HEALTH SERVICES

ACTIONS TO TAKE DURING PREGNANCY

TAKE NOTE:
Planning. Husbands and wives may need to discuss how many children to have. In developing countries it is common to see women with small children nursing a baby and, at the same time, expecting another. Careful planning and consideration might allow time to elapse between the birth of one child and the next, resulting in relief for the woman, who would then be able to recuperate after giving birth.Nutrition.According to the Coalition for Positive Outcomes in Pregnancy, before becoming pregnant a woman needs at least four months to recover from exposure to harmful substances and to build a good nutritional supply. For example, the risk of spina bifida, caused by a defective closing of the neural tube, is greatly reduced when the expectant mother has an ample supply of folic acid. Since the embryo's neural tube closes between the 24th and 28th day after conception—long before many women realize that they are pregnant—some women who are planning to become pregnant take folic acid.Another crucial nutrient is iron. Indeed, a woman's iron requirement doubles during pregnancy. If her reserve is low—which is true of many women in developing countries—she can come to have iron-deficiency anemia. This condition can be worsened by repeated pregnancies, as the woman may not have time between them to replenish her iron reserve.*Age.Risk of death in pregnant girls under 16 is 60 percent greater than in those in their 20's. On the other hand, women over 35 are more likely to give birth to babies with congenital abnormalities, such as Down's syndrome. Mothers who are very young or are in their later childbearing years are more prone to preeclampsia. This disorder, characterized by high blood pressure after the 20th week of gestation along with the presence of edema and an increased amount of protein in the urine, increases the risk of mortality in both baby and mother.Infections. Urinary, cervicovaginal, and gastrointestinal infections can worsen during pregnancy and can increase the risk of premature birth and preeclampsia. Any infection is best treated before pregnancy.Health Care During PregnancyPrenatal care. Regular visits to a doctor throughout pregnancy lower the risk of maternal death. Even in countries where regular access to clinics and hospitals is limited, properly trained midwives may be available.Prenatal care can alert trained personnel to situations that could make special care necessary. These include multiple gestation, hypertension, heart and kidney problems, and diabetes. In some countries a pregnant woman can receive tetanus toxoid vaccine to prevent neonatal tetanus.

STROKE AND HOW TO COPE

A LEADING cause of death and chronic disability in the Western industrialized world is stroke. The very word "stroke" implies the suddenness with which a "brain attack" occurs. One moment, you may be feeling fine, and the next moment, you feel as if you were hit by a bolt of lightning-a major stroke can abruptly and dramatically change your life. Cruelly maiming and crippling you, it may render you speechless, wreak havoc on your emotions, alter your personality and powers of cognition, and thrust upon you a seemingly endless struggle to regain the normal life you and your family once knew.Consider Ellen Morgan.* On Wednesday, Ellen was a healthy, active 64-year-old. On Thursday, while shopping with her husband, Ellen suddenly lost her ability to speak, and her face became distorted. Her body weakened, and she lurched as if in a drunken condition. Ellen was suffering a major stroke!In the aftermath of the stroke, Ellen was so disabled that she could not do the simplest of things, like bathing or dressing herself. Unable to write, knit, or sew, she became plagued with bouts of uncontrollable weeping and overwhelming fatigue. In all of this, Ellen's thought processes were not impaired; however, feelings of embarrassment would arise when she felt that perhaps others looked upon her as a simpleton. Later, Ellen explained: "Few realize how the shock of this sudden change affects one emotionally and psychologically. I almost felt as though it were the end of my existence as a person."What causes a stroke? Is everyone who has a stroke affected in the same way? How have survivors coped with this disease? How do families of stroke survivors cope? What can all of us do to provide support?Most of today's poststroke rehabilitation supports the notion that if one area of the brain is damaged, other centers can assume the role of the injured tissue. One purpose of therapy is to both bring out the potential of these uninvolved centers and provide the stimulation to permit the brain to reorganize and adapt," state researchers Weiner, Lee, and Bell. However, recovery is determined by other factors too, such as the site and the severity of the stroke, the general health of the individual, the quality of medical care, and the support of others. Support of Family and FriendsErikka engaged in rehabilitative exercises for three years, learning to walk and to use her right hand to compensate for her disabled left hand. She tells what enabled her to cope: "The most important thing was that my husband and my friends remained loyal to me. To know that they loved me gave me strength, and when they encouraged me not to give up, that motivated me." Family members become partners in the recovery process of their loved ones. They need to ask questions of medical personnel and observe therapies that may need to be continued at home so as not to lose the gains already made. The patience, kindness, understanding, and affection shown by family members and friends provide a secure emotional environment in which to relearn speech, reading, and other skills of daily livingLearning to Render SupportMood swings and a heightened tendency to cry can be embarrassing for the stroke victim, as well as disconcerting to onlookers who may not know how to respond. However, learning to be supportive, friends can rescue a stroke victim from the isolation that may otherwise result. Usually, crying spells become less frequent. But when tears come, remain calm and stay by the person, saying what you would like to hear if your roles were reversed.

HEART ATTACK AND SURVIVAL ACTIONS

Heart Disease—A Threat to Life Each year millions of men and women worldwide have heart attacks. Many survive with few aftereffects. Others do not survive. For still others the heart is so damaged that "a return to useful activities is questionable," cardiologist Peter Cohn says, adding: "It is imperative, therefore, to nip heart attacks in the bud whenever possible."The heart is a muscle that pumps blood throughout the body. In a heart attack (myocardial infarction), part of the heart muscle dies when deprived of blood. To stay healthy, the heart needs oxygen and other nutrients that are carried by the blood. It gets these by way of the coronary arteries, which wrap around the outside of the heart.Diseases can affect any part of the heart. However, the most common is the insidious disease of the coronary arteries called atherosclerosis. When this occurs, plaque, or fatty deposits, develops in the artery walls. Over a period of time, plaque can build up, harden and narrow the arteries, and restrict blood flow to the heart. It is this underlying coronary artery disease (CAD) that sets the stage for most heart attacks.Clogging in one or more arteries precipitates an attack when the heart's demand for oxygen exceeds the supply. Even in arteries less severely narrowed, a deposit of plaque can crack and lead to the formation of a blood clot (thrombus). Diseased arteries are also more susceptible to spasm. A blood clot can form at the site of a spasm, releasing a chemical that further constricts the artery wall, triggering an attack.If you or someone you know shows symptoms of heart attack:Recognize the symptoms. Stop whatever you are doing and sit down or lie down. If symptoms last more than a few minutes, call a local emergency telephone number. Tell the dispatcher that you suspect heart attack, and give him the information needed to locate you. If you can get the victim to a hospital emergency room more quickly by driving there yourself, do so. If you think you are having a heart attack, ask someone to drive you there.If you wait for an emergency medical crew:Loosen tight clothing, including a belt or a necktie. Help the victim to get comfortable, propping him with pillows if necessary. Stay calm, whether you are the victim or the helper. Excitement may increase the likelihood of life-threatening arrhythmia. Prayer can be a strengthening aid in remaining calm.If the victim seems to stop breathing:In a loud voice ask, "Can you hear me?" If there is no response, if there is no pulse, and if the victim is not breathing, begin cardiopulmonary resuscitation (CPR). Remember the three basic steps of CPR: Lift the victim's chin up, in order to open the airway. With airway open, while pinching the victim's nostrils closed, blow slowly twice into the mouth until the chest rises. Press 10 to 15 times on the middle of the chest between the nipples to push blood out of the heart and the chest. Every 15 seconds, cycle two breaths followed by 15 compressions until pulse and breathing are regained

DIABETES AND IS MEANING

THE NAMEThe term "diabetes mellitus" comes from a Greek word meaning "to siphon" and a Latin word meaning "sweet like honey." These words aptly describe the disorder, for water passes through the person who has diabetes as if it were being siphoned from the mouth through the urinary tract and right out of the body. Furthermore, the urine is sweet with sugar. In fact, prior to the discovery of more efficient techniques, one test for diabetes was to pour patient's urine near an anthill. If the insects were attracted, this indicated the presence of sugar.WHY IS IT SERIOUSDiabetes has been called "a disorder of the very engine of life," and for good reason. When the body cannot metabolize glucose, a number of vital mechanisms can break down, sometimes with life-threatening consequences. "People don't die directly from diabetes," says Dr. Harvey Katzeff, "they die from complications. We do a good job of preventing complications, but a poor job of treating [them] once they occur."*Is there hope for those who are afflicted with diabetes? Yes—if they recognize the seriousness of the disorder and submit to a program of treatment.#Diet and ExerciseAlthough Type 1 diabetes cannot be prevented, scientists are studying the genetic risk factors and are trying to find ways to suppress an immune attack. (See the box "The Role of Glucose.") "With type 2, the picture is much brighter," says the book Diabetes—Caring for Your Emotions as Well as Your Health. "Many of those who might be genetically susceptible avoid showing any sign of this disease simply by eating a balanced diet and exercising regularly, thereby staying physically fit and keeping their weight within normal limits."%Proper diet is essential for diabetes sufferersUnderscoring the value of exercise, the Journal of the American Medical Association reported on a large study involving women. The study found that "a single bout of physical activity increases insulin-mediated glucose uptake [by the body's cells] for more than 24 hours." Hence, the report concludes that "both walking and vigorous activity are associated with substantial reductions in risk of type 2 diabetes in women." The researchers recommend at least 30 minutes of moderate physical activity on most if not all days of the week. This can include something as simple as walking, which, says the American Diabetes Association Complete Guide to Diabetes, "is probably the best, safest, and least expensive form of exercise."However, exercise by people with diabetes should be professionally supervised. One reason is that diabetes can damage the vascular system and nerves, thus affecting blood circulation and feeling. Hence, a simple scratch on the foot may go unnoticed, get infected, and turn into an ulcer—a serious condition that may lead to amputation if not treated immediately.

STRESS AND YOU

STRESS AND YOU WHAT is stress? According to one expert, stress may be defined as “any physical, chemical, or emotional factor that causes bodily or mental tension.” Does this mean that stress is inherently harmful? No. As Dr. Melissa C. Stöppler observes, “a mild degree of stress and tension can sometimes be beneficial. Feeling mildly stressed when carrying out a project or assignment often compels us to do a good job and to work energetically.”So when is stress a problem? Says Stöppler: “It is only when stress is overwhelming, or poorly managed, that its negative effects appear.” Consider some common sources of stress.The Stress of Making a LivingKing Solomon said: “With a man there is nothing better than that he should eat and indeed drink and cause his soul to see good because of his hard work.” (Ecclesiastes 2:24) However, for many employees, the workplace is a caldron of pressures.A report from the European Agency for Safety and Health at Work stated that workers are often stressed on their jobs because, among other things, there is poor communication between management and employees, management gives workers little say in decisions that affect them, there are conflicts with fellow workers, or there is job insecurity and/or inadequate pay. Whatever the reasons, coping with the strains of the workplace may leave working parents with little energy to deal with the demands of their families. And those demands can be enormous. In the United States, for example, during a one-year period, some 50 million people provided care for an ill or elderly family member. Financial problems can also be a potent source of family stress. Rita, a mother of two, faced financial distress when her husband, Leandro, had an automobile accident, leaving him in a wheelchair. Rita admits: “Financial problems cause tension. When you do not have the money to cover all the expenses in the home, it affects your mood.”Whether you are young or old or the stress in your life comes from work or school, chronic stress can take a heavy toll on your health. One medical writer explains: “The stress response of the body is somewhat like an airplane readying for take-off.” Yes, when you feel stress, your heart rate and blood pressure soar. Your levels of blood sugar rise. Hormones are released. “If stress becomes persistent,” the same writer continues, “all parts of the body’s stress apparatus (the brain, heart, lungs, vessels, and muscles) become chronically over- or under-activated. This may produce physical or psychologic damage over time.” The list of illnesses in which stress may play a role is alarmingly long: heart disease, stroke, immune disorders, cancer, musculoskeletal disorders, and diabetes, to name just a few.“The pressure can build up so much that I feel as though I will explode”Of particular concern is the unhealthy way in which many—especially young ones—try to cope with stress. Dr. Bettie B. Youngs laments: “It is very depressing to find out that in their desire to escape from pain, teenagers take routes such as alcohol and drug abuse, truancy, delinquency, sexual promiscuity, aggression and violence, and running away from home—routes that lead them into problems more overwhelming than those they were trying to esca

HOW TO COPE WITH SRESS

give your body sufficient rest each day Maintain a reasonable diet. Avoid overeatingEngage in proper and regular exercise, such as brisk walkingIf something worries you, talk to a friend about it Spend more time enjoying your family Delegate or share household chores Know your own physical and emotional limitations Set realistic goals; do not be a perfectionist Be organized; have a balanced, reasonable schedulePosted by mark john at

GENETICALLY MODIFIED FOOD

DEPENDING on where you live, you may have had some genetically modified (GM) food in your breakfast, lunch, or dinner today. It might have been in the form of potatoes with a built-in insect repellent or tomatoes that stay firm longer after being picked. In any case, the GM food or ingredient may not have been labeled, and your palate could hardly distinguish it from the natural one.Even as you read these lines, such GM crops as soybeans, maize, rapeseed, and potatoes are growing in Argentina, Brazil, Canada, China, Mexico, and the United States. According to one report, "by 1998, 25 percent of corn, 38 percent of soybeans, and 45 percent of cotton grown in the United States were genetically altered, either to make the crops resistant to weedkillers or to produce their own pesticides." By the end of 1999, an estimated 100 million acres [40 million ha] were covered with GM crops in commercial cultivation worldwide, though not all of these are food crops.Is genetically altered food safe for you? Do the scientific techniques used to produce GM crops pose any threat to the environment? In Europe the debate over GM foods is heating up. Said a protester from England: "My only objection to genetically modified foods is that they're unsafe, unwanted and unnecessary."How Is Food Genetically Altered?The science behind GM food is called food biotechnology—the use of modern genetics to improve plants, animals, and microorganisms for food production. Of course, the concept of tinkering with living things is almost as old as agriculture itself. The first farmer who bred his best bull with the best cow in his herd to improve the stock, instead of allowing the animals to breed randomly, was implementing biotechnology in a rudimentary sense. The first baker who used yeast enzymes to make bread rise was likewise using a living thing to produce an improved product. The one feature common to these traditional techniques was the use of natural processes to bring about changes in foods.Modern biotechnology likewise employs living organisms to make or modify products. But unlike traditional methods, modern biotechnology allows for modifying the genetic material of organisms directly and precisely. It enables the transfer of genes between completely unrelated organisms, allowing for combinations unlikely to occur by conventional means. Breeders can now take qualities from other organisms and put them into the genome of a plant—for instance, frost tolerance from fish, disease resistance from viruses, and insect resistance from soil bacteria.Suppose that a farmer does not want his potatoes or apples to turn brown when they are cut or bruised. Researchers come to the rescue by removing the gene that is responsible for this browning and replacing it with an altered version that blocks browning. Or let us assume that a beet grower would like to plant earlier in order to reap a better harvest. Ordinarily he couldn't because the beets would freeze in the cold weather. Biotechnology comes into play when genes from fish that easily survive in cold water are transplanted into the beets. The result is a GM beet that can withstand temperatures as low as 20°F. [-6.5°C], more than twice as cold as the lowest temperature beets can typically withstand.

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