Health care is the physical and mental impairment in humans and treatment, diagnosis and disease, illness, injury. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers.
Tuesday 13 March 2012
Sunday 11 March 2012
This Blog is about health
Health is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain. The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.Although this definition has been subject to controversy, in particular as having a lack of operational value and the problem created by use of the word "complete", it remains the most enduring.Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health.
Health is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain. The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.Although this definition has been subject to controversy, in particular as having a lack of operational value and the problem created by use of the word "complete", it remains the most enduring.Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health.
Good Health
Good Health
Good Health
The health is a word of english comes from the old english word hale, meaning ''wholeness, a being whole, sound or well.and Health is the word used to describe how your body feels. Being healthy is important because it makes you feel good and live longer.
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain.The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain.The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Health
Health
Health
Tuesday 28 February 2012
This blog is about athlete's foot infections
The medical name for athlete's foot is tinea pedis. Usually, athlete's foot affects the soles of the feet and the areas between the toes, and it may also spread to the toenails. Athlete's foot can also spread to the palms of your hands, groin, or underarms if you touch your feet and then touch another area of your body.
Athlete's foot doesn't just aggravate athletes; anyone whose feet tend to be damp or sweaty can get this infection. The fungi that cause athlete's foot thrive in warm, moist environments.
The signs and symptoms of athlete's foot include itching, burning, redness, and stinging on the soles of the feet. The skin may flake, peel, blister, or crack.
The medical name for athlete's foot is tinea pedis. Usually, athlete's foot affects the soles of the feet and the areas between the toes, and it may also spread to the toenails. Athlete's foot can also spread to the palms of your hands, groin, or underarms if you touch your feet and then touch another area of your body.
Athlete's foot doesn't just aggravate athletes; anyone whose feet tend to be damp or sweaty can get this infection. The fungi that cause athlete's foot thrive in warm, moist environments.
The signs and symptoms of athlete's foot include itching, burning, redness, and stinging on the soles of the feet. The skin may flake, peel, blister, or crack.
Sunday 15 January 2012
Types of GermsThe term germs is really just a generic word for four different types of organisms: bacteria, viruses, fungi, and protozoa.
Bacteria
Bacteria are tiny, single-celled organisms that are found throughout nature, including in the bodies of human beings. A certain number of bacteria are good for our bodies — they help keep the digestive system in working order and keep harmful bacteria from moving in. Some bacteria are even used to produce medicines and vaccines.
But bacteria can cause trouble, too — ever had a urinary tract infection or strep throat? These infections are caused by bacteria.
Viruses Viruses are even smaller than bacteria and can't live on their own. In order to survive, grow, and reproduce, they need to be inside other living organisms. Most viruses can only live for a very short time outside other living cells. For example, they can stay on surfaces like a countertop or toilet seat in infected bodily fluids for a short period of time, but they quickly die there unless a live host comes along. But some viruses, such as the kind that cause hepatitis (an infection of the liver), can survive on surfaces for a week or longer and still be able to cause infections.
Once they've moved into your body, viruses spread easily and can make you quite sick. Viruses are responsible for not-so-serious diseases like colds as well as extremely serious diseases like smallpox.
Fungi
Fungi (pronounced: fun-jye) are multi-celled, plant-like organisms that usually aren't dangerous in a healthy person. Fungi can't produce their own food from soil, water, and air, so instead, they get nutrition from plants, food, and animals in damp, warm environments.
Two common fungal infections are athlete's foot and ringworm. People who have weakened immune systems (from diseases like AIDS or cancer) may develop more serious fungal infections.
Protozoa
Protozoa (pronounced: pro-toe-zo-uh) are one-celled organisms like bacteria. Protozoa love moisture, so intestinal infections and other diseases they cause are often spread through contaminated water.
Once organisms like bacteria, viruses, fungi, and protozoa invade your body, they get ready to stay for a while. These germs draw all their energy from you! They may damage or destroy some of your own healthy cells. As they use up your nutrients and energy, most will produce waste products, known as toxins.
Some toxins cause the annoying symptoms of common colds or flu-like infections, such as sniffles, sneezing, coughing, and diarrhea. But other toxins can cause high fever, increased heart rate, and even life-threatening illness.
If you're not feeling well and visit your doctor, he or she may order testing to examine your blood and other fluids under a microscope or perform cultures to determine which germs (if any) are making you sick.
Bacteria
Bacteria are tiny, single-celled organisms that are found throughout nature, including in the bodies of human beings. A certain number of bacteria are good for our bodies — they help keep the digestive system in working order and keep harmful bacteria from moving in. Some bacteria are even used to produce medicines and vaccines.
But bacteria can cause trouble, too — ever had a urinary tract infection or strep throat? These infections are caused by bacteria.
Bacteria
Bacteria
Epidermidis Bacteria
Once they've moved into your body, viruses spread easily and can make you quite sick. Viruses are responsible for not-so-serious diseases like colds as well as extremely serious diseases like smallpox.
Viruses
Viruses
Viruses
Fungi (pronounced: fun-jye) are multi-celled, plant-like organisms that usually aren't dangerous in a healthy person. Fungi can't produce their own food from soil, water, and air, so instead, they get nutrition from plants, food, and animals in damp, warm environments.
Two common fungal infections are athlete's foot and ringworm. People who have weakened immune systems (from diseases like AIDS or cancer) may develop more serious fungal infections.
Fungi
Fungi
Protozoa
Protozoa (pronounced: pro-toe-zo-uh) are one-celled organisms like bacteria. Protozoa love moisture, so intestinal infections and other diseases they cause are often spread through contaminated water.
Once organisms like bacteria, viruses, fungi, and protozoa invade your body, they get ready to stay for a while. These germs draw all their energy from you! They may damage or destroy some of your own healthy cells. As they use up your nutrients and energy, most will produce waste products, known as toxins.
Some toxins cause the annoying symptoms of common colds or flu-like infections, such as sniffles, sneezing, coughing, and diarrhea. But other toxins can cause high fever, increased heart rate, and even life-threatening illness.
If you're not feeling well and visit your doctor, he or she may order testing to examine your blood and other fluids under a microscope or perform cultures to determine which germs (if any) are making you sick.
Protozoa
Protozoa
Protozoa
Protozoa
Flu Vaccine
It's especially important for people with certain medical conditions (like kidney disease, diabetes, HIV, heart problems, or asthma) to get a flu vaccine because getting vaccinated can protect against complications like pneumonia. Kids and teens who take aspirin regularly also need to be vaccinated because they're at risk for developing a serious condition called Reye syndrome if they get the flu.Another reason for getting vaccinated is to protect the people around you who might get seriously ill from flu, especially because many (like very young babies) can't be vaccinated themselves. It's what scientists call "herd immunity" by protecting yourself you are also protecting other people who are more vulnerable because there's less chance you'll get the flu and pass it on.
So be sure to get vaccinated if you are around people who are at risk if they get the flu, like babies, people with a serious illness, and the elderly.
Swine Flu Vaccine
Jock itch
Jock itch is a pretty common fungal infection of the groin and upper thighs. It's part of a group of fungal skin infections called tinea. The medical name for jock itch is tinea cruris (pronounced: tih-nee-uh krur-us).
Jock itch, like other tinea infections, is caused by several types of mold-like fungi called dermatophytes (pronounced: dur-mah-tuh-fites). All of us have microscopic fungi and bacteria living on our bodies, and dermatophytes are among them. Dermatophytes live on the dead tissues of your skin, hair, and nails and thrive in warm, moist areas like the insides of the thighs. So, when the groin area gets sweaty and isn't dried properly, it provides a perfect environment for the fungi to multiply and thrive.
Jock itch is a pretty common fungal infection of the groin and upper thighs. It's part of a group of fungal skin infections called tinea. The medical name for jock itch is tinea cruris (pronounced: tih-nee-uh krur-us).
Jock itch, like other tinea infections, is caused by several types of mold-like fungi called dermatophytes (pronounced: dur-mah-tuh-fites). All of us have microscopic fungi and bacteria living on our bodies, and dermatophytes are among them. Dermatophytes live on the dead tissues of your skin, hair, and nails and thrive in warm, moist areas like the insides of the thighs. So, when the groin area gets sweaty and isn't dried properly, it provides a perfect environment for the fungi to multiply and thrive.
Saturday 14 January 2012
This Blog Post is about Dengue Fever Signs and Symptoms With Photos
Dengue Fever Signs and Symptoms
Typically, people infected with dengue virus are asymptomatic (80%) or only have mild symptoms such as an uncomplicated fever.[1][2][3] Others have more severe illness (5%), and in a small proportion it is life-threatening.[1][3] The incubation period (time between exposure and onset of symptoms) ranges from 3–14 days, but most often it is 4–7 days.[4] Therefore, travelers returning from endemic areas are unlikely to have dengue if fever or other symptoms start more than 14 days after arriving home.[5] Children often experience symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea),[6] but are more susceptible to the severe complications.[5]
Clinical course
The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, and a rash. The alternative name for dengue, "break-bone fever", comes from the associated muscle and joint pains.[1][7] The course of infection is divided into three phases: febrile, critical, and recovery.[8]
The febrile phase involves high fever, often over 40 °C (104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days.[7][8] At this stage, a rash occurs in approximately 50–80% of those with symptoms.[7][9] It occurs in the first or second day of symptoms as flushed skin, or later in the course of illness (days 4–7), as a measles-like rash.[9][10] Some petechiae (small red spots that do not disappear when the skin is pressed, which are caused by broken capillaries) can appear at this point,[8] as may some mild bleeding from the mucous membranes of the mouth and nose.[5][7] The fever itself is classically biphasic in nature, breaking and then returning for one or two days, although there is wide variation in how often this pattern actually happens.[10][11]
In some people, the disease proceeds to a critical phase, which follows the resolution of the high fever and typically lasts one to two days.[8] During this phase there may be significant fluid accumulation in the chest and abdominal cavity due to increased capillary permeability and leakage. This leads to depletion of fluid from the circulation and decreased blood supply to vital organs.[8] During this phase, organ dysfunction and severe bleeding, typically from the gastrointestinal tract, may occur.[5][8] Shock (dengue shock syndrome) and hemorrhage (dengue hemorrhagic fever) occur in less than 5% of all cases of dengue,[5] however those who have previously been infected with other serotypes of dengue virus ("secondary infection") are at an increased risk.[5][12]
The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream.[8] This usually lasts two to three days.[5] The improvement is often striking, but there may be severe itching and a slow heart rate.[5][8] During this stage, a fluid overload state may occur; if it affects the brain, it may cause a reduced level of consciousness or seizures.[5]
Associated problems
Dengue can occasionally affect several other body systems,[8] either in isolation or along with the classic dengue symptoms.[6] A decreased level of consciousness occurs in 0.5–6% of severe cases, which is attributable either to infection of the brain by the virus or indirectly as a result of impairment of vital organs, for example, the liver.[6][11]
Other neurological disorders have been reported in the context of dengue, such as transverse myelitis and Guillain-Barré syndrome.[6] Infection of the heart and acute liver failure are among the rarer complications.
Dengue Fever Signs and Symptoms Photos
Dengue Fever Signs and Symptoms
Dengue Fever Diagnosis
The diagnosis of dengue is typically made clinically, on the basis of reported symptoms and physical examination; this applies especially in endemic areas.[1] However, early disease can be difficult to differentiate from other viral infections.[5] A probable diagnosis is based on the findings of fever plus two of the following: nausea and vomiting, rash, generalized pains, low white blood cell count, positive tourniquet test, or any warning sign (see table) in someone who lives in an endemic area.[23] Warning signs typically occur before the onset of severe dengue.[8] The tourniquet test, which is particularly useful in settings where no laboratory investigations are readily available, involves the application of a blood pressure cuff for five minutes, followed by the counting of any petechial hemorrhages; a higher number makes a diagnosis of dengue more likely.[8] It can be difficult to distinguish dengue fever and chikungunya, a similar viral infection that shares many symptoms and occurs in similar parts of the world to dengue.[7] Often, investigations are performed to exclude other conditions that cause similar symptoms, such as malaria, leptospirosis, typhoid fever, and meningococcal disease.[5]
The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis.[5] In severe disease, plasma leakage results in hemoconcentration (as indicated by a rising hematocrit) and hypoalbuminemia.[5] Pleural effusions or ascites can be detected by physical examination when large,[5] but the demonstration of fluid on ultrasound may assist in the early identification of dengue shock syndrome.[1][5] The use of ultrasound is limited by lack of availability in many settings.
Dengue Fever Diagnosis
Dengue Fever Diagnosis
Dengue Fever Diagnosis
Dengue Fever Diagnosis
Dengue Fever Diagnosis
Spinal Cord Injury With Photos
A spinal cord injury (SCI) refers to any injury to the spinal cord that is caused by trauma instead of disease.[1] Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence.[2][3] Spinal cord injuries are described at various levels of "incomplete", which can vary from having no effect on the patient to a "complete" injury which means a total loss of function.
Treatment of spinal cord injuries starts with restraining the spine and controlling inflammation to prevent further damage. The actual treatment can vary widely depending on the location and extent of the injury. In many cases, spinal cord injuries require substantial physical therapy and rehabilitation, especially if the patient's injury interferes with activities of daily life.
Spinal cord injuries have many causes, but are typically associated with major trauma from motor vehicle accidents, falls, sports injuries, and violence. Research into treatments for spinal cord injuries includes controlled hypothermia and stem cells, though many treatments have not been studied thoroughly and very little new research has been implemented in standard care.
Signs and symptoms
Signs observed by a physician and symptoms experienced by a patient will vary depending on where the spine is injured and the extent of the injury. These are all determined by the area of the body that the injured area of the spine innervates. A section of skin innervated through a specific part of the spine is called a dermatome, and spinal injury can cause pain, numbness, or a loss of sensation in the relevant areas. A group of muscles innervated through a specific part of the spine is called a myotome, and injury to the spine can cause problems with voluntary motor control. The muscles may contract uncontrollably, become weak, or be completely unresponsive. The loss of muscle function can have additional effects if the muscle is not used, including atrophy of the muscle and bone degeneration.
A severe injury may also cause problems in parts of the spine below the injured area. In a "complete" spinal injury, all function below the injured area are lost. In an "incomplete" injury, some or all of the functions below the injured area may be unaffected. If the patient has the ability to contract the anal sphincter voluntarily or to feel a pinprick or touch around the anus, the injury is considered to be incomplete. The nerves in this area are connected to the very lowest region of the spine, the sacral region, and retaining sensation and function in these parts of the body indicates that the spinal cord is only partially damaged.
A complete injury frequently means that the patient has little hope of functional recovery.[citation needed] The relative incidence of incomplete injuries compared to complete spinal cord injury has improved over the past half century, due mainly to the emphasis on better initial care and stabilization of spinal cord injury patients.[8] Most patients with incomplete injuries recover at least some function.[citation needed]
In addition to sensation and muscle control, the loss of connection between the brain and the rest of the body can have specific effects depending on the location of the injury.
Determining the exact "level" of injury is critical in making accurate predictions about the specific parts of the body that may be affected by paralysis and loss of function. The level is assigned according to the location of the injury by the vertebra of the spinal column. While the prognosis of complete injuries are generally predictable since recovery is rare, the symptoms of incomplete injuries can vary and it is difficult to make an accurate prediction of the outcome.
Cervical
Cervical (neck) injuries usually result in full or partial tetraplegia (Quadriplegia). However, depending on the specific location and severity of trauma, limited function may be retained.
Injuries at the C-1/C-2 levels will often result in loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing.
C3 vertebrae and above : Typically results in loss of diaphragm function, necessitating the use of a ventilator for breathing.
C4 : Results in significant loss of function at the biceps and shoulders.
C5 : Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands.
C6 : Results in limited wrist control, and complete loss of hand function.
C7 and T1 : Results in lack of dexterity in the hands and fingers, but allows for limited use of arms.
Patients with complete injuries above C7 typically cannot handle activities of daily living and cannot function independently.[citation needed]
Additional signs and symptoms of cervical injuries include:
Inability or reduced ability to regulate heart rate, blood pressure, sweating and hence body temperature.
Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances.
Thoracic
Complete injuries at or below the thoracic spinal levels result in paraplegia. Functions of the hands, arms, neck, and breathing are usually not affected.
T1 to T8 : Results in the inability to control the abdominal muscles. Accordingly, trunk stability is affected. The lower the level of injury, the less severe the effects.
T9 to T12 : Results in partial loss of trunk and abdominal muscle control.
Lumbosacral
The effects of injuries to the lumbar or sacral regions of the spinal cord are decreased control of the legs and hips, urinary system, and anus.
Bowel and bladder function is regulated by the sacral region of the spine. In that regard, it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder and anal incontinence, after traumatic injury.
Sexual function is also associated with the sacral spinal segments, and is often affected after injury. During a psychogenic sexual experience, signals from the brain are sent to spinal levels T10-L2 and in case of men, are then relayed to the penis where they trigger an erection. A reflex erection, on the other hand, occurs as a result of direct physical contact to the penis or other erotic areas such as the ears, nipples or neck. A reflex erection is involuntary and can occur without sexually stimulating thoughts. The nerves that control a man's ability to have a reflex erection are located in the sacral nerves (S2-S4) of the spinal cord and could be affected after a spinal cord injury.[9]
Causes
Spinal cord injuries are most often traumatic, caused by lateral bending, dislocation, rotation, axial loading, and hyperflexion or hyperextension of the cord or cauda equina. Motor vehicle accidents are the most common cause of SCIs, while other causes include falls, work-related accidents, sports injuries, and penetrations such as stab or gunshot wounds.[11] SCIs can also be of a non-traumatic origin, as in the case of cancer, infection, intervertebral disc disease, vertebral injury and spinal cord vascular disease.[12]
Diagnosis
A radiographic evaluation using a x-ray, MRI or CT scan can determine if there is any damage to the spinal cord and where it is located. A neurologic evaluation incorporating sensory testing and reflex testing can help determine the motor function of a person with a SCI.
Rehabilitation
The rehabilitation process following a spinal cord injury typically begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals typically work as a team to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition.
In the acute phase physical therapists focus on the patient’s respiratory status, prevention of indirect complications (such as pressure sores), maintaining range of motion, and keeping available musculature active.[25] Physical therapists can assist immobilized patients with effective cough techniques, secretion clearance, stretching of the thoracic wall, and suggest abdominal support belts when necessary. The amount of time a patient is immobilized may depend on the level of the spinal cord injury. Physical therapists work with the patient to prevent any complications that may arise due to this immobilization.
As a team, health-care professionals help to re-orient the patient, provide support for the patient and family, and begin to develop goals with the patient.
Occupational therapy plays an important role in the management of SCI.[26]
Recent studies emphasize the importance of early occupational therapy, started immediately after the client is stable. This process includes teaching of coping skills, and physical therapy.[27]
In the first step, acute recovery, the focus is on support and prevention. Interventions aim to give the individual a sense of control over a situation in which the patient likely feels little independence.[28]
As the patient becomes more stable, they may move to a rehabilitation facility or remain in the acute care setting. The patient begins to take more of an active role in their rehabilitation at this stage and works with the team to develop reasonable functional goals.[25]
Though rehabilitation interventions are performed during the acute phase, recent literature suggests that 44% of the total hours spent on rehabilitation during the first year after spinal cord injury, occur after discharge from inpatient rehabilitation.[29] Participants in this study received 56% of their total physical therapy hours and 52% of their total occupational therapy hours after discharge.[29] This suggests that inpatient rehabilitation lengths of stay are reduced and that post-discharge therapy may replace some of the inpatient treatment.
Whether patients are placed in inpatient rehabilitation or discharged, physical therapists attempt to maximize functional independence at this stage. Depending on the level of the spinal cord injury, whatever sparing the patient has is optimized. Bed mobility, transfers, wheelchair mobility skills, and performing other activities of daily living (ADLs) are just a few of the interventions that physical therapists can help the patient with.
ADLs can be difficult for an individual with a spinal cord injury; however, through the rehabilitation process, individuals with SCI may be able to live independently in the community with or without full-time attendant care, depending on the level of their injury.[28]
Further interventions focus on support and education for the individual and caregivers.[28] This includes an evaluation of limb function to determine what the patient is capable of doing independently, and teaching the patient self-care skills.[30] Independence in daily activities like eating, bowel and bladder management and mobility is the goal, as obtaining competency in self-care tasks contributes significantly to an individual's sense of self confidence[28] and reduces the burden on caregivers. Quality of life issues such as sexual health and function are also addressed.[31]
Assistive devices such as wheelchairs have a substantial effect on the quality of life of the patient, and careful selection is important.[32] Teaching the patient how to transfer from different positions, such as from a wheelchair into bed, is an important part of therapy, and devices such as sliding transfer boards and grab bars can assist in these tasks.[30] Individuals who are able to transfer independently from their wheelchair to the driver's seat using a sliding transfer board may be able to return to driving in an adapted vehicle. Complete independence with driving also requires the ability to load and unload one's wheelchair from the vehicle.[28]
In addition to acquiring skills such as wheelchair transfers, individuals with a spinal cord injury can greatly benefit from exercise reconditioning. In the majority of cases, spinal cord injury leaves the lower limbs either entirely paralyzed, or with insufficient strength, endurance, or motor control to support safe and effective physical training. Therefore, most exercise training employs the use of arm crank ergometry, wheelchair ergometry, and swimming.[33] In one study, subjects with traumatic spinal cord injury participated in a progressive exercise training program, which involved arm ergometry and resistance training. Subjects in the exercise group experienced significant increases in strength for almost all muscle groups when compared to the control group. Exercisers also reported less stress, fewer depressive symptoms, greater satisfaction with physical functioning, less pain, and better quality of life.[34] Physical therapists are able to provide a variety of exercise interventions, including, passive range of motion exercises, upper body wheeling (arm crank ergometry), functional electrical stimulation, and electrically stimulated resistance exercises all of which can improve arterial function in those living with SCI.[35] Physical therapists can improve the quality of life of individuals with spinal cord injury by developing exercise programs that are tailored to meet individual patient needs. Adapted physical activity equipment can also be used to allow for sport participation: for example, sit-skiis can be used by individuals with a spinal cord injury for cross-country or downhill skiing.
Body weight supported treadmill training is another intervention that physiotherapists may assist with. Body weight supported treadmill training has been researched in an attempt to prevent bone loss in the lower extremities in individuals with spinal cord injury. Research has shown that early weight-bearing after acute spinal cord injury by standing or treadmill walking (5 times weekly for 25 weeks) resulted in no loss or only moderate loss in trabecular bone compared with immobilized subjects who lost 7-9% of trabecular bone at the tibia.[36] Gait training with body weight support, among patients with incomplete spinal cord injuries, has also recently been shown to be more effective than conventional physiotherapy for improving the spatial-temporal and kinematic gait parameters.[37]
The patient's living environment can also be modified to improve independence. For example, ramps or lifts can be added to a patient's home, and part of rehabilitation involves investigating options for returning to previous interests as well as developing new pursuits.[31] Community participation is an important aspect in maintaining quality of life.
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury
Nerve Injury
Nerve injury is injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injury. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis.[citation needed] In 1941, Seddon introduced a classification of nerve injuries based on three main types of nerve fiber injury and whether there is continuity of the nerve.[1]
Types
Neurapraxia
This is the least severe form of nerve injury, with complete recovery. In this case, the actual structure of the nerve remains intact, but there is an interruption in conduction of the impulse down the nerve fiber. Most commonly, this involves compression of the nerve or disruption to the blood supply (ischemia). There is a temporary loss of function which is reversible within hours to months of the injury (the average is 6–8 weeks). Wallerian degeneration does not occur, so recovery does not involve actual regeneration. There is frequently greater involvement of motor than sensory function with autonomic function being retained. In electrodiagnostic testing with nerve conduction studies, there is a normal compound motor action potential amplitude distal to the lesion at day 10, and this indicates a diagnosis of mild neuropraxia instead of axonotmesis or neurotmesis.[2]
Axonotmesis
This is a more severe nerve injury with disruption of the neuronal axon, but with maintenance of the myelin sheath. This type of nerve damage may cause paralysis of the motor, sensory, and autonomic. Mainly seen in crush injury.
If the force creating the nerve damage is removed in a timely fashion, the axon may regenerate, leading to recovery. Electrically, the nerve shows rapid and complete degeneration, with loss of voluntary motor units. Regeneration of the motor end plates will occur, as long as the endoneural tubules are intact.
Axonotmesis involves loss of the relative continuity of the axon and its covering of myelin, but preservation of the connective tissue framework of the nerve ( the encapsulating tissue, the epineurium and perineurium, are preserved ). Because axonal continuity is lost, Wallerian degeneration occurs. Electromyography ( EMG ) performed 2 to 3 weeks later shows fibrillations and denervation potentials in musculature distal to the injury site. Loss in both motor and sensory spines is more complete with axonotmesis than with neurapraxia, and recovery occurs only through regenerations of the axons, a process requiring time.
Axonotmesis is usually the result of a more severe crush or contusion than neurapraxia, but can also occur when the nerve is stretched (without damage to the epineurium). There is usually an element of retrograde proximal degeneration of the axon, and for regeneration to occur, this loss must first be overcome. The regeneration fibers must cross the injury site and regeneration through the proximal or retrograde area of degeneration may require several weeks. Then the neuritis tip progresses down the distal site, such as the wrist or hand. Proximal lesion may grow distally as fast as 2 to 3 mm per day and distal lesion as slowly as 1.5 mm per day. Regeneration occurs over weeks to years.
Neurotmesis
Neurotmesis is the most severe lesion with potential of recovering. It occurs on severe contusion, stretch, laceration, or Local Anesthetic Toxicity. Not only the axon, but the encapsulating connective tissue lose their continuity. The last (extreme) degree of neurotmesis is transsection, but most neurotmetic injuries do not produce gross loss of continuity of the nerve but rather internal disruption of the architecture of the nerve sufficient to involve perineurium and endoneuruim as well as axons and their covering. Denervation changes recorded by EMG are the same as those seen with axonotmetic injury. There is a complete loss of motor, sensory and autonomic function. If the nerve has been completely divided, axonal regeneration causes a neuroma to form in the proximal stump. For neurotmesis, it is better to use a new more complete classification called the Sunderland System.
[edit]
Regeneration
Main article: Neuroregeneration
Physiological mechanisms or neuroregeneration may include remyelination, generation of new neurons, glia, axons, myelin or synapses. Neuroregeneration differs between the Peripheral Nervous System (PNS) and the Central Nervous System (CNS) by the functional mechanisms and especially, the extent and speed.
Surgery can be done in case a peripheral nerve has become cut or otherwise divided. Recovery of a nerve after surgical repair depends mainly on the age of the patient. Young children can recover close-to-normal nerve function.[3] In contrast, a patient over 60 years old with a cut nerve in the hand would expect to recover only protective sensation, that is, the ability to distinguish hot/cold or sharp/dull.[3] Many other factors also affect nerve recovery.[3]
In contrast, repair after damage to the central nervous system is limited.
Nerve Injury
Nerve Injury
Nerve Injury
Nerve Injury
This Blog is about Soft Tissue Injury and Photos
Soft Tissue Injury
A Soft tissue injury (STI) is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain, a one off blow resulting in a contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain, swelling, bruising and loss of function (Lovering, 2008).
Management
Immediately after the injury occurs one should apply the RICE principle to minimize the local tissue damage and reduce inflammation.
[l.]
’R’est ’I’ce ’C’ompression ‘E’levation
’PROTECTION’ Protect the individual from further injury by preventing them from moving and keep further hazards away from the individual (Flegel, 2004).
‘REST’ Rest the individual from any activity that causes pain. If simple movements such as bending, straightening or walking are causing pain ‘’rest’’ means immobilizing the injury by splinting or preventing weight bearing with crutches (Flegel, 2004). If walking does not cause any pain, continue to walk for short distances as comfort allows (Lindsay, Watson, Hickmott, Broadfoot & Bruynel, 1994).
’ICE’ During the first 72 hours following an injury ice can help minimize pain and control swelling caused by bleeding and fluid loss from the injured tissue (Flegel, 2004). Icing is recommended for 15minutes every 4 hours to help control the swelling and pain (Subotnick, 1991).
‘COMPRESSION’ Compression is the application of pressure over the injured area with the use of a bandage, elastic wrap or compression tape (Lindsay et al., 1994). This is to control the initial bleeding of joint or limb tissues, or to reduce residual swelling (Flegel, 2004). It is vital that compression is applied within the first few minutes following the injury to see the benefits (Lindsay et al., 1994).
‘ELEVATION’ Used in combination with ice and compression, elevation can also minimize initial tissue bleeding and swelling. Elevate the injured part above the level of the heart as much as possible for the first 72hours, or longer of the swelling persists. (Flegel, 2004). Meh
Treatment
If severe pain persists after the first 24hours it is recommended that an individual consults with a professional who can make a diagnosis and implement a treatment plan so the patient can return to everyday activities (Flegel, 2004). These are some of the tools that a professional can use to help make a full diagnosis;
Nerve conduction studies may also be used to localize nerve dysfunction (e.g., carpal tunnel syndrome), assess severity, and help with prognosis. Electrodiagnosis also helps differentiate between myopathy and neuropathy.
Ultimately, the best method of imaging soft tissue is magnetic resonance imaging (MRI), though it is cost-prohibitive and carries a high false positive rate.
Soft Tissue Injury
Soft Tissue Injury
Soft Tissue Injury
Soft Tissue Injury
Soft Tissue Injury
Soft Tissue Injury
Sports Injury
Sports injuries are injuries that occur to athletes participating in sporting events. In many cases, these types of injuries are due to overuse of a part of the body when participating in a certain activity. For example, runner's knee is a painful condition generally associated with running, while tennis elbow is a form of repetitive stress injury at the elbow. Other types of injuries can be caused by a hard contact with something. This can often cause a broken bone or torn ligament or tendon
Injuries are a common occurrence in professional sports and most teams have a staff of Athletic Trainers and close connections to the medical community. Controversy has arisen at times when teams have made decisions that could threaten a players long-term health for short term gain.
Classification
Sports injuries can be broadly classified as either traumatic or overuse injuries. Traumatic injuries account for most injuries in contact sports such as Association football, rugby league, rugby union, Australian rules football, Gaelic football and American football because of the dynamic and high collision nature of these sports. These injuries range from bruises and muscle strains, to fractures and head injuries.
A bruise or contusion is damage to small blood vessels which causes bleeding within the tissues. A muscle strain is a small tear of muscle fibers and a ligament sprain is a small tear of ligament tissue. The body’s response to these sports injuries is the same in the initial five day period immediately following the traumatic incident – inflammation.
Signs and symptoms
Inflammation is characterized by pain, localized swelling, heat, redness and a loss of function.
Mechanism
All of these traumatic injuries cause damage to the cells that make up the soft tissues. The dead and damaged cells release chemicals, which initiate an inflammatory response. Small blood vessels are damaged and opened up, producing bleeding within the tissue. In the body’s normal reaction, a small blood clot is formed in order to stop this bleeding and from this clot special cells (called fibroblasts) begin the healing process by laying down scar tissue.
The inflammatory stage is therefore the first phase of healing. However, too much of an inflammatory response in the early stage can mean that the healing process takes longer and a return to activity is delayed. The sports injury treatments are intended to minimize the inflammatory phase of an injury, so that the overall healing process is accelerated. intrinsic and extrinsic factors
Prevention
A warm-up program has been founded to decrease injuries in association football.[1] Many athletes will partake in HGH Treatment for Athletic Enhancement as a way to prevent injuries.[dubious – discuss]
Injury can be minimalised by doing an effective warm up, this consists of a heart raiser to get your pulse up, followed by sport specific dynamic stretches (stretches whilst moving). To reduce the risk of injury:
Time off. Plan to have at least 1 day off per week form a particular sport to allow the body to recover.
Wear the right gear. Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee, shin), helmets, mouthpieces, face guards, protective cups, and/or eyewear. Young athletes should not assume that protective gear will protect them from performing more dangerous or risky activities.
Strengthen muscles. Conditioning exercises before games and during practice strengthens muscles used in play.
Increase flexibility. Stretching exercises before and after games or practice can increase flexibility.
Use the proper technique. This should be reinforced during the playing season.
Take breaks. Rest periods during practice and games can reduce injuries and prevent heat illness.
Play safe. Strict rules against headfirst sliding (baseball and softball), spearing (football), and body checking (ice hockey) should be enforced.
Stop the activity if there is pain. Avoid heat injury by drinking plenty of fluids before, during and after exercise or play; decrease or stop practices or competitions during high heat/humidity periods; wear light clothing.
Sports-Related Emotional Stress
The pressure to win can cause significant emotional stress for a child. Sadly, many coaches and parents consider winning the most important aspect of sports. Young athletes should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition.
Using proper equipment is key in preventing injury.[2] The NFL is conducting tests with new helmet designs that could reduce the number of head injuries in the league.[3]
Doctors believe fatigue can be a contributing factor in sports injuries because it is more difficult for the body to protect itself when fatigued. Stopping an activity at the first sign of fatigue can prevent sports related injuries.[4]
Treatment
Sports injuries can be treated and managed by using the P.R.I.C.E.S... DR. ABC, and T.O.T.A.P.S regimes:
P – Protect
R – Rest
I – Ice
C – Compression
E – Elevation
S - Stabilize
D – Danger
R – Response
A – Airway
B – Breathing
C – Circulation
T – Talk
O – Observe
T – Touch
A – Active movement
P – Passive movement
S – Skills test
The primary inflammatory stage typically lasts around 5 days and all treatment during this time is designed to address the cardinal signs of inflammation – pain, swelling, redness, heat and a loss of function.
Compression sportswear is becoming very popular with both professional and amateur athletes. These garments are thought to both reduce the risk of muscle injury and speed up muscle recovery.
Portable Mild Hyperbaric Chamber 40" diameter
Although not proven some professional athletes use hyperbaric chambers to speed healing. Hines Ward of the Steelers sent his personal hyperbaric chamber,(similar to the one pictured), to his hotel to sleep in believing it would help heal his sprained medial collateral ligament he suffered in their playoff win against the Ravens. Hines went on to play in Super Bowl XLIII.
Sports Injury
Sports Injury
Sports Injury
Sports Injury
Sports Injury
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles.[1] It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than being in hibernation or a coma. Sleep is also a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular systems. It is observed in all mammals, all birds, and many reptiles, amphibians, and fish.
The purposes and mechanisms of sleep are only partially clear and are the subject of intense research.[2] Sleep is often thought to help conserve energy,[3][4] but actually decreases metabolism only about 5–10%.[3][4] Hibernating animals need to sleep despite the hypometabolism seen in hibernation, and in fact they must return from hypothermia to euthermy in order to sleep, making sleeping "energetically expensive."[5]
Sleep stages
In mammals and birds, sleep is divided into two broad types: rapid eye movement (REM) and non-rapid eye movement (NREM or non-REM) sleep. Each type has a distinct set of associated physiological, neurological, and psychological features. The American Academy of Sleep Medicine (AASM) further divides NREM into three stages: N1, N2, and N3, the last of which is also called delta sleep or slow-wave sleep (SWS).[6]
Hypnogram showing sleep cycles from midnight to 6.30 am, with deep sleep early on. There is more REM (marked red) before waking.
Stage N3 sleep; EEG highlighted by red box. Thirty seconds of deep sleep, here with greater than 50% delta waves.
REM sleep; EEG highlighted by red box; eye movements highlighted by red line. Thirty seconds of sleep.
Sleep proceeds in cycles of REM and NREM, the order normally being N1 → N2 → N3 → N2 → REM. There is a greater amount of deep sleep (stage N3) earlier in the sleep cycle, while the proportion of REM sleep increases later in the sleep cycle and just before natural awakening.
The stages of sleep were first described in 1937 by Alfred Lee Loomis and his coworkers, who separated the different electroencephalography (EEG) features of sleep into five levels (A to E), which represented the spectrum from wakefulness to deep sleep.[7] In 1953, REM sleep was discovered as distinct, and thus William Dement and Nathaniel Kleitman reclassified sleep into four NREM stages and REM.[8] The staging criteria were standardized in 1968 by Allan Rechtschaffen and Anthony Kales in the "R&K sleep scoring manual."[9] In the R&K standard, NREM sleep was divided into four stages, with slow-wave sleep comprising stages 3 and 4. In stage 3, delta waves made up less than 50% of the total wave patterns, while they made up more than 50% in stage 4. Furthermore, REM sleep was sometimes referred to as stage 5.
In 2004, the AASM commissioned the AASM Visual Scoring Task Force to review the R&K scoring system. The review resulted in several changes, the most significant being the combination of stages 3 and 4 into Stage N3. The revised scoring was published in 2007 as The AASM Manual for the Scoring of Sleep and Associated Events.[10] Arousals and respiratory, cardiac, and movement events were also added.[11][12]
Sleep stages and other characteristics of sleep are commonly assessed by polysomnography in a specialized sleep laboratory. Measurements taken include EEG of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. In humans, each sleep cycle lasts from 90 to 110 minutes on average,[13] and each stage may have a distinct physiological function. This can result in sleep that exhibits loss of consciousness but does not fulfill its physiological functions (i.e., one may still feel tired after apparently sufficient sleep).
Scientific studies on sleep having shown that sleep stage at awakening is an important factor in amplifying sleep inertia. Alarm clocks involving sleep stage monitoring appeared on the market in 2005.[14] Using sensing technologies such as EEG electrodes or accelerometers, these alarm clocks are supposed to wake people only from light sleep.
NREM sleep
Main article: Non-rapid eye movement sleep
According to the 2007 AASM standards, NREM consists of three stages. There is relatively little dreaming in NREM.
Stage N1 refers to the transition of the brain from alpha waves having a frequency of 8–13 Hz (common in the awake state) to theta waves having a frequency of 4–7 Hz. This stage is sometimes referred to as somnolence or drowsy sleep. Sudden twitches and hypnic jerks, also known as positive myoclonus, may be associated with the onset of sleep during N1. Some people may also experience hypnagogic hallucinations during this stage. During N1, the subject loses some muscle tone and most conscious awareness of the external environment.
Stage N2 is characterized by sleep spindles ranging from 11 to 16 Hz (most commonly 12–14 Hz) and K-complexes. During this stage, muscular activity as measured by EMG decreases, and conscious awareness of the external environment disappears. This stage occupies 45–55% of total sleep in adults.
Stage N3 (deep or slow-wave sleep) is characterized by the presence of a minimum of 20% delta waves ranging from 0.5–2 Hz and having a peak-to-peak amplitude >75 μV. (EEG standards define delta waves to be from 0 to 4 Hz, but sleep standards in both the original R&K, as well as the new 2007 AASM guidelines have a range of 0.5–2 Hz.) This is the stage in which parasomnias such as night terrors, nocturnal enuresis, sleepwalking, and somniloquy occur. Many illustrations and descriptions still show a stage N3 with 20–50% delta waves and a stage N4 with greater than 50% delta waves; these have been combined as stage N3.
REM sleep
Main article: Rapid eye movement sleep
Rapid eye movement sleep, or REM sleep, accounts for 20–25% of total sleep time in most human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG. Most memorable dreaming occurs in this stage. At least in mammals, a descending muscular atonia is seen. Such paralysis may be necessary to protect organisms from self-damage through physically acting out scenes from the often-vivid dreams that occur during this stage.
Timing
The human biological clock
Sleep timing is controlled by the circadian clock, sleep-wake homeostasis, and in humans, within certain bounds, willed behavior. The circadian clock—an inner timekeeping, temperature-fluctuating, enzyme-controlling device—works in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. In diurnal animals, sleepiness occurs as the circadian element causes the release of the hormone melatonin and a gradual decrease in core body temperature. The timing is affected by one's chronotype. It is the circadian rhythm that determines the ideal timing of a correctly structured and restorative sleep episode.[15]
Homeostatic sleep propensity (the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode) must be balanced against the circadian element for satisfactory sleep.[16] Along with corresponding messages from the circadian clock, this tells the body it needs to sleep.[17] Sleep offset (awakening) is primarily determined by circadian rhythm. A person who regularly awakens at an early hour will generally not be able to sleep much later than his or her normal waking time, even if moderately sleep-deprived.
Sleep duration is affected by the gene DEC2. Some people have a mutation of this gene; they sleep two hours less than normal. Neurology professor Ying-Hui Fu and her colleagues bred mice that carried the DEC2 mutation and slept less than normal mice.[18][19]
Optimal amount in humans
[edit]Adult
The optimal amount of sleep is not a meaningful concept unless the timing of that sleep is seen in relation to an individual's circadian rhythms. A person's major sleep episode is relatively inefficient and inadequate when it occurs at the "wrong" time of day; one should be asleep at least six hours before the lowest body temperature.[20] The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening:[21]
maximum concentration of the hormone melatonin, and
minimum core body temperature.
For more information on the human circadian rhythm and body temperature, see Determining the human circadian rhythm (in the article Circadian rhythm).
Human sleep needs can vary by age and among individuals, and sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Moreover, self-reported sleep duration is only moderately correlated with actual sleep time as measured by actigraphy,[22] and those affected with sleep state misperception may typically report having slept only four hours despite having slept a full eight hours.[23]
A University of California, San Diego psychiatry study of more than one million adults found that people who live the longest self-report sleeping for six to seven hours each night.[24] Another study of sleep duration and mortality risk in women showed similar results.[25] Other studies show that "sleeping more than 7 to 8 hours per day has been consistently associated with increased mortality," though this study suggests the cause is probably other factors such as depression and socioeconomic status, which would correlate statistically.[26] It has been suggested that the correlation between lower sleep hours and reduced morbidity only occurs with those who wake after less sleep naturally, rather than those who use an alarm.
Main health effects of sleep deprivation,[27] indicating impairment of normal maintenance by sleep
Researchers at the University of Warwick and University College London have found that lack of sleep can more than double the risk of death from cardiovascular disease, but that too much sleep can also be associated with a doubling of the risk of death, though not primarily from cardiovascular disease.[28][29] Professor Francesco Cappuccio said, "Short sleep has been shown to be a risk factor for weight gain, hypertension, and Type 2 diabetes, sometimes leading to mortality; but in contrast to the short sleep-mortality association, it appears that no potential mechanisms by which long sleep could be associated with increased mortality have yet been investigated. Some candidate causes for this include depression, low socioeconomic status, and cancer-related fatigue... In terms of prevention, our findings indicate that consistently sleeping around seven hours per night is optimal for health, and a sustained reduction may predispose to ill health."
Furthermore, sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder.[30] Up to 90% of adults with depression are found to have sleep difficulties. Dysregulation found on EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across the night and density of eye movements.[31]
Hours by age
Children need more sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages.[17] A newborn baby spends almost 9 hours a day in REM sleep. By the age of five or so, only slightly over two hours is spent in REM.[32]
Age and condition Average amount of sleep per day
Newborn up to 18 hours
1–12 months 14–18 hours
1–3 years 12–15 hours
3–5 years 11–13 hours
5–12 years 9–11 hours
Adolescents 9–10 hours[33]
Adults, including elderly 7–8 hours
Pregnant women 8(+) hours
Sleep debt
Main article: Sleep debt
Sleep debt is the effect of not getting enough rest and sleep; a large debt causes mental, emotional and physical fatigue.
Sleep debt results in diminished abilities to perform high-level cognitive functions. Neurophysiological and functional imaging studies have demonstrated that frontal regions of the brain are particularly responsive to homeostatic sleep pressure.[34]
Scientists do not agree on how much sleep debt it is possible to accumulate; whether it is accumulated against an individual's average sleep or some other benchmark; nor on whether the prevalence of sleep debt among adults has changed appreciably in the industrialized world in recent decades. It is likely that children are sleeping less than previously in Western societies.[35]
Genetics
It is suspected that a considerable amount of sleep-related behavior, such as when and how long a person needs to sleep, is regulated by our genetics. Researchers have discovered some evidence that seems to support this assumption.
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles.[1] It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than being in hibernation or a coma. Sleep is also a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular systems. It is observed in all mammals, all birds, and many reptiles, amphibians, and fish.
The purposes and mechanisms of sleep are only partially clear and are the subject of intense research.[2] Sleep is often thought to help conserve energy,[3][4] but actually decreases metabolism only about 5–10%.[3][4] Hibernating animals need to sleep despite the hypometabolism seen in hibernation, and in fact they must return from hypothermia to euthermy in order to sleep, making sleeping "energetically expensive."[5]
Sleep stages
In mammals and birds, sleep is divided into two broad types: rapid eye movement (REM) and non-rapid eye movement (NREM or non-REM) sleep. Each type has a distinct set of associated physiological, neurological, and psychological features. The American Academy of Sleep Medicine (AASM) further divides NREM into three stages: N1, N2, and N3, the last of which is also called delta sleep or slow-wave sleep (SWS).[6]
Hypnogram showing sleep cycles from midnight to 6.30 am, with deep sleep early on. There is more REM (marked red) before waking.
Stage N3 sleep; EEG highlighted by red box. Thirty seconds of deep sleep, here with greater than 50% delta waves.
REM sleep; EEG highlighted by red box; eye movements highlighted by red line. Thirty seconds of sleep.
Sleep proceeds in cycles of REM and NREM, the order normally being N1 → N2 → N3 → N2 → REM. There is a greater amount of deep sleep (stage N3) earlier in the sleep cycle, while the proportion of REM sleep increases later in the sleep cycle and just before natural awakening.
The stages of sleep were first described in 1937 by Alfred Lee Loomis and his coworkers, who separated the different electroencephalography (EEG) features of sleep into five levels (A to E), which represented the spectrum from wakefulness to deep sleep.[7] In 1953, REM sleep was discovered as distinct, and thus William Dement and Nathaniel Kleitman reclassified sleep into four NREM stages and REM.[8] The staging criteria were standardized in 1968 by Allan Rechtschaffen and Anthony Kales in the "R&K sleep scoring manual."[9] In the R&K standard, NREM sleep was divided into four stages, with slow-wave sleep comprising stages 3 and 4. In stage 3, delta waves made up less than 50% of the total wave patterns, while they made up more than 50% in stage 4. Furthermore, REM sleep was sometimes referred to as stage 5.
In 2004, the AASM commissioned the AASM Visual Scoring Task Force to review the R&K scoring system. The review resulted in several changes, the most significant being the combination of stages 3 and 4 into Stage N3. The revised scoring was published in 2007 as The AASM Manual for the Scoring of Sleep and Associated Events.[10] Arousals and respiratory, cardiac, and movement events were also added.[11][12]
Sleep stages and other characteristics of sleep are commonly assessed by polysomnography in a specialized sleep laboratory. Measurements taken include EEG of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. In humans, each sleep cycle lasts from 90 to 110 minutes on average,[13] and each stage may have a distinct physiological function. This can result in sleep that exhibits loss of consciousness but does not fulfill its physiological functions (i.e., one may still feel tired after apparently sufficient sleep).
Scientific studies on sleep having shown that sleep stage at awakening is an important factor in amplifying sleep inertia. Alarm clocks involving sleep stage monitoring appeared on the market in 2005.[14] Using sensing technologies such as EEG electrodes or accelerometers, these alarm clocks are supposed to wake people only from light sleep.
NREM sleep
Main article: Non-rapid eye movement sleep
According to the 2007 AASM standards, NREM consists of three stages. There is relatively little dreaming in NREM.
Stage N1 refers to the transition of the brain from alpha waves having a frequency of 8–13 Hz (common in the awake state) to theta waves having a frequency of 4–7 Hz. This stage is sometimes referred to as somnolence or drowsy sleep. Sudden twitches and hypnic jerks, also known as positive myoclonus, may be associated with the onset of sleep during N1. Some people may also experience hypnagogic hallucinations during this stage. During N1, the subject loses some muscle tone and most conscious awareness of the external environment.
Stage N2 is characterized by sleep spindles ranging from 11 to 16 Hz (most commonly 12–14 Hz) and K-complexes. During this stage, muscular activity as measured by EMG decreases, and conscious awareness of the external environment disappears. This stage occupies 45–55% of total sleep in adults.
Stage N3 (deep or slow-wave sleep) is characterized by the presence of a minimum of 20% delta waves ranging from 0.5–2 Hz and having a peak-to-peak amplitude >75 μV. (EEG standards define delta waves to be from 0 to 4 Hz, but sleep standards in both the original R&K, as well as the new 2007 AASM guidelines have a range of 0.5–2 Hz.) This is the stage in which parasomnias such as night terrors, nocturnal enuresis, sleepwalking, and somniloquy occur. Many illustrations and descriptions still show a stage N3 with 20–50% delta waves and a stage N4 with greater than 50% delta waves; these have been combined as stage N3.
REM sleep
Main article: Rapid eye movement sleep
Rapid eye movement sleep, or REM sleep, accounts for 20–25% of total sleep time in most human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG. Most memorable dreaming occurs in this stage. At least in mammals, a descending muscular atonia is seen. Such paralysis may be necessary to protect organisms from self-damage through physically acting out scenes from the often-vivid dreams that occur during this stage.
Timing
The human biological clock
Sleep timing is controlled by the circadian clock, sleep-wake homeostasis, and in humans, within certain bounds, willed behavior. The circadian clock—an inner timekeeping, temperature-fluctuating, enzyme-controlling device—works in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. In diurnal animals, sleepiness occurs as the circadian element causes the release of the hormone melatonin and a gradual decrease in core body temperature. The timing is affected by one's chronotype. It is the circadian rhythm that determines the ideal timing of a correctly structured and restorative sleep episode.[15]
Homeostatic sleep propensity (the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode) must be balanced against the circadian element for satisfactory sleep.[16] Along with corresponding messages from the circadian clock, this tells the body it needs to sleep.[17] Sleep offset (awakening) is primarily determined by circadian rhythm. A person who regularly awakens at an early hour will generally not be able to sleep much later than his or her normal waking time, even if moderately sleep-deprived.
Sleep duration is affected by the gene DEC2. Some people have a mutation of this gene; they sleep two hours less than normal. Neurology professor Ying-Hui Fu and her colleagues bred mice that carried the DEC2 mutation and slept less than normal mice.[18][19]
Optimal amount in humans
[edit]Adult
The optimal amount of sleep is not a meaningful concept unless the timing of that sleep is seen in relation to an individual's circadian rhythms. A person's major sleep episode is relatively inefficient and inadequate when it occurs at the "wrong" time of day; one should be asleep at least six hours before the lowest body temperature.[20] The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening:[21]
maximum concentration of the hormone melatonin, and
minimum core body temperature.
For more information on the human circadian rhythm and body temperature, see Determining the human circadian rhythm (in the article Circadian rhythm).
Human sleep needs can vary by age and among individuals, and sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Moreover, self-reported sleep duration is only moderately correlated with actual sleep time as measured by actigraphy,[22] and those affected with sleep state misperception may typically report having slept only four hours despite having slept a full eight hours.[23]
A University of California, San Diego psychiatry study of more than one million adults found that people who live the longest self-report sleeping for six to seven hours each night.[24] Another study of sleep duration and mortality risk in women showed similar results.[25] Other studies show that "sleeping more than 7 to 8 hours per day has been consistently associated with increased mortality," though this study suggests the cause is probably other factors such as depression and socioeconomic status, which would correlate statistically.[26] It has been suggested that the correlation between lower sleep hours and reduced morbidity only occurs with those who wake after less sleep naturally, rather than those who use an alarm.
Main health effects of sleep deprivation,[27] indicating impairment of normal maintenance by sleep
Researchers at the University of Warwick and University College London have found that lack of sleep can more than double the risk of death from cardiovascular disease, but that too much sleep can also be associated with a doubling of the risk of death, though not primarily from cardiovascular disease.[28][29] Professor Francesco Cappuccio said, "Short sleep has been shown to be a risk factor for weight gain, hypertension, and Type 2 diabetes, sometimes leading to mortality; but in contrast to the short sleep-mortality association, it appears that no potential mechanisms by which long sleep could be associated with increased mortality have yet been investigated. Some candidate causes for this include depression, low socioeconomic status, and cancer-related fatigue... In terms of prevention, our findings indicate that consistently sleeping around seven hours per night is optimal for health, and a sustained reduction may predispose to ill health."
Furthermore, sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder.[30] Up to 90% of adults with depression are found to have sleep difficulties. Dysregulation found on EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across the night and density of eye movements.[31]
Hours by age
Children need more sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages.[17] A newborn baby spends almost 9 hours a day in REM sleep. By the age of five or so, only slightly over two hours is spent in REM.[32]
Age and condition Average amount of sleep per day
Newborn up to 18 hours
1–12 months 14–18 hours
1–3 years 12–15 hours
3–5 years 11–13 hours
5–12 years 9–11 hours
Adolescents 9–10 hours[33]
Adults, including elderly 7–8 hours
Pregnant women 8(+) hours
Sleep debt
Main article: Sleep debt
Sleep debt is the effect of not getting enough rest and sleep; a large debt causes mental, emotional and physical fatigue.
Sleep debt results in diminished abilities to perform high-level cognitive functions. Neurophysiological and functional imaging studies have demonstrated that frontal regions of the brain are particularly responsive to homeostatic sleep pressure.[34]
Scientists do not agree on how much sleep debt it is possible to accumulate; whether it is accumulated against an individual's average sleep or some other benchmark; nor on whether the prevalence of sleep debt among adults has changed appreciably in the industrialized world in recent decades. It is likely that children are sleeping less than previously in Western societies.[35]
Genetics
It is suspected that a considerable amount of sleep-related behavior, such as when and how long a person needs to sleep, is regulated by our genetics. Researchers have discovered some evidence that seems to support this assumption.
Body Weight
The term body weight is overwhelmingly used in daily English speech as well as in the contexts of biological and medical sciences to describe the mass of an organism's body. Body weight is measured in kilograms throughout the world, although in some countries it is still measured in pounds (e.g. United States) or stones and pounds (e.g. among people in the United Kingdom) and thus may not be well acquainted with measurement in kilograms. Most hospitals, even in the United States, now use kilograms for calculations, but use kilograms and pounds together for other purposes. Body weight of a person is theoretically the weight of the person without any items on. However, for all practical purposes, body weight is taken with clothes on but often without the shoes and heavy accessories like mobile phones and wallets.
In physics, body mass (an expression of matter that does not change due to gravity) is expressed in kilograms while body weight (which is an expression of force that includes gravity) is expressed in Newtons.
Average weight around the world
Country/Region Average male weight/kg Average male weight/lb Average female weight/kg Average female weight/lb Sample population /
age range Methodology Year Source
Brazil 72.7 160.3 62.5 137.8 20–74 Measured 2008–2009 [1]
Chile 77.3 170.4 67.5 148.8 15 and over Measured 2009–2010 [2]
Germany 82.4 181.7 67.5 148.8 18 and over Measured 2005 [3]
United States 86.6 190.9 74.4 164.0 20–74 Measured 1999–2002 [4
Estimation in children
An example of a half unfolded Broselow tape.
A number of ways to estimate weight in children have been developed. They include: Broselow tape, Leffler formula, and Theron formula.[5] The Broselow tape is based on length with weight read from the appropriate color area.
The Leffler formula is used for children 0–10 years of age.[5] In those less than a year old it is
and for those 1–10 years old it is
m = 2ay + 10
where m is the number of kilograms the child weighs and am and ay respectively are the number of months or years old the child is.[5]
The Theron formula is
where m and ay are as above.
The term body weight is overwhelmingly used in daily English speech as well as in the contexts of biological and medical sciences to describe the mass of an organism's body. Body weight is measured in kilograms throughout the world, although in some countries it is still measured in pounds (e.g. United States) or stones and pounds (e.g. among people in the United Kingdom) and thus may not be well acquainted with measurement in kilograms. Most hospitals, even in the United States, now use kilograms for calculations, but use kilograms and pounds together for other purposes. Body weight of a person is theoretically the weight of the person without any items on. However, for all practical purposes, body weight is taken with clothes on but often without the shoes and heavy accessories like mobile phones and wallets.
In physics, body mass (an expression of matter that does not change due to gravity) is expressed in kilograms while body weight (which is an expression of force that includes gravity) is expressed in Newtons.
Average weight around the world
Country/Region Average male weight/kg Average male weight/lb Average female weight/kg Average female weight/lb Sample population /
age range Methodology Year Source
Brazil 72.7 160.3 62.5 137.8 20–74 Measured 2008–2009 [1]
Chile 77.3 170.4 67.5 148.8 15 and over Measured 2009–2010 [2]
Germany 82.4 181.7 67.5 148.8 18 and over Measured 2005 [3]
United States 86.6 190.9 74.4 164.0 20–74 Measured 1999–2002 [4
Estimation in children
An example of a half unfolded Broselow tape.
A number of ways to estimate weight in children have been developed. They include: Broselow tape, Leffler formula, and Theron formula.[5] The Broselow tape is based on length with weight read from the appropriate color area.
The Leffler formula is used for children 0–10 years of age.[5] In those less than a year old it is
and for those 1–10 years old it is
m = 2ay + 10
where m is the number of kilograms the child weighs and am and ay respectively are the number of months or years old the child is.[5]
The Theron formula is
where m and ay are as above.
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of rituals, to induce trances and spiritual enlightenment.
The most common method of smoking today is through cigarettes, primarily industrially manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers and bongs. It has been suggested that smoking-related disease kills one half of all long term smokers but these diseases may also be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each year die as a result of smoking.[1]
Smoking is one of the most common forms of recreational drug use. Tobacco smoking is today by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are often not commercially available.
history
The history of smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures across the world. Early smoking evolved in association with religious ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americans, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Subsaharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown.
Perception surrounding smoking has varied over time and from one place to another; holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. Only relatively recently, and primarily in industrialized Western countries, has smoking come to be viewed in a decidedly negative light. Today medical studies have proven that smoking tobacco is among the leading causes of many diseases such as lung cancer, heart attacks, COPD, erectile dysfunction and can also lead to birth defects. The inherent health hazards of smoking have caused many countries to institute high taxes on tobacco products and anti-smoking campaigns are launched every year in an attempt to curb tobacco smoking.
The history of smoking dates back to as early as 5000 BC in shamanistic rituals.[2] Many ancient civilizations, such as the Babylonians, Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure, or as a social tool.[3] The smoking of tobacco, as well as various hallucinogenic drugs was used to achieve trances and to come into contact with the spirit world.
Substances such as Cannabis, clarified butter (ghee), fish offal, dried snake skins and various pastes molded around incense sticks dates back at least 2000 years. Fumigation (dhupa) and fire offerings (homa) are prescribed in the Ayurveda for medical purposes, and have been practiced for at least 3,000 years while smoking, dhumrapana (literally "drinking smoke"), has been practiced for at least 2,000 years. Before modern times these substances have been consumed through pipes, with stems of various lengths or chillums.[4]
Cannabis smoking was common in the Middle East before the arrival of tobacco, and was early on a common social activity that centered around the type of water pipe called a hookah. Smoking, especially after the introduction of tobacco, was an essential component of Muslim society and culture and became integrated with important traditions such as weddings, funerals and was expressed in architecture, clothing, literature and poetry.[5]
Cannabis smoking was introduced to Sub-Saharan Africa through Ethiopia and the east African coast by either Indian or Arab traders in the 13th century or earlier and spread on the same trade routes as those that carried coffee, which originated in the highlands of Ethiopia.[6] It was smoked in calabash water pipes with terra cotta smoking bowls, apparently an Ethiopian invention which was later conveyed to eastern, southern and central Africa.
At the time of the arrivals of Reports from the first European explorers and conquistadors to reach the Americas tell of rituals where native priests smoked themselves into such high degrees of intoxication that it is unlikely that the rituals were limited to just tobacco.[7]
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of rituals, to induce trances and spiritual enlightenment.
The most common method of smoking today is through cigarettes, primarily industrially manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers and bongs. It has been suggested that smoking-related disease kills one half of all long term smokers but these diseases may also be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each year die as a result of smoking.[1]
Smoking is one of the most common forms of recreational drug use. Tobacco smoking is today by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are often not commercially available.
history
The history of smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures across the world. Early smoking evolved in association with religious ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americans, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Subsaharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown.
Perception surrounding smoking has varied over time and from one place to another; holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. Only relatively recently, and primarily in industrialized Western countries, has smoking come to be viewed in a decidedly negative light. Today medical studies have proven that smoking tobacco is among the leading causes of many diseases such as lung cancer, heart attacks, COPD, erectile dysfunction and can also lead to birth defects. The inherent health hazards of smoking have caused many countries to institute high taxes on tobacco products and anti-smoking campaigns are launched every year in an attempt to curb tobacco smoking.
The history of smoking dates back to as early as 5000 BC in shamanistic rituals.[2] Many ancient civilizations, such as the Babylonians, Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure, or as a social tool.[3] The smoking of tobacco, as well as various hallucinogenic drugs was used to achieve trances and to come into contact with the spirit world.
Substances such as Cannabis, clarified butter (ghee), fish offal, dried snake skins and various pastes molded around incense sticks dates back at least 2000 years. Fumigation (dhupa) and fire offerings (homa) are prescribed in the Ayurveda for medical purposes, and have been practiced for at least 3,000 years while smoking, dhumrapana (literally "drinking smoke"), has been practiced for at least 2,000 years. Before modern times these substances have been consumed through pipes, with stems of various lengths or chillums.[4]
Cannabis smoking was common in the Middle East before the arrival of tobacco, and was early on a common social activity that centered around the type of water pipe called a hookah. Smoking, especially after the introduction of tobacco, was an essential component of Muslim society and culture and became integrated with important traditions such as weddings, funerals and was expressed in architecture, clothing, literature and poetry.[5]
Cannabis smoking was introduced to Sub-Saharan Africa through Ethiopia and the east African coast by either Indian or Arab traders in the 13th century or earlier and spread on the same trade routes as those that carried coffee, which originated in the highlands of Ethiopia.[6] It was smoked in calabash water pipes with terra cotta smoking bowls, apparently an Ethiopian invention which was later conveyed to eastern, southern and central Africa.
At the time of the arrivals of Reports from the first European explorers and conquistadors to reach the Americas tell of rituals where native priests smoked themselves into such high degrees of intoxication that it is unlikely that the rituals were limited to just tobacco.[7]
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