Health related information and news from around the world.

There are some scholars who believe the decline and fall of the Roman Empire was not due to moral decadence but to the debilitating effects of malaria.

Malaria was once widespread through Europe but is not longer endemic there.

The Romans believed the disease was due to the effects of the bad air, or “mal aria” arising from the swamps outside Rome. These swamps were the breeding ground of the anopheles mosquito, which spreads the disease to man.

A protazoa, or small one-celled animal, Plasmodium, causes the disease. There are four types of Plasmodium, P. ovale, P. falciparum, P. vivax and P. malariae, which can affect man and the falciparum is the most dangerous.

Until a few years ago, there was great hope that public health measures might lead to almost total eradication of this most ancient plague.

Unfortunately, this optimism was misplaced and the world situation is rapidly becoming worse. The control of malaria lies mainly in getting rid of the vector which is the anopheles mosquito.

*490/71/1*

Bunions may be due to narrow-pointed shoes — too narrow for the feet that occupy them.

But I don’t think scientific opinion will stand against fashion.

The main deformity in this condition is the displacement of the big toe toward the other toes.

This is known as hallux valgus and this disrupts the joint between the toe and the long bone of the foot, or metatarsal.

The head of the first metatarsal moves towards the centre of the body, that is, in the opposite direction from the toe, and as a result of pressure between this bone and the toe a bursa, or bag of fluid, forms in the tissues.

This is the bunion. The bursa becomes inflamed and painful and may even become infected.

Pressure on this bunion causes considerable pain.

As well, osteoarthrosis develops in the joint and causes further pain.

As the big toe moves across, the second toe, especially if it is longer than the first, has no room and then tends to bend upwards at the first joint.

*234/71/1*

Should you try acupuncture?

Many patients dislike taking medication, or they find that it is no longer working for them. Others suffer from undesirable side effects. Acupuncture is a relatively benign therapy that may help in some cases for pain management. A study done by Dr. Joseph M. Helms, a family practitioner in Berkeley. California, demonstrated how this ancient treatment may be effective for sufferers of dysmenorrhea.

Dr. Helms set up an experiment in which he divided forty-three women into four groups. One group got real acupuncture treatment at appropriate acupuncture points (specific points on the feet, knees, forearms, and lower abdomen). A second group was given false acupuncture, that is, at random points on their bodies. A third group was followed without medical attention or acupuncture, and the fourth group just “visited” the project doctor once a month. All of these women were regularly taking medication to control their monthly pain. (Remember, cramps are caused by high prostaglandin levels prompting the uterus to contract. Antidotes for cramps arc prostaglandin inhibitors.)

Dr. Helms’s study was undertaken for a period of twelve months before tabulating his results: 90.9 percent of those treated with mil acupuncture (ten out of eleven subjects) showed improvement; four out of eleven given false acupuncture said they felt improved. The real acupuncture group reported a decrease in cramping, pain, nausea, headache and backache, and premenstrual symptoms of fluid retention and breast tenderness, and they improved immediately. From his firsthand analysis. Dr. Helms theorises that acupuncture may work for any number of reasons, the concentration of prostaglandins in the endometrium is altered either directly by the stimulation of the acupuncture treatment or “indirectly via the concentration of estrogen or progesterone.” Again, he reported, it may be some other “neural mechanism triggered by the acupuncture treatments.”

Part of such a positive result of acupuncture treatment, Dr. Helms feels, is a “bias of self-selection.” This means chat it is possible that patients trilling to accept acupuncture as a valid medical treatment would be more willing to participate in such a study, while those who were against acupuncture were underrcpresented.

Nevertheless, the study had an interesting resolution, since most women in these groups wanted to stop taking medication and handle the treatment of pain in some other way. Dr. Hoffman feels that acupuncture can help in certain cases, but that women with endometriosis in an advanced state may get little pain relief Acupuncture has mystique, but it’s not a miracle cure.

*60\43\4*

There are a number of relatively minor disorders of the nails and the surrounding skin. These are fairly common in the community, and for this reason will be mentioned. Most of the more major disorders are fortunately less common, so only some of these will be discussed.

Paronychia is the most common nail condition seen in medical practice. It is an infection of the nail-fold caused by bacteria and yeast, and only very rarely by fungi. Most commonly, it affects people whose hands are frequently immersed in water. Women are more often affected than men, and diabetics more often than non-diabetics. It is particularly common among housewives, barmen, cooks, and cleaners. The predisposing factor is the loss of cuticle, which has most likely been damage by constant wetting or manicuring. This allows organisms to enter the exposed space between the nail-fold and the underlying nail. One or several fingers may be involved, but the index and middle fingers of the right hand are the most commonly affected.

As a result, the nail-fold becomes red, swollen, and painful. Pus will discharge from beneath, and the nail become discoloured and ridged. Treatment involves keeping the nails dry until the cuticle reforms and is able to exercise its protective function.

This means minimizing contact with water, soap, detergents and other irritants—a formidable undertaking for the housewife with young children. Loose rubber gloves with cotton linings should be used for all wet work. Unlined rubber gloves should be avoided, as they increase the softening of the skin by making the hands sweat. When getting the hands wet is unavoidable, then a drying spirit lotion should be immediately applied to the nail-fold after thorough drying of the hands. Overnight, an antibiotic cream effective against both bacteria and yeast should be applied.

Hangnails are splits in the skin along the sides of the nails, resulting in pieces of skin breaking away. They are due either to nail biting or to excessive dryness of the skin. Because dried skin loses its elasticity and tends to crack, the tendency is to pick at it. Often the cause of the dryness is repeated washing and/or inadequate drying of the hands. Protection of the hands, adequate drying, and careful manicuring followed by the application of softening ointments, will help prevent hangnail developing.

Nail biting is an extremely common habit, particularly amongst children. Often several members of the family may be nail biters. The patient is usually somewhat anxious, and the family background may contain elements of insecurity. Usually all fingernails are bitten, frequently right back to where the nail plate separates from the nail-bed. Consequently paronychia, nail deformities, hangnail and warts are very common. Occasionally, the application of foul-tasting paint to the nails may discourage the habit, although it is rarely an effective treatment. Some form of psychotherapy is probably the most useful treatment for adults.

*87\44\4*

There are three main energy systems that provide fuel for muscle. Two of these are anaerobic (literally, without oxygen), and the third is aerobic (with air or oxygen).

The final product used by each of these three systems is the high-energy molecule adenosine triphosphate (ATP) which, when split, provides energy for the muscles to contract. For those

Studying exercise performance, it’s the outcomes of these energy systems, particularly muscular contraction, and the types of exercises which improve them, which are important.

For those interested in fat loss, however, it is the fuel use, or substrate utilisation, operating within these systems and leading to the end product of ATP, which is most important, because this determines the rate at which energy is utilised and excess fat ‘burned up’.

The energy systems in relation to exercise have been covered in much more detail elsewhere, and so muscle physiology will only be considered in summary form here. We will then look at the metabolic pathways that provide the options for fuel for muscle. The implications of these for exercise planning for fat loss will be considered in detail. These pathways are complicated and much information is still to be learned from research in this area, but the following will provide an introduction for an understanding of the fat-burning process in humans.

Myth-information. Sit-ups to reduce abdominal fatness will result only in a “tight’ fat waist instead of a ‘loose’ fat waist. Sit-ups can tone muscle but will have little effect on the subcutaneous fat overlaying this muscle.

*139\186\4*

Chronic pelvic pain is associated with as many as 10% of hysterectomies but its cause is uncertain. Some studies suggest that there may be a link between this type of pain and psychological factors or a history of childhood sexual abuse. Investigation of the underlying cause usually entails a pelvic examination, laparoscopy, and ultrasound or magnetic resonance imaging (MRI) investigations. These can help rule out the presence of fibroids, endometriosis, adenomyosis, disorders of the ovaries and Fallopian tubes, and pelvic inflammatory disease. When no cause is identified for the pain, medical treatments such as nonsteroidal anti-inflammatory agents and the contraceptive Pill are often tried, with hysterectomy being the last resort when pain is so severe that it is disrupting everyday activities and seriously diminishing quality of life.

There are two main types of period pain or dysmenorrhoea (pronounced dis-men-or-eea). Primary dysmenorrhoea usually affects young women who have never been pregnant. It begins when bleeding starts or just beforehand and rarely lasts more than twenty-four hours. The pain is cramp-like and is usually felt in the lower abdomen, lower back or the insides of the thighs. Occasionally it is so severe that it causes fainting, nausea or vomiting. The cause of the pain is linked to an increase in contraction of the uterus. This may be related to excessive secretions of prostaglandin substances by the endometrium or an increased sensitivity of the uterus to them, causing stronger contractions. Secondary dysmenorrhoea is more often experienced by women whose periods have been painless for some years. The pain may last throughout the menstrual bleeding phase and is thought to be a symptom of something amiss in the reproductive system, for example tissue inflammation, endometriosis, pelvic infection or fibroids. Drugs with anti-prostaglandin activity are often used to treat dysmenorrhoea; in severe cases of primary dysmenorrhoea the pain can be stopped by the inhibition of ovulation through hormone treatments such as the contraceptive Pill.

*13\198\4*

Let us now explore the psychological influence of how much sleep we think we need on how we actually sleep.

It is an age-old exercise to classify people into different groups; for example, tall and short, intelligent and not intelligent, hardworking and lazy, and so on. When we try to classify people on the basis of different behaviours we are in fact dealing with characteristics that may overlap between groups. There are two common types of sleep pattern:

* The lark type, who wakes up very early in the morning

* The owl type, who goes to sleep late at night but stays in bed all day

Of course, these two represent the extremes and there is a continuum of behaviour in between. In other words, there is a giant lark and a giant owl on opposite ends of the spectrum and many smaller larks and smaller owls in between. Most of us are a bit of a lark and a bit of an owl, depending on the circumstances.

The lark is a North American singing bird that sings very early in the morning. Lark types are normally short sleepers, believing sleep to be a waste of time. Thomas Edison, the great inventor, was certainly a lark. He slept only a few hours each night, so that he could have more time for his study and research. He probably wished that there was no such thing as sleep and that there were 25 hours on the clock.

The owl is the big eyed, round faced bird that we see sitting on the branches of a tree with the moon behind. Owl types hate to wake up in the morning. They enjoy sleeping and being in bed, even if they are already awake. They like to stay in their beds as long as possible.

Carl Jung (1875-1961), the famous psychologist, identified two types of personality: the extrovert and and introvert. Larks belong to the extroverts. They are ambitious, full of energy, perfectionists, and unable to tolerate laziness. They dislike being alone, and are attracted to the outside world rather than to their immediate surroundings, such as their bedrooms. There is a tendency to superficiality, and their happiness may depend on making a good impression on others. They are absolutely essential to any party.

Owls belong to the introverts. They enjoy being alone in their own world and are lost in large gatherings. They are tolerant and reserved, sensitive and not outspoken. They may be over-conscientious, pessimistic, and critical, always keeping their best quality to themselves. They may often possess unusual knowledge or great talent. They love to stay in their houses and their beds.

*13\174\4*

This aggressive element is very deep-rooted; its beginnings can be seen in early infancy. Baby is happy when mother’s milk comes freely and easily, but if it does not come quickly enough or if it comes too quickly, he is frustrated, and in a moment we see anger in his face, and his aggression is vented in crying and generalized movements of his body.

Different children react differently to parental discipline. One child’s aggression may be aroused by a degree of discipline that would be easily tolerated by another. Anything which serves to make the child different from his fellows may arouse his aggression. Forced attendance at Sunday school, for example, or the failure of the parents to interest themselves in the matter, may worry the child and make him tense. When basic cultural or religious factors work to separate the family from others in the district, the child often suffers a smouldering aggressive reaction and his childhood may be marred by chronic anxiety and tension.

The adolescent is striving for adult status. He wants to be a man, and he is angered if he is still treated as a boy. He resents the controls which his parents and society exert over him for his well-being. This arouses aggression. To prove that he is grown-up he becomes defiant, and by his behaviour unconsciously sets about to show the world that no one can tell him what he must do. There may be impulsive and quite unpredictable displays of aggression which may take the form of unnecessary and inappropriate self-assertion. Such behaviour may alternate between the good-humoured and the vicious. The company of young men of his own age with impulsive aggression similar to his own provides an easy milieu for the dissipation of his aggression, and we have the genesis of the teen-age gang.

Sometimes the aggressive behaviour of the adolescent is easily explained. Recently a

long-haired youth of nineteen was brought to see me by his mother and father because he would not have his hair cut. When asked about it quietly, he said that he really did not care if his hair was short or long; but he was simply not going to be told when to have it cut by mother and father. He was merely expressing his right to make his own decisions. Like many youths, this lad was very tense because he felt constantly frustrated by his parents in his attempt to achieve adult status; his aggression was aroused and found expression in his behaviour and his way of wearing his hair. Many such lads lose their tension and come to behave in a more socially acceptable fashion when they realize what has been driving them to behave in this way.

*38\57\2*

As I have already mentioned, it is possible to administer St John’s Wort with a variety of other anti-depressants and other medications in general. A survey of European colleagues who have treated collectively several hundred patients with St John’s Wort revealed no drug interactions noted to date except for potential problematic interactions with the MAOIs as noted above. At one point it was thought that St John’s Wort might itself be an MAOI and might exert its anti-depressant effects by that mechanism. If that were the case, it would be potentially dangerous to combine St John’s Wort with other anti-depressants. Fortunately this does not appear to be the case to any significant degree and St John’s Wort can be used freely with other anti-depressants. Furthermore, you need not worry that you will develop the extremely uncomfortable and sometimes dangerous high blood pressure reaction after eating cheese or drinking red wine, as can occur with those who are on an MAOI. There are no dietary restrictions whatsoever when you are on St John’s Wort.

As I mentioned above, you might be best off moving more gradually with dosages if St John’s Wort is used in combination with other anti-depressants or stimulants as these medications all act on the nerve cells in the brain and can enhance one another’s effects. While this is one of the desired goals of the exercise, namely to induce a more powerful anti-depressant effect than would be obtained on any of the medications alone, it is also a reason to increase dosages gradually to avoid the development of exaggerated and unduly unpleasant side-effects.

*90\75\2*

SEIZURES-MOOD AND OTHER ILLNESSES

Mothers of young children with epilepsy can sometimes tell from their child’s mood and behaviour that they are ‘building up to a fit’. Adults with epilepsy may experience a peculiar feeling of heaviness or depression on the morning of the days of their seizures. Occasionally elation rather than depression is reported. It is impossible to decide whether these emotional changes cause the seizures, whether both the mood and the seizures are caused by some common factor, or whether the change in mood is in some way produced by a limited paroxysmal discharge that finally erupts into an obvious seizure.

Other illnesses-Any one with epilepsy may have a seizure in relation to a severe other illness such as pneumonia. In children with epilepsy, fever may precipitate seizures, but it is important to retain the distinction between these and febrile convulsions.

*29\188\2*