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Thứ Bảy, 29 tháng 11, 2014

Ebola only the la tét dificulty for the CDC

It's been a rough year for the CDC.
In that incident, the U.S. Department of Agriculture's Southeast Poultry Research Laboratory asked the CDC for a sample of the low-pathogenicity H9N2 virus, but instead found the dangerous H5N1 virus in the sample it received. The agency investigated and found that a scientist -- who was not named by the agency -- did not follow proper procedures when he or she inoculated each virus into canine kidney cells.
Then, in June, 84 CDC staff members in Atlanta were inadvertently exposed to anthrax due to a breakdown in safety procedures. In that mishap, which the CDC reported in August, a scientist planning to autoclave and discard samples of anthrax bacteria couldn't open the autoclave door and instead returned the samples to an incubator; another researcher noticed growth on the samples a week later, kicking off an investigation.
Now, of course, the CDC is dealing with a case of Ebola in Dallas and the public's concerns about the spread of that virus; the agency has generally gotten good marks for its actions in what is, nonetheless, likely a stressful situation for CDC officials. (On the other hand, the Dallas case has, in the view of manyMedPage Today readers, undermined the agency's assurances that imported Ebola cases could be readily managed.)
The CDC is hardly the only federal agency to have come in for heavy scrutiny and criticism lately. Julia Pierson, the director of the Secret Service, resigned Oct. 1 after several White House security breaches were made public. In 2013, Lois Lerner, an official at the Internal Revenue Service (IRS) who has since retired, came under fire for the IRS' apparent targeting of certain conservative-leaning political groups for close scrutiny.
The FDA has also had its share of critics for issues such as its handling of opioid medications and for approving many drugs later found to have serious safety problems.


The CDC may want to seek advice from crisis management experts such as the ones MedPage Today spoke with (see our story here). But agency officials will also likely be glad to see 2014 in their rear-view mirror in a few months.

CDC Faces Yet Another Problem: A Tarnished Image

Published: Oct 7, 2014
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Mishandled anthrax samples. Mishandled avian influenza samples. And now, a case of Ebola in Dallas.
It's been a tough year for the CDC. What can the beleaguered Atlanta-based agency do to enhance its image?
Not a lot, said Larry Smith, senior consultant with the Institute for Crisis Management, a crisis communications consulting firm in Denver.
"CDC faces a couple of dilemmas it doesn't control," said Smith, who is based in Louisville, Ky. "First of all, most people don't pay a bit of attention to whatever the CDC is dealing with ... until it's their family, their child, their spouse, that may have a healthcare problem."
"So when something does go wrong, and the media or social media pick up on it, it doesn't get as much attention today as it did 5 years ago, but then when something happens in your town ... Then people come alive, and they usually react very strongly and very negatively," he said.
Right now, the agency faces two equally bad possibilities, according to Eric Dezenhall, founder of Dezenhall Resources, a crisis communications firm in Washington.
"If there is an Ebola outbreak, it will be declared to be mismanaged by CDC, but if there is not, they'll be accused of scaring the public by talking about it," said Dezenhall, the author of "Glass Jaw: A Manifesto for Defending Fragile Reputations in an Age of Instant Scandal."
Experts acknowledge that while the CDC is certainly facing a number of challenges at present, it has not gone so far as to lose its brand. But the Ebola situation has created a perfect storm of disinformation and distrust.
"Unfortunately, the public isn't really aware of what the CDC does," said Chris Zaenger, president of Z Management Group, a consulting firm, and president-elect of the National Society of Certified Healthcare Business Consultants. In addition, people don't want to hear what Ebola actually is, preferring instead to create a more sensationalized narrative, added Zaenger, in Elgin, Ill.
The explosion of social media has certainly contributed to this stream of misinformation, noted Josh Zeitz, executive vice president and deputy corporate practice head at MWW Group, a public relations firm in New York City.
Twenty years ago, the CDC would have taken control of the story, Zeitz said. But social media has forced the CDC to be "reactive rather than informative."
Zeitz added that "steady erosion in the trust of public institutions" has also played a role in the CDC's current predicament. The CDC is facing the same challenges from a skeptical public as doctors, hospitals, public officials, and the press.
In addition to a lack of trust, the public also holds the healthcare industry to a much higher standard, according to Zaenger. When charged with protecting something as important as health, hospitals and public health organizations are not allowed to be fallible.
"We expect [healthcare organizations] to be perfect, but we do not respect them as if they are," Zaenger said.
The next few weeks are crucial for the CDC, because the agency now needs to demonstrate that its assessment of the Ebola situation is correct, Zeitz said. He pointed to how emergency response teams in New York City and Boston handled the terrorist attacks. "Successful management of a public crisis leads to lasting public faith."
And if an Ebola outbreak doesn't occur in the U.S., that will be good news not only for the public but also for the CDC, according to Dezenhall. "If we don't [have an outbreak], this will recede from the news and we'll be on to the next crisis."
Alicia Daugherty, practice manager for research and insights at The Advisory Board Company, in Washington, explained that transparency is always the best strategy for any healthcare organization, especially when answering questions.
"The most important thing is a consistent message that shows you are taking your constituents seriously," Daugherty said.
Acknowledging mistakes may also help to regain the public's goodwill. Zeitz pointed out that the public is most incensed by any perceived "lack of candor" or responses that sound like "self-preservation."
Zaenger agreed: "Be honest, be believable, and tell the truth. The sooner you do that, the sooner you can stop the cycle."
The CDC's greatest advantage in this situation is its reputation as a trusted organization, the experts said. If the agency can prove to the public that it can assert control, the public will begin to trust it again. Zaenger even wondered if CDC officials could use the power of social media to their advantage -- "#cdcisgreat, and move on."

Missed Pill, Missing Period?


I have not had a period in two months — I doubt that I'm pregnant since I don't feel that way. Could this be due to the one or two days I missed taking my pill? 
— Laura, Chicago
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Missing one or two days of active (non-placebo) pills in abirth control pill pack should not cause you to miss your period. Sometimes the hormone levels in the birth control pill are low enough that you actually do not bleed every cycle. If you had skipped an entire week of active pills or had recently lost a lot of weight, then those two situations might also cause you to miss a period.
Of course, it's important to get a pregnancy blood test to confirm that you aren’t pregnant — it is possible to be pregnant and not experience any of the typical symptoms, such as nausea and morning sickness. If you haven't had your period in three cycles in spite of a negative pregnancy test, see your gynecologist for further tests, including a sonogram and a pelvic examination.

Thứ Sáu, 28 tháng 11, 2014

6 Emergency Complications of Diabetes Type 2

People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
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Heart disease and stroke are the top causes of death and disability in people with diabetes. Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort. If you experience any of the following heart attack warning signs, call 911 immediately:
  • Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
  • Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
  • Shortness of breath
  • Nausea or lightheadedness
Stroke
If you suddenly experience any of the following stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death. Stroke warning signs may include:
  • Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
  • Feeling confused
  • Difficulty walking and talking and lacking coordination
  • Developing a severe headache for no apparent reason
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb. A recent large study from Sweden of 2,480 patients with diabetic foot ulcers found that certain factors increased the likelihood of amputation, including being male and having had diabetes for longer than 23 years.
Diabetes can also make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
  • Inflammation and tenderness anywhere on your body
  • Red, itchy rash surrounded by small blisters or scales
  • Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
  • Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
  • Sharp pain that gets worse at night
  • Muscle weakness that makes walking difficult
  • Bladder infections and problems with bladder control
  • Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
  • Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
  • Swelling in your ankles and legs
  • Leg cramps
  • A need to go to the bathroom more often at night
  • A reduction in your need for insulin
  • Nausea and vomiting
  • Weakness and paleness
  • Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
  • Blurry vision that lasts for more than two days
  • Sudden loss of vision in one or both eyes
  • Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
  • A sensation of seeing "flashing lights"
  • Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
  • Frequent urination
  • Extreme thirst
  • Feeling tired and weak
  • Blurry vision
  • Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.

     
    Với những mẹ có con trai thì việc có nên cắt bao quy đầu cho bé là điều mà mẹ khá đắn đo và quan tâm. Phần lớn mọi người đều cho rằng nên cắt bao quy đầu cho bé càng sớm càng tốt để giảm đau đớn, hạn chế các nguy cơ về bệnh tiết niệu, đường tiểu ở bé, liệu điều này có đúng?

    me_co_nen_cat_bao_qui_dau_som_cho_be
    Lớp da ở đầu dương vật thuộc loại nhạy cảm nhất trên cơ thể con người, nó đảm bảo cho khoái cảm sinh lý. Nếu cắt bỏ lớp da đó thì sẽ ảnh hưởng đến cuộc sống tình dục sau này của bé trai, vì khoái cảm sinh lý chắc chắn sẽ bị giảm bớt.
    Ngoài ra việc phẫu thuật cắt da quy đầu phụ thuộc nhiều vào tay nghề của bác sĩ thực hiện. Trong nhiều trường hợp, bác sĩ đã cắt đi khá nhiều lớp da này nên dễ gây ra tổn thương không chỉ cho đầu dương vật, mà còn cho cả ống dẫn nước tiểu đi qua đầu dương vật nữa. Việc này gây nguy cơ lớn về biến chứng khiến bé rất khó đi tiểu bình thưởng, và điều trị cho biến chứng này không hề dễ.
    Vì vậy, việc cắt bao quy đầu rõ ràng là việc không cần thực hiện nếu bé vẫn đi tiểu tốt và không bị hẹp bao quy đầu (khi bé lớn tầm 4 tuổi, dương vật phát triển và tự kéo tuột lớp da xuống giúp bé đi tiểu bình thường). Thay vào đó, mẹ có thể chăm vệ sinh vùng nhạy cảm của bé và hướng dẫn bé tự vệ sinh khu vực nhạy cảm của mình mỗi lần vệ sinh xong (Với các bé lớn). Và với những triệu chứng hẹp bao quy đầu mẹ có thể thử nong phần da quy đầu của bé với thuốc mỡ; nếu không hiệu quả thì có thể hỏi ý bác sĩ để cắt bao quy đầu cho bé.
    Chúc bé khoẻ mẹ vui ^^
     
     
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    Living Low-Carb : Pros vs cons of the Diet


    Living Low-Carb: Pros of the Diet
    Some of the positive aspects of the diet are:
    • Low-carb diets can work. Studies have shown that a low-carb diet can be more effective in helping you lose weight, especially when you first start dieting. And low-carb dieters' cholesterol levels tend to improve while on the diet.
    • Most Americans need to cut back on processed grains. "The problem really with grain foods is just that people are eating too many processed grains," says Andrea Giancoli, MPH, RD, a spokesperson for the American Dietetic Association. Processed grains include foods like sweet baked goods, white bread, white pasta, and white rice.

      Katherine Tallmadge, MA, RD, national spokesperson for the American Dietetic Association and author of Diet Simple: 192 Mental Tricks, Substitutions, Habits and Inspirations, agrees that people who eat too many carbohydrates are likely to gain weight. "Excess carbohydrates — excess anything — is going to mean excess calories," she says. And that adds up to excess pounds.
    Living Low-Carb: Cons of the Diet
    Living Low-Carb, like many popular diets, has certain potential drawbacks:
    • Advocating going into ketosis. Ketosis is a condition in which there is a build-up of ketones, byproducts of fat metabolism, in your blood. McCullough says that for people who need to lose weight, it is ideal to be in ketosis. But Giancoli disagrees: "Ketosis is not ideal — it is a survival mechanism that the body goes into when deprived of carbohydrates." Giancoli says that when you are in ketosis, your metabolism slows, you lose muscle tissue, your body loses minerals in the blood, and your brain doesn't work as well as it should.
    • Uncomfortable side effects. Eating too few carbohydrates has the potential to leave you feeling miserable, since low-carb eating can cause you to become constipated, nauseous, weak, and fatigued. Other side effects may include diarrhea, bad breath, headaches, or sleeping problems.
    • Cutting out healthful foods. In addition to refined carbohydrates, the Living Low-Carb diet limits some healthful foods, including milk and high-carb fruits and vegetables like bananas and potatoes. Tallmadge recommends steering clear of diets that make people afraid of eating healthful foods for fear of gaining weight. "You should be able to eat all of the fruits and vegetables you want and still be able to lose weight," Tallmadge says.
    • Risk of nutrient deficiency. When you limit the amount of fruits and whole grains you are eating, you may not be getting all of the vitamins, minerals, and fiber you need. Ask your doctor to recommend amultivitamin and a fiber supplement while you are on a low-carb diet.
    Living Low-Carb might be worth trying if you want to lose weight and cut down on carbs. Giancoli says that a low-carb diet can be healthful and balanced "as long as people are choosing lean protein, incorporating some whole grains, and are consuming some fruits and vegetables."

    How does the low-carb Diet work?


     
    The Living Low-Carb plan outlines an eating system designed to help people lose weight by reducing the amount of carbohydrates they consume.
    The calories in the foods you eat come from a combination of protein, fats, and carbohydrates. Carbohydrates are found in starchy and sugary (both natural and refined sugar) foods, such as bread, pasta, sweets, fruits, and vegetables. Low-carb diets, which usually require people to choose high-protein foods, such as milk, eggs, and cheese, over high-carbohydrate foods, including fruits and grains, have become more popular in recent years and have been shown to help people lose weight.
    In addition to teaching you how to eat, snack, attend parties, and dine out while on a low-carb diet, McCullough provides readers with 175 simple low-carb recipes. (She is also the author of The Low-Carb Cookbook.)
    A typical day on the diet might include:
    • Fruit and cottage cheese for breakfast
    • A green salad with chicken for lunch
    • Fruits, vegetables, hard-cooked eggs, seeds, or other low-carb snacks throughout the day
    • A burger without a bun for dinner
    • A low-carb after-dinner treat, like raspberries with chocolate