful and be simple. What you should tell your child depends on your child’s age, sophistication, and level of understanding. It is best to be truthful. Otherwise, sooner or later you may get trapped in a web of lies and cover-ups that will only make things worse. If your child does not ask questions, it may be because he’s too frightened or unable to articulate his fear. So don’t take his silence as meaning he has no concerns. Remember that your child probably has no memory of the event that was so frightening to you. His first memory is likely to be of awakening in the ambulance or in the hospital emergency room. He is likely to be frightened because he doesn’t know what happened—and is as fearful now of the unknown as you were.
To a young child, your explanation may be as simple as, “You had a seizure. You couldn’t talk to me for a few minutes, and Mommy and Daddy got very excited and called the doctor, but he says that you’re fine.”
For an older child, you might talk about what a seizure is, about electricity in the brain, and tell him that a seizure is like a short circuit or a little static on the radio. The pre-teenager or teenager needs a more in-depth explanation. Your doctor or a nurse should do this, but you should discuss it with your child as well. He has heard about seizures and may have many misunderstandings. Give your child a chance to ask questions. Get him some of the Epilepsy Foundation’s publications.
Explain that while there is no guarantee that a similar episode will not recur, most children never have another one. He is still your normal boy (or girl) and everything is fine now. Be truthful and reassuring. Let him know that you were scared, too, but that when you understood what had happened you were not afraid.
*168\208\8*
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   Jun 06

DIABETES IN CHILDREN: ROLE OF TEACHING TEACHERS

Children spend nearly half their waking hours at school and school heads and teachers should be told that a pupil has diabetes. Teachers should be given:
1.   Precise details of the pupil’s dietary and treatment needs.
2.   Clear instructions as to what to do should problems arise.
The British Diabetic association provides information folders for parents to give to schools. Most diabetic clinics are also happy to help in this way. It is important that every teacher who comes into contact with your child is taught about diabetes. This may mean speaking to fifteen to twenty teachers – and repeating the discussion each year as your child moves up in the school. Informing the teachers can be organized more efficiently through the principal. It also helps if your child’s classmates know about his or her diabetes, so that they understand why the extra food and injections are needed.
Janine is fifteen years old and has been diabetic for three years. For about a year her diabetes was very difficult to control. At that time she would have severe hypoglycemic episodes of which she had no warning. It was not unusual for her suddenly to fall to the ground unconscious, a very rare problem for people with diabetes. Her best friend at school, Sue, knew nothing about diabetes until she met Janine. Now Sue has learned to recognize an impending hypoglycemic attack and gives her friend glucose immediately.
During the bad year, Sue also calmly dealt with the more severe episodes, awakening Janine from coma by rubbing glucose tablets inside her mouth. She came to think of coping with Janine’s attacks as part of her daily routine and neither she nor their other school-friends were unduly disturbed by them.
Fortunately these bad hypoglycemic attacks stopped and Janine’s diabetes is now better controlled.
*42/102/5*
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   May 20

MOLD KILLERS – TEA TREE TREASURE

Nothing natural works for mold and mildew as well as this spray. I’ve used it successfully on a moldy ceiling from a leaking roof, on a musty bureau, a musty rug, and a moldy shower curtain. Tea tree oil is expensive, but a little goes a very long way. Note that the smell of tea tree oil is very strong, but it will dissipate in a few days.
2 teaspoons tea tree oil 2 cups water
Combine in a spray bottle, shake to blend, and spray on problem areas. Do not rinse. Makes 2 cups
Preparation Time: Under a minute Shelf Life: Indefinite Storage: Leave in the spray bottle
Straight vinegar reportedly kills 82 percent of mold. Pour some white distilled vinegar straight into a spray bottle, spray on the moldy area, and let set without rinsing if you can put up with the smell. It will dissipate in a few hours.
*35/165/1*
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   May 14

WHY YOU CAN’T STAY AWAKE: THE DANGERS OF SLEEP APNEA – OTHER CARDIAC COMPLICATIONS AND OTHER RISKS

Other Cardiac Complications
Apnea has been shown to lead to chronic heart disease or cardiopulmonary failure, causing a buildup of toxins and acids in the blood. Hypoxemia (lowered oxygen), which results in lowered cardiac output, increases the risk of strokes or myocardial ischemia. It may also generate one or more types of irregular heartbeats, some of which can be lethal. Incidence of some heart problems is at its highest during the early-morning hours, a phenomenon which many experts feel is related to breathing disturbances during sleep. OSA is thought to be responsible for as many as two to three thousand cases each year of sudden death during sleep.
Other Risks
Lowered blood output means that less blood, and thus less oxygen, is circulated to the brain. Naturally this has a detrimental effect on brain-stem functioning; the brain becomes less able to work at overcoming the problem of disordered breathing, thus causing further hypoxemia. Unless this vicious circle is broken, the apneas will become more frequent and prolonged, and symptoms will worsen, starting with restless sleep and excessive daytime sleepiness and eventually progressing to stupor or even coma. Apnea may also contribute to the decline of mental functioning associated with aging, resulting in loss of memory, diminished attention span, confusion, and impaired cognitive and motor performance. Some patients report changes in personality, including irritability and mood swings. In some cases apnea leads to problems of impotence, diminished sex drive, bed-wetting, and, in men, difficulty with erection and ejaculation.
Sickle-cell anemia poses a special risk for OSA victims, since lowered oxygen saturation at night can precipitate an anemic crisis. Similarly, polycythemia—elevation of the total red cell mass—may occur due to episodes of apnea resulting in lowered oxygen in the arteries.
*140\226\8*
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   May 09

HIV: MOUTH PROBLEMS-SORES, BLISTERS, OR ULCERS ON THE LIPS OR MOUTH: APHTHOUS ULCERS

Sores or blisters on the lips or mouth or in the throat are usually caused by one of two conditions. One is an infection by the virus herpes simplex; the other is a condition called aphthous ulcers, whose cause is unknown.
Aphthous ulcers are open sores that may look like herpes simplex sores, occurring in the mouth, usually on the inside surface of the cheeks, on the gums, and on the tongue. Aphthous ulcers are usually very painful, especially when touched or when food or liquids pass over them. The pain can severely limit a person’s desire to eat. Like thrush and herpes, the ulcers may extend to the esophagus and impair the ability to swallow. The ulcers can occur in people with or without HIV infection, but they are more common and severe in those with HIV infection.
Aphthous ulcers are often mistaken for herpes simplex infection, which they resemble. But laboratory tests of aphthous ulcers do not show any specific microbe, and the treatment for herpes simplex infection is unsuccessful in treating aphthous ulcers. The cause of these ulcers is not known. Aphthous ulcers are not transmitted to others. Aphthous ulcers may recur over a period of many years.
The usual treatment is to rinse the mouth with viscous lidocaine (2 percent concentration) or the combination of viscous lidocaine and benadryl taken by mouth. Both of these drugs are available without prescription. Severe ulcers may require prescription drugs such as
corticosteroids given either as a pill or as a gel that can be applied to the surface of the ulcer. Aphthous ulcers in the esophagus are usually treated with corticosteroids and usually respond well.
*121\191\2*
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   Apr 30

SKIN PROBLEMS RELATED TO AGEING: DRY SKIN AND DRUG ERUPTIONS

Dry skin
Dry, itchy skin is the most common skin problem occurring in the elderly. As people get older, their skin gets drier. This is made worse by central heating, sitting close to heating ducts, the use of electric blankets and long, hot showers.
In order to counteract this problem, excessive heating should be avoided, and it can be useful to use a humidifier or place a tray of water close to the heating ducts to produce water vapour. Dimplex heaters, which do not emit dry heat, are another alternative.
Older people should bath or shower with a bath oil, which will replace the oil that is lost from the skin’s surface. The protective layer of the skin is re-created and further water evaporation is prevented. Normal soap should be avoided as these tend to be drying. Gentle soaps such as Aveenobar and Dove are more suitable.
After bathing a moisturizing cream should be used all over the body. Aquatain, 10% glycerol in sorbolene cream, Nutraplus, QV skin cream and Ureaderm are all good products. These simple measures will make many older people feel much more comfortable.
Drug eruptions
Many elderly people are prescribed multiple drugs which can lead to drug eruptions. Sulphur-based drugs, including some blood pressure tablets, heart tablets, anti-diabetic tablets and some antibiotics all commonly cause skin eruptions.
*68/150/5*
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