American Women smoking and the problems for non-smokers

 Women smoking a pack or more a day the risk is more than 4 times as great as the other women. Inhaling is a significant factor. Every smoker gets some smoke into his Lung, but purposeful inhalation multiplies the amount. Men who think they do not inhale or inhale only slightly have 8 times the risk and men who inhale deeply have 14 times the risk of lung cancer as against non-smokers. Women who do not inhale or who inhale only slightly have it and women who inhale moderately or deeply 3.7 times the risk in comparison with those who do not smoke. 

The earlier smoking starts, the greater the risk. Men who begin before 10 years of age have nearly 5 times as much risk as those who start after the women who start before 25 run twice the risk of women who start Liter. Although lung cancer sometimes does occur in nonsmokers, this is so relatively rare that it is estimated by authorities that at least 90 percent of lung cancer deaths would not occur if there were no smoking of cigarettes. Other cancers are associated with smoking.

The incidence of cancer of the larynx is 6 times as great and that of cancer of the esophagus 4 times as great in men cigarette smokers, aged 45 to 64, as in nonsmokers. Similarly, cancer of the pancreas is 2.7 times as great, cancer of the liver and biliary passages 2.8 times, cancer of the urinary bladder 2 times, cancer of stomach and kidney 1.4 times, and leukemia 1.4 times as great. 

Women smokers have death rates 1.8 times as high as nonsmokers for cancer of the mouth, larynx, esophagus, and pancreas. Pipe and cigar smokers have rates for lung cancer twice as high as nonsmokers; for cancer of the oral cavity, 4.9 times as great; for cancer of esophagus and larynx, 3 to 4 times as high. While the cancer death rates associated with smoking are not as high in women as in men, it seems likely that they will catch up because of the great increase of smoking by women in recent years. 

Smoking problems and healthcare

No HEALTH problem in our time has commanded more attention than smoking. The issuance of the official Surgeon General's Report in 1964 constituted a major scientific and medical event and began a public and medical concern that continues. Despite the concern, however, one third of the women and half the men in the United States still smoke cigarettes. 

Deaths from diseases associated with cigarette smoking continue. A large proportion of health resources and money must be devoted to trying to treat such diseases. But there are encouraging events. As many as 1.5 million people a year recently have been abandoning smoking.

Among them, fortunately, are young and middle-aged men who are at particularly high risk of premature death from lung cancer and coronary heart disease. Also hopeful is evidence from a Public 

Health Service survey indicating that while 29 percent of boys and 15 percent of girls at age 17 are regular smokers, this represents a significant reduction in the proportion of young people taking up smoking. And school systems across the country are emphasizing educational programs on smoking and health in the hope of creating a "smokeless generation."

The evidence about the dangers of cigarette smoking to health is now overwhelming. In the words of the Surgeon General of the U.S. Public Health Service, smoking "is the greatest preventable cause of illness, disability and premature death in this country."

 A conviction shared by medical and health agencies has been expressed by the New York State Commission of Health: "No other single factor kills so many Americans as cigarette smoking .... Bullets, germs and viruses are killers; but for Americans, cigarettes are more deadly than any of them. No single known lethal agent is as deadly as the cigarette." Smoking is a certain irony in the history of tobacco use. American Indians, early explorers discovered, smoked tobacco in pipes for ceremonial silicoses, and believed it had some medicinal values. 

Weight Control - THE DANGERS OF UPS AND DOWNS

Weight Control  

 THE DANGERS OF UPS AND DOWNS 

The frequent weight gains and losses indulged in by. The many obese people who practice what one writer calls the "rhythm method of birth control" may actually be more harmful than maintenance of a steady excess weight. For example, it has been shown that serum cholesterol is elevated during periods of weight gain, thus increasing the risk that it will be deposited on artery walls? 

We have no evidence to show that once cholesterol is deposited it can be removed by weight reduction. And it is possible that a person whose weight has fluctuated up and down a number of times has been subjected to more Atherogenic (artery- hardening) stress than a person with stable though excessive weight- and such stress increases the danger of heart attack and stroke.

 Animal experiments have shown that animals of normal weight have a longer life expectancy than obese animals. They have also shown that if an animal has been obese and has been repeatedly reduced, it will have a shorter life expectancy than the obese animal that has never been reduced. Such evidence adds further question to the advisability of undertaking weight reduction that cannot be sustained.

 THE ONLY SCIENTIFIC WAY TO REDUCE

There is nothing complicated about the principles for safe, sound, and effective weight reduction and they are principles that rest on solid scientific study.

1.       There are no healthy substitutes for them, and any attempts to circumvent them are only invitations to frustration and failure.

2.       Without any equivocation but rather as forcibly as we can, we wish to emphasize that all else is bunk, junk, profitable only to the purveyors and never truly so to the believer-buyers-and this is the set of principles upon which you must, and can reliably, pin your hopes for safe and effective weight control: If the number of calories you eat averages more than the number your body uses, you gain.

3.      

        If calorie intake totals less than calorie use, you lose weight. If you are to lose one pound of fat, you will have to take in 3,500 calories less than you expend. And while a sound reducing diet should, of course, lead to weight loss, it must, in addition, have three basic characteristics:

It must produce loss of weight at a safe pace.

 It must offer variety so that it maintains health and provides some pleasure in eating as well as some satisfaction of hunger.

Building General Health as Preventive Therapy

It must teach new, and enjoyable, eating patterns so that you do not promptly slip back into old, weight-gaining eating habits. And, in most cases, coupled with a good reducing diet having such characteristics there must be a sound program of exercise or other physical activity that will increase the calorie expenditure level, ease the dieting regimen, and contribute to general health in the process. 

How to manage Infections, overdoses, side effects in modern medicine

Friendly bacteria keep under control harmful organisms that also are natives of the digestive tract. When friendly bacteria are killed off in large numbers, there is less competition for the harmful residents and they have a chance to multiply. The result may be super infection-a new and different infection that develops as a result of another's being treated. Again, the super infection is often mild and disappears once antibiotic treatment stops. 

But super infection sometimes can be severe.

What it comes down to is this: use of potent modern medications, not only antibiotics but many others, involves a calculated risk and alertness. Ideally, the physician uses them after careful consideration and upon arriving at the decision that the good to be gained outweighs any risks along the way-and uses them with caution, keeping alert to the earliest indications of any new trouble from the drugs which he may be able to overcome by change of dosage, switch of medication, addition of other medication, or when necessary discontinuance of treatment.

One of the major problems, though, has been the insistence of many patients upon willy-nilly prescription of medication. They may demand penicillin, for example, for a cold or any fever. They have the feeling that a visit to the doctor is not complete unless the doctor "gives" them something. Too often, this has put physicians on the spot; and to please patients, some have prescribed medication against their better judgment.

So far as your own health is concerned, you can do much to preserve it not just by seeking timely medical advice but by taking it-by avoiding insistence upon medications, by indicating to your physician that you are aware of the values and also limitations of medications, the need to use them wisely not indiscriminately, to use them when they are required and not otherwise.

DOSAGE PROBLEMS

A man who took double the prescribed dose of an anticoagulant-a drug that, in effect, acts to thin the blood to prevent clot formation-found himself in the hospital a few days later with severe nosebleedsand vomiting of blood.

 A woman with bronchial asthma was admitted to the hospital with heart palpitations after she had used, contrary to instructions, an isoprenaline (isoproterenol) spray repeatedly for several hours. Another patient, a 29-year-old man, who had decided to take 50 percent' more than his prescribed dose of a cortisone like drug, came- to the hospital with changed personality, considerable weight gain from fluid retention, and other effects. 

Fever : Temperature to measurement and prevention of diseases

 If there is a severe chill or a rash, then no matter how mild the temperature elevation, medical help is needed. A stiff neck, even if the fever is slight, may be an early indication of meningitis. A fever that develops after an accidental cut or other injury which could have become infected may mean blood poisoning (septicemia). 

When a fever, even mild, is accompanied by nausea and pain in the abdomen, especially in the lower right part of the abdomen, the problem could be appendicitis. Appendicitis often progresses rapidly, and whereas it can be treated effectively early in its course, it may become a major problem if neglected for even a few hours. One final note about slight fever: If you have a chronic disorder such as rheumatic heart disease, asthma, diabetes, or nephritis, your physician may warn you to let him know the minute you discover a fever or even a common cold coming on.

PAIN

All of us have occasional headaches. And there are mild and fleeting aches and pains from unaccustomed exertion and even family arguments and business or other anxieties. These are certainly no medical emergencies. But any new or unusually acute pain in the chest or abdomen should call for medical consultation. Pain in the chest accompanying exertion may be due to heart trouble-but not invariably. Pain at its worst when you take a deepbreath may be due to pleurisy. Chest pain that develops upon bending over after eating may be due to a hernia of the diaphragm. Many relatively mild abdominal pains are associated with gas in the bowel; some stem from constipation; some are associated with fatigue, depression, or anxiety. 

Sometimes, aches and pains that appear to be originating inside the abdomen or chest are actually coming from the abdominal or chestwall as the result of fibrositis of muscles. Peptic ulcer pain usually comes with hunger and is relieved by food or an acid- neutralizing agent. Gallbladderpain often starts under the lowest right ribs in front and runs up under theright shoulder blade. 

How often periodic medical checkups should be carried out?

How often periodic medical checkups should be carried out is best determined by the physician on the basis of what is most suitable for you as an individual rather than on the basis of a general rule. Age is one determinant. The elderly and the very young generally need more frequent examinations than those in between. But other factors must be considered-present state of health, past medical history, family medical history, occupational hazards if any, etc. Your physician will take these into account in deciding what is most appropriate for you -a checkup once a year, or twice a year, or perhaps once in two years.

BETWEEN CHECKUPS Manifestations of illness or impending illness take the form of signs or symptoms, or both. Signs are objective evidence: for example, a change in skin color or the swelling of a body part. Symptoms are subjective: for example, nausea or pain.

They can vary greatly, of course, from mild' and fleeting to severe and persistent. All deserve attention, though it is likely that if they are mild and transient the reason for them is inconsequential. Any persistentor recurring sign or symptom deserves action. Even if mild it should not be ignored. Passing it off as something not worth notice except by a hypochondriac is dangerous.

 You may become so habituated to its presence that you regard it as something "normal" for you-until the underlying problem reaches a stage where it is irreversible or leads to serious consequences. The following discussion is intended to help you interpret the significance of signs andsymptoms that may appear between checkups, as a guide to when to consult your physician without delay. 

How AUTOMATED MULTI-PHASE SCREENING helps to check diseases in health care

One of the relatively recent developments that is almost certain to bring striking changes in the practice of medicine, adding further to the emphasis on and practicality of preventive medicine, is automated multi- phase screening. The idea is to link electronic detection devices, large numbers of chemical tests, and computer science together to screen or check, at low cost, large numbers of apparently healthy people, looking for the most subtle signs of early disease and even of pre-disease states, doing far more routine testing than physicians have time for, providing them with the results of the tests, and giving them more opportunity to counsel patients and practice preventive medicine.

In a periodic checkup that may run two to three hours, a patient moves from one station to another for checks of hearing, visual acuity, respiration rate, lung capacity. An electrocardiogram is made; a measurement of pressure within the eye is quickly made for detection of glaucoma, a major cause of blindness. A chest x-ray is taken and, in the case of women, a three-dimensional breast photograph (mammography). Pulse and blood pressuremeasurements are included. The patient answers a self-administered questionnaire on health history. And blood and urine samples are taken and automatically checked for indications of infection, gout, diabetes, and other diseases and also for a variety of biochemical values that may give some indications of pre disease changes. A computer summarizes the findings and produces a printed record for the patient's personal physician to evaluate. Automated multiphase screening is moving rapidly out of the experimental phase. Much of the pioneering work in its development was done by physicians at the Kaiser Foundation Health Plan in northern California with some financial assistance from the U.S.Public Health Service

The Public Health Service has awarded funds to set up pilot programs in Milwaukee, New Orleans, Brooklyn, and Providence-some affiliated with health centers in poverty areas, others with universities, and still others with city health departments. Already, some large industries are planning automated multiphase screening facilities as part of their occupational health programs. And there are plans for forming medically directed private companies which would provide automated screening service for patients referred by physicians.

Automated screening facilities may not be available in your community yet. Ask your doctor about them. Tell him you are interested. If the facilities are not available, you will be doing a public service by encouraging your doctor to push for their establishment in the near future.

YOUR ROLE

You AS the patient in preventive medicine have a role to play that goes far beyond cooperating in regular checkups. You can build and maintain your health, taking advantage of the latest knowledge in such areas as nutrition, weight control, physical activity, rest and relaxation (to be covered in later sections of this posts). You can be alert, too, between checkups for any danger signals.

How Supplementary Tests are useful along with Blood tests to determine and eradicate diseases?

A chest x-ray to disclose abnormality of the lungs is commonly made. X-ray studies are also used, when considered necessary, to check on heart size and, with the help of barium' either taken by mouth or given by enema, to study the upper and lower gastrointestinal tract. In addition, with the aid of injections of special dyes, x-rays today can be used to study the chambers within the heart and the condition of blood vessels. There is a method of using x-ray, after injection of a dye into an artery leading to the brain, to detect a brain tumor; this technique shows the blood vessel architecture of the brain and where tumor growth has pushed one or more vessels out of normal position. Blood studies have many values.

For a blood count, blood is drawn from a vein in the arm or fingertip, mixed with a diluting fluid, placed in a glass chamber so the number of red and white blood cells can be counted. Red pigment (hemoglobin) in the blood can be determined by comparison with color standards. The proportion of red cells in relation to the rest of the blood can be established by whirling the blood in a centrifuge so that heavier red cells settle in the bottom of a small measured tube called a hematocrit.

 Any departures from normal-such as too little hemoglobin indicative of anemia, too few white cells indicative of inability to combat infection, too many white cells indicative of body response to an infection not otherwise apparent-can are noted quickly.

Blood, usually taken from a vein in small amounts, also may be checked for sugar content as a test for diabetes and for the level of a substance, uric acid, as a test for gout. And sophisticated new blood tests often are valuable for heart problems, supplementing the information provided by the electrocardiogram. The electrocardiogram, a record of the electrical activity of the heart, is useful for analyzing any disturbances of heartrhythm, detecting inflammation, showing damage to the heart muscle, and making other determinations. An electrocardiogram, taken in good health, is of value because it provides a baseline for the future; it establishes what is normal for the individual and allows better interpretation of any changes that occur later. When a heart attack occurs-and many heart attacks are silent-an electrocardiogram will show that it has occurred. But it may not show accurately how much of the heart has been damaged. 

How does a preventively minded physician function? Follow 1000 posts in the series

You can expect that in working with you he will get to know you thoroughly-past medical history, family medical history, job, working habits, living habits-so he can weigh any possibility that you-as a member of a specific group based on heredity, environment, age, sex, color, personal habits-may face certain specific health hazards.

In his regular periodic examinations, he will follow your health progress in general and will be alert for the slightest early indication of anything wrong in any area of special risk for you. He may, in fact, from time to time use special tests to make certain all is going well in a special risk area.

During your visits, he will be concerned, of course, with any physical complaints and also with any mental or emotional problems (job, marital, and others), since these can affect health.

He will be interested in any changes in your habits and their possible effects, for good or ill, on your health. From time to time, he may have suggestions for an alteration, perhaps minor, of diet, exercisepattern, sleep, relaxation, etc.

As he regularly checks you, alert for earliest indications, even pre-indications, of possible trouble, he will be prepared to intervene without delay. Rather than wait, say, for obvious symptoms of diabetes to develop-especially if you belong to the group with greater than average probability of developing the disease-he will intervene to try to correct, if they appear, the very first changes that could possibly lead to diabetes.

As medicine has been practiced generally to now, it has been the patient who, in effect, has turned up after making a self-diagnosis. It has been the patient who has decided, "I think I am or may be sick or becoming sick," and then has sought help.

How it will be the preventively minded physician who increasingly will be able to tell the patient, "You are about to become sick and we are going to take a few measures in advance so you won't actually develop the sickness." 

CALCULATING RISKS and nature care on Our body care, diseases and conditions-1000 posts following

CALCULATING RISKS of Diseases and conditions

First, it became evident not only that people vary in susceptibility to disease but that increased risk depends upon many factors and that it is possible to calculate risks. Breast cancer, for example, occurs in 5 percent of white women over black in the United States-and so, on the average, there is a 1 in 20 But a woman with a positive family history of breast cancer-one mother or sister or aunt developed the disease-has triple the risk on her women. (Let us say, at once, that if this increased hazard be- of hereditary influences stood by itself it' would be only a more But it stands with increasingly sensitive and detecting her at earlier and earlier-and therefore more curable-stages, and scores the wisdom of special emphasis on breast cancer detection such a woman.
Other factors, racial and social, help to identify special proneness’s. Japanese have a high risk of stomach cancer but relatively low risk breast cancer; the Chinese and Malaysians have a high risk of nose throat cancer. In unskilled American workers and their wives, the incidence of cancer of the stomach and uterine cervix is three to four times higher than among people in the professional fields. On the other hand cancer of the breast and leukemia are substantially more common in the higher economic classes. there are occupational factors to be considered.

For example, urinary bladder cancer has an increased incidence among dye workers, in that industry programs have annual tests of urine. Medicine also has been establishing other characteristics associated with high risk of specific diseases as a means of permitting preventive medical care to be used. For coronary heart disease, which may lead to the heart attack, the characteristics include excessive levels of certain fats II the blood, high blood pressure, high pulse rate, cigarette smoking, physlcal inactivity, and premature cessation of ovarian activity in a woman. The incidence of the disease, in men aged 40 to 59 for example, (from 9 per 1,000 when one of these factors is present to 77 per 1,000 when any three of them are present.